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Home My WebLink About07-25-16 Septic Compliance � ; Minnesota Pollution Compliance Inspection Form .�� ControC Agency 520 Lafayette Road North Existing Subsurface Sewage Treatment Systems (SSTS) St.Paul,MN 55155-A194 Doc Type:Compliance and Enforcement InspeCtion results based on Minnesota Pollution Control Agency(MPCA) For local tracking purposes: requirements and attached forms—additional local requirements may also apply. Submit completed form to Local Unit of Government(LUG)and system owner within 15 days System Status System status on date(mm/dd/yyyy): 07/25/2016 � Compliant— Certificate of Compliance ❑ Noncompliant— Notice of Noncompliance (Valid for 3 years from report date, unless shorter time (See Upgrade Requirements on page 3.) frame outlined in Local Ordinance.) Reason(s)for noncompliance (check all applicable) ❑ Impact on Public Health (Compliance Component#1)—Imminent threat to public health and safety ❑ Other Compliance Conditions(Compliance Component#3)—Imminent thieat to public hea/th and safety ❑Tank Integrity(Compliance Component#2)—Failing to protect groundwater ❑ Other Compliance Conditions(Compliance Component#3)—Failing to protecf groundwater ❑ Soil Separation (Compliance Component#4)—Failing to protecf groundwater ❑ Operating permiUmonitoring plan requirements(Compliance Component#5)—Noncompliant Property Information Parcel ID#or Sec/Twp/Range: Property address: 795 Lakeview Parkway Reason for inspection: New Installation Property owner: Owner's phone: or Owner's representative: Hayes&Sons Excavating Representative phone: 763-479-1762 Local regulatory authority: Ciry of Orono Regulatory authority phone: 952-249-4600 Brief system description: Mound Comments or recommendations: New Installation Certification 1 hereby certify that al/the necessary information has been gathered to 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, possib/e abuse of the system, inadequate maintenance, or future water usage. Inspector name: Roger Peitso Certification number: #6683 Business name: License number: • Inspector signature: Phone number: 952-249-4625 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 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in altemative formats wq-wwists4-31b • 6/4/14 Page 1 of 3 Property address: 795 Lakeview Parkway Inspector initials/Date: RLP � 07/25/2016 (mMdd/yyyy) 1. Impact on Public Health— Compliance component#1 of 5 Com liance criteria: Verifcation 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 ❑ Excessive ponding in soil 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 Comments/Explanation) health and safety. ❑ Other methods not listed(See Comments/Explanation) Com m ents/Explanati on: New Installation 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 meeting 7080.2550 may be ❑ Examined Tank Integrity Form(Attach) com liant if allowed in local ordinance. Sewage tank(s) leak below their ❑Yes � No �Observed liquid level below operating depth 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. ❑Other methods not listed(See Comments/Explanation) Com ments/Explanation: New Installation 3. Othel'COmpl1d11Ce C011d1t10115—Compliance component#3 of 5 a. Maintenance hole covers are damaged,cracked,unsecured,or appear to be structurally unsound. ❑Yes* �No ❑Unknown b. Other issues(elechical hazards,etc.)to immediately and adversely impact public health or safety. ❑Yes* �No ❑Unknown *System is an imminent threat to public hea/th and safety. Explain: c. System is non-protective of ground water for other oonditions as detertnined by inspector. ❑Yes* �No *System is failing to protect groundwater. Explain: www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in altemative formats wq-wwists4-316 • 6/4/14 Poge 2 of 3 . � � Property address: 795 Lakeview Parkway Inspector initials/Date: RLP � 7/25/2016 (mm/dd/yyyy) 4. Soil Separation—Compliance component#4 of 5 Date of installation: 7/25/2016 ❑ Unknown Verification method(s): (mMdd/yyyy) ShorelandNVellhead protection/Food beverage Soil observa6on does not expi►e. Previous soil lodging� ❑Yes � No observa6ons by two independent parties are su�cient, unless site conditions have been altered or/oca/ Com lianCe Criteria: requirements differ. Forsystems built prior to Apri!1, 1996, and ❑Yes ❑ No ❑Conducted soil observation(s)(Attach boring logs) not located in Shoie/and or Wellhead Protecfion A�a or not serving a food, ❑Two previous verifications(Attach boring logs) beverage or lodging establishment: ❑ Not applicable(Holding tank(s),no drainfield) Drainfield has at least a two-foot vertical ❑ Unable to verify(See Comments/Explanation) separation distance from periodically ❑ Other(See Comments/Explanation) saturated soil or bedrock. Non performance systems builtApril 1, �Yes ❑ No Comments/Explanation: 1996, or later or for non performance systems/ocated in Shorieland or Wellhead New Installation Protection A�as or serving a food, beverage, or lodging establishmenf: Drainfield has a three-foot vertical separation distance from periodically saturated soil or bedrock* Experimental; �Other", or Peifo►mance" ❑Yes ❑ No IndiCate de ths or elevatlons systems built under pre-2008 Ru/es; Type IV or V systems built under 2008 Rules(7080. A. Bottom of distribution media 2350 or 7080.2400 (Advanced Inspector License requir'ed) B. Periodicall saturated soil/bedrock Drainfield meets the designed vertical C. S stem se aration separation distance from periodically saturated soil or bedrock. D. Re uired com liance se aration"` Any"no"answer above indicates the system is "May be reduced up to 15 percent if allowed by Local failing 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 Is the system required to employ 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 completed. Com liance criteria a. Operating Permit number: Have the O eratin Permit re uirements been met? ❑Yes ❑ No b. Is the re uired nitro en BMP in lace and ro erl functionin ? ❑Yes ❑ No Any "no"answer indicates Noncompliance. Upgrade Requirements(Minn. Stat§115.55)An imminent threat to public health and safety(ITPHS)must be upgraded,replaced,or its use discontinued within ten months of receipt of this notice or within a sho►ter period if required by local ordinance.lf the system is failing to protect ground water,the system must be upgraded,replaced,or its use disaontinued within the time required by local orclinance.If an existing system is not failing as defined in law,and has at least two feet of design soil separation,then the system need not be upgraded,repaired,replaced,or its use discontinued,notwithstanding any local ordinance that is more strict This provision does not apply to systems in shoreland areas, 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 altemative formats wq-wwists4-31b • 6/4/14 Pnge 3 of 3