882 Lakewood Hills Rd N - MPCA Compliance Inspection Forms Sep 08 15 07: 33a p. l
MC Contracting, Inc
Compliance Inspection
�/2015
Existing Subsurface Sewage Treatment System
(SSTS)
Owner: William Freeman
Property Address: 882 Lakewood Hills Rpad ��
Eagan, MN 55122
County: Dakota Counfy
Inspector: Michael Conboy
22285 Albatross Circle
Farmington, MN 55024
License# L1800
Certification � C4826
Company Disclaimer:
Based on what we are able to observe and out experience with onsite wastewater technology,we
submit this Onsite Wastewater Treatment System Inspection Report based on the present
condition of the onsite wastewater treatment system. MC Cont�acting, Inc has not been retained to
warrant guarantee,or certify the proper functioning of the system for any period of time in the future.
Because of the numerous factors(usage,soil characteristics, previous failures,ect.)which may
effect the proper operation of a wastewater treatment system,this report shall not be construed as
a warranty by our company that the system will function prope�ly for any particular buye�.
MC Contracting� Inc DISCLAIMS ANY WARRANTY,either expressed or implied,arising from the
inspection of the wastewater treatment or this report. We are also not ascertaining the impact the
system is having on the environment.
MC Contracting, Inc -651-210-5052
Sep 08 15 07: 33a p. 2
Minnesota Poliution Compliance I nspection Form
; Control Agency
520 Lafayette Road North Existing Subsurface Sewage Treatmen# Systems (SSTS)
St.Paul,MN 55755-4194 Doc Type:Comprance and Entoicement
I�SpeCtiOn fesuits based on Minnesota Pollution Control Agency(MPCA) �or local traciting purposes:
requirements and attached forms—additional local requirements may also apply.
SubmR completed form to Locai Unit of G�vemment(LUG)and system owner
within 15 days
System Status
System status on date(mm/dd/yyyy): 9/6/2015
� Compliant—Certificate of Compliance ❑ Noncompliant--Notice of Noncompliance
(Valid for 3 years from repo�f date, unless shorter time (See Upgrade Requirements on page 3.)
frame outlined in Loca!Ordinance.)
Reason(s)for noncompliance(check a1!applica6le)
❑ Impac�on Public Health(Compliance Component#1)—Imminent threat to public health and safety
❑Other Compliance Cond'Rions(Compliance Component�t3)—lmminent threat to pubfic health and safefy
❑Tank Integrity(Compliance Componenf#2)—Failing to protect groundwater
❑Other Compliance Conditions(Compliance Compvnent#3)—Failing to proteet groundwater
❑Soil Separation(Compliance Component#4)—Failing to protect groundwater
❑Operating permit/monitoring plan requirements(Compfiance Componenf#5)—Noncompliant
Property Information Parcel ID#or Sec/Twp/Range: 104435000170
Property address: 882 Lakewood Hills rd Eagan Mn.55122 Reason for inspection: propertvtransfer
Property owner: William Freeman Owners phone: 507 4581064
or
Owners representative: Representative phone:
Local regulatory authority: City of Eagan Regulatory authority phone:
Brief system desa'iption: 1500 gal septic tank-300' Drainfield Trenches-Gravity Flow System _
Comments or recommendations:
Certification
1 hereby certify that all the necessery information has been gafhered tv determine the compliance status of this system.No
determinafion of future system performance has been r+or ean be made due fo unknown condifions during sysfem consfruction,
possible abuse of the system,inadequate maintenance, or fufure water usage.
Inspector name: Mike Conboy Certification number: 4826
Business name: MC Contracting Inc. License number: 1800
Inspector signature: .� � Phone number 651 210 5052
Necessary or Localiy Required Attachments
�Soil boring logs � System/As-built drawing � Forms per local ordinance
❑ Other information tlist):
Sep 08 15 07: 33a p. 3
Property address: 882 Lakewood Hilis rd Eagan Mn.55122 Inspector initials/Date:��/ji� 9/6/2015
(mm/ddh'YYY7
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/backup in home
System discharges sewage to drain ❑Yes � No ❑Excessive ponding in soil system/D-boxes
tile ur surface waters. ❑Homeowner testimony(See CommenfsiExptanation)
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 verity(See CommentslExplanation)
health and safety. ❑ Other methods not listed(See Commenfs/Explana6on)
Comments/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 ieaching pit. � Examined construction records
' Seepage pifs meefing 7080_2550 may be ❑Examined Tank Integrity Form(Attach)
com liant if aHowed in focal adinance.
❑Observed liquid level below operating depth
Sewage tank(s)leak below their ❑Yes � No �Examined empty(pumped)tanks(s)
� s' ed o eratin de th.
de ign p g p
If yes,which sewage tank(s)leaks: ❑Probed outside tank(s)for"black soil"
❑ Unable to Veflfy(See Comments�Exp/anation)
Any "yes"answer abvve indica�es the
system is fafling to protect groundwater. ❑�her m�hods not listed(See Comments/Explanation)
Comments/Facplanation:
3. Other Compliance Conditions—compliance component�of 5
a. Maintenance hole covers are damaged,cracked,unsecured,or appear to be structurally unsound. ❑Yes* �No p Unknown
b. Other issues(e/ecbieal hazards,etc.)to immediately and adversely impact public heafth or safety. ❑Yes" �No ❑Unknown
'"�ystem fs an imminenf threat to public bealth and safety_
Explai�:
c. System is non-protective of ground water for other conditions as deteRnined by inspector. p Yes* �No
'System is failing to protect grourtdwater.
Explain:
Sep 08 15 07: 33a p. 4
Property address: 882 Lakewood Hilis rd Eagan Mn 55122 Inspector initials/Date:?���) 9/6/2015
(mm/ddiyyyy)
4. Soil Separation—Compliance component#1t of 5
Oate of installation: 11/14/1998 ❑ Unknown Verification method(s):
�m'r'�d°Vyyyy� Soil observation does nof expire. Previous soil
ShorelancUWellhead protectioNFood beverage �Yes � No obseNations by fwo independent parties are s�cient,
lodging? unJess site conditions have been attered orloca/
Com liance criteria: requiremenfs differ.
For systems builf prior to April 1, 99% and ❑Yes ❑ No � Conducted soil observation(s)(Attach boring►ogs)
not located in Shoreland or Wellhead ❑Two previous verifications(Attach boring/ogs)
Protection Area or not servrng a food,
beverage or lodging estab/ishment ❑ Not applicable(Holding tank(s),no drainliel�
Drainfield has at least a two-foot vertical ❑Unable to verify(See Comments/Explanation)
separation distance from periodically ❑Other(See Commen4s/Explanation)
saturated soil or bedrock.
Non-performance sysfems built Aprrl 9, � Yes ❑ No Comments/Explanation:
1996, or/ater or for non-performance compliance boring 9'off west end of drainfield
systems located in Shoreland or Wellhead
Protection Areas or serving a food,
beverage, or lodging esfablishmenf:
Drainfield has a three-foot vertical
separation distance from periodically
saturated soil or bedrock.*
"Experimenta!'; "Othe/;or 'Performance" ❑Yes ❑ No IndiCate de thS o�elevations
systems built under pre-2008 Rules; Type!V
or V systems bui(t under 2008 Rules(7080. A. eottom of distribution media 12'�
2350 or 7080.2400 (Advanced Inspector
License requifed) 8. Periodicall saturated soil/bedrock 48"
Drainfield meets the designed veRical � C. S stem se aration 36"
separation distance from periodically '
saturated soil or bedrock. D. Re uired com liance se aration' 36"
Any "no"answer above indicates the system is `May be reduced up to 15 percent if allowed by Local
failing to protect groundwater, orainance.
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
8MP=Best Management Practice(s)specified in the system design
If the answer to both questions is"no';this section afoes not need ro be completed.
Compliance criteria
a. Operating Permit number
❑Yes ❑ No
Have the O eratin Permit re uirements been met?
b. Is the re uired nitro en BMP in lace and ro erl functionin ? ❑Yes ❑ No
Any "no"answerindicates Noncompliance. '
Upgrade Requlrements(Minn.SYat.§415.55)An imminent threat fo public healfh and safety pTPHS)musf be upgreded,replaced,orits use ,
discontinued Within ten months of receipt of this notice or wkhin a shorte�period if required by local ordinance.If the system is faqing to proted ,
ground water,the system must be upgraded,rep/aced,or its use discontinued wifhin the time�equired by local o�dinance,li an exlsting system �
is not failing as defined in law,and has at/east two feef of design soil separation,fh�n the system need not be upgraded,repaired,replaced,or
its use discontinued,nohvithstanding anylocal ordinance thal is more sfrict.This provision daes not epply fo sysfems in shoreland areas, I
Wellhead Protection Areas,orthose used in connection with taod,beverage,and lodging establishments as defined in law.
Sep 08 15 07: 34a p. 5
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