Compliance Inspection Compliance Inspection Submission # Submission-2024-4166, UID # 53191
Status: Pending Review
 

System Status

System status on date: 06/01/2024 System Status: Compliant

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
350292023002216141 6TH ST N, CITY OF LAKELAND161416THSTNLAKELANDCITY OF LAKELAND55043WHITCOMB JOHN F JR & KAREN M103LAKELAND HILLS1978
Owner's representative:
Name:
John Whitcomb
Phone:
(651208 - 3139
Email:
jfw24@outlook.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)

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: 12/21/2015

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):
Two previous verifications (Attach boring logs)
A. Bottom of distribution media: 2.5 Decimal Feet
B. Periodically saturated soil/bedrock: 6 Decimal Feet
C. System separation: 3.5 Decimal Feet
D. Required compliance separation: 3 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
David R. BrownL3649651-788-3296PO Box 251026 Woodbury, MN 55125NoNoNoYesYes
Please search for and choose SELF/OTHER if what you need does not appear in the list
Inspector Email Address: drufusb1@yahoo.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 #10282 (06/05/2024)

Charge Cost Quantity Total
Non-Taxable
added 06/05/2024 7:16 AM

$47 Flat Fee

$46.00 x 1 $46.00
Grand Total
Total $46.00
Due$46.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantDavid R. Brown - 06/05/2024 7:16 AM
f8cb848810279fbb1ba251602f41d2ca
14d5b932e7a831466e97f946edc91a99
 
#1 Compliance Inspection Accepted 
You do not have the necessary rights for this signature
Inspection will be approved after the above signatures are obtained.
Text:
File(s):
    Text:
    12-23-2024 Invoiced and emailed for payment.  Files below. DL 
    7/19 - emailed David Brown for payment, unable to process
    6/11 - John W. called, selling property and requested copy of the COC. Payment is due.
    File(s):
    Compliance Letter Type: Who's signature should be on the letter? Permit number to reference in "No Replace" letter:
    Was the letter sent? Compliant/Non-Compliant:
    Certificate of Compliance:
      Letter of Non-Compliance:
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