Compliance Inspection Compliance Inspection Compliance Inspection # CI-2017-1004, Submission # Submission-2017-1049, UID # 11141
Status: System Replaced
 

System Status

System status on date: 10/19/2017 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 StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
15030211300059710 JOLIET AVE N, CITY OF GRANT9710JOLIETAVENSTILLWATERCITY OF GRANT55082AHLBOM GREGORY J & VICKI J81VICTORIA STATION NO.31980
Owner's representative:
Name:
Greg Ahlbom
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:
No
Verification method(s):
Searched for surface outlet
Searched for seeping in yard/backup into home
Comments/Explanation:
System is surfacing onto the ground

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):
Other methods not listed (See Comments/Explanation)
Comments/Explanation:
System is failed

Other Compliance Conditions

Maintenance hole covers are damaged, cracked,
unsecured, or appear to be structurally unsound:
Unknown
Other issues (electrical hazards, etc.) to
immediately and adversely impact public
health or safety:
Unknown
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):
Other (See Comments/Explanation)
Comments/Explanation:
system is failed
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:

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 #2745 (10/20/2017)

Charge Cost Quantity Total
Non-Taxable
added 10/20/2017 5:52 AM

$40 Flat Fee

$40.00 x 1 $40.00
Grand Total
Total $40.00
Payment 10/20/2017$40.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantBrian Humpal - 10/20/2017 5:52 AM
7f6147b875c6acd12c91d636deaf6997
0bfc48d1f412683f9a8216e24a7dccab
 
#1 Compliance Inspection AcceptedAlex Pepin - 10/27/2017 12:46 PM
7840ac964c2619ecfdc9c065e5dcf6ba
fefdf725ef305bcf9ab811e280e4f317
 
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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