Compliance Inspection Compliance Inspection Compliance Inspection # CI-2022-3029, Submission # Submission-2022-3236, UID # 40072
Status: Compliance Inspection Accepted
 

System Status

System status on date: 03/22/2022 System Status: Compliant

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
21029211200258540 IRONWOOD TRL N, CITY OF LAKE ELMO8540IRONWOODTRLNLAKE ELMOCITY OF LAKE ELMO55042PERRIZO JOSHUA & SHELBY53TABLYN PARK1973
Owner's representative:
Name:
Jeff Anderson
Phone:
(651216 - 7663
Email:
anderson.construction.inc@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):
Other methods not listed (See Comments/Explanation)
Comments/Explanation:
Visual Inspection of the area.  No signs of sewage to the ground surface.  The homeowners did not report back-ups in to the house.

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):
Other methods not listed (See Comments/Explanation)
Comments/Explanation:
Tanks pumped and visually inspected with camera.  No signs of cracks or leaking in any of the tanks.

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
Explain:
Inspected area around tanks.  No signs of damage.

Date of Install

Date of install known: Yes
Date of installation: 11/15/2013

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.:
No
Drainfield meets the designed vertical separation
distance from periodically saturated soil or bedrock.:
No
Verification method(s):
Two previous verifications (Attach boring logs)
Other (See Comments/Explanation)
Comments/Explanation:
See attached soil boring logs and As-Built from installation in 2013.
A. Bottom of distribution media: 3.1 Decimal Feet
B. Periodically saturated soil/bedrock: 7 Decimal Feet
C. System separation: 3.9 Decimal Feet
D. Required compliance separation: 2.6 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:
See attached soil boring logs
Attach Files:

Certification

Inspector:
NameLicense NumberPhone NumberAddressMaintainerInstallerService ProviderDesignerInspector
SELF/OTHERn/an/an/a
Please search for and choose SELF/OTHER if what you need does not appear in the list
Inspector Contact (If 'self/other' is selected from the Inspector Lookup): Jesse Kloeppner
Inspector Email Address: jesse@ksd-mn.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 #7853 (03/25/2022)

Charge Cost Quantity Total
Non-Taxable
added 03/25/2022 12:45 PM

$47 Flat Fee

$44.00 x 1 $44.00
Grand Total
Total $44.00
Payment 03/25/2022$44.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantJesse J. Kloeppner - 03/25/2022 12:45 PM
c890316951445f997c30c51236da027b
00e4171bae2d161ebcb8d78440634eb4
 
#1 Compliance Inspection AcceptedSarah Borrell - 03/30/2022 11:28 AM
96b36b75f147d5c41392dcbe3eaf0f98
fef5cc355cbcb8db44147b93fa7380cc
 
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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