Compliance Inspection Compliance Inspection Compliance Inspection # CI-2021-2553, Submission # Submission-2021-2731, UID # 33450
Status: Compliance Inspection Accepted
 

System Status

System status on date: 04/16/2021 System Status: Compliant

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
020282042003416678 7TH ST S, CITY OF LAKELAND166787THSTSLAKELANDCITY OF LAKELAND55043ST CROIX RE LLC91METHODIST CHURCH ADD2013
Owner's representative:
Name:
Marcus Gustafson
Email:
marcus.m.gustafson@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):
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):
Other methods not listed (See Comments/Explanation)
Comments/Explanation:
Tanks pumped and visually inspected for water-tightness

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: 05/01/2021

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):
Other (See Comments/Explanation)
Comments/Explanation:
See Soil Boring and Site Map
A. Bottom of distribution media: 1.5 Decimal Feet
B. Periodically saturated soil/bedrock: 5.3 Decimal Feet
C. System separation: 3.8 Decimal Feet
D. Required compliance separation: 2.6 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 Soil Boring and Site Map
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 #6660 (04/20/2021)

Charge Cost Quantity Total
Non-Taxable
added 04/20/2021 3:17 PM

$42 Flat Fee

$42.00 x 1 $42.00
Grand Total
Total $42.00
Payment 04/20/2021$42.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantJesse J. Kloeppner - 04/20/2021 3:17 PM
3a7a6b2c50ae7c3c05793fbaa773e963
4c04157c26ec1364a136c17f2ee5a991
 
#1 Compliance Inspection AcceptedTyler Dale - 04/28/2021 3:42 PM
f7dc3f86cbe37085bfcab09d6891463b
d0ea87e846f18d75e31fed2d6405a965
 
Inspection has been approved. All signatures have been obtained.
Text:
File(s):
    Text:
    File(s):
      Compliance Letter Type: Certificate of Compliance Who's signature should be on the letter? Tyler Dale Permit number to reference in "No Replace" letter:
      Was the letter sent? Compliant/Non-Compliant: Compliant
      Certificate of Compliance:
        Letter of Non-Compliance:
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