SSTS Permitting

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
			3002721230005	5940 PIONEER RD S, TOWN OF GREY CLOUD ISLAND	5940	PIONEER	RD	S	ST PAUL PARK	TOWN OF GREY CLOUD ISLAND	55071	FOSTER TIMOTHY J				1973

Owner's representative:

Name:

James Hard

Phone:

(405

) 204

- 5924

Email:

sjhinokc@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:	No
Verification method(s):	Searched for surface outlet Searched for seeping in yard/backup into home Homeowner testimony (See Comments/Explanation)

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

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:	2 Decimal Feet
B. Periodically saturated soil/bedrock:	5.3 Decimal Feet
C. System separation:	3.3 Decimal Feet
D. Required compliance separation:	3 Decimal Feet

Certification

Inspector:

Name	License Number	Phone Number	Address	Maintainer	Installer	Service Provider	Designer	Inspector
David R. Brown	L3649	651-788-3296	PO Box 251026 Woodbury, MN 55125	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:

drufusb1@yahoo.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 #6489 (03/04/2021)

Charge	Cost	Quantity	Total
Non-Taxable
2025 Compliance Inspection Fee added 03/04/2021 5:27 AM $47 Flat Fee	$42.00	x 1	$42.00
Subtotal			$42.00 0
Grand Total
Total			$42.00
Payment 03/04/2021			$42.00
Due			$0.00

Action: Print

Approvals

Approval	Signature	Options
Applicant	David Brown - 04/14/2021 9:01 AM - witnessed by Tyler Dale 3373bf50458889f07c554f7ab93723d2 5194410f8769aaf13c78c332da0815b0
#1 Compliance Inspection Accepted	Tyler Dale - 04/14/2021 9:01 AM a25cc7d996812813a0bef2561ada1058 4a8849fe5848319372031ed963db0fb6

Inspection has been approved. All signatures have been obtained.

Public Notes

Text:
File(s):

Internal Notes

Text:

Hi Dave,

The compliance inspection you submitted for the address above uses an old MPCA compliance inspection form. All compliance inspections need to use the new form, https://www.pca.state.mn.us/document/wq-wwists4-31bdocx.

In addition the inspection indicated that the tank compliance was assessed by probing the tanks. Tanks are required to either be observed empty or have a valid tank certification submitted. I do not see either in the submitted compliance inspection. If the tanks are not observed empty they are considered non-compliant.

Due to the issues listed above the compliance inspection is not considered complete. Please send an updated compliance inspection form.

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:

Date of install known:	Yes
Date of installation:	06/29/2000

SSTS Permitting

System Status

Property Information

Impact on Public Health

Tank Integrity

Other Compliance Conditions

Date of Install

Soil Separation

Operating Permit and Nitrogen BMP

Comments and File Attachments

Certification

Terms

Invoice #6489 (03/04/2021)

Approvals

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 Tank Integrity Form (Attach)

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