Compliance Inspection Compliance Inspection Submission # Submission-2020-2330, UID # 28371
Status: System Replaced
 

System Status

System status on date: 06/16/2020 System Status: Noncompliant

System - Noncompliant

Reason(s) for noncompliance:
Soil Separation (Compliance Component #4) - Failing to protect groundwater

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
21029204100222390 OVERLOOK CT N, TOWN OF WEST LAKELAND2390OVERLOOKCTNSTILLWATERTOWN OF WEST LAKELAND55082HEAGREN DAWN & DOUGLAS121FOXRIDGE 3RD ADD1994
Owner's representative:
Name:
Suzann Brown
Phone:
(123456 - 7890
Email:
noemail@noemail.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
Homeowner testimony (See Comments/Explanation)
Other methods not listed (See Comments/Explanation)

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.

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):
Conducted soil observation(s) (Attach boring logs)
Other (See Comments/Explanation)
Comments/Explanation:
Install year: 1994
A. Bottom of distribution media: 1.75 Decimal Feet
B. Periodically saturated soil/bedrock: 1.66 Decimal Feet
C. System separation: 0 Decimal Feet
D. Required compliance separation: 2 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
Midwest Sewer ServicesL2896651-492-75506616 Indian Wells Trail Grant, MN 55110YesYesYesYesYes
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 #5652 (06/19/2020)

Charge Cost Quantity Total
Non-Taxable
added 06/19/2020 9:59 AM

$41 Flat Fee

$41.00 x 1 $41.00
Grand Total
Total $41.00
Payment 06/23/2020$41.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantBrian Humpal - 06/19/2020 9:59 AM
7f02f183a72701a7f628c6359748058f
2d432411b8c85bef5ad718f5b4b29b8d
 
Text:
File(s):
    Text:
    File(s):
      Compliance Letter Type: Failed System, Notice and Order to Comply, Separation Who's signature should be on the letter? Paul O'Neel Permit number to reference in "No Replace" letter:
      Was the letter sent? Yes Compliant/Non-Compliant:
      Certificate of Compliance:
        Letter of Non-Compliance:
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