Compliance Inspection Compliance Inspection Compliance Inspection # CI-2021-2864, Submission # Submission-2021-3065, UID # 36692
Status: Compliance Inspection Accepted
 

System Status

System status on date: 09/21/2021 System Status: Compliant

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
28029202400261578 OLENE AVE N, TOWN OF WEST LAKELAND1578OLENEAVENSTILLWATERTOWN OF WEST LAKELAND55082DECARLO PETER J & MATTIE H82SUN RAY HEIGHTS1969
Owner's representative:
Name:
Kelli Anderson
Phone:
(651335 - 4996
Email:
kelli.shanley.anderson@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: No

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 Decimal Feet
C. System separation: 3.8 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
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 #7433 (10/01/2021)

Charge Cost Quantity Total
Non-Taxable
added 10/01/2021 8:48 AM

$47 Flat Fee

$42.00 x 1 $42.00
Grand Total
Total $42.00
Payment 10/01/2021$42.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantDavid R. Brown - 10/01/2021 8:48 AM
561e81b4dc4885e81608c318c1c4abde
750e3b1587a72a17c89bce3ddc4ecfc8
 
#1 Compliance Inspection AcceptedSarah Borrell - 10/06/2021 3:48 PM
81af3e76b148acf13c4106e92a63c8c0
6ce8290f4aa179c9f98df3758c54c7a9
 
Inspection has been approved. All signatures have been obtained.
Text:
File(s):
    Text:
    Confirmation Number: 3815128839
    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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