HomeMy WebLinkAbout525 Leaf Street Certiiia MINNESOTA POLLUTION Compliance inspection report form
CONTROL AGENCY
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 https://www.pca.state.mn.us/sites/defaultlfiles/wq-wwists4-31a.pdf.
Property information Local trackina number:
Parcel ID# or Secfrwp/Range: 051 1 72341 0020 Reason for Inspection Propery Transfer
Local regulatory authority info: City of Orono
Property address: 525 Leaf Street, Orono, Hennepin County
Owner/representative: Jeff McCall Owner's phone: 612-718-4345
Brief system description: 2 -1000 -gallon septic tanks at the church, 1-1500 combination septic tank at the house and a 2000 -gallon
lift station and 410 square feet of mound rock bed.
System status
System status on date (mm/dd/yyyy): _ 6/9/2024
® 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. 7080.9504 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 permit/monitoring plan requirements (Compliance component #4) — Noncompliant - local ordinance applies
Comments or recommendations
There is 1.4 feet of sand under the rock bed found. the design called for 1.2 feet of sand.
TBM: Top of the church lowest floor slab. ELV.-100.0
Soils were verified by Sewer Services Inc. on 01/18/2022
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):
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Property Address: 525 Leaf Street, Orono, Hennepin County
Business Name: Rusty Olson Soil & percolation Testing Date: 6/9/2024
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
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
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, drywe[, leaching pit,
or other pit? --
Sewage tank(s) leak below their ❑ Yes' ® No
designed operating depth?
If yes, which sewage tanks leaks:
Any "yes" answer above indicates the system
is failing to protect groundwater.
Describe verification methods and results:
Duane's Septic Service pumped the tanks.
https://www.pca.state.mn.us
wq-wwists4-31b • 4/18/2021
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 5/23/2024
(mmIddiyyyy): (must be within three years)
(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:
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Page 2 of 4
Property Address: 525 Leaf Street, Orono, Hennepin Coun!y
Business Name: Rusty Olson Soil & percolation Testing
3. Other compliance conditions — Compliance component #3 of 5
Date: 6/9/2024
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?
3d. System not abandoned in accordance with Minn. R. 7080.2500?
*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 ❑
❑ Yes' ® No
[--]Yes* ® No
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
!f 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) ❑
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Property Address: 525 Leaf Street, Orono, Hennepin County
Business Name: Rusty Olson Soil & percolation Testing
5. Soil separation — Compliance component #5 of 5
Date of installation
8/31/2004
(mm%dd/yyyy)
❑ Unknown
Shoreland/Wellhead 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.
5 b. 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"
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.
❑ Yes ❑ No*
*Any "no" answer above indicates the system is
failing to protect groundwater.
Describe verification methods and results:
Date: 6/9/2024
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
B. Periodicallv saturated soil/bedrock
101.4
98.4
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 (ITPI-1S) 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.
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wq-wwists4-31b • 4/28/2021 Page 4 of 4
MINNESOTA POLLUTION Sewage tank integrity assessment form
CONTROL AGENCY g � Y
520 Lafayette Road North Subsurface Sewage
St. Paul, MN 55155-4194 Treatment Systems (SSTS) Program
Doc Type: Compliance and 1=nfarcement
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:
httos:Nwww.oca.state.m n.us/waterrnspections.
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 fwq-wwists4-31 b). This form can be found on
the MPCA website at htips://www.pca-state,mn.us/waterlinspections.
The information and cerltified 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. Additional Administrative Rule references for this activity can be found at Mirtn. R. 7082.0700, subp. 4(B),(C),
and (D) and; Minn. R. 7083.0730(C). Z TK5t �vr ;� � r'L- 17-a � `3 [u l,-' -
Owner information v
Owner/Representative /Vi -
Property address: _ 5-;L i[ _ -�- 5-T
Local Regulatory Authority: t_&k tA-L- Parcel ID:
System status
System sesta/tus on date (mm/dd/yyyy): 5-a I iO
F 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." ❑ Yes' �]TVo
The SSTS has a sewage tank that leaks below the designed operating depth - "Failure to Protect ❑ Yes' 2 -No
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 ❑ Yes" Ergo
Public Health or Safety."
Any "yes" answer above indicates ser;ragre tank non-compliance.
Company information Designated Certified individual (DCI) information
Company name: Duane's Septic Service LLC Print name: -I-r ✓t't ;F LC_Yt0c
Business license numter: L4286 Certification number: r< g~!'7 2—
I personally conducted the work described above as a Designated Certified Individual of a Minnesota -!/tensed SSTS inspection,
maintenance, installation, or service provider Business. I personally conducted the necessary procedures to assess the compliance
status of each sewage tank in this SSTS.
By typing/signing my name below, f certify the above statements to be true and correct to the best of my knowledge, and that
this information can b s used for the purpose of processing this form.
Designated Certified Individual's signature: Date (mm/dd/yyyy):
(Thi cement has been electronically signed.)
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wq-wwists4-91 • 5/10%11 Page 1 of 1
.� .
S -P TESTING, INC. Steven B. Schirmers • MPCA Cert.No. 627
951 Katydid Lane NE • St. Michael, MN 55376 - (763) 497-3566
FAX • (763) 497-5011
State License #394
New Thought Church of Religious Science
525 Leaf Street
Orono, Henn. Co., MN
Borings completed on 12-16-02, with a hand bucket auger.
BORING NUMBER 9- Elev.100.3 - MOTTLED SOIL AT 26" - no standing water present
in boring.
0 -
2"
Fill soil - loam with rocks
2" -
18"
Original soil dark brown loam 10YR 312
18" -
26"
Brown clay loam 10YR 514
26" -
40"
Rust brown clay loam 10YR 516 - mottles 10YR 618
40" -
48"
Rusty brown clay loam 10YR 516 - mottles 10YR 7/1,10YR 618
BORING NUMBER 2- Elev.100.7 - MOTTLED SOIL AT 20" - no standing water present
in the boring.
0 -
6"
Topsoil dark brown loam 10YR 312
6" -
12"
Gray brown loam 1 OYR 512
12" -
20"
Brown clay loam 10YR 516
20" -
38"
Rust brown clay loam 10YR 516 - mottles 10YR 711,618
38" -
48"
Rust olive brown loam 10YR 613 - mottles 10YR 711,618
BORING NUMBER 3- Elev.99.9 - MOTTLED SOIL AT 38" - no standing water present
in the boring.
0 -
8"
Topsoil dark brown loam 10YR 312
8" -
14"
Gray brown loam 10YR 512
14" -
22"
Brown loam 10YR 514
22" -
38"
Yellowish brown loam 10YR 616
38" -
44"
Rust brown loam 10YR 516 - mottles 10YR 618
44" -
48"
Rust olive brown loam 10YR 613 - mottles 10YR 711, 10YR 618
S. Soil separation — Compliance component #5 of 5
Date of installation 7/4/2003 ❑ Unknown
(mm%ddlyyyy)
ShorelandMellhead protection/Food ® Yes ❑ No
beverage lodging?
Compliance criteria (select one):
5a. For systems built prior to April 1, 1996, ❑ Yes ❑ No'
and 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 April 1, Yes ❑ No
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 1V or V systems built under 2008
Rules 7080. 2350 or 7080.2400
(Advanced Inspector License required)
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:
Boring
1-11" 10yr 312 loam
12-25" 10yr 414 clay loam
Redox @ 24"
Attached supporting documentation:
® Soil observation logs completed for the report (Attach)
❑ Two previous verifications of required vertical
separation (Attach)
❑ Not applicable (No soil treatment area)
Indicate depths or elevations
A. Bottom of distribution media 14"
B. Periodically saturated soil/bedrock 22" design
C. System separation 36"
D. Required compliance separation" 36"
*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 (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. 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
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Page 4 of 4
Site Address:
525 Leaf St
Owner Name:
J.S.M. Inc.
Owner Address:
3920 Hillcrest Way
SEPTIC SYSTEM INVENTORY
Deephaven MN 55331 -
PID 05-117-23-41-0020
BuildingTvpe. church Installer: Peterson
Date of Permit: 8120104
Svstem Tvae: mound BR's Designed for 3
In Musa?: No Shoreland?: y
SEPTIC TANKS:
Material: precast concrete Capacity: 2.1000,1500,2000 Tank Filter: yes
DRAINFIELD:
Treatment Area: 41*63 Soil Boring: yes DF Ht above Wt: 3
WELL DATA
Setbacks - Well Tanks: 50 Well DF: 50 Report In File: Depth:
INSPECTION RECORDS _
PU
P UT RECORDS
Date Notes
Date
GailonsOfLiquid
8/31/2004 installation
9/4/2019
2000
8/19/2002 non-compliant
3/18/2013
4000
6/6/2000 non-compl iant, repair by 12/31/2010
6/20/2010
4000
8/5/1997 non-compl iant-repair by 12/31/2007
8/25/2008
5/2/1991 no surfacing -DF area disturbed
6/19/2001
1800
9/24/1987 DF saturated
6/19/2001
1800
4/4/1984 DF surfacing
4/4/1984 DF surfacing
Sas Leak S -t
C
mmm
M�1 S Ha,
MND LO
iI -30