HomeMy WebLinkAbout820 Old Crystal Bay Road South - Septic ComplianceMINNESOTA POLLUTION Compliance ins ection 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/wg-wwists4-31a.pdf.
Property information Local trackina number:
Parcel ID# or Sec/Twp/Range: 0411723430008 Reason for Inspection Propery Transfer
Local regulatory authority info: City of Orono
_ --- -
Property address: 820 Old Crystal Bay Road S.
Owner/representative: Hans Frees _ Owner's phone: 763-286-2429
Brief system description: Approximately 2-1000-gallon septic tanks, 1-1000-gallon lift station and 550 square feet of mound rock bed
per city records.
System status
System status on date (mm/dd/yyyy): 9/22/2025
® 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 (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 was design with 1.0 feet of sand under the rock bed.
TBM- Top of the lift station manhole cover. ELV.-100.0
Included are two sets of soil borings
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 & � rcolation 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: 820 Old Crystal Bay Road S.
Business Name: Rusty Olson Soil 8 percolation Testin
1. Impact on public health — Compliance component #1 of 5
Compliance criteria:
System discharges sewage to the I ❑ Yes* ® No
ground surface
System discharges sewage to drain I ❑ Yes* ® No
tile or surface waters.
System causes sewage backup into ❑ Yes" ®No
dwelling or establishment. I
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: 9/22/2025
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 pit?
Sewage tank(s) leak below their ❑ Yes' ® No
designed operating depth?
If yes, which sewage tanks) 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 8/13/2025
(mm/dd/yyyy): must be within three ears
(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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Property Address: 820 Old Crystal Bay Road S.
Business Name: _ Rusty Olson Soil & percolation Testing Date: 9/22/2025
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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Page 3 of 4
Property Address: 820 Old Cr�rstal Ba r_Road S.
Business Name: Rusty Olson Soil & percolation Testing -
S. Soil separation — Compliance component #5 of 5
Date of installation _5/8/1992 ❑ Unknown
(mm/d d/yyyy)
ShorelandNNelIhead protection/Food ❑ Yes ®No
beverage lodging?
Compliance criteria (select 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 ❑ Yes ❑ No
April 1, 1996, or later or for non-
performance systems located in Shore/and
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" j ❑ Yes ❑ No
systems built under pre-2008 Rules, -
Type /V 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:
Date: 9/22/2025
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
98.6
B. Periodically saturated soil/bedrock 95.6
C. System_separation 3.0
D. Required compliance separation* 2.0
*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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i INNESOTA POLLUTION Sewage tank integrity rit assessment form
CONTROL AGENCY
520 Lafayette Road North Subsurface Sewage
St. Paul, MN 55155-4194 Treatment Systems (SSTS) Program
Doc Type: ConWilarx a and Entomsment
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.gca.state.mn.us/water inspecti ns.
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 certifted professional, it becomes necessary supporting documentation to an Existing
System Compliance Inspection Report: Comoliance inspection form - Existing systgM (wq-wwists4-31 b). This form can be found on
the MPCAwebsits at httos:/iwww.2ca.state.mn.us/waterfinspections.
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 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. 7083.0730(C). 2- 100-01-->
Owner information
Owner/Representative
Property address: St 40 _fit ek C r t />< r C \
Local Regulatory Authority: ifr 0^0
System status
System status on date (mm/dd/yyyy): _C
Parcel ID:
Elbel ficate of sewage tank co(npliance ❑ Notice of sewage tank non-compliance
Compliance criteria: �,
The SSTS has a seepage pit, cesspool, dryweli, leaching pit, or other pit - `Failure to Protect [J Yes* [d, o
Groundwater."
The SSTS has a sewage tank that leaks below the designed operating depth - "Failure to Protect ❑ Yes* ErN000
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* ;;tad"
Public Health or Safety."
Any "yes" s"'17s—wvi above indicates saiw gg tank non-conatafle ca.
Company information Designated Certified individual (DCI) information
Company name: Duane's Septic Service LLC Print name: - l't c
Business license number L4286 Certification number. ($' ( %
1 personally conducted the work described above as a Designated Certified Individual of a Minnesota -licensed SSTS inspection,
maintenance, installation, or service provider Business / personally conducted the necessary procedures to assess the compllance
status of each sewage tank In this SSTS.
By typing(slgning my name below, I certify the abov statements to be true and correct, to the best of my knowledge, d that
this information can be used 1br the purpose of p s ing this : �,
Designated Certified Individual's signature: Date (mm/dd/yyyy): a�
(This n been a ec icaW signed.)
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wq-ww1sts4-91 • 5/I0/21 Page 1 of 1
SEPTIC SYSTEM INVENTORY
Site Address: 820 Old Crystal Bay Rd S PID 04-117-23-43-0008
Owner Name: Keaton & Hans Frees
Owner Address: 820 Old Crystal Bay Rd S Wayzata MN 55391-
BulldinaTvae: residence Installer: Jerry Johnson
Date of Permit: 518/92
Svstem Tvpe: mound BR's Designed for 4
In Musa?: Yes Shoreland?:
SEPTIC TANKS:
Material: precast concrete Capacity: 1000,1000,1000 Tank Filter:
DRAINFIELD:
Treatment Area: 90*39 Soil Boring: yes DF Ht above Wt: 3
WELL DATA
Setbacks - Well Tanks: 50 Well DF: 75 Report in File: Depth:
Date Notes
12/6/2010Point of sale septic certification valid until 12/06/2013
9/9/2003;no surfacing
8/28/2001 no surfacing,pump tanks
10/29/1999,code system, no surfacing
8/13/1997 no surfacing -pump tanks
5/8/1992.installation
5/8/1992 :installation
I Date GallonsOfLquid
9/16/2016 3000
5/3/2013 0
8/25/2010 2000
10/24/2007 2000
9/21/2001 2000
7/10/1998, 2000
7/10/1998 2000
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Boas of soli oonINGS
Locstion oX•
pro j t Date
Sor ings made by �_,,,...� other
• IUISII0 USIA-SCS - —'• other
Class if ication System. — or bucket �•
Auptetr used (check tvo) : {land . or Power --: flight •
' 0�1•tl�. t:or 1 nP numhe r
borinR nuvber --- -- in
.Depths surface elevation
in Surface elevation feet
feet n
0
2 f..
3 r
4
i
8
t
End of boring at
2 feet.
Standing aster tablet
ffet of depths
Present at --w -----
hour$ after borinR.
Not present in borinR
hole _,,,,�. •
Mottled soil s f I l�
At of depth.
Observed at Not p --
resent to borinR hole
10 --
End of boring at
/l feet.
Standing water tables
feet of deptf"•
Present tit ________.—
hours after !►oring•
_._.-•
Not present in borinR hole
Mottled soils f1
Observed at 4t: of depth.
Not ptreeent !n bnclh► "Olen
•
OF SOIL nonINGS
_._.. ,. LOGS
of Pl°1 hate
Location
` �- � other ._..
got loge made by Un 1 t led _____
gym; &AS11h �.._._ USDA-SCS �� t i� i other
Cloeeiticstion sYat or Burke
Auer uaed (check ttio) s hand �,..� or Polder�ltpl�t
" ti�rtl� ltor i nf.pit of
.Qep
th. DorinK number 3 in SuTtece elevation
in Surface elevation teat
feet
3 --
L
6
i
a4
End o t bor intt at
standing ,"atet tablet
?resent • t
feet of depth.
_-----
hours after boring.
pot present in boring
hole_•
Nottled roils
at��A4'feet of depth.
Observed
,lot present in borint hole
CA
10 --
End of boring at A�feet•
Standing Voter tablet
Present at ___ feet of depcl' •
__.__.._
hours after horinit.
-------------
Nat pr+tsent in borin?. hole
Mottled eotlt
1l
th.
Observed at 3 _ t t of d�eP
Not present in 'hor InP lini! �_•
.
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S-P TESTING, INC. moms. soh - Mom► catNo. 627
951 Katydid Lane NE - St. Michael, MN 55376 - (783) 497-36M
FAX - (763) 497-5011
State License E394
Bridget Hust
820 S. Old Crystal Bay Rd.
Orono, Henn. Co., MN
Borings completed on 11-1-2010, with a hand bucket auger.
RGEM NUMBER 1- Elev.98.9 - MOTTLED SOIL AT 20" Into the original soil - no standing
water present In goring.
0 - 20" FIN soli loam, day loam & sand
20" - 34" Original soN dark brown loam 10YR 3/3
34- - 40" Gray brown day barn 10YR 512
40" - 48" Gray brown day loam 10YR 6/2 - distinct mottles, 10YR 711,10YR a%
Boma - Elev.97.0 - MOTTLED SOIL AT 26" - no standing water present in the
boring.
0 -
16"
Topsoil dark brown loam 10YR 313
16" -
24"
Dark gray brown loom 10YR 4/2
24" -
28-
Gray brown day l>em 10YR W
28" -
32"
Gray brawn day loam 10YR 612 - distinct mottles 10YR 711,10YR 618
32" -
42"
Pale brown day loam 10YR 6/3 - distinct mottles 10YR 7/1,10YR 6/8
Elev.99.3 - through the mound.
0 - 16" Fill soil loam S day loam
16" - 30" Fill soli medium sand
30" - 36" Original soil dark brown loom 10YR 313
SORM NUMBER 4- Elev.99.7 - through the mound.
0 - 20" FBI soil loam & day loom
20" - 32" FIN soli medium sand
32" - 38" Original soft dark brown loam 10YR 3/3
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