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Minnesota Poilution Compliance Inspection Form
Control Agency
520 Lafayette Road North Existing Subsurface Sewage Treatment Systems (SSTS)
St.Paul,MN 55155-4194 Instructions on page 7
Parcel number: 0411723340008 For Local Tracking Purposes:
System status: � Compliant ❑ Noncompliant
(based on all compliance►equirements)
Summary Form
Property Information
Property owner name(s): Chistopher Smith
Property address: 2943 Farview Lane,Orono,MN 55356
Property ownePs address(if different):
County: Hennepin Property owner phone: 952-404-3337 Permitting authority: City of Orono
Date system constructed: 9/08/03 Reason for inspection: Property Transfer
System Description
Approximately 2-1300 gallon septic tanks, 1-1300 gallon lift station and Approximately 630 square
Brief system description: feet of mound rodcbed as per city records.
Local permit number: P06672 Number of bedrooms: 5 Design flow rate: .83
Is the system:
In Shoreland area? �Yes ❑ No In Wellhead Protection Area? ❑Yes � No
An U.S. Environmental Protection System serving a Minnesota Department
Agency(EPA)Class V Injection Well?0 Yes � No of Heath(MDH)licensed facility? ❑Yes � No
COI'T1P�1dnC@ $t8tU5(Based on state requirements—additional local requirements may also apply.)
Based on the information gathered and reported on attached forms,the compliance status of this system is(check one):
�Certificate of Compliance—valid u�til(3 years from date of report): 10/11/2010
❑Notice of Noncompliance-For Noncompliant systems:
The reason for noncompliance is:
This noncompliant system is classified as(check one below):
❑ Imminent threat to public health&safery ❑ Failing to protect ground water ❑ Not in compliance with operating permit
C@rt1flCdtlOn (Completed form must be submitted to the local unit of government within 15 days.)
1 hereby certify that all the necessary informafion has been gathered fo 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.
Name: Joseph J.Olson Certification number: 1255
Business license name and number: Rusty Olson's soil and perculation testing Lic#810 or
Name of local unit overnment: Ciry of Orono
Signature: Date: 10/11/10
Require Attachments �nspectorComplete:This Inspection Report is (� pages long.
Check compliance fortns attached: �Hydraulic Performance �Tank Integrity �Soil Separation ❑Operating Permit Fortn(if
applipble) �System drawing/As�uift drawing ❑An assessment of any local requirements that are diffierent from what is required on this
form �Soil Boring Logs ❑Abandonment form(if appropriate) ❑Other infonnation(list):
Upgr'dde Requirements(derived from Minn_Stat.§115.55)M imminent threat to public heafth and satety(ITPHS)must be upgraded,repJaced,or
its use discon5nued within ten monUrs of�aei�of this notice or within a shorter period if required by loca/ordinance.If the system is failing to protect ground
water,the system must be upgraded,rep/aced.or its use discontinued within the time required by loca/ordinance.If an existing system is not failing as defined in
law,and has at least hvo feet of design soil separation,then the system need not be upg2ded,repaired,replaced,or its use disContinued,nohvithstanding any
local ordinance that is more shict. This provision dces not appty to systems in shore/and areas,Wellhead Protection Areas,or thase used rn connection with food,
beverage,and lodging establishments as defined in law.
wq-wwists4-31 Compliance Inspection Form for Existing SSTS
4/4/08
�
Parcel number: 0411723340008 System status: �Compliant ❑ Noncompliant
(as deteimined by fhis form)
Nydraulic Performance and Other Compliance
Compliance Issue #1 of 4
Date of observation: 10/11/10 Reason for observation: Property Transfer
This form expires upon next inspection or in three years,whichever occurs first: 10/11/13
Compliance questions/criteria: (Required) Veri�cation Method*: (Optional)
Check the a rn riate box
(Check the appropriate box)
Does the system discharge sewage to the ❑Yes � No � Searched for surface outlet
round surtace?
❑ Performed hydraulic test
Does the system discharge sewage to drain ❑Yes � No
tile or surface waters? � Searched for seeping in yard
Does the system cause sewage backup ❑Yes � No � Checked for backup in home
into dwellin or establishment? ❑ Excessive ponding in soil system/D-boxes
Do other situations exist that have the ❑Yes � No
potential to immediately and adversely ❑ Homeowner testimony
impact or threaten public health or safety ❑ Examined for surging in tank
_�electrical, unsafe covers,etcJ?
Any"yes"answer indicates that the system Is an imminerrt ❑ "Black soil"above soil dispersal system
thr�eat to public health and safety. ❑ System requires"emergency"pumping
❑ Performed dye test
Does the system pose a threat to ground ❑Yes � No � pther: Peterson Company
water for any conditions deemed non- —
rotective as deteRnined b the ins or?
"Yes"indicates that the system is failing to protect
ground water.If"yes'; describe the condition noted:
*No standard protocol exists. This list is not exhaustive,
in sequential ortler, nor does it indicate which
combinations are necessary to make this determination.
Certification
This form is to be completed and attached to the Summary Form of the Minnesota Pollution Control Agency's(MPCA)Compliance
Inspection Form for Existing Subsurface Sewage Treafinent Systems.Observations,interpretations,and conGusions must be
completed by an inspector. Completed form must be submitted to the local unit of govemment within 15 days.
Property owner name(s): Chistopher Smith
Property address: 2943 Farview Lane,Orono, MN 55356
Property owner's address('rf different):
County: Hennepin _ Phone: 952-404-3337
1 herieby cerfify that/personally made the obse►vations,inte►pretations, and conclusions reported on this form and that they are
coirect.
Name: Joseph J.Olson Certifiqtion number: 1255
Business license name and number: Rusty Olson's soil and perculation testing Lic#810 or
Name of local unit vemment: City of Orono
Signature: Date: 10/11/2010
wq-wwists4-31 Comptionce Inspection Form for Existing SSTS
4/4/08
•.•.. � � �.. �...viu �niiv� u.rciviav�i v�. In3-y1L-/L I / p.L
i
Parcel number. System status_ �Compiiant ❑iJoncompliant
(as determined by fhis form)
Tank Integ�#y and Safety Compliance - Campliance lnspectron Form for Fxisting SSTS
Camp(iance issue #2 of 4
Oate of observation: �Q��30 Reason for abservaaan: Reques!From tiomeowner
This forrn expires on{three years): 1018110
Compliance questionslcriteria: (RequiredJ Verification Method**:{Op�onal)
(Ci�eck the appraprrate box
(Check the appropriete boxi
Joes the systerr�consist of a seepsge pif', ❑Yes �Na � prabed tark boYom
c oi,d e{I or ieschEn 't?
� ❑ Observed iow iiquid level
Do any sewage tank(sj?eak below their � ❑Yes � No
designed oeerating depth? ! ❑ Examined construction records
If yes, iden6fy which [�] Examined empty(pumped)tanR
sewage�nk leaks. ❑ Probed autside tsnk for"black soil'
An�"yes„answer lnd�cates ihet ihe system is talling ro protaet
grottod water. ❑ Pressuralvacuum chedc
' See a e ❑ Q1her �
p g pits mee�ng 708Q2550 may be comot;ant if allflwed
!n flrdinance by iocal permi�ing authority.
"'No standa►d proteco!exists. This list Is rrot exhauscive. in
seqwential order.nor dces if ir,oticafe�ch oambinabons
are necesssry to rnaks t�iis detertninefion.
Safety Check
1. • Are maintenancs;�ole caYers damaged,crack,ed, a appeared to be structt:rally c:nsaund? ❑Yes` �No
2. L'Lere mair�tenance hate covsrs replaced in a secured man�er(e.g.,scxsws replaced)? Q Yes �1Vo`
?. Was sscondary access restraint present(safety pan,sscond cover,or safety neriing)—highly reco�nm�ded. ❑Yes� No
d. A�2 ath�r saf�tylFtealih iss�ue prsserzt? ❑Yes" �Na
Explein:
'Sysiem/s an immirtet+t thr+�az in publlc hea�lth artd safefy.
Certification
This form is to be cornplated and aitached to the Surnmary s=ar►n ot ths Minnesota PelE�tion Contral Rgency's(WiPCA)Compltance
Inspectlon Form for Existiny Subsurtace Sev,rage Treatrnerrt�ystems.Observatiores, interpretations, and conGusions must be
completed by an inspector, mainta�ner,or service provider.Completed form must be submitted to tl�e loca{;.init of govemmen,v+rithirt
15 days.
Properry owr,er name(s): Chris Smith
Propecty address: 2943 Fan�iew l.ane Long Lake. MN 55356
Prgperty owne�s address(ildiBerent):
County- Nenriepin Praperty ownar phone: 952-9�3-7588
l neieby�erfify Lhat 1 personafiy mada fFie abservations,inteqoretetiorrs,artd conctusions�poRed on ffiis form and ttist they are
correct.
Narne_ .:am�s Braegeimann Certificxtion number:
�usinass I:censs name and number. E�mer J. Peterson Co. License#218 or
Name of locat�nit of govemme .
Signahxe: �� D�e: 1018a'10
www.pca.state.mn.us • b51-296-6300 • 8�-657-386A • TTY b51-282-5332 or 800-b57-3isb� • Availabte in alternative formats
wG-wwlsts4-31 . 4I24I04 �age 3 of 8
Parcel number: 0411723340008 System status: �Compliant ❑ Noncompliant
(as determined by this fonn)
Soil Separation Compliance and Other Compliance
Compliance Issue #3 of 4
Date of observation: 10/11/2010 Reason for observation: Property Transfer
This infom►ation on this form does not expire.
Compliance questionslcriteria: (Required) Verification Method'"`: (Optional)
(Check the appropriate box) (Check the appropriate box)
For systems built prior to April 1, 1996,and not � Conducted soil observation(s)(attach boring logs)
located in Shoreland or Wellhead Protection
Area or not serving a food,beverage or ❑ Two previous verifications(attach boring logs)
lodging establishment: ❑ Other:
Does the system have at least a two-foot
vertical separafion distance ftom periodically
saturated soil or bedrock? ❑Yes ❑ No
For non-performance systems built April 1,
1996,or later or for non-performance systems
located in Shoreland or Wellhead Protection Soil observation does not expire. Previous observations
Areas or serving a food, beverage or lodging by two independent pafies are sufficient,unless site
establishment: conditions have been altered.
I
Does the system have a three-foot vertical
separation distance from periodiqlly saturated
soil or bedrock?* �Yes ❑ No
For reduced separation distance systems(i.e.,
"perFormance"systems under old 7080.0179 or ' May be reduced by up to 15 percent if allowed in local
Type IV or V system under new 7080.2350 or ordinance.
7080.2400): "No standard protoco!exists. This list is not exhaustive,
Does the system meet the designed vertical in sequential order, nor does it indicate which
separation distance from periodically saturated combinations are necessary to make this
soil or bedrock?* ❑Yes ❑ No detem►ination.
Any"no"answer indicates fhat the system is failfng!o probect
ground water.
Certification
This form is to be completed and attached to the Summary Form of the Minnesota Pollution Control Agency's(MPCA)Compliance
Inspection Form for Existing SubsurFace Sewage Treatment Systems.Observations, interpretations, and condusions must be
completed by an inspector or designer.Completed form must be submitted to the local unit of govemment within 15 days.
Property owner name(s): Chistopher Smith
Property address: 2943 Farview Lane,Orono,MN 55356
Property owners address(if different):
County: Hennepin Phone: 952-404-3337
1 hereby cerfify that 1 personally made the obseiva6ons, interpretations, and conclusions reported on this form and that they are
comect.
Name: Joseph J.Olson Certifiqtion number: 1255
Business license name and number: Rusty Olson's soil and perculation testing Lic#810 or
Name of local unit vemment: Ciry of Orono
Signature: Date: 10/112010
wq-wwists4-31 Compfiance Inspection Form for Existing SSTS
4/4/08
Loqs of Soii Borinqs
License#810
Lacation or Project: 2943 Farview Lane
Borings made by: Rusty Olson's Soil and Perc testing 10/11/2010
Classification System: AASHO ; USDS•USDS-SCS X ; Unified ; Other
Auger used (check two): Hand_X_, or Power , Flight, Bucket or Probe_X_
Boring Number_1_Surface elevation_94.0_ Mottled Soil at 3.6 feet
0-8" Loam &sand fill mound H20 present at_X_
8"-20" Dark brown loam 10yr4/3 eroded
20"-44" Dark brown loam 10yr3/1
44"-52" Rusty dark brown loam 2.5y4/2
52"-60" Rusty olive brown clay loam 2.5y5/4
TBM: Top of front step Elv.-100.00 assumed
Original grade under the rockbed Elv.- 94.3
Bottom of rock bed Elv.-95.3
There is 1.0 feet of sand under the rockbed
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� � � Municipal Offices
Street Address: Mailing Address:
��9 ��G 2150 Kelley Parkway P.O. Box 66
k'EsBo
-.-- - .- -:-- Orono, MN 55356 Crystal Bay, MN 55323�0066
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To: The Current Owner of Address � � � 3 �' � �'f' �L��' �
City Ordinance requires that onsite sewage treatment systems in Orono be
inspected on a periodic basis. The onsite sewage treatment system at the above
address has been inspected and the following is known about the system. A
sketch of the known components of the system is available for most properties at
the Orono City Hall.
Imminent Public Health Threat
Yes �No
If yes, please contact the Onsite Systems Mana�er at 952-249-4626 within 10
days of receipt of this notice. The septic system must be brought into compliance
within 90 days. Failure to do so will result in referral to the City Attorney for
legal action.
System Identified as Non-Compliant
Yes �No
If yes, system must be brought into compliance by:
December 31, 2007
December 31, 2010
Other
Septic Tank(s) Pump out Needed
Yes �
No �.�'
The City recommends the septic tank(s) and/or lift tank be serviced and pumped
out every three years. City records indicate the tanl:(s) were last pumped out on
�' .,� .. -, �� . The tank(s) should be cleaned throu�h the manhole and
not through the inspection pipes, this allows for proper cleanin�.
Comments:
�.
Inspecto��.�l� �.� �,��� Date of Inspection ��'- CiJ
Telephone (9�2)Z�d9-4600 � Fax (9�2) 249-461h
w«w.ci.orono.mn.us
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�����-����� CITY of ORONO
,�i, � �' �6';`�� ,�,ti Municipal Offices
., ..
�.� � a ��.7-� �.�� Street Address: Mailing Address:
`�CEgHO�' 2750 Kelley Parkway P.O. Box 66
Orono, MN 55356 Crystal Bay, MN 55323-0066
October 21, 2002
JOSEPH T DECKMAN &
KAY COULTER DECKMAN
2943 FARVIEW LA
LONG LAKE MN 55356
Dear Mr. Deckman:
This letter is regarding the failing septic system on your property. After several inspections in
the past and an inspection performed last week, it appears that your septic system is still
surfacing and classified as an imminent health risk that must be replaced next spring, 2003. I
sent you a letter on 7-11-01 that your drainfield was surfacing and must be monitored in the
suminer of 2002. A failing septic system is a hazard to your family, pets and to your neighbors.
You must contact a licensed septic designer to draw up plans to repair your mound.
Efforts must be made immediately to stop the surfacing of raw sewage on the surface of the
ground until a new drainfield is installed. One temporary option to get you through this winter is
to use your septic tanks as holding tanks. The tanks would be pumped until a new drainfield is
installed next spring. This would stop sewage from going into your drain field and surfacing on
the ground.
Please contact me at 952-249-4600 to discuss this matter further so we can get this problem taken
care of as soon as possible.
Sincerely,
vlTl�
Matt Bolterman
On-Site Septic System Manager
Encl: Past violation notice
Telephone(952)249-4600 • Fa�c(952)249-4616
www.ci.orono.mn.us
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�i�����-� CITY of ORQNO
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`"�+� ��' �'"',t���'��' 'ti� Munici
,� ��',r.� ,� G pal Offices
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� '�',:c���'h��►
, �;`�� � Street Address:
��K�g 2750 Keiley Parkway Mailin� Addreu:
Orona, MN 55356 P•�� Bax 66
Crystai Bay, MN 55323-0066
Owner:_ �0 S 2, p�-. ��C,'(�.`f� � �� �3 �'1��/;��
Address: I � _
Cin�Ordinance 199 requires that each existing on-site sewage treatment system in Orono be inspected every rivo years.
The on-site se�vage treatment system at the above address has been inspected and appears to fall into the categories checked belo�v.
SYSTE�1 CONFORI�IITY 1-3 : �
1 °CODE SYSTEM�� An ISTS which mzets a11 tha location,drsigi and coastruceion standard�ofthe cu:rent Orono�funicipal Code.
2 ��C01�IPLI.ANT SYSTEM" An ISTS which does not mcet ail the localioq design and construceion st�ndard�op�z��t pi.ono lfunicipal
Code but dots meet the threz foot sepazation requiremrnt,and which is not failing or an imminrnt threat to public health or saf'zty,
3 NON-COIvIPLIAN'f SYSTEM�� A prohibited ISTS;an ISTS locatad within a designated 100-year flood plair�any ISTS which rr�ay
" or may not mret al!the localior�design,or constructio❑ standa��of the currerrt Orono Municipal Coda and which'
any ISTS with less than three feet of unsaturatad soil or sand between tha distribution device and tht(imiting soil characteriytics,any reason;and
T�NK CONDITION(5-10):
Tsnk inspection indicates:
� Pumpout not needad at this time.
l � ) Tank must ba pumped out Ihis yzar (city cpde requires tartla to be pumpzd out evzry 3 years. Tarilc was last pumped U'��N
�� �).
7 Solids accumulation in tanks is at a critica!a crieicat leve(. Tanks should be pumpzd out�soon bs possible.
3 System is discharging to the surfacz. Tanks must ba pumpad out within 43 hours to tliminate surface discharge.
y Inspection risers missing-tanlcs eou(d not be irupectzd Inspection risers(4"dia.PiPz)must be installed in each Lznk at ne�ct pumpout If tanks
hz�•e not bten pumptd out�c�ithin the last three yeus�thzy should be pumped out now.
1� Inspzction pipe is located directl}over tank ba�lz�doas not gve accurata mz�surement of solids accumulation). If tanks have not bzen pumped
out wi[hin tha lut threr yean,they should be pumped out now.
DRAINFIELD COi��ITION(11-14): 1c�
Drunfield is dry,na surfacing evident
12 Some evidrncz of surfacing,nat critical yet
Draintir(d is sacurzced and visibly discharging untreated eQluent to tha surface. Contact the City Incpector irrvnediately.Repairs muse bt
completad within 90 days.
1� Drainfieid e��ter.t and condition unknown. •
C O�VIMENTS: 5�I S-}�-� : S U c���- Cq�� �v,,,��cr— .r-v r
(�C c�:r ra�� C n. , U�.. � .
n
�-\-7 -b � �� _-
Date ofInspection
' Scptic System Inspector '
Note: In tha event that this inspection report is used to satisfy the requirernents for a moRgsge or otha trarupzr of property,be advised that this repoR doa not guazantee
or certify that an tsisting s}stzm will continue to funetion propaly,but is merely an opinion of the adequacy of the systzm undar current condilioru ha�r�i�.,rh.�.,,;t,tii.
informatioa
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' �;�:��? CITY of �AZONQ
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Munlcipal Of�ices
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'� "`'��t�i'� '� Street Address: Mailing Address:
.�E8130g 2150 Kelley Parlcway P.O. Box 66
Orono, MN 55356 Crystal Bay, MN 55323-0066
Owner: So e. �2 c.��t`��c� Address: a�i 4 3 Fqr v;e�,,, � r� •
Ciry Ordinance 199 requires that each existing on-site sewage treatment system in Orono be inspected every rivo yeazs.
The on-site se�vage treatment system at the above address has been inspected and appears to fall into the categories checked belo�v.
SYSTEM CONFORM[TY (1-31: � �
� "CODE SYSTEM° An ISTS which raeeu a11 t�e lacxtion,daigi and construction staadards of the current Orono I�funicipal Code.
2 "CO�LIANT SYSTEM" An ISTS wluch doa not med a11 the locatioa,daign and coastcuction standards of the eurre�prono Muaicipal
Code but dors meet the thcee foot separatioa requiremeat,and which u not failing or aa imraiae�threat to public h�alth er saf Ky,
3 "NON-COMPLIANT SYSTEM" A prohibited ISTS;an ISTS located within a designated 100-yeaz flood plaia,any ISTS which may
or may not meet aIl the locatioa,design,or coastruction standards of the cumut prono biunicipal Coda aad wiiich is failing for any reasoq and
any ISTS with less than three feet of unsaturated soil or sand betwern the distn'bution device and the lirniting$ail�ha��y�a.
TANK CONDITION(�-101: � � � •�
Tank inspection indicates: .. -
� Pumpout not needed at this time.
6 Tsnk must bt pumped out tlsis ytar (city code requira tanks to be pumped out every 3 yeacs. Tank wu last pumped �.
7O Solids accumulation in tanks is at a critica(a critical IavaL Tanks should be pumptd out az soon as possible.
8 S}stam is discharging to the sucfaee. Tanks must ba pumpcd out within 48 hours to eliminate surface discharge,
9 Irupection risers missing-tanks eould not be inspected Iacpeccion risers(4"di�pipe)must be installed in each tank at next pumpout If tanlec
hiva nut bten pumped out within the last three years,they should bz pumped out now.
10 Inspe��tiun pipa u located direcdy over tank baffle(does not give accurate measuremcnt of solids accumutation). If tanks have not bern pumped
out�vithin the lut three yeazs,they should be pumped out no�v.
DRAINFIELD CONDITION(11-14): �_
11 �Drsinfield'u dry.no surfacing evident
12 Some e��idrnce of surfacing,not eritica!yet � � . ' ' • .
13 Drsinfield'u saturstzd and visibly discharginq untreated e�luent to tha surfaca Contacc the City Inspeccoc imatediately.Repairs musi be
eompltted uithin 90 days.
1� Driinfield tstrnt and condition unkno«�n.
COI1�Ii�NTS: Sys�c,� � �S S�r.��,�,� o� to� 0� n�.o.t�� w �� w��- ���
�o oc�•'t-or _ � v doc r�o d(` OU 0.',r �- : \ bc �� �;n�,
� v �� �c�.c.\� _
� . .
7 —l.�—b� . "� r\QJ�C .
Date of Iaspectioa � f�
Septic System Inspectoc . �
Not�: In tfie rvent that this mspeclion repoR is used to satisfy tfie requirements for a mortgage or otha taiufa of prapecty�be advised that tfii.s repoR doa not guarantee
or certify that aa esisting system will eontinue to function properly,but is merety an opinion of the adequary of the systrm unda cucre¢e�Q�tioas bazed on the availab(e
inforautioa