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Home My WebLink AboutCertificate of Compliance for Septic 7/20/2015 �� , ,; Minnesota Pollution � �,mi�:, �ontro, A�e�,�y Compliance Inspection Form 520 Lafayette Road North Existing Subsurface Sewage� Treatment Systems (SSTS) ' St.Paul,MN 55155-4194 poc Type:Compllance and Enforcement �-------- . _.____ _ -- _ Inspection results based on Minnesota Pollution Control Agency{MPCA} ! For local tracking purposes: � i requirements and attached forms-additional local requirements may also apply. � i � Submit completed form to Local Unit of Government(LUG)and system owner { � within 15 days � i I_��___�_ --- .._____ i � 5ystem Status � ` System status on date(mm/dd/yyyy); 7/20/2015 ___ _ _ � � Compliant– Certificate of Cornpf'rance ❑ Noncompliant– Nofiice of Noncompiiance � (Valid for 3 years from re port date, unless sh o rte r t i m e (S e e U p g r a d e R e q u i i e m e n t s o n p a g e 3.) � � (rame outfined in Local Ordinance.) � � Reasan(s)for noncompliance(check a/i applkable) ❑ Impact on Public Health (Compliance Component#1)-Imminenf threat to public heatih and safety ❑Other Compliance Conditions(Complrance Componenf�3)-/mminenl fhr�at to public health and safety ❑Tank Integrity(Compiiance Component#2)-Failing to protect groundwater � ❑ Other Compliance Conditions(Complianca Cvmponent#3)-Failing to p�atect groundwater ❑Soii Separation(Compliance Component#4)-F�iling to profect groundwater ❑ Operating permitJmonitoring plan requirements(Compfiance Component#5)-Noncompliant Property Information Parcei io#or secrrwpiRange: _____ __ ' — ._ ---- - Property address: _17311 Sunset Ave ___ ___ __ __ : Reason for inspection: Homeowner Re�uest ___ --- --. .__.__ __ Property owner. _ Kevin Gardener_ ___ __ __ _ _ __ Owner's phone: 763-300-9003 or _ -- --._. ._---_— ___ ____ ._. Owner's representative: _ __ _ _ � _ �_ Representative phone: __ — -__ _ _-- ' Local regulatory authonty: Scott Co _ _ _ _ Re ulator authorit hane. 952-496 8475 � —_� 9 Y Y P ---___ — --- Brief system description. _Septic, Gravity Drainf eld_ j . . -- ---.._. _____--- ---_�_.. - --____---- I Comments or recommendations: ---- _ __ _. Certification !hereby cerfify thaf all fhe necessary information has been gafhered tn detennine the compliance stafus of this sysfem. No determination of future system perforrnance has been nor can be made due to unknown conditions dunng system construction, possible abuse of the system, inadequate maintenance, or future water usage. Inspector name: _Matt Mckinley___ __� ___ __ Certification number, 8067 ' Business name: Mike's Sept�c+Mckinley�e er___ _ _ License number: �2899�� _ � __ - - --- -- -- ' --- -- -. _- Inspector sig�ature: �.�ri'�-�'C�� - Phone number. 952-440-1800 ._._�. .�-._.. Necessary or Loca(ly Requi ed chments � Soil boring logs � SystemlAs-built drawing � Forms per local ordinance ❑Other information (list): --_._...�..------ -- - --�—__—.�,_,.__.__—_------__--_---- - - . _----------- __ ----- _ _ www.pca.state.mn.us • 651•296-6300 • 80p•657-3864 • TT'Y 651-282-5332 or 800-657•3864 • Avaitabte in attemative formats wq-wwists9•31b • 6/4/14 Page 1 of 3 Propeity address: 17311 Sunset Ave ___ _ __ _____ __ Inspector initials/Date: M=M._j 7/20/2015_____ _ , __ --------- _ ._ . - (mm%dd/YYYY) 1, impact on Public Health — Compliance component#1 af 5 Compliance_cr�teria: Verification method(s}: - _--- --- - - -� __— __ _ System discharges sewage to the { ❑Yes � No �Searched for surface outlet ground surface. __ ___ � ___ _._____ � Searched for seeping in yard/backup in home System discharges sewage to drain � ❑Yes � No ❑ Excessive ponding in soil system/D-boxes tile or surface waters. � _._ .__.__— ___________,___�_._ � Homeowner testimony(5ee Comments/Explanation) System causes sewage backup into ❑Yes � No ❑"Black soil"above soil dispersal system dwelling or establishment. � � _ _ ' ❑ System requires"emergency" pumping 1 Any"yes"answer above indicafes fhe ❑ Performed dye test ` system is an imminent threat to public ❑ Unable to verify(See Comments/Explanation) health and safefy. � ' ---- -- -.--.,__-___ ❑ Other methods not listed {See Cornments/Explanation) 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 leaching pit. � Examined construction records Seepage pits rneeting 7080.2550 may be ❑ Examined Tank Integrity Form (Attach) com liant if allowed in local ordlnance.__ ' _— .__._._ Observed liquid level below operating depth Sewage tank(s)leak below their ❑Yes � No 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 � ❑ unab�e to verify�see commenrs�Xptanar;o„J system is fatltng to pJ'oteCt gI'oundW�fer. ❑ Other methods not listed (See Comments/Exptanation) Comments/Explanation: ` � 3. �ther ComplianCe COndition5—Compliance component#3 of 5 a. Maintenance hole covers are damaged,cracked,unsecured,or appear to be structurally unsound. ❑Yes"` �No O Unknown b. Other issues(electrical haza�a's,etc.)to immediately and adversely impact pubfic health or safety. p Yes" �No ❑Unknown *Systenr Js an imminenf threat fo public health and safery. Expiain: c. System is non-protective of ground water for other conditions as determined by inspector. ❑Yes` �No *System is failing to profect groundwater. Explain: ------------ - __. _--_-- -------- ____.._----_ __._ _---_ --- --_-- www.pca.state.m�.us • 651•296-6300 • 800-657-3864 • 'FTY 651-282-5332 or 800•657•38b4 • Avaitable in alternative formats wq•wwfsts4-31b • 6/4/14 Page 2 of 3 Property address: 17311 Sunset Ave. __ Inspector initials/Date: M.M. �_7/20/2015 __.-- ___ ____._______ ---� -- (mm/dd/YYYY) 4.' Soil Separation —Compliance component#4 of 5 Date of installation: 2l1o/1s97_____ ❑ Unknown Verification method(s): (mm/dd/YYYY) ' ShorelandJWellhead protectionlFood beverage Soil observation does not expire. Previous soil lodging? �Yes ❑ No observations by two independent parties are su�cient, unless site conditions have been altered orlocal Compliance criteria: _ ____ _ �quirements differ. For sysfems builf prior to Aprit 1, 1996, and �Yes ❑No ❑Conducted soil observation(s)(Attach boring logs) not located in Shoreland or Weflhead I ❑Two previous verifications(Attach boring logs) Protecfion Area or not serving a food, beverage orlodging esfablishment: � ❑ Not applicabie(HoJd;ng tank(s),no draintleld) Drainfield has at least a two-foot ve�tical ❑ Unable to verify(See Comments/ExpJanation) separation distance from periodically ❑ Other(See Comments/Explanation) saturated soii or bedrock. Non-performance systems builf April 1, �Yes ❑ No Comments/Explanation: 1956, or later or for non-performance ; systems located in Shoreland or Wephead Profection A�as or serving a food, beverage, orlodging establishment: Drainfield has a three-foot vertical separation distance from periodically � saturated soil or bedrock.* _ "Experimental", "Other'; or "Performance" ❑Yes ❑ No (ndicate d�e ths or elevations systems built under pre-2008 Rules Type IV or V sys[ems built under 2008 Rules(7080. A. eottom of distribut�on med�a �_12 inches ` 2350 or 7080.2400 (Advanced Inspector � ' � License required) B. Periodically saturated soiUbedrock ! 48 inches __-_____ __ _ __ ...._-- -a---------- -----_ __ Drainfield meets the designed vertical C. S stem se aration_ � 36 inches separation distance from periodically —� —P-- -- -- � -- -- saturated soil or bedrock. ` p. Re uired com liance se aration• 36 mches _._____�___..__�_____ __ _-----------_____..__.__i_.--� _..__-- --_._. ---�_9_.__�-P_�L_ _ — __- -- _- Any "no"answer above ►ndicafes the system is `May be reduced up to 15 percent if allowed by�ncal failing to protect groundwater. Ordinance. 5. Operating Permit and Nitrogen BMP*—Compiiance component#5 of 5 � Not appticable � Is the system operated under an Operating Permit? ❑Yes ❑ No If"yes",A below is required Is the system required to empioy a Nitrogen BMP? ❑Yes ❑ No If"yes", B below is.required 8MP=Best Management Practice(sJ speci�ed in fhe sysfem design /f the answer to both questions Is "no", thls section does not need to be completed. � Compiiance�criteria � __ � ' a. Operating Permit number. __ ❑Yes ❑ No �_ Have the Operatin�Permit requirements been met? _________ ___T_______ .—__�� b. Is the requiredFn+trogen BMP in place and propey functioning? ___i �_Yes � No Any "no"answer indicates Noncompiiance. Upgrade Requfrements(Minn. Stat. §115.55)An imminent threat to pubfic health and safery(ITPNS)must be upgraded,replaced,orits use discontinued within fen months ot receipt of this nofice or within a shafer period if required by loca!ordinance.N the system is faiiing to protect ground water,the system must be upgreded,replaced,or its use discontinued within the fime required by/aca!orcii'nance. /f an existing system is not failing as de�ned in law,and has at leest two feet of design soil separation,then fhe sysfem need not be upgraded,repaired,replaced, or its use discontinued, natwithstandfng any local oniinance that is more strict. This provision does not appty to systems in shoreland areas, Weflhead Protection Areas,or those used in connection with food,beverage,and lodging establishments as deflned in law. -_----- - ._-._—_�---_--_ _ _____ . ..._ _ . �_ _.._ -- ----__—.--- ----- ----- - www.pca.state.mn.us • 651•296-6300 • 800-657•3864 • TTY 651-282-5332 or 800-657-38b4 • Avaitable iii atternative formats wq-wwisfs4-3fb • 6/4I14 Page 3 of 3 / �7 � r � s��.j.�� G�-v� . �s� 'cK*'�L S� � _""----_____s �.7�,�C ' � � i � � � f -�'_ ��.� � � � �_.�..ry�Y t U L�Y` �C�Cc.Jln 1 ' ( n.a " � D � �, �ex� , � /� �� / �/� � �� b�-�� 5��,�,� �� < < � 4`� � �! �.��v�� ` J �/-�-N° ��"� �-c',r,---r'Yl �� -�� _.� �� ,�_____ �� . . . .. . . _ '_ .s;-a,s r , ;'�; � . � . . , . . . . . .. . , ,. �� - � . g SCOTT COUNTY, MINNESOTA Permit# �� INDIVIDUAL SEWAGE TREATMENT 5YSTEM (ISTS) PUMPING PERMIT ) � , Owner t��V i..� ('�(,��=( °, , ,+:'�. Address e��,� � � � t��l ,��°-� ��df C��', � ��'�S - ��-� No. of Tanks Pum ed�_ Total Gallons Pum ed �✓�� Pumper d'�r`� •• � , , , ,7 p P � � � . � � � � SCOTT COUNTY, MINNESOTA ��`� �"�� INDIVIDUAL SEWAGE TREATME Permit# � � � � �,;� NT SYSTEM (ISTS) PUMPING PERMIT r O�vner ;��';�';�� , �<�.. Address �w,�--, � � � � �,� #. r ` `� d ! `��y � � � 1�t�}_ Pumper `} t �^�.�=`.; . � :, No. of Tanks Pumped�_ Total Gallons Pumped �4�;;t�-� Check all that apply; [�/ Residential ❑ Commercial ❑Rental ^ � �Septic ❑ Holding ❑Pump Chamber ❑ Cesspool ❑Abandoned ❑ Other: Condition of Baffles (baffles must be inspected) (�r Acceptable ❑ Unacceptable [�Replaced Baffles ,�--, Depth of sludge layer �r':� inches Disposal Location (be specific) ��,i`_� Did you observe a surface discharge? ❑ Yes [�No Pumped From: []'Maintenance Hole ❑Removed Tank Lid(stave, for exam le p ) ❑ Inspection Pipe (see below) ' I have been informed about the correct tank cleaning procedures and understand that I risk having my system fail prematurely � if the tank is not pumped through the Maintenance Hole/Tank Lid to enable the removal of solids. Signature of Owner/Owner's Agent Reason for not pumping through the Maintenance Hole/Tank Lid Comments �� Pumper/Inspector Signature �,�:�?,�i{ f'��;'r,,� ,v„ Date �� " c� �� Only one permit is needed per ISTS. If th e is more tha� one ISTS on a property,submit a separate permit for each ISTS. Submit a permit whenever a tank is pumped for abandonment.Pumping the tank does not constitute a compliance inspection. White-County Canary-Homeowner Pink-Pumner