Compliance Inspection Compliance Inspection Compliance Inspection # CI-2021-2670, Submission # Submission-2021-2867, UID # 34364
Status: System Replaced
 

System Status

System status on date: 06/17/2021 System Status: Noncompliant

System - Noncompliant

Reason(s) for noncompliance:
Soil Separation (Compliance Component #4) - Failing to protect groundwater

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
240322111001920993 KESWICK AVE N, CITY OF FOREST LAKE20993KESWICKAVENFOREST LAKECITY OF FOREST LAKE55025CAMPBELL DAVID J & ROBIN L11JOHNSON'S SYLVAN SHORES PLAT 21978
Owner's representative:
Name:
Robin Campbell
Phone:
(612940 - 6288
Email:
robincampbell610@yahoo.com

Impact on Public Health

System discharges sewage to
the ground surface:
No System discharges sewage to
drain tile or surface waters:
No System causes sewage backup
into dwelling or establishment:
No
Verification method(s):
Other methods not listed (See Comments/Explanation)
Comments/Explanation:
Visual Verification and interview with homeowner.

Tank Integrity

System consists of seepage pit,
cesspool, drywell, or leaching pit:
No
Sewage tank(s) leak below their
designed operating depth:
No
Verification method(s):
Other methods not listed (See Comments/Explanation)
Comments/Explanation:
Tank is being replaced when system is installed.  Tank will be abandoned.

Other Compliance Conditions

Maintenance hole covers are damaged, cracked,
unsecured, or appear to be structurally unsound:
No
Other issues (electrical hazards, etc.) to
immediately and adversely impact public
health or safety:
No
System is non protective of groundwater for other
conditions as determined by the inspector:
No

Date of Install

Date of install known: No

Soil Separation

Shoreland/Wellhead Protection/Food, beverage, lodging? No
Drainfield has at least a three-foot vertical separation
distance from periodically saturated soil or bedrock.:
No
Drainfield meets the designed vertical separation
distance from periodically saturated soil or bedrock.:
No
Verification method(s):
Other (See Comments/Explanation)
Comments/Explanation:
Trenches showed signs of being oversaturated

The finger style trenches showed signs of failure.  Homeowner reported system and a new drainfield will be built to replace failing system.
A. Bottom of distribution media: 0 Decimal Feet
B. Periodically saturated soil/bedrock: 0 Decimal Feet
C. System separation: 0 Decimal Feet
D. Required compliance separation: 0 Decimal Feet

Operating Permit and Nitrogen BMP

Is system operating under an Operating Permit: No
Is the system required to employ Nitrogen BMP: No

Comments and File Attachments

Comments or recommendations:
See Soil Report
Attach Files:

Certification

Inspector:
NameLicense NumberPhone NumberAddressMaintainerInstallerService ProviderDesignerInspector
SELF/OTHERn/an/an/a
Please search for and choose SELF/OTHER if what you need does not appear in the list
Inspector Contact (If 'self/other' is selected from the Inspector Lookup): Jesse Kloeppner
Inspector Email Address: jesse@ksd-mn.com

Terms

Certification
  • By submitting this form I hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of the 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

Invoice #6930 (06/21/2021)

Charge Cost Quantity Total
Non-Taxable
added 06/21/2021 10:14 AM

$42 Flat Fee

$42.00 x 1 $42.00
Grand Total
Total $42.00
Payment 06/21/2021$42.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantJesse J. Kloeppner - 06/21/2021 10:14 AM
08d895d86b7bdfdc18be53e424d2f6c3
b5942e9cfcf76332b6523e1e8bcd6544
 
#1 Compliance Inspection AcceptedSarah Borrell - 07/14/2021 6:20 AM
3920db5d187770bad2e3cd7eb083c7c5
2ad2c7f66075524c158e03db659c9273
 
Inspection has been approved. All signatures have been obtained.
Text:
File(s):
    Text:
    File(s):
      Compliance Letter Type: Failed System, Notice and Order to Comply, Separation Who's signature should be on the letter? Sarah Borrell Permit number to reference in "No Replace" letter:
      Was the letter sent? Yes Compliant/Non-Compliant: Noncompliant
      Certificate of Compliance:
        Letter of Non-Compliance:
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