Compliance Inspection Compliance Inspection Compliance Inspection # CI-2019-1734, Submission # Submission-2019-1848, UID # 22078
Status: Compliance Inspection Accepted
 

System Status

System status on date: 06/21/2019 System Status: Compliant

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
36032212100079655 190TH ST N, CITY OF FOREST LAKE9655190THSTNFOREST LAKECITY OF FOREST LAKE55025JOHN THOMAS A & PATRICIA L MORGAN-JOHN1972No
Property Owner's Mailing Address
(if different than property address):
9655 190th St. N.
Forest Lake MN 55025
Owner's representative:
Name:
Chris Greene
Phone:
(651208 - 7316
Email:
chrisgreene@kw.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 seeping in yard/backup into home
Homeowner testimony (See Comments/Explanation)

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):
Probed tank(s) bottom

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: 05/17/2010

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: 28 Decimal Feet
B. Periodically saturated soil/bedrock: 65 Decimal Feet
C. System separation: 37 Decimal Feet
D. Required compliance separation: 36 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:
Report says NA on last two questions
Attach Files:

Certification

Inspector:
NameLicense NumberPhone NumberAddressMaintainerInstallerService ProviderDesignerInspector
MJL Contracting IncL2449763-444-66685265 269th Ave NE Isanti, MN 55040YesYesNoYesYes
Please search for and choose SELF/OTHER if what you need does not appear in the list
Inspector Email Address: mjlcontract@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 #4533 (06/26/2019)

Charge Cost Quantity Total
Non-Taxable
added 06/26/2019 9:08 AM

$41 Flat Fee

$41.00 x 1 $41.00
Grand Total
Total $41.00
Payment 06/26/2019$41.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantChris Greene - 06/26/2019 9:09 AM
d642b3f334ad3aebd1d80b710b6821cc
ec6561de0ea6a9c24bae3f25a599ce2b
 
#1 Compliance Inspection AcceptedTyler Dale - 06/27/2019 11:13 AM
0e3cbdb882c99590a999aa5469ad67f0
73fbd13b1ceec424b599ae78f1ded3fc
 
Inspection has been approved. All signatures have been obtained.
Text:
File(s):
    Compliance Letter Type: Certificate of Compliance Who's signature should be on the letter? Tyler Dale Permit number to reference in "No Replace" letter:
    Was the letter sent? Yes Compliant/Non-Compliant:
    Certificate of Compliance:
      Letter of Non-Compliance:
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