HomeMy WebLinkAbout2625 Fox Street - Septic ComplianceMINNESOTA 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/files/wq-wwists4-31a.pdf.
Property information Local trackina number:
Parcel ID# or Sec/Twp/Range: 3311823440039 Reason for Inspection Propery Transfer
Local regulatory authority info: City of Orono
Property address: 2625 Fox Street
Owner/representative: Nate_ Wasgatt (Son) _ _ Owner's phone: 952-451-9017
Brief system description: Approximately 2-1000-gallon septic tanks and 840 square feet of Trench system with a curtain drain per city
records.
System status
System status on date (mm/dd/yyyy): 10/25/2025
❑ 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. 7080.9500 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 existing system has a curtain drain with no monitoring.
Ground at the lowest trench is at Elv.-90.0 Bottom of the rock in the lowest trench is at Elv.-87.8 Redox found at Elv.-87.5.
TBM: Top of the existing well. ELV.-100.0
The outlet sides of both tanks are rotten. This could cause the tanks to cave in. 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, 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.
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):
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 1 of 4
Property Address: 2625 Fox Street
Business Name: Rusty Olson Soil & percolation Testing Date: 10/25/2025
1. Impact on public health — Compliance component #1 of 5
Compliance criteria:
System discharges sewage to the 1[:]Yes-* ®No
ground surface
System discharges sewage to drain ❑ Yes' ® No
tile or surface waters.
System causes sewage backup into ❑ Yes* ® No
dwellipg orestablishment.
Any "yes" answer above indicates the system is an
imminent threat topublic health and safeW.
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 pit?
Sewage tank(s) leak below their ❑ Yes' ® No
designed operating depth?
If yes, which sewage tank(S)_Ieaks:
Any "yes" answer above indicates the system
is failing 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 10/712025
(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:
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 2 of 4
Property Address: 2625 Fox Street
Business Name: Rusty Olson Soil & percolation Testing Date: 10/25/2025
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? 0 Yes ❑ No ❑ Unknown
*Yes to sa 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:
The outlet side walls are rotten. This could cause the tanks to cave in. See tank report..
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 Available in alternative formats
wq-wwists4-31b • 412812021 Page 3 of 4
Property Address: 2625 Fox Street
Business Name: Rusty Olson Soil & percolation Testier__
S. Soil separation — Compliance component #5 of 5
Date of installation 7/21/1993 ❑ Unknown
(mm/dd/yyyy)
Shoreland/Welihead 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 I ❑ 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 /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) j
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:
Soil borings.
Date: 10/25/2025
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 87.7 _
B. Periodically aturated soil/bedrock 87.5
C. _System separation 0.2
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.
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
I)ate: October 7, 2025
hllner .I. I'ete►:sou Go.
5921 I)ague ve.
Delano, MN 55.`3,28
Phone ; 6 1-9 ;1-1 20
Fa x , 63-972-711 ;
INI1)(' 1 license# 219
David Peterson
2625 Fox Street
Orono, MN
952-451-9017 Nate
Baffles: ON I OFF
"Tank Capacity.1-1000 Gallon Tanks Per City Records
# of "Tanks: 2
"I'ype of 'Tank~: Concrete
Gallons I'urnpecl:
2000
Manholes to Grade: h.S� / NO
('ominen ts:
On October 7, 2025, Elmer J. Peterson Co. pumped tanks. Outlet sides of both tanks are rotten.
N01'E-: This is only a tank report. This is not a compliance inspection fir point of' sale nor does it
replace a compliance inspection.
MINNESOTA POLLUTION SewagQe tank integrityassessment form
CONTROL AGENCY b
520 Lafayette Road North Subsurface Sewage
St. 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_///www.pca state,mn.us/water/inspections.
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 - Existin-qs1rstem Lwg=wwists4-31b). This form can be found on
the MPCA website at httpsl/www.pca.state.inn.us/water/ins 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 David Peterson
Property address: 2625 Fox Street Orono, MN
Local Regulatory Authority: _ Parcel ID:
System status
System status on date (mm/dd/yyyy): 10/7/2025
❑ Certificate of sewage tank compliance 0 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 CZ No
Groundwater."
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 2) No
Public Health or Safety."
Any "yes" answer above indicates sewage tank non-compliance.
Company information
Company name- Elmer J. Peterson Co
Business license number: 219
Designated Certified Individual (DCI) information
Print name: James L Braegelmann
Certification number:
I 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 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 Braegselmalec
nn _ _ _ Date (mm/dd/yyyy):_ 10/7/2025
(This document habeen etronically signed.)
www.pca.state.mn.us 651-296-6300 800-657-3864 Use your preferred relay service Available in alternative formats
wq-wwists4-91 • 5110121 Page 1 of 1
Property Owner / project:
Property Address / PID:
Soil Observation Log
David Peterson
2625 Fox Street
Owner Information
www.SepticResource.com vers 12.4
Date 10/24/2025
Soil Survey Information ❑ refer to attached soil survey
Parent matl's: [a Till ❑ Outwash ❑ Lacustrine ❑ Alluvium ❑ Organic ❑ Bedrock
landscape position: ❑ Summit ❑ Shoulder p Side slope ❑ Toe slope
soil survey map units: L22D2 slope % direction- Linear
Soil Log #1
0 Boring ❑ Pit Elevation 90.0 Depth to SHWT 30 Inches
Depth (in) Texture fragment % matrix color redox color consistence grade shape
0-10
Loam
<35
1Oyr3/1
Friable
Strong
Blocky
10-18
Clay Loam
<35
1Oyr4/3
Friable
Strong
Blocky
18-30
Clay Loam
<35
1 Oyr5/4
Friable
Strong
Blocky
30-36
Clay Loam
<35
10yr5/4
10y4/8,1-6/1Oy
Friable
Strong
Blocky
<35
loose
loose
single grain
- 50
friable
weak
granular blocky35
firm
moderate
prismatic platy
>50
rigid
strong
massive
Comments:
Ink
--
tir
— 34
�243
opt-
-
-- z 0
as 16
I
"
ri bt� 1
3616
qa� --
—
i
I 2
q
`'6 -2
--
--
1
61,6
6q ct
�
•
1 I 1
i S1
/ 6L
u► Ok
�' !
4
� �
C
A}
O A
Cbib
•�
A v
N
t
¢ C
A 1
r
•t
t a
1 \
ti
SEPTIC SYSTEM INVENTORY
Site Address: 2626 Fox St
Owner Name: David & E Peterson
Owner Address: 2625 Fox St Wayzata MN 55391-
PID 04-117-23.43-0009
BuildinQTvpe: residence Installer: Ritter Exc.
Date of Permit: 2 /26/93
Svstem Tvpe: shallow trench w/curtain BR's Designed for 3
In Musa?: Yes Shoreland?: No
SEPTIC TANKS:
Material: precast concrete Capacity: 1000,1000 Tank Filter:
DRAINFIELD:
Treatment Area: 840 Soil Boring: yes DF Ht above Wt: 1 (see file)
WELL DATA
Setbacks - Well Tanks: 75 Well DF: 75 Report In File: Depth: 176
INSPECTION RECORDS
Date Notes
9/1/2006 OK
8/8/2002 no surfacing,pump tanks
5/9/2000 no surfacing
9/15/1997 no surfacing -pump tanks
11/10/1994 no surfacing
7/21/1993 replacement installation
7/21/1993 replacement installation
PUMPOUT RECORDS
Date GallonsOfLiquid
8/10/2016
2000
8/15/2013
2000
8/20/2010
2000
8/8/2007
2000
1/27/2000
2000
1/27/2000
2000