935 Lakewood Hills Rd - Septic Compliance Inspection NONcompliant 2023-04-14MINNESOTA POLLUTION Compliance
CONTROL AGENCY p inspection report form
520 Lafayette Road North Existing Subsurface Sewage Treatment System (SSTS)
St. Paul, MN 55155-4194
Doc Type: Compliance and Enforcement
Instructions: Inspector must submit completed form to Local Governmental Unit (LGU) and system owner within 15 days of
final determination of compliance or noncompliance. Instructions for filling out this form are located on the Minnesota Pollution
Control Agency (MPCA) website at https://www.Dea.state.mn.us/sites/default/files/wa-wwists4-31a pdf.
Property information Local tracking number:
P ra cel ID# r Sec/Twp/Range:/A o -o• 06. a S S Reason for Inspection
Local regulatory authont info:
Property address:3
O /Y• 4 4n/C1 ke
Owner/representative: Owner's phon --`7/36
Brief system descdption: D� Q -lp SySVe^,k
System status
System status on date (mm/dd/yyyy): — /r/�ZD Z 3
❑ Compliant - Certificate of compliance` KNoncompliant - Notice of noncompliance
(Valid for 3 years from report date unless evidence of an
imminent threat to public health or safety requiring removal and
abatement under section 145A.04, subdivision 8 is discovered or
a shorter time frame exists in Local Ordinance.)
*Note: Compliance indicates conformance with Minn.
R. 7080.1500 as of system status date above and does not
guarantee future performance.
Systems failing to protect ground water must be upgraded, replaced, or
use discontinued within the time required by local ordinance.
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 or
under section 145A.04 subdivision 8.
Reason(s) for noncompliance (check all applicable)
❑ Impact on public health (Compliance component #1) - Imminent threat to public health and safety
'Tank integrity (Compliance component #2) - Failing to protect groundwater
❑ Other Compliance Conditions (Compliance component #3) - Imminent threat to public health and safety
❑ Other Compliance Conditions (Compliance component #3) - Failing to protect groundwater
❑ System not abandoned according to Minn. R. 7080.2500 (Compliance component #3) - Failing to protect groundwater
Soil separation (Compliance component #5) - Failing to protect groundwater
❑ Operating permit/monitoring plan requirements (Compliance component #4) - Noncompliant - local ordinance applies
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.
By typing my name below, I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be
used for the purpose of processing this form.
Business name: Gt.rt'41-640. Certification number: / q
Z S—
rInspector signatu. License number: 3��/
(Th ocument has been electronically signed) Phoneds/-
Necessary or locally required supporting documentation (mast be attached)
❑ Soil observation logs ❑ System/As-Built ❑ Locally required forms ❑ Tank Integrity Assessment ❑ Operating Permit
❑ Other information (list):
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Property Address:
Business Name:
a.- /"-1 /V,
1. Impact on public health — Compliance component #1 of 5
nce criteria:
System discharges sewage to the ❑ Yes• V No
ground surface j
System discharges sewage to drain i ❑ Yes` �TNo
tile or surface waters.
System causes sewage backup into ❑ Yes, [)'No
dwelling or establishment.
Any "yes" answer above indicates the system is an
imminent threat to public health and safety.
Describe verification methods and results:
Date: Y- 15`202
Attached supporting documentation:
❑ Other:
❑ Not applicable
2. Tank integrity — Compliance component #2 of 5
Compliance criteria:
System consists of a seepage pit,
cesspool, drywell, leaching pit,
0--d Attached supporting documentation:
No ❑ Empty tank(s) viewed by inspector
or other pit? Name of maintenance business:
Sewage tank(s) leak below their I❑ Yes` ❑ No License number of maintenance business:
designed operating depth? Date of maintenance:
❑ Existing tank integrity assessment (Attach)
Date of maintenance
If yes, which sewage tanks leaks: (mm/dd/yyyy): (must be within three years)
Any "yes" answer above indicates the system (See form instructions to ensure assessment complies with
is failing to protect groundwater. Minn. R. 7082.0700 subp. 4 B (1))
If -
'Tank is Noncompliant (pumping not necessary -explain below)
❑ Other:
Describe verification methods and results:
-,415KMCdOLO l3�L`fvr�l,Si%A-.t!t
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Property Address:
Business Name: �'S. �. �i �� �•
3. Other compliance conditions — Compliance component #3 of 5
Date:% �Y z° Z
3a. Maintenance hole covers appear to be structurally unsound (damaged, cracked, etc.), or unsecured?
❑ Yes' 54 No i3 Unknown
3b. Other issues (electrical hazards, etc.) to immediately and adversely impact public health or safety? ❑ Yes' j$' No ❑ Unknown
*Yes to 3a or 3b - System is an imminent threat to public health and safety.
3c. System is non -protective of ground water for other conditions as determined by inspector? ❑ Yes` t9 No
3d. System not abandoned in accordance with Minn. R. 7080.2500?
*Yes to 3c or 3d - System is failing to protect groundwater.
■ ME
Describe verification methods and results: //70 — �ce 1�i1igd � %`a -44
f-74
Attached supporting documentation: ❑ Not applicable a
4. Operating permit and nitrogen BMP* —Compliance component #4 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 specified in the system design? ❑ 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. 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:
Attached supporting documentation: ❑ Operating permit (Attach) ❑
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Property Address:
Business Name:
S. Soil separation — Compliance component #5 of 5
Date of installation ❑ Unknown
(mm/ddlyyyy)
ShorelandlWellhead protection/Food ❑ Yes [9 No
beverage lodging?
Compliance criteria (select one):
5a. For systems built prior to April 1, 1996, and ❑ Yes I? No*
not located in Shoreland or Wellhead
Protection Area or not serving a food, V
beverage or lodging establishment: 7`
Drainfield has at least a two -foot vertical
separation distance from periodically
saturated soil or bedrock. 1
5b. Non-performance systems built j ❑ Yes ❑ No*
April 1, 1996, or later or for non-
performance systems located in Shoreland
or Wellhead Protection Areas or serving a
food, beverage, or lodging establishment:
Drainfield has a three-foot vertical
separation distance from periodically
saturated soil or bedrock.*
5c. "Experimental, "Other", or "Performance" ❑ Yes ❑ No*
systems built under pre -2008 Rules;
Type IV or V systems built under 2008
Rules 7080. 2350 or 7080.2400
(Intermediate Inspector License required <
2,500 gallons per day; Advanced Inspector
License required > 2,500 gallons per day)
Drainfield meets the designed vertical
separation distance from periodically
saturated soil or bedrock.
*Any "no" answer above indicates the system is
failing to protect groundwater.
Describe verification methods and results:
Date: Y -' 7— 2 o -
Attached supporting documentation:
❑ Soil observation logs completed for the report
❑ Two previous verifications of required vertical separation
❑ Not applicable (No soil treatment area)
Indicate depths or elevations
A. Bottom of distribution media 7
1
B. Periodically saturated soil/bedrock ~%
C. System separation D
D. Required comnliance sanarntinn* 7
*May be reduced up to 15 percent if allowed by Local
Ordinance.
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.
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