HomeMy WebLinkAbout455 Sussex Lane - Septic ComplianceMINNESOTA POLLUTION Compliance inspection report form
CONTROL AGENCY r 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.usisitesidefaultifiiesiwg-w-wists4-3,la.pdf.
Property information Local tracking number:
Parcel ID# or Sec/Twp/Range: 0411723320011 Reason for Inspection Property Transfer
Local regulatory authority info: City Of Orono, (95249-4600
Property address: 455 Sussex Lane, Orono
Owner/representative: Bruce &Dale Crawford Owner's phone: 952-249-0603
Brief system description: 2-1300-gallon septic tanks, 1-1300-gallon lift station and 620 Square feet Rock bed
System status
System status on date (mm/dd/yyyy): 7/5/2025
® 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.)
*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 1.0 feet of sand found under the south rock bed.
TBM: Top of the lift station manhole cover. ELV.- 100.0
Included are the original design 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 &son percolation Testing Certification number: C1255
Inspector signature: Joseph J. OlLicense 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: 455 Sussex Lane, Orono _
Business Name: Rusty Olson Soil & percolation Testing
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 1El 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 safety._
Describe verification methods and results:
Visual. Nothing was found
Date: 7/5/2025
Attached supporting documentation:
❑ Other:
® Not applicable
2. Tank integrity — Compliance component #2 of 5
Compliance criteria:
System consists of a seepage pit, rO Yes' ® No
cesspool, drywell, leaching pit, f
or other pit?
Sewage tank(s) leak below their ❑ Yes` ® No
designed operating depth?
If yes, which sewage tank(s) leaks
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 6/16/2025
(mm/ddiyyyy): (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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Property Address: 455 Sussex Lane, Orono
Business Name: Rusty Olson Soil & percolation Testing Date: 7/5/2025
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 Id - System is failing to protect groundwater.
Describe verification methods and results:
Visual. Nothing was found
Attached supporting documentation: E 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: 455 Sussex Lane, Orono
Business Name: Rusty Olson Soil &Percolation Testing
S. Soil separation — Compliance component #5 of 5
Date of installation 9/14/2000 ❑ Unknown
(mm/dd/yyyy) `---
Shoreland/Wellhead 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 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)
Drainfield meets the designed vertical
separation distance from periodically f
saturated soil or bedrock.
*Any "no" answer above indicates the system is
failing to protect groundwater.
Describe verification methods and results:
Date: 7/5/2025
Attached supporting documentation:
® Soil observation logs completed for the report
❑ Two previous verifications of required vertical separation
❑ Not applicable (No soil treatment area)
U
Indicate depths or elevations
A. Bottom of distribution media 1 103.0
B. Periodically saturated soil/bedrock
C. System separation _
D. Reauired compliance separation*
100.2
2.8
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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Tank Report
Elmer .1. Peterson Co.
5921 Dague Ave.
Delano, MN 55328
Phone 763-972-2420
Fax 763-9 , 2-7217
INZPCA License# 219
Bruce or Dale Crawford
455 Sussex Lane
Orono, MN
952-249-0603
Baffles: r1\4 / OFF
3-1 -300 Galion Tanks
"Tank Capacity:
# of Tanks: 3
"Type of'I'anks: _
Gallons Pui pcd:
Concrete
3000
Manholes to Grade: i07E--
/ NO
Com111ents:
Date: June 16, 2025
On June 16, 2025. Elmer J. Peterson Co. pumped tanks. No cracks or water leaking in tanks at the tinit of
pumpinI.
1\O`l'E: This is only a tank report. This is not a compliance inspection for point of sale nor does it
replace a compliance inspection.
MINNESOTA POLLUTION Sewage tank integrity assessment form
CONTROL AGENCY
520 Lafayette Road North Subsurface Sewage
St. Paul, MN 55155-4194 Treatment Systems (SETS) 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.nin,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 - Existing system (wq-wwists4-31 b). This form can be found on
the MPCA website at https://www.pca.state,mn.us/water/inspections.
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 Bruce or Dale Crawford
Property address: 455 Sussex Lane Orono, MN
Local Regulatory Authority: Parcel ID:
System status
System status on date (mm/dd/yyyy): 6/16/2025
® Certificate 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 ❑ Yes- ® 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- ® 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 Braegelmann Date (mm/dd/yyyy): 6/16/2025
(This document has been electronically signed.)
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wq-wwists4-91 • 5110121 Page 1 of 1
Soil Observation Log
www.SepticResource.com vers 12.4
Owner Information
Property Owner / project: Bruce & Dale Crawford Date 6/14/2025
Property Address / PID: 455 Sussex Lane
Soil Survey Information ❑ refer to attached soil survey
Parent matl's: Cl Till ❑ Outwash ❑ Lacustrine ❑ Alluvium ❑ Organic ❑ Bedrock
landscape position: ❑ Summit ❑ Shoulder (] Side slope ❑ Toe slope
soil survey map units: L37B slope % direction -
Soil Log #1
M Boring ❑ Pit Elevation 102.0 Depth to SHWT 22 Inches
Depth (in) Texture fragment % matrix color redox color consistence grade shape
0-12
Loam
<35
10yr3/1
Friable
Strong
Blocky
12-22
Clay Loam
<35
10yr5/4
Friable
Strong
Blocky
22-30
Clay Loam
<35
10yr5/4
IOy4/8,1-6/l0y
Firm
Strong
Blocky
<35
loose
loose
single grain
35 - 50
friable
weak
granular blocky
firm
moderate
prismatic platy
>50
rigid
strong
massive
<35
loose
loose
single gain
35-50
friable
weak
granular blocky
firm
moderate
prismatic platy
>50
rigid
strong
massive
Comments: TBM: Top of the lift station manhole cover. Elv.-100.0
y 5�5
A a
C p
Fu �,Rt
5�f�=
ROIA,m p
P
TyP6-z
Neil
L-13
CERTILFIC.ATION # 00527 `Logs of Soil Borings
Location or Project Wildman Property, Lot 6, Fox Bend, Orono
Borings made by S-P Testing, Inc. Steve Schirmers Date 6-27-89
Classifiction System:-AASHU ; USDA-SCS X I Unified ; Other
Auger used (check two) : Hand X or Power , Flight_.____, or Bucket X
Depth,
Boring number_,, 5
Depth,
Boring number 6
in
in
feet
Surface elevation 985.7
feet
Surface elevation 985.6
0
0 -
Topsoil dark brown loam
Topsoil dark brown
1 _
loam
1 -
Brown loam
2 -
6" - 21-MOTTLING
2' 4'-MOTTLLING
0 - 2-1/2-1
'
3
Rusty olive brown
Olive brown loam
'
3 -
2-1 2' - .31211
-
loam
4 _
Rusty olive brown
4 _
2' - 4'
loam
Rusty gray loam
5 -
5 -
6_
3 1'2" - 61.
6_
41 _ 6
7 -
7 -
8 -
8 -
End of boring at _61 _ feet,
Standing water table:
present at feet of -depth,
hours efter boring.
Not present in hole X
Mottled soil:
Observed at2'-4" ., f*et-. of depth.
Not present in hole
Comments:
End of boring at 6' feet.
Standing water table:
present at feet of depth,
hours after boring.
Not present in hole X ,
Mottled soil:
Observed at 2' feet of depth.
.Not present in hole
Comments:
L-13
•CERTE FICA.TION # 00627 'Logs of -Soil Borings
Locattion or Project Wildman Property, Lot 6, Fox Bend, Orono
Borings made byPTesting, Inca Steve Schirmers Date.6-2?-89
Classifiction System: AASHU_; .USDA-SCS ,X; Unified ; Other
Auger used (check two): Hand X , or Power , Flight_____, or Bucket X
Depth, Boring number 3 Depth, Boring number 4
in in
feet Surface elevation 983.3 feet Surface elevation- 984-.2
00-
Topsoil dark brown Topsoil.dark brown loam
loam 0 - 10"
l fl - 11 1 - Brown loam
Brown loam
1' - .1- 1 2' -MOTTLING 10" - 1' 8"-MOTTLING
2 ..- 2
Rusty olive brown Rusty olive brown
loam loam
3 - 3 -
4 1-1/21 4' 4 -
HIT ROCK
5
6 - r�.
i;
End of boring at .4' feet.
Standing water table:
present at feet of�*depth,
hours of�er boring.
Not present• in hole' X
Mottled soil:
Observed at 1-1/ 2'
--=—. feet•. of depth.
Not present in hole
Comments:
5 -
1'8" - 4'
Rusty gray loam
6 - 1 41 - 61
7 -
8 -
I ._
End of boring at 6' feet.
Standing water table:
present at feet of depth,
hours after boring.
Not present in hole_ X
Mottled soil:
Observed at 11811 feet of depth.
.Not present in hole
Comments:
v
u
0
Q
41
v
(mo
4
41
ON
td
CD
V