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Home My WebLink AboutSeptic info ��=� Minnesota Poliution Compliance Inspection Form �' '' Control Agency 520 Lafayette Road North Existing Sabsurface Sewage Treatment Systems (SSTS) St Paul,MN 55155-4194 Doc Type:Compliance and Enforcement InspeCtion �esults based on Minnesota Potivaon Control Agency(MPCA) For local tracking purposes: requirements and attached forms—additional local requirements may also apply. R��-� �"''1 �. Submit completed form to Local Unit of Govemment(LUGf and system owner within 15 days System Status �ITY OF OROf�O System status on date(mmlddlyyyy): 9/25/2014 � Compliant-Certificate of Compliance ❑ Noncompliant- Notice of Noncompliance (Valid for 3 years from�port date, unless shorter time (See Upgrade Requirements on page 3.) frame outlined in Locaf Ordinance.) Reason(s)for noncompfiance(check all applicable) ❑ Impact on Public Health (Compliance Component#1)—lmminent threat to public health and safety ❑ Other Compliance Conditions(Compliance Component#3)—Imminent thneat to public health and safety ❑Tank Integrity(Compliance Componenf#2)—Failing to prr�tect grr�undwater ❑Other Comp{iance Conditions(Compliance Component#3}—Failing to piotect groundwafer ❑Soil Separation(Compliance Component#4)—Failing fo protect groundwater ❑Operating permiUmonitoring plan requirements(Compliance Component#5)—Noncompliant Property fnformation Parcel ID#or SeclT'wp/Range: Property address: 645 Ferndale Road, Orono,MN Reason for inspection: property transfer Property owner: Tom Page Owner's phone: _ or Owners representa#ive: Representative phone: Local regulatory authority: �of Orono Regulatory authority phone: Brief system description: 2-1000 septic tank 1-1000 pump tank mound treatment with 10ftX50ft rockbed __ Comments or recommendations: Certification I hereby certify that all fhe necessary infonnafion has been gathe�d to determine the compliance status of fhis system. No determination of future system perfom►ance has been nor can be made due to unknown condifions during sysfem construction, possible abuse of fhe system,in�dequafe maintenance, or futuie wafer usage. Inspector name: Andrew Kleindl ____ Certification number: 7927 Business name: Jim's Excavatin LLC . License number: 2926 Inspector signature: _ Phone number: 952-4442-9282 Necessary or Localty Required Attachments �Soil boring logs ❑ System/As-built drawing ❑ Forms per local ordinance ❑Other information(tist): www.pca.state.mn.us • 651-296-b300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in altemative formats wq-wwfists4-31b • 6/4/14 Page 1 of 3 Property address: 645 Femdale Road,Orono,MN Inspector initials/Date: �� (mm/dd/YYNY) 1. impact on Pubtic Hea(th—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 ❑ Excess{ve ponding in sal 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 CommentsiExplana6on) health and safety. ❑Other methods not listed(See Comments/Explanation) Com ments/Explanation: 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 meefing 7080.2550 may be ❑Examined Tank Integrity Form(Attach) com /iant if al/owed in loca/ordinance. ❑Observed liquid level below operating depth Sewage tank(s)leak below their ❑Yes � No designed operating depth. � Examined empty(pumped)tanks(s) If yes,which sewage tank(s)leaks: ❑ Probed outside tank(s)for"black soif AI1y "yes"answer above indicafes fhe ❑ Unable to verify(See Comments/Explanation) system is failing to protect groundwater. ❑Other methods not listed(See Comments✓Exp/anation) Com ments/Explanation: 3. Other Compliance Conditions—Compliance component#3 of 5 a. Maintenance hole covers are damaged,cracked,unsea�red,or appear to be structurally unsound. ❑Yes" �No ❑Unknown b. Other issues(electrica�hazards,et�.)to immediately and adversely impad 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-Z82-5332 or 800-657-3864 • Available tn altemative formats wq-wwists4-316 • 6/4/14 Poge 2 of 3 Property address: 645 Femdale Road,Orono,MN Inspector initials/Date: _ ' b `/ I (mm/dd�yyyy) 4. Soil Separation—Compliance component#4 of 5 Date of installation: 9/19/2008 ❑ Unknown Verification method(s): (mm/dd/YYYYJ ShoretandNYel)head protectioNFood beverage Soil observafion does not expire.Pr�vious soil ��9��? ❑Yes �No observafions by two independenf parfies are su�cient, unless site conditions have been altered or local Com liance criteria: requirements differ. Forsysfems builf priorto April 1, 1996,and ❑Yes ❑ No � Conducted soil obsenration(s)(Attach boring iogs) not/ocated in Shoreland or Wellhead ❑Two previous verifications(Attach boring logs) Pmtecfion Area or not serving a food, beverage or lodging estabfishment.� ❑Not applicable(HolrSing tank(s),no drainfield) Drainfield has at least a two-foot vertical ❑ Unable to ver'rfy(See Comments✓Explanation) separation distance from periodically ❑Other(See Comments/Exp/anafion) saturated soil or bedrock. Non�erformance systems builtApril 1, �Yes ❑ No Comments/Explanation: 1996,or later or for non-performance systems located in Sho�land or Wellhead Protecfion Areas or serving a food, beverage, orlodging esfablishmenf: Drainfield has a three-#oot vertical separation distance nom periodically saturated soil or bedrock.* "Experimental'; "Other; or "Performance' ❑Yes ❑ No IndiCate de ths or elevations systems buiff unaler pre-2008 Rules;Type!V or V sysfems built under 2008 Rules(7080. A. Bottom of distribution media 14 inch sand 2350 or 7080.2400 (Advanced Inspector License required) B. Periodicall saturated soiubedrodc 26 inch Drainfield meets the designed vertical C. S stem se aration 40 inch separation distance from periodically saturated soif or bedrock. D. R uired com liance se aration` 36 i►ich Any "no"answer above indicates the system is 'May be reduced up to 15 percent if allowed by Local failing tQ 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 empfoy 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 nitroqen BMP in place and properiy functioninq� ❑Yes ❑ No Any"no"answer indicates Noncompliance. Upgrade Requirementa(Minn. Stat§115.55)An imminent threat to public hea/th and sefety{ITPHS)must be upgraded,replaced,or its use disconGnued within ten months of receipt of this notice or within a shorter period if required by local orrlinance.If the system is failing to protect ground water,the system must be upgraded,rep/aced,or its use discontinued within the time r�quired by/oca/ordinance./f an existing system is not failing as defined in law,and has at/east two feet of design soil separation,then the system need not 6e upgraded,repaired,rep/aced,or its use discontinued,notwithstanding any loca/ordinance that is more strick This provision does not apply to systems in shoreland aroas, 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 ��S �er�a�' �oa�' �V��''o/ ��' _ .�s;�---�- . ; - - .- : : - � - " =_ i ' - � t � -_ ' - � i - :—E �^��..�....---;~ - _ �V= : :� * s � _ . � :� r��.�..��.---i=� [ . . 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