HomeMy WebLinkAbout1650 North Farm Road - Septic ComplianceMINNESOTA POLLUTION Compliance inspection report form
CONTROL AG
ENCY
ENCY �
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://wvww.pca.state.mn.us/sites/default/files/wg-wvvists4-31 g.pdf.
Property information Local tracking number:
Parcel ID# or Sec/Twp/Range: 2711823440009 _ Reason for Inspection JPropery Transfer
Local regulatory authority info: City of Orono
Property address: 1650 North Farm Road
Owner/representative: Paul Mack Owner's phone: 612-423-3332
Brief system description: Approximately 2-1250-gallon septic tanks, 1-1250-gallon lift station and 500 square feet of mound rock bed.
System status
System status on date (mm/dd/yyyy): 6/17/2026
E 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 (I TPHS) 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
This system is designed for a four bedroom house.
There is 1.1 feet of sand under the West end of the rock bed. There is 3.1 feet of sand under the East end of the rock bed.
TBM: Top of the garage floor slab. 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 &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 Z Tank Integrity Assessment ❑ Operating Permit
❑ Other information (list):
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Property Address: _1650 North Farm Road__
Business Name: Rustv Olson Soil & percolation Testin
1. Impact on public health —Compliance component #1 of S
Date: 6/17/2026
Compliance criteria: Attached supporting documentation:
System discharges sewage to the 1RYes% i] No ❑ Other:
ground surface
I E Not applicable
System discharges sewage to drain 'El Yes ® No
the or surface waters.
System causes sewage backup into ❑ Yes EJ 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
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?
❑ Yes* ® No
If y s,_which sewaoe tank(s) leaks:
Any "yes" answer above indicates the system
is failing to protect groundwater.
Describe verification methods and results:
Duane's Septic Service 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 6/12/2026
(mm/dd/yyyy): (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: 1650 North Farm Road
Business Name: Rustv Olson Soil & percolation Testinq Date: 6/17/2026
3. Other compliance conditions —Compliance component #3 of 5
3a. Maintenance hole covers appear to be structurally unsound (damaged, cracked, etc.), or unsecured?
❑ Yes E No ❑ Unknown
3b. Other issues (electrical hazards, etc.) to immediately and adversely impact public health or safety? ❑ Yes ® No [:1 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? F] Yes E 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 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: 1650 North Farm Road
Business Name: Rusty Olson Soil & percolation Testing
5,, Soil separation — Compliance component #5 of 5
Date of installation 03/18/1997 ❑ Unknown
41111niuwyyyyj
Shoreland/Wellhead protection/Food ® Yes ❑ No
beverage lodging?
Compliance criteria (select one):
5a. For systems built prior to April ?, 1996, and
not located in Shore/and 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
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"
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,
❑ Yes [ 1 No
Date: 6/17/2026
Attached supporting documentation:
E Soil observation logs completed for the report
❑ Two previous verifications of required vertical separation
❑ Not applicable (No soil treatment area)
1-1
Yes ❑ No Indicate depths or elevations
A. Bottom of distribution media 100.2
B. Periodicals saturated soil/bedrock 97.2
C. System separation 3.0
D. Required compliance separation* 2.55
*May be reduced up to 15 percent if allowed by Local
Ordinance.
❑ Yes ❑ No --
*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 (ITPNS) 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 pOLLUT10j'*' Sewage tank integrity assessment form
CONTROLAGENCY
520 Lafayette Road North Subsurface Sewage
St. Maui, MN 55155-4194 Treatment Systems (SSTS) Program
Doc rye: 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:
tts-11vNi.� ..,�. �tl �ter ectlor s.
Instructions: This form may be completed, and signed, by a Designated Certified Individual (DCi) of a licensed SSTS inspection,
Mai- tc-0 R nce, 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 infarrnafion 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 suppoift documentation to an Existing
System Compliance Inspection Report: Compliance insertion forrn Exi:;tIn !yat(jarn � _q -%, rwis_ts4—,31, b). This form can be found on
the MPCA website at https:/iyr,yw pc state (411LIS!"eater/inspections.
The lnformabon 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, sump. 4(13)(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
Property address: 4.0 jQ0 r +0
Local Regulatory Authority: 0 runty'
System status
Parcel 1D:
System status on date (mmiddlyyyy): Zf
certificate of sews a tank co pliance [] Notice of sewage tank non-compliance
g
Compliance criteria:
The SSTS has a seepage pit, cesspool, drywell, leaching pit, or other pit - "Failure to Protect Yes No
it
�3roundwater,
The SSTS has a sewage tank that leaks below the designed operating depth - "Failure to Protect
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
Public health or Safety."
C3 Yes 7 01GO
'-O�
❑ Yes' No
Company information Designated Certified individual (DCQ information
Company name: DuanWs Septic Service LLC Pant name: J1 (A.'t E tt
Business license number: L4288 Certification number: C"...
r
I personally conducted the work described above as a Designated Ce&ifed 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 typinglsigning my name below, 1 cerdfy the above statements to be true and cormct, to the best of my knowledge, and that
this information can be used for the purpose of ing this form.
Designated Certified individuals signature; 5:7Date (mrnldd/yyyy): 1
(Th dc�cctunent electro»ically signed. j
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Property Owner /project:
Property Address / PID:
Soil Observation Log
Owner Information
Paul Mack
1650 North Farm Road
w xm. SepticResource. com veers 12.4
Date 6/ 1.1 /2026
Soil Surve Information ❑ refer to attached soil survey
Parent matl's: Q Till ❑ outwash ❑ Lacustrine ❑ Alluvium ❑ organic ❑ Bedrock
Landscape position: ❑ Summit ❑ Shoulder Cam] Side slope ❑ Toe slope
soil survey map units: L 123A slope % direction -
Soil Log #1
L7 Boring ❑ Pit Elevation 101.6 Depth to SHWT 54 inches
Depth (in) Texture fragment % matrix color redox color consistence grade shape
0-30
Fill
<35
3 0-40
Loam
<3 5
1 Oyr2/ 1
Friable
Strong
Blocky
40-44
Loam
<3 5
1 Oyr4/3
Friable
Strong
Blocky
44-54
Clay Loam
<3 5
1 Oyr5/4
Friable
Strong
Blocky
<3 5
loose
loose
single grain
35-50
friable
weak
granular blocky
firm
moderate
prismatic platy
>50
rigid
strong
massive
Comments:
CERTIFICATION 4 00627 Logs of Soil Sor
Location or Project 0. Terry DahlstromFLot8rBlk,1j The Farm at Long Lake, Orono
IBQriqgs made by S-P Testing,* Inc. Steve Schirmers Date 6-23-95
Classifiction System: AASHO USDA-SCS X Unified Other
Auger used (check two): Hand X or Power, Flight or Bucket x
Depth,
Boring number
Depth, Boring number 4
in
in
feet
Surface elevation
ifeet Surface elevation 993.6
0
_____
0 Topsoil dark brown loam
Topsoil very dark
brown loam
0 - 1011
0 loll
1 brV g
Gray brown loam
101f - 11411
vau to
�-10 11411-MOTTLED 114
ftay
Rusty olive brown clay loam
CAM
11411 - 11101'-MO�PTLED 111C
2
2 Rusty olive brown clay loam
Very dark gray
1
110" - 2-1/ 2'
3
clay loam
3 Rusty olive gray
clay loam
2-1/2' - 3-1/ 2'
4
4
5 11411 51 5
6
6 -
7
7
8
8
End of boring at 51, feet.
Standing water table:
present at 4'4" feet of depth,
18 hours -after boring,
Not present in hole .0
Mottled soil:
Observed at 1'4"
feet of depth.
Not present in hole
Comments:
End of boring at 3-1/21 feet.
Standing water table:
present at feet of depth,
hours after boring.
Not present in hole x
Mottled soil:
Observed at 1110" feet of depth.
Not present in hole
Comments:
CERTIFICA7'ION 4 00627 Logs of Soil Borin
Locatio'n or Project Terry Dah1stromILot8fBlk,1.fThe Farm at Long Lake,Orond
Borings made by g-P Testinq.A Inc* Steve Schirmer s me. Date--- 6-23-95
Class if fiction System: AASBU USDA-SCS X Unified ; Other
Auger used (check two) Hand X or Power, Flight.._.., or Bucket x
Dep . the
Boring number 5
Depth, Boring number 6
in
in
feet
surface elevation 993.4
feet Surface elevation 993.*2
0
0
Topsoil dark brown
Topsoil dark brown
loam
0 - 1011 loam
0 11
rown 1011 11211 loam
Brown clay loam
11 - 111011-MOTTLED 11101
Brown clay loam
2
2 1 ' 2 " - 2'2"-MOTTLED 22'
Rusty olive brown
clay loam
Rusty olive brown
clay loam
3
111011 - 31211
3 212#1 - 3 14"
Rusty olive brown
loam
31211- 41
4 Rusty olive brown
4
loam
Ru.sty 4 & . 4-1/2' gf8xm5ilty
Rusty" olive brown loam
4-1/21 - 51
31411 50
5
5
6 -
7 -
8 --
End of boring at 59- feet,.
Standing water table:
present at feet of depth,
hours after boring.
Not present in hole x
Mottled soil:
Observed at1'10"
---feet of depth.
Not present in hole
Comments:
RM
7 -
8 �n
End ofboring at 5 f eet
Standing water table:
present at feet of depth,
hours after boring.
Not present in hole x
Mottled soil:
Observed at 21211 feet of depth.
Not present in hole
domments:
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