Compliance Inspection Compliance Inspection Compliance Inspection # CI-2020-2217, Submission # Submission-2020-2359, UID # 28783
Status: Compliance Inspection Accepted
 

System Status

System status on date: 10/01/2018 System Status: Compliant

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
310322111000118980 FENWAY AVE N, CITY OF FOREST LAKE18980FENWAYAVENFOREST LAKECITY OF FOREST LAKE55025ST GEORGE MATTHEW J & STACY A1910
Owner's representative:
Name:
Dan Kahler
Phone:
(000000 - 0000
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 seeping in yard/backup into home
Excessive ponding in soil system/D-boxes
"Black soil" above soil dispersal system

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):
Other methods not listed (See Comments/Explanation)
Comments/Explanation:
See attached tank integrity report

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: 102 Decimal Feet
B. Periodically saturated soil/bedrock: 0 Decimal Feet
C. System separation: 3 Decimal Feet
D. Required compliance separation: 3 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
Schirmers Percolation Testing, IncL394763-497-3566951 Katydid Lane NE Saint Michael, MN 55376NoNoNoYesYes
Please search for and choose SELF/OTHER if what you need does not appear in the list
Inspector Email Address: www.sptesting.wastewater@comcast.net

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 #5706 (06/29/2020)

Charge Cost Quantity Total
Non-Taxable
added 06/29/2020 3:58 PM

$41 Flat Fee

$41.00 x 1 $41.00
Grand Total
Total $41.00
Payment 06/29/2020$41.00
Due$0.00

Approvals

ApprovalSignature
ApplicantSteve Schirmers - 06/29/2020 4:00 PM - witnessed by Denise Lange
587064de0bfb696bdd8044516711a908
4b6bdcf3928529d6f3833b3d263777d5
#1 Compliance Inspection AcceptedDenise Lange - 06/29/2020 4:00 PM
bc613cdc02a0983467be12f2d1297f4b
24fadb300e38ea94ac0f9e224a059f72
Inspection has been approved. All signatures have been obtained.

Public Notes

Text:
File(s):

    Internal Notes

    Text:
    File(s):
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