Compliance Inspection Compliance Inspection Compliance Inspection # CI-2020-2108, Submission # Submission-2019-2042, UID # 24111
Status: Compliance Inspection Accepted
 

System Status

System status on date: 09/17/2019 System Status: Compliant

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
260272124000710377 KIMBERLY CT S, CITY OF COTTAGE GROVE10377KIMBERLYCTSCOTTAGE GROVECITY OF COTTAGE GROVE55016DOMAGALA JEFFREY & AMANDA51EAGLE RIDGE1998
Owner's representative:
Name:
Chris Anderson
Phone:
(651357 - 4351
Email:
ctanderson@usfamily.net

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)
Comments/Explanation:
There have never been any issues per owner.

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 construction records
Examined empty (pumped) tank(s)

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.:
No
Verification method(s):
Conducted soil observation(s) (Attach boring logs)
A. Bottom of distribution media: 28 Decimal Feet
B. Periodically saturated soil/bedrock: 72 Decimal Feet
C. System separation: 44 Decimal Feet
D. Required compliance separation: 36 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: noemail@noemail.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 #4899 (09/27/2019)

Charge Cost Quantity Total
Non-Taxable
added 10/09/2019 11:41 AM

$41 Flat Fee

$41.00 x 1 $41.00
Grand Total
Total $41.00
Payment 03/30/2020$41.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantDavid R Brown - 04/01/2020 8:53 AM - witnessed by Denise Lange
c9c71a88df784624e45129712308faeb
27ed2b7cf122fb9a82c095bb6d2da419
 
#1 Compliance Inspection AcceptedDenise Lange - 04/01/2020 8:53 AM
a80b033e4e644c21776516a73ed8268c
5843804788b49f2953d3a9fab1883c9c
 
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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