Compliance Inspection Compliance Inspection Compliance Inspection # CI-2020-2162, Submission # Submission-2020-2264, UID # 27599
Status: Compliance Inspection Accepted
 

System Status

System status on date: 04/27/2020 System Status: Compliant

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
240322112001520780 KEEWAHTIN AVE N, CITY OF FOREST LAKE20780KEEWAHTINAVENFOREST LAKECITY OF FOREST LAKE55025MEUSBURGER TY50SYLVAN SHORES AND HURD COMPANY FARMS1959
Owner's representative:
Name:
Cassandra Washington
Phone:
(952686 - 1014
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
Comments/Explanation:
This system is 29 years old and longevity is not guaranteed.

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
Comments/Explanation:
Pumped by Olsons, Pump is not on block.  New alarm installed.

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: 06/28/1991

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:
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: 94.5 Decimal Feet
B. Periodically saturated soil/bedrock: 91.1 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

Certification

Inspector:
NameLicense NumberPhone NumberAddressMaintainerInstallerService ProviderDesignerInspector
Ark Septic LLCL3974763-257-4378PO Box 229 Zimmerman, MN 55398NoYesNoYesYes
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 #5467 (05/04/2020)

Charge Cost Quantity Total
Non-Taxable
added 05/04/2020 1:53 PM

$41 Flat Fee

$41.00 x 1 $41.00
Grand Total
Total $41.00
Payment 05/14/2020$41.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantARK Septic - 05/14/2020 11:29 AM - witnessed by Denise Lange
a6436cdbd18ba29fb099c7dc1da7e578
628d057d0ed4f0e02acf780b4ba486aa
 
#1 Compliance Inspection AcceptedDenise Lange - 05/14/2020 11:29 AM
d538351e65f039be2dc4eb304511a1db
c17ff7067df1a612c3423f68b7ede480
 
Inspection has been approved. All signatures have been obtained.
Text:
File(s):
    Text:
    Invoice # 5467 
    Invoiced 5-4-20
    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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