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Home My WebLink About11-06-2015 Septic Compliance Inspection f �� MinnesotaPollution Compliance Inspection Form -�- Control Agency 520 Lafayette Road North Existing Subsurface Sewage Treatment Systems (SSTS) St.Paul,MN 55155-4194 Doc Type:Compliance and Enforcement Inspection results based on Minnesota Pollution Control Agency(MPCA) For local tracking purposes: requirements and attached forms—additional local requirements may also apply. Submit completed form to Local Unit of Government(LUG)and system owner within 15 days System Status System status on date(mm/dd/yyyy): 11/06/2015 � Compliant— Certificate of Compliance ❑ Noncompliant— Notice of Noncompliance (Valid for 3 years from report date, unless shorter time (See Upgrade Requirements on page 3.) frame outlined in Local Ordinance.) Reason(s)for noncompliance (check all applicable) ❑ Impact on Public Health (Compliance Component#1)—Imminent threat to public health and safety ❑ Other Compliance Conditions (Compliance Component#3)—Imminent threat to public health and safety ❑Tank Integrity (Compliance Component#2)—Failing to protect groundwater ❑ Other Compliance Conditions(Compliance Component#3)—Failing to protect groundwater ❑ Soil Separation (Compliance Component#4)—Failing to protect groundwater ❑ Operating permiUmonitoring plan requirements (Compliance Component#5)—Noncompliant Property Information Parcel ID#or Sec/Twp/Range: Property address: 4355 Bayside Road Reason for inspection: Replacement system Property owner: Greg White Owner's phone: or Owner's representative: Hayes and Sons Representative phone: (763)479-1762 Local regulatory authority: City of Orono Regulatory authority phone: 952-249-4600 Brief system description: Type I Mound Comments or recommendations: Replacement 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. Inspector name: Roger Peitso Certification number: C6683 Business name: License number: Inspector signature: Phone number: 952-249-4625 Necessary or Locally Required Attachments ❑ Soil boring logs ❑ System/As-built drawing ❑ Forms per local ordinance ❑ Other information(list): www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats wq-wwists4-31b • 6/4/14 Page 1 of 3 Property address: 4355 Bayside Road Inspector initials/Date: RLP � 11/06/2015 (mm/dd/yyyy) 1. Impact on Public Health —Compliance component#1 of 5 Com liance criteria: Verification method(s�: System discharges sewage to the ❑Yes � No ❑ Searched for surface outlet round surface. ❑ Searched for seeping in yard/backup in home System discharges sewage to drain ❑Yes � No ❑ Excessive ponding in soil system/D-boxes tile or surface waters. ❑ Homeowner testimony(See Comments/Explanation) System causes sewage backup into ❑Yes � No ❑ "Black soil"above soil dispersal system dwelling or establishment. ❑ System requires"emergency"pumping Any"yes"answer above indicates the ❑ Performed dye test system is an imminent threat to public ❑ Unable to verify(See Comments/Explanation) health and safety. ❑ Other methods not listed (See Comments/Exp/anation) Comments/Explanation: Replacement system Type I Mound 2. Tank Integrity— Compliance component#2 of 5 Com liance criteria: Verification method(s): System consists of a seepage pit, ❑Yes � No ❑ Probed tank(s)bottom cesspool, drywell, or leaching pit. ❑ Examined construction records Seepage pits meeting 7080.2550 may be ❑ Examined Tank Integrity Form (Attach) com liant if allowed in local ordinance. Sewage tank(s) leak below their ❑Yes � No � �bserved liquid level below operating depth designed operating depth. ❑ Examined empty(pumped)tanks(s) If yes,which sewage tank(s)leaks: ❑ Probed outside tank(s)for"black soil" AI1y "yes"answer above indicates the ❑ Unable to verify(See Comments/Explanation) system is failing to protect groundwater. ❑ Other methods not listed (See Comments/Explanation) Comments/Ezplanation: Existing tanks inspected and passed by pumping contractor 3. Other ComplldnCe CondltlOns—Compliance component#3 of 5 a. Maintenance hole covers are damaged,cracked, unsecured,or appear to be structurally unsound. ❑Yes* �No ❑Unknown b. Other issues(electrical hazards,etc.)to immediately and adversely impact public health or safety. O Yes* �No ❑Unknown *System is an imminenf threat to public health and safety. Explain: c. System is non-protective of ground water for other conditions as determined by inspector. p Yes` �No *System is failing to protect groundwater. Explain: www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats wq-wwists4-31b • 6/4/14 Page 2 of 3 Property address: 4355 Bayside Road Inspector initials/Date: RLP � 11/06/2015 (mm/dd/yyyy) 4. $oil Separation— Compliance component#4 of 5 Date of installation: 11/6/2015 ❑ Unknown Verification method(s): (mm/dd/yyyy) ShorelandNVellhead protection/Food beverage Soil observation does not expire. Previous soil lod �n � ❑Yes � No observations by two independent parties are sufficient, 9 9� unless site conditions have been altered or local Com liance Criteria: requirements differ. For systems built prior to April 1, 1996, and ❑Yes ❑ No ❑ Conducted soil observation(s) (Attach boring/ogs) not located in Shoreland or Wellhead Protection Area or not serving a food, ❑ Two previous verifications(Attach boring logs) beverage or lodging establishment: ❑ Not applicable(Holding tank(s),no drainfie/d) Drainfield has at least a two-foot vertical ❑ Unable to verify (See Comments/Explanation) separation distance from periodically ❑ Other(See Comments/Explanation) saturated soil or bedrock. Non-performance systems built April 1, �Yes ❑ No Comments/Explanation: 1996, or later or for non-performance systems located in Shoreland or Wellhead Mound Replacement Protection Areas or serving a food, beverage, or lodging establishment Drainfield has a three-foot vertical separation distance from periodically saturated soil or bedrock." "Experimental", "Other", or "Performance" ❑Yes ❑ No Indicate de ths or elevationS systems built under pre-2008 Rules; Type IV or V systems built under 2008 Rules(7080. A. Bottom of distribution media 2350 or 7080.2400 (Advanced Inspector License required) B. Periodicall saturated soil/bedrock Drainfield meets the designed vertical C. S stem se aration separation distance from periodically saturated soil or bedrock. D. Re uired com liance se aration" Any "no"answer above indicates the system is *May be reduced up to 15 percent if allowed by Local failing to protect groundwater. ordinance. 5. Operating Permit and Nitrogen BMP*— Compliance component#5 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? ❑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. Com liance criteria a. Operating Permit number: Have the O eratin Permit re uirements been met? ❑Yes ❑ No b. Is the re uired nitro en BMP in lace and ro erl functionin ? ❑Yes ❑ No Any "no"answer indicates Noncompliance. Upgrade Requirements(Minn. Stat.§115.55)An imminent threat to public health and safety(ITPHS)must be upgraded,replaced,orits 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/oca/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,rep/aced,or its use discontinued,nohvithstanding any local ordinance that is more strict. This provision does not apply to systems in shore/and areas, Wellhead Protection Areas,or those used in connection with food,beverage,and lodging establishments as defined in law. www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats wq-wwists4-316 • 6/4/14 Page 3 of 3