Compliance Inspection Compliance Inspection Compliance Inspection # CI-2016-0019, Submission # Submission-2016-0030, UID # 980
Status: Compliance Inspection Accepted
 

System Status

System status on date: 12/12/2015 System Status: Compliant

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
09029212400168460 DEER POND TRL N, CITY OF LAKE ELMO8460DEER PONDTRLNLAKE ELMOCITY OF LAKE ELMO55042LUSIS MICHELLE6OACE ACRES 2ND ADD1959No
Property Owner's Mailing Address
(if different than property address):
8460 Deer Pond Trl N
Lake Elmo MN 55042
Owner's representative:
Name:
Loren Johnson
Phone:
(651777 - 3014
Email:
septic@co.washington.mn.us

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):
Observed liquid level below operating depth

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: No

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: 3 Decimal Feet
B. Periodically saturated soil/bedrock: 0 Decimal Feet
C. System separation: 2 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

Certification

Inspector:
Name:
Larry Christiansen
MPCA License #:
L484
Business Name:
C&B Excavating
Phone:
(651433 - 3986

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 #492 (01/19/2016)

Charge Cost Quantity Total
Non-Taxable
added 01/19/2016 3:52 PM

$40 Flat Fee

$40.00 x 1 $40.00
Grand Total
Total $40.00
Payment 01/19/2016$40.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantLarry Christiansen - 01/19/2016 3:52 PM - witnessed by Stephanie Holt
ba07baf533744e7f14ed21faffda17ec
84c1c1bb91f86901fc6a6459a3506a8c
 
#1 Compliance Inspection AcceptedStephanie Holt - 01/19/2016 3:53 PM
71d345055d905d14ea8083a30fbe1406
16dd001e723376dc75526a3461fa1561
 
Inspection has been approved. All signatures have been obtained.
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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