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HomeMy WebLinkAbout280 Hollander Road - Septic ComplianceM 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 (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/default/files/wq-wwists4-31a.pdf. Property information Local tracking number: Parcel ID# or Sec/Twp/Range: 2511823430012 Reason for Inspection Property Transfer Local regulatory authority info: City Of Orono, (952) 249-4600 Property address: 280 Hollander Road, Orono Owner/representative: Mox Gunderson Owner's phone: 651-231-6106 Brief system description: 2-1300-gallon septic tanks, 1-1300-gallon lift station and 620 Square feet Rock bed System status System status on date (mm/dd/yyyy): 6/9/2026 Compliant — Certificate of compliance* ❑ Noncompliant — Notice 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 An imminent threat to public health and safety (ITPHS) must be a shorter time frame exists in Local Ordinance.) 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 1.2 feet of sand under the uphill side of rock bed, Included are two sets of soil verification boring logs. There is a filer in the second tank that will require periodical maintenance. 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 Tesbng __ Certification number: C1255 Inspector signature: Jose h J. Olson License number: L810 (This document has been electronically signed) Phone: 763498-8779 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): https://www.pca.state.mn.us 651-296-6300 800-657-3864 Use your preferred relay service Available in alternative formats wq-wwists4-31b • 412812021 Page 1 of 4 Property Address: 280 Hollander Road, 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 tile 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: 6/9/2026 Attached supporting documentation: ❑ Other: Not applicable 2. Tank integrity — Compliance component #2 of 5 Compliance criteria: �❑ System consists of a seepage pit, I0 Yes' ® No cesspool, drywell, leaching pit, or other pit? Sewage tank(s) leak below their ❑ Yes" ® No designed operating depth? Ids, which sewage tankO leaks: _ L_ Any "yes" answer above indicates the system is failing to protect groundwater. Describe verification methods and results: Elmer J Peterson Company 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 5/20/2026 (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: https://www.pca.state.mn.us 651-296-6300 800-657-3864 Use your preferred relay service Available in alternative formats wq-wwists4-31b • 412812021 Page 2 of 4 Property Address: 280 Hollander Road, Orono Business Name: Rusty Olson Soil & percolation Testing Date: 6/9/2026 I 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? 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 ❑ 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) ❑ https://www.pca.state.mn.us 651-296-6300 800-657-3864 Use your preferred relay service Available in alternative formats wq-wwists4-31b • 412812021 Page 3 of 4 Property Address: 280 Hollander Road, Orono Business Name: Rus Olson Soil &percolation Testing 5. Soil separation — Compliance component #5 of 5 Date of installation 7/7/2005 ❑ Unknown (mm/ddlyyyy) 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 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: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. Date: 6/9/2026 Attached supporting documentation: ❑ Soil observation logs completed for the report ® Two previous verifications of required vertical separation ❑ Not applicable (No soil treatment area) ® Yes ❑ No* Indicate depths or elevations A. Bottom of distribution media 102.9 B. Periodically saturated soil/bedrock 100.1 C. System separation 2.8 D. Required com liance se aration* 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 (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. https://www.pca.state.mn.us 651-296-6300 800-657-3864 Use your preferred relay service Available in alternative formats wq-wwists4-31b • 412812021 Page 4 of 4 Tank Report Tamer I Peterson Co. 5921 Dague Ave. Delano, MN 55328 Phone 763-972-2Wo fax 763-972-7217 MPC,A License# 21J Mox Gunderson 280 Hollander Road Orono, MN 651-231-6106 Raffles: (OaNOFF Tank Capacity: 3-1300 Gallon Tanks # of Tanks: 3 Type of Tanks: _ Gallons Pumped: Concrete 3500 Manholes to (trade: YES / NO Comments: Date: May 20.2026 On May 20, 2026, Elmer J. Peterson Co. pumped septic tanks and cleaned filter in 2,,d tank. Wood chips over 2"d manhole and lift station manhole. No cracks or water leaking in tanks at the time of pumping. NOTE: This is only a tank report. This is not a compliance inspection for point of'sale nor does it replace a compliance inspection. M MINNESOTA POLLUTION Sewage tank integrity rit assessment form CONTROL AGENCY 520 Lafayette Road North Subsurface Sewage 5t. Paul, NN 55155-4194 Treatment Systems (SSTS) Program Luc Type: 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: httos://www.i)ca..state.mn us/waterhospections. Instructions: This form may be completed, and signed, by a Designated Certified Individual (DCI) of a licensed SSTS inspection, maintenance, 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 information 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 becornes necessary supporting documentation to an Existing System Compliance Inspection Report: Compliance ins ection form -Existing system (wg-wwists4_31W. This form can be found on the MPCAwebsite at https.//www.pca_state.mn.us/water/inspections. 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(6)(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(8),(C). and (D) and, Minn. R. 7083.0730(C). Owner information Owner/Representative Mox Gunderson Property address: 280 Hollander Road Orono, MN _ Local Regulatory Authority: Parcel ID: System status System status on date (mm/dd/yyyy). 5/20/2026 Certificate of sewage tank compliance L7 Notice of sewage tank non-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- ® No 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 ❑ Yes- ® No Public Health or Safety." Any "yes" answer above indicates sewage tank non-compliance. Company information Company name: Elmer J. Peterson Cc Business license number: 219 Designated Certified Individual (DCI) information Print name: James L Brae eg Imann Certification number: I personally conducted the work described above as a Designated Certified 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 SS TS. 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. Designated Certified Individual's signature: James L Braegelmann Date (mm/dd/yyyy): 5/20/2026 (This document has been electronically signed.) www.pca.state.mn.us 651-296-6300 800.657-3864 Jse your preferred relay service Available in alternative formats wq-wwists4-91 • 5110121 Page 1 of 1 Sep 30 2016 06:07AM HP FaxRusty Olson 7634988290 page 8 Soil Observation Log www.Septicitmurce.com vers 12.4 Owner Property Owner / project: Jilt Payne Date 9/2/2016 Property Address i PTD: 280 Hollander Road Soil Survey Infornwtion ❑ refer to attached sou survey Parent matl's: Q rn p Outwash ❑ law#Ane [] &Ann ❑ Organic ❑ Bedrock landscape Position: ❑ Summit ❑ Shoulder [] Side slope ❑ Toe slope soil survey neap units: L701)2 L22D2 slope % direction- Lineal Soil Log #1 (� Boring [ Pit Elevation 1,002.7 Depth to SHWT 32 inches Depth (in) Texture fragment °Yo matrix color redox color consistence grade sh loose loose sinQleStain 0-12 Fill <35 friable weak grsntilw blocky firm roderate Pie PlatY rigid strong 12-20 Topsoil <35 10yr3t2 Loose Loose Siaglegrein 20-26 Loam <35 10yrV3 Friable Strong Blocky 26-32 Clay Loam <35 1Oyr5i4 Firm Strong Slocky 32-40 Clay Loam <35 1OyrSl4 IOy4i8,1-6tIOy Firm Moderate Plow Comments: Sep 30 2016 0&07AM HP FaAlusty Olson 76349W90 page 9 280 Hollander Road Soil L #2 D Wng ❑ Pit Elevation 97.7 Depth to SHWT 36 inches De (in) Texture fragment % matrix color redox color consistence amde shape loose loose single $rzin 0-28 Fill <35 10yr3n friable weak emsW bbft firm moderate prismatic platy rigid won& massive 28-36 Topsoil 45 10yr4/2 loose Loose Single grain 36-42 Clay Loam <35 10yr5/4 I0y4/8,1-6/l0y Firm Strong Prismatic <35 loose loose silk grain 35 - 50 friable weak VvWu blwky >So firm moderate prismatic Wiry rigid strong massive <35 loose loose �. 35 - 50 friable weak granular bbeky >50 firm moderate prismatic platy rigid strong massive 280 Hollander Road Soil Log #3 D Boring ❑ Pit Elevation Depth to SHWT Depth in Texture anent % matrix color redox color consistence grade shape <35 loose loose single grain 35 - 50 friable weak granular blocky >50 firm moderate Pik Piety rigid strong massive <35 loose 10030 single grain 35 - 50 friable weak grwAdw bbl >50 firm moderate Prismatic Plate' rigid strongmaaaive <35 loose loose h*k vain 35 - 50 friable weak granul r block > AM moderate Pr c Pwy rigid strongmassive <35 loose loose si*e grain 35 - 50 friable weak grmmlar blocky >50 firm moderate Prismatic platy rigid sttxtng maBBivs <35 loose loose tingle grain 35 - 50 E friable weak granular blocky >50 firm moderate Pri�c Platy rigid strong Imassive I hereby certify this work was completed in accordance with AIN 7080 and any local req's. Rusty Olson's Soil & Pem 810 r . 'Baer Signature Company License 1v w c hti S 96ed O6Z8 MI. u0s10 AlsnUxed dH WY9990 M? OE dO5 SwP 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 Jill Payne 280 Hollander Rd. Orono, Henn. Co., MN Borings completed on 4-21-05, with a hand bucket auger. BO.R NI G NUMMA J., Elev.1.09.6 - MOTTLED SOIL AT 22" - no standing water present in boring. 0 6" Topsoil dark brown day loam 10YR 4/2 6" - 12" Yellowish brown clay loam 10YR 5/4 12" - 22" Yellowish brown day loam 10YR 5/6 22" - 38" Rusty yellowish brown clay loam 10YR 5/6 - mottles 10YR 7/1,6/8 38" - 48" Rusty pale brown loam 10YR 6/3 - mottles 10YR 7/1,6/8 WRING NUMBER 2- Elev.110.2 - MOTTLED SOIL AT 22" - no standing water present in the boring. 0 - 6" Topsoil brown day loam 10YR 4/2 6" - 22" Brown day loam 10YR 4/3 22" - 38" Rusty brown day loam 10YR 5/3 •mottles 10YR 7/1,6/8 38" - 48" Rusty brown loam 10YR 513 - mottles 10YR 7/1,6/8 BORING NUMBER 3- Elev.111.3 - MOTTLED SOIL AT 24" - no standing water present in the boring. 0 - 6" Topsoil dark brown loam 10YR 3/2 6" - 12" Brown clay loam 10YR 4/3 12" - 24" Yellowish brown day loam 10YR 5/4 24" - 42" Rusty yellowish brown day loam 10YR 5/5 - mottles 10YR 7/1,6/8 42" - 48" Rusty yellowish brown loam 10YR 5/6 - mottles 10YR 7/1,6/8 m ra B W cc SEPTIC SYSTEM INVENTORY Site Address: 280 Hollander Rd PID 25-118-23-43-0012 Owner Name: Byron & Jill Payne Owner Address: 280 Hollander Rd Wayzata MN 55391- BuildingTvpe: residence Installer: E. Peterson Date of Permit: 7/06105 System Type: mound BR's Designed for 5 In Musa?: No Shoreland?: Yes SEPTIC TANKS: Material: precast concrete Capacity: 1300,1300,1300 Tank Filter: y DRAINFIELD: Treatment Area: 620 Soil Boring: yes DF Ht above Wt: 3 WELL DATA Setbacks - Well Tanks: 75 Well DF: 75 Report In File: Depth: 288 Date Notes 8/1/2006 OK 7/7/2005 installation 8/12/2004 non-com 8/1/2002 non-compliant,replace by 12/31/2010 10/3/2000 non -compliant, repair by 12/31/2010 11/20/1998 non -compliant -repair by 12/31/2005 5/19/1995 no surfacing -pump tanks 8/4/1992 no surfacing 7/4/1990 no surfacing 3/6/1987 no surfacing 9/26/1985 no surfacing 4/17/1980 pump setup complete 1/2/1980 installation Date GallonsOfLiquid 9/9/2015 3000 5/10/2013 3000 10/6/2009 0 7/5/2005 2000', 5/21/2003 2000 5/31/2000 2000. 5/31/1995 2000 10/4/1990 1500 10/19/1987 1500 -t ,dA