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610 Lone Oak Rd - Septic Compliance Inspection 2021-07-06313 Lyndale Ave New Prague, Mn. 56071 Phone (612) 232-9737 Fax (952) 758-6278 Memo To: Maxine Holmstrom/BrandonKunimura From: Tom Klanchnik Date: July 21, 2021 Re: Comp. Insp. 610 Lone Oak Road Eagan, MN. 55121 Hi, Please find the enclosed M.P.C.A. compliance inspection information. The septic system compliance inspection for the above mentioned location was completed on July 7, 2021. A physical inspection of the entire septic system area and components was conducted. No evidence of discharge of any kind was evidentlobserved. Both (X 2) 1,000 Gallon Septic Tanks were probed, pumped, viewed empty and certified by the maintainer to verify as precast with a solid bottom and meeting MPCA Standards for Certification. See Tank Integrity Assessment Forms attached. The existing Trench type drain field with three drop boxes and one shallow trench w/12" of rock below the pipe was field located. Probing of the trenches set the trench/distribution media bottom at a max of 30" below surface grade. A soil boring was completed and flagged to 61 inches below surface grade in the drain field area, but outside the influence of the trenches (please see sketch). The condition noted as "Redox Features' was absent to that 61" inches below surface grade measure. "Redox Features' indicate a restrictive layer/high water table condition. Regulations for this system (No Historical -AS-BUILT or Cl- Documents could be located (County, City, & Inspectron) therefore the most restrictive requirement—Post April 1, 1996 with (15% Rule) = 30.6" below surface grade- of separation between the redox features (clean to 61 inches below surface grade) up to the trench/distribution media bottom (30 inches below surface grade). It is apparent (61" - 30" = 31 ") that the required 30.6" of separation is rp esent. Based upon my site evaluation on June 7, 2021 with previous certification of the tanks (attached) this septic system has been classified as a passing or complying system. Please note that no determination of future hydraulic performance has been nor can be made due to unknown conditions during system construction, abuse of the system, inadequate maintenance, or future water usage. If you have any questions please feel free to contact me at (612) 232-9737. Thanks! mlk �INNESOTA POLLUTION Com liance inspection ort form CNTROLAGENCY p p report ) Lafayette Road North Existing Subsurface Sewage Treatment System (SSTS) Paul, MN 55155-4194 Doc Type: Compliance and Enforcement Inspection results based on Minnesota Pollution Control Agency (MPGA) requirements and attached supporting r— additional local requirements may also apply. Further information can be found here: Inspector i iust submit completed form to Local Governmental Unit (LGU) and system owner within 15 days of final detaffninai on of compliance or noncompliance. Propert r information Local tracking number. Parcel ID# rSec/Twp/Range:/o-6A900o-QJ//,jit-ocalregulatory authority: d• iqiAXM1V Property ad cess: p Owner/repentative: Owner's phone: Brief system descrietion.WtzMei ? /1,_ I Alt_ v System status on date (mm/dd/yyyy): Compliant— Certificate of col (Valid for 3 yearn from report date unless evidence of an imminent threat to public health or safety requiring removal and abatement under section 145A.04. subdi 'sion 8 is discovered or a shorter time frame exists in Loc I Ordinance.) 'Note Compliance indicates conformance with Minn. R. 7010.1500 as of system status date above and does iotguarantee future performance. ❑ Noncompliant— Notice of noncompliance 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 /f required by local ordinance or under section 145A. 04 subdivision 8. Systems failing to protect ground water must be upgraded, replaced, or use discontinued within the time required by local ordinance. Re n(s) for noncompliance (check all applicable) ❑ mpact on public health (Compliance component #1) — Imminent threat to public health and safety ❑ ank integrity (Compliance component #2) — Failing to protect groundwater ❑ er Compliance Conditions (Compliance component #3) — Imminent threat to public health and safety ❑ ther Compliance Conditions (Compliance component #3) — Failing to protect groundwater ❑ ystem not abandoned according to Minn. R. 7080.2500 (Compliance component #3) — Failing to protect groundwater ❑ oil separation (Compliance component #5) —Failing to protect groundwater perating permit/monitoring plan requirements (Compliance component #4) — Noncompliant -local ordinance applies Comi nents or recommendations Certifice tion I hereby ce, Vft Mat all the necessary information has been gathered to determine the compliance status of this system. No determinate n of future system performance has been nor can be made due to unknown cond&ons during system construction, possible abuse of the system, inadequate maintenance, or future water usage. By typing i ny name below, i certify the above statements to be true and correct, to the best of my knowledge, and that this information can be use for the purpose of processing this form. 59y5 Business n me: d I ;C G Certification number: _ Inst ectors nature: License number:to (nss documem has been electronically signed) Phone: Necessary or locally required supporting documentation (must be attached) Soil observation logs ❑ Locally required forms Tank Integrity bAssessment ❑Operating Permit ❑ Other i iformation (list): ittps://www. ca.state.mn.us 651-296.6300 • 800-657-3864 Use your preferred relay service Available in alternative formats .vq-mvmtsF3 b • 1/31/21 Poge i of 4 1. Imptct on public health —Compliance component #1 of 5 2. Stem discharges sewage to the ❑ Yes- P(No and surface discharges sewage to drain ❑ Yes' )KI No Intace waters. Sy#tem causes sewage backup into El Yes* KNo lino or establishment "yes" answer above indicates the system is an verification methods and results: — Com Attached supporting documentation: ❑ Other: ❑ Not applicable #2 of 5 S) stem consists of a seepage pit, �l❑ Yes* ❑ No cs pool, drywell, leaching pit, or other it? Sewage tank(s) leak below their ❑ Yes, ❑ No d signed operating depth? i If yes, which sews a tanks leaks: Any "yes" answer above indicates the system I., failing to protect groundwater. Describe verification methods and results: Attached supporting documentation: ❑ Pumped at time of inspection Name of maintenance business: License number of maintenance business: Date of maintenance: Xi Existing tank integrity assessment (Attach) Date of maintenance InA/ /721 (mmidd"): (must 5e within tKree years) (See form instructions to ensure assessment complies with Minn. R" 7082"0700 subp. 4 B (1)) ❑ Tank is Noncompliant (pumping not necessary—explain below) ❑ Other: /'�e�"�ee. F R/Y% .state.mn.us 651-296-6300 800-657-3864 Use your preferred relay service Available in alternative formats • 1/11/21 Page 2 of 4 rMMINNESOTA POLLUTION ONTROL AGENCY Sewage tank 520 Lafayette Road5155- Nor194 maintenance reporting form . Paul, MN 55755-4794 Subsurface Sewage Treatment Systems (SETS) Program Purpose: Management and maintenance of Subsurface Sewage Treatment Systems (SSTS) are important to ensure resource protection and long-term and cost-effective sewage treatment. Completion of this form complies with the sewage tank maintenance requirements under Minn. R. 7080.2450 and 7082.0800. This form may be used to certify the compliance status of the sewage tank components of the SSTS. This form Is not a complete SSTS inspection report and may only certify sewage tank compliance status when entirely completed and signed on page 3 by a qualified professional. Instructions: A copy of this information must be submitted to the system owner within 30 days of the maintenance date and be maintained by the licensed SSTS maintainer business for a period of five (5) yeas from the maintenance date. Maintenance reporting to the local unit of govemment May be required by local ordinance. Check with your local SSTS program for maintenance reporting protocol. Secure maintenance hole covers All mainterence hole covers must be returned to service In a sound and durable condition and be capable of withstanding the antic0ted load. Covers mus be re -secured in accordance with Minn. R. 7080.2450, subp. 3, Items C or D: a) Caters installed under local ordinances adopted after February 4, 2008 must be locked, bolted or screwed or must be 95 pounds in weight. They must be made of material suitable for outdoor use, resistantto ultraviolet degradation and leaks, and not susceptible to being slid or flipped. They must have a label warning of hazardous conditions inside the tank. All screw openings must be refastened. b) Co,ers installed under local ordinances adopted before February 4, 2008 must either be buried with at least 12 inches of soil cover or be secured according to the local ordinance in effect before February 4, 2008. C) Covers must meet Hem 'a' above when raised to the ground surface or less than 12 inches from the ground surface. Date of i Property City: _ Property City: _ Phone n 1- Did information Routine Pumping l( L W name: .-'? t f address if dMerent State: MN State: Email address: Zip code: measure the accumulation of scum and sludge? ❑ Yes 'W No (tank(s) pumped without measuring) c _ Tank (teckMpreaem)_Saum Slu> cl SeGholdino tank #1 ? O�attngde� Percentfuli _ Se ticJholding tank in Pretreatment tank 0 PumD tank i 2. Accessto remove septage: N Maintenance hole ❑ Other (Unless a holding tank, go to #4 below) 3. If themFIntenanriehleowas used, were all covers secured in place? n Yes ❑ No If no, please explain below. 4. If the ovmer refuses to allow a Subsurface Sewage Treatment System (SSTS) to be pumped through the maintenance hole, have them complete and sign the following statement. I, , refuse to allow the removal of the solids and liquids through the maintenance (Prior olvmr-s name) hole. 1u{tderstand that removal of solids and liquids through other access points is not considered a compliant method of solids removal and does not fulfill the solids removal requirements of Minn. R. 7080.2450 and 7082.0600. • 651-296.6300 • 800-657-3864 • 10/12/18 Date (mm/dd/yyyy): Use your preferred relay service Available in alternative formats Page 1 of 3 S. 6. 7. 8. 9. 10 Pt Con Q..i Ems Emp WW wQ roperty real: Same as Reportirg Information its � _ Parcel ID: ity' _ State: - — Trp code. is the nk designed as a leaky tank? (Example. seepage pit, cesspool, drywa{l�l, lestching pit) Tank 1: ❑ Yes No Verification method used: Y i g {fj �yi(,{.� Tank '-- • ❑ Yes No Verification method used: evidence of the folloadng? Maintenance hole cover is Tank Maks below the Tank leaks above the damaged cracked, unsecured, or Tank Ic eck Ifpresent) desi ned oneratina dooth des rod operating depth appears to be structurally unsound rS Ser idholdinq Tank #1 Yes S1 No ElYes CjNo ❑ Yes tS No icJhoIdmc Tank #2 _ Yes Tq No ❑ Yes IRNo ❑ YesNo ETPretreatmentTank Yes No U Yes No ❑Yes ❑ No _ Pun ip Tank Yes No 0 Yes No ❑ Yes ❑ No DesrAt adetail for any *Yes" , i How m any goJlonsp}f septage were removed? ,,ll_ Tank 1: }., 1 Tank #2: ti l(jtp1 Pretreatment Tank; Pump Tank: Where the septage taken? ® Wastewater treatment facility ❑ Land ar,prpf tion ❑ Other Explain'on (Facility name/Site#): _ iIiA \A AN ti t Did yo i identify any operational issues or unsafe conditions while assessing the sewage tanks in this system? ❑ Yes �RNo If yes, identify tank and explain: ❑ ividence of non-domestic waste ❑ Baffle(s) condition ❑ Effluent screen condition ❑ 4aintenance hole and extensions condition ❑ Other conditions (e.g, structural integrity of tank or lid, electrical hazard, etc.) Explan ion: List an f troubleshooting and mirror repairs completed or declined by owner: Trot bieshooting and repairs conducted: 0 Repairs declined by owner. Addifioi at comments or suggestions for owner's consideration: impin record irsonairy ouducted the work described above on behalf of a Minnesota -licensed SSTS Maintenance Business, in compliance i Minnes Ja Rules Chapters 7080 – 7083: As a non entified individual who has received proper training, daily work review, and periodic observation, or As a des i;noted certified individual of the business listed below. npany li formation Employee information parry na e: B's Pumping Service Print name: Mark Smith n000 uw wo number. 41+0 Gertroca on numoer. (a awicabla7: orT4 it: markA Ynpumping.com Phone number: 651-460-8015 ._ –r , loyee's s nature: _ t """ Date (mm/ddtyyyy):- w.pcasta .mn.us • 651-296-6300 800-657-3864 Use your preferred relay service Available in alternative formats wwists4-4 8• 10/12/18 Page 2 of 3 Property City: — State: MN section: Sewage Tank Compliance Certification Parcel ID: Zip code: This form {foes not represent a complete system inspection report and only certifies sewage tank compliance status. This section of the form may be completed and signed by a Designated Certified Individual (DCI) of a licensed SSTS Business who personally conducts the necessary procedures to assess the compliance status of each sewage tank in the system; When this 'ection of the form is signed by a qualified certified professional, it becomes necessary supporting documentation to an Existing System Compliance Inspection Report: Comniiance insnactiorfors, - Existing sys em !wa-WWist94-31b�. This form can be found on th i MPCA website at httos:!/www.bdastate-rpm-uslwaterfssts-and-msis-terhndrai-and-co+nchancc-criteria, The informi tion and certified statement on this form is required when existing septic tank compliance status is determined by an individualer than the SSTS Inspector that submits the inspection report. It represents a third party assessment of SSTS component�compliance and is allowable under Minn. R. 7082.0700, subp. 4 Item (B) subitem (1). This form is valid for a period of three years beyond the signature date on this form unless a new evaluation is requested by the owner or owner's agent or is required acpording to local regulations. Additional Administrative Rule references for this activity can be found at Minn. R. 7082.07. , subp. 4 items B, C, and D; 7083.0730 Item C. Certifi 'ate of sewage tank compliance Affirm a I three statements: qTJ ie SSTS does not contain a seepage pit, cesspool, d all, leaching pit, or other pit. ft oes not contain a sewage tank that was designed be watertight, but subsequently leaks below the di signed operating depth. 'b7 It Joss not represent an imminent safety threat by 'repson of unsecured, damaged, or weak m intenance hole cover(s) or other unsafe condition. Company information Company ri ime*. B's Pumping Service Business fic qnse number. 4149 ❑ Notice of sewage tank non-compliance Select all that apply: ❑ The SSTS has a seepage pit, cesspool, drywell, leaching pit, or other pit — "Failure to Protect Groundwater." ❑ it has a sewage tank that was designed to be watertight, but subsequently leaks below the designed operating depth —'Failure to Protect Groundwater." Cl It presents a threat to public safety by reason of unsecured, damaged, or weak maintenance hole cover(s) or other unsafe condition —'Imminent Threat to'Public Health or Safety.". Designated Certified Individual (DCI) information Print name: Mark Smith Certification number. 8774 conducted the work described above as a Designated Caroled Individual of a Minnesota-frcensed SSTS Maintenance personally conducted the necessary procedures to assess the compliance status of each sewage tank in this SSTS: Certified signature:Date (mm/ddtyyyy)' • 651-2966300 • 800.657-3864 121I8 Use your preferred relay service Available in alternative formats Page 3 of 3. Other compliance conditions — Compliance component #3 of 5 4. 3a. Maintenance hole covers appear to be structurally unsound (damaged, cracked, etc.), or unsecured? 1�1 ❑ Yes' No ❑ Unknown 3b. 01 her issues (eMxtrical hazards, eta) to immediately and adversely impact public health or safety? ❑ Yes- KNo ❑ unknown 0 3a or 3b - System is an imminent threat to public health and safety. 3c. S stem is non -protective of ground water for other conditions as determined by inspector? ❑ Yes' XNo 3d. Fribe m not abandoned in accordance with Minn. R. 7080.2500? ❑ Yes- �No to 3c or 3d - System is failing to protect groundwater. verification methods and results: Attached supporting documentation: ❑ Not applicable ❑ operating permit and nitrogen BMP* —Compliance component #4 of 5 XNot applicable Is the stem operated under an Operating Permit? ❑ Yes ❑ No If "yes", A below is required Is the gystsm required to employ a Nitrogen BMP specified in the system design? ❑ Yes ❑ No If "yes", B below is required MP = Best Management Practice(s) speed in the system design H the answer to both questions is "no", this section does not need to be completed. Compliance criteria: a. 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. Describe verification methods and results: t Attached supporting documentation: ❑ Operating permit (Attach) ❑ state.mn.us • 651-296-6300 • a00-657-3364 Use your preferred relay service Available in alternative formats • 1/11,/21 Page 3 of 4 S. Soil separation — Compliance component #5 of 5 Date ol installationj�Unknown (mm/dd/yyyy) ShonatundilliVelthead protection/Food ❑ Yes ❑ No Attached supporting documentation: bevera &dodging? ❑ Soil observation logs completed or the report (Attach) Compi lance criteria select one): ❑ Two previous verifications of required vertical 5a. For ystems built prior to April 1, 1996, ❑Yes C1 No* separation (Attach) and not located in Shoreland or Wellhead ❑ Not applicable (No soil treatment area) Proi icitan Area ornot serving a food, T7bev rage or lodging establishment. Ora nfield has at least a two -foot vertical sap ration distance from periodically sat rated soil or bedrock. 5b. No -performance systems built April 1, VYes ❑ No' Indicate depths or elevations 19 sy , or later or for non-performance i ms located in Shoreland or Wellhead' A Bottom of distribution media . p Pro action Areas or serving a food, B. Periodically saturated soillbedrock 97i l7 be rage, or lodging establishment. C Svstem separation D nfield has &three-foot Vertical I as; ration distance from periodically D. Required compliance separation' L sat rated soil or bedrock.' 'May be reduced up to 15 percent if allowed by Local 5c. 'E erimental", 'Other", or "Performance" ❑ Yes ❑ No' Ordinance. / fv/f �45i U� jr¢,�.4YG/1 �✓ �.g��jv% sy ems built under pre -2008 Rules; LdP./'2 ��ei� C.Z Type Rules IV or V systems built under 2008 7080.2350 or 7080.2400 L A/0(Advanced G� suc�esS% Inspector License required) ID " infield meets the designed vertical Ooc"AewS c<d se aration distance from periodically Upgrade or its use system is local orcth no" answer above indicates the system is to protect groundwater. methods and results: -equirements: (Minn. Stat. § 115.55) An imminent threat to public health and safety (17Ph'S) must be upgraded, replaced, iiscontinued within ten months of receipt of this notice or within a shorter period IF required by local ordinance. If the Failing to protect ground water, the system must be upgraded, replaced, or its use discontinued within the time required by ante. rr an extaang ayatem to not railing d3 deAned in few, and has at least two feat of dasion soi/ separation, than the ad not ba upgraded, repaired. fapraoad. or its use discontinuad. notwithstanding any local ordinance that is mote strict. s'lon ages not apply to systems in snomiana areas, IrVellnead PnIIecrron Atcca, or moat, uaca fn oonnocaon min r000, and lodging establishments as defined in law. • 1/11/21 • 653-796-6300 800-657-3864 Use your preferred relay service Available in alternative formats Page 4 of4 6,,lfe' /04 I c TM liema 3Le €G ai: WdL %F= seem* 0 wmm- o esa= es���• - � Ks eFt tr �df. svr_a. tlwe Lamm IiCi �^�sii'iiL y^�`: Sam. wampurk a" &tn �J• eit �'�T iSS.i:� Y �'a? i 1sek 9 dw ad leas* aad 4wsel m d kee F.sa tt.e:sm �s �. x s.=z -.-Id�:ldins. %esse ra h zs- N*ft maPA`^. '.3 C!o -ve aid?G#C�s; at hor,:*.v7. Law each an the Ya le, :-ACM m Gii.�. son li vsatre. 3srxazra eew, &P& of awh & fe .nc sol: typo._ i3e:x . o. � .. *'uw i= V t1m me a :` is 51" BR = = F E2 31 /vY4 z �oRQ SA00i 1-o .. `�< I yy 5.4,� �'"- to,t I!yy s4a; zo ofm 4 /�- Ir