Compliance Inspection Compliance Inspection Compliance Inspection # CI-2021-2487, Submission # Submission-2021-2677, UID # 32947
Status: Compliance Inspection Accepted
 

System Status

System status on date: 02/25/2021 System Status: Compliant

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
15030214200099610 DELLWOOD RD N, CITY OF GRANT9610DELLWOODRDNST PAULCITY OF GRANT55115CHRISTENSON PAUL & TERRI103VICTORIA STATION NO.31986
Owner's representative:
Name:
Rebecca Kaup
Phone:
(612743 - 5657
Email:
ms.music@mac.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
Other methods not listed (See Comments/Explanation)
Comments/Explanation:
Visual Inspection

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 Tank Integrity Form (Attach)
Comments/Explanation:
Tank Intergrity form is attached

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: 01/01/1986

Soil Separation

Shoreland/Wellhead Protection/Food, beverage, lodging? No
Drainfield has at least a two-foot vertical separation
distance from periodically saturated soil or bedrock:
No
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: 2.6 Decimal Feet
B. Periodically saturated soil/bedrock: 4.8 Decimal Feet
C. System separation: 2.2 Decimal Feet
D. Required compliance separation: 2 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

Comments or recommendations:
See attached report
Attach Files:

Certification

Inspector:
NameLicense NumberPhone NumberAddressMaintainerInstallerService ProviderDesignerInspector
SELF/OTHERn/an/an/a
Please search for and choose SELF/OTHER if what you need does not appear in the list
Inspector Contact (If 'self/other' is selected from the Inspector Lookup): Jesse Kloeppner
Inspector Email Address: jesse@ksd-mn.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 #6514 (03/11/2021)

Charge Cost Quantity Total
Non-Taxable
added 03/11/2021 10:16 AM

$42 Flat Fee

$42.00 x 1 $42.00
Grand Total
Total $42.00
Payment 03/11/2021$42.00
Due$0.00

Approvals

ApprovalSignature
ApplicantJesse J. Kloeppner - 03/29/2021 11:37 AM
c26a5af0ee49907f88b82bb58f757b26
3b2e0d8d44e57ca93be6377081f3c90e
#1 Compliance Inspection AcceptedTyler Dale - 04/05/2021 8:46 AM
93b91967ad3257e5e93f2574fd1a6bd3
d35e065f28faf8160b55587d9570a5ab
Inspection has been approved. All signatures have been obtained.

Public Notes

Text:
File(s):

    Internal Notes

    Text:
    File(s):
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