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.
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• 10/12/18
Date (mm/dd/yyyy):
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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
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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)'
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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) ❑
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• 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
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