SSTS Permitting

Compliance Inspection Compliance Inspection Compliance Inspection # CI-2017-0969, Submission # Submission-2017-1001, UID # 10671
Status: System Replaced

System Status

System status on date:

09/26/2017

System Status:

Noncompliant

System - Noncompliant

Reason(s) for noncompliance:

Impact on Public Health (Compliance Component #1) - Imminent threat to public health and safety

Other Compliance Conditions (Compliance Component #3) - Imminent threat to public health and safety

Soil Separation (Compliance Component #4) - 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
			2503221440004	10000 190TH ST N, CITY OF FOREST LAKE	10000	190TH	ST	N	FOREST LAKE	CITY OF FOREST LAKE	55025	ZIERHUT JUSTIN J				1973

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

10000 190th St N

Forest Lake	MN	55025

Owner's representative:

Name:

Tom Trooien

Phone:

(651

) 439

- 7323

Email:

tomtrooien@aol.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:	Yes
Verification method(s):	Searched for surface outlet Searched for seeping in yard/backup into home	Comments/Explanation:	basement shower appears to back up

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):	Probed tank(s) bottom Examined empty (pumped) tank(s)

Other Compliance Conditions

Maintenance hole covers are damaged, cracked, unsecured, or appear to be structurally unsound:	Yes
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:	09/26/1973

Soil Separation

Shoreland/Wellhead Protection/Food, beverage, lodging?	No
Drainfield has at least a two-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):	Conducted soil observation(s) (Attach boring logs)
Comments/Explanation:	2.5 YR redox depletions at 44"
A. Bottom of distribution media:	2.5 Decimal Feet
B. Periodically saturated soil/bedrock:	3.67 Decimal Feet
C. System separation:	1.17 Decimal Feet
D. Required compliance separation:	2 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: 10000_190th_St_N_.pdf

Certification

Inspector:

Name	License Number	Phone Number	Address	Maintainer	Installer	Service Provider	Designer	Inspector
All State Septic Services	L1568	651-439-7323	12155 Norell Ave N Stillwater, MN 55082	No	No	No	Yes	Yes

Please search for and choose SELF/OTHER if what you need does not appear in the list

Inspector Email Address:

tomtrooien@aol.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 #2652 (09/26/2017)

Charge	Cost	Quantity	Total
Non-Taxable
Compliance Inspection Fee added 09/26/2017 4:49 PM $40 Flat Fee	$40.00	x 1	$40.00
Subtotal			$40.00 0
Grand Total
Total			$40.00
Payment 09/26/2017			$40.00
Due			$0.00

Action: Print

Approvals

Approval	Signature	Options
Applicant	Tom Trooien - 09/26/2017 4:49 PM 976d11572d3eefcf620d1aa4b9e608dc f7987d12ea8baf6d4388f4dd756bbbc8
#1 Compliance Inspection Accepted	Christopher W. LeClair REHS - 10/06/2017 10:40 AM 1657c268ee20a265354d997f7c798105 fb3b13f5af05fbda913d0979f84627ae

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: 10000_190th_ST_N_ITPHS_10-6-2017.pdf