HomeMy WebLinkAbout2650 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 aetermination 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/filesiwq-wwists4-31a.pdt.
Property information Local tracking number:
Parcel ID# or Sec/Twp/Range: 0411723410003 Reason for Inspection PropertyTransfer
Local regulatory authority info: City Of Orono, 952) 249-4600
Property address: 2650 Fox Street, Orono
Owner/representative: Nick Lee Owner's phone: 952-215-6888
Brief system description: 2-1300-gallon septic tanks, 1-1500-gallon lift station and 630 Square feet Rock bed
System status
System status on date (mm/dd/yyyy): 7/17/2025
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 is designed for a five bedroom house.
There is 1.8 feet of sand under the rock bed.
TBM: Top of the lift station manhole cover. ELV.-100.0
Included are the original 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: Rustle Olson Soil &_percolation Testing___
Inspector signature: Joseph J. Olson
(This document has been electronically signed)
Certification number: C1255
License number: L810
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: 2650 Fox Street, 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 ❑ 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 public health and safety.
Describe verification methods and results:
Visual. Nothing was found
Date: 7/17/2025
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 tank(s) leaks:
Any "yes" answer above indicates the system
is failing to protect groundwater.
Describe verification methods and results:
Chip's Septic Services 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 7/9/2025
(mmiddiyyyy): (must be within three years)
(See form 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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Property Address: 2650 Fox Street, Orono
Business Name: Rusty Olson Soil & percolation Testing
3. Other compliance conditions — Compliance component #3 of 5
Date: 7/17/2025
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 jrriminetit inteat to Nuniic 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 tailing 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: 2650 Fox Street, Orono
-- - - -------
Business Name: Rusty Olson Soil & ercolation Testigg_____ Date: 7/17/2025
S. Soil separation — Compliance component #5 of 5
Date of installation 7/22/2011 ❑ 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
April 1, 1996, or later or for non-
performance systems located in Shoreland
or Wellhead Protection Areas or serving a i
food, beverage, or lodging establishment:
Drainfield has a three-foot vertical
separation distance from periodically
saturated soil or bedrock.*
Attached supporting documentation:
® Soil observation logs completed for the report
❑ Two previous verifications of required vertical separation
❑ Not applicable (No soil treatment area)
El
❑ No Indicate depths or elevations
A. Bottom of distribution media 99.3 _
B. Periodically saturated soil/bedrock 996.3
C. System separation 3.0
D. Required compliance separation* I 2.55
*May be reduced up to 15 percent if allowed by Local
Ordinance.
5c. "Experimental", "Other', or "Performance" ❑ 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:
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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MIINNESOTA POLLUTION
CONTROL AGENCY
520 ,afayette Roao North
St. Paul, MN 55155-4194
Sewage tank
maintenance reporting form
Subsurface Sewage
Treatment Systems (SSTS) Program
Purpose: Management and maintenance of Subsurface Sewage Treatment Systems (SSTS) are important to ensure resource
protection and long-term and cost-effective sewage treatment. Completion of this form complies with the sewage tank maintenance
requirements under Minn. R. 7080.2450 and 7082.0600. 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 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 five (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 protocol.
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. 71080.2450, 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 12 inches of
soil cover or be secured according 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 (mmlddiyyyy):
Property address.- 2650 Fox Street
City: __W�yzata
Property owner's name: Nick Lee
Property -owner's address if different:
7/9/2025 Reason for maintenance: Transfer of Title
Parcel ID: 0411723410003
State: MNZip code: 55391
City: State: Zip code:
Phone number: 952-215-68887 Email address:
1
2.
3.
Did you measure the accumulation of scum and sludge? ❑ Yes ® No (tank(s) pumped without measuring)
Tank (check if present Scum Sludge Operating ck# _ Percent full
® Septicthold i ng_ tank #1 normal level
--- -- --- ----
® Septic/holding tank #2 normal level
❑ Pretreatment tank
_® Pump tank normal level
Access used to remove septage: 0 Maintenance hole ❑ Other (Unless a holding tank, go to #4 below)
If the maintenance hole was used, were all covers secured in place? ® Yes ❑ 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.
I, refuse to allow the removal of the solids and liquids through the maintenance
(Print o:vners name;
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 7082.0600.
Owner's signature _ _. - . _ . ___--_- __----_ _— Date (mm/dd/yyyy) _------_---_ _.-- __--
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Property address: 2650 Fox Street
City: _Wayzata__
State: MN
Parcel ID: 0411723410003
Zip code: 55391
5. Is the tank designed as a leaky tank? (Example: seepage pit, cesspool, drywell, leaching pit)
Tank #1: ❑ Yes ® No Verification method used: visual
Tank #2: ❑ Yes ® No Verification method used:
6. Is there evidence of the following?
Maintenance hole cover is
Tank leaks below the Tank leaks above the damaged, cracked, unsecured, or
Tank heck if present) ..igned o�eratin�depth designed operating depth _ - appears to be structurally unsound
_ _
_ ® Septiclholding an #1 Yes ® No ❑ Yes No ❑ Yes No
Septictholding Tank #2 [] Yes 0 No _ ❑ Yes No � Yes No
Pretreatment Tank _(] Yes _� No ❑ Yes No Yes No
® Pump Tank -- - - [] Yes ® No - - ❑..Yes ® No ..___Q Yes _ 0-No
Describe detail for any "Yes"
7. How many gallons of seppage were removed?
Tank #1: 1300 _ Tank #2: _1300 Pretreatment Tank: Pump Tank:_750
B. Where was the septage taken? ® Wastewater treatment facility ❑ Land application ❑ Other
Explanation (Facility name/Site #): Watertown
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 lid, electrical hazard, etc.)
Explanation: _
10. List any troubleshooting and minor repairs completed or declined by owner:
❑ Troubleshooting and repairs conducted: 1 ❑ Repairs declined by owner:
Additional comments or suggestions for owner's consideration:
Pumping record
I personally conducted the work described above on behalf of a Minnesota4censed SSTS Maintenance Business, in compliance
with Minnesota Rules Chapters 7080 - 7083:
❑ As a noncertified individual who has received proper training, daily worts review, and periodic observation, or
® As a designated certified individual of the business listed below.
Company information Employee information
Company name: Chip's Septic Services
Business license number: 2064
Print name: Pemel Hentges
Certification number: (if applicable): 4761
Email: chipseptioMgmail,com __._..._ _ Phone number: 952-200-3176
Employee's signature: mm/dd Date ( IYYYY): 7/9/2025
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Property address: 2650 Fox Street Parcel ID: 0411723410003
City: _Wayzata State: MN Zip code. 55391
Optional section: Sewage Tank Compliance Certification
This form does not represent a complete system inspection report and only certifies sewage tank compliance status.
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 form - Existing system (wq-wwists4-31b). This form can be
found on the MPCA website at httos:/!wwwpca state, mn us/water/ssts-and_-msts-technical-and-compliance-criteria.
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 the inspection report. It 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.
Q Certificate of sewage tank compliance
Affirm all three statements:
Q The SSTS does not contain a seepage pit, cesspool,
drywell, leaching pit, or other pit.
Q it does not contain a sewage tank that was designed
to be watertight, but subsequently leaks below the
designed operating depth.
® It does not represent an imminent safety threat by
reason of unsecured, damaged, or weak
maintenance hole cover(s) or other unsafe condition.
Company information
Company name- Chip's Septic Services
Business license number: 2064
❑ Notice of sewage tank non-compliance
Select all that apply:
❑ The SSTS has a seepage pit, cesspool, drywell,
leaching pit, or other pit — "Failure to Protect
Groundwater."
❑ It has a sewage tank that was designed to be
watertight but subsequently leaks below the designed
operating depth —"Failure to Protect Groundwater."
❑ It presents a threat to public safety by reason of
unsecured, damaged, or weak maintenance hole
cover(s) or other unsafe condition — "Imminent Threat
to Public Health or Safety."
Designated Certified Individual (DCI) information
Print name: Pernel Hentges
Certification number: 4761
I personally conducted the work described above as a Designated Certified Individual of a Minnesota -licensed SSTS Maintenance
Business. I personally conducted the necessary procedures to assess the compliance status of each sewage tank in this SSTS:
Designated Certified
Individual's signature:
Date (mm/dd/yyyy): c,
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Soil Observation Log
NNww..SepticResourcc.com vers 12.4
Owner Information
Property Owner / project: Nick Lee Date 7/7/2025
Property Address / P1D: 2650 Fox Street
Soil Survey Information ❑ refer to attached soil survey
Parent matl's: Q Till ❑ Outwash ❑ Lacustrine ❑ Alluvium ❑ Organic ❑ Bedrock
landscape position: ❑ Summit ❑ Shoulder [A Side slope ❑ Toe slope
soil survey map units: L408 slope % direction -
Soil Log #1
p Boring ❑ Pit Elevation 97.6 Depth to SHWT X Inches
Depth (in) Texture fragment % matrix color redox color consistence grade shape
0-10
Loam
<35
10yr3/2
Friable
Strong
Blocky
10-18
Clay Loam
<35
10yr5/4
Friable
Strong
Blocky
<35
loose
loose
single grain
35-50
friable
weak
granular bloc].-y
>50
firm
moderate
prismatic platy
rigid
strong
massive
<35
loose
loose
single grain
35 - 50
friable
weak
granular blocky
>50
firm
moderate
prismatic platy
la_
rigid
strong
massive
<35
loose
loose
single grain
35-50
friable
weak
granular block.-y
>50
firm
moderate
prismatic platy
rigid
strong
massive
Comments:
2650 Fox Street Soil Lo #2
Q Boring ❑ Pit Elevation 97.6 Depth to SHWT 16 Inches
Depth (in) Texture fragment % matrix color redox color consistence grade shape
0-10
Loam
<35
10yr3/2
Friable
Strong
Blocky
10-16
Clay Loam
<35
10yr5/4
Friable
Strong
Blocky
16-22
Clay Loam
<35
10yr5/4
10y4/8,1-6/l0y
Firm
Strong
Blocky
<35
loose
loose
single grain
35-50
friable
weak
granular blocky
>50
firm
moderate
prismatic platy
rigid
strong
massive
<35
loose
loose
single grain
35-50
friable
weak
granular blocky
>50
firm
moderate
prismatic platy
rigid
I strong
massive
2650 Fox Street Soil Log #3
p Boring ❑ Pit Elevation 86.8 Depth to SHWT 12 Inches
Depth (in) Texture fragment % matrix color redox color consistence grade shape
0-26
Loam
<35
10yr2/1
Friable
Strong
Blocky
26-32
Clay Loam
<35
10yr4/3
10y4/8,1-6/l0y
Friable
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 grain
35-50
friable
weak
granular blocky
>50
firm
moderate
prismatic platy
rigid
strong
massive
35
loose
loose
single grain
35-50
friable
weak
granular blocky
>50
firm
moderate
prismatic platy
rigid I
strong I
massive
I hereby certify this work was completed in accordance with MN 7080 and any local req's.
Rusty Olson Soil & Perc 810
4rSure Company License #
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