Compliance Inspection Compliance Inspection Compliance Inspection # CI-2020-2283, Submission # Submission-2020-2421, UID # 29605
Status: Compliance Inspection Accepted
 

System Status

System status on date: 08/06/2020 System Status: Compliant

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
320322141000218323 FOREST BLVD N, CITY OF FOREST LAKE18323FORESTBLVDNFOREST LAKECITY OF FOREST LAKE55025BOWSER JUSTIN2001
Owner's representative:
Name:
Adam Biedny
Phone:
(612709 - 1829
Email:
adamfree96@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
Homeowner testimony (See Comments/Explanation)
Comments/Explanation:
See attached report.

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)
Comments/Explanation:
See attached report.

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: 05/16/1995

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.:
Yes
Verification method(s):
Conducted soil observation(s) (Attach boring logs)
A. Bottom of distribution media: 101.9 Decimal Feet
B. Periodically saturated soil/bedrock: 99 Decimal Feet
C. System separation: 2.9 Decimal Feet
D. Required compliance separation: 2 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
Zierke Soil Testing, LLCL119651-249-134628587 Jeffrey Ave Chisago City, MN 55013NoNoNoYesYes
Please search for and choose SELF/OTHER if what you need does not appear in the list
Inspector Email Address: benzierke@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 #5878 (08/11/2020)

Charge Cost Quantity Total
Non-Taxable
added 08/11/2020 7:34 AM

$41 Flat Fee

$41.00 x 1 $41.00
Grand Total
Total $41.00
Payment 08/11/2020$41.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantBenjamin J. Zierke - 08/11/2020 7:34 AM
450dfeab0e77b4059533afe5a24172f1
dd7d24e28e9ec1f8ed0d2f4422219a5d
 
#1 Compliance Inspection AcceptedDenise Lange - 08/11/2020 9:02 AM
2ec5b3b5123e9eb505e6d24a5c0fa900
7585d683bf6db95468c7a5bea9f2fe34
 
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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