Compliance Inspection Compliance Inspection Compliance Inspection # CI-2023-3623, Submission # Submission-2023-3839, UID # 47679
Status: Compliance Inspection Accepted
 

System Status

System status on date: 07/27/2023 System Status: Compliant

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
050282014000113761 TOMAHAWK DR S, CITY OF AFTON13761TOMAHAWKDRSAFTONCITY OF AFTON55001JAMES V KUBIAK TRS & MARY E KUBIAK TRS6TOMAHAWK HILLS1960
Owner's representative:
Name:
James Kubiak
Phone:
(612940 - 9842
Email:
jvkubiak@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):
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 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):
Examined empty (pumped) tank(s)
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
Explain:
Inspected area around tanks. No signs of damage.
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: 10/09/2016

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)
Comments/Explanation:
See attached soil boring log and site plan for location of trenches and boring.
A. Bottom of distribution media: 2.5 Decimal Feet
B. Periodically saturated soil/bedrock: 5.5 Decimal Feet
C. System separation: 3 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 log and site plan for location of trenches and boring.
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 #9375 (08/02/2023)

Charge Cost Quantity Total
Non-Taxable
added 08/02/2023 11:48 AM

$47 Flat Fee

$45.00 x 1 $45.00
Grand Total
Total $45.00
Payment 08/02/2023$45.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantJesse J. Kloeppner - 08/02/2023 11:48 AM
fbb5c3912362bfa13f16236392aa6741
9024458d252178aa40e39c024b0e8f09
 
#1 Compliance Inspection AcceptedSarah Borrell - 09/20/2023 12:42 PM
515c6004fed6b29cdff91b0bc5b16d03
389c62f7e4ee5a5ca0e88acf878fdb01
 
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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