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HomeMy WebLinkAbout460 Orchard Park Road - Septic Compliance - 2025MINNESOTA POLLUTION CONTROL AGENCY 520 Lafayette Road North St, Paul, MN 55155-4194 Compliance inspection report form Existing Subsurface Sewage Treatment System (SSTS) Doc Type: Compliance and Enforcement Instructions: Inspector must submit completed Corm to Loral 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/def ault/f iles/wq-wwi sts4 - 31 a. pdf I Property Information Local tracking number: Parcel ID# or Sec/Twp/Range: 3211823230012 _Reason for Inspection Property Transfer Local regulatory authority info: City Of Orono, (952) 2494600 Property address: 460 Orchard Park Road, Orono Owner/representative: Patrick Mulheran Owner's phone: 612-702-8693 Brief system description: 2-1300-gallon combination septic tanks, 1-1300-gallon lift station and 630 Square feet Rock bed System status System status on date (mm/dd/yyyy): 6/4/2025 __ ® 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 wum.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 1.7 feet of sand or greater under the rock bed. The soils were verified by the city inspector on 10/03/2016. TBM: Top of the back door threshold. Elv.-100.0 Certification 1 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 &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 El 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-wwists431b • 412812021 Page 1 of 4 Property Address: 460 Orchard Park Road, Orono Business Name: _ Rusty Olson Soll &percolation Testing _ __ L. 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 tile or surface waters. System causes sewage backup into I'❑ Yes" ®No dwelling or establishment. Any `yes" answer above indicates the system Is en imminent threat "public health and safety. Describe verification methods and results: Visual. Nothing was found Date: 6/4/2025 Attached supporting documentation: ❑ Other: ® Not applicable 2. Tank integrity —Compliance component #2 of 5 Compliance criteria: System consists of a seepage pit, ❑ Yes1r® No cesspool, drywell, leaching pit, or other pit? Sewage tank(s) leak below their �❑Yes, ®No designed operating depth? Ifyes, which sewage tank(s) leaks: 1 Any "yes" answer above Indicates the system is falling to protect groundwater. Describe verification methods and results: Kothrade Sewer,Water &Excavating pumped the tanks. https://www. pca,state. m n. us wq-wwists4.31b 4/28/2021 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 6/3/2025 (mm/dd/yyyy): (must be within three years) (See form instructions to ensure assessment complies with Minn. R. 7082.0700 subp. 9 8 (1)) ❑ Tank is Noncompliant (pumping not necessary -explain below) ❑ Other: • 661-296-6300 800-657-3864 Use your preferred relay service Available in alternative formats Page 2 of 4 Property Address: 460 Orchard Park Road, Orono Business Name: Rusty Olson Soil & percolation Testing-_ 3. Other compliance conditions — Compliance component #3 of 5 Date: 6/4/2025 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 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 to 3c or 3d -System is failing to protect groundwater Describe verification methods and results: Visual. Nothing was found Attached supporting documentation: ®Not applicable ❑ ❑ Yes ®No 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 Practices) 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 noncantpliance. Describe verification methods and results: Attached supporting documentation hops://www.pca.state.mn.us 651-296-6300 wq-wwists4-31b 412812021 ❑ Operating permit (Attach) ❑ 800-657-3864 0 Use your preferred relay service • Available in alternative formats Page 3 of 4 Property Address: 460 Orchard Park Road, Orono Business Name: Rusty Olson Soil & percolation Testing 5. Soil separation — Compliance component #5 of 5 Date of installation 8/8/2011 ❑ Unknown (mm/ddYYYY) Shoreland/Wellhead protectionlFood ❑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 atwo-foot vertical separation distance from periodically saturated soil or bedrock. 5b.hon-performance systems built April 11 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 athree-foot vertical separation distance from periodically saturated soil or bedrock.* 5c. "Experimental ; "Other; or "Performance" systems built under pre-2008 Rules; Type IV or V systems built under 2008 Rules 7080, 2350 or7080,2400 (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. ® Yes ❑ No' ❑ Yes ❑ No' Any "no" answer above indicates the system is failing to protect groundwater. Describe verification methods and results: Daie: 6/4/2025 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 Bottom of distr A. ion media j 85.9 B. Periodically saturated soil/bedrock 82.9 C. System separation 3.0 D. Required compliance separation* 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 focal 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 800-667-3864 Use your preferred relay service Available in alternative formats wq-wwists4-31b 4/28/2021 Page 4 of 4 520 Lafayette Road North St. Paul, MN 55155=4194 Doc Type: Compflance and Enfo►cement 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, 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 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. 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 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 (mmlddtyyyyj: 6/312025 Reason for maintenance: Septic Compliance Property address: 460 Orchard Park Rd Parcel ID: 32-118-23-23-0012 City: Orono State: MN Zip code: 55366 Property owner's name: Patrick Mulheran Property -owner's address (if different): City: State: Zip code: Phone number: 612-702-8693 Email address: 1. Did you measure the accumulation of scum and sludge? ❑Yes No (tank(s) pumped without measuring) Tank check if resent Scum Sludge Operating depth Percent full ❑ Septic/holdingSeptic/holding tank #1 ❑ Septic/holdingSeptic/holding tank #2 Pretreatment tank ❑ Pump tank 2. Access used to remove septage: 'Maintenance hole El Other (Unless a holding tank, go to #4 below) 3. 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 ownels 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, 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. Owner's signature: Date (mm/dd/yyyy): www.pca.state.mn.us • 651-296-6300 BM657-3864 Use your preferred relay service • Available in alternative formats wq•wwists4-38 • 4128121 Page 1 of 3 rroperty address:i Wrrchard r1ark Rd Orono State: MN is e tanK designed as a leaky tank r (Example: seepage pit, Tank #1: 0 Yes VfNo Verification method used: Tank 92: ■ Yes ■ No Verification method used: 6. Is there evidence of the following? teaching pit) 11 code: 55356 Tank check if resent Tank leaks below the designed operating depth Tank leaks above the designed operating depth Maintenance hole cover Is damaged, cracked, unsecured, or appears to be strut urall unsound ❑ Septic/holdingSeptic/holding Tank #1 ❑ Yes o ❑ Yes &2 No ❑ Yes ftNo ❑ Septic/holdingSeptic/holding Tank #2 ❑ Yes tR No Q Yes E Wo ❑ Yes No ❑ Pretreatment Tank ❑ Yes ❑ No ❑ Yes No El Yes ❑ No ❑ Pump Tank ❑ Yes No ❑ Yes No El Yes PNo Describe detail for any "Yes" 7. How many gallons of septage were removed? Tank #1: 1300 Tank #2: ! 34iJ Pretreatment Tank: Pump Tank: a2(V 8. Where was the septage taken? Waste ater 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 YNo 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: ❑ Repairs declined by owner. Additional comments or suggestions for owner's consideration: Pumping record ! personally conducted the work described above on behalf of aMinnesota-licensed SSTS Maintenance Business, in compliance with Minnesota Rules Chapters 7080 — 7083: ❑ As a noncertifled individual who has received proper training, daily work review, and periodic observation, or ® As a designated certified individual of the business listed 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 & Excavating, Inc Print name: Larry Bursch Business license number: MPCA 192 Certification number: (1rapplicable): C9199 Email: info@kolhrac Employee's signature: Phone number: 763-498-8702 Date (mm/dd/yyyy): 07 www.pca.state.mn.us wq-wwist5438 • 4/28/11 651-296-6300 800-657-3864 • Use your preferred relay service Available in alternative formats Page 2 of 3 Property address: 460 Orchard Park Rd Parcel ID: 32well8eme23�23w0012 City: Orono State: MN Zipcode: This form does not represent a complete system inspection report and only certifies 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 form - Existing system (wq-wwists4=31W. This form can be found on the MPCA website at https://www,pca.state,mn.ustwater/service-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. 41tem (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 (mm/dd/yyyy): 6/3/2025 `r' -' - I�ct-(�l- ertificate of sewage tank compliance ❑Notinorincompliance of sewage tank no -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* 23 No Groundwater." The SSTS presents a threat to public safety by reason of structurally unsound (damaged, cracked, or ❑ Yes* No weak) maintenance hole cover(s) or lids or any other unsafe condition - "Imminent Threat to Public Health or Safety." Any "yes" answer above indicates sewage tank non-compliance. Company information Designated Certified Individual (DCI) information Company name: Kothrade Sewer, Water & Excavating, Inc Print name: Larry Bursch Business license number: MPCA 192 Certification number: C9199 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. By typing/signing my name below, I certify the above sta ments to be true and c ct, to the best of my knowledge, and that this Information can be used for the purpose of processi his form. Pleeee Designated Certified Individual's signature: Date (mm/dd/yyyy): www.pca.state.mn.us wq-wwisLs4-38 • 4/28/21 651-296-6300 • 800-657-3864 • Use your preferred relay service • Available in alternative formats Page 3 of 3 oil observation (hw ner Information 1'n,pern (1\\ner pru;r.t: i'aU'1�'k �1LtI11Cra11 1)tllr % i1 �UI(1 I'roprrl% Address HD: 1,012. Block 1 Orchard Fades Soil Sun c�Information refe• to atta:tled so.! survey I'afenl Illdtl �: __, Outt` ash acustr ne Alluv0.,m J O'garr; Bedrock landscape pmitilul: Sunrl,t Slhouder Side slope �e slope ,oil suers slap unit,: 1441 C 2 .i0pe X direction- Linear Soil Lod #I _Sot l'9 _ At' f lrta!i011 98�46 Depth t0 S I I 1 16 In�he. Dg111 (In I e\1lIIY Ir:1i1nen1 °n IIla1141\ Color redo\ Lolo. CUIUI�le1kC grade ,hdcle Icp,oiI Ul1>C �1 t$1�l' I \II1CI: 9Lll1! ! 6-1 Om Loam ?s )I1\1'! 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SITE C d'i ❑ DEMO - FINAL ❑ PLUMBING R► ❑ PLUMBING FINAL ❑ MECHANICAL RI ❑ MECHANICAL FINAL ❑ WOOD BURNER/FIREPLACE ❑ WATER HOOK-UP ❑ SEWER HOOK-UP ❑ SEPTIC INSTALL .._ 4. . a:wig�.; ❑ SEPTIC FINAL ❑ EXCAV/GRADWG/FILLING ❑ TREE REMOVAL ❑ SITE INSPECTION ❑ RATED WALLS ❑ COMPLAINT ❑ FOLLOW-UP ❑ FOUNDATION/REMOVAL .TEMPORARY 0 Burns Septic Tanksw 2=1300 Pump Tanks 1300 Date Finaled. 8/8/17 Bedrooms System Type* ©, ■ . 0 Trenches Pressure :'r. Other structure. Show locvMons of drop Boxes and length of trenches / m / JI 9 fell /ge a ./ - ` 0 % /eateep4m Release estimate gomoommm/� i Comment afflowoza"7�wagoomo,x go T > Ng� 7RA LE® / / I I �N ®®� ®._®.�®L®®^�®®