Compliance Inspection Compliance Inspection Compliance Inspection # CI-2021-2452, Submission # Submission-2021-2622, UID # 32490
Status: Compliance Inspection Accepted
 

System Status

System status on date: 12/29/2020 System Status: Compliant

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
260272124001410348 KIMBRO CT S, CITY OF COTTAGE GROVE10348KIMBROCTSCOTTAGE GROVECITY OF COTTAGE GROVE55016REDMOND TONY & JILL121EAGLE RIDGE1998
Owner's representative:
Name:
Lloyd Holm
Phone:
(651262 - 3618
Email:
gnlholm@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
Homeowner testimony (See Comments/Explanation)

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

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.:
Yes
Verification method(s):
Conducted soil observation(s) (Attach boring logs)
A. Bottom of distribution media: 2.5 Decimal Feet
B. Periodically saturated soil/bedrock: 6.3 Decimal Feet
C. System separation: 3.8 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

Attach Files:

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: drufusb1@yahoo.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 #6359 (01/07/2021)

Charge Cost Quantity Total
Non-Taxable
added 01/07/2021 11:49 AM

$42 Flat Fee

$42.00 x 1 $42.00
Grand Total
Total $42.00
Payment 01/07/2021$42.00
Due$0.00

Approvals

ApprovalSignature
ApplicantDavid R. Brown - 01/07/2021 11:50 AM
3ed95e32a33cde9ce514c8f2b35c38be
dc2cfeb2b74b00d5bdaa2fc708ea7a4f
#1 Compliance Inspection AcceptedDenise Lange - 01/07/2021 12:55 PM
84a0c94fbee354c0de3c04589a834762
71eb73f74acab88b3b3aa7a4191ef286
Inspection has been approved. All signatures have been obtained.

Public Notes

Text:
File(s):

    Internal Notes

    Text:
    File(s):
      Powered by