Compliance Inspection Compliance Inspection Compliance Inspection # CI-2020-2364, Submission # Submission-2020-2518, UID # 30761
Status: Compliance Inspection Accepted
 

System Status

System status on date: 10/05/2020 System Status: Compliant

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
06027211400646425 PRESERVE PASS S, CITY OF COTTAGE GROVE6425PRESERVEPASSSCOTTAGE GROVECITY OF COTTAGE GROVE55016OLSON BERGEN R283HOMESTEAD AT HIGHLAND HILLS2010
Owner's representative:
Name:
Gabe Karber
Phone:
(612219 - 0279
Email:
gabekarber@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
Comments/Explanation:
see report

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 construction records
Examined Tank Integrity Form (Attach)
Comments/Explanation:
see 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: Yes
Date of installation: 09/20/2010

Soil Separation

Shoreland/Wellhead Protection/Food, beverage, lodging? Yes
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.:
Yes
Verification method(s):
Conducted soil observation(s) (Attach boring logs)
Comments/Explanation:
No redox observed.  End of boring at 5' which is adequate for system.
A. Bottom of distribution media: 98.42 Decimal Feet
B. Periodically saturated soil/bedrock: 94.36 Decimal Feet
C. System separation: 4.06 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
Ten Thirty Environmental Solutions, SBCL4082612-248-42811684 132nd Ave NE Blaine, MN 55449NoNoYesYesYes
Please search for and choose SELF/OTHER if what you need does not appear in the list
Inspector Email Address: alex.pepin@tenthirtyenvironmental.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 #6133 (10/06/2020)

Charge Cost Quantity Total
Non-Taxable
added 10/06/2020 2:27 PM

$41 Flat Fee

$41.00 x 1 $41.00
Grand Total
Total $41.00
Payment 10/06/2020$41.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantAlex Pepin - 10/06/2020 2:27 PM
40a2f0c622cf51a4a8cbd56065f1fd3d
8203ec89fa910e53a20f34fa49738b37
 
#1 Compliance Inspection AcceptedDenise Lange - 10/06/2020 3:39 PM
a1f246e6c3487bfc696e973a527d24e5
2c0b74996dff8d592506618ccff70f71
 
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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