Compliance Inspection Compliance Inspection Compliance Inspection # CI-2021-2811, Submission # Submission-2021-3011, UID # 36065
Status: Compliance Inspection Accepted
 

System Status

System status on date: 08/23/2021 System Status: Compliant

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
33030211100056920 JAMACA AVE N, CITY OF GRANT6920JAMACAAVENSTILLWATERCITY OF GRANT55082SCHULTZ ANDREW C & KELLY M11SCHIFSKY GREEN RIDGE1993
Owner's representative:
Name:
Andy Schultz
Phone:
(612363 - 0123
Email:
acschultz100@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):
Examined Tank Integrity Form (Attach)

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: 10/20/1993

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: 101.22 Decimal Feet
B. Periodically saturated soil/bedrock: 99.22 Decimal Feet
C. System separation: 2 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

Comments or recommendations:
Will be hooking up future pool building to system since it was deemed compliant.
Attach Files:

Certification

Inspector:
NameLicense NumberPhone NumberAddressMaintainerInstallerService ProviderDesignerInspector
Ten Thirty Environmental Solutions, SBCL4082612-248-42811684 132nd Ave NE Blaine, MN 55449NoNoYesYesYes
Please search for and choose SELF/OTHER if what you need does not appear in the list
Inspector Email Address: alex.pepin@tenthirtyenvironmental.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 #7301 (09/02/2021)

Charge Cost Quantity Total
Non-Taxable
added 09/02/2021 2:01 PM

$47 Flat Fee

$42.00 x 1 $42.00
Grand Total
Total $42.00
Payment 09/02/2021$42.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantAlex Pepin - 09/02/2021 2:01 PM
20c54c978f24c53edf7e7cc7f16dcd8e
01ab823c4fc9d71bcb4e7ddd1620873d
 
#1 Compliance Inspection AcceptedSarah Borrell - 09/17/2021 12:13 PM
71e96f9be14adf8475fd5567138f70d3
60b82288ec327a39ce269b614f96fb2b
 
Inspection has been approved. All signatures have been obtained.
Text:
A permit for the pool house may be necessary.  If the flow will increase, a septic permit would be required.
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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