SSTS Permitting Sandbox site

Compliance Inspection Compliance Inspection Compliance Inspection # CI-2017-0556, Submission # Submission-2017-0595, UID # 7238
Status: System Replaced

System Status

System status on date:

12/01/2016

System Status:

Noncompliant

System - Noncompliant

Reason(s) for noncompliance:

Tank Integrity (Compliance Component #2) - Failing to protect groundwater

Property Information

Property Information:

Compliance Status		Property Record		Property Address								Property Owner	Property Attributes
Compliance Expiration	Compliance Status	Parent GeoCode	PIN	Site Address	Building Number	Street Name	Type	Dir	City	Municipality	zip	Owner	Lot	Block	Plat	Year Built	Property Hold
			2903221440009	6220 190TH ST N, CITY OF FOREST LAKE	6220	190TH	ST	N	FOREST LAKE	CITY OF FOREST LAKE	55025	THAO FONG				1961

Property Owner's Mailing Address
(if different than property address):

6220 190th St N

Forest Lake	MN	55025

Owner's representative:

Name:

Andrew Nelson

Phone:

(651

) 403

- 3505

Email:

thejakeandbelleshow@hotmail.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):	Searched for surface outlet Searched for seeping in yard/backup into home

Tank Integrity

System consists of seepage pit, cesspool, drywell, or leaching pit:	No
Sewage tank(s) leak below their designed operating depth:	Yes
:	2nd tank in the series
Verification method(s):	Examined empty (pumped) tank(s)
Comments/Explanation:	Mike Haseltine with Hassell Free Septic pumped the septic tanks on 12/05/2016 and discovered that the middle septic has a crack in the bottom of tank and that ground water was coming back into the tank at the time the tank was pumped.

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:	Yes
Date of installation:	08/19/2004

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.:	Yes
Drainfield meets the designed vertical separation distance from periodically saturated soil or bedrock.:	Yes
Verification method(s):	Conducted soil observation(s) (Attach boring logs)
A. Bottom of distribution media:	-1.83 Decimal Feet
B. Periodically saturated soil/bedrock:	1.17 Decimal Feet
C. System separation:	3 Decimal Feet
D. Required compliance separation:	3 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

Attach Files:

File 1: 6220_190th_St_N_Forest_Lake,_MN_55025_Andrew___Tracy_Nelson_12-13-2016_septic_compliance.pdf

Certification

Inspector:

Name	License Number	Phone Number	Address	Maintainer	Installer	Service Provider	Designer	Inspector
Sewer Works II LLC	L2015	763-753-1611	17725 Nowthan Blvd Anoka, MN 55303	Yes	Yes	No	Yes	Yes

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):

Jeffrey Peterson

Inspector Email Address:

sewerworks@gmail.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 #1768 (01/18/2017)

Charge	Cost	Quantity	Total
Non-Taxable
Compliance Inspection Fee added 02/08/2017 4:45 PM $40 Flat Fee	$40.00	x 1	$40.00
Subtotal			$40.00 0
Grand Total
Total			$40.00
Payment 02/08/2017			$40.00
Due			$0.00

Action: Print

Approvals

Approval	Signature	Options
Applicant	Jeffrey R. Peterson - 02/08/2017 4:45 PM e3217771033cd5802e30a1ba28eee3fd 5c804562b359abddd9877b1d56e8c8c9
#1 Compliance Inspection Accepted	Christopher W. LeClair REHS - 02/21/2017 8:34 AM daa8c553ce8fb7f54f9777eb32ebfc84 1fac1e5babec711b0cf7f625fca9174b

Inspection has been approved. All signatures have been obtained.

Public Notes

Text:
File(s):

Internal Notes

Text:
File(s):

Create Letter

Compliance Letter Type:		Who's signature should be on the letter?		Permit number to reference in "No Replace" letter:
Was the letter sent?		Compliant/Non-Compliant:

Letter of Compliance

Certificate of Compliance:

Letter of Non-Compliance

Letter of Non-Compliance:

File 1: 6220_190th_ST_N_02-21-2017.pdf