Compliance Inspection Compliance Inspection Submission # Submission-2024-4416, UID # 57173
Status: Pending Review
 

System Status

System status on date: 12/05/2024 System Status: Compliant

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
15029213300169095 31ST ST N, CITY OF LAKE ELMO909531STSTNLAKE ELMOCITY OF LAKE ELMO55042CORAJOD JEFFREY & KALLI A SHADES1948
Owner's representative:
Name:
Jeff Corajod
Phone:
(555555 - 5555
Email:
noname@noname.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):
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 in 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.
The effluent filter is tilted due to settling. Filter could not be removed.

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: 07/31/2017

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: 112.2 Decimal Feet
B. Periodically saturated soil/bedrock: 109 Decimal Feet
C. System separation: 3.2 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 mound 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 #10887 (12/12/2024)

Charge Cost Quantity Total
Non-Taxable
added 12/12/2024 3:50 PM

$47 Flat Fee

$46.00 x 1 $46.00
Grand Total
Total $46.00
Payment 12/12/2024$46.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantJesse J. Kloeppner - 12/12/2024 3:50 PM
bcda72db4c505196df3ea24945044bd7
831fcbe255bb2dcee4da03c970a8d334
 
#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:
    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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