05.a Norcross Septic Compliance Report 2022https://www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • Use your preferred relay service • Available in alternative formats
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Compliance inspection report form
Existing Subsurface Sewage Treatment System (SSTS)
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.pca.state.mn.us/sites/default/files/wq-wwists4-31a.pdf.
Property information Local tracking number:
Parcel ID# or Sec/Twp/Range: 04.032.20.34.0004 Reason for Inspection New outbuilding tieing in
Local regulatory authority info: Washington County
Property address: 23183 Meadowbrook Ave N, Scandia, MN
Owner/representative: Mira Norcross (Owner’s phone:
Brief system description: System expanded in 2011 to 90' mound with 3,000 gallons of septic tank capacity and a pump tank.
System status
System status on date (mm/dd/yyyy): 9/21/2022
Compliant – Certificate of compliance* Noncompliant – 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
Only issues of note that are not a compliance criteria are that three irrigation box covers have been damaged that protect the
cleanouts. These should be replaced to protect the cleanouts on the mound.
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: Ten Thirty Environmental Solutions Certification number: 9844
Inspector signature: License number: 4082
This document has been electronically signed) Phone: 612-248-4281
Necessary or locally required supporting documentation (must 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: 23183 Meadowbrook Ave N, Scandia, MN
Business Name: Ten Thirty Environmental Solutions Date: 9/21/2022
1. Impact on public health – Compliance component #1 of 5
Compliance criteria: Attached supporting documentation:
System discharges sewage to the
ground surface
Yes* No Other:
Not applicable
System discharges sewage to drain
tile or surface waters.
Yes* No
System causes sewage backup into
dwelling or establishment.
Yes* No
Any “yes” answer above indicates the system is an
imminent threat to public health and safety.
Describe verification methods and results:
No backups reported, no ponding observed or indicators of surfacing. Dry inspection pipes.
2. Tank integrity – Compliance component #2 of 5
Compliance criteria: Attached supporting documentation:
System consists of a seepage pit,
cesspool, drywell, leaching pit,
or other pit?
Yes* No Empty tank(s) viewed by inspector
Name of maintenance business:
Olson's Sewer
Service
Sewage tank(s) leak below their
designed operating depth?
Yes* No License number of maintenance business: 216
Date of maintenance: 9/21/2022
Existing tank integrity assessment (Attach)
If yes, which sewage tank(s) leaks:
Date of maintenance
mm/dd/yyyy): must be within three years)
Any “yes” answer above indicates the system
is failing to protect groundwater.
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:
Describe verification methods and results:
No cracks observed below the operating depth in empty tanks. Effluent filter cleaned.
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Property Address: 23183 Meadowbrook Ave N, Scandia, MN
Business Name: Ten Thirty Environmental Solutions Date: 9/21/2022
3. Other compliance conditions – Compliance component #3 of 5
3a. Maintenance hole covers appear to be structurally unsound (damaged, cracked, etc.), or unsecured?
Yes* No Unknown
3b. Other issues (electrical hazards, etc.) to immediately and adversely impact public health or safety? Yes* 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* No
3d. System not abandoned in accordance with Minn. R. 7080.2500? Yes* No
Yes to 3c or 3d - System is failing to protect groundwater.
Describe verification methods and results:
No issues observed. Alarm tested and operational.
Attached supporting documentation: Not applicable
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: 23183 Meadowbrook Ave N, Scandia, MN
Business Name: Ten Thirty Environmental Solutions Date: 9/21/2022
5. Soil separation – Compliance component #5 of 5
Date of installation 9/1/2011 Unknown
mm/dd/yyyy)
Shoreland/Wellhead protection/Food
beverage lodging?
Yes No Attached supporting documentation:
Soil observation logs completed for the report
Two previous verifications of required vertical separation
Not applicable (No soil treatment area)
Compliance criteria (select one):
5a. For systems built prior to April 1, 1996, and
not located in Shoreland or Wellhead
Protection Area or not serving a food,
beverage or lodging establishment:
Drainfield has at least a two-foot vertical
separation distance from periodically
saturated soil or bedrock.
Yes No*
5b. Non-performance systems built
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.*
Yes No* Indicate depths or elevations
A. Bottom of distribution media 108.25'
B. Periodically saturated soil/bedrock 104.43'
C. System separation 3.82'
D. Required compliance separation* 3.0'
May be reduced up to 15 percent if allowed by Local
Ordinance.
5c. “Experimental”, “Other”, or “Performance”
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.
Yes No*
Any “no” answer above indicates the system is
failing to protect groundwater.
Describe verification methods and results:
Sunny ~9:00am but shady in area. 9/21/22.
0-6 10YR3/2 fine sandy loam
6-17 10YR3/3 fine sandy loam
17-20 10YR4/3 loamy fine sand
20-30 10YR4/4 loamy medium sand
30-36 10YR4/4 with 10YR4/6&10YR6/3 sandy clay loam
Redox at 30" - Compliant
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 req uired 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 th e
system need not be upgraded, repaired, replaced, or its use discontinued, notwithstanding any local ordinance that is more st rict.
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.
Following Pages Are From 2011 Septic Permit For Expansion of System