HomeMy WebLinkAboutCompliance Inspection : Min�esota Pollution Compliance inspection Form
� <�°-s����� Controi Agency
520 L,afayette Road Nonh Existing Subsurface Sewage Treatment Systems
sc.P�,i,MN 55155-4194 (SSTS)
Doc Type:Compliance and Enfoicement
Instructions: Inspedion results based on Minnesota Pollution Controi Agency{MPCA) For local tracking purposes:
requirements and attached forms-additional local requirements may also appfy.
Submit completed form to Locai Unit of Government(LUG)and system owner
within 15 days .......--- '
System Status
System status on date(mm/dd/yyyy): 6i02/17
� Compliant—Certificate of Compliance ❑ Noncompliant— Notice of Noncompliance
(Valid for 3 years from report date, unless shorter fime (See Upgrade Requirements on page 3)
frame ouflined in Local Ordrnance.)
Reason(s)for noncompliance(check all applicabteJ
❑ impact on P�blic Health(Comptiance Component #'1)-Imminent threat to public heatth and safety
❑Other Compiiance Conditions(Comptiance Gomponent#3)-lmmrnent threat fo public health and safety
❑Tank Integrity(Gompliance Component #2)-Faiting to protect groundwater
❑Other Compiiance Gonditions(Compliance Component#3)-Faifing to protect grnundwafer
❑Soil Separation(Compliance Component #4)-Faiting to protect graundwater
❑Operating permiUmonitoring plan requirements(Gompfiance Camponent #5)-Noncomp(iant
�
Property information Parcel ID#or SeclTwp/Range: 3111823110012
__ _ _ --
Property address: 560 Kokesh Farm Road Orono MN Reason for inspection: Property Transfer
- -_. __
Property owner. Brian Siska _ Owner's phone: 952 327-9391
_ ._�... _ _ .__. �_ ..__
or
Owner's representative: � .. __ Representative phone:
_ _....
Local regulatory authority: City of Orono � Regu{atory authority phone: 952-249-4600
Approximately 2-1500 gallon septic tanks,l-15(}0 gailon lift statiort and 750 square feet of mound rock
Brief system description: bed rackbed.
__ _...... _...... ___ _.__ _._ _ ..
Comments or recommendations:
TBM:Top of lift station manhole cover
Certification
!hereby certify that alI the necessary information has been gathered to determine the compliance status of this system. Na
determination of/utur�system performance has been nor can bs made due to unknown conditions dunng system construction,
possible abuse of fhe system,inadequate mainrenance, or future water usage.
Inspector name: Joseph J Olson Ce�tification number: 1255
_... ____. _ . __
Business name: Rusty ' 'oil&Perc.Testing License number: 810
Inspector signature: __ Phone number: 763-498-8779
_. .._ __ .___—
�`
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-b57-3864 • TTY 651-282-5332 or 8�-65T•3864 • Avaitable in altemative formats
wq•wwists4-31 • 1l24/11 Page 1 af 3
Property address: 560 Kokesh Fartn Road Orono MN inspector initis�IDate: J.0.6�2/17
1. Impact on Public Health—Compiiance component�t1 of 5
Compllence criteM�: VeriNcaticn method(s):
System discharge sewage to the � ❑Yes �No � ����$urFace outlet
ground surfaoe. � Searchad for seeping in yard/badcup in home
System disd�arge sewage to drain tile ❑Yes �No � ���rye ponding in soil system/D-box�
or surfat�e waters. ❑ Homeowner teatimony(See CommentadExpanatiart)
System cause sewage backup into ❑Yes �No � °Bladc soil"above soii dispersal sysfiem
c!v►relling or establishment � ❑ System requires'emergency"pumping
❑ PerFormed dye test
Any"yes"anawer abave Ind/cat�as the system/a ❑ Unabie to veriry(see cann�renrs�caenaann)
an Imm/nent Threat to Public Haal�r snd Salet�r. ❑ pthe�m�ods not listed(Sse Cornme�ta�F rpranatron)
CommentslExplanatiorr
2. Tank Integrlty—Compliance cbmponent#2 of 5
Complianc�criteria: Veri�catian method(sj:
System�r�isis of a seepage pit, � ❑Yes �No � Probed tank(s)bottom
cesspool,drywell,or leaching pit• � Exsmined construdi�records
SeepeQe plts+�eHrtg 7o8o•2s50 may be ❑ Examined Tank Integrity Form(Attedr)
oomdlant if aAlow�d in bcN o►dine�.
❑ Obsenred liquid level below operating depth
Sewago tank(s}leak below their ❑Ycs �No
designed oPeretin9 dePth. ❑ Examined emPtY(Pumped)tanks(s)
If yes,which sewage tank{s)leaka: � ❑ Probed outside tank(s)for"black soil"
Any`yres"a�swer above ina�cates the ❑ Unabie ta verify(See Ca»ments/�xplanation)
system is Failfn�to Protect Groe�ndwater; ���'°ds not iiatea�see comme�r�p+s,�►/
Comments/Explanation:
Peterson Company pumped the tanks.
3. Other Compliance Conditions—Compliance component#3 of 5
a. MaiMeneu�oe t�ale covets are tl�amaged,cxac�c�,unsecured,or appear to stttx:turaity unsau�d. �Y�' �No ❑Unkno�nm
b. Othef isa�(elecxrtca►hssmds,e�.)to imrrrediatey and adve�y impad public heaith or safety. O Y�* �I�b p U�cnam
"�ys�rn is an�nmlm�►►t threat to pubiic/w�itl►and sahty
F�cplain:
c. System is r�-protedive of g�rxt wafier for�conditions as dedertniried by inapecdor ❑Yas• �No
'�yst�rn is faiNn��o p�t,�ur►ahv�r
Explain:
www.pca.stats.mn.us • 65�-296-6300 • 800-657-3864 • TTY 651-2$2�5332 or 800-657-38ba • Available in attemative formats
wq-wwists�-31 • 1124/t2 Poge 2 of 3
Property address: 560 Kokeah Farm Road Orcmo MN Inspector initiais/Date: _J.O.6/02/17
4. Soil Sepa�ation—Compliance cqmpanent#4 of 5
Oate ot installation: 7/27/04 ❑Unkncrim Verification method(s):
ShonlandlWMihe�d pr�sctioNPood ew� ❑Yes �No Soi!observation does not exptf'i9.Previous&01!
LOda�? observations b [►Mo i
y ndependent pa�fies s�sulflcient,
Com liancs criteris: unless site conditions have been altened or�Ocai
For syshems 6uilt p►iw to April 1, 18A8,and ❑Yes ❑No re9'ui�ements difi'far.
not bcated in Shore/end or Wellhead ; � Conducted sal observadQn(s)(Attadr bairg bgs)
Protecdion Area or not serving a food, ❑ Two p�evious verificadons(Attac�►bortng 1v,Qs)
beirerage or tod�ng esteblishment: � ❑ Not applic�ble(Hotdtrrg tank(s),rro dreinfrehi)
Drair�ield has at leasf a two-foot uertical j ❑ Unable to verify(See Comr►rentsiExplanaGor►)
separation disianc�e from periodically
satu�eted soil or bedrodc. ❑ Other(See Comme�►ts/Exp�ana�)
Non pe�fiwmance sysfiems built Aprif�, ° �Yes ❑No Comments�F�c�ar►ei�cx►:
1996,or later or/or non-perfnrr»a�e
systems bcated in Shoreland or Wetlhead i
Protecb'on Arees or serving a fiooal, �
bever�qe,orlodging estabtlshment ;
Drainfield has a thre�-foot vertical (
separation distanoe Trom periodicaly a
saiurated sal or bedrodc.'
"Experimental" "Othe�',or °Psrfamance' ❑Yes ❑No IndlC�to de ths of slev#tions
systems buitt under p�e-2008 Rules;Type lV
or V syshems built under 2008 Rutes(7�. A. eottom of d�ibution media 109.5 _....._..
2350 or 7080.?400 (Advanced Inspector
License required) � B. Periodicall saturated soiUbedrodc 1Q8.9
�
Drainfietd meets tl�e designed v�rtical ' C. S te�n ae ration 2.8
separation dista�oe from periodicaly ;
saturated soil or bedrock. ; D. ReQuirod C�»qliaf�ce seDat8ti0n• � 2.6
Any"no"answer above ina�catas the aystem fs •Mey pe,�educ;ed up to 15 percerrt N allowed by Loca1
Failing to Protect Groundwat�v: Ordinanoe.
5. Operating Permit and Nitra�en QMR*-ccxnp�iance component#5 of 5 �Not applicable
Is the syatem opereted under an Operating Pennit? ❑Yes ❑No If"y�",A bslow is required
Is the system required to empby a Nitrogen BMP? ❑Yea ❑No If"y�",B belcw is required
BMP=Best Management Pr�6Pce(s)specfied fn(t►e sys�+em design
!f d�e ansrrer to bodr quos�ons Js"no';�is soctfon does not need i�o bo complst�ed.
Complisnce criterla
a. Operating Permit number: �
Have the Operating Permit requirerran�been met? a �Y� ❑No
;
b. Is the required nitrogen BMP in plac�and propedY functianing? ❑Yes ❑No
Any"no„answer indicatea NoncompUance.
Upg�RequinmsMs(Muu►.StaG§115.5��imml►�snt mreat to p�bNic hea/hb end set�ty(lTPHS)must be upgraBed,r�placad,or its use
discor�in�sd wKtun ten rrwr►ths M rewipt�'d�is notkse ot witf►rt e aNarDer per�af N requirad by bca/adVner�ce.If die syatem Js fallfrrQ to p�tect
ground wsA�r,die syst�m must be upqradsd,reA�eced,or lts r�dfso�nued�tt►in tlie time required by bcel adinance.!P an ex�dr�sysfem
is not fa�fi►g es dsflned ln/aw,�d has�lsa�tt�o taM9t at dss�gn�!sep+�s6on,fhen the syalem need rx�t be upgm�ed,ropeir�sd,r+eplaced,or
its u�e�ntinued,no�ithstandbag arty Ibcat otdinartce thaf is m�e sh�iCL This A�vi�doea not apply to systems!n�oretsnci er�as,
Wel�head Protection Arees,ar ttto�e u�i in vwtne�ction►v#t►faod,bev+erag�e,arni/odgir►g es�bllsluner�ts as deflired fn law.
www.pca.state.mn.us • 651-296-63pp • 800-657-38b4 • 'TT'Y 65t-282-5332 a 800-657-3864 • Availat�in attemative formats
wq-wwists4-3f • fl24/1Z Poge 3 of 3
�a�k Renort
��, JuM 2,2017
I31n�nr J.Peottson Co.
5921 Da�t�e Av�,
Dtleno,MN SS338
!'twne 763-972-24�0
Fs�c 7b3-972-731�
MPCA I.iccnse�M 2t9
�,ana nwr�cy s�cs
580 Kdc�sh Farm Road
Mapb Plain,MN 5595�{4ro�o}
852-237-p391 Nancyr
13et�les•' ()N, OFF
1'mk Capecity: 3-1500 C�a�Tmk:
#of Tanics:___3___ _
TYTk of Tankg: Concro�e
Gs�loas Pnmpad: 35�D
Manholes to Cmde: YES�! NO ,
Coau»ents:
Qn June 2,2017,Eimer J.P�sraon Cc.ur�covaad msnhoks(1■-12 inch�clo�.2�—5 inches deeP,
Gft atatlon—2 inch�ds�p)�Pumps4 up��4iMts. Fiti�in 2n0 Te�nit. NO cradu or w8ter Making p�
tenks at tlrtle cf pum�np.
NOi`E:'Ihis is oaly a t�k rapcM, 7'hi�is rat a aamptisnoe wspxxion for poi�of sak nor doea it
r�lace a�1�inspe�ba.
Prop�tY addrea: �00 KokMh Fam Road. ..� In�P��s: 81TJ17
1. It�att at Pubtk HNtEt1-Goimt�as ownoo�ent#1 af 5
�.��� V�hReatlon�q�odts�:
�Mm�btl�rg�aw�p�lo ths ❑Ya ❑No ❑ 8�d ikrr auriros oudet
��� ❑ 3e�Md kr�e�iny In y�db�ict�ie h01rN
_�-��fo dr�+tp+s � ❑Y�s 0 No a ��"��"baes
�o�r fSw
��bt�M11D � ❑Y�s ❑No ❑ ��i ��PMrM Mhm
�
Anj►'I'�'aru+w/M�vro lndkrlM�llt a,yaM�b C� Pedoanrd dy�but
an�x�&wa rr�aar ia Pr�rc ta.�a�d sNw�►. O �m wny rs..c�.�
❑ �mwad�na Ii�sa�.. �y
2. Tank tnte�ttY—Comvl�Os componant aa ot s
��� _ . VirMle�ion n�tl�od(s);
�m oa�b ot a�PM, ❑Yes �Nc O Probed i�dcts)ba4lom
aa�pooi.drYrwl,ar N�d�r+0 P�. ❑ E,�nlr»d oorrAnxtwn rocads
�AAs+aNM�70A0.?d�7 nry bs ❑ F.�ra�tl�d Trr�k Mkpril�r Fartn(AM�C»1
oanol�ntfabr�QinbO�fadFw�. ❑ Ob�vsdYquldkMMbebwopa�daplh
Swwp�tank{o)N�k bNow 1Mir ❑Yea �ND
��+•_ � � ��1Y(P�d)�e)
Nltas�whieh Nw�ps dnlKs?INkt:_L ❑ �o0�d oub�eM dnk(s)br'W�ck w�
Mr'�"aaw.r.boM.lnaY�.r dn a un�.to v�aiy�s.. aon,
!Y+�a�r to Prolref�now�d�wMr. ❑a�r m.mo�na wNa�s..a,��J
On BtZJt7,Ekn�J.PM�raon Co.punp�tl�rd�,
3. OtFter Comptlat�te Condhkf�n- aon'�p�wnt#k�of 6
a IN�iMer�w+a hde cowrs an d�d.aa�d,wwpued.or appse►to aumu�y urrarid. ❑ws� p ao O t�rswwn
e. aher�hrl�aaforlWr�.�.)tn inw»dI.INy�„d adyar�Ny i��c1aMNt►ar srdWy. O ra�• ❑ao O tJnw,a�
'S�v�rn b an�t1A�t bpabAk hWlp�dadllgi
�:
G �"��orqnxM�d wMK tar atlwr aondiYons w dM�n+�t�e0 Dp Y�r ❑Yes• O No
'�n/���p b peoll�tgeoundY�r
Explain.
www.pa.wa.mn.�n . bstd46-slOo . �oD�7-7�M . mr85t-�s3�orlOIYd67•3C64 • AvaR+pteinat��vetom�att
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fhpe I of 3
Soil Observation Log
www.SepticResource.com vers 12.4
�H�T���i�it�lII
Properry Owner/prnject: Brian Siska Date 6/2/2417
Properry Address/PtD: 560 Kokesh Farm Road
5ui��� I�l+an�uetfo� C��r co sc��
Parent matPs: o�n p a�twas�, ❑�aa�ne ❑�u�uv�Ium p orc�an�c o sedroc�c
�����t��: ❑�� o� a�� o Tce�
soil survey map units: L41� stope % direction-Lin�al
5��1 #1
��� ❑� Elevation 110.3 Depth to SHWT 40 Inches
(in) Texture fragment% matrix cola� redox color consistence e sha
0-26 Fill <35
26-40 Topsoil <35 I Oyr4/2 Loose Loose Singie grain
40-48 ' Clay Loam <35 10yr514 IOy4/8,1-6/l0y Firm Strong stocky
QS loose loose singlegrain
35-50 ��e H`� sranular btocky
�s� fi1"t11 mOdel'ste prismatic platy
rigid strong massive
�35 loose loose single grain
35-50 friable weak �ranuier blocky
�50 f1rrr1 mOderetB Prismatic platy
rigid strong �S�ve
Comments:
560 Kokesh Farm Road �oi� �2
�� ❑�t Elevation 114.1 Depth w SHWT 34 Inches
th(in) Texture fragcnent% matrix color redox color consistence de sh
0-17 Fill <35
17-30 Topsoil <35 10yr4t2 Friable Loose 5ingle grain
30-34 Clay Loam <35 14yr5/4 Friab(e Stirong Biocky
34-40 ClayLoem <35 lUyrS/4 10y4i8,1-6/l0y Firtn Strong Prismatic
<35 �O°S� �0�� single grain
35-50 fi'iahle weak ganu�ar b�ocky
�50 firm moderate P�Ismatic platy
rigid strong ��ve
560 Kokesh Farm Road S�il �
❑��9 ❑� Elevation Depth to SHWT
De th(in) Texture fra$ment% m�atrix color redox color consistence e
<35 frisble N,� singic grain
35-50 s�8"u�ar b�°�h'
�50 flim ntpderate Prismatic platy
rigid strong massive
<35 loase laose $;���n
$i8b1C wCBk granular blocky
" 35-50 fi� moderate P P��Y
>50 rismatic
rigid strong ��ve
<35 loose loose singlc grain
35-50 friable weak g�,ular blocky
�50 fiTm mOdef8te P��ic platy
rigid �ang �s��e
�3$ loose loose single grain
35-50 ���e �'� grenular blocky
�s� firnl moderate P�matic P�Y
rigid strong ��ve
<35 �oose loose single grain
35-50 friable weak granuiar blocky
�50 flrnl modetSte Pnsmatic plary
rigid s�png massive
1 hereby certify this work was cornpleted rn acc�dance with MN 7080 and arry Incal reg's.
-.,,`
Rusty Olson's Soil&Ferc 810
signer Signature Company License#
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