Compliance Inspection Compliance Inspection Compliance Inspection # CI-2020-2046, Submission # Submission-2019-2122, UID # 25474
Status: Compliance Inspection Accepted
 

System Status

System status on date: 11/25/2019 System Status: Compliant

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
32030213400083511 LONG LAKE RD, CITY OF PINE SPRINGS3511LONG LAKERDST PAULCITY OF PINE SPRINGS55115HOEMKE CURTIS J & JACQUELINE M HILLSTROM1951
Owner's representative:
Name:
Kubes Realty Attn: Gloria Flicek
Phone:
(612245 - 1998
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):
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):
Probed tank(s) bottom
Examined construction records
Comments/Explanation:
Consulted AS-Built Construction Data from LGU files.

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: 06/29/1999

Soil Separation

Shoreland/Wellhead Protection/Food, beverage, lodging? Yes
Drainfield has at least a three-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 Decimal Feet
B. Periodically saturated soil/bedrock: 93 Decimal Feet
C. System separation: 36 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

Certification

Inspector:
NameLicense NumberPhone NumberAddressMaintainerInstallerService ProviderDesignerInspector
Advanced Onsite, Inc.L2656952-461-2356313 Lyndale Ave N New Prague, MN 56071NoNoNoYesYes
Please search for and choose SELF/OTHER if what you need does not appear in the list
Inspector Email Address: aos@bevcomm.net

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 #5103 (12/05/2019)

Charge Cost Quantity Total
Non-Taxable
added 12/05/2019 11:30 AM

$41 Flat Fee

$41.00 x 1 $41.00
Grand Total
Total $41.00
Payment 01/22/2020$41.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantTom Klanchnik - 01/22/2020 1:06 PM - witnessed by Denise Lange
a3bd73223f8431c15bab07261891c119
bd3d953aa9b837ce66579f127a529239
 
#1 Compliance Inspection AcceptedDenise Lange - 01/22/2020 1:06 PM
66f036b707a55cc65def3c116a2616da
e0b973309684174617856bf763ac8a99
 
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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