SSTS Permitting

Compliance Inspection Compliance Inspection Compliance Inspection # CI-2023-3553, Submission # Submission-2023-3774, UID # 46795
Status: System Replaced

System Status

System status on date:

06/15/2023

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
			2303221330001	8355 202ND ST N, CITY OF FOREST LAKE	8355	202ND	ST	N	FOREST LAKE	CITY OF FOREST LAKE	55025	REHBEIN RANDY D & KASSIE L HOWARD				1987

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

38223 EwingCt

North Branch	MN	55056

Owner's representative:

Name:

Jennifer Millsap

Phone:

(651

) 755

- 3296

Email:

noemail@gmail.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 Homeowner testimony (See Comments/Explanation)	Comments/Explanation:	See attached report.

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 empty (pumped) tank(s)
Comments/Explanation:	See attached report.

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:	06/22/1987

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)
A. Bottom of distribution media:	96 Decimal Feet
B. Periodically saturated soil/bedrock:	100 Decimal Feet
C. System separation:	-4 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: Millsap_Inspection_6-15-23.pdf

Certification

Inspector:

Name	License Number	Phone Number	Address	Maintainer	Installer	Service Provider	Designer	Inspector
Zierke Soil Testing, LLC	L119	651-249-1346	28587 Jeffrey Ave Chisago City, MN 55013	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:

benzierke@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 #9204 (06/18/2023)

Charge	Cost	Quantity	Total
Non-Taxable
2025 Compliance Inspection Fee added 06/18/2023 9:29 PM $47 Flat Fee	$45.00	x 1	$45.00
Subtotal			$45.00 0
Grand Total
Total			$45.00
Payment 06/18/2023			$45.00
Due			$0.00

Action: Print

Approvals

Approval	Signature	Options
Applicant	Benjamin J. Zierke - 06/18/2023 9:29 PM 5c2ff2e43c86b8e0b5155b4c414736e2 37c9208448d26fcb23cb2f885928d814
#1 Compliance Inspection Accepted	Sarah Borrell - 07/10/2023 3:54 PM c6afa37a09e26997344c5d2f41941be8 f34c1561a99faa6b4f3b2e95fc339107

Inspection has been approved. All signatures have been obtained.

Public Notes

Text:
File(s):

Internal Notes

Text:
File(s):

Create Letter

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

Letter of Compliance

Certificate of Compliance:

Letter of Non-Compliance

Letter of Non-Compliance: