SSTS Permitting Sandbox site

Compliance Inspection Compliance Inspection Compliance Inspection # CI-2019-1907, Submission # Submission-2019-1928, UID # 23012
Status: Compliance Inspection Accepted

System Status

System status on date:

05/17/2019

System Status:

Compliant

Property Information

Property Information:

Compliance Status		Property Record		Property Address								Property Owner	Property Attributes
Compliance Expiration	Compliance Status	Parent GeoCode	PIN	Site Address	Building Number	Street Name	Type	Dir	City	Municipality	zip	Owner	Lot	Block	Plat	Year Built	Property Hold
			0102721330005	6855 LAMAR AVE S, CITY OF COTTAGE GROVE	6855	LAMAR	AVE	S	COTTAGE GROVE	CITY OF COTTAGE GROVE	55016	MALONEY SHEAMUS J P & JESSICA A S				1979

Property Owner's Mailing Address
(if different than property address):

6855 Lamar Ave S

Cottage Grove	MN	55016

Owner's representative:

Name:

Carolyn Benson

Phone:

(651

) 438

- 6866

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

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):	Probed tank(s) bottom Examined Tank Integrity Form (Attach)
Comments/Explanation:	Please see tank integrity form from Maintainer

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:	New risers/manholes with covers installed. Pipe was replaced from house to tank recently per homeowner.
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:	11/08/1978

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):	Two previous verifications (Attach boring logs)
A. Bottom of distribution media:	2 Decimal Feet
B. Periodically saturated soil/bedrock:	7 Decimal Feet
C. System separation:	5 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

Comments or recommendations:	System updated last year per home owner. Pipe from house to tank replaced and brought to code. Risers installed and brought to code.
Attach Files:	File 1: Scan0001.pdf File 2: Scan0004.pdf File 3: Scan0005.pdf File 4: Scan0006.pdf File 5: Scan0013.pdf File 6: Scan0014.pdf File 7: Scan0015.pdf File 8: Scan0016.pdf File 9: Scan0017.pdf

Certification

Inspector:

Name	License Number	Phone Number	Address	Maintainer	Installer	Service Provider	Designer	Inspector
D. Schlomka Inc.	L1106	320-384-7911	41788 Fleming Logging Rd Hinckley, MN 55037	No	Yes	No	Yes	Yes

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 #4701 (08/06/2019)

Charge	Cost	Quantity	Total
Non-Taxable
Compliance Inspection Fee added 08/06/2019 7:18 PM $41 Flat Fee	$41.00	x 1	$41.00
Subtotal			$41.00 0
Grand Total
Total			$41.00
Payment 08/06/2019			$41.00
Due			$0.00

Action: Print

Approvals

Approval	Signature	Options
Applicant	Shelley L. Schlomka - 09/12/2019 4:46 PM 1bceec62dc8fbddc22a0b48fdb1a2eae e9ea1e1522753b14fd104905050d49d9
#1 Compliance Inspection Accepted	Denise Lange - 09/13/2019 3:19 PM c9ff557e1d11c8d54653179caa277876 beedb4dcf31850b55277b0487d5fe02d

Inspection has been approved. All signatures have been obtained.

Public Notes

Text:
File(s):

Internal Notes

Text:
File(s):

Create Letter

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:

Letter of Compliance

Certificate of Compliance:

Letter of Non-Compliance

Letter of Non-Compliance: