HomeMy WebLinkAbout2015-00619 - septic CITY OF ORONO * Z QJ 1 5 - 0 0 6 1 9 *
2750 KELLEY PARKWAY DATE ISSUED: OS/26/2015
' ' ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 2450 COUNTRYSIDE DR
PIN : 04-117-23-11-0004
LEGAL DESC : COUNTRYSIDE MANOR
: LOT 002 BLOCK 001
PERMIT TYPE : SEPTIC
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : NEW OR REPLACEMENT(SEPTIC SYSTEM)
ACTIVITY : MOUND SYSTEM-SEPTIC
APPLICANT SEPTIC NEW OR REPLACEMENT 400.00
STATE SURCHARGE SEPTIC 5.00
BURNS EXCAVATING, INC. TOTAL 405.00
3470 CO. RD 21
MAYER, MN 55360- Payment(s)
(612)685-4303 CHECK 26525 405.00
Minnesota State License#: SW-1888
OWNER
& S GRANDE, LORRAINE KRETCHMAN
2450 COUNTRYSIDE DR
LONG LAKE, MN 55356-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additional or celated work which requires separate
permits. All provisions of laws and ordinances governing this type orwork
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any[ime afrer work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
- _ � S �-�i��
Applicant Permitee Signature Date Issued By Signature Date
05/18/2015 14:15 952-955-5071 BURNS EXCAVATING PAGE 02
City o�OfOno +, Iit�Ry+C17Y'u�E`ON4�Y
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�V 2754 Kelley pafkwaY l��'t�'sRA!t�W'�t�!�� P��!� /�— �/ J
Grystal Bay,MN 55323
� j952)249-4800 �i��+� . �; ,� - � `.�''1)
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CfTY �F ORONO—3�PTIG SYSTEM P�RN!'IT APPLICATION
(,411 pemtlts must he appro�ed by the OnSite Septic Manager and/or Bulltling Offlciaq
Site Address: <�!�U "Grt,;�,i��' I�,i '��L�. i�i�f�t�
Owner: � ci��1�c'��hze�n� �Lnl�6���,�1�: Mailing Address: z�! ` _�" �, tz �y�fr� L�;�.'��
ci�Y� �1�� .. �Zip: � ,..� '�.3"7r
Home Phone:� ,. �_ Alternate Phone:
Con#ractor/ApP�- � ContaGt Person: _� ,"�-�.r�: ?�t�t���,�;,,
Address: �j„��;� ('��i���-�/ ����( �j State �icense#; j�_�
C�ry: � Zip: �;:5�l,at^> Explratlon Date: ����'�Zt�l�
Phane: ���Z.� ���- �3 l 17 Alternate Phone; jQal Z} /4� "'.��/3�r�'
,,�,::='��,��:��
� Residential ❑ Commercial ❑ Other
r
New or Repiacement System $4QO.d0 � �
F2epair�xis#ing System 100.00
(Tanks or Qrainfleld)
State Surcharge 5.00 5.00
T�t91 4 ' r- �:a.�
1 /2
05/18/2015 14: 15 952-955-5071 BURNS EXCAVATING PAGE 03
!wlll he i�nstalling the following.
Ta ks
'� Precast Concrete ❑ Fiberglass ❑ Plastic [] Other
(Ils!manufaclurer)
Number af Tanks: 3
Sfze of Tanks: �;��., �� _
Treatment System
Trenches S,#,
� Mound ��z- s.f.
Grav�l less s.f.
Chamber _ g,�,
NOTE: The contr�cto�r is required tv pro�id� an As-Built of the systern befare the
final inspectlan.
The undersigned hereby applies to the Ci#y of Orono for fssuance of a septic system
inst2�ll�tion permit, agrees to do all the work in striCt accordance with ordin�nces of the City
and regulations of th� State of Minnesata and c�rtifies that alI statements made on this
application are camplete, true and cornect.
Signature of Applicant ��t�-e��, g ���P; � � ���
MPCA License No.: ��
S'taff Ro�iew: ❑ Accept ❑ Denlad
Reviewer: Date:
Reason fior Denlal:
Camments (to b� printed on Insp�ctivn cardy:
zrz
05/18/2015 14: 15 952-955-5671 BURNS EXCAUATING PAGE 04
CITY OF ORbNO �SEPTiC SYST�M PERNlIT ApPLICA7IQN
1. Applications for septic system permits may be mailed or submitted in person at the City
offices; however, permits will not be mailed out. The permit must be picked up in person at
the City offices and work mus# not begin unles5 the permit card is on the job site.
'��'* DQ NOT MAfL PAYMENT WNTH THIS AppLICATION **"
2. Permits will be only issued to cantractors holding a Mfr�nesofia Pollution Controf Agency
(MPCA) Septic Sysfem Install�rs License.
3. All wark must be done in accordance with the appro�ed septic system design.
4. The following inspect�ons will be required for all sept�c systems:
A. 7ank instalfation prior to covering,
B. Dr�infield trench installation prior to covering. For mounds, inspection is required after
rough up, but prior #a sand placement (sand must be jar tes#ed for silt conten#} and
again during pressure distribu#iQn piping ins#affation in the rQck bed.
C. Final inspection to weri�fy final cover depths and to verify that al! pump s#ation (where
required) companents ar�fiunctional and camply with codes.
5_ MPCA lir,�nsed Installers or their DRP (Designated Resppnsible Person) shall be present
during all inspections.
A za�HOUR NOTrCE IS REQUiR�D FOR ALL inlSPECTIONS.
3 /2
�°`�o SEPTIC SYSTEM APPROVAL
y � Street Address: Mailing Address: Telephone: (952)249-4600
`�t,y �,� 2750 Kelley Parkway PO Box 66 Fax: (952)249-4616
kESHO� Orono, MN 55356 Crystal Bay, MN 55323 www.ci.orono.mn.us
Address: o�yi��3 �o�+��`�ys��e� �,t, �I'� Home Phone:
Owner: �� ��4 �c,�,a,�,�,� '�— �. � ��-��s. Work Phone:
Site Evaluator: I��S X-r D�Se.� State License#
Site Evaluator Phone Number: ���
7
Garbage Disposal? Yes .No Number of bedrooms: _� Est. gallons per day: �o�D
Water meter required? Yes No Notes:
TYPE OF TREATMENT SYSTEM
At-grade system: Gravity trenches system:
Pressurized : />?ma a.aP Gravity trenches with lift:
Pressurized bed system: Holding tank with alarm:
Number of tanks: 3'/am� Septic Tank Sizes: o?� /� DD �� L,
Lift tank size: o d Pump brand: GPM:�� Head: �'`3�
TREATMENT SYSTEM
c.
Minimum: c�4 0 square feet with /oZ inches of rock below pipe
I ype ot covering: Fabric: ✓ Other:
SEPTIC HISTORY
Compliance Report attached? YES No�
City as-built on file attached? YES �, explain IV�*"' S-� J� �o�ik�'�/
SITE EVALUATION
YES NO N/A
Soils borin s.
At least three soil borings shall be completed for each new drainfield site designed. Each soil boring must be
located within the drainfield site or within close proximity along similar contours such that similar soil conditions are
likel .
For additions to an ISTS,at least one soii borin shall be made in the ex ansion area.
Percolation tests
At least two percolation tests shall be completed for each new drainfield site designed. Each percolation test must
be located within the drainfield site or within close proximity along similar contours such that similar soil conditions
are likel .
For additions to existin ISTSs, at least one ercolation test shall be com leted in the ex ansion area.
Plot Plan. A scale drawin of the entire lot showing the following:
All ro ert lines and lot dimensions
All existin and ro osed structures
l All existin or ro osed well locations or water su I i in
� Relative elevations of house, lot comers and drainfield areas
Slo e of round at drainfield sites b contour lines or direction arrows and slo e ercenta es
� Location of all percolation test holes and soil borings with identifying symbols and relative ground elevations of
e
� Prima nd atternate drainfield areas identified
nce from primary and alternate drainfield areas to property lines,well locations and any lake, stream, march
or draina e channel within 75 of an art of the se tic s stem.
w:lseptic\septic system approval revised 2-2015.docx
Page 1 of 2
City of Orono Septic System Approval '
ISTS DESIGN
YES NO NA
ISTS design specifications shali include proposed flows or other sizing information, minimum sewage tank
capacity, minimum soil treatment area requirements,a plan of the component layout and all other information
necessary to assure the City that the ISTS is designed and wiil be constructed to receive,treat and dispose of all
� of the sewa e from the buildin served.
Setbacks
Feature Sewage Tank(feet Soil Treatment Area(feet)
Dee well 50 50
Wetland 50 50
� General Develo ment Lake 75 75
� Recreational Develo ment Lake 75 75
/ Natural Environment�ake 150 150
.�- Tributaries/Streams 75 75
Drivewa s, sidewalks, decks and other hardcover 10 10
1/' Pro ert lines, buildin s and buried i es 10 20
Lawn s rinkler s stems 10 10
Sewa e Tanks.
Number of Bedrooms Tanks Liquid Capacities(gallons)
r less 1,000+ 1,000 re ardless of arba e dis osal use
/ 5 or 6 1,250+ 1,000 re ardless of arba e dis osal use
l 7, 8 or 9 1,500+ 1,500 re ardless of arba e dis osal use
10 or more Sewa e tanks shall be sized as other establishments er MN Rules 7080.
Pumping Stations.
In order to standardize installation and electrical connection methods,the following pumping station requirements
must be met in addition to MN Rules cha ter 7080
Electrical connection:
� A waterti ht,lockable electrical box must be mounted on a four-inch b four-inch treated redwood or cedar ost.
All electrical connections shall be made within the box. Pump connection must not be made using a direct line
� lu -in onl . Wire ent to the electrical box shall be sealed with a waterti t material such as foam or utt .
/ Alarm and um floats shall be on se arate electrical circuits. ev.�.b d /�AaJK bt �.s�-e� O
� Electrical wire from the power supply must not run over any tanks and must be laid beside the tanks and placed in
conduit alon the electrical ost.
Electrical cords from the pump and floats must be run through a two-inch PVC(or equivalent)conduit(schedule
� 80)with a one-inch gap between the conduit and the electrical box. Electrical cords must not run through or under
the manhole cover. Wires must not have round contact.
Pumping Chamber:
Pressure pipe exiting the pumping chamber must be laid on a uniform slope up to the soil treatment area for
�. proper drain back. The pressure pipe must be sleeved and inside a larger diameter pipe for additional support if
spanning ground that has been excavated. If the pipe at the tank must be lower than union to get elevation for
drain back,a one- uarter inch wee hole must be used.
When soil depths above the pressure distribution pipe is less than 3'h feet, insulation must be added to achieve
� an insulating factor equal to 3'h feet of soil to decrease the potential for freezing(Styrofoam or concentric piping
are acceptable methods). Piping under hardcover, such as tennis courts or driveways shalt be insulated pipe or
e uivalent.
/ A reserve capacity equaling 75%of the anticipated daily flow must be allowed into the pumping chamber between
� the alarm activation level and the um tank inlet.
Protection of drainfield area.
Proposed drainfield areas shall be identified and marked off on the lot at the time of the site evaluation and prior to
any construction or grading occurring in the area. The drainfield area shall remain undisturbed until drainfield
� construction is commenced. No vehicular traffic shall be allowed in the drainfield area either before or after
drainfield installation.
ACCEPTED DENIED by the Metro West on behalf of the City of Orono subject to existing regulations and the
following conditions:
Inspections re ir d:
1.fLl��C 1 ��� `F S e� � /�� � 5.
2. R e v L ,.� 6.
3. $a„ I(m�fC . ,� �0,.. 7.
a. ,w� , �,r.. + ta�e� _� . �►6 u* 6„ a.. �� �.
y: �iP.� �►-�w> Printed Name: �o4,fi�1 �ft�vBU Date:��/ ��
w:\septic\septic system approval revised 2-2015.docx
Page 2 of 2
� . �2� ��
r �<<o��``��
Joseph Olson D.B.A. �,�.�,,,''���.�o���
Rusty Olson's--Soil and Percolation Test i�,_a:��T'o,��ti
Joseph J. Olson--MPCA License # 810 �'`��� `s
11481 Riverview Rd. NE, Hanover, MN 55341 ``�,,,�'
: � (763) 498-8779 Fax (763) 498-8290
� � � �
� ,S x
�>' "�,a,�,�.'",' � ti .i; ��`' ..� Y s;,.� f� -,
April 29, 2015 � �,. �� '�'�� �
L.A. Kretchman& S.D. Grande � � �"� �� `Q, ;
2450 Countryside Drive ��; 1�
Orono, Hennepin County ��` �.. �"�'
This on-site Sewage Treatment System is designed for a Type 1 four-bedroom home in accordance with �
the
Minnesota Pollution Control Agency Chapter 7080 and local ordinances.
The periodically saturated soils were located at 22-26 inches(mottled soil). Due to the periodically saturated
soils, a pressurized mound system will need to be installed to treat the septic effluent. The bottom of the
treatment area must be located at least 3' above the saturated soils.
The existing septic system does not conform to the state code chapter 7080
All neighboring wells are greater than 100' from proposed treatment areas.
The soils at a depth of 12"have a percolation rate averaging 8 MPI.
The existing septic tanks must be abandoned and two new 1300 gallon and 1300 septic tanks need to be
installed. The new tanks wili be approximately 7 feet deep.
All new tanks need to be insulated if there is less than two feet of cover over the top of the tanks. Clean outs
must be installed on the end of the laterals for maintenance.
A 1300 gallon pumping chamber will need to be installed to lift the effluent to the treatment area.The power
supply and switches must be located outside the manhole and pumping chamber in a weatherproof enclosure.
A warning device must be installed with light and sound devices;this is in case of a pump failure. A flow
measurement device must be installed. Including but not limited to a water meter,event counter,running time
clocks or electronically controlled dosing.
Nothing other than grav water (laundrv showers etc)Human water and toilet tissue should be
disaosed of�nto the sentic tanks Garba�e disaosals are not recommended Additives must not be
'� used: thev mav cause harmful damaQe to vour septic svstem It is recommended that you pump the
tank everv two vears for two septic tanks
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Minnesota Pollution
OSTP Design Summary Worksheet uNI�ERs�TY ��„�
ControlAgency OF MINNESOTA „L��
Property Owner/Client: L A Kretchman 8 S D Grande Project ID:�v 06.12.13
Site Address: 2450 Countryside Drive. Date: 4/29/15
1. DESIGN FLOW AND TANKS
A. Design Flow: 600 Gallons Per Day(GPD) Note: The estimoted design flow is considered o peok flow rate
including a safety factor. For(ong term performance, the average
B. Septic Tonks: dai(y f(ow is recommended to be� 60%of this value.
Minimum Code Required Septic Tank Capacity: 2250 Gallons,in �Tanks or Compartments
Recommended Septic Tank Capacity: 2250 Gallons,in ��Tanks or Compartments
Effluent Screen: No Alarm: No
C. Holding Tanks On(y:
Minimum Code Required Capacity:�Gallons,in �Tanks
Designer Recommended Capacity:�Gallons,in �Tanks
Type of High Level Alarm:
D. Pump Tank 1 Capacity(Code Minimum):C�Gattons Pump Tonk 2 Capacity(Code Minimum): ��Gallons
Pump Tonk 1 Capacity(Designer Rec): �Gallons Pump Tank 2 Capacity(Designer Rec): C�Gallons
Pump 1 38.0 GPM Total Head 43.6 ft Pump 2C�GPM Total Head �ft
Supply Pipe Dia. 2,00 in Dose Volume:�gal Supply Pipe Dia.�in Dose Volume:��gal
2. SYSTEM TYPE
Type of Soil Treatment and Dispersal Area*
Q Trrnch Q Bed �Q Mound r �Gravity Distrbutlon Q Ressure Distributbn-Level Q Ressure Distrlbutim-Unlevel
�Drip Q Holding Tank Q a,t-�rade •Selection Required Benchmark Elevation: 100.0 �ft
Benchmark Location: Top of iron
System Type
Type of Distribution Media:
0 Type I ❑Type I I ❑Type 111 �Type IV ❑Type V �Drainfeld Rak �Registered Treatment Media:
3. SITE EVALUATION:
A. Depth to Limiting Layer: 22 in 1.8 ft B. Measured Land Slope%: 3.0 %
G. Elevation of Limiting Layer: 96.5 D. Soil Texture: Clay Loam
E. Loc. of Restricive Elevation: F. Soil Hyd. Loading Rate: 0.45 �GPD/ftz
G. Minimum Required Separation: 36 in 3.0 ft H. Perc Rate: 8.0 MPI
I. Code Maximum Depth of System: Mound in Comments:
4. DESIGN SUMMARY
Trench Design Summary
Dispersal Area�ft2 Sidewall DepthC�in Trench Width�_�in
Total Lineal Feet��ft Number of Trenches�� Code Maximum Trench Depth�in
Contour Loading Rate�ft Designer's Max Trench Depth�in
Bed Design Summary
Absorption Area��ftz Media Below PiPe�in Code Maximum Bed Depth�in
Bed WidthC�ft Bed Length�ft Designer's Max Bed Depth��in
Y���
OSTP Design Summary Worksheet UNIVERSITY
Minnesota Pollution OF MINNESOTA
Control Agency +L�'A.
Mound Design Summary
Absorption Area 500.0 ftZ Bed Length 50.0 ft Bed Width 10.0 ft
Absorption Width �Z.O ft Clean Sand Lift �,Z ft Berm Width (0-1q)�ft
Upstope Berm Width 11.0 ft Downslope Berm Width 20.0 ft Endslope Berm Width ��,p ft
Total System Length 7z,p ft Total System Width 41.0 ft Contour Loading Rate 12.0 gat/ft
At-Grade Design Summary
Absorption Bed Width�ft Absorption Bed Length�ft System Height�ft
Contour Loading Rate�gal/ft Upslope Berm Width�ft Downslope Berm Width�ft
Endslope Berm Width�ft System Length�ft System Width�ft
Level&Equal Pressure Distribution Summary
No. of Perforated Laterals� Perforation Spacing��ft Perforation Diameter 1/4 in
Lateral Diameter 2.00 in Min. Delivered Volume�gal Maximum Delivered Volume 150 gal
Non-Level and Unequal Pressure Distribution Summary
Elevation Pipe Volume Pipe Length Perforation Size
(ft) Pipe Size(in) (gal/ft) (ft) (in) Spacing(ft) Spacing(in)
Lateral 1 Minimum Delivered Volume
Laterat 2
gal
Lateral 3
Lateral 4 Maximum Delivered Votume
Lateral 5
gal
Lateral 6
5, Additional Info for Type IV/Pretreatment Design
A. Ca(culate the organic loading using option 1 or 2
1. Organic Loading =Pounds of BOD X Units
lbs/day X �� _ �lbs BOD/day
2, Organic Loading to Pretreatment Unit =Design Flow X Estimoted BOD in mg/L in the effluent X 8.35: 1,000,000
gpd X ��mg/L X 8.35: 1,000,000= ��lbs BOD/day
B. Type of Pretreatment Unit Being Instalted:
�. Calculate Soil Treatment System Organic Loading: (bs. BOD/day:Bottom Areo =lbs/day/ftz
lbs/day= �ftz= ��lbs/day/ft2
Comments/Special Design Considerations:
I hereby certify that I have completed this work in accordance with all applicable ordinances, rules and laws.
Joseph J Olson 810 04/29/15
(Designer) (Signature) (License#)
(Date)
OSTP Mound Desi n �
� UNIVERSITY "�
MinnesotaPollution �yorksheet � � � S�� e OF MINNESOTA
Control Agency p �+z,�J-
1. SYSTEM SIZING: Project ID; v 06.12.13
a. Design Flow: 600 GPD TABLE IXa
B. Soit Loading Rate: 0.45 GPD/ft2 �OADING RATES FOR DETERMINING BOITOM ABSORPTION AREA
AND ABSORPTION RATI05 USING PERCOLATION TESTS
Treatment Level C TreatmeM�evel A,A•2,8,
C. Depth to Limiting Condition: 1.8 ft
Percolatlon Rate '�OfP�O� ��rption
Area Loading �und Area Loading �u�
D. Percent Land Slope: 3.0 % �'"`�'> eac� '��"°" Rate "��°`�"°"
(�d�=) RaHo (��ftt) Ratio
E. Design Media Loading Rate: 1.2 GPD/ftZ
<o, � �
F. Mound Absorption Ratio: 2.60 0"°5 �,2 � �.s �
o,�o s�n�e�� o.s z � �.s
Table I and�oa tine sand
MOUND CONTOUR LOADING RATES: �1O�5 o.�e t.5 1 1.6
hteasured ' Texturc-dcrivod
COt1t0Uf �6 to 30 0.6 2 0.76 2
Perc Rate �R mound absorp[an ratio Loading 3i�o Qs o.5 2.4 0.78 2
� �t�' �t�� 0.45 2.6 0.6 2.6
=60mpi 1.0, 1.3. 2.0. 2.J. 2.6 _�z si�o izo - 5 0.3 5.3
. >1zo . . . _
61-120 mpi OR 5.0 . _1z
. �Systems with these values are not Type I systems.
� 120 mpi• ,5,0� ,6. Contour Loading Rate (linear loading rate) is a
recommended value.
2. DISPERSAL MEDIA SIZING
A• Calculate Dispersal Bed Area: Design Flow = Design Media Loading Rate = ft�
600 GPD = 1.2 GPD/ftz = 500 ftz
If a larger dispersal media area is desired, enter size:�ft2
B. Enter Dispersat Bed Width: 10.0 ft Con not exceed 10 feet
C. Calculate Contour Loading Rate: Bed Width X Design Media Loading Rate
�� ftz X 1•2 GPD/ftz = 12.0 gal/ft Can not exceed Toble 1
D. Calculate Minimum Dispersal Bed Length: Dispersal Bed Area = Bed Width = Bed Length
500 ftz : 10.0 ft = 50.0 ft
3. ABSORPTION AREA SIZING
A. Calculate Absorption Width: Bed Width X Mound Absorption Ratio =Absorption Width
10.0 ft X 2.6 = 26.0 ft
B. For slopes >1%, the Absorption Width is measured downhill from the upslope edge of the Bed.
Calculate Downslope Absorption Width: Absorption Width - Bed Width
26.0 ft - 10.0 ft = 16.0 ft
4. DISTRIBUTION MEDIA: ROCK
A. Media Volume: Media Depth X Length X Width
1.00 ft X 50.0 ft X 10.0 ft = 500 ft3 = 27 = 19 yd3
5. DISTRIBUTION MEDIA: REGISTERED TREATMENT PRODUCTS: CHAMBERS AND EZFLOW
A. Enter Dispersal Media:
B. Enter the Component Length: �ft Enter the Component Width: �ft
C. Number of Components per Row = Bed Length divided by Component Length (Round up)
�� ft - � ft = ��components/row
D. Actual Bed Length = Number of Components/row X Component Length:
�components X C�ft = ��ft
E. Number of Rows = Bed Width divided by Component Width (Round up)
C� ft : � ft = �� rows Adjust width so this is an who(e number.
F. Total Numb��mponent��r of Components per Row X Number of Rows
X ��components
b. MOUND SIZING
A. Calculate Minimum Clean Sand Lift: 3 feet minus Depth to Limiting Condition = Clean Sand Lift
3.0 ft - 1.8 ft = 1.2 ft Design Sand Lift (optional): ��ft
B. Calculate Upslope Height: Clean Sand Lift + media depth + cover (1 ft.) = Upslope Height
1.2 ft + 1.0 ft + 1.0 ft = 3.2 ft
C. Select Upslope Berm Multiplier (based on land slope): 3.57
Land Slope% 0 1 2 3 4 S 6 7 8 9 10 11 12
Upslope Berm 3:1 3.00 2.91 2.83 2.75 2.68 2.61 2.54 2.48 2.42 2.36 2.31 2.26 2.21
Ratio 4:1 4.00 3.85 3.70 3.57 3.45 3.33 3.23 3.12 3.03 2.94 2.86 2.78 2.70
D. Calculate Upslope Berm Width: Multiplier X Upslope Mound Height = Upslope Berm Width
3.57 ft X 3.2 ft = 11.0 ft
E. Calculate Drop in Elevation Under Bed: Bed Width X Land Slope : 100 = Drop (ft)
10.0 ft X 3.0 % = 100 = 0.30 ft
F. Calculate Downslo pe Moun d H e i g h t: U p s l o p e H e i g h t + D r o p i n E l e v a t i o n = D o w n s l o p e H e i g h t
3.2 ft + 0.30 ft = 3.5 ft
G. Select Downslope Berm Multiplier (based on land slope): 4.54
Land Slope% 0 1 2 3 4 5 6 7 8 9 10 il 12
Downslope 3:1 3.00 3.09 3.19 3.30 3.41 3.53 3.66 3.80 3.95 4.11 4.Z9 4.48 4.69
Berm Ratio 4:1 4.00 4.17 4.35 4.54 4.76 5.00 5.26 5.56 5.88 6.25 6.67 7.14 7.69
H. Calculate Downslope Berm Width: Multiplier X Downslope Height = Downstope Berm Width
4.54 x 3.5 ft = 15.7 ft
I. Calculate Minimum Berm to Cover Absorption Area: Downslope Absorption Width +4 feet
16.0 ft +� 4 � ft = 20.0 ft
�- _�
J. Design Downslope Berm = greater of 4H and 41: 20.0 ft
K. Select Endslope Berm Multiptier: 3.00 (usu4((y 3.0 or 4.0)
L. Calculate Endslope Berm X Downslope Mound Height = Endslope Berm Width
3.00 ft X 3.5 ft = 11.0 ft
M. Calculate Mound Width: Upslope Berm Width + Bed Width + Downslope Berm Width
11.0 ft + 10.0 ft + 20.0 ft = 41.0 ft
N. Calculate Mound Length: Endslope Berm Width + Bed Length + Endslope Berm Width
11.0 ft + 50.0 ft + 11.0 ft = 72.0 ft
7. MOUND DIMENSIONS
,� Upslope (4.D)- �i o ,.
� --- --------- ,
, ,
� ,
� �
� �
� � Dispersal Bed: 12.B x 2.C► '
Endslo e (4.L► -o Endslo e (4.L
� o �
�
� � �1�0 ,o.o x 50.0 � ��.o;
,
� � `� �
, � �
-a � v �
� � �
�
� `� 20 0 %
,
�
Downslope (4.J) '
� ------------------------------------ —-------_
Total Mound Len th (4.N► 72•0
4" inspection pipe
18" cover on top 20.0
U slo e berm (4.D) Downslo e berm 4.J
11.0
12" cover on sides
(6" topsoit)
Clean sand lift (4.A} 1,2
C�, ; ;'.i� ; 1.�
;
- -_ _ � �
� �f�j7r ���� r -_ - -._ 1.8
)I::I!(lt,;, � �
-- ...
Absor tion Width (3.A) . --
Note: 26.0
For 0 to 1� slopes, Absorption Width is measured from the Bedequally in both directions.
For s(opes >1%, Absorption Width is measured downhill from the upslope ed�e of the Bed.
Comments:
OSTP Mound Materials Worksheet UNIVERSITY ��,�
Minnesota Pollution OF MINNESOTA
Control Agency �,1�
ProjectiD: v 06.12.13
A• Calculate Bed (rock)Vo(ume: Bed Length (2.0 X Bed Width 2.6)X Depth =Volume ft'
50.0 ft X 10.0 ft X 1.0 = 500.0 ft;
Divide ft3 by 27 ft3/yd'to calculate cubic ards:
500.0 ft' : 27 = 18.5 yd3
Add 20%for constructability: 18.5 yd'X 1.2 = 22.2 '
yd
B. Calculate Clean Sond Volume:
Volume Under Rock bed:Average Sond Depth x Media Width x Media Length =cubic feet
1.3 ft X 10.0 ft X 50.0 ft = 658.3 ft3
For a Mound on a slope from 0-1%
Volume from Length=((Upslope Mound Height-1)X Absorption Width Beyond Bed X Media Bed Length)
ft •1) X X ft =
Volume from Width=((Upslope Mound Height-1)X Absorption Width Beyond Bed X Media Bed Width)
ft -1) X X ft =
Tota(Clean Sand Vo(ume: Volume from Lenqth+ Vo(ume from Width+Vo(ume Under Media
ft' + ft3 + ft' = ft3
For a Mound on a slope greater than 1%
Ups(ope Volume: ((Upslope Mound Height - 1)x 3 x Bed Length��2=cubic feet
(( 3.2 ft -1) X 3.0 ft X 50.0 )�2= 162.5 ft3
Downslope Volume: ((Downslope Height- 1) x Downslope Absorption Width x Media Length)-2=cubic feet
(( 3.5 ft-1) X 16.0 ft X 50.0 )-2= 986,7 pt'
Endslope Vo(ume: (Downslope Mound Height- 1) x 3 x Media Width =cubic feet
( 3.5 ft- 1 ) X 3.0 ft X 10.0 ft = 74.0 f�3
Total C(ean Sand Vo(ume: Upslope Vo(ume +Downslope Vofume +Ends(ope Vo(ume +Volume Under Medio
162.5 ft' + 986.7 ft' + 74.0 ft' + 658.3 3 3
ft = 1881.5 ft
Divide ft'by 27 ft'/yd'to calculate cubic yards: 1881.5 qt3 , 27 = 6q,7 yd'
Add 20%for constructability: 6g,7 =
yd3 X 1.2 83.6 yd'
C. Calculate Sandy Berm Volume:
Tota(Berm Vo(ume(approx): ((Avg.Mound Height-0.5 ft topsoil)x Mound Width x Mound Length)-2=cubic feet
( 3.3 _ 0.5 )ft X 41 A ft X 72.0 )-2= 4157.4 ft'
Tota(Mound Vo(ume-C(ean Sand volume-Rock Volume=cubic feet
4157.4 ft' _ 1881.5 ft' _ 500.0 ft3 = 1775.9 q�;
Divide ft'by 27 ft'/yd'to calculate cubic yards: »�5•9 ft' : 27 = 65.8 yd'
Add20%forconstructability: (,5,g Yd3 X �,2 = �g.q yd3
D. Calculate Topsoil Materia!Vo(ume: Totol Mound Width X Tota(Mound Length X.5 ft
41.0 ft X 72.0 ft X 0.5 ft = 1476.0 ft3
Divide ft'by 27 ft'/yd3 to catculate cubic yards: 1476.0 ft' : 27 = 54.7 yd3
Add 20%for constructability: 54•7 yd3 x 1.2 = 65.6 yd3
OSTP Pressure Distribution �;�,;
Minnesota Pollution Desi n Worksheet UNIVERSITY ''��
Controi A enc � OF MINNES � \�
g y OTA �.., �
Project ID: v 06.12.13
1. Media Bed Width: �� ft
2. Minimum Number of Laterals in system/zone = Rouded up number of [(Media Bed Width - 4) = 3] + 1.
( 10 - 4 ) + � _ �laterals Does not apply to at-grades
3. Designer Selected Number of Loterals: � 3 �laterals
Cannot be less than line 2 (accept in at-Qrades) -
4. Select Perforotion Spacing: 3.0 ft �- � � ������•�-•• - __ __
w��l.�� ��11 M111 �I��rk I!"
. .t�..t�l i i
i�n •t__
i�'1 .�1��.����Ir.i� '.��.��1 /..
5. Select Perforation Diameter Size: 1/4 in = �,,. ' _
, ,,.,.�,.,.,,,,�,,.,,
6. Length of Lotera(s = Media Bed Length - 2 Feet.
50 - 2ft = 48 ft Perforation can not be Noser then 1 foot from edge.
� Determine the Number of Perforation Spaces. Divide the Length of Laterals by the Perforation Spacing
and round down to the nearest whole number.
Number of Perforotion Spaces 48 ft = � 3 �ft = 16 Spaces
Number of Perforations per Lotero( is equal to 1.0 plus the Number of Perforation Spoces. Check table
8. below to verify the number of perforations per lateral guarantees less than a 10% discharge variation. The
value is double with a center manifold.
Perforotions Per Latera( = 16 Spaces + 1 = 17 Perfs. Per Lateral
Maximum Nurtibef of Perforatso�s Per Lateral co Guanntee<10%D'escha►ge Yariation
!*E"� P °rah°^5 7/311nch Perforations
Perforation Spacing IFeetl �����(lnthesl Perfofadon Spacing Pipe Diameter(Inches)
t 1S4 1K 2 3 (Feet1 1 1�6 1ti4 2 3
2 1Q 13 18 30 60 2 11 16 21 3� 68
2� 8 1I 16 18 54 2�: 10 14 20 32 64
3 8 12 ib 25 52 3 9 14 19 30 60
3'161nch Pertorations t:'8 Inch Perforations
Pipe Diameter(lnches) Perforation Pi Dia
Perforatirsn Spacing(Feet� ��9 Pe "►ete�f�nches)
I 114 1v: 2 3 (FeetM 1 11� 1t2 1 3
2 11 18 26 46 87 2 21 33 4t 14 149
2� �Z �� 24 40 8� Z�: 10 30 41 69 135
3 12 16 22 31 75 3 20 24 38 6� 128
9• Total Number of Perforations equals the Number of Perforations per Lateral multiplied by the Number of
Perforated Laterals.
17 Perf. Per Lat. X ��Number of Perf. Lat. = 51 Total Number of Perf.
10. Select Type of Manifo(d Connection (End or Center): 0 End ❑ Center
11. Select Lateral Diameter (See Table): 2.00 in
OSTP Pressure Distribution :;�.
Minnesota Pollution ' UNIVERSITY �
Des�gn Worksheet OF MINNESOTA �"i1�'
Control Agency
12. Calculate the Square Feet per Perforotion. Recommended volue is 4-11 ft Z per perforation.
Does not app(y to At-Grades
a, Bed Area = Bed Width (ft) X Bed Len�th (ft)
10 ft X 50 ft = 500 ftZ
b. Square Foot per Perforation = Bed Area divided by the Total Number of Perforations.
500 ftz .- 51 perforations - 9.8 ft�/perforations
13. Select Minimum Average Head: 1.0 ft
14. Select Perforation Discharge (GPM) based on Table: 0.74 GPM per Perforation
15. Determine required Flow Rate by multiplying the Tota( Number of Perfs. by the Perforation Discharge.
51 Perfs X 0.74 GPM per Perforation = 38 GPM
16. Vo(ume of Liquid Per Foot of Distribution Pipinq (Table 11): 0.170 Gallons/ft
�7. Vo(ume of Distribution Piping =
Table II
_ [Number of Perforated Latera(s X Length of Laterols X (Volume of Volume of�iquid in
Liquid Per Foot of Distribution Piping] �Pe
� � �g = � Pipe Liquid
3 X 48 ft X 0.170 al/ft 24.5 Gallons �ameter Per Foot
(inches) (Gallons) '
18. Minimum Delivered Volume = Votume of Distribution Piping X 4 1 0.045 j
1.25 0.078 '
24.5 gals X 4 = 97.9 Gallons 1.5 0.110 ;
2 0.170 �
manio pipe� 3 0.380 �
i 4 0.661
�
� .-Cleanouts ��� —�
pipe from pump �
� Manitold pipe�
lean outs , �' `
�
� • ' �
� � �
alternate location -'-
of i e ftom um �Alternate laation
of pipe from pump
Pi e from um
Comments/Special Design Considerations:
. OSTP Basic Pump Selection Design UNIVERSITY - '���
Minneso ta Po l lu tion W o r k s h e e t O F M I NNESOTA�► 1��
Control Agency
1. PUMP CAPACITY Project ID: v 06.12.13
Pumping to Gravity or Pressure Distribution: Q craviry QQ Presave Selection required
1. If pumping to gravity enter the gallon per minute of the pump: �GPM (10-45 gpml
2. If pumping to a pressurized distribution system: 38.0 GPM
3. Enter pump description:
�VeatlT�en[Sy51em
8 pa�nt of discharge
2. HEAD REQUIREMENTS
A. Elevation Difference z8 ft `��,,,,e�e°B�"
S�PP
between pump and point of discharge:
nlet p�pe Ekva�ion;•
Citterence
g, Distribution Head Loss: ��ft -
C, Additiondl H2dd Lo55: ��ft(due to special equipment,etc.) � ----------------------------- -------------
L�
Table I.Friction Loss in Plastic Pipe per 100ft
--__ _. -. ---
Distribution H�ad Loss Flow Rate ___P? e Diameter linchesl___
Gravity Distribution = Oft (GPM) 1 1.25 1.5 2
Pressure Distribution basecl on Minimum Average Head 10 9,1 3.1 1.3 0.3
Value on Pressure Distribution Worksheet: 12 12.8 4.3 1.8 0.4
Minimum Avera e Head Distribution Head Loss 14 17.0 5.7 2.4 0.6
1ft 5ft 16 21.8 7.3 3.0 0.7
2ft 6ft �g 9.1 3.8 i 0.9
5ft ��t Zp 11.1 4.6 I 1.1
25 16.8 6.9 ' 1.7
D. 1.Supply Pipe Diameter. 2.0 in 30 23'S 9'� II 2'4
35 12.9 3.2
2.Supply Pipe Length: 230 ft 40 16.5 I 4.1
45 20.5 5.0
E. Friction Loss in Plastic Pipe per 100ft from Table I: 50 6 �
Friction Loss= 3.67 ft per 100ft of pipe 55 ��3
60 I 8.6
F, Determine Equivolent Pipe Length from pump discharge to soil dispersal area discharge 65 ' 10.0
point. Estimate by adding 25%to supply pipe length for fitting loss. Suppfy Pipe Length 70 I 11.4
(D.2) X 1.25=Equivalent Pipe Length 75 i 13.0
85 16.4
230 ft X 1.25 = 287.5 ft qg i 20.1
G. Calculate Supply Friction loss by multiplying Friction Loss Per 100ft (Line E)by the Equivolent Pipe Length (Line F)and divide by 100.
Supply Friction Loss=
3.67 ft per 10aft X 287.5 ft 100 = 10.6 ft
H. Totol Heod requirement is the sum of the Elevation Difference (Line A), the Distribution Head Loss(Line B),Additionat Head Loss (Line C),and the
Supply Friction Loss(Line G )
28.0 ft + 5.0 ft + ��ft + 10.6 ft = 43.6 ft
3. PUMP SELECTION
A pump must be selected to deliver at least 38,0 GPM(Line 1 or Line 2)with at least 43.6 feet of total head.
Comments:
. Soil Observation Log
www.SepticKesource.com vcrs 12.4
Owner Information
Property Owner/project: L A Kretchman & S D Grande �ate 4/28/2015
Property Address/PID: 2450 CountlySlde Drlve
Soil Survey Information ❑ refer to attached soil survey
Parent matl's: � Till � Outwash � Lacustrine � Alluvium ❑ Organic ❑ Bedrock
landscape position: ❑ Summit ❑ Shoulder � Side slope ❑ Toe slope
soil survey map units: L3713 slope 3 % direccion- Linear
Soil Log#1
� Boring ❑ Pit Elevation 98.3 Depth to SHWT 22"
Depth(in) Texture tragment% matrix color redox color consistence grade shape
0-14 Topsoil <;5 10yr3/2 Loose Loose s�r,g�e gra�n
14-18 Loam <35 IOyr4/3 Friable Strong alocky
18-22 Clay Loam <35 10yr5/4 Firm Strong Blocky
22-30 C1ayLoam <35 10yr5/4 10y4/8,1-6/l0y Firm Strong Nrismacic
<35 loose loose single grain
35 -50 friable weak granular blocky
>50 �i� moderate prismatic platy
rigld strong massive
Comments:
2450 Countryside Drive Soil Log#2
� Boring ❑ Pit Elevation 98.3 Depth to SHWT 26��
Depth(in) Texture fragment% matrix colar redox color consistence grade shape
0-16 Topsoil <;5 IOyr3/2 Loose Loose Singlegrain
16-20 Loam <35 10yr4/3 Friable Strong E3locky
20-26 Clay Loam <35 10yr5/4 Friable Strong Blocky
26-30 Clay Loam <;5 l OyrS/4 l 0y4/8,1-6/]Oy Friable Strong Prismatic
2450 Count side Drive Soil Lo #3
0 Boring ❑ Pit Elevation 97.5 Depth to SHWT 22"
Depth(in) Texture fragment% matrix color redox color consistence grade shape
0-14 'Topsoil <;5 10yr3/2 Loose Loose Singlegrain
14-18 Loam <35 10yr4/3 Friable Strong I��ocky
18-22 Clay Loam <35 ]OyrS/4 Firm Strong B�ocky
22-30 Clay Loam <35 10yr5/4 10y4/8,1-6/]Oy Firm Strong �rismatic
1 hereby certify ihis work was completed in accordance with MN 7080 and any local req's.
�..-w _
Rusty Olson's Soil & Perc. 810
'gner Signature Company License#
Percolation Test Data Sheet
Lic.#810
Percolating test readings made by: Rusty Olson's Perc. starting at 12:15 P.M. On 4/28/15
Location: 2450 Countyside Drive
Hole number: 1
Date hole was prepared: 4/27/15
Depth of hole bottom_12"_inches, Diameter of hole 6" inches.
Soil data from test hole:
Depth, inches Soil texture
0-12" Dark Brown Loam 10yr3/2
Method of scratching side wall: Knife
Depth of gravel in bottom of hole 2 inches:
Date of initial water filling 4/27/15 depth of initial water filling 12 inches above the hole bottom
Method used to maintain at least 12 inches of water depth in hole for at least 4 hours Automatic Siphon
Maximum water depth above hole bottom during tests 6 inches
Time Time Depth Drop in H20 Perc Rate
12:30 12:45 6" 2.6 5.7
12:48 1:03 6" 2.5 6.0
1:04 1:19 6" 2.5 6.0
AVERAGE PERC. RATE 5.9 MPI
Percolation Test Data Sheet
Lic.#810
Percolating test readings made by: Rusty Olson's Perc. starting at 12:15 P.M. On 4/28/15
Location: 2450 Countyside Drive
Hole number: 2
Date hole was prepared: 4/27/15
Depth of hole bottom_12"_inches, Diameter of hole_6"_inches.
Soil data from test hole:
Depth, inches Soil texture
0-12" Dark Brown Loam 10yr3/2
Method of scratching side wall: Knife
Depth of gravel in bottom of hole 2 inches:
Date of initial water filling 4/27/15 depth of initial water filling 12 inches above the hole bottom
Method used to maintain at least 12 inches of water depth in hole for at least 4 hours Automatic Siphon
Maximum water depth above hole bottom during tests 6 inches
Time Time Depth Drop in H20 Perc Rate
12:31 12:46 6" 1.6 9�4
12:47 1:02 6" 1.5 10.0
1:05 1:20 6" 1.5 10.0
AVERAGE PERC. RATE 9.8 MPI
�
� Minnesota Pollution Com liance Ins ection Form
�'� � Control Agency p �
520 Lafayette Road North Existing Subsurface Sewage Treatment Systems (SSTS)
St.Paul,MN 55155-4194 Doc Type:Compliance and Enforcement
InspeCtlon results based on Minnesota Pollution Control Agency(MPCA) I 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(mmldd/yyyy): 6/4/2015
� 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 permit/monitoring plan requirements (Compliance Component#5)—Noncompliant
Property Information Parcel ID#or Sec/Twp/Range:
Property address: 2450 Countryside Road Reason for inspection: New installation
Property owner: Owner's phone:
or
Owner's representative: Representative phone:
Local regulatory authority: City of Orono __ _ Regulatory authority phone: 952-249-4600
Brief system description: Type I Mound pressure distribution
Comments or recommendations:
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.
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-wwists4-316 • 6/4/14 Page 1 of 3
R
Property address: 2450 Countryside Road Inspector initials/Date: RP � 6/4/2015
(mm/dd/yyyy)
1. Impact on Public Health — Compliance component#1 of 5
Compliance criteria: Verification method(s):
System discharges sewage to the ! ❑Yes � No ❑ Searched for surface outlet
ground 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)
hea/th and safety.
❑ Other methods not listed (See Comments/Explanation)
Comments/Explanation:
2. Tank Integrity— Compliance component#2 of 5
Compliance 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 'I
compliant if allowed in local ordinance. � ❑ Examined Tank Integrity Form (Attach)
Sewage tank(s) leak below their i, ❑Yes � No � Observed liquid level below operating depth
designed operating depth. ' ❑ Examined empty(pumped)tanks(s)
If yes,which sewage tank(s) leaks: i ❑ Probed outside tank(s)for"black soil"
Any "yes"answer above indicates the ❑ Unable to verify(See Comments✓Explanation)
system is failing to protect groundwater. ❑ Other methods not listed (See Comments/Explanation)
CommentslExplanation:
3. Othel' COmpl1d11C2 COndltlOtls—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(electricai nazards,etc.)to immediately and adversely impact public health or safety. ❑Yes' � No ❑ unknown
"System is an imminent threat to public health and safety.
Explain:
c. System is non-protective of ground water for other conditions as determined by inspector. ❑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-wwists4-316 • 6/4/14 Page 2 of 3
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Property address: 2450 Countryside Road _ Inspector initials/Date: RP � 6/4/2015
(mm/dd/yyyy)
4. Soil Separation — Compliance component#4 of 5
Date of installation: 6/4/2015 ❑ Unknown Verification method(s):
(mm/dd/yyyy)
ShorelandNVellhead protection/Food beverage Soil obseivation does not expire. Previous soil
lod �n � ❑ Yes � No observations by iwo independent parties are sufficient,
g g' unless site conditions have been altered or local
Compliance criteria: requirements differ.
For systems built prior to Apnl 1, 1996, and ', ❑ Yes ❑ No ❑ Conducted soil observation(s) (Attach boring iogs)
not located in Shoreland or Wellhead I
Protection Area or not serving a food, ' ❑ Two previous verifications (Attach boring logs)
beverage or lodging establishment: ❑ Not applicable(Holding tank(s),no drainfield)
Drainfield has at least a two-foot vertical ❑ Unable to verify(See Comments/Explanation)
separation distance from periodically I ❑ Other(See Comments/Explanation)
saturated soil or bedrock. '
Non-performance systems builtApril 1, , ❑ Yes ❑ No Comments/Explanation:
1996, or later or for non-performance i
systems located in Shoreland or Wellhead I This page does not apply, New system
Protection Areas or serving a food, II
beverage, or lodging establishment: ,
Drainfield has a three-foot vertical I
separation distance from periodically '
saturated soil or bedrock.*
"Experimental'; "Othe�", or "Performance" ❑ Yes ❑ No IndiCate depths or elevations
systems built under pre-2008 Rules; Type IV '
or V systems built under 2008 Ru/es(7080. A. Bottom of distribution media '
2350 or 7080.2400 (Advanced Inspector I
LiCense required) !I B. Periodically saturated soil/bedrock
Drainfield meets the designed vertical I C. System separation
separation distance from periodically � ,
saturated soil or bedrock. '
D. Required compliance separation`
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 comp/eted.
Compliance criteria
a. Operating Permit number:
❑Yes ❑ No
Have the O eratin Permit re uirements been met?
b. Is the required nitrogen BMP in�lace and properly functioning? ' ❑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, 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.
www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Availabte in alternative formats
wq-wwists4-316 • 6/4/14 Page 3 of 3
, � INSPECTION NOTICE
DATE TIME
CITY OF ��/t�I CALLED-IN
SCHEDULED
PERMIT NO. COMPLETED
ADDRESS ��.�0 �°o� +��.e,_ .r•� C�.�
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❑CONC SLABS ❑ MECHANICAL FINAL ❑ FOLLOW-UP
❑ FOOTING ❑ INSULATION ❑ COMPLAINT
❑ POURED WALL ❑ RATED ASSEMBLY ❑ FIREPLACE
❑ FOUND. DRAINAGE ❑BUILDING FINAL ❑SPRINKLER SYSTEM
❑ FRAMING {d SEPTIC INSTALL�L�F'.:.� 1❑
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❑ CORRECT UNSAFE CONDITION IMMEDIATELY.
❑ STOP ORDER POSTED. CALL INSPECTOR
j�INSPECTiON REQUIRED. CALL TO ARRANGE ACCESS.
� TO SCHEDULE YOUR INSPECTIONS
PLEASE CALL: (763) 479-1720
Metro West Inspection Services Inc.
Owner/Co . on si •
Inspecto • �iLc-� � �
• DATE TIME ✓
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❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
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DATE TIME ` /
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❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Cal1 for the next inspection 24 hours in advance. (952� 249-4600
OwnerlContract site:
Inspector.
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White Copyllnspector's File Canary CopylSite Notice
DATE TIME� /
CITY OF ORONO CALLED IN �
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❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Ca11 for the next inspection 24 hours in advance. (952� 249-4600
OwnerfContra on site:
Inspector. �
White Copyllnspector's File Canary CopyfSite Notiee
� � DATE TIME �
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PERMITNO. a�ls����s COMPLETED �
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Inspector.
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