SSTS Permitting

Compliance Inspection Compliance Inspection Submission # Submission-2024-4415, UID # 57171
Status: Pending Review

System Status

System status on date:

12/06/2024

System Status:

Noncompliant

System - Noncompliant

Reason(s) for noncompliance:

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

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
			0902921130011	4539 BIRCH BARK TRL N, CITY OF LAKE ELMO	4539	BIRCH BARK	TRL	N	LAKE ELMO	CITY OF LAKE ELMO	55042	JOHNSON SUZANNE M	16		OACE ACRES 2ND ADD	1961

Owner's representative:

Name:

Suzanne Johnson

Phone:

(612

) 358

- 8195

Email:

billcallas@comcast.net

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):	Other methods not listed (See Comments/Explanation)	Comments/Explanation:	Visual Inspection of the area. No signs of sewage to the ground surface. The homeowners did not report back-ups in to the house.

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)

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:	12/01/1988

Soil Separation

Shoreland/Wellhead Protection/Food, beverage, lodging?	Yes
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:	97.6 Decimal Feet
B. Periodically saturated soil/bedrock:	95.7 Decimal Feet
C. System separation:	1.9 Decimal Feet
D. Required compliance separation:	2.6 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

Comments or recommendations:	See attached soil boring log and site plan for location of mound and boring.
Attach Files:	File 1: KSD_SSTS_INSPECTION_4539_Birch_Bark_Trl_N_Lake_Elmo_Ver_1.0_12-10-24.pdf

Certification

Inspector:

Name	License Number	Phone Number	Address	Maintainer	Installer	Service Provider	Designer	Inspector
SELF/OTHER	n/a	n/a	n/a

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):

Jesse Kloeppner

Inspector Email Address:

jesse@ksd-mn.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 #10885 (12/12/2024)

Charge	Cost	Quantity	Total
Non-Taxable
2025 Compliance Inspection Fee added 12/12/2024 3:14 PM $47 Flat Fee	$46.00	x 1	$46.00
Subtotal			$46.00 0
Grand Total
Total			$46.00
Payment 12/12/2024			$46.00
Due			$0.00

Action: Print

Approvals

Approval	Signature	Options
Applicant	Jesse J. Kloeppner - 12/12/2024 3:14 PM b2d855f369051785e32381b232e0cbf6 c18288e0d4d0918cfb16e1f7fd31b071
#1 Compliance Inspection Accepted		You do not have the necessary rights for this signature

Inspection will be approved after the above signatures are 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: