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08.b1 Norcross applicationFite No. 2 D 22 — lo APPLICATION FOR PLANNING AND ZONING REQUEST City of Scandia, Minnesota 14727 209th Street North, Scandia, MN 55073 Phone 651/433-2274 Fax 651/433-5112 Web http://www.ei.scandia.mn.tis Please read before completing: The City will not begin processing an application that is incomplete. Detailed submission requirements may be found in the Scandia Development Code, available at the City office and website (www.cLscandia_mn.us) and in the checklist fonns for the particular type of application. Application fees are due at the time of application and are not refundable. 1. Property Location: (street address, if applicable) 2-; j93 EA 06 w BROO t- 14-V6- 2. Washington County Parcel ID: o (1. O - Z - 2-0. 3 -/ , Q 0 Q Ll 3. Complete Legal Description: (attach if necessary) 5G -e- 74_T-TA_1 ht G: 9 4. Owner(s): c-z-- 4C9-0sS Street Address: 2L 183A&AD-OW116ox A"g-w City/ State: 5CA-1V D /A M /V 5. Applicant/Contact Person: ISL / per-De-Ce_0sT Street Address (Mallin }: 731 Z3 " J`J City/ State: M 6. Requested Action(s): (check all that apply) Variance Administ atative Permit Variance Extension ( fie) ' "'"re Conditional Use Permit (CUP) Site Plan Review CUP Extension ( type) CUP/ Open Space Subdivision. Site Plan Modification CUP/ Planned Unit Development Site Plan Extension Interim Use Permit (IUP) Sign (Permanent) Annual Operators Permit Phone: h) Zip: 9-5-073 Phone: - h) b) E -Mail: ( Zip: Amendment (Development Code ) Amendment (Comp. Plan) Subdivision, Minor Subdivision, Preliminary Plat/Major Subdivision, Final Plat Environmental Review Wetland Review 7. Brief Description of Request: (attach separate sheet if necessary; include Variance Rationale if necessary) F S r tr IFnV T) A -L_ 4E15a K Y 11C_ ru 6 MU i_ri - a R P-00 J C W DIV *L- 70P_4f zird clV104 /-Awc r CN11 CF S77Y 9 V,(, " ea0 l'`rM & E A&"q T-0 A M ftE p r_ fiVsID i_.P11v C I avcE s 12 writ, I N t T 1411, IF W10 T JAIJ rj )444 N Te -1N 9 0Ir IS A PE -D LHiS C•4N ACvA WTC I jlrrAJ Prot r L y TD I 11j itfC CorvR E A/<T0 ^.,V1nr.4 L /'you D rF) C Q t o APP, T ,, 0,r VA -C U L),= --S T IN /0 7-0 8. Project Name: 4C4 LES 0 e ' 4 I hereby apply for consideration of the above described request and declare that the information and materials submitted with this application are complete and accurate. I understand that no application shall be considered complete unless accompanied by fees as required by city ordinance. Applications for projects requiring more than one type of review shall include the cumulative total of all application fees specified for each type of review. I understand that applicants are required to reimburse the city for all out-of-pocket costs incurred for processing, reviewing and hearing the application. These costs shall include, but are not limited to: parcel searches; publication and mailing of notices; review by the city's engineering, planning and other consultants; legal costs, and recording fees. An escrow deposit to cover these costs will be collected by the city at the time of application. The minimum escrow deposit shall be cumulative total of all minimum escrow deposits for each type of review required for the project, unless reduced as provided for by ordinance. The city may increase the amount of the required escrow deposit at any time if the city's costs are reasonably expected to exceed the minimum amount. Any balance remaining after review is complete will be refunded to the applicant. No interest is paid on escrow deposits. PLEASE NOTE: If the fee owner is not the applicant, the applicant must provide written authorization by the fee owner in order for this application to be considered complete. Pr F wn r Sig tures) Date: Q+a2, A nt atur } Date: CUI P A c, Use Only FOCT HD Application Fees: 0 19 2022 Escrow Deposit: 1 c4cp,(_ o NDIA City of Scandia, Minnesota 23183 Meadowbrook Avenue [North I Scandia I i'IIN 155073 Qesi Hated School for this Parcel: ISD #2144 Chisago-Lakes School Choice Available - Near Boundary: ISD #831 Forest Lake Open Enrollment is available through District Office and likely bus service, as well. LANDMARK SURVEYING INC 21150 Ozdrk Yen ve North — Box 65 Scandia, ?r linnesoto 55073 I Telephrevi 651-433-3421 Joel T. Anes, i.S Fox, 651-433-4781 Hillian L. Setb, L51T a -mall, jrt ftatdfml.earn LEGAL DE $CRIPTIGN PARCEL A That part of the Southeast Quarter of the Southwest Quaver of Section 4, Township 32 North, mange 20 West, Washington County, Minnesota described as follows: I Commencing at the Southeast corner of said? South ast QiMrter of Southwest Quarter, thence North 42 degrees 36 minutes 45 seconds West, bearing orientt:d to the Wa§hington C6tnty Coordinate System, NAD83, along the east line of said Southeast Quarter 00the Sopthwest Quarter a distance of 439.04 feet to the point of beginning; thence South 87 degrees 23 minutes 15 seconds West 34.85 feet; thence North 02 degrees 36 minutes 45 seconds West, parallel Mdi said-ewt.line, Z 1.12 feet; thknce North 82 degrees 31 minutes 56 seconds West 35136 feet; thence North 89 degrees36 rnidutes 22 seconds West 3,70.00 feet; thence South 87 degrees 12 minutes 38 seconds West 230.00 feet to the west lisle of said Southeast Quarter of the Southwest Quarter, thence North 02 degrees 47 minutes 22 seconds Vilest, along said west line' 581.92 feet to the northwest corner of said Southeast Quarter vit:'c Southwest Quarter, thence South 88 degrees 56 minutes 26 second; East, along the north line of said Southeast Quarter of the Southwest Quarter, a distance of 1299.74 feet to the northeast coater of said Southeast Quartet of the Southwest Quarter, thence South 02 degrees 36 minutes 45 seconds East, along said east line of the Southeast Quarter of the Southwest uarter, a distance of 859.99 feet to the point of beginning, containing 19.45 acres, more or less. Subject to the right-of-way of existing Meadowbrook Avpnue a ng the westerly line thereof. t S1 I HEREBY CERTIFY THAT THIS PLAN, SPECIFICATION, OR REPORT WAS PREPARED BY ME OR UNDER MY DIRECT SUPERVISION AND THAT I AM A DULY REGISTERED PROFESSIONAL ENGINEER UNDER THE LAWS OF THE STATE OF MINNESOTA. William A. Becklin, P.E. DATE: SEPT 02, 2022 LIC. NO. 18494 Sheet Checked OWNER / CONTACT Commission Number Date Drawn KJ MICHAEL & MIRA NORCROSS Sheet Name 06/24/2222-1-083 WB Consulting Engineers, Inc. 139 1st Ave. E, Suite 100 P.O. Box 471 Cambridge, MN 55008 Phone: (763) 689-5631 Fax: (763) 552-5631 Becklin & Whitney Project 23183 MEADOWBROOK AVE. NORTH SCANDIA, MN 55073 NORCROSS BARN FRONT ELEVATION RIGHT ELEVATION STRUCTURALELEVATIONS7'- 10"12'- 0"1'-6 3/ 4"6'- 8"7'- 10"12'- 0"1'- S2 I HEREBY CERTIFY THAT THIS PLAN, SPECIFICATION, OR REPORT WAS PREPARED BY ME OR UNDER MY DIRECT SUPERVISION AND THAT I AM A DULY REGISTERED PROFESSIONAL ENGINEER UNDER THE LAWS OF THE STATE OF MINNESOTA. William A. Becklin, P.E. DATE: SEPT 02, 2022 LIC. NO. 18494 Sheet Checked OWNER / CONTACT Commission Number Date Drawn KJ MICHAEL & MIRA NORCROSS Sheet Name 06/24/2222-1-083 WB Consulting Engineers, Inc. 139 1st Ave. E, Suite 100 P.O. Box 471 Cambridge, MN 55008 Phone: (763) 689-5631 Fax: (763) 552-5631 Becklin & Whitney Project 23183 MEADOWBROOK AVE. NORTH SCANDIA, MN 55073 NORCROSS BARN REAR ELEVATION LEFT ELEVATION STRUCTURALELEVATIONS7'- S3 I HEREBY CERTIFY THAT THIS PLAN, SPECIFICATION, OR REPORT WAS PREPARED BY ME OR UNDER MY DIRECT SUPERVISION AND THAT I AM A DULY REGISTERED PROFESSIONAL ENGINEER UNDER THE LAWS OF THE STATE OF MINNESOTA. William A. Becklin, P.E. DATE: SEPT 02, 2022 LIC. NO. 18494 Sheet Checked OWNER / CONTACT Commission Number Date Drawn KJ MICHAEL & MIRA NORCROSS Sheet Name 06/24/2222-1-083 WB Consulting Engineers, Inc. 139 1st Ave. E, Suite 100 P.O. Box 471 Cambridge, MN 55008 Phone: (763) 689-5631 Fax: (763) 552-5631 Becklin & Whitney Project 23183 MEADOWBROOK AVE. NORTH SCANDIA, MN 55073 NORCROSS BARN FOUNDATION PLAN 108'-0" 48'-0" 12'- 6" UNEXCAVATED UNEXCAVATED UNEXCAVATED 34'-0"39'-6" 34'- 6"CELLAR17'-0"51'- 6"39'- 6"12'- 0"9'-1"10'-3"10'-0"10'-2"22'-0"26'- 0"22'-0"12'-0"9'-6"24'-0"24'-0"R8'-6"6'-0"11'- 0" 11'- 0"12'- 0"11'-0"11'- 6"12'- 0"12'- 6"19'-6"2'-6"20'- 0"19'-6"13'- 8"11'- S4 I HEREBY CERTIFY THAT THIS PLAN, SPECIFICATION, OR REPORT WAS PREPARED BY ME OR UNDER MY DIRECT SUPERVISION AND THAT I AM A DULY REGISTERED PROFESSIONAL ENGINEER UNDER THE LAWS OF THE STATE OF MINNESOTA. William A. Becklin, P.E. DATE: SEPT 02, 2022 LIC. NO. 18494 Sheet Checked OWNER / CONTACT Commission Number Date Drawn KJ MICHAEL & MIRA NORCROSS Sheet Name 06/24/2222-1-083 WB Consulting Engineers, Inc. 139 1st Ave. E, Suite 100 P.O. Box 471 Cambridge, MN 55008 Phone: (763) 689-5631 Fax: (763) 552-5631 Becklin & Whitney Project 23183 MEADOWBROOK AVE. NORTH SCANDIA, MN 55073 NORCROSS BARN 34'-0"39'-6" 108'-0" 48'-0" REC AREA PORCH STORAGE 12'-6"17'-10 1/4"3'-7 3/4"10'-3"9'-9"9'-9" 9'-9"12'-6"19'-6"2'-6"9'-9"9'-9"10'-3"10'-0" 9'- 9"13'- 8"BATH STORAGE ROOM 22'-0"26'-0"60'-0"39'-6" 12'-0"9'-1" 10'-3" 10'-0"10'- 2"R8'-6" 11'-0" 11'-0" 12'-0"11'-0"11'-6"12'-0"11'-10" 8'-6"4'-0"8'-4"n n MAIN FLOOR PLAN MAIN S5 SECOND FLOOR PLAN I HEREBY CERTIFY THAT THIS PLAN, SPECIFICATION, OR REPORT WAS PREPARED BY ME OR UNDER MY DIRECT SUPERVISION AND THAT I AM A DULY REGISTERED PROFESSIONAL ENGINEER UNDER THE LAWS OF THE STATE OF MINNESOTA. William A. Becklin, P.E. DATE: SEPT 02, 2022 LIC. NO. 18494 Sheet Checked OWNER / CONTACT Commission Number Date Drawn KJ MICHAEL & MIRA NORCROSS Sheet Name 06/24/2222-1-083 WB Consulting Engineers, Inc. 139 1st Ave. E, Suite 100 P.O. Box 471 Cambridge, MN 55008 Phone: (763) 689-5631 Fax: (763) 552-5631 Becklin & Whitney Project 23183 MEADOWBROOK AVE. NORTH SCANDIA, MN 55073 NORCROSS BARN LOFT MECH. 34'-6"73'-6" 108'-0" 48'-0"34'-6"39'-6" 34'-0"5'-0"14'-3 1/4"12'-3 1/2" 7'- 11 1/4"LOFT13'-6"12'-0"24'-0" 12'-0"12'-0" 34'-6" 73'-6"108'-0"13'-6"12'-0"24'-0"12'-0"12'-0"8'-2"12'-0" 5'- 10" 8'-6" 27'-47/8" 5'-0"6'- 5" 6'- 5"5'- 0"4'- 1" 39'- 6"48'- 0" S6 I HEREBY CERTIFY THAT THIS PLAN, SPECIFICATION, OR REPORT WAS PREPARED BY ME OR UNDER MY DIRECT SUPERVISION AND THAT I AM A DULY REGISTERED PROFESSIONAL ENGINEER UNDER THE LAWS OF THE STATE OF MINNESOTA. William A. Becklin, P.E. DATE: SEPT 02, 2022 LIC. NO. 18494 Sheet Checked OWNER / CONTACT Commission Number Date Drawn KJ MICHAEL & MIRA NORCROSS Sheet Name 06/24/2222-1-083 WB Consulting Engineers, Inc. 139 1st Ave. E, Suite 100 P.O. Box 471 Cambridge, MN 55008 Phone: (763) 689-5631 Fax: (763) 552-5631 Becklin & Whitney Project 23183 MEADOWBROOK AVE. NORTH SCANDIA, MN 55073 NORCROSS BARN BUILDING SECTION8'- 1 1/ 8"12'-1 1/ 4"22R. @ 7. 4" EACH = S7 I HEREBY CERTIFY THAT THIS PLAN, SPECIFICATION, OR REPORT WAS PREPARED BY ME OR UNDER MY DIRECT SUPERVISION AND THAT I AM A DULY REGISTERED PROFESSIONAL ENGINEER UNDER THE LAWS OF THE STATE OF MINNESOTA. William A. Becklin, P.E. DATE: SEPT 02, 2022 LIC. NO. 18494 Sheet Checked OWNER / CONTACT Commission Number Date Drawn KJ MICHAEL & MIRA NORCROSS Sheet Name 06/24/2222-1-083 WB Consulting Engineers, Inc. 139 1st Ave. E, Suite 100 P.O. Box 471 Cambridge, MN 55008 Phone: (763) 689-5631 Fax: (763) 552-5631 Becklin & Whitney Project 23183 MEADOWBROOK AVE. NORTH SCANDIA, MN 55073 NORCROSS BARN BUILDINGSECTION35'- 0"13'- S8 I HEREBY CERTIFY THAT THIS PLAN, SPECIFICATION, OR REPORT WAS PREPARED BY ME OR UNDER MY DIRECT SUPERVISION AND THAT I AM A DULY REGISTERED PROFESSIONAL ENGINEER UNDER THE LAWS OF THE STATE OF MINNESOTA. William A. Becklin, P.E. DATE: SEPT 02, 2022 LIC. NO. 18494 Sheet Checked OWNER / CONTACT Commission Number Date Drawn KJ MICHAEL & MIRA NORCROSS Sheet Name 06/24/2222-1-083 WB Consulting Engineers, Inc. 139 1st Ave. E, Suite 100 P.O. Box 471 Cambridge, MN 55008 Phone: (763) 689-5631 Fax: (763) 552-5631 Becklin & Whitney Project 23183 MEADOWBROOK AVE. NORTH SCANDIA, MN 55073 NORCROSS BARN 8'- 1 1/ 8"12'- S9 I HEREBY CERTIFY THAT THIS PLAN, SPECIFICATION, OR REPORT WAS PREPARED BY ME OR UNDER MY DIRECT SUPERVISION AND THAT I AM A DULY REGISTERED PROFESSIONAL ENGINEER UNDER THE LAWS OF THE STATE OF MINNESOTA. William A. Becklin, P.E. DATE: SEPT 02, 2022 LIC. NO. 18494 Sheet Checked OWNER / CONTACT Commission Number Date Drawn KJ MICHAEL & MIRA NORCROSS Sheet Name 06/24/2222-1-083 WB Consulting Engineers, Inc. 139 1st Ave. E, Suite 100 P.O. Box 471 Cambridge, MN 55008 Phone: (763) 689-5631 Fax: (763) 552-5631 Becklin & Whitney Project 23183 MEADOWBROOK AVE. NORTH SCANDIA, MN 55073 NORCROSS BARN STRUCTURAL NOTES S9 I HEREBY CERTIFY THAT THIS PLAN, SPECIFICATION, OR REPORT WAS PREPARED BY ME OR UNDER MY DIRECT SUPERVISION AND THAT I AM A DULY REGISTERED PROFESSIONAL ENGINEER UNDER THE LAWS OF THE STATE OF MINNESOTA. William A. Becklin, P.E. DATE: SEPT 02, 2022 LIC. NO. 18494 Sheet Checked OWNER / CONTACT Commission Number Date Drawn KJ MICHAEL & MIRA NORCROSS Sheet Name 06/24/2222-1-083 WB Consulting Engineers, Inc. 139 1st Ave. E, Suite 100 P.O. Box 471 Cambridge, MN 55008 Phone: (763) 689-5631 Fax: (763) 552-5631 Becklin & Whitney Project 23183 MEADOWBROOK AVE. NORTH SCANDIA, MN 55073 NORCROSS BARN STRUCTURAL NOTES S9 I HEREBY CERTIFY THAT THIS PLAN, SPECIFICATION, OR REPORT WAS PREPARED BY ME OR UNDER MY DIRECT SUPERVISION AND THAT I AM A DULY REGISTERED PROFESSIONAL ENGINEER UNDER THE LAWS OF THE STATE OF MINNESOTA. William A. Becklin, P.E. DATE: SEPT 02, 2022 LIC. NO. 18494 Sheet Checked OWNER / CONTACT Commission Number Date Drawn KJ MICHAEL & MIRA NORCROSS Sheet Name 06/24/2222-1-083 WB Consulting Engineers, Inc. 139 1st Ave. E, Suite 100 P.O. Box 471 Cambridge, MN 55008 Phone: (763) 689-5631 Fax: (763) 552-5631 Becklin & Whitney Project 23183 MEADOWBROOK AVE. NORTH SCANDIA, MN 55073 NORCROSS BARN STRUCTURAL NOTES S9 I HEREBY CERTIFY THAT THIS PLAN, SPECIFICATION, OR REPORT WAS PREPARED BY ME OR UNDER MY DIRECT SUPERVISION AND THAT I AM A DULY REGISTERED PROFESSIONAL ENGINEER UNDER THE LAWS OF THE STATE OF MINNESOTA. William A. Becklin, P.E. DATE: SEPT 02, 2022 LIC. NO. 18494 Sheet Checked OWNER / CONTACT Commission Number Date Drawn KJ MICHAEL & MIRA NORCROSS Sheet Name 06/24/2222-1-083 WB Consulting Engineers, Inc. 139 1st Ave. E, Suite 100 P.O. Box 471 Cambridge, MN 55008 Phone: (763) 689-5631 Fax: (763) 552-5631 Becklin & Whitney Project 23183 MEADOWBROOK AVE. NORTH SCANDIA, MN 55073 NORCROSS BARN STRUCTURAL NOTES S9 I HEREBY CERTIFY THAT THIS PLAN, SPECIFICATION, OR REPORT WAS PREPARED BY ME OR UNDER MY DIRECT SUPERVISION AND THAT I AM A DULY REGISTERED PROFESSIONAL ENGINEER UNDER THE LAWS OF THE STATE OF MINNESOTA. William A. Becklin, P.E. DATE: SEPT 02, 2022 LIC. NO. 18494 Sheet Checked OWNER / CONTACT Commission Number Date Drawn KJ MICHAEL & MIRA NORCROSS Sheet Name 06/24/2222-1-083 WB Consulting Engineers, Inc. 139 1st Ave. E, Suite 100 P.O. Box 471 Cambridge, MN 55008 Phone: (763) 689-5631 Fax: (763) 552-5631 Becklin & Whitney Project 23183 MEADOWBROOK AVE. NORTH SCANDIA, MN 55073 NORCROSS BARN STRUCTURAL NOTES S9 I HEREBY CERTIFY THAT THIS PLAN, SPECIFICATION, OR REPORT WAS PREPARED BY ME OR UNDER MY DIRECT SUPERVISION AND THAT I AM A DULY REGISTERED PROFESSIONAL ENGINEER UNDER THE LAWS OF THE STATE OF MINNESOTA. William A. Becklin, P.E. DATE: SEPT 02, 2022 LIC. NO. 18494 Sheet Checked OWNER / CONTACT Commission Number Date Drawn KJ MICHAEL & MIRA NORCROSS Sheet Name 06/24/2222-1-083 WB Consulting Engineers, Inc. 139 1st Ave. E, Suite 100 P.O. Box 471 Cambridge, MN 55008 Phone: (763) 689-5631 Fax: (763) 552-5631 Becklin & Whitney Project 23183 MEADOWBROOK AVE. NORTH SCANDIA, MN 55073 NORCROSS BARN STRUCTURAL NOTES S9 I HEREBY CERTIFY THAT THIS PLAN, SPECIFICATION, OR REPORT WAS PREPARED BY ME OR UNDER MY DIRECT SUPERVISION AND THAT I AM A DULY REGISTERED PROFESSIONAL ENGINEER UNDER THE LAWS OF THE STATE OF MINNESOTA. William A. Becklin, P.E. DATE: SEPT 02, 2022 LIC. NO. 18494 Sheet Checked OWNER / CONTACT Commission Number Date Drawn KJ MICHAEL & MIRA NORCROSS Sheet Name 06/24/2222-1-083 WB Consulting Engineers, Inc. 139 1st Ave. E, Suite 100 P.O. Box 471 Cambridge, MN 55008 Phone: (763) 689-5631 Fax: (763) 552-5631 Becklin & Whitney Project 23183 MEADOWBROOK AVE. NORTH SCANDIA, MN 55073 NORCROSS BARN STRUCTURAL NOTES S9 I HEREBY CERTIFY THAT THIS PLAN, SPECIFICATION, OR REPORT WAS PREPARED BY ME OR UNDER MY DIRECT SUPERVISION AND THAT I AM A DULY REGISTERED PROFESSIONAL ENGINEER UNDER THE LAWS OF THE STATE OF MINNESOTA. William A. Becklin, P.E. DATE: SEPT 02, 2022 LIC. NO. 18494 Sheet Checked OWNER / CONTACT Commission Number Date Drawn KJ MICHAEL & MIRA NORCROSS Sheet Name 06/24/2222-1-083 WB Consulting Engineers, Inc. 139 1st Ave. E, Suite 100 P.O. Box 471 Cambridge, MN 55008 Phone: (763) 689-5631 Fax: (763) 552-5631 Becklin & Whitney Project 23183 MEADOWBROOK AVE. NORTH SCANDIA, MN 55073 NORCROSS BARN STRUCTURAL NOTES S9 I HEREBY CERTIFY THAT THIS PLAN, SPECIFICATION, OR REPORT WAS PREPARED BY ME OR UNDER MY DIRECT SUPERVISION AND THAT I AM A DULY REGISTERED PROFESSIONAL ENGINEER UNDER THE LAWS OF THE STATE OF MINNESOTA. William A. Becklin, P.E. DATE: SEPT 02, 2022 LIC. NO. 18494 Sheet Checked OWNER / CONTACT Commission Number Date Drawn KJ MICHAEL & MIRA NORCROSS Sheet Name 06/24/2222-1-083 WB Consulting Engineers, Inc. 139 1st Ave. E, Suite 100 P.O. Box 471 Cambridge, MN 55008 Phone: (763) 689-5631 Fax: (763) 552-5631 Becklin & Whitney Project 23183 MEADOWBROOK AVE. NORTH SCANDIA, MN 55073 NORCROSS BARN STRUCTURAL NOTES S9 I HEREBY CERTIFY THAT THIS PLAN, SPECIFICATION, OR REPORT WAS PREPARED BY ME OR UNDER MY DIRECT SUPERVISION AND THAT I AM A DULY REGISTERED PROFESSIONAL ENGINEER UNDER THE LAWS OF THE STATE OF MINNESOTA. William A. Becklin, P.E. DATE: SEPT 02, 2022 LIC. NO. 18494 Sheet Checked OWNER / CONTACT Commission Number Date Drawn KJ MICHAEL & MIRA NORCROSS Sheet Name 06/24/2222-1-083 WB Consulting Engineers, Inc. 139 1st Ave. E, Suite 100 P.O. Box 471 Cambridge, MN 55008 Phone: (763) 689-5631 Fax: (763) 552-5631 Becklin & Whitney Project 23183 MEADOWBROOK AVE. NORTH SCANDIA, MN 55073 NORCROSS BARN STRUCTURAL NOTES https://www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • Use your preferred relay service • Available in alternative formats wq-wwists4-31b • 4/28/2021 Page 1 of 4 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): https://www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • Use your preferred relay service • Available in alternative formats wq-wwists4-31b • 4/28/2021 Page 2 of 4 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. https://www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • Use your preferred relay service • Available in alternative formats wq-wwists4-31b • 4/28/2021 Page 3 of 4 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) https://www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • Use your preferred relay service • Available in alternative formats wq-wwists4-31b • 4/28/2021 Page 4 of 4 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