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HomeMy WebLinkAbout8.5.24 2920 Fox Street septic certMINNESOTA 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/default/tiieslwq-wwists4-31a,pdf. Property information Local tracking number: Parcel ID# or Sec/Twp/Range: 0411723310018 Reason for Inspection Propery Transfer Local regulatory authority info: City of Orono _ Property address: 2920 Fox Street Owner/representative: Chad Abraham Owner's phone: 612-481-6128 Brief system description: 2-1250-gallon septic tanks, 1-1500-gallon lift station and 750 square feet of mound rock bed per city records. System status System status on date (mm/dd/yyyy): 8/5/2024 ® 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 (ITFHS) 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 six bedroom house. There is 1.2 feet of sand under the rock bed found. TBM: Bottom of rock bed. ELV.-100.0 The soils were verified see soil boring reports. The 2 inch pipie leaks ground water where it exists the lift station. That should get sealed. See tank report. 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-wwists4-31b • 412812021 Use your preferred relay service Available in alternative formats Page 1 of 4 Property Address: 2920 Fox Street Business Name: Rusty Olson Soil & percolation Tesl 1. Impact on public health — Compliance component #1 of 5 Compliance criteria: System discharges sewage to the ground surface Date: 8/5/2024 Attached supporting documentation: ❑ Yes- ®No ❑ Other: ® Not applicable System discharges sewage to drain ❑ Yes- ®No tile or surface waters. System causes sewage backup into ❑ Yes' ® No dwellina 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' ® No ❑ Yes- ® No If yes, which sewage tanks leaks: Any "yes" answer above indicates the system is faiiing 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 5/8/2024 (mmlddlyyyy): (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: https://www.pca.state.rnn.us wq-wwists4-31b • 4/28/2021 • 651-296-6300 800-657-3864 use your preferred relay service Available in alternative formats Page 2 of 4 Property Address: 2920 Fox Street Business Name: Rusty Olson Soil & percolation Testing Date: 8/5/2024 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) ❑ https://www.pca.state.mn.us 651-296-6300 800-657-3864 Use your preferred relay service 0 Available in alternative formats wq-wwists4-31b • 412812021 Page 3 of 4 Property Address: 2920 Fox Street Business Name: Rusty Olson Soil 8 percolation Testing 5. Soil separation — Compliance component #5 of 5 Date of installation 6/28/2006 (mm/dd/yyyy) ShorelandlWellhead protection/Food beverage lodging? Compliance criteria (select one): ❑ Unknown ❑ Yes ® No 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 2,500gallons per day; Advanced Inspector I 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: 8/5/2024 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 100.0 B. Periodically saturated soil/bedrock 97.3 C. System separation 2.7 D. Required compliance se)aration* 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 • 412812021 Page 4 of 4 Tank Report Date: May 8, 2024 Elmer J. Peterson Co. 5921 Dague Xve. Delano, MN 55328 Phone , 6S-9 ; 2-2-1,20 Fax 7 63-9 7 2-; 21 , MPCA License# 219 Chad Abraham 2920 Fox Street Orono, MN 612-481-6129 Baffles: ON Tank Capacity: # of Tanks: 3 OFF 2-1250 Gallon Tanks, I-1500 Galion Lift Station Type of'Tanks: Concrete Gallons Pumped: 3500 Manholes to Grade: 'E / NO Comments: On May 8, 2024, Elmer J. Peterson Co. pumped tanks. -I'liere is a little seepage at the 2" pipe leaving the lift station to the mound. NOTE: This is only a tank report. This is not a compliance inspection for point of sale nor does it replace a compliance inspection. MINNESOTA POLLUTION Sewage tank integrity assessment form CONTROL AGENCY b 520 t afayette Road North Subsurface Sewage St. Paul, MN 55155-4194 Treatment Systems (SSTS) Program Doc Type, Compliance and Enfoicernimi 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://www.pca. state,mn. ustwater/inspections. Instructions: This form may be completed, and signed, by a Designated Certified Individual (DCI) of a licensed S5TS 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 (6) 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 (wa-wwist54-3tb), This form can be found an the MPCA website at ftttps: twww pca.state,mn,us/water/inspections. 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 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 Minn. R. 7082.0700, subp. 4(B),(C), and (D) and; Minn. R. 7083.0730(C), Owner information Owner/Representative Chad Abraham _ Property address: 2920 Fox -street Orono, MN Local Regulatory Authority: Parcel ID: System status System status on date (mm/dd/yyyy): 5/8/2024 ® 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." ❑ Yes' ® No The SSTS has a sewage tank that leaks below the designed operating depth - "Failure to Protect Yes' ®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 ® No Public Health or Safety." Any "yes" answer above indicates sewage tank non-compliance. Company information Designated Certified Individual (DCI) information Company name: Elmer J. Peterson Co Print name: James L Braegelmann-_ Business license number: 219 Certification number: 1 personalty conducted the work described above as a Designated Certifed 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, 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 Date (mm/dd/yyyy): 5/812024 (This document has been electronically signed.) www.pC8.6tate.mn.us + 651-296-6300 • 800-657-3864 Use your preferred relay service • Available in alternative formats wq-wwists4-91 • 5110121 Page I of 1 �k I / 50' \\ \ \ \ \\ \ \ \\\ DEEP WELL rj \ \ BENCHMARK: 7flP OF qvp '_00/- i\ '-IROM-PIPE \ ELEVA-nON-=§7914,) rl� sb20 - i � I s1,3 � 0 sb12 10' EASE�ENT EDGE OF Bit - LEGEND — — — -- — — — — ® denotes well location p denotes pert test location 0 denotes soil boring location ( 97*8 ) denotes proposed elev. 97*8 denotes existing eJev. denotes surface drainage APPROXIMATE PRIMARY MOUND QUANT177ES Notes Rock Quantity = 27.7t yards 1, Avoid compaction of mound area before, during and after Sand Quantity = 225i yds. construction. Loamy Sand Quantity = 20t yds. 2. Verify before construct,on Chet no wells are within 50 feet Top Soil Quantity = lODf yds. of the proposed or existing septic tank, *Quantities are approximate 3. Verity before construction that no shallow wells are within 100 feet, and do not include waste or any deep wells within 50 feet of proposed tfeotment area. 4. All materiols used for construction must meet or exceed ti,e I hereby certify that this site plan was prepared by me of M.P.C.A. Chapter 7080 requirements under my direct supervision. 5. Divert surface drainage away or around the septic area _ S. All dimensions. quantities and elevation shown on plan are apprewimate- hie MAW D.R.P. M. P. C. A. License 1 1921 MILLER'S SEWAGE TREATMENT SOLUTfONS PROPERTY LOCATVON Lot 2, Black ,, Stubbs Farm, Hennepin County. Minnesota. Septic System Site Plan PREPARED FOR: Anthony Thomas Homes A division of WRbf Services Inc. ©ATE I JOB NO. I SCALE PO BOX 458 Kimbofl, MN 55353 (320) 398-2705 cell (320) 980-1737 8/8/05 006'77 7R40 J Ir Q Cd LCi N-1 Fr ti O O � C � O � ra� c� A O y O CA Q 60 p � 0yJ p W x 0 O a a G J Co y •� O C�Ab vi as a v �Lk Q 0O MO /0 MQ M 4.1 L O O �y O � "U U � b a,. 0 to tro to tn E ►e r� v a° a U b Iry r� N IT L� 0 ❑ R-. v `8 i. 4] �Q MM� F�+-a v O u a m 0 O °° fV I r .. v c� CN � C rn d V •p eC � w o ac rr� VI W F+y MMc Y8i V1 �I i. O y N_ G � O U Oa � O b y, � L a u iG N N N a L a � d v G a .dI4 e� c a, 4 Cd 0 Q Fy "y it N V V �I b v ~I a U x V O C! � � O p � N O ^" � I � � C►r 'w+ U CLi O L ad 03 cu V Via• iMyy� Via• � C M� M� �yil MMQ ���yy 0/} O L O p ago ono ono O L L a. i■ O v N N N N 8 8as 0 r O a O a y O a n RA w N N O O d A rW O rMi rtl�+l ab C4 en In r- 0 C` 7 00 7f- oV1. }� ffu9 �S < � oPoFr V) m ; ti7-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 Stubbs Property 2920 Fox St. Lot 2, South Site Orono, Henn. Co., MN Borings completed on 6-5-02, with a hand bucket auger. BORING NUMBER 7- Elev.977.1 - MOTTLED SOIL AT 28" - no standing water present in boring. 0 - 8" Topsoil dark brown loam 1 OYR 3/2 8" - 12" Brown loam 1 OYR 5/3 12" - 28" Brown clay loam 1 OYR 5/6 28" - 38" Rusty brown clay loam 1 OYR 516 - mottles 7/1,618 38" - 48" Rusty olive brown loam 10YR 6/3 - mottles 711,6/8 13ORING NUMBER - Elev.977.0 - MOTTLED SOIL AT 28" - no standing water present in the boring. 0 - 10" Topsoil dark brown loam 10YR 3/2 10" - 16" Brown loam 1 OYR 5/3 16" - 28" Brown clay loam 10YR 5/6 28" - 38" Rusty brown clay loam 10YR 5/6 - mottles 7/1,618 BORING NUMBER 9- Elev.972.9 - MOTTLED SOIL AT 22" - no standing water present in the boring. 0 - 10" Topsoil dark brown loam 1 OYR 3/2 10" - 14" Gray brown loam 10YR 5/2 14" - 22" Brown clay loam 10YR 516 22" - 36" Rusty brown clay loam 1 OYR 5/6 - mottles 7/1,6/8 36" - 48" Rusty olive brown clay loam 1 OYR 613 - mottles 7/1,6/8 Soil borings cont'd. BORING NUMBER 10-_Elev.973.9 - MOTTLED SOIL AT 18" - standing water present in the boring at 32", 23 hours after the boring. 0 - 10" Topsoil dark brown loam 10YR 3/2 10" - 14" Brown loam 10YR 5/3 14" - 18" Brown clay loam 10YR 514 18" - 28" Rusty brown clay loam 10YR 514 - mottles 711,618 28" - 48" Rusty gray brown clay loam 10YR 6/3 - mottles 7/1,6/8 BORING NUMBER 11-_Elev.974.1 - MOTTLED SOIL AT 22" - no standing water present in the boring. 0 - 8" Topsoil dark brown loam 10YR 3/2 8" - 14" Brown loam 10YR 5/3 14" - 22" Brown clay loam 10YR 5/6 22" - 34" Rusty brown clay loam 10YR 5/6 - mottles 7/1,6/8 34" - 48" Rusty olive brown loam 10YR 6/3 - mottles 7/1,6/8 50 - ING NUMBER 12- Elev.978.6 - MOTTLED SOIL AT 26" - standing water present in the boring. 0 - 10" Topsoil dark brown loam 10YR 3/2 10" - 26" Brown clay loam 10YR 5/4 26" - 34" Rusty brown clay loam 10YR 5/6 - mottles 7/1,6/8 34" - 40" Rusty olive brown silty clay loam 10YR 613 - mottles 711,6/8 40" - 48" Rusty olive brown loam 10YR 6/3 - mottles 7/1,6/8 BO_ RINQ NVMBER_13- Elev.973.1 - MOTTLED SOIL AT 24" - no standing water present in boring. 0 - 10" Topsoil dark brown loam 10YR 3/2 10" - 16" Gray brown loam 10YR 5/2 16" - 24" Brown clay loam 10YR 5/6 24" - 36" Rusty gray brown clay loam 10YR 6/3 -mottles 711,618 2 1 L— ;24a0Street