SSTS Permitting

System Status

System status on date:

10/12/2020

System Status:

Noncompliant

System - Noncompliant

Reason(s) for noncompliance:

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
			2403221120025							CITY OF FOREST LAKE		HEIT CHRISTOPHER C & SHANNON	7	1	SYLVAN SHORES TERRACE	2007

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

20930 Keewahtin Ave N

Forest Lake	MN	55025

Owner's representative:

Name:

Alex Pepin

Phone:

(612

) 248

- 4281

Email:

alex.pepin@tenthirtyenvironmental.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:	No
Verification method(s):	Examined Tank Integrity Form (Attach)

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:	07/01/1997

Soil Separation

Shoreland/Wellhead Protection/Food, beverage, lodging?	Yes
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):	Conducted soil observation(s) (Attach boring logs)
A. Bottom of distribution media:	98.42 Decimal Feet
B. Periodically saturated soil/bedrock:	96.45 Decimal Feet
C. System separation:	1.96 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: 20920_Keewahtin_Ave_N_Septic_Inspection_-_TTES_-_10-13-2020.pdf

Certification

Inspector:

Name	License Number	Phone Number	Address	Maintainer	Installer	Service Provider	Designer	Inspector
Ten Thirty Environmental Solutions, SBC	L4082	612-248-4281	1684 132nd Ave NE Blaine, MN 55449	No	No	Yes	Yes	Yes

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

Inspector Email Address:

alex.pepin@tenthirtyenvironmental.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 #6152 (10/13/2020)

Charge	Cost	Quantity	Total
Non-Taxable
Compliance Inspection Fee added 10/13/2020 3:46 PM $41 Flat Fee	$41.00	x 1	$41.00
Subtotal			$41.00 0
Grand Total
Total			$41.00
Payment 10/13/2020			$41.00
Due			$0.00

Action: Print

Approvals

Approval	Signature	Options
Applicant	Alex Pepin - 10/13/2020 3:46 PM 77f5202d532e7dfb11662cc825e8265f 7dd57f3c63690179ac9e0f05f884932c

Compliance Letter Type:	Failed System, Notice and Order to Comply, Separation	Who's signature should be on the letter?	Paul O'Neel	Permit number to reference in "No Replace" letter:
Was the letter sent?	Yes	Compliant/Non-Compliant:	Noncompliant

Text:
File(s):