SSTS Permitting Sandbox site

System Status

System status on date:

06/15/2020

System Status:

Noncompliant

System - Noncompliant

Reason(s) for noncompliance:

Impact on Public Health (Compliance Component #1) - Imminent threat to public health and safety

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
			2202920420006	2440 PERIWINKLE AVE N, TOWN OF WEST LAKELAND	2440	PERIWINKLE	AVE	N	STILLWATER	TOWN OF WEST LAKELAND	55082	MONSON ANN K & DUSTIN C	2	1	SUMMERFIELD	1996

Owner's representative:

Name:

Dave Hughes

Phone:

(123

) 456

- 7890

Email:

noemail@noemail.com

Impact on Public Health

System discharges sewage to
the ground surface:

Yes

System discharges sewage to
drain tile or surface waters:

No

System causes sewage backup
into dwelling or establishment:

Yes

Verification method(s):

Searched for surface outlet

Searched for seeping in yard/backup into home

Excessive ponding in soil system/D-boxes

Other methods not listed (See Comments/Explanation)

Comments/Explanation:

The chamber drainfield trenches are nearly filled or completely filled with soil. This is most likely the result of animal activity and/or
soil infiltration into the chambers. The total capacity of the drainfield has been significantly reduced and could surface onto the
ground and/or back-up into the house at anytime in the near future and/or when the system is placed back in service. If this occurs,
this system would be considered an imminent threat to public health and safety.

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 Examined construction records Other methods not listed (See Comments/Explanation)
Comments/Explanation:	Lowered underwater camera into tanks - baffles and tank walls OK. Lift pump and alarm were operational at the time of the inspection.

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:

No

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.:	No
Drainfield meets the designed vertical separation distance from periodically saturated soil or bedrock.:	No
Verification method(s):	Not applicable (Holding tank(s), no drainfield) Other (See Comments/Explanation)
Comments/Explanation:	Chamber Trenches Are Full Of Soil
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

Attach Files:

File 1: 2440_Periwinkle_Ave_N.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 #5637 (06/19/2020)

Charge	Cost	Quantity	Total
Non-Taxable
Compliance Inspection Fee added 06/19/2020 10:54 AM $41 Flat Fee	$41.00	x 1	$41.00
Subtotal			$41.00 0
Grand Total
Total			$41.00
Payment 06/23/2020			$41.00
Due			$0.00

Approvals

Approval	Signature
Applicant	Brian Humpal - 06/19/2020 10:54 AM a3de342763b79ca424ecffbd841fff2a 06f53cfc9864cc2b822dd1b1f6b57159

Public Notes

Text:
File(s):

Internal Notes

Text:
File(s):