4895 Dodd Rd - Septic Inspection 2017-08-01 NonCompliant Minnesota Pollution RECEDE
control Agency ALIv 1 ; ?P17
Compliance inspection Form
520 Lafayette Road North Existing Subsurface Sewage Treatment Systems (SSTS)
St.Paul,MN 55155-4194 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):
❑ 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 43)—Imminent threat to public health and safety
❑Tank Integrity(Compliance Component 42)—Failing to protect groundwater
❑ Other Compliance Conditions(Compliance Component#3)—Failing to protect groundwater
( oil Separation (Compliance Component#4)—Failing to protect groundwater
❑Operating permit/monitoring plan requirements(Compliance Component#5)—Noncompliant
Property Information Parcel ID#or Sec/Twp/Range:
Property address: x'3.9 0
, ��" � i I�,3J J►1/?r' Reason for inspection: g�
Property owner: / y } .�r , Owner's phone:
or
Owner's representative: Representative phone:
Local regulatory authority. / R ulatory tho ' hone:
Brief system description:
Comments or recommendations:
Certification
I hereby certify that all 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,
possible abuse of the system, inadequate maintenance, or future water usage.
Inspector name: Bob Freiermuth Certification number: C818
Business name: Bob Freiermuth Santitati n, LLC License number: L492
Inspector signature: Phone number: 651-437-5566
Necessary or Locally Required Attachments
.e"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 alternative formats
wq-wwists4-31b • 614114
Page 1 of 3
Property address:
p y � C�o� .9e;Jit Inspector initials/Da
7�t(mm/dd/yyyy)
1. Impact on Public Health—Compliance component#1 of 5
-Compliance criteria: Verification method(s):
System discharges sewage to the ❑Yes �o ETSearched for surface outlet
round surface. Q Searched for seeping in yard/backup in home .
System discharges sewage to drain [:]Yes eNo ❑ Excessive ponding in soil system/D-boxes
the or surface waters.
❑ Homeowner testimony(See CommentslExplanation)
System causes sewage backup into ❑Yes No ❑ "Black soil"above soil dispersal system
dwelling or establishment.
El System requires"emergency"pumping
"yes"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 CommentslExplanation)
Comments/Explanation:
2. Tank Integrity—Compliance component#2 of 5
Compliance criteria: Verification method(s):
System consists of a seepage pit, ❑Yes ❑ No robed tank(s)bottom
cesspool,dryweil,or leaching pit.
El Examined construction records
Seepage pits meeting 7080.2550 may be
compliant if allowed in local ordinance. ❑ Examined Tank Integrity Form (Attach)
Sewage tank(s)leak below their El Yes ❑ No El 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 CommentslExplanation)
System is failing to protect groundwater. ❑ Other methods not listed(See CommentslExplanation)
Comments/Explanation: '
3. Other Compliance Conditions—Compliance component#3 of 5
a. Maintenance hole covers are damaged,cracked,unsecured,or appear to be structurally unsound. ❑Yes* 21Ko ❑Unknown
b. Other issues(electncat hazards,etc.)to immediately and adversely impact public health or safety. ❑Yes*4 rNo ❑Unknown
*System is an imminent threat to public health and safety.
Explain:
c. System is non-protective of ground water for other conditions as determined by inspector. ❑Yes* a 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 alternative formats
wq-wwists4-31b • 614114
Page 1 of 3
i
Property address: 4yu Inspector initials/Da f
(mm/dd/y)yy)
4. Soil Separation— Compliance component#4 of 5
Date of installation: Unknown Verification method(s):
(mm/dd/yyyy)
ShorelandNVellhead rotectioniFood beverage Soil observation does not expire. Previous soil
lodging? P g ❑Yes ❑ No observations by two independent parties are sufficient,
unless site conditions have been altered or local
Compliance criteria: requirements differ.
For systems built prior to April 1, 1996, and es ❑ No Conducted soil observation(s)(Attach boring logs)
not located in Shoreland or Wellhead
Protection Area or not serving a food, ❑Two previous verifications(Attach boring logs)
beverage or lodging establishment. ❑ Not applicable(Holding tank(s),no drainfreld)
Drainfield has at least a two-foot vertical ❑ Unable to verify(See Comments/Explanation)
separation distance from periodically
saturated soil or bedrock. ❑Other(See CommentslExplanation)
7,
Non-performance systems built April 1, ❑Yes No Comments/Explanation:
1996, or later or for non-performance �/2 - yl 4
systems located in Shoreland or Wellhead
Protection Areas or serving a food,
beverage, or lodging establishment.
Drainfield has a three-foot vertical7�/
separation distance from periodically
saturated soil or bedrock.* f4e2
4.3 .
"Experimental", "Other", or Performance" ❑ Yes [J No Indicate depths or elevations
systems built under pre-2008 Rules, Type lV /
or V systems built under 2008 Rules(7080. A. Bottom of distribution media f
2350 or 7080.2400 (Advanced Inspector
License required) � it
B. Periodically saturated soillbedrock
Drainfield meets the designed vertical
separation distance from periodically C. System separation
saturated soil or bedrock. n
D. Required compliance separation* c�
Any "no"answer above indicates the system is *May be reduced up to 15 percent if allowed by Local
failing to protect groundwater. Ordinance.
_rte
5._ Operating Permit and Nitrogen BMP*—Compliance component#5 of 5 of 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.
Compliance criteria
a. Operating Permit number:
Have the Operating Permit requirements been met? ❑Yes ❑ No
b. is the required nitrogen BMP in place and properly functioning? ❑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 shorter period if required by local ordinance.if the system is failing to protect
ground water, the system must be upgraded,replaced, or its use discontinued within the time required by local ordinance.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 alternative formats
wq-wwists4-31b • 614114
Page 3 of 3
Date: l
Customer Name:
Street Address: 5
City, State, Zip: ,
Phone Number: 6:5:1--- Z qr
COMPANY DISCLAIMER
Based on what we were able to observe and on our experience with on-site wastewater
technology, we-submit this Onsite Sewage Treatment System Inspection Report based
on the present condition of the onsite sewage disposal system.
Bob Freiermuth 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
r
factors (usage, soil characteristics, previous failures, etc.) which may affect the proper
operation of a septic system, as well as the inability of our company to supervise or
monitor the use or maintenance of the system,'this report shall not be construed as a
warranty by our company that the system will function properly for any particular
buyer. Bob Freiermuth hereby DISCLAIMS ANY WARRANTY, either expressed or implied,
arising from the inspection of the septic system or this report. We are also not
ascertaining any affect the system is having on the groundwater.
Inspecting Company Phone 651-437-5566 (office)
Bob Freiermuth Sanitation, LLC License No. 818
Owners signature _
I have studied the information confained herein and certify that my assessment is
honest, thorough, and to the best of my ability, correct.
Name:
Title: SSTS Inspector 818
" i
�. . ...�
a § \/ �§
tig�/ �2 g\
\ . \/«3 29z ,
./}y/� \�\ ,
�6 �
� �
�
. y\/
y
\.
/
\
�
\ �
�
^
2`
�
� - .
��
,
;
�y
� !
z
{ � �
/§
� �
!
! !
: .
!
{
\ |
�
�
�{
\ �
» SKY / /
. �