HomeMy WebLinkAbout12.21.24 septic certMMINNESOTA POLLUTION
it CONTROL AGENCY p p p 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 forth are located on the Minnesota Pollution
Control Agency (MPCA) website at hftps://www.oca.state.mn.us/sites/defaulUfiles/wq-wwists4-31a.pdf.
Property information Local tracking number
Parcel ID# or Sec/Twp/Range: 1511723210005 Reason for Inspection Property Transfer
Local regulatory authority info: City Of Orono, (952) 249-4600
Property address: 2070 Shoreline Drive Orono
Owner/representative: Marc Hirschmann Owner's phone: 561-926-4986
Brief system description: 1-1000-gallon, 1-1250-galion septic tanks, 1-1250-gallon lift station and 630 Square feet Rock bed
System status
System status on date (mm/dd/yyyy): 12/21/2024
® Compliant —Certificate of compliance" ❑ Noncompliant— Notice of noncompliance
(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.)
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
•Note. Compliance indicates conformance with Minn. of this notice or within a shorter period if required by local ordinance or
R. 7080.1500 as of system status date above and does not under section 145A.04 subdivision 8.
guarantee future performance.
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 1.0 feet of sand under the rock bed.
The soils were verified by the city inspector.
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 8 percolation Testing Certification number. C1255.
Inspector signature: Joseph J. Olson License number: L810
(This document has been electronically signed) Phone: 763498-8779
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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wq-wwists4-33b • 4/28/2021 Page 1 of 4
M�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.oca.state.mn.us/sites/defaulUfiles/w0-wwists4-31a.pdf.
Property information Local tracking number
Parcel ID# or Secfrwp/Range: 1511723210005 Reason for Inspection Property Transfer
Local regulatory authority info: City Of Orono (952) 249-4600
Property address: 2070 Shoreline Drive, Orono
Owner/representative: Marc Hirschmann Owner's phone: 561-926-4986
Brief system description: 1-1000-gallon, 1-1250-gallon septic tanks, 1-1250-gallon lift station and 630 Square feet Rock bed
System status
System status on date (mm/dd/yyyy): 12/21/2024
® Compliant— Certificate of compliance" ❑ Noncompliant — Notice of noncompliance
(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.
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 permittmonitoring plan requirements (Compliance component #4) — Noncompliant - local ordinance applies
Comments or recommendations
The system is designed for a five bedroom house.
There is 1.0 feet of sand under the rock bed.
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, 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 8 percolation Testing Certification number: C1255
Inspector signature: Joseph J. Olson License number: L810
(This document has been electronically signed) 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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wq-wwists4-31b • 412812021 Page 1 of 4
Property Address: 2070 Shoreline Drive, Orono
Business Name: Rusty Olson Soil & percolation Testing
1. Impact on public health — Compliance component #1 of 5
criteria:
System discharges sewage to the ❑ Yes* ® No
ground surface
discharges sewage to drain I ❑ Yes* ® No
System causes sewage backup into ❑ Yes' ® No
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: 12/21/2024
Attached supporting documentation:
❑ Other:
® Not applicable
2. Tank integrity — Compliance component #2 of 5
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 tank(s) leaks: I
Any "yes" answer above 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 11/26/2024
(mm/dd/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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wq-wwists4-31b • 412812021 Page 2 of
Property Address: 2070 Shoreline Drive, Orono
Business Name: Rusty Olson Soil & percolation Testing Date: 12/21/2024
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 property 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: 2070 Shoreline Drive, Orono
Business Name: Rusty Olson Soil & percolation Testing Date: 12/21/2024
5. Soil separation —Compliance component #5 of 5
Date of installation 5/16/2018 ❑ Unknown
(mmlft yyyy)
Shoreland/Wel l head protection/Food
beverage lodging?
5a. For systems built prior to April 1, 1996, 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
5b. Non-performance systems built
April1, 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.*
❑ Yes ❑ No*
® Yes ❑ No*
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" answer above indicates the system is
failing to protect groundwater.
Describe verification methods and results:
Attached supporting documentation:
❑ Soil observation logs completed for the report
❑ Two previous verifications of required vertical separation
❑ Not applicable (No soil treatment area)
® Soils verified by the city inspector.
Indicate depths or elevations
A. Bottom of distribution media
98.7
B. Periodically saturated soil/bedrock
95.7
C. System separation
3.0
D. Required compliance separation*
2.56
*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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wq-wwists4-31b • 4/28/2021 Page 4 of 4
MiNNESOTA POLLUTION CONTROL AGENCY Sewage tank integrity assessment form
520 Lafayette Road North Subsurface Sewage
St. Paul, MN 55155-4194 Treatment Systems (SOTS) Program
Doc Type: Compliance and Enfomernent
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 SM Inspection report only a tank Integrity, aassaamsnt, and may only certify sewage tank compliance status
when entirely completed and signed by a qualified prvtsadonal. SSTS compliance Inspection report forma can be found at
httos:/Maww.Dca. state.mn.us/waterAnsoacdons.
km4ra:tlons: This forth may be completed, and signed, by a Designated Certified Individual (DCI) of a licensed SSTS Inspection,
makdernence, insfelletion, or service provider business who personally conducts the necessary procedures to assess the compliance
status of each sewage tank In the system Only a Hosirsed maintenance business is authorized to pump the tank for assessment. A
copy of this hilomallm shouts be eubmNled to the system owner and be rnai nfalned bythe licensed SSTS business for a period of
Ave (5) yams ftn the saeeeernent data.
yiharn fhla form is signed by a qualified certlged professbnel, it becomes necessary supporting documentation to an 6dsting
System Compliance Inspection Report: Compliance in agection form - Facistinc system (wc-wwists4-31 b). This form can be found on
tins MPCA wabefta at htMs://www Dca.state.mn.ushwater/Insrections.
The Information and owWW statement on this form is required when existing septic tank compliance statue is determined by an
individual olhrr than to SETS Inspector that subNts an inspection report. This form represents a third party assessment of SSTS
component compliance and fs allowable under Minn. R. 7082.0700, subp. 4(B)(1). This forth 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 owners 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. 7088.0730(C).
Owner information
Ownerillepresentative _I
Property address: _
Local Regulatory Authority:
system status
System statue on date (mm/ddlyyyy): 1J 2-tee ! u Lc{
Grdncats of sewage tank compliance ❑ Notice of sewage tank non-compliance
Compliance criteria:
The SSTS has a seepage pit, cesspool, dryereA, load" pit, or otter pit - •'allure to Protect � ❑ Yes' P(No
Groundwati A
The SETS has a sewage tank that leaks below the designed operating depth -"Failure to Protect ❑ Yes' ?�No
Groundwater."
The SSTS presents a threat to public esfety by reason of structurally unsound (damaged, cracked,
or w�lc) maintenance hole oover(s) or tide or any other unsafe condition - Imminent Threat to ❑Yes ps No
Public Nnraltin or safety." r
Any yes" answer above indicates sewage tank non-compliance.
Company information Designated Certified individual (DCI) Information
Company name: Duane% Septic Service LLC Print name: lei cuel h � �r4,t e'
Business }lease number. L4286 Ceriftafion number. lg (o3
1 personalty conducted the work described above as a Dealiyrated Certified Indhddual of a Mfnnesots4ca rsed SSTS kwectian,
maintenance, dnstaoaborr, oraervke pmvlder Suainess. / personally conducted the necessary procedures to assess the compliance
status of each sewage tank in this SSTS.
By typbapMgnbug my name below, I certify the above statements to be true and correct to the best of my knowledge, and that
dds kibrmadon can be used Ibr the purpose afPro�rea%slr4lks karm.
Designated Certified Indlvkluars slgrsiure: Date (mmlddlyyyy):
{TMa dowrnerrt hoe been efactradcally signed.
www.peaslatemnus 651-I9G68ap BW57-a664 Use your preferred relay service Available inauemameroman
wq'Mw6tW-W • 41101 Pope t oil
Letter View
file:///C:/Users/rusty/Downloads/Inspection%20 Report°/o20lndividual...
From: rpeitso@ci.orono.mn.us
Sent: 05/16/2018 - 10:15 AM
To: chad@patnodebrothers.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
2070 Shoreline Dr
Permit Number: 2017-01394
Site Address: 2070 Shoreline Dr, , MN 55364
Property Owner:
Description: SEPT RESI SEPN
Inspection Date: 05/16/2018
Inspection Type: Septic Tanks
Inspection Results: Work Satisfactory: Proceed
Inspection Status: General Comment
1. 1,000 R 1,250 Septic 1,250 Pump Tank appear stepped looks good OK to backfill
Sincerely,
Roger Peitso V
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!
I of 1 12/21/2024, 10:08 AM
PERMIT TYPE AND FEES
New or Replacement System $400.00
Repair Existing System 100.00
(Tanks or Drainfield)
�c
Total $
The undersigned hereby applies to the City of Orono for issuance of a septic system
installation permit, agrees to do all the work in strict accordance with ordinances of the City
and regulations of the State of Minnesota and certifies that all statements made on this
application are complete, true and correct.
Signature of Applicant Date: /Z' -4 U
MPCA License No.:
Staff Review: ept ❑ Denied
Reviewer: �i„ Date: 'D
Reason for Denial:
Comments (to be printed on inspection card):
GENERAL INSTRUCTIONS
1. Applications for septic system permits may be mailed or submitted in person at the City
offices; however, permits will not be mailed out. The permit must be picked up in person at
the City offices and work must not begin unless the permit card is on the job site.
*** DO NOT MAIL PAYMENT WITH THIS APPLICATION ***
2. Permits will be only issued to contractors holding a Minnesota Pollution Control Agency
(MPCA) Septic System Installers License.
3. All work must be done in accordance with the approved septic system design.
4. The following inspections will be required for all septic systems.
A. Tank installation prior to covering.
B. Drainfield trench installation prior to covering. For mounds, inspection is required after
rough up, but prior to sand placement (sand must be jar tested for silt content) and
again during pressure distribution piping installation in the rock bed.
C. Final inspection to verify final cover depths and to verify that all pump station (where
required) components are functional and comply with codes.
5. MPCA licensed Installers or their DRP (Designated Responsible Person) shall be present
during all inspections.
Page 2
Soil Observation Log
www.SepticResource.com vets 12.4
Owner
Property Owner / project: John Thysell Date 7/15/2017
Property Address / PID: 2070 Shoreline Drive
Soil Survey Information ❑ refer to attached soil survey
Parent matl's: O Till ❑ Outwash ❑ Lacustrine ❑ Alluvium ❑ Organic ❑ Bedrock
landscape position: ❑ Summit ❑ Shoulder O Side slope ❑ Toe slope
soil survey map units: L37B slope 8-12 % direction- Linear
Soil Log #1
p Boring ❑ Pit Elevation 101.2 Depth to SHWT 28 Inches
Depth (in) Texture fragment % matrix color redox color consistence grade shape
0-8
Topsoil
<35
10yr3/2
Loose
Loose
Single grain
8-18
Sandy Loam
<35
10yr4/3
Friable
Strong
Blocky
18-28
Clay Loam
<35
10yr5/4
Friable
Strong
Blocky
28-36
Clay Loam
<35
10yr5/4
10y4/8,1-6/10y
Firm
Strong
Blocky
<35
loose
loose
single grain
friable
weak
granular blocky
35 - 50
firm
moderate
prismatic platy
>50
rigid
strong
massive
Comments:
2070 Shoreline Drive Soil Log #2
O Boring ❑ Pit Elevation 97.7 Depth to SHWT 24 Inches
Depth (in) Texture fragment % matrix color redox color consistence grade shape
0-10
Topsoil
<35
10yr3/2
Loose
Loose
Single grain
10-18
Sandy Loam
<35
10yr4/3
Friable
Strong
Blocky
18-24
Clay Loam
<35
10yr5/4
Friable
Strong
Blocky
24-28
Clay Loam
<35
10yr5/4
IOy4/8,1-6/l0y
Firm
Strong
Blocky
2070 Shoreline Drive Soil Log #3
I] Boring ❑ Pit Elevation 101.2 Depth to SHWT 30 Inches
Depth (in) Texture fragment % matrix color redox color consistence grade shape
0-10
Topsoil
<35
10yr3/2
Loose
Loose
Single grain
10-18
Sandy Loam
<35
10yr4/4
Friable
Strong
Blocky
18-30
Clay Loam
<35
10yr5/4
Friable
Strong
Blocky
30-36
Clay Loam
<35
10yr6/4
IOy4/8,1-6/l0y
Firm
Strong
Blocky
I hereby certify this work was completed in accordance with MN 7080 and any local req's.
Rusty Olson's Soil & Perc. 810
signer Signature Company License #
2070 Shoreline Drive Soil Log #4
❑ Boring ❑ Pit Elevation 99.7 Depth to SHWT 30 Inches
Depth (in) Texture fragment % matrix color redox color consistence grade shape
0-8
Topsoil
<35
1 Oyr3/2
Loose
Loose
Single grain
8-18
Sandy Loam
<35
1Oyr4/3
Friable
Strong
Blocky
18-28
Clay Loam
<35
I Oyr5/4
Friable
Strong
Blocky
28-36
Clay Loam
<35
10yr5/4
I Oy4/8,1-6/1 Oy
Firm
Strong
Blocky
<35
loose
loose
single grain
friable
weak
granular blocky
35 - 50
firm
moderate
prismatic platy
>50
rigid
strong
massive
2070 Shoreline Drive Soil Log #5
❑ Boring ❑ Pit Elevation Depth to SHWT
Depth (in) Texture fragment % matrix color redox color consistence grade shape
<35
loose
loose
single grain
friable
weak
granular blocky
35 - 50
firm
moderate
prismatic platy
>50
rigid
strong
massive
<35
loose
loose
single grain
friable
weak
granular blocky
35 - 50
firm
moderate
prismatic platy
>50
rigid
strong
massive
<35
loose
loose
single grain
friable
weak
granular blocky
35 - 50
firm
moderate
prismatic platy
>50
rigid
strong
massive
<35
loose
loose
single grain
friable
weak
granular blocky
35 - 50
firm
moderate
prismatic platy
>50
ri id
strop
massive
<35
loose
loose
single grain
friable
weak
granular blocky
35 - 50
firm
moderate
prismatic platy
>50
ri id
strop
massive
I hereby cert fy t iswrnk was completed in accordance with MN 7080 and any local req's.
Rusty Olson's Soil & Pere. 810
esigner Signature Company License #
N ' \
scale :
Date :
1" = 50'
�\
11-23-82
Iron marker
(::;L6 16 rem(/its oil -
Certificate of Survey
for Krutzig Custom Homes
of Lot 6, Block 1, Hartwood
Hennepin County, Minnesota
THIS ITEM HAS BEEN
a MICROFILMED
/
k a /
i hereby certify that
° this is a true and cor-
rect representation of
�o. a survey of the bourdarle:
of iaot tit Block 1, Hartwood
t'ne lz)catior, of all existing
buil:inge, is any, thereon,
and the prc,p-.,sed lor�ation of a
proposed building. It does not
purport to show other improvements
or encriachments.
C°J�{ /
;ord�on R..in Re +C. 064
.and Surveyor and Planner
-,-ng Lake, Minnesota