SSTS Permitting

Compliance Inspection Compliance Inspection Submission # Submission-2016-0023, UID # 928
Status: Compliance Inspection Accepted

System Status

System status on date:

12/30/2015

System Status:

Compliant

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
			2403221130020	20630 KEEWAHTIN AVE N, CITY OF FOREST LAKE	20630	KEEWAHTIN	AVE	N	FOREST LAKE	CITY OF FOREST LAKE	55025	SAIKO STEVEN G & LYNN M	40		SYLVAN SHORES AND HURD COMPANY FARMS	1972

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

20630 Keewahtin Ave N

Forest Lake	MN	55025

Owner's representative:

Name:
Karen Wong
Email:
septic@co.washington.mn.us

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):	Other methods not listed (See Comments/Explanation)
Comments/Explanation:	Tanks Pumped and OK by Olson's Sewer 9/26/14

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:

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:	98.2 Decimal Feet
B. Periodically saturated soil/bedrock:	94.8 Decimal Feet
C. System separation:	3.4 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: 240322130020-compinsp-20151230.pdf

Certification

Inspector:

Name:
Benjamin Zierke
MPCA License #:
119
Business Name:
Zierke Soil Testing

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 #455 (01/05/2016)

Charge	Cost	Quantity	Total
Non-Taxable
Compliance Inspection Fee added 01/05/2016 2:13 PM $40 Flat Fee	$40.00	x 1	$40.00
Subtotal			$40.00 0
Grand Total
Total			$40.00
Payment 03/01/2016			$40.00
Due			$0.00

Action: Print

Approvals

Approval	Signature	Options
Applicant	3bikmC720 - 01/08/2016 8:41 AM - witnessed by Christopher W. LeClair REHS cbbd14334c57fed89219c1dfeb249c41 3d58a8174db4a157daf5ac5c45dca119

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: