Compliance Inspection Compliance Inspection Compliance Inspection # CI-2020-2193, Submission # Submission-2020-2316, UID # 28263
Status: Compliance Inspection Accepted
 

System Status

System status on date: 05/27/2020 System Status: Compliant

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
11028204400161770 RIVIERA AVE S, CITY OF LAKE ST CROIX BEACH1770RIVIERAAVESLAKELANDCITY OF LAKE ST CROIX BEACH55043BREGER DAVID & LISA1950
Owner's representative:
Name:
Lisa Breger
Phone:
(920843 - 1242
Email:
davidlisabreger@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):
Probed tank(s) bottom
Examined construction records

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: 07/29/2015

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.:
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: -1.5 Decimal Feet
B. Periodically saturated soil/bedrock: 1.5 Decimal Feet
C. System separation: 3 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

Attach Files:

Certification

Inspector:
NameLicense NumberPhone NumberAddressMaintainerInstallerService ProviderDesignerInspector
David R. BrownL3649651-788-3296PO Box 251026 Woodbury, MN 55125NoNoNoYesYes
Please search for and choose SELF/OTHER if what you need does not appear in the list
Inspector Email Address: drufusb1@yahoo.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 #5614 (06/09/2020)

Charge Cost Quantity Total
Non-Taxable
added 06/09/2020 7:39 AM

$41 Flat Fee

$41.00 x 1 $41.00
Grand Total
Total $41.00
Payment 06/09/2020$41.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantDavid R. Brown - 06/09/2020 7:39 AM
5eaa7402120cc48aa2f0925d3c80bd27
31d4076bc8bb921678b90c273ee89525
 
#1 Compliance Inspection AcceptedDenise Lange - 06/09/2020 8:41 AM
4ef5f04888d402b708ce1dbdf3cffe21
2671c9c3a34fc6fa707aaf7838f2349a
 
Inspection has been approved. All signatures have been obtained.
Text:
File(s):
    Text:
    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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