Compliance Inspection Compliance Inspection Compliance Inspection # CI-2023-3743, Submission # Submission-2023-3972, UID # 49835
Status: Compliance Inspection Accepted
 

System Status

System status on date: 11/03/2023 System Status: Compliant

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
15030201300069633 PAWNEE AVE N, TOWN OF STILLWATER9633PAWNEEAVENSTILLWATERTOWN OF STILLWATER55082GAG ROSEMARY J & THOMAS J21HORIZON HEIGHTS 2ND ADD1991
Owner's representative:
Name:
Tom Gag
Phone:
(651439 - 0225
Email:
sssepticsolutions@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):
Searched for surface outlet
Searched for seeping in yard/backup into home
Homeowner testimony (See Comments/Explanation)
Comments/Explanation:
Homeowner said they have not had any problems with the system.

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: 12/03/1991

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)
A. Bottom of distribution media: 2 Decimal Feet
B. Periodically saturated soil/bedrock: 5 Decimal Feet
C. System separation: 3 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

Attach Files:

Certification

Inspector:
NameLicense NumberPhone NumberAddressMaintainerInstallerService ProviderDesignerInspector
SS Septic Solutions LLCL4137651-343-911714845 113th St S Hastings, MN 55033NoYesNoYesYes
Please search for and choose SELF/OTHER if what you need does not appear in the list
Inspector Email Address: sssepticsolutions@gmail.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 #9731 (11/07/2023)

Charge Cost Quantity Total
Non-Taxable
added 11/07/2023 5:30 PM

$47 Flat Fee

$45.00 x 1 $45.00
Grand Total
Total $45.00
Payment 11/07/2023$45.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantShelley L. Schlomka - 11/07/2023 5:30 PM
a317de80c6535f024ede2afff05e5f4d
31b140eaae3b94e20095b0b706e173a7
 
#1 Compliance Inspection AcceptedSarah Borrell - 12/21/2023 4:18 PM
c63f38f489f85e23562b4280659fffa0
9575a3a45ffcaabd00ae55f5b0154f88
 
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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