Compliance Inspection Compliance Inspection Compliance Inspection # CI-2016-0338, Submission # Submission-2016-0367, UID # 4446
Status: Compliance Inspection Accepted
 

System Status

System status on date: 08/11/2016 System Status: Compliant

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
190292033000312077 22ND ST N, TOWN OF WEST LAKELAND1207722NDSTNLAKE ELMOTOWN OF WEST LAKELAND55042LANGER TARA J & ERIC R21DOWNS LAKE ESTATES 2ND ADD1993
Owner's representative:
Name:
Mary Tevlin
Phone:
(651777 - 7124
Email:
kaytevlin@comcast.net

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

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: Yes

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:
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)
A. Bottom of distribution media: 2.8 Decimal Feet
B. Periodically saturated soil/bedrock: 7 Decimal Feet
C. System separation: 4.2 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 #1248 (08/16/2016)

Charge Cost Quantity Total
Non-Taxable
added 08/16/2016 11:33 AM

$40 Flat Fee

$40.00 x 1 $40.00
Grand Total
Total $40.00
Payment 08/16/2016$40.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantDavid R. Brown - 08/16/2016 11:34 AM
b062d4275009d164afe6ad410b06f16e
a79c0d19da64199d53ea263a7b86b739
 
#1 Compliance Inspection AcceptedKati Hallermann - 08/17/2016 12:04 PM
ff345b572b7fc9d9b3125a391a985047
a649c966d95a273e853e2e65be4712f0
 
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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