Compliance Inspection Compliance Inspection Compliance Inspection # CI-2022-3033, Submission # Submission-2022-3240, UID # 40192
Status: Compliance Inspection Accepted
 

System Status

System status on date: 03/28/2022 System Status: Compliant

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
32030211300117680 66TH ST N, CITY OF PINE SPRINGS768066THSTNST PAULCITY OF PINE SPRINGS55115SILVERBERG DANIEL P & LAURA L14WINMAR ESTATES 2ND ADD1986
Owner's representative:
Name:
Gary Brown
Phone:
(651402 - 0565
Email:
gsbrown7680@comcast.net

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
Comments/Explanation:
see report

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: 10/20/1986

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.:
Yes
Verification method(s):
Conducted soil observation(s) (Attach boring logs)
Comments/Explanation:
just out of wellhead protection area.  Boring log on separation page of report.
A. Bottom of distribution media: 96 Decimal Feet
B. Periodically saturated soil/bedrock: 91.83 Decimal Feet
C. System separation: 4.17 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

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 #7862 (03/29/2022)

Charge Cost Quantity Total
Non-Taxable
added 03/29/2022 11:13 AM

$47 Flat Fee

$44.00 x 1 $44.00
Grand Total
Total $44.00
Payment 03/29/2022$44.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantAlex Pepin - 03/29/2022 11:13 AM
afdabb2e302848ec6a00c34eea078b7a
ec57a3a9bbc61742a67d6564c44f6ea5
 
#1 Compliance Inspection AcceptedSarah Borrell - 03/30/2022 1:03 PM
1bd8aae672dd95991c6e3867ff389c20
99a792fd0cf3d17c3264b6b836643185
 
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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