Compliance Inspection Compliance Inspection Compliance Inspection # CI-2021-2618, Submission # Submission-2021-2811, UID # 33919
Status: Compliance Inspection Accepted
 

System Status

System status on date: 05/13/2021 System Status: Compliant

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
300292044001212910 12TH ST N, TOWN OF WEST LAKELAND1291012THSTNLAKE ELMOTOWN OF WEST LAKELAND55042KOLODNY LUCIANO & ADRIANA S202WEST LAKELAND BLUFFS1996
Owner's representative:
Name:
David Picka
Phone:
(651242 - 0311
Email:
dmpicka@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)

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: 05/24/1996

Soil Separation

Shoreland/Wellhead Protection/Food, beverage, lodging? No
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: 2 Decimal Feet
B. Periodically saturated soil/bedrock: 5.2 Decimal Feet
C. System separation: 3.2 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
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 #6828 (05/27/2021)

Charge Cost Quantity Total
Non-Taxable
added 05/27/2021 11:59 PM

$47 Flat Fee

$42.00 x 1 $42.00
Grand Total
Total $42.00
Payment 05/27/2021$42.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantDavid R. Brown - 05/27/2021 11:59 PM
0c4cf8482e1e07e39ee8fc1f1dea4e53
c2dfe806cd0d19b9bbcc89c309105bbb
 
#1 Compliance Inspection AcceptedSarah Borrell - 06/15/2021 8:47 AM
68f1d2fd0f82805db83474f6fcdabb2f
c4e7683b00a4b26b196295df45f622d8
 
Inspection has been approved. All signatures have been obtained.
Text:
File(s):
    Text:
    File(s):
      Compliance Letter Type: Certificate of Compliance Who's signature should be on the letter? Sarah Borrell Permit number to reference in "No Replace" letter:
      Was the letter sent? Yes Compliant/Non-Compliant: Compliant
      Certificate of Compliance:
        Letter of Non-Compliance:
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