Compliance Inspection Compliance Inspection Compliance Inspection # CI-2019-1910, Submission # Submission-2019-1937, UID # 23229
Status: Compliance Inspection Accepted
 

System Status

System status on date: 08/09/2019 System Status: Compliant

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
02029214400065040 LAKE ELMO AVE N, CITY OF LAKE ELMO5040LAKE ELMOAVENLAKE ELMOCITY OF LAKE ELMO55042GLOVER JEFF & ERIK CLIPPARD1986
Property Owner's Mailing Address
(if different than property address):
5040 Lake Elmo Ave N
Lake Elmo MN 55042
Owner's representative:
Name:
Joe Fleming
Phone:
(651271 - 1142
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):
Examined Tank Integrity Form (Attach)
Comments/Explanation:
See attached 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
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: 06/01/1986

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: 4 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
D. Schlomka Inc.L1106320-384-791141788 Fleming Logging Rd Hinckley, MN 55037NoYesNoYesYes
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 #4731 (08/15/2019)

Charge Cost Quantity Total
Non-Taxable
added 08/15/2019 6:48 PM

$41 Flat Fee

$41.00 x 1 $41.00
Grand Total
Total $41.00
Payment 08/15/2019$41.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantShelley L. Schlomka - 09/14/2019 11:25 AM
1072628aebfbb92f7644fa381fc8eef2
c80ee97ecc1b9145260e0cd9675b05e3
 
#1 Compliance Inspection AcceptedDenise Lange - 09/17/2019 1:22 PM
86fd7f10a9b26bbe13f8ebcb7cc5e9c4
a642737c2ec44e5a23933fd9823c89ed
 
Inspection has been approved. All signatures have been 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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