SSTS Permitting Sandbox site

System status on date:

09/22/2021

System Status:

Compliant

Property Information:

Compliance Status		Property Record		Property Address								Property Owner	Property Attributes
Compliance Expiration	Compliance Status	Parent GeoCode	PIN	Site Address	Building Number	Street Name	Type	Dir	City	Municipality	zip	Owner	Lot	Block	Plat	Year Built	Property Hold
			0902921330017	8260 LAKE JANE TRL N, CITY OF LAKE ELMO	8260	LAKE JANE	TRL	N	LAKE ELMO	CITY OF LAKE ELMO	55042	HENDRICKSON NICHOLAS & NICOLE	14	1	OACE ACRES 5TH ADD	1978

Property Owner's Mailing Address
(if different than property address):

Owner's representative:

Name:

Nicole Hendrickson

Phone:

(123

) 456

- 7890

Email:

noemail@noemail.com

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:	See Report

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 Report

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
Explain:
System is non protective of groundwater for other conditions as determined by the inspector:	No
Explain:

Date of install known:	No
Date of installation:

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):	Other (See Comments/Explanation)
Comments/Explanation:	See Report
A. Bottom of distribution media:	0 Decimal Feet
B. Periodically saturated soil/bedrock:	0 Decimal Feet
C. System separation:	0 Decimal Feet
D. Required compliance separation:	0 Decimal Feet

Is system operating under an Operating Permit:	No
Is the system required to employ Nitrogen BMP:	No

Comments or recommendations:
Attach Files:

Inspector:

None

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Inspector Contact (If 'self/other' is selected from the Inspector Lookup):

Inspector Email Address:

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