Compliance Inspection Compliance Inspection Compliance Inspection # CI-2023-3621, Submission # Submission-2023-3837, UID # 47610
Status: Compliance Inspection Accepted
 

System Status

System status on date: 07/13/2023 System Status: Compliant

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
280292033001014210 10TH ST N, TOWN OF WEST LAKELAND1421010THSTNSTILLWATERTOWN OF WEST LAKELAND55082TEOREY ROBERT M41OAKWOOD FARM2001
Owner's representative:
Name:
Keller Williams Mike Olsen
Email:
pam@mikeolsen.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
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: Yes
Date of installation: 08/31/2001

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: 2.5 Decimal Feet
B. Periodically saturated soil/bedrock: 5.16 Decimal Feet
C. System separation: 2.67 Decimal Feet
D. Required compliance separation: 2.67 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
B's Pumping ServiceL4149651-460-801524483 Chippendale Ave W Farmington, MN 55024YesYesYesYesNo
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): Mark Smith
Inspector Email Address: mark@bspumping.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 #9357 (07/31/2023)

Charge Cost Quantity Total
Non-Taxable
added 08/01/2023 12:35 PM

$47 Flat Fee

$45.00 x 1 $45.00
Grand Total
Total $45.00
Payment 08/01/2023$45.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantMark Smith - 09/15/2023 4:27 PM - witnessed by Sarah Borrell
4203b9f3d42632a16e22a744f27d4c32
a8adfe9c238767d1b54fc8af7202aa0c
 
#1 Compliance Inspection AcceptedSarah Borrell - 09/15/2023 4:28 PM
9b51271dd75ef803de324080422a93a4
dab47d3b5962a7c390d6a0c91f741578
 
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:
          Powered by