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Home My WebLink About05-24-2023 Septic ComplianceM MINNESOTA POLLUTION Compliance inspection report form CONTROL AGENCY p 520 Lafayette Road North Existing Subsurface Sewage Treatment System (SSTS) St. Paul, MN 55155-4194 Doc Type: Compliance and Enforcement Instructions: Inspector must submit completed form to Local Governmental Unit (LGU) and system owner within 15 days of final determination of compliance or noncompliance. Instructions for filling out this form are located on the Minnesota Pollution Control Agency (MPCA) website at htt s://www. ca.state.mn.us/sites/defauIt/files/w-wwists4-31a. df. Property information Local tracking number: Parcel ID# or Sec/Twp/Range: _2711823320009 Reason for Inspection Property Transfer Local regulatory authority info: Cit)tOf Orono, (952249-4800_ Property address: 1200 Phillips Drive, Orono Owner/representative: David Denniston _ Owner's phone: 612-247-8986 Brief system description: 2 -1300 -gallon septic tanks, 1 -1300 -gallon lift station and 630 Square feet Rock bed System status System status on date (mm/ddlyyyy): 5/24/2023 ® Compliant—Certificate of compliance* (Valid for 3 years from report date unless evidence of an imminent threat to public health or safety requiring removal and abatement under section 145A.04, subdivision 8 is discovered or a shorter time frame exists in Local Ordinance.) *Note: Compliance indicates conformance with Minn. R. 7080.1500 as of system status date above and does not guarantee future performance. ❑ Noncompliant— Notice of noncompliance Systems failing to protect ground water must be upgraded, replaced, or use discontinued within the time required by local ordinance. An imminent threat to public health and safety (ITPNS) must be upgraded, replaced, or its use discontinued within ten months of receipt of this notice or within a shorter period if required by local ordinance or under section 145A.04 subdivision 8. Reason(s) for noncompliance (check all applicable) ❑ Impact on public health (Compliance component #1) — Imminent threat to public health and safety ❑ Tank integrity (Compliance component #2) — Failing to protect groundwater ❑ Other Compliance Conditions (Compliance component #3) — Imminent threat to public health and safety ❑ Other Compliance Conditions (Compliance component #3) — Failing to protect groundwater ❑ System not abandoned according to Minn. R. 7080.2500 (Compliance component #3) — Failing to protect groundwater ❑ Soil separation (Compliance component #5) — Failing to protect groundwater ❑ Operating permittmonitoring plan requirements (Compliance component #4) — Noncompliant - local ordinance applies Comments or recommendations The system is designed for a five bedroom house. There is 1.6 feet of sand under the rock bed on West side and there is 2.5 feet of sand under the rock bed on East side. TBM: Top of the basement door thershold. ELV.-100.0 Certification I hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. By typing my name below, t certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing this form. Business name: -Rusty Olson Soil & percolation_Testing Inspector signature: Joseph J. Olson (This document has been electronically signed) Certification number: C1255 License number: L810 Necessary or locally required supporting documentation (must be attached) Phone: 763-498-8779 ® Soil observation logs ® System/As-Built ❑ Locally required forms ® Tank Integrity Assessment ❑ Operating Permit ❑ Other information (list): https://www.pca.state.mn.us 651-296-6300 800-6573864 Use your preferred relay service Available in alternative formats wq-wwists4-316 • 4/28/2021 Page 1 of 4 Property Address: 1200 Phillips Drive, Orono Business Name: Rusty Olson Soil & percolation Testing 1. Impact on public health — Compliance component #1 of 5 Compliance criteria: System discharges sewage to the ❑ Yes' ® No ground surface System discharges sewage to drain ❑ Yes' ® No file or surface waters. System causes sewage backup into ❑ Yes' ® No dwelling or establishment. Any "yes" answer above indicates the system is an imminent threat to public health and safety Describe verification methods and results: Visual. Nothing was found Date: 5/24/2023 Attached supporting documentation: ❑ Other: ® Not applicable 2. Tank integrity — Compliance component #2 of 5 Compliance criteria: System consists of a seepage pit, ❑ Yes* ® No cesspool, drywell, leaching pit, or other pit? Sewage tank(s) leak below their FE]Yes• ®No designed operating depth? If yes, which sewage tank(§) leaks.- Any eaks:Any "yes" answer above indicates the system is failing to protect groundwater. Describe verification methods and results: Albin's Septic Pumping Company pumped the tanks. Attached supporting documentation: ❑ Empty tank(s) viewed by inspector Name of maintenance business: License number of maintenance business: Date of maintenance: ® Existing tank integrity assessment (Attach) Date of maintenance 5/18/2023 (mmlddlyyyy): (must be within three years) (See form instructions to ensure assessment complies with Minn. R. 7082.0700 sub p. 4 B (1)) ❑ Tank is Noncompliant (pumping not necessary - explain below) ❑ Other: https://www.pca.state.mn.us 651-296-6300 800-657-3864 • Use your preferred relay service • Available in alternative formats wg-wwists4-31b • 4/28/2021 Page 2 of 4 Property Address: 1200 Phillips Drive, Orono Business Name: Rusty Olson Soil & percolation Testing Date: 5/24/2023 3. Other compliance conditions — Compliance component #3 of 5 3a. Maintenance hole covers appear to be structurally unsound (damaged, cracked, etc.), or unsecured? ❑ Yes* ® No ❑ Unknown 3b. Other issues (electrical hazards, etc.) to immediately and adversely impact public health or safety? ❑ Yes* ® No ❑ Unknown `Yes to 3a or 3b - System is an imminent threat to public health and safety. 3c. System is non -protective of ground water for other conditions as determined by inspector? [--]Yes* ® No 3d. System not abandoned in accordance with Minn. R. 7080.2500? ❑ Yes` ® No *Yes to 3c or 3d - System is failing to protect groundwater. Describe verification methods and results: Visual. Nothing was found Attached supporting documentation: ® Not applicable ❑ 4. Operating permit and nitrogen BMP* -- Compliance component #4 of 5 ® Not applicable Is the system operated under an Operating Permit? ❑ Yes ❑ No If "yes", A below is required Is the system required to employ a Nitrogen BMP specified in the system design? ❑ Yes ❑ No If "yes", B below is required BMP = Best Management Practice(s) specified in the system design If the answer to both questions is "no", this section does not need to be completed. Compliance criteria: a. Have the operating permit requirements been met? ❑ Yes [:]No b. Is the required nitrogen BMP in place and properly functioning? ❑ Yes ❑ No Any "no" answer indicates noncompliance. Describe verification methods and results: Attached supporting documentation: ❑ Operating permit (Attach) ❑ https://www.pca.state.mn.us 651-296-6300 • 800-657-3864 • Use your preferred relay service Available in alternative formats wq-wwists4-31b - 4/28/2021 Page 3 of 4 Property Address: 1200 Phillips Drive, Orono Business Name: Ruses Olson Soil & percolation Testing 5. Soil separation — Compliance component #5 of 5 Date of installation 5/26/1994 ❑ Unknown m_m/dd/yyyy) - Shoreland/Wel Ihead protection/Food ® Yes ❑ No beverage lodging? Compliance criteria (select one 5a. For systems built prior to April 1, 1996, and ❑ Yes ❑ No* not located in Shoreland or Wellhead Protection Area or not serving a food, beverage or lodging establishment: Drainfield has at least a two -foot vertical separation distance from periodically saturated soil or bedrock. 5b. Non-performance systems built ® Yes ❑ No` April 1, 1996, or later or for non- performance systems located in Shoreland or Wellhead Protection Areas or serving a food, beverage, orlodging establishment. Drainfield has a three-foot vertical separation distance from periodically saturated soil or bedrock.`" 5c. Experimental', "Other", or "Performance" ❑ Yes ❑ No* systems built under pre -2008 Rules; Type IV or V systems built under 2008 Rules 7080. 2350 or 7080.2400 (Intermediate inspector License required <_ 2,500 gallons per day, Advanced Inspector License required > 2,500 gallons per day) Drainfield meets the designed vertical separation distance from periodically saturated soil or bedrock. *Any "no" answer above indicates the system is failing to protect groundwater. Describe verification methods and results: Date: 5/24/2023 Attached supporting documentation: ® Soil observation logs completed for the report ❑ Two previous verifications of required vertical separation ❑ Not applicable (No soil treatment area) Indicate depths or elevations A. Bottom of distribution media 106.3 B. Periodically saturated soil/bedrock 103.3 C. System separation 3.0 D. Required compliance separation" 2.55 "May be reduced up to 15 percent if allowed by Local Ordinance. Upgrade requirements: (Minn. Stat. § 115.55) An imminent threat to public health and safety (ITPNS) must be upgraded, replaced, or its use discontinued within ten months of receipt of this notice or within a shorter period if required by local ordinance. If the system is failing to protect ground water, the system must be upgraded, replaced, or its use discontinued within the time required by local ordinance. If an existing system is not failing as defined in law, and has at least two feet of design soil separation, then the system need not be upgraded, repaired, replaced, or its use discontinued, notwithstanding any local ordinance that is more strict. This provision does not apply to systems in shoreland areas, Wellhead Protection Areas, or those used in connection with food, beverage, and lodging establishments as defined in law. https://www.pca.state.mn.us 651-296-6300 800-657-3864 • Use your preferred relay service Available in alternative formats wq-wwists4-31b • 4/28/2021 Page 4 of 4 2023 SEPTIC MAINTENANCE REPORT Site address: 1200 Phillips Drive ( David & Michelle Denniston ) Number of tanks: 3 Date fast pumped: 05/18/2023 Gallons pumped: 2700 Name of pumper J maintenance provider: Albin's Septic Purnpinq, LLC Are tanks watertight?: Is the system functioning properly? Yes YIS NO please circle one) (ie slow drainage, wetness in the drainfield?) Do you have any specific concerns or issues that you'd like to discuss with the SSTS Program Manager? No If so, please indicate best time and telephone number(s) to be reached between 8 am and 4:30 pm. Best Times Telephone Number(s) Alicia Johnson CITY OF ORONO PO BOX 68 CRYSTAL BAY MN RETURN IN THE ENCLOSED ENVELOPE AS SOON AS POSSIBLE 55323-0466 David & Michelle Denniston Property address: 1200 Phillip s Drive city: Orono - Medina _ _ State: MN Orono PID# 2711823320009 Medina PID# 2711823230002 Parcel ID: Zip code:_ 55356 Optional section: Sewage Tank Compliance Certification This form doss not represent a complete system tnepeodon report and only certifies sewage tank compliance status. Inst mesons: This section of the form may be cornpleted and signed by a Designated Certified Individual (DCI) of a licensed SSTS Maintenance Business who personalty conducts the necessary procedures to assess the compliance status of each sewage tank In the system. When this section of the form Is signed by a qualified certified professional, it becomes neaessefy supporting documentation to an Existing System Compliance Inspection Report: Compliance insR@Oon f 1 t . This form can be found on the MPGA website at htto :/ oca state mn uglMortssts-and :msts-tochn_icai-and-camAllance-crit$na. The information and certified statement on this form is required when existing septic tank compliance status is determined by an individual other than the SSTS Inspector that submits the Inspection report. It represents a third party assessment of SSTS component compliance and is allowable under Minn. R. 7082.0700, subp. 4 Item (s) subitem (1). This form is valid for a period of three years beyond the signature date on this form unless a new evaluation is requested by the owner or owner's agent or is required according to local regulations. Additional Administrative Rule references for this activity can be found at Minn. R. 7082.0700, subp. 4 Mms B, C, and D; 7083.0730 Um C. ® Certificate of sewage tank compliance Affirm all three statements: $ The SSTS does not contain a seepage pit, cesspool, drywell, leaching pit, or other pit. it does not contain a sewage tank that was designed to be watertight, but subsequently leaks below the designed operating depth. ® It does not represent an imminent safety threat by reason of unsecured, damaged, or weak maintenance hole cover(s) or other unsafe condition. Company Information Company name: Albin's 8e kPurnpin_ g, LLC Business license number: 3346 ❑ Notice of sewage tank non-compliance Select all that apply: ❑ The SSTS has a seepage pit, cesspool, drywell, leaching pit, or other ph. ❑ it has a sewage tank that was designed to be watertight, but subsequently leaks below the designed operating depth. ❑ It presents a threat to public safety by reason of unsecured, damaged, or weak maintenance hole cover(s) or other unsafe condition. Designated Certified Individual (I)CQ Information Print name: Peter Peterson Certification number. 9227 I personally conducted the warlc described above as a Designated Certified individual of a Minnesotadicensed SSTS Maintenance Business. ! personally conducted the ry pmoodures to assess the compliance status of each sewage tank in this SSTS: Designated Certified Individual's signature: _ Date (mm/dWyyyy): _ 05/18/2023 www.pca.state.mn.us • 651-296-63M 806.657-3864 Use your preferred relay service Available in altemative formats wq-wwists4.38 • 1127117 Paye 3 of 3 Soil Observation Log M,WW.SepticResource.com vers 12.4 Owner Information Property Owner / project: David Denniston Date 5/19/2023 Property Address / PID: 1200 Phillips Drive Soil Survey Information ❑ refer to attached soil survey Parent matl's: E) Till ❑ Outwash ❑ Lacustrine ❑ Alluvium ❑ Organic Bedrock landscape position: ❑ Summit ❑ Shoulder [A Side slope ❑ Toe slope soil survey map units: L132A slope % direction - Soil Log #1 El Boring ❑ pit Elevation 104.6 Depth to SHWT 12 inches Depth (in) Texture fragment % matrix color redox color consistence grade shape 0-4 Loam <35 10yr3/1 Friable Strong Block% 4-12 Clay Loam <35 10yr413 Friable strong IWAN <35 loose loose single grain 35-50 friable weak granular blocky >50 firm moderate prismatic platy rigid strong massive <35 loose loose single grain 35-50 friable weak granular blocky >50 firm moderate prismatic platy rigid strong massive <35 loose loose single grain 35-50 friable weak granular blocky >50 firm moderate Prismatic platy rigid strong massive Comments: 1200 Phillips Drive Soil Log #2 2 Boring ❑ pit Elevation 105.0 Depth to SHWT 20 Inches Depth (in) Texture fragment % matrix color redox color consistence grade shape 0-20 Loam X35 10yr2/1 Friable Strong Blocky <35 loose loose single grain 35-50 friable weak granular blocky firm moderate prismatic platy >50 rigid strong massive <35 loose loose single grain 35-50 friable weak granular blocky firm moderate prismatic platy >50 rigid strong massive <35 loose loose single grain 35-50 friable weak granular blocky firm moderate prismatic platy >50 rigid strong massive <35 loose loose single grain 35-50 friable weak granular blocky firm moderate prismatic platy >50 rigid strong massive 1200 Phillips Drive Soil Log #3 ❑ Boring ❑ pit Elevation Depth to SHWT Depth (in) Texture fragment % matrix color redox color consistence grade shape <35 loose loose single grain 35 50 friable weak granular blocky firm moderate prismatic platy >50 rigid strong massive <35 loose loose single grain 35-50 friable weak granular blocky >50 firm moderate prismatic platy rigid strong massive X35 loose loose single grain 35-50 friable weak granular blocky >50 firm moderate prismatic platy rigid strong massive <35 loose loose single grain 35-50 friable weak granular blocky >50 firm moderate prismatic platy rigid strong massive <35 loose loose single grain 35-50 friable weak granular blocky >50 firm moderate prismatic platy rigid strong massive I hereby certify this work was completed in accordance with MN 7080 and any local reqs. Rusty Olson's Soil & Perc 810 tgner Signature Company License # 1N o sa 01 000 Rill -lips L)I-, 0