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HomeMy WebLinkAboutCompliance Inspection Form,,or, Minnesota P011iltion Control Agency Compliance Inspection Form 520 Lafayette Road Worth Existing Subsurface Sewage Treatment Systems St. Paul, MN 55755.4194 (SSTS) Doo Type: Compliance and Enforcement Instructions: Inspection results based an Minnesota Folluti3n Convol P,yency (11lPCA) For local tracking purposes: requirements and attached forms — additional local requirements may also apply, Submit completed form to Local Unit of Government (LUG) and system owner within 15 days System Status System status on date (mmlddlyyyy): 5/1212014 ® Compliant — Certificate of Compliance ❑ Noncompliant -- Notice of Noncompliance (Valid for 3 years from report date, unless shorter time (See Upgrade Requirements on page 3) frame eutlined in Local Ordinance.) Reason(s) for noncompliance (check all applicable) (] Impact on Public Health (Compliance Component #1) — Imminent threat to public health and safety ❑ Other Compliance Conditions (Compliance Component #3) — Imminent threat to public health and safety ❑ Tank Integrity (Compliance Component #2) — Failing to protect groundwater ❑ Other Compliance Conditions (Compliance Component #31— Failing to protect groundwater ❑ Soil Separation (Compliance Component #4) — Failing to protect groundwater ❑ Operating permittmonitoring plan requirements (Compliance Component #5) -- !Noncompliant Property Information Parcel IDA or Sec/TwplRange: 2711823320018 Piciperly address: 1000 Cox Farm Road, Long Lake. MN 553M Reagon for inspection: Transfer of Title Property owner: David Narum Owner's phone: i or _...- w Owner's representative: Representative phone: Local regulatory authority: City of Orono _ _ Regulatory authority phone: _ Brief system description: Pre --cast Septic Tanks, and above grade drainfeld Comments or recommendations - Tanks should be pumped on a regular basis to make sure solids do not enter the drainfeld from the pump tank Septic tank sizes were a(1) 1300 gallon septic tank, (1) 1000 gallon septic tank, and a (1) 1000 gallon pump tank. 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 Mum water usage. Inspector name: Pero ip s Certification number: _ Business name: Chip' optic Se v' � License nuniber. _2064 Inspector signafrlre _ Phone number, 952-200-3176 Necessary or Locally Required Attachments ® Soil boring logs ® SystemlAs-built drawing ❑ Other information (list): www.pca.state.mn.us 651-296-6300 800-657-3864 wq-wwists4.3I • 1124112 ❑ Forms per local ordinance • TTY 651-282-5332 or 800.657-3864 • Available in alternative formats page t of 3 Property address: 1000 Cox Farm Road, Long Lake, MN 65356 1. Impact on Public Health —Compliance component #1 of 5 ComRliknice criteria: System discharge sewage to the ❑ Yes ® No _ground surface._ T System discharge sewage to drain the ❑ Yes I No or surface waters. System cause sewage backup into ❑ Yes ® No dwelling or establishment. Any "yes" answer above indicates the system Is an imminent Threat to Public Health and Safety. CommentslExplanation: 2. Tank Integrity —Compliance component #2 of 5 Compliance criteria: System consists of a seepage pit, ❑ Yes ® No cesspool, drywell. or leaching pit. Seepage pits meeting 7080.2560 may be compliant if allowed in local ordinance Sewage lank(s) leak below their I ❑ Yes ® No _designed operating depth. _ If yes, which sewage tank(s) teaks: Any "yes" answer above indicates the system is Failing to Protect Groundwater. Comments/Explanation: Tanks were pumped at time of inspection Inspertor initialslDate: 5-12-14 RK Verification method(s): ® Searched for surface outiet ® Searched for seeping in yardibackup in home ❑ Excessive ponding in soi) systemlD-boxes ❑ Homeowner testimony (See Comments/Explanation) ❑ "Black soil" above soil dispersal system ❑ System requires "emergency" pumping ❑ Performed dye test ❑ Unable to verify (See Cnmments/Fxpianation) ❑ 01her methods not listed (see Ccmmenis/Explanation) Verification method(s): Probed tank(s) bottom ❑ Examined construction records ❑ Examined Tank Integrity Form (attach) ❑ Observed liquid level below operating depth D4 Examined empty (pumped) tanks(s) ❑ Probed outside tank(s) for black soil" ❑ Unable to verify (See Comment.vFxpianation) ❑ Gther methods not listed (See CammentslExplanation) 3. Other Compliance Conditions —Compliance component #3 of 5 a. Maintenance hoie covers are damaged, cracked, unsecured, or appear to structurally unsound. ❑ Yes' 0 No ❑ Unknown b. Other issues (erectrfcalhazards, etc,) to immediately and adversely impact public health or safety. ❑ Yes" ®No ❑ unknown "System is an imminent threat to public health and safety Explain: c. System is non -protective of groundwater for other conditions as determined by inspector ❑ Yes' ® No "System is failing to protect groundwater Explain: wwy+-pra.state.mn.us 651-296-6300 800-657-3864 TTY 651-282.5332 or 800-657-386d - Available in alternative formats wq-wwists4.31 • f124112 Page 2 of 3 0 Property address: 1000 Cox Farm Road, Long Lake, MN 55356 4. Soil Separation —Compliance component #4 of 5 Date of installation: 1996 _ ❑ Unknown 5horeland/Wellhead protectionlFood Beverage ❑ yes ® No Lodging? Compliance criteria: For systems built prior to April 1, 1996, and ❑ Yes ❑ No not located in 5horeland or Wellhead Protection Area or- not serving a food, beverage or lodging establishment: Drainfield has at least a two -foot vertical separation distance frorn neriodically saturated soil or bedrock. 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, bcveragge. orlodgfng establishrrlenl. Drainfield has a three-foot vertical separation distance from periodicaliy saturated soil or bedrock." "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 (Advanced Inspector License required) Drainfield meets the designed vertical separation distance from periodically F saturated soil or bedrock. Any "no" answer above indicates the system i8 Failing to Protect Groundwater. _ Inspector inilialslDate: 5-12-14 Verification method(s): Soil observation does not expire. Previous soil observations by two independent parties nm sufriciont unless site conditions have been altered or local requirements differ. ® Conducted soil observation(s) (Attach boring logs) ❑ Two previous verifications (Attach boring logs) ❑ Not applicable {Holding tank(s), no drainfield) ❑ Unable to verify (See Cornrnents/1 .eplanationJ ❑ Other (See Comments/Explanation) CommentslExplanation: Indicate depths of elevations A Bottom of distribution media 101.5_ B. Periodically saturated soillbedrock 98,5 C. System separation 36 inches 0 Required compliance separation.• 36 inches 'May be reduced up to 15 percent if allowed by Local Ordinal icc. 5. Operating Permit and Nitrogen BMP* —Compliance component #5 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? ❑ 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. Operating Permit number, -- n Yes ❑ No Have the Operatiqg_Permit requirements been met? b. Is the required nitrogen BMP in )glace and properly functioning? ❑ Yes ❑ No Any "no" answer indicates Noncompliance. Upgrade Requirements (Minn. Stat. § 115 55) An imminent threat rn public health and safety (ITPHS) must be upgraded, replaced, or its use discontinued svrihin 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 bo upgraded, replaced, or its use discontinued within the time required by local ordinance tf an existing system is not tailing as defined in law, and has at least twa 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, Wotfhcad PrWoclicn Areas. or those used in connection v.4tt food, beverage, and lodging establishments as defined in law. www.oca.state.mn.us • 651-296-6300 - 800.657-3864 TTY 651-282-5332 or 800-657-3864 Available in alternative formats wq-wwists4-31r • f124112 Page 3 of 3 G!! u� yyr�d AA 'BEd r-O rk C) i� IE \t\ � � u V J Q w � 1d fl W � � L7 rx [P �I f i C r`y r a r�Crt7 y G � P4 � iCd. Ago a p o I a} g .� M •M U p R ti a O. C7 ia. C?C�'.'A+f»�C7 G. L"'0. uJ ,� C.7 G.G0.CA C�0.LG-•rA .�2 C7 P•L�Ca Y: r� �f I O P 00 C D p ett ' •Y p oar-, O a 16 a� eti m u u u rs UAC7 ...u�{7 UGlC7 CJ�u'C7 {J©L� n u� UFaC7 k \ •■ \ � � A C) a ,Q o dl @J rti p �! It ft rA %J i+f �-'+ •r pyq •d � Fl r A Z 9 ts m •� 48 O •C Z n R •q O M W ii iZ �i s.i f to C H �'✓5r1 ✓wry i7F+�F�.rn`G��•�cC.rn�Un.pa.cr,�L7wc�win�C7a,q�v��C�G.ga.�n� 1 f i _ t o V ._� I CITY OF ORONO Street Address: Am"ing Address: 2750 Kelley Park my P 0 Box 66 Long Lalze, MN 55356 Crystal Bay, MN 55323 512812014 David & Carol Narum 1000 Cox Farm Road Long Lake MN 55356- The City of Orono records show the last pumping at: 1000 Cox Farm Rd was performed on 8/11/2006 According to Orono City Code Sec. 58-51(b) System Operation, Use and Maintenance states that "...No sewage tank shall remain in service without being pumped at least once every three years, whether or not measurement indicates a sludge buildup." Please have your tank(s) pumped: Immediately Complete the attached Septic Maintenance Report providing the City of Orono proof of pumping. A list of licensed pumping contractors can be obtained ati www.pce.state.mn.us/programs/iststregsstration.htm1. If you have any questions please contact me at loma,-,@ci.orono.mn.us or at 952-249-4625. Thank you in advance for your cooperation. Sincerely, CITY OF ORONO Lyle Oman, Building Official Attachment Office (952) 249-4600 1 Fax (952) 2494616 wwN.Ci.orono.R1n.us 2014 SEPTIC MAINTENANCE REPORT Site address. x A Ck Number of tanks: J Date last pumped: �°� ! Gallons pumped: 62 ' Name of pumper/ maintenance provider. c f� tT� C-- J ate tJ t C LZ- C— Are tanks watertight?. IS the System functioning properly? YES , NO (please circle one) {ie slow drainage. wetness in the drainfield?) ❑o you have any specific concerns or issues that you'd like to discuss with the SSTS Program Manager? AIo If so, please indicate best time and telephone numbers) to be reached between 8 am and 4.30 prn. Best Trues Telephone Number(s) RETURN IN THE ENCLOSED ENVELOPE AS SOON AS POSSIBLE LYLE OMAN CITY OF ORONO PO BOX 66 CRYSTAL BAY MN 65323-0066 Chip's Septic Service, LLC Maintenance/pumping Report Qate_Servieed; __ —_���^- -- -- - - .. —Driver:—_ 6* -- Residential____ _'�. Commercial. Start:_ �_.1=inish_ Type of Service: Regular Maintenance: - _- -----Emergency:-. - -- Name:.. Vu,o �A?,Uw. — Phone:-_ - -- --- — LeFI Address:-&o 6o�FAP_&JW - -. City,State, Zip:----U�a�I' _ S`i✓a Gallon Pumped: Tank #1:_/SO!0 - Tank #2:--/- _ .-_ Pump Tank:_ Zoe Total:. 2•5-00 Access used for pumping: an Standpipe (Explanation):- - Tank Condition:_- lwa( _ Evidence of problems: . Comments:_ �c� s�,... E• _�d—'-._—.�eu�ic�-lus .__� .. _ Disposal Location:!" Waste typ • ornestic Holding Tank Next recommended pumping date: Chip's Septic Service, LLC Designs, Inspections & Maintenance Pernel "Chip" Hentges 16762 Babcock Avenue Lester Prairie, MN. 55354 #952.200.3176 chipseptic@gmail,com MPCA License No. 2064 Bihina 111formation Pumping: Exposing Manholes Excessive Distance t:::cessive Grade _ Materials:--- Labor:— Total Due: "yhe Guys in the Big Yellow Trurk" 1C: 0 Cox�av -m W, 433 r z camp TAW,