HomeMy WebLinkAboutSeptic Compliance Inspection Minnesota Pollution Compliance Inspection Form
Control Agency
5201.afayette Raad North ��$ling Subsurface Sewage Treatment Systsms
sc.Pa�,a,MN 55155-4194 (SSTS)
Doc Type:Compliance and Enforcement
Instructions: Inspection results based on Minnesota Pollution Con#rol Ag�ncy(MPCA) For local tracking purposes:
requirements and attached forrns-additional local requirements may also apply. ,
Submit completed form to Local Unit of Gavernment(LUG)and system owne� '
within 15 days I_ '
System Status
System status on date(mm/ddlyyyy): 6f02N7
� Compliant-Certificate of Compliance ❑ Noncompliant- Notice of Noncompliance
(Valid for 3 years from report date, unless shoRer time (Ses Upgrade Requirements on page 3)
frame outlined in Loca!Ordinance.)
Reason(s)for noncompliance(check all appt�cable)
❑ Impact on Public Health(Compliance Component #f)-lmminent fhreat to public health and safety
❑Other Compliance Gonditions(Compliance Component#3)-Imminent threat to public hea/fh and safety
❑Tank Integrity(Compliance Camponent #2)-Failing fo protect groundwater
❑ Other Compliance Conditions(Comptiance Component#3)-Failing to protecf groundwater
❑Soil Separation (Compliance Component #4)-Failing to protect groundwater
❑Operating permit/monitoring plan requirements(Gomptiance Component #5)-Noncompliant
Property Informatian Parcel ID#or Sec(fwp/Range: 3111823110Q12
------
Property address: 560 Kokesh Farm Road Orono MN Reason for inspedion: Property Transfer
__.__
Property owner: Brian Siska Owner's phone: 952-327-9391
or — _�.._�
Owner's representative: __ _ _ Representative phone:
____ _. .
_. __.._.
Local regulatory authority: �,of Orono Regulatory authority phone: 952-249-4600
Approximately 2-1500 gallo�septic tanks,l-15Q0 gallon lift station and 750 square feet of mound rock
Brief system description: bed rockbed.
___ _. _ _...._..-- ___ _._ --
Comments or recommendations:
TBM:Top of lift station manhole cover
Certification
I heieby certify thaf al!the necessary information has been gathered to determine the compJiance status of this system. No
determination of future system performance has been nor can be made due to unknown conditions during system construction,
passible abuse of fhe system,inadequate maintenance, or fufure water usage.
Inspector name: Joseph J Olson Certification number: 1255
_ _ ___ . . ._. .
Business name: RustLr • ' 'I 8 Perc Testing License number. 810
Inspector signature`��,r� _ _ Phone number: 763-498-8779 _
Necessary or Locatly Required Attachments
�Soil boring logs �SystemlAs-built drawing ❑Forms per local ordinance
❑ Other information{list): _
._._.. � __ _ ___ _ --
www.pca.state.mn.us • b51-295-6300 • 800-557-3864 • TTY 651-282-5332 or 8�•657-3$64 • Avaitable in altemative formats
wq-wwists4-31 • 1/T4/12 Page 1 of 3
Property address: 560 Kolc�h Famt Road Orono MN Inspector initiatslDate: J.0.6�7117
1. Impact on Pualic Health—Compliance com�nent�1 of 5
Compliance cHt�ria: Veriticst(on msthod(sj:
System discharge sewage to the � ❑Yes� �No � ���for su�acc�outlet
gr�nd surfaoe. � Searc�ed for seeping in yard/badcup in home
System discharge sewsge to drain tl{e ❑Yes �No � ���rve ponding in soil system/D-boxes
o�surface waters. ❑ Homeowner testimony(see Comments/�xplanet+w+)
System cause sewage bacicup into ❑Yes �No � °Bladc soil"above sai dispersal system
dwelling or estabtishment. ❑ System requires"emergency'pumping
❑ Perfortned dye test
Any"yea"answsr ebovs Jndicata�!he aystem la ❑ Unabk�to verify(See Comments�E�cplanatior,)
an/mmJnent Thr�et to Pub/lc Heaitlt end Safery. ❑ pthe�n,et�,ods not listed(See Comme,tta�cplenatia,)
Ccmments/Expianation:
2. Tank Integtity—Compliance c:omponent#2 of 5
Com�plianca criteria: Veriticatian method(s):
System c�r�ists of a seepage pit, I ❑Yes �No � Probed iank(a)bottom
cesspool,drywell,or leaching pit. � Exsmined�nstrudion records
�1�P���9��•25�+neY be ❑ Examin�d Tank integrity Fonn(Attach)
cOmd+eRt if eNowed in Ioc8/oldh►a/K:B. i
' ❑ Obsarved liquid level below operadng depth
Sewags tank{s)leak below their ; ❑Yes �Plo ❑ �mined empty(pumped)tanks(s)
des�9ned Oqeretin9 depth, i
If yes,which sewage tenk{s)leaks: { � P������nk(s)for"bladc soii"
Any`yres'°an�wer above in+c�icates the � Unabie to verify(See Canments/Ex�alan�ion)
aysi�em is Fallinp to Protect Groundwat+er. ��metnods not i�aced�see comme�,ra��►,auor,�
Comments/Explanation:
Peterson Company pumped the tanks.
3. Other Comptiance Conditions—Compiiance component#3 of 5
a. MaiMenance F�le covers are dams�d,c�lced,unaea�red.�a�pear to sbuduraliy unsound. O Y�" �No ❑u�cnovm
b. Other issues(e�cal hezerdis,e�c.)to immedi�tely arx! impad publiC tt�ldt or safety. ❑Y�" �No p U�knawm
*Sysbvn!s art/mmJnent throat to public healdr and safity
E�lain:
c. System is non-protedive of ground wa�e�fer�conditions as detertnined bY��SP�a O Yes• �No
•Systam 3s fall�ng to p�t g�rur�dw�hr
Explain:
www.pca.state.mn.us • 65t-2%-6300 • �0-657-3864 • TTY G51-282•5332 or 800-65T-3864 • Available in altemative formats
wq-wwlsts4-31 • 1/24/t2 Paqe 2 of 3
Property address: 560 Kokesh F�rm Road Orono MN Inspedor initials/Date: J.O,8J02/17
4. Soil Sepa�ation—Compliance component#4 of 5
Date ot Installation: 7/27/04 ❑unknown Verification m�thod(s):
$hO�'"�'�'�p��O°��"/°� ❑Yes �!Vo sat observaban does nor expire.Previous saMl
L��? ObS6N8SOt1S by IWO/Il�I9Q61K�@At�8/fl@S 8!9 SfII�ICl9flf
ComplianCe criteria: unless site ca�dditians h�ve been altered or bca!
For sysGems built pria to Apri11, 1986,and ; ❑Yes ❑No �uiiements dit�er.
not bcated in Shore/arM or VYeNheed I � Conducted sal observation(s)(Att�r�r baing togsJ
Protection Area ornot servir�a food, i ❑ Two previous verifications(Atrach bortng logs)
beirera�e or bdg�r�e�stablishment.• I ❑ Nat applicabie(HWding tank(s),ra drelr►field)
f
Drainfreld has at legst a t+aro-foot vertical '
separatiar�disiance from periodicaliy � ❑ Unabie to verify(See Comments�Ex�er:a6on)
saturated s0il or bedrodc. ❑ �ther(See commsr►rs/L�cpranaaa,)
Nony�e�fOrrnance systems built,4prfl 1, ' �Yea ❑No CanmentS/Exp/anation:
1996,or later or for na►-perfom�ancs ;
systems bcated in Shore/end or WeNhead �
Protection Areas or serving a fiood,
bevergge,orlodg/ng estaWist�r►ent: ;
Drainfield has a thr�-foot verNcal 1
separation distence trom periadicaly i
saturated sal or bedrodc.`
�
"Experimental" "Othe�',o� "Performenc�e" ❑Yes ❑No IndlC�te da ths of elevations
systems buitt w�der pre-200aB Rules;Type IV
Or V syst+ems buiJt under 2Q08 Rules(70�. ; A. Bott�n c�distribution media 109.5 . __.
2350 or 7080.24Q0 (Advanc�d Inspec;tor j .
Lic�nse required) ' B. Peradically saturated soiubedrodc J 108.9
Drainfieid meets the designed vertical ,
separstion distance from periodica{hr i C. System separation � 2.8
saturated sal or bedrock. � D. Reouirod canplianoe ss�ara�tion• I 2.6
Any"no"answer above Ina�cates fhe syst�m fs •�y p��uc�d up to 15 percertt if allowed by Local
Feiling to Protect Groundwate/: Ordinanc�.
5. Operating Permit and Nitrogen BMP*—Canp�iance component#5 of 5 �Not applicable
la the syatem operated under an Operating Pertnit? ❑Yes ❑No If"y�",A bNa�r�required
Is the system required to empioy a Nitropen BMP? ❑Yea ❑No If"y�",B b�aw is r+equired
BMP=Best Management Prec�ce(s)spscil7ed in the syst�sm�sig�t
lf the anawer to both quastJons is "no';thia s�ct3on d�s rrot rteed to be com�et�ed.
Compliance criterfa
a. Operating Permit number. €
Have the Operating Permft reQuiremeMs been met? ? ❑Yes ❑No
f
b. Is the required nitrogen BMP in plac:e and propedy functioning� ❑Yes ❑No
Any"no"answer indicate�s NoncomplJance.
Upg�ade Rsquiromenb(M'um.StaG§t f 5.5�An imrninsnt Mueet to p�bN�c hea/th and sefiety(lTPHS)must be upgnacied,rmpdaced.cr its uae
discor�inusd wXhin Gsn ma►tha o/recefpt o1 ti►is notkae ot w#hm e ahort�sr pe�od if roquirod Dy bca/or�nerxae.If the syatwm Js faillnQ to pro�
ground we�r,the syatam must be upgraded,reA�ed,cu tts ute discon�nued wi�►in tl�Gane requimd by tOce/ardinar�ce.!f an ex�system
rs n�r�as deni,ed a►iaw,�d nas�rea�nMo�r�c�ss�,►�se�aor,,nren me sysrem need r►or be u�raded,reve�r�d,rer�aaad,or
its use dlaoa�ntinued,notwithstendenp�►ty bcaJ ord'marx:e that ia rm�e� Thls provisia►does not ap�ly to sy�ems in shore/erld�,
W�l/head PrGtection Arees.or thase t�ed fi�►nrectlort with food,beverage.end bargk�g estab/Tshments es deflned!n/aw.
www.pca.state.mn.us • 651-296-G300 • 800-l►57-386q • TTY 651-282-5332 or 800-657-3864 • Availabte in attemative formats
wq-wwists4•3t • 1/24/12 Aose 3 of 3
�'ank Reoort
na�: .��.�,soi 7
Elr�l.PeL�r�on Co.
5921 Ik�tte Ave.
Qelaao,lMN 53338
Phone 763-972-2420
Fax 763-gT1-7217
MP'CA t.ic�rtse#219
�an and Nancy SN�Ca
580 KtNcastr Ferm RoYd
Mspte P�e6t,MN 55558(pi'p11o)
652-237-9391 Nar►cy
Ba$lea:' UN, OFF
7'ank Capscity: 3-1500 Ga►bn T�ks
#of Tanks:_��_
Type of`fenk�; Concrete
Gallans Yut�ed: 35tt0 .
Mant�les to Grs�de: YE.S / NO ,
Commentc:
0�June 2,2017,Elmer J.Pa6aroon Co.unaav�red msnhpiss{1■-12 inc�es deap,2�—5lnches doep,
Git at�tion—2 irw�ee de�p)aMf pumPsq sapti�t�Mcs. FitEe�in 2"0 Tank. Nu crac�cs or water Iwking in
te�lks at time oi�rnpMp,
NOTE:'Thia is a�}r a teak repoit. Th�a is aot a cwmP����Fa'Poittt of seis n�doea it
replace a�liance in�.
RvpMy�ddrs�s: 5ED K,o1�N►Fum t�ed. � ►n�P�'' ' : 8ITJ17
1. impact an Publk Fl�ltfi—ComP�c�mP�t�i of 5
��' Y�itiptlon m�qiod�s�:
�+dl�dw9�a�wop�b 1h� Q Yst ❑No ❑ S�d tar�o�let
.�.�• ❑ SeiriclMd fa���M fio1M
���todrr�� t QY�s ❑No O ����
�f9�r��onMNah�B�r�Ya�l
S�an i�e fwrp!bMdq�►ir� ! ❑Y�s ❑NO � '�k�'�OVf�oi ap�s�sy�
�«� � ❑ Pafo�ms4 dya��
Am►"Yrs'�►�llndkiMrt/A!ayN�w� � IkWJM b w1y f�q��
.��x�,r naa.r oo r+r��.nd s.�,, a c��na�.aa t�»c%�vw»crw�,
2. Tank Integrtty—compi�nce cnmpo�rt�2 ot s
�—��: Y�Me�ion nNq�odfs):
S�y�em ao�b d a a�p.De D�, � �No ❑ Probed�(�1 baam
�P�W.dry�n��ar�np p�. � Exa�d oo�tn+adon noords
e��pAlts�NF�7G�t?lydOmy6s � ❑ �dTanit Form
oonuowntp'aAbw�Onbata�diria. �Y (�d►!
S�w�q�taMc{e)iNk bNav Ywir ❑Yes �No � Obwivsd W�uld kvN Oabw opar�tlnp dspM�
�d�•_ � ��Y(P++�dl�s)
If YN�whkh s�ppr�(s)iMk�:._L _ ❑ ProErd a+bid��Mc(t3 for'b�Ck aaN'"
Mr'y�"aa�wr,�.JnaNca�a,. o un.a.a,r.ny�s..p�°�„'u
�y�daa a F+�yr to Mrot�ct QnamOw+t�rr. �o��a na w�w rs..aa�,«�n��wa„�
On 81'1f1T,Ehnsr J.PMrtwn Co.ptnp�tl tardcs.
3. Od�er CompNa�te Conditions—car�or�n�o►�t#�3 of 6
•. MslMmr�a nd.cnwn w d�nrp.d.crad�d,un�ahed.«app�r a�u�x�r urpouid. p v.r O uo D tt�awwn
o. opw iq�s NA�o9iOrn�.ec.)b imnt�r�nd+�y��ctMMh or s�latr. O ra• ❑aa Q unNnow�
'S�rn b ari iu�wb�nt N�f bpai6Nc ha�le�rd aNqr
��
G Sywr"is�a�pol�dw af yround waMr br otl+w�aaidi�a�s�s delomYnad b�r Y�qor ❑ver O ao
�al�a U ANNnp bpeol�atytoe�dM�Nr
�=
www-ou.uw.�.w . ��-�-�smo • eoo�a�a�-�+ . mr es�-m-s�a�oaee�•� • +wan+au►�+.�oe�nxn�eo„n.n
nq•wwdksh3l . 1f2l/12
A�e I oJ 3
Soil Ubserv�tion Log
www.SepticResource.com vers 12.4
�YIILI �B�I�I'AI��lO1f
Properry Owner/pmject: Brian Siska Date 6/2/2017
Properry Address�PtD: 560 Kokesh Farm Road
Sai15t� Ii�f�t� ❑r+�ir to�ed s+c�sur�ey
Parent matl�s: o��� ❑�►�, o�� ❑a��,� o��� o��
�anascape pos�t�on: �sum�„it ❑sna,k�r Q side sbpe p ra s�e
soil survey map units: L41� slope % direction-Lineal
SQi1 #1 _
��^� �� Elevation 110.3 Depth to SHWT 40 tnches
Depth(in) Texture fragmens 9% matrix cola redox color consistence e sha
0-26 FiU <3S
26-40 Topsoil <35 10yr4/2 Loose Loose Single grain
40-48 � Clay Loam <35 10yr514 10y4l8,1-6f10y Firm Strong Btocky
�5 loose loose singlegrain
35-SO fr'��� w'� S�ular blocky
�S� firnt mOdel'ate prismatic platy
rigid strong massive
�35 loose loose single grain
35-50 friabte weak �ra„u�er blocky
�50 firn'1 mOdCr8te Prismatic platy
rigid strong messive
Comments:
s6a x��,�n F�� �►� �
0� ❑�t Elevation 110.1 Depth w SHWT 34 Inches
(in) Texture fragment°/a matrix color redox cotor consisttnct
0-17 Fill <35
17-30 Topsoil <35 10yr4/2 Friable Loose Single grain
30-34 Clay Loam <35 10yr5/4 Friable SVong a�ocky
34-40 C1ayLosm <35 IOyr5/4 IOy4l8,1-6/l0y Firm Strong Prismatic
�35 loose laose sing�e grain
fitiable weak granular bloety
35-50 �� moderate p�sma�ic platy
>50 rigid strong �ive
550 Kol�es�Farm Itoad ._ Se�1 #3
❑��9 ❑� Elevation Depth to SHWT
De th(in) Texture fragxnent% matrix color redox color consistence e
�35 loose loose single grain
35-50 friabte weak ganular blocky
f1171] m0(�eTBte Prismatic platy
>SO �g�� �.ang massive
�35 loose loose single grain
fi'IBbIC we8k granular blocky
' 35-50
firm modetate prismatic plary
�50 rigid strong massive
<35 t�� 1�� single grain
35-50 fnable weak granutar blocky
fiTtTl mOdetBtC P�matic platy
>SO rigid strong mass��e
<35 ��� 100� single grain
friable weak granular blocky
35-50 � m��e prismatic platy
�s� rigid strong �sive
<35 loose loose single grain
35-50 friabte weak gar►ut� blocky
>5� firm moderate PT»ic plary
rigid strong �sive
1 hereby certify this work was complered in accordance with MN 708�and arry foca!req's.
---�
R Olson's Soil&Perc 810
signer Signature Company License#
l�c� k � ��► t �
� V .
�� e �
�
�
�
�1 , , � _ . _
.� , ;
.� ,
� o
; - �
, A ,
� _ _ /
0
. y�
, ��� ��
�
r
r�N � aa` 4 �' �'`
�
M�,� �7 ' y i' 6+`
i`� �t �;q� `�� � .
3
�v -t-u c t�
�'���
1 t� � a,0 � 0�