SSTS Permitting Sandbox site

System Status

System status on date:

08/13/2019

System Status:

Noncompliant

System - Noncompliant

Reason(s) for noncompliance:

Tank Integrity (Compliance Component #2) - Failing to protect groundwater

Soil Separation (Compliance Component #4) - Failing to protect groundwater

Property Information

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
			1603020330001	9111 STONEBRIDGE TRL N, TOWN OF STILLWATER	9111	STONEBRIDGE	TRL	N	STILLWATER	TOWN OF STILLWATER	55082	FAIRY FALLS FARMS LLC				1969

Owner's representative:

Name:

Bernice Drier

Phone:

(123

) 456

- 7890

Email:

noemail@email.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 Excessive ponding in soil system/D-boxes	Comments/Explanation:	None of the above found.

Tank Integrity

System consists of seepage pit, cesspool, drywell, or leaching pit:	Yes
Sewage tank(s) leak below their designed operating depth:	No
Verification method(s):	Probed tank(s) bottom Examined construction records Other methods not listed (See Comments/Explanation)
Comments/Explanation:	Lowered underwater camera into tank - tank walls of block construction.

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

Date of Install

Date of install known:	Yes
Date of installation:	01/01/1974

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):	Unable to verify (See Comments/Explanation) Other (See Comments/Explanation)
Comments/Explanation:	High rock content. Drainfield is 45 years old, do not recommend reusing
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

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 Report
Attach Files:	File 1: 9111_Stonebridge_Trail.pdf

Certification

Inspector:

Name	License Number	Phone Number	Address	Maintainer	Installer	Service Provider	Designer	Inspector
Midwest Sewer Services	L2896	651-492-7550	6616 Indian Wells Trail Grant, MN 55110	Yes	Yes	Yes	Yes	Yes

Please search for and choose SELF/OTHER if what you need does not appear in the list

Inspector Email Address:

brian@midwestsoiltesting.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 #4724 (08/14/2019)

Charge	Cost	Quantity	Total
Non-Taxable
Compliance Inspection Fee added 08/16/2019 2:08 PM $41 Flat Fee	$41.00	x 1	$41.00
Subtotal			$41.00 0
Grand Total
Total			$41.00
Payment 08/16/2019			$41.00
Due			$0.00

Approvals

Approval	Signature
Applicant	Brian Humpal - 08/16/2019 2:09 PM 58470489c86a24d427fdcee6f6acf300 c5ca8adf92afa77b73b4afd4735f8222
#1 Compliance Inspection Accepted	Tyler Dale - 09/11/2019 11:21 AM 98537b4c7c61f111fd68b85989110135 a45570cd26fc5f25d8de20438576da34

Inspection has been approved. All signatures have been obtained.

Public Notes

Text:
File(s):

Internal Notes

Text:
File(s):