Compliance Inspection Compliance Inspection Compliance Inspection # CI-2019-2037, Submission # Submission-2019-1978, UID # 23680
Status: Compliance Inspection Accepted
 

System Status

System status on date: 08/27/2019 System Status: Compliant

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
14030212100029899 KESWICK AVE N, CITY OF GRANT9899KESWICKAVENSTILLWATERCITY OF GRANT55082JENA ZIEGLER REV TRS1981
Owner's representative:
Name:
Jeffrey Holker
Email:
noemail@noemail.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):
Other methods not listed (See Comments/Explanation)
Comments/Explanation:
Nothing Checked

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: 01/01/1981

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:
Yes
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: 24 Decimal Feet
B. Periodically saturated soil/bedrock: 54 Decimal Feet
C. System separation: 24 Decimal Feet
D. Required compliance separation: 24 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:

Certification

Inspector:
NameLicense NumberPhone NumberAddressMaintainerInstallerService ProviderDesignerInspector
Sunrise Septic Services, IncL2299651-253-296912180 St. Croix Trl North Branch, MN 55056NoNoNoNoYes
Please search for and choose SELF/OTHER if what you need does not appear in the list
Inspector Email Address: noemail@noemail.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 #4809 (09/05/2019)

Charge Cost Quantity Total
Non-Taxable
added 09/05/2019 1:07 PM

$41 Flat Fee

$41.00 x 1 $41.00
Grand Total
Total $41.00
Payment 12/18/2019$41.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantJeffrey Fertig - 09/05/2019 1:09 PM - witnessed by Denise Lange
587c49d752acc0d003d580bc886647aa
11012733d9c781f47f1278e88bd7d962
 
#1 Compliance Inspection AcceptedDenise Lange - 12/18/2019 1:17 PM
7926f5eb2f92771ab6dc011294b04b7b
2c2747fa39a75fd1881ea45a5c9e1b5c
 
Inspection has been approved. All signatures have been obtained.
Text:
File(s):
    Text:
    Invoiced 12.9.19
    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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