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�� Minnesota Pollution � � Compljance inspect�on Forrr�
` �`�'���� �� Control Agency
'���=`�`�' Existing Subsurface Sewage Treatment Systerr�s (SSTS)
520 Lafayette Road North
St Paul,MN 55155-4194 Doc Type:Compliance and EnforGemenf
In8peCtion�esults based on Minnesota Pollution Control Agency(MPCA) For local tracking purposes:
requirements and attached forms–additional local requi�ements may also apply.
Submit complebed form to Locai Unit of Govemment(LUG)and system owner
within 15 days
System Status
System status on date(mm/dd/yyyy): 6l26/2013
� Compliant—Certificate of Compiiance ❑ Noncompliant— Notice of Noncompliance
(Valid for 3 years from report date, unless sho►ter time (See Upgrade Requi�ements on page 3.)
ifarne outfined in Local O►rlinance.}
Reason(s)for noncompliance(check all applicable)
❑ Impact on Public Health(Compliance Component#1)–lmminent threat to pu6lic health and safety
❑Other Compliance Conditions(Compliance Component#3)–Imminent th►eat fo public health and safety
❑Tank Integrity(Compliance Corrfponent#2)–Failing to protect groundwater
❑Other Compliance Conditions(Compliance Component#3)–Failing to protect groundwater
❑Soil Separation(Compliance Component#4)–Failingr to p►atecf groundwater
❑Operating permiUmonitoring plan requirements(Compliance Component#5)–Noncompliant
Property Information Parcel ID#or SecJTwp/Range:
Property address: 2680 Fox St Orono MN Reason for inspection: property transfer
Property owner: Randy Bremher Owner's phone:
or
Owner's representative: Representative phone:
Local regulatory authority: Hennipen County C��O��� Regulatory authority phone:
Brief system description: 2-1000 se tic tanks, 1-1000 um tank,mound heatment 10ft X66 ft rockbed
Comments or recommendations:
Certification
1 he%by cer6fy that a11 the necessary informafion has been gathened to detem►ine ihe comprance status of this system.Alo
detennination of futu�e system perfo►mance has been nor can be made due to unknown ca►ditions during system consfruction,
possiWe abuse of the sysfem,inadequate maintenance,or futu�water usage.
Inspector name: Andrew Kleindl __ Certification number: 2926
Business name: Jim's Excavatin LLC License number: 2926
Inspector signature� Phone number. 952-442-9282
Necessary or Locally Required Attachments
�Soil boring logs ❑System/As-built drawing ❑ Forms per local ordinance
❑Other irtfortttation(iistj: _ —
www.pca.state.mn.us • 651-2%-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in altemative formats
wq-wwists4-31 • 3/16/12 Page 1 of 3
Property address: 2690 Fox St Orono,MN Inspedor initialslDate:�,�I Iv"'ou�C�
(i►►►►✓dd/YYYYI
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/badcup 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 ❑`glack soil"above soil dispersal system
dwelling or establishment.
❑System requires"emergency"pumping
Any"yes"answer above indicates the ❑Performed dye test
system is an imminerrt threat to public ❑Unable to verify(See Comments/Explanation)
hea/th and safety.
❑Other methods not listed(See Comments/Explanation)
Comments/ExplanaUon:
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 mee6ng 7080.2550 may be ❑Examined Tank Integrity Form(Attach)
com iant if allowed in loca!ordinance.
❑Observed liquid le�el 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 soil"
Any"yes"answer above indicates the ❑ Unable to verify(See Comments/Explanation)
system is failing to protect groundwater. ❑��r methods not listed(See Comments/Explanation)
Com ments/Explanati on:
3 Other Compliance Conditions—comp�iance component#3 of s
a. Maintenance ho�e covers are damaged,cracked,unsecured,or appear to be stn.icturalty unsound. ❑Yes" �No ❑Unknown
b. Other issues(elechical heza�ds,et�.)to immediately and adversely impad public heatth or safety. ❑Yes* �No ❑UMcnown
"Sysi�em is an imminent fhreat to pub►fc health and safety.
Explain:
a System is non-protedive of ground water for other conditions as detertnined by inspector. p Yes• �No
*System is failing to protecf groundwat�er:
Exptain:
www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 65t-28Z-5332 or SW-65T-3864 • Availab[e in altemative famats
wq-wwists4-31 • 3/16/11 Poge I of 3
Property address: 2890 Fox St Orono,MN Inspector inifrats/Date: � ��'�J 6'�3
(mMdd/yyyy)
4. Soil Separation—Compliance component#4 of 5
Date of installation: �Unknown Verification method(s):
(mm/ddly�yp} Soil observafion does not expire.P�vious soil
ShorelandnNellhead protectioNFood beverage �Yes ❑No obse�vations by iwo independent pa�ties a►e suffrcient,
�°dgi�g? unless site conditions have 6een a/tened or local
Com liance criteria: requirements differ.
For systems built prior to April 1, 1996, and ❑Yes ❑No �Conducted soil observation(s)(Attech boring logs)
not located in Shoreland or Wellhead ❑Two previous verifications(Attech baing logs)
Protection Aiea or not serving a fooal,
beverage or lodging establisi►menfi ❑Not applicable(Holding tank(s),no drainfield)
Drainfield has at least a two-foot vertical ❑Unable to verify(See Comments/Expianation)
separation distance from periodiqlly ❑Other(See Comments/Explanatan)
saturated sal or bedrodc.
Non�erfonnance systems built Apri11, �Yes ❑No Comments/Explanation:
1996, or later or for non-perfom►ance
systems located in Shoreland or Wellhead
Protection A►eas or serving a food,
beverage, orlodging establishment
Drainfield has a three-foot vertical
separation distance from periodically
saturated soil or bedrock.'
Experimental; "Other", or "Pe►fom►ance" ❑Yes ❑No Indicate de hs or elevations
systems 6ui(t under pre-2008 RWes;Type(V
or V systems built under 2008 Ru/es(7080. A. Bottom of distribution media 24 inch sand
2350 or 7080.2400 (Advanced Inspedor
License required) B. Periodical saturated soiUbedrock 22 inch
Drainfield meets the designed vertical C. S tem se ration 46 inch
separation distance from periodically
saturated soit or bedrock. D Required compliance separatan* � 36 inch
Any"no"answer above lndicates the system is 'May be reduced up to 15 percent if allowed by Local
iailing 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
fs the system required to emptoy a Nitrogen BMP? ❑Yes �No tf"yes",B below ia required
BMP=Best Management Practice(s)specifled in the system design
!f the answer to both questfons is"no'; thls section does not need to be comp/eted.
Com liance criteria
a. Operating Permit number:
❑Yes ❑No
Have the O eratin Permit r uiremeMs been meY?
b. Is the r uired nitro en BMP in lace and ro erl functionin ? Yes No
Any"no"answer indicates Noncompliance.
Upgrade Requlrements(Minn.Stat.§115.55)An imminent threat to public health and safety(lTPHS)must be upgraded,�oplaced,or its use
discontinued within ten months of receipt of this notice or wifhin a shorter period if required by local ordinarrce.If the system is failing to protect
ground water,the system must be upgraded,raplaced,or ifs use dis�aontinued within the time required 6y local ordinance.H an existing system
is not faifing as defined in law,and has at least two feet of design sal separation,then the system need rrot be upgraded,repaired,replaced,or
its use discorrtinued,nohvithstsnding any loca!adinance that is more strict This provision does not apply to systems in shoreland aieas,
We!lhead Protection Ariaas,or those used in connecUon with food,6everage,end lodging establishments as defrned in law.
www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in altemative formats
wq-wwists4-3f • 3/16/f2 Pvge 3 of 3
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SEPTIC SYSTEM INVENTORY
Site Address: 2690 FoX St PID 04-117-23�2-0003
Owner Name: Randy 8� Elizabeth Brehmer
Owner Address: 2690 Fox St Wayzata MN 55391-
BuildinqTvpe: new sfr Installer: Elmer Peterson
Date of Permit: 11/14/2007
Svstem Tvpe: mound BR's Designed for 5
In Musa?: No Shoreland?: No
SEPTIC TANKS:
Material: precast concrete Capacitv: 1300, 1300, 1300 Tank Filter: n
DRAINFIELD:
Treatment Area: 620 Soil Boring: yes DF Ht above Wt: 3
WELL DATA
Setbacks -Well Tanks: 75 Well DF: 100 plus Report In File: Depth: 134
INSPECTION RECORDS____ ___ __ _ PUMPOUT RECORDS
_____ _ _ __ __ -
Date Notes Date GallonsOfLiquid
7/2/2013 Point of sale septic certification valid until 7/1/2016 � 6/26/2013 0
8/23/2007 New home and septic- Not yet occupied 8/23/2010 0
9/1/2006 Non-compliant, replace by 12/31/2010 8/23/2010 2500 ,
' 7/29/2004 Non-compliant, replace by 12/31/2010 ' S/18/2004 1000 �
8/8/2002 non-compliant,replace by 12/31/2010 12/16/2000 500
� 5/9/2000 non-compliant, repair by 12/31/10 ', 7/15/1999 500
' 9/18/1997 non-compliant-repair by 12/31/2007 1/30/1997 500
11/8/1994 no surfacing I 7/7/1993 500
6/17/1991 no surfacing 7/26/1990 1500
7/8/1988 no surfacing, DF pipe exposed 10/1/1987 1000
, 8/8/1986 no surfacing 5/29/1981 1500 �
10/2/1981 no surfacing
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��:¢,O�: , CITY of ORONO
/%0,�,,, 0����� ON SITE SEPTIC SYSTEM DESIGN & INSPECTION �
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�� , �°���� �, � Crystal Bay, MN 55313
\��k s�io4`�%/ 952-249-4600 Fax 952-249-4616
`� � DATE TIME
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INSPECT/ON NOTICE SCHEDULED
PERMITNO. � �/��7� COMPLETED 1�� f� �'���7
CITY OF TEL.NO.
ADnRESS �- fG��_��,X .S`3T`�'-C'�i-- -
OWNER/CONTR. � i�L'li",�7 ('c� � i w � /in�� ��'--�{; -����''.1L1'
❑ SITE INSPECTION C' EXCAV./GRADING/FILLING u SEWER CERTIFICATION
` � °�SEPTIC INSTALL � REINSPECTION ❑ SITEASSESSMENT
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�SEPTIC FINAL J COMPLAINT ❑
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¢ ❑ CORRECT WORK AND PROCEED.
� � CORRECT WORK. CALL FOR REWSPECTION BEFORE COVERING.
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w n INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. °'
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