HomeMy WebLinkAbout465 Lakeview Parkway septic certM MINNESOTA POLLUTION re Compliance inspection ort form
CONTROL AGENCY p p 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/defaulVfiles/w-wwists4-31a. df.
Property information Local trackino number:
Parcel ID# or Sec/Twp/Range: 0611723320005 Reason for Inspection Propery Transfer
Local regulatory authority info: City of Orono
Property address: 465 Lakeview Parkway
Owner/representative: Gary Gronneberg _ Owner's phone: 612-860-4575
Brief system description: 1 -2250 -gallon septic tanks, 1 -1300 -gallon lift station and 380 square feet of mound rock bed
System status
System status on date (mm/dd/yyyy): 7/15/2024
® 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. 7080.1500 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 (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) — 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
This system is designed for a three bedroom house
There is 1.0 feet of sand under the North end of the rock bed.
TBM: Bottom of rock bed. ELV. -100.0
The soils were verified by the city inspector.
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, 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.
Business name: Rusty Olson Soil & percolation Testing _ Certification number: C1255
Inspector signature: Joseph J. Olson
(This document has been electronically signed)
License number: L810
Phone: 763-498-8779
Necessary or locally required supporting documentation (must be attached)
® Soil observation logs ❑ System/As-Built ❑ Locally required forms ® Tank Integrity Assessment ❑ Operating Permit
❑ Other information (list):
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Page 1 of 4
Property Address: 465.Lakeview Parkway
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
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
Date: 7/15/2024
Attached supporting documentation:
❑ Other:
® Not applicable
2. Tank integrity — Compliance component #2 of 5
Compliance criteria:
System consists of a seepage pit, j ❑ Yes, ® No
cesspool, drywell, leaching pit,
or other pit?
Sewage tank(s) leak below their El ® No
designed operating depth?
If yes, which sew�g a tanks leaks:
Any "yes" answer above indicates the system
is failing to protect groundwater.
Describe verification methods and results:
Elmer J. Peterson Company pumped the tanks.
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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 5/25/2023
(mmlddlyyyy): (must be within three years)
(See form instructions to ensure assessment complies with
Minn. R. 7082.0700 subp. 4 8 (1))
❑ Tank is Noncompliant (pumping not necessary - explain below)
❑ Other:
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Page 2 of 4
Property Address: 465 Lakeview Parkway
Business Name: Rusty Olson Soil & percolation Testing Date: 7/15/2024
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) ❑
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Page 3 of 4
Property Address: 465 Lakeview Parkway
Business Name: Rusty Olson Soil & percolation Tesi
S. Soil separation — Compliance component #5 of 5
Date of installation 7/19/2018 ❑ Unknown
(mm/d&y3Ty)
Shoreland/Wel I head 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 ❑ Noy
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" answerabove indicates the system is
failing to protect groundwater.
Describe verification methods and results:
Date: 7/15/2024
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 100.0
B. Periodically saturated soil/bedrock 97.16
C. System separation 2.84
D. Required compliance separation* : 2.55
*May be reduced up to 15 percent if allowed by Local
Ordinance.
Upgrade requirements: (Minn. Stat. § 915.55) 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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Tank Report
Eimer. Peterson Co.
.5921 Dague Ave.
Delano, MN 55.928
Phone , 63-97, 2-2+20
Fax 7 63-1972-71 1
iliPCA License# <219
Gary Gronneberg
465 Lakeview Parkway
Orono, MN
612-860-5475
I?ate: May 25, 2023
Battles: 8 / OFF
Tank Capacity: 1-2250 Gallon Compartment Tank, 1-1300 Galton Lift Station
# of Tanks: 2
"Type of Tanks: Concrete
Gallons Pumped: .3000
Manholes to Grade: OL
/ N
Comments:
On May 25, 2023, 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 sloes it
replace a compliance inspection.
M MINNESOTA POLLUTION Sewage tank integrity rit assessment form
CONTROL AGENCY b
520 Lafayette Road North Subsurface Sewage
5t. 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 forth 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.i/www.pca. state.rrin. a s/waterli 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 primp 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 - Existina system lwa--wwists4-31 b). This form can be found on
the MPGA website at httpsJ/www.pca state mn.usluvater/inspections.
The information and certified statement on this form is required when existing septic tank compliance status is determined by an
individual other than they 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(13)(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(B),(C),
and (D) and; Minn. R. 7083A730(C).
Owner information
Owner/RepresentativE! Gary Gronneberr
Property address: 465 Lakeview Parkway Orono, MN
Local Regulatory Authority: Parcel ID:
System status
System status on date (mm/ddlyyyy): 5/25/2023
® 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 El Yes Na
Groundwater."
The SSTS has a sewage tank that leaks below the designed operating depth - "Failure to Protect ❑Yes ®Na
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 ® No
Public Health or Safety."
Ariy yes answer avove iiWicates iNwage tat)k roue -compliance.
Company information
Company name: Elmer J. Peterson Co
Business license number: 219
Designated Certified Individual SDCI) 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. l personally conducted the necessary procedures to assess the compliance
status of each sewage tank in this SSTS.
By typing/signing 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.
Designated Certified Individual's signature:_ James L Braegelmann Date (mmlddlyyyy); 512_512.023
(This document has been electronically signed.)
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wq-wwists4-91 • 5110121 Page I of 1
From: rpeitso@ci.orono.mn.us
Sent: 05/07/2018 - 02:45 PM
To: amyw@nortonhomes.com,chrisn@nortonhomes.com
CC:
Subject: Inspection Report Individual
CITY OF ORONO
2750 KELLEY PARKWAY
ORONO, MN 55356
PH: (952) 249-4600
FAX: (952)249-4616
Inspection Report
465 LAKEVIEW PKWY
Permit Number: RPS18-000005
Site Address: 465 LAKEVIEW PKWY, MOUND, MN 55364
Property Owner: SOURCE LAND DEVELOPMENT INC
Description: Single Family
Inspection Date: 05/07/2018
Inspection Type: Septic Verification
Inspection Results: Work Satisfactory: Proceed
Inspection Status: General Comment
1. Boring #1 0-6 topsoil 10 yr 212 loose sandy loam 6-12 10yr 212 weak sandy loam granular 12-18
10yr 413 weak silty clay blocky dark stratifications 18-24. 10yr 414 strong blocky 24-30 10yr 414
strong blocky dark stratifications, reds,yellow mottling @ 26?
2. Boring #2 0-6 10yr 212 loose sandy loam 0-12 10yr 212 weak blocky sandy/ silty loam 12-18 10yr
4/3 strong platty dark stratifications 18-24 10yr 4/4 strong platty light and dark stratifications Some
reds mottled @22?
Sincerely,
Roger Peitso
Building Official
952-249-4625
To schedule your inspections please call: (952) 249-4600
To schedule your inspection online Click Here
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH AND SAFETY!
Logs of Soil Borings
License #810
Location or Project: Lot 2, Block 1
Borings made by; Rusty Olson's Soil and Perc testing 6/1/2014
Classification System: AASHO ; USDS• USDS-SCS X Unified ; Other
Auger used (check two): Hand _X—, or Power , Flight, Bucket or Probe _X
Boring Number –
loam 10yr3/2
H2O present at
–X–
W-114" Brown loam 10yr4/4
14"-20" Brown loam 10yr5/4
20"-30" Rusty brown loam 10yr514
Boring Number _2— Surface elevation
_977.5
Mottled Soil at_1.5_
feet
0%8" Dark brown loam 10yr3/2
H2O present at
_X _
8"-18" Brown loam 10yr414
18"-24" Rusty brown loam to clay loam 10yr5/4
Boring Number _3_ Surface elevation
969.2
Mottled Soil at
_2.1 feet
0"-14" Dark brown loam 10yr3I2
H2O present at
—X—
IV-26" Brown loam 10yr4/4
26"-30" Rusty brown loam 10yr5/4
Boring Number 4� Surface elevation
969.5
Mottled Soil at
–2.1— feet
0"-14" Dark brown loam 10yr3/2
H2O present at
—X-
14"-26" Brown loam 10yr4/4
26"-30" Rusty brown loam 10yr5/4
Boring Number _5_ Surface elevation
_ 977.1
Mottled Soil at
_1.7_ feet
0"-8" Dark brown loam 10yr3/2
H2O present at
—X-
8"-14" Brown loam 10yr4/4
8"- 14
14"-20" Brown loam 10yr5/4
20"-30" Rusty brown loam 10yr5/4
Boring Number —6 _ Surface elevation
_968.1
Mottled Soil at
_1.7_ feet
0"-10" Dark brown loam 10yr3/2
H2O present at
—X-
10"-20" Brown loam 10yr4/3
20"-26" Rusty brown loam 10yr5/4
..
\'
19
3,50-22
- _-'��
/ ! ~^----- �-- ---' -- --
SEPTIC SYSTEM INVENTORY
Site Address: 465 Lakeview Pkwy PID 06-117-23-32-0005
Owner Name: 2667
Owner Address: 18215 45th Ave N STE D Plymouth MN 55446-
BuildingTvpe: Residence Installer: Hayes and Sons Excavating
Date of Permit: 711912018
Svstem Tvpe: Mound BR's Designed for 3
In Musa?: No Shoreland?: No
SEPTIC TANKS:
Material: Precast Concrete Capacity: 2250 Septic 1300 Pump Tank Filter:
DRAINFIELD:
Treatment Area: 380 Soil Boring: Yes DF Ht above Wt; 3
WELL DATA
Setbacks -Well Tanks: Greater than 50 Well DF: Report In File: Yes Depth:
INSPECTION RECORDS PUMPOUT RECORDS
Date j Notes Date . GallonsOfl_�:uid
11/28/2018 New System Compliance Valid until 11/28/2023 11/28/2018' 0
Inspector
Owner_
Prop"
v r��
OFJNVI�PFNNENck• (713
WORKSHEET FOR SEWAGE DISPOSAL WORK
Date—A
Building Permit No,
Fee
of Building
Plumbing Contractor -Outside Sewage Disposal4 ILL 14 Jr _Zp
Septic Tanks VW_
Material_ capacities fin" �Op
Proper Cutlet &Inlet?
Baffle Plates? `rte
Drain Field: r
Total lenifth of lines- Number of lines__ -•
Type of :coil Percolation Test`s S
Width of trench Type of filter materialtankVIVIr--- --
Amount of filter material Wow line
Depth from top of tile to finished grade
Check Vents_ Check Caulking
Check Grade in Horizontal Waste Pipes Clean Outs
Tonage or Yards of Filter Material Total Sq. Footage of Drain Field, 3- --
Sand Rock
Overall Size of Mound System
Size of Mound System Rock Filter Material
Draw detailed diagram to scale with measurements below, 1
W