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HomeMy WebLinkAbout1250 Lyman Ave. Septi Cert��MINNESOTA POLLUTION Compliance inspection report form CONTROL AGENCY N 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 (MPGA) website at https://www.pca.state.mn.us/sites/default/files/wq-wwists4-31a.pdf, Property information Local trackinq number: Parcel ID# or Sec/Twp/Range: 3511823340015 Reason for Inspection Propery Transfer Local regulatory authority info: City of Orono Property address: 1250_Lyman Ave. Owner/representative: William Dworsay Owner's phone: 612-670-1985 Brief system description: Approximately 2 -1300 -gallon septic tanks, 1 -1300 -gallon lift station and 550 square feet of mound rock bed. System status System status on date (mm/dd/yyyy): 3/23/2024 ® Compliant —Certificate of compliance* ❑ Noncompliant — Notice of noncompliance (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. 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 (ITPHS) 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) — Farling 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 permit/monitoring plan requirements (Compliance component #4) — Noncompliant- local ordinance applies Comments or recommendations There is 1.7 feet of sand under the rock bed. TBM: Top of the lift station elect. box. 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, I 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 800-657-3864 wq-wwi5ts4-31b • 4/28/2021 Use your preferred relay service Available in alternative formats Page 1 of 4 Property Address: 1250 Lyman Ave. Business Name: Rus Olson Soil & percolation Testing Date: 3/23/2024 1. Impact on public health — Compliance component #1 of 5 Compliance criteria: Attached supporting documentation: System discharges sewage to the ❑ Yes' ® No ❑ Other: ground surface ® Not applicable System discharges sewage to drain ❑ Yes` ® No tile 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 2. Tank integrity — Compliance component #2 of 5 Compliance criteria: System consists of a seepage pit, cesspool, drywell, leaching pit, or other pit? Sewage tank(s) leak below their designed operating depth? Yes' M No [--]Yes* ® No Any "yes" answer above indicates the system is failing to protect groundwater. Describe verification methods and results: Elmer J. Peterson 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 3/19/2024 (mm/dd/yyyy): (must be within three years) T (See form instructions to ensure assessment complies with Minn. R. 7082.0700 subp. 4 B (1)) ❑ Tank is Noncompliant (pumping not necessary - explain below) ❑ Other: https://www.pca.state.mn.us 651-296-6300 • 500-657-3964 Use your preferred relay service Available in alternative formats wq-wwists4-316 • 4/28/2021 Page 2 of 4 Property Address: 1250 Lyman Ave. _ Business Name: Rusty Olson Soil & percolation Testing 3. Other compliance conditions — Compliance component #3 of 5 Date: 3/23/2024 3a. Maintenance hole covers appear to be structurally unsound (damaged, cracked, etc.), or unsecured? ❑ Yes" 0 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 Practices) 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 Poge 3 of 4 Property Address: 1250 Lyman Ave. Business Name: Rusty Olson Soil & percolation Testing 5. Soil separation — Compliance component #5 of S Date of installation 9/26/2000 ❑ Unknown (mm/dd/yyyy) Shoreland/Wellhead protectionlFood ❑ 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, or lodging 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 5 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: 3/23/2024 Attached supporting documentation: ® Soil observation logs completed for the report ❑ Two previous verifications of required vertical separation ❑ Not applicable (No soil treatment area) u Indicate deaths or elevations A. Bottom of distribution media 93.0 B. Periodically saturated soil/bedrock 90.0 C. System separation 3.0 D. Reauired compliance separation* 1 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 (1TPHS) 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 500-657-3864 wq-wwists4-31b • 4/28/2021 Use yaur preferred relay service Available in alternative formats Page 4 o14 Tank Report Elmer J. Peterson Co. 5.921 Dague Ave. Delano, MN 55H8 Phone '765-97 2-2420 Fax 163-972-7217 MPGA License# 219 William Dworsky 1250 Lyman Ave Orono, MN 612-670-1985 Baffles:oat�y,: / Tank C # of Tanks: 3 Type of Tanks OFF Gallons Pumped: 3-1300 Gallon Tanks Darwin Concrete 3500 Manholes to (.oracle: DES NO Comments: Date: March l y, 2024 On March 19, 2024, Elmer J. Peterson Co. pumped tanks. No cracks or water leaking in tanks at the time of pumping. NOTE: This is only a tank report. This is not a compliance inspection for point of sale nor does it replace a compliance inspection. M MINNESOTA POLLUTION Sewage tank integrity assessment form CONTROL. AGENCY 520 Lafayette Road North Subsurface Sewage St. Paul, MN 55155-4194 Treatment Systems (SSTS) Program Doc Type: Compliance and Enforcement Purpose: This form may be used to certify the compliance status of the sewage tank components of the SSTS. This form is not a complete SSTS inspection report, only a tank integrity assessment, and may only certify sewage tank compliance status when entirely completed and signed by a qualified professional. SSTS compliance inspection report forms can be found at: https:/lwww. pca . state. m r . u slwaterli nsoections. Instructions: This form may be completed, and signed, by a Designated Certified Individual (DCI) of a licensed SSTS inspection, maintenance, installation, or service provider business who personally conducts the necessary procedures to assess the compliance status of each sewage tank in the system. Only a licensed maintenance business is authorized to pump the tank for assessment. A copy of this information should be submitted to the system owner and be maintained by the licensed SSTS business for a period of five (5) years from the assessment date. When this form is signed by a qualified certified professional, it becomes necessary supporting documentation to an Existing System Compliance Inspection Report: Compliance inspection form - Existing system w-wwists4-31 b . This form can be found on the MPGA website at httrLs:Nwwvr pca-statee.mn.ustwaterlinspections. The informations 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 an inspection report. This form represents a third party assessment of SSTS component compliance and is allowable under Minn. R. 7082.0700, subp. 4(B)(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. Addil:ional Administrative Rule references for this activity can be found at Minn. R. 7082.0700, subp. 4(B),(C), and (D) and; Minn. R. 70B3.0730(C). Owner information Owner/Representative William Dworsky__ Property address: 1250 Lyman Ave Oron MN Local Regulatory Authority: Parcel ID: System status System status on date (mmlddlyyyy): 3/19/2024 ® Certificate of sewage tank compliance ❑ Notice of sewage tank non-compliance Compliance criteria: The SSTS has a seepage pit, cesspool, drywell, leaching pit, or other pit - "Failure to Protect Groundwater." The SSTS has a sewage tank that leaks below the designed operating depth - "Failure to Protect Groundwater." The SSTS presents a threat to public safety by reason of structurally unsound (damaged, cracked, or weak) maintenance hole cover(s) or lids or any other unsafe condition - "Imminent Threat to Public Health or Safety" Any "yes" answer above indicates sewage tank non-compliance. Company information Company name: Elmer J. Peterson Co Business license number: 219 ❑ Yes" ® No ❑ Yes" ® No ❑ Yes" ® No Designated Certified Individual (DCI) information Print name: James L Braegelmann Certification number: I personally conducted the work described above as a Designated Certified Individual of a Minnesota -licensed SSTS inspection, maintenance, installation, or service provider Business. 1 personally conducted the necessary procedures to assess the compliance status of each sewage tank in this SSTS. By typing/signing my name below, 1 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. Designated Certified Individual's signature: James L Braegelmann _ (This document has been electronically signed.) www.pca.state.mn,us • 651-296-6300 800-657-3864 ■ Use your preferred relay service wq-wwists4-91 - 511W1 Date (mmlddlyyyy): 311912024 Available in alternative formats Page 1 oft Soil Observation Log www.SepticResource.com vers 12.4 Owner Information Property Owner 1 project: William Dworsay Date 3/18/2024 Property Address / PID: 1250 Lyman Ave. Soil Survey Information ❑ refer to attached soil survey Parent matl's: 0 Till ❑ Outwash ❑ Lacustrine ❑ Muvium ❑ Organic ❑ Bedrock landscape position: ❑ summit ❑ Shoulder 0 Side slope �1 Toe slope soil survey map units: L41E slope % direction - Soil Log 41 Boring ❑ Pit Elevation 91.3 Depth to SHWT X Inches Depth (in) Texture fragment % matrix color redox color consistence grade shape 0-8 Loam .35 10yr3/1 Friable Strong Blocky 8-16 Loam < 135 1Oyr4/3 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 Comments: TBM: Top of the lift station elect. box. ELV.-100.0 I hereby certify this work was completed in accordance with W 7080 and any local reqs. Rusty Olson's Soil & Perc 810 lgner Signature Company License # 1250 Lyman Ave. Soil Log #2 El Boring ❑ pit Elevation 91.3 Depth to SHWT 16 Inches Depth (in) Texture fragment % matrix color redox color consistence grade shape 0-8 Loam <35 10yr3/2 Friable Strong Blocky 8-14 Loam <35 10yr4/4 Friable Strong Blocky 14-16 Clay Loam <35 10yr5/4 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 1250 Lyman Ave. Soil Log 43 ❑ Boring ❑ Pit Elevation Depth to SHWT Depth (in) Texture fragment % matrix color redox color consistence grade shape 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 <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 W 7080 and any local reqs. Rusty Olson's Soil & Perc 810 lgner Signature Company License # 12-5o %vE. N r r � 1 S � BPI A r � OD r