Compliance Inspection Compliance Inspection Compliance Inspection # CI-2016-0361, Submission # Submission-2016-0273, UID # 3910
Status: Compliance Inspection Accepted
 

System Status

System status on date: 06/30/2016 System Status: Compliant

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
28029202300021512 OLDRIDGE AVE N, TOWN OF WEST LAKELAND1512OLDRIDGEAVENSTILLWATERTOWN OF WEST LAKELAND55082WELLMAN CLARK & EMILY1986
Owner's representative:
Name:
Dave Bossard
Phone:
(000000 - 0000
Email:
chad@chadlashinski.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: 12/08/1986

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.:
No
Verification method(s):
Conducted soil observation(s) (Attach boring logs)
A. Bottom of distribution media: 30 Decimal Feet
B. Periodically saturated soil/bedrock: 66 Decimal Feet
C. System separation: 36 Decimal Feet
D. Required compliance separation: 24 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:
Name:
Chad Lashinski
MPCA License #:
L3636
Business Name:
Residential Testing Solutions
Phone:
(612991 - 7004
Email:
chad@chadlashinski.com
Address:
16739 Ward Lake Drive NW
Andover MN 55304

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 #1047 (07/01/2016)

Charge Cost Quantity Total
Non-Taxable
added 07/01/2016 9:40 AM

$40 Flat Fee

$40.00 x 1 $40.00
Grand Total
Total $40.00
Payment 09/02/2016$40.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantChad Lashinski - 07/01/2016 9:41 AM - witnessed by Kati Hallermann
4f123aecbdb468b7e4819f42e0f46e30
71831d4d3de50ccd8e7652dff21711cb
 
#1 Compliance Inspection AcceptedKati Hallermann - 09/02/2016 2:06 PM
1de434d59d4087fabc6b08aac8b4d29d
8f46463a84c40d1b643e297a75da0e37
 
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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