HomeMy WebLinkAbout4665 West Branch Road - Septic Compliance - 2026M MINNESOTA 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 (I -GU) 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 httpsi//www.pca.state.mn.us/sites/default/files/wq-wwists4-31a.pdt.
Property information Local tracking number:
Parcel ID# or Sec/Twp/Range: 0711723220015 Reason for Inspection Propery Transfer
Local regulatory authority info: City of Orono
Property address: 4665 West Branch Road.
Owner/representative: Eric Truskoski
Owner's phone: 860-866-8489
Brief system description: Approximately 2-1000-gallon septic tanks, 1-1000-gallon lift station and 410 square feet of mound rock bed.
System status
System status on date (mm/dd/yyyy): 4/9/2026
❑ Compliant — Certificate of compliance' ❑ Noncompliant — Nctice of noncompliance
(Valid for 3 years from report date unless evidence of an Systems failing to protect ground water must be upgraded, replaced, or
imminent threat to public health or safety requiring removal and use discontinued within the time required by local ordinance.
abatement under section 145A.04, subdivision 8 is discovered or
a shorter time frame exists in 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
There is 1.0 feet of sand under the rock bed.
TBM: Top of the garage service door threshold. ELV.-100.0
This system is designed for a three bedroom house.
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 rr y knowledge, and that this information can be
used for the purpose of processing this form.
Business name: Rusty Olson Soil &percolation TesUng_ ___ _ _ 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):
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Property Address: 4665 West Branch Road.
Business Name: Rusty Olson Soil & percolation Testing Date: 4/9/2026
1. Impact on public health — Compliance component #1 of 5
Compliance criteria: Attached supporting documentation:
System discharges sewage to the [:]Yes* ® No ❑ Other: _
ground surface
® Not applicable
System discharges sewage to drain ❑ Yes' ® No
tile or surface waters.
System causes sewage backup into I ❑ Yes* ® No
dwelling or establishment. l
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
2. Tank integrity — Compliance component #2 of 5
Compliance criteria:
System consists of a seepage pit,
cesspool, drywell, leaching pit,
or other pit?
Sewage tank(s) leak below their
designed operating depth?
Attached supporting documentation:
❑ Yes' ® No ❑ Empty tank(s) viewed by inspector
❑ Yes` ® No
If yes, which sewage tank(s) leaks:
Any "yes" answer above indicates the system
is failing to protect groundwater.
Describe verification methods and results:
Kothrade Sewer & Water pumped the tanks.
Name of maintenance business:
License number of maintenance business:
Date of maintenance:
® Existing tank integrity assessment (Attach)
Date of maintenance 4/7/2026
(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:
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Property Address: 4665 West Branch Road.
Business Name: Rusty Olson Soil & Dercolation Testina Date: 4/9/2026
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 3d - System is failing 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: 4665 West Branch Road.
Business Name: Rusty Olson Soil & percolation Testing
5. Soil separation — Compliance component #5 of 5
Date of installation 11/4/2008 ❑ Unknown
(mmlddlyyyy)
Shoreland/Wellhead protection/Food ❑ Yes ® No
beverage lodging?
Com Nance 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 1V or V systems built under 2006
Rules 7080. 2350 or 7080.2400
(Intermediate Inspector License required 5
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:
Date: 4/9/2026
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
102.8
B. Periodically saturated soil/bedrock
99.8
C. System separation
3.0
D. Reauired 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 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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��MINNESOTA POLLUTION
CONTROL AGENCY
520 Lafayette Road North
St Paul, MN 55155-4194
Sewage tank
maintenance reporting form
Subsurface Sewage
Treatment Systems (SSTS) Program
Doc type: Complfance and Enfomement
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 kcal unit of
government may be required by local ordinance. Check with your focal 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 kcal 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 waming of hazardous conditions inside the tank. All
screw openings must be refastened.
b) Covers installed under local ordinances adopted before February 4, 2 ^08 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 (mmiddyyyy): 41712026 Reason for m:i i ntcnance: Septic Compliance
Property address: 4665 West Branch Rd Parcel ID: 07-117-23-22-0015
City: Orono State: _ M: a Zip code: 56364
Property owner's name: Eric Truskoski I Brigitte Hamblin
Property -owner's address (if different): 6520 Belle St
City: Greenfield State: _ NI N
Phone number. 860-866-8489 Email address-.
1. Did you measure the accumulation of scum and sludge? ❑ Yes
Tank check ifpresent)
Scum
Slud e
Septic/holdingSeptic/holding tank #1
Septic/holdingSeptic/holding tank #2
Pretreatment tank
Pump tank
Zip code: 55357
IC;'IVo (tank(s) pumped without measuring)
! Operating Le h Perrentfull
2. Access used to remove septage: IffMaintenance hole ❑ Other (tt.i, ss a holding tank, go to #4 below)
3. If the maintenance hole was used, were all covers secured in place? t($,sYes L] No If no, please explain below:
4. if the owner refuses to allows Subsurface Sewage Treatment Sys 1, , ;9STS) to he pumped through the maintenance
hole, have them complete and sign the following statement.
I, , refuse to allow the removal : r !lie solids and liquids through the maintenance
(Print owners name)
hole. I understand that removal of solids and liquids through other acr•o, r,,,ints is not c(,nsidered a compliant method of
solids removal and does not fulfill the solids removal requirements of t.:. R. 7080.2450 and 7082.0800.
By typirWsigning my name below, I certify the above statements to 1,,:: ue and correct, to the best of my knowledge, and
that this information can be used for the purpose of processing this forr:
Owner's signature: (rnmidd/yyyy):
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Page 1 of 3
Property address: 4685 West Branch Rd Parcel ID: 07-117-23-22-0015
City: Orono State: MN Zip code: 55364
S. Is the tank designed as a leaky tank? (Example: seepage pit spoof, dryweq, leaching pit)
Tank #1: ❑ Yes (q No Verification method used: --
Tank #2: ❑ Yes ❑ No Verification method used:
6. Is there evidence of the following?
Tank check if resent
Tank teaks below the
designed rating de th
Tank leaks above the
designed operating depth
Maintenance hole cover is
damaged, sacked, unsecured, or
ammrs to be dructuraft unsound
Se ticlholdin Tank #1
Yes
No
Yes
No
11Yes No
Septic/holdingSeptic/holding Tank #2
El YesFNo
No
Yes
Yes
Yes
o
No
HNo
Yes Q No
Yes No
Yes No
Pretreatment Tank
Yes
Pump Tank
r3 Yes Or No
Describe detail for any "Yes'
7. How many gallons of septage were removed?
Tank #1: 49,00` Tank #2: l ij J Pretreatment Tank: Pump Tank: S%6u
8. Where was the septage taken?p Waste_watef 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 4'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, electrkal 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
l personally conducted the work described above on behalf of a Minnesota -licensed SSTS Maintenance Business in compliance
with Minnesota Rules Chapters 7080 — 7083:
❑ As a noncertiiied 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 8 Excavating Inc Print name: L. Bursch
Business license number: MPCA 192 Certification number. tirsp ruble?: C9199
Email: info kothrade.com Phone number: 763-49t3-8702
Employee's signature: Date (mm/dd/yyyy): � 7
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Page 2 of
Property address: 4686 West Branch Rd _ Parcel ID: 07-117-23-22-0015
City: Orono State: MN Zip code: 55364
Optional section: Sewage Tank Compliance Certification (Tank integrity assessment)
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 (wa-wwists4-31b1. This form can be
found on the MPCA website at https:/Avww.pco.state.mn.us/water/service-and-r;iai;ilenance.
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 (U) 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 referencr,-, fir !his activity can be found at Minn.
R. 7082.0700, subp. 4 Items B. C, and D; 7083.0730 hem 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): 4/U2026
Certificate of sewage tank compliance
❑ tj,)tine of sewage tank non-compliance
Compliance criteria:
The SSTS has a seepage pit, cesspool, drywell, leaching pit, or other pit -"Failure to Protect
Groundwater."
The SSTS has a sewage tank that leaks below the designed operating depth - "f-ailirre to Protect
Groundwater."
The SSTS presents a threat to public safety by reason of structurally unsound ( ! .,n.r :ed. cracked, or
weak) maintenance hole cover(s) or lids or any other unsafe condition - "Immi, icnt Threat to Public
Health or Safety"
Any "yes" answer above Indicates sewag. ik ,, -.,,i ; ompliance.
Company information
Company name: Kothrade Sewer, Water & Excavating, Inc
Business license number: MPCA 192
Yes' 1y�- to
❑ Yes" QM
❑ Yes•, :mo
Designal,.-d Certirr�d Individual (DCI) information
Print na-
Certifrcr-
L- sch
ni. .:,, C9199
l penbrraAy conducted the work described above as a Designated Certified Irur or a nainnesota4censed SSTS Mairrtenanoe
Business. l personally conducted the necessary procedures to assess the cov, int • • ; ; s of each sewage tank in this SSTS.
By typing/signing my name below, l car* the above sta ments to be true a -4 cn - refn ef. the best of my knowledge, and that
this information can be used for the pu►pose of processir�Ts form.
Designated Certified Individual's signature: 1 Date (mm/dd/yyyy): 7 ~ 7 e
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Page 3 of 3
Soil Observation Log
www.SepticResource.com vers 12.4
Owner Information
Property_ Owner / project: Date 4/7/2026
Property Address / PID: 4665 West Branch Road
Soil Survey Information ❑ refer to attached soil survey
Parent matl's: [21 Till ❑ Outwash ❑ Lacustrine ❑ Alluvium ❑ Organic ❑ Bedrock
landscape position: ❑ Summit ❑ Shoulder p Side slope ❑ Toe slope
soil survey map units: 1-41 C2 slope % direction- Linear
Soil Log #1
Q Boring ❑ Pit Elevation 104.3 Depth to SHWT 58 Inches
Depth (in) Texture fragment % matrix color redox color consistence grade shape
0-32
Mound sand fill
<35
32-54
Loam
<35
10yr2/1
Friable
Strong
Blocky
54-58
Clay Loam
<35
10yr4/3
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
Comments:
P SURV f C ES, INC. • 743-4-M-1 2(
CITY OF d ✓t/'Y"�t
WORKSHEET FOR SEWAGE DISPOSAL WORK
41141�.�1)�1n 0� ! ��:fY►►iLr. �yf'.rn Building
Date -/---_ ,C)
Permit No. 26OV" 003s;
Fee
Property Address�� S� LAI-eS+ )3" "cA, W of Building
—
Plumbing �
3
Plumbing Contractor -Outside Sewage Disposal AL14
Septic Tanks
Material ClMGYL C�i'1,�lh.-- Capacities"
Proper Outlet & Inlet? Baffle Plates? —
Drain Field:
r
Total length of lines% Number of lines 3
Type of soil �lr.G— Percolation Test
Width of trench Type of filter material
Amount of filter material below line
Depth from top of tile to finished grade
Check Vents >f Check Caulking •—✓�
Check Grade in Horizontal Waste Pipes �~ Clean Outs
Tonage or Yards of Filter Material ItgOU64.5, Total Sq. Footage of Drain Field Y/0
Sand x Rock
Overall Size of Mound System N5 Size of Mound System Rock Filter Material i --
Draw detailed diagram to scale with measurements below.
4: L V,
1
1't;'yr I
S-P TESTING, INC. Steven B. Schirmers - MPCA Cert.No. 627
951 Katydid Lane NE - St. Michael, MN 55376 - (763) 497-3566
FAX - (763) 497-5011
State License #394
Carmen Coyle
4665 West Branch Rd.
Orono, Henn. Co., MN
Borings completed on 4-28-08, with a hand bucket auger.
BORING NUMBER 1- Elev.101.7 - MOTTLED SOIL AT 24" - standing water present in the boring
at 14", 26 hours after the boring.
0 -
10"
Topsoil dark brown loam 10YR 3/3
10" -
14"
Brown clay loam 10YR 4/3
14" -
24"
Yellowish brown clay loam 10YR 5/6
24" -
32"
Yellowish brown clay loam 10YR 5/6 - distinct mottles 10YR 7/1, 10YR 6/8
32" -
38"
Pale brown clay loam 10YR 6/3 - distinct mottles 10YR 7/1, 10YR 6/8
38" -
48"
Gray brown silty loam 10YR 512 - distinct mottles 10YR 7/1, 10YR 6/8
BORING NUMBER 2- Elev.101.4 - MOTTLED SOIL AT 28" - standing water present in the boring
at 16", 26 hours after the boring.
0 -
18"
Topsoil dark brown loam 10YR 3/3
18" -
28"
Dark gray brown loam 10YR 4/2
28" -
36"
Dark gray brown clay loam 10YR 4/2 - distinct mottles 10YR 6/8
36" -
48"
Gray brown clay loam 10YR 6/2 - distinct mottles 10YR 711, 10YR 6/8
BORING NUMBER 3- Elev.101.9 - MOTTLED SOIL AT 24" - standing water present in the boring
at 11", 26 hours after the boring.
0 - 12" Topsoil dark brown loam 10YR 3/3
12" - 24" Brown clay loam 10YR 4/3
24" - 32" Brown clay loam 10YR 5/3 - distinct mottles 10YR 6/8
32" - 36" Brown clay loam 10YR 5/3 - distinct mottles 10YR 7/1, 10YR 6/8
Ti
ri
0
Pi 9'
rr
rr
Em