HomeMy WebLinkAbout4645 Saint Andrew Street - Septic ComplianceMINNESOTA POLLUTION Compliance inspection report form
CONTROL AGENCY 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 https://www.pca.state.mn.us/sites/default/files/wq-wwists4-31a.pdf.
Property information Local tracking number
Parcel ID# or Sec/Twp/Range: 0611723310011 Reason for Inspection Property Transfer
Local regulatory authority info: City Of Orono, (952) 249-4600
Property address: 4645 Saint Andrews Street, Orono
Owner/representative: Holly & Chet Broman Owner's phone: 612-462-3285
Brief system description: 2-1300-gallon combination septic tanks, 1-1300-gallon lift station and 630 Square feet Rock bed per city
records.
System status
System status on date (mm/dd/yyyy): 9/18/2025
® 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.)
❑ 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
*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 1.8 feet of sand under the rock bed.
The soils were verified by the city inspector.
TBM: Bottom of the rock bed. Elv.-100.0
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 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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Property Address: 4645 Saint Andrews Street, Orono
Business Name: Rusty Olson Soil & percolation Testing _ _ Date: 9/18/2025
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
the 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 ublic health and safes.
Describe verification methods and results:
Visual. Nothing was found
Attached supporting documentation:
❑ Other:
® Not applicable
2. Tank integrity — Compliance component #2 of 5
Compliance 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 tanker leaks:
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 9/16/2025
(mm/dd/yyyy): (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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wq-wwists4-31b 9 412812021 Page 2 of 4
Property Address: 4645 Saint Andrews Street, Orono _
Business Name: Rusty Olson Soil & percolation Testing Date: 9/18/2025
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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Property Address: 4645 Saint Andrews Street, Orono
Business Name: Rusty Olson Soil & percolation Testing__
S. Soil separation — Compliance component #5 of 5
Date of installation 5/20/2016 ❑ Unknown
(mmlddlyyyy)
ShorelandNVelihead protection/Food ❑ Yes ® No
beverage lodging?
Compliance_ criterialselect 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
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.*
Date: 9/18/2025
Attached supporting documentation:
❑ Soil observation logs completed for the report
® Two previous verifications of required vertical separation
❑ Not applicable (No soil treatment area)
® Yes [:]No Indicate depths or elevations
5c. "Experimental, "Other", or "Performance" I ❑ 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 <_
2,500 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:
A. Bottom of distribution media
100.0
B. Periodically saturated soil/bedrock 1 97.0
C. S�rstem 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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MMINNESOTA POLLUTION Sewage tank inte rity assessment form
: CONTROL AGENCY
520 Lafayette Road North Subsurface Sewage
St. Paul, MN 55155-4194 Treatment Systems (SSTS) Program
Doc Type: Compliance and Enfoicement
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:
httrs://wow. Dca. sta#e. m n. us/water/;nspecii qns.
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 irr rmation 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 lns2gcoga form - Existing system (wo-wwists4-31 b). This form can be found on
the MPCA website at https://-w--ww-.Dca.state.mn.us/wat rfintions.
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 Nnat 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
r. Owner/Representative 6rc �+^•�
Property address: Yto 4T JVr Arc r...s 3`T,
Loot Regulatory Authority. o rwt 0 Parcel ID:
System status
System status on date (mm/ddfyyyy): / 3
�ertiflcate of sewage tank co pliance ❑ Notice of sewage tank non-compliance
Compliance criteria:
The SSTS has a seepage pit, cesspool, drywell, leaching pit, or other pit - "Failure to Protect ❑ Yes. is 0
Groundwater."
The SSTS has a sewage tank that leaks below the designed operating depth - "Failure to Protect ❑ Yes- 2-Ko'_
Groundwater."
The SSTS presents a threat to public safety by reason of structurally unsound (damaged, cracked,
or weak) maintenance hole covers) or lids or any other unsafe condition - "Imminent Threat to ❑Yes' ja-i'Oo�
Public Health or Safety."
Any "yes" answer above indicates sewage tank non-compliance.
Company information Designated Certified Individual (DCQ information
Company name: Duane's Septic Service LLC Print name: C �1? Z l l'�► f'�c
Business license number 14286 Certification number.
I personally conducted the work described above as a Designated Certified Individual of a Minn t&-&tensed 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 above statements to be true and correct, to the best of my knowledge, and that
this inibnnatfon can be used for the pu►pose of p ng this form.
7
Designated Certified Individual's signature: Date (mm/dd/yyyy):
(Th has been a 6dmnloWly signed.)
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Pope 1 of 1
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTICE SCHEDULED
PERMIT NO. COMPLETED � •
ADDRESS
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OWNER TELEPHONE NO.
CONTRACTOR
DESCRIPTION
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❑ COMPLAINT
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❑ STOP ORDER POSTED. CALL INSPECTOR
❑ INSPECTION REQUIRED. CALL TO ARRANGE ACCESS.
Can for the next Inspection 24 hours in adrranoe. (952) 249-4600
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Logs of Soil Borings
License #810
Location or Project: Lot 14, Blk 3
Borings made by: Rusty Olson's Soil and Perc testing 6/1/2014
Classification System: AASHO_______; USDS- USDS4CS X UnWied.; Other
Auger used icheck two): Hand X , or Power , Flight, Bucket or Probe )
Boring Nur7ba: _1 Surface elevation
_964.7
Mottled Soil at 1.7 feet
0"-8" Dark brown loam 1 Oyr3/2
H2O present at X
8"-20" Bros ;�t loam. 10yr414
20"-26" Rusty brown loam 10yr5/4
Boring Number _2__-, Surface elevation
_„_964.7
Mottled Soil at 2.3 feet
0"-18" Dark brov/n loam 10yr3/2
H2O present at X
18"-28" Grown loam 10yr4/4
_
28"-38" Rusty brown loam 10yr5/4
Boring Number 3y Surface elevation
�959.2_
Mottled Soil at 1.2 feet
0"-14" Dark brown loam 10yr3/2
H2O present at� �
14"-20" Rusty brown loam 10yr4/3
Boring Number 4 Surface elevation ,,,_959.2
Mottled Soil at 1. = feet
0"-1 2" Dark brown loam 10yr3/2
H2O present at X
12"-20" Brown loam 10yr4/4
20"-28" Rusty brown loam 10yr4/4
Boring Number 5 Surface elevation ,.,_964.7
Mottled Soil at 2.2 feet
0"-12" Dark brown loam 10yr3/2
H2O present at X___
12"-16" Brown Icam 1 Cyr4/4
16"-26" Brown !parr. 10yr5/4
26"-30" Rusty brown loam 10yr5/4
1Boring NNmbet 6_ Surface elevation ,_,957.4
Mottled Soil at feet
0"-12" Dark br,,.n i loam, 10yr3/1
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H2O present at X
12%2G" Rusty csc k brovin loam 10yr3/2
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Septic Tanks 1.301 ' ' Pump Tank — 1 A r
System Type fl II 0 III 0 ,Mound 0 Trenches 0 Pressure Bed 0 Other
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