HomeMy WebLinkAbout705 Old Long Lake Road - Septic ComplianceN TRSDTA POLLUTION
CONTRO
L OL AGENCY
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 form are located on the Minnesota Pollution
Control Agency (MPCA) webslte aP t ca.s ate mn,us!sites/default/fileslwc-wwists4 31a,gdf.
Property Information Local trackin number:
Parcel ID# or Sec/TwplRange: Reason for inspection
Local regulatory authority info:
Property address: -
Ownerlrepresentalive:. A NA5_Vp V 0 J) �4 Owner's phone:
Brief system description: '&-jriva I•01.40y-(1t1 i1000y.1 ftJwa4.(4fA%4_ ty�t MvsfsAZ�
5'�yiv� u��^i43 4 %tdt"F a0V t 'A* 'Y.r 190)S V)A Womo
System status
System status on date (mmlddlyyyy): 5�r,_a-
2 Compliant -Certificate of compliance-
(Valid for 3 years from report date unless evidence of an
imminenf threat to public health or safety requiring removal and
abatement undersection 145A.04, subdivision 8 is discovered or
a shorter time frame exists in Local Ordinance.)
❑ Noncompliant- Notice of noncompllance
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 (ITPNS) must be
'Note; Compliance Indicates conformance with Minn. upgraded, replaced, or its use discontinued within ten months ofreceipi
R. 7080.1500 as of system status date above and does not of this notice or within a shorter period if required by local ordinance or
guarantee future performance. 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
0 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
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 systam construction, possible abuse of the system,
inadequate maintenance, or future water usage.
By typing my name below, I certify the above statements to be two and cormcf, to the best ofmyknowledga, and that this information can be
used for the purpose of processing this form,
Business name: 41 '( I L' Certification number:-�
Inspector signature:
t License number:
O 1ys document has been electronically signed)
Phone;��gey�,
Necessary or locally required supporting documentation (must be attached)
[2 Soil observation logs Q System/As-Built ❑ Locally required forms Q Tank Integrity Assessment ❑ Operating Permit
Q Other information (list): Sj�� it Go-vei¢
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Property Address: 9 Q 0'1.q V�
Business Name: . Q .('¢ W I Cr
1. Impact on public health — Compliance component #1 of 5
Comolianrp rrifnrin-
System discharges sewage to the ❑ Yes* No
ground surface
System discharges sewage to drain I] Yes- ® No
tile or Surface watarc
System causes sewage backup Into �❑ Yes* ® No
dwelling or estahlishmpnr
Any "yes" answer above indicates the system is an
imminent threat to pijhlfc health and safet .
Describe verification methods and results:
2. Tank integrity— Compliance component #2 of 5
System consists of a seepage pit,
cesspool, drywell, leaching pit,
or other it?
Sewage lank(s) leak below their
designed operating depth?
If
0 Yes' ❑ No
❑ Yes' ❑ No
Any "yes" answer above indicates the system
is failing to protect groundwater.
Describe verification methods and results:
Date:
Attached supporting documentation:
❑ Other:
❑ Not applicable
Attached supporting documentation:
* Empty tank(s) viewed by Inspector
Name of maintenance business: too
r
License number of maintenance business:_1 a a
Date of maintenance;
❑ Existing tank Integrity assessment (Attach)
Date of maintenance
(mrrVdd/yyyy), (must be within three years)
(See farm 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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Page 2 of 4
Property Address:
Business Name: c
3. Other compliance conditions — Compliance component #3 of 5
Date: .5"-q
3a. Maintenance hole covers appear to be structurally unsound (damaged, cracked, etc.), or unsecured?
❑ Yes' I!I'] No ❑ Unknown
3b. Other issues (etectrtcalhazards, 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? V1 Yes • 0No Nf A
`Yes to 3c or 3d - System Is falling to protect groundwater.
Describe verification methods and results:
Attached supporting documentation: ❑ Not applicable ❑
4. Operating permit and nitrogen BMP* —Compliance component #4 of 5 R 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 6MP 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: r) t? 5
Business Name' - S - 4> >
Q
S. Soil separation — Compliance component #5 of 5
Date of installation L9 g i ❑ Unknown
(mmlddlyyyy)
Shore I andMell head protection/Food
beverage lodging?
criteria (select one):
❑ Yes ® No
5a. For systems built prior to April 1, 1996, and .N Yes ❑ No*
not located in Shoreland or Wellhead
Protection Area or not serving a food,
beverage or lodging establishment;
Draintield has at least a two -foot vertical
separation distance from periodically
saturated soil or bedrock.
5b.Non-parfomtance 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.
Draintleld has a three-foot vertical
separation distance from periodically
saturated soil or bedrock.*
5c. *Experimental", "Other", or "Performance" ❑ Yes ❑ No*
systems built underpre-2008 Rules;
Type 1V or V systems built under 2008
Rules 7080. 2350 or 7080.2400
(intermediate inspector License required s
2,500 gallons per day; Advanced Inspector
License required > 2,500 gallons per day)
Dralnfield 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-- eg —
Attached supporting documentation:
® Soil observation logs completed for the report
❑ Two previous verifications of required vertical separatlon
❑ Not applicable (No soil treatment area)
❑
"May be reduced up to 15 percent if allowed by Local
Ordinance.
Upgrade requirements: (Minn. Stall. § 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.
5�
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SP TESTING INC.
Steven B. Schirmers —951 Katydid Lane NE — St. Michael, MN 55376
Cert. No 627 — State License #394 — Phone 763-497-3566 — Fax 763-497-5011
www.s testin -wastewater comcast.net— schirmerswastewater.com
LOG OF SOIL BORINGS
May 12 2025
Anand Gopinath
705 Old Long Lake Rd.
Orono, MN
Soil borings were completed on 5-5-25.
Soil boring #1 - Elev. 94.0 - mottled soil present in the boring at 24" Into the
original soil. Standing water at 281P.
0 -
8"
Topsoil dark brown loam 10YR 312
8" -
12"
Brown loam 10YR 313
12" -
2411
Brown clay loam IOYR 5/3
24" -
30"
Brown clay loam 10YR 513 -
distinctive mottles 10YR618, 10YR 711
Soil boring #2 - Elev. 99.6 - Mottled soil present In the boring at 22" into the
original soil.
0 - 6" Topsoil dark brown loam 10YR 312
6" - 22" Brown clay loam 10YR 413
22" - 30" Brown clay loam 10YR 413
Distinctive mottles 10YR 618, 10YR 711
Soil boring #3 -- Elev. 101.3 -through the mound.
0 - laps pill soil loam
12" - 32" pill soil medium sand
32" - 44" Original soil dark brown loam
Soil boring #4 - Elev. 103.9 -through the mound.
0 - 18" pill soil loam
18" - 20" Fill soil medium sand
30" - 36" Original soil dark brown loam
MINNESOTA POLLUTION
CONTROL AGENCY Sewage tank
520aul,M Lafayette Road
-4194North maintenance reporting form
St. Paul, MN 55i55-4194
Subsurface Sewage
Treatment Systems (SSTS) Program
Doc Type: Compliance and Enforcement
Purpose: Management and maintenance of Subsurface Sewage Treatment Systems (SSTS) are Important to ensure resource
protection and long-term and cost-effective $swags treatment. Completion of this form complies with the sewage tank maintenance
requirements under Minn. R. 7080.2450 and 7082.0800. 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 on page 3 by a qualified professional.
Instructions: A copy of this information must be submitted to the system owner within 30 days of the maintenance date and be maintained
by the licensed SSTS maintainer business for a period of fire (5) years from the maintenance date. Maintenance reporting to the local unit of
government may be required by local ordinance. Check with your local SSTS program for maintenance reporting prooft Page 3 is
optional and not required to be completed on routine maintenance events.
Secure maintenance hole covers
All maintenance hole covers must be returned to service in a sound and durable condition and be capable of withstanding
the anticipated load.
Covers must be re -secured In accordance with Minn. R, 7080.2450, subp. 3, items C or D:
a) Covers installed under local ordinances adopted after February 4, 2008 must be locked, bolted or screwed or must be
95 pounds in weight. They must be made of material suitable for outdoor use, resistant to ultraviolet degradation and leaks,
and not susceptible to being slid or flipped. They must have a label warning of hazardous conditions Inside the tank. All
screw openings must be refastened.
b) Covers Installed under local ordinances adopted before February 4, 2008 must either be buried with at least 12Inches of
soil cover or be secured acoording to the local ordinance In effect before February 4, 2008.
c) Covers must meet item `a' above when raised to the ground surface or less than 12 Inches from the ground surface.
Reporting information
Date of maintenance (m,nrddlyyyy): 412512025 Reason for maintenance: Septic Compliance 1 Sale of Property
Property address: 705 Old Long Lake Rd Parcel ID: 36-118-23-33 2-0006
City: Orono State. MN Zip code: 55391
Property owner's name: Anand Go 'nath
Property -owner's address (if differeno: 46SSTallv Ho Trail
City: Boulder State: CO Zip code: 80301
Phone number: 617-308-5567 Email address:
1. Did you measure the accumulation of scum and sludus? 1-1 Yes``CRln rtar,irrei ,,,,. -A n....,.
Tank check If resent
11 Se ttclholdin tank #
❑ Se tlolholdln tank
Pretreatment tank
Pump -tank
#2
Scum
51ud e
Operating de th
Percent full
2. Access used to remove septage: 99? Maintenance hole ❑ Other (Unless a holding tank, go to #4 below)
3. If the maintenance hole was used, were all covers secured In place? 'Pres ❑ No If no, please explain below.•
4. If the owner refuses to allow a Subsurface Sewage Treatment System (SSTS) to be pumped through the maintenance
hole, have them complete and sign the following statement (Pr6fr owners name)
1, , refuse to allow the removal of the solids and liquids through the maintenance
hole. I understand that removal of solids and liquids through other access points is not considered a compliant method of
solids removal and does not fulfill the solids removal requirements of Minn. R. 7080.2450 and 7082.0800.
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 processinq this form.
Owners signature:
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Date (mmfddfyyyy):
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Page 1 oj3
Property address: 705.Old Long Lake Rd Parcel ID: 38-118-23-32-0008
City. Orono State: MN Zip code: 55391
G. Is the tank designed as a leaky tank? (Example: seepage pit, cess col, dlywell, leaching pit)
Tank #1: ❑ Yes &No Verification method used:
Tank #2: ❑ Yes ❑ No Verification method used:
6. Is there evidence of the following?
Tank Icheck ifpresent)
Tank leaks below the
designed operatInA denth
Tank leaks above the
designed opetatInR depth
Maintenance hate cover is
damaged, cracked, unsecured, or
appears to be structure unsound
Sepickolding Tank #1
0 Yes M&NO
Q Yes RNO
Q Yes RNO
S d(rAcidin Yank #2
Yes MNo
0 Yes tfto
El Yes ONO
Pretreatment Tank
Yes No
Q Yes D No
Q Yes No
Pump Tank
Yes No
Q Yes 2 No
0 Yes No
Describe detall for any 'Yes"
7. Now many gallons of septage were removed?
Tank #1: 00 Tank #2: Pretreatment Tank: Pump Tank: 02AQ
8. Where was the seepage taken?�l Wastewater treatment facility ❑ Land application ❑ Other
Explanation (Facility name/Site #):
9. Did you Identify any operational Issues or unsafe conditions while assessing the sewage tanks In this system?
❑ Yes �?No If yes, Identify tank and explain:
❑ Evidence of non -domestic waste ❑ Baffle(s) condition ❑ Effluent screen condition
❑ Maintenance hole and extensions condition ❑ Other conditions (e.g. structural integrity of tank or tld, electrical hazard, etc.)
Explanation:
10. List any troubleshooting and minor repairs completed or declined by owner:
Additional comments or suggestions for owner's consideration:
Pumping record
I personally conducted the work described above on behalf ofa Minnesota -licensed SSTS Maintenance Business, in compliance
with Minnesota Rules Chapters 7080 — 7083:
❑ As a noncerftfed individual who has received proper training, daily work review, and periodic observation, or
® As a designated certified Individual of the business fisted below.
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.
Company information Employee information
Company name: Kothrade Sewer, Water 8 Excavating, Inc Print name: Larry Bursch _
Business license number. MPCA 192 Certification number: gagpticabre): C9199
Email: inf kothrade.com Phone number: 783-498-8702
Employee's signature: Date (mmlddfyyyy):
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Property address: 705 Old Long Lake Rd Parcel ID: 36-118-23-32-OON
City: Orono State: MN Zip code: 55391
Optional section: Sewage Tank Compliance Certification (Tank integrity assessment)
This form does not represent a complete system Inspection report and only certlfEes sewage tank compliance status. i.e.,
this form, completed, may serve as a tank Integrity assessment.
Instructions: This section of the form may be completed and signed by a Designated Certified Individual (DCI) of a licensed SSTS
Maintenance Business who personally conducts the necessary procedures to assess the compliance status of each sewage tank In
the system.
When this section of the form is signed by a qualified certified professional, it becomes necessary supporting documentation to an
Existing System Compliance Inspection Report: Compliance Inspection fo - Existing s s m w-wwists4- 1b . This foam can be
found on the MPCA website at https:Nwww.pca.state.mn.usAmatertservice-and-maintenance.
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 Item (B) subitem (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 Items B, C. and D; 7083.0730 Item C.
Pages 1 and 2 are not required to accompany this form when the optional third page is completed and used to certify
sewage tank compliance status.
system status
System status on date (mmlddlyyyy): 412M025 4:p t `tQ r
�Cert€ficate of sewag p to of sa tank compliance CE f
ewage tank noa-compliance
Compliance criteria:
The SSTS has a seepage pit, cesspool, drywell, teaching pit, or other pit -'Failure to Protect ❑Y�� o
Groundwater."
The SSTS has a sewage tank that leaks below the designed operating depth -"Failto Protect [I Yes" �iVo
Groundwater."
The SSTS presents a threat to public safety by reason of structurally unsound (damaged, cracked, or ❑ Yes' PNo
weak) maintenance hole cover(s) or lids or any other unsafe condition -'Imminent Threat to Public
Health or Safety."
Any 'ryes" answer above indicates sewage tank non-compliance.
Company Information Designated Certified Individual [DCI) information
Company name_ Kothrade Sewer. Water & Excavatlnp Inc Print name: Larry Bursch _
Business ilcense number: MPCA 192 Certification number. C9189
I personally conducted the work described above as a Designated Ceffrfred Individual of a Minnesotadicensed SSTS Maintenance
Business. !personally conducted the necessary procedures to assess the compliance status ofeach 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 Inh mratian can be used for the purpose of proses g this form.
Designated Certified Individual's signature: Date (mrnldd/yyyy):
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