HomeMy WebLinkAbout9.11.24 3445 Watertown Road septic certMINNESOTA POLLUTION
CONTROL AGENCY Compliance inspection report form
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.r)ca.state.mn.us/sites/default/files/wg-wwists4-31a pdf.
Property information Local tracking number:
Parcel ID# or Sec/Twp/Range: 3211823430009 Reason for Inspection Property Transfer _
Local regulatory authority info: City Of Orono, 952 249-4600
Property address: 3445 Watertown Road, Orono
Owner/representative: Joe McPherson
Owner's phone: 612-369-3736
Brief system description: 2-1300-gallon septic tanks, 1-1300-gallon lift station and 630 Square feet Rock bed
System status
System status on date (mm/dd/yyyy): 9/11/2024
® 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
The system is designed for a five bedroom house.
There is 1.5 feet of sand under the rock bed on the East side and there is 2.0 feet of sand under the rock bed on the West side.
TBM: Top of the door thresholod. Elv.-100.G
Certification
1 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 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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Property Address: 3445 Watertown Road, Orono
Business Name: Rusty Olson Soil & percolation Testing Date: 9/11/2024
1. Impact on public health — Compliance component #1 of 5
Pee 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
dwellinq 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
!lance criteria:
System consists of a seepage pit, ❑ Yes- ® No
cesspool, drywell, leaching pit,
or other it?
Sewage tank(s) leak below their ❑ Yes- ® No
designed operating depth?
If yes, which sewage tanks leaks:
Any "yes" answer alcove indicates the system
is failing to protect groundwater.
Describe verification methods and results:
Duane's Septic Service 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 8/13/2024
(mmidd/yyyy): (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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Property Address: 3445 Watertown Road, Orono
Business Name: Rusty Olson Soil & percolation Testis
3. Other compliance conditions — Compliance component #3 of 5
Date: 9/11/2024
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? []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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Property Address: 3445 Watertown Road, Orono
Business Name: Rusty Olson Soil & percolation Testing Date: 9/11/2024
5. Soil separation — Compliance component #5 of 5
Date of installation 7/2712015 ❑ Unknown
fmm/dd/Wy)
ShorelandlWel[head protection/Food ❑ Yes ® No
beverage lodging?
ComDliance criteria (select one):
5a. For systems built prior to April 1, 1996, and ❑ Yes ❑ Now
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 j
5 b. Non-performance systems built
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.*
Attached supporting documentation:
® Soil observation logs completed for the report
❑ Two previous verifications of required vertical separation
❑ Not applicable (No soil treatment area)
01
® Yes ❑ No* Indicate depths or elevations
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 a 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:
A. Bottom of distribution media
102.3
B. Periodically saturated soil/bedrock
! 99.3
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 (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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' RAIN CONTROL
AGENCY POLLUTION Sewage tank integrity assessment form
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 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,./Atvww.pca.state.mn.us/waterfinspecfions.
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 L,6-wwists4-31 b). This form can be found on
the I IPCA website at htt;)s://www.oce.state.mn.usiwaterl'ins1)ections.
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
Property address: q � � h 1
Local Regulatory Authority: nro.1fs Parcel ID:
system status
r
System=erfificate
date (mm/ddlyyyy): c; ? 3
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 ]o
The SSTS has a sewage tank that leaks below the designed operating depth - "Failure to Protect
Groundwater." ❑ Yes No
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' ffeNo
Public Health or Safety."
Any ",yes'; answer above la ica:es ser,^rage rank non-compliance.
Company information Designated Certified Individual (DCQ information
Company name: Duane's Septic Service LLC Print name:[ fi c:�
Business license number: L4286 Certification number: C 191`7
1 personally conducted the work described above as a Designated Certified Individual of a Minnesota -licensed 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, I certify the ab ve statements to be true and correct to the best of my knowledge, and that
this infonvation can be used for the purpose of c sing th' nn.
Designated Certified Individual's signature: L Date (mm/dd/yyyy): Q f 3 7o;Lv
rcument has been electronically signed.}
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wq-ww1sts4-91 • 5110121 Page 1 of 1
Soil Observation Log
www.SepticResource.com vers 12.4
Owner Information
Property Owner / project: Joe McPherson
Property Address 1 PID: 3445 Watertown Road
Date 9/4/2024
Soil Survey Information ❑ refer to attached soil survey
Parent matl's: ❑r Till ❑ Outwash ❑ Lacustrine ❑ Aliuvium ❑ Organic ❑ Bedrock
landscape position: ❑ Summit ❑ Shoulder 0 Side slope ❑ Toe slope
soil survey map units: L40B slope % direction- Lineal
Soil Log #1
D Boring ❑ pit Elevation 103.8 Depth to SHWT 65 inches
Depth (in) Texture fragment % matrix color redox color consistence grade shape
0-43
Mound sand Fill
<35
43-58
Loam
<35
10yr3!1
Friable
Moderate
Blocky
58-65
Loam
<35
10yr4/3
Friable
Strong
Block}
<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 ty
rigid
strong
massive
Comments: TBM: Top of door threshold. Elv.- 100.0
3445 Watertown Road Soil Log 92
21 Boring ❑ Pit Elevation 103.7 Depth to SHWT 54 inches
Depth (in) Texture fragment % matrix color redox color consistence grade shape
0-35
Mound sand Fill
<35
35-42
Loam
<35
10yr3/1
Friable
Moderate
Blocky
42-48
Loam
<35
10yr4/3
Friable
Strong
Blocky
48-54
Clay Loam
<35
10yr5/4
Friable
Strong
Blocky
54-60
Clay Loam
<35
10yr5/4
10y4/8,1-6/10y
Firm
Strong
stocky
3445 Watertown Road Soil Log #3
❑ Boring ❑ Pit Elevation Depth to SHWT
Depth (in) Texture fragment % matrix color redox color consistence grade shape
<35
loose
loose
single grain
35 - 50
friable
weak
granular blocky
firm
moderate
Prismatic platy
h'
>50
rigid
strong
massive
<35
loose
loose
single grain
35 - 50
friable
weak
granular blocky
>50
%
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
#-ff n
moderate
prismatic platy
rigid
strong
massive
I hereby certify this work was completed in accordance with MN 7080 and any local req's.
00,
Rusty Olson's Soil & Perc 810
Designer Signature Company License #
METRO WEST INSPECTION SERVICES, INC. • 763-479-1720
BOX 248 • LORETTO, MN 55357
Inspector,
Owner
CITY OF OL� Q N
WORKSHEET FOR SEWAGE DISPOSAL WORK
Date -7 a 7 7 -~ )S
Building Permit No. 1 '�
A 1M e-D% ..✓_
Property Address :3 L4 Lt i�3 i,L'-'•Yo,ti. �_
Kind of Building
SSTS Installer License # �.
Septic Tanks
Material C' v'wl�-Number of Tanks
Size rr
Drain Field;
Total length of lines (y 1 Number of lines
Type of soil _1g �— Percolation Test _LsS D E5
Width of trench Type of filter material C-
1
Size of Rock Bed _L&)4 (b Size of Absorption Area
Draw detailed diagram with measurements indicating distances to septic tank risers from a
ran wins ndnf �.4winfrs
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