Compliance Inspection Compliance Inspection Compliance Inspection # CI-2018-1138, Submission # Submission-2018-1184, UID # 14247
Status: Compliance Inspection Accepted
 

System Status

System status on date: 03/08/2018 System Status: Compliant

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
25027221100035910 PIONEER RD S, TOWN OF GREY CLOUD ISLAND5910PIONEERRDSST PAUL PARKTOWN OF GREY CLOUD ISLAND55071LUTHER TERRANCE L1955
Owner's representative:
Name:
Pamela Hendrickson
Phone:
(612226 - 1788
Email:
pamela.hendrickson@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
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 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
Explain:
Septic lid on Lift tank was wood and was replace with riser and a plastic lid that is fastened down
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: 06/28/1988

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:
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: 2 Decimal Feet
C. System separation: 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

Comments or recommendations:
System should be pumped minimum every two years.
Attach Files:

Certification

Inspector:
NameLicense NumberPhone NumberAddressMaintainerInstallerService ProviderDesignerInspector
Sewer Works II LLCL2015763-753-161117725 Nowthan Blvd Anoka, MN 55303YesYesNoYesYes
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): Jeffrey Peterson
Inspector Email Address: sewerworks@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 #3092 (03/17/2018)

Charge Cost Quantity Total
Non-Taxable
added 03/17/2018 4:33 PM

$40 Flat Fee

$40.00 x 1 $40.00
Grand Total
Total $40.00
Payment 03/17/2018$40.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantJeffrey R. Peterson - 03/17/2018 4:33 PM
f07da387b9926d52b28905ec2064feba
41a864d302bbb0394ca8b1394af38a5a
 
#1 Compliance Inspection AcceptedKati Hallermann - 03/19/2018 9:00 AM
dfaec3f698584979cdbcfa03279230ba
60b913cc1b23b6e65db44a61c2212cc9
 
Inspection has been approved. All signatures have been obtained.
Text:
File(s):
    Text:
    Invoice#3092
    File(s):
      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:
      Certificate of Compliance:
        Letter of Non-Compliance:
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