Compliance Inspection Compliance Inspection Compliance Inspection # CI-2020-2156, Submission # Submission-2020-2260, UID # 27586
Status: Compliance Inspection Accepted
 

System Status

System status on date: 04/16/2020 System Status: Compliant

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
2803121430004CITY OF HUGOWHITE OAKS HEIGHTS HOACWHITE OAK HEIGHTSNo
Owner's representative:
Name:
Debbie
Phone:
(651982 - 1368
Email:
noemail@noemail.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 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: Yes
Date of installation: 10/30/1997

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: 12 Decimal Feet
B. Periodically saturated soil/bedrock: 54 Decimal Feet
C. System separation: 36 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
AT Septic Inspection & Design IncL3886320-980-023549861 Government Rd Rush City, MN 55069YesYesYesYesYes
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 #5463 (05/01/2020)

Charge Cost Quantity Total
Non-Taxable
added 05/01/2020 2:45 PM

$41 Flat Fee

$41.00 x 1 $41.00
Grand Total
Total $41.00
Payment 05/12/2020$41.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantAmy thompson - 05/12/2020 9:38 AM - witnessed by Denise Lange
88489e3a76a05b12b2fda6ce7974c180
a1e8b3d79ac5e58170ed2a8be2b875b9
 
#1 Compliance Inspection AcceptedDenise Lange - 05/12/2020 9:38 AM
ff21a8f40dcd70ef58909d71482ec016
0d61b636e5183bccad94a00f171eaa5a
 
Inspection has been approved. All signatures have been obtained.
Text:
File(s):
    Text:
    Invoiced 5-1-20 (Holding) Invoice # 5463
    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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