Compliance Inspection Compliance Inspection Compliance Inspection # CI-2018-1109, Submission # Submission-2018-1154, UID # 13290
Status: System Replaced
 

System Status

System status on date: 02/09/2018 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
31028214100025676 WOODLANE CT, CITY OF WOODBURY5676WOODLANECTWOODBURYCITY OF WOODBURY55129KOEHNEN RYAN T & STACEY N1979
Owner's representative:
Name:
Ryan Koehnen
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:
Yes
Verification method(s):
Excessive ponding in soil system/D-boxes
Homeowner testimony (See Comments/Explanation)
System requires "emergency" pumping
Other methods not listed (See Comments/Explanation)
Comments/Explanation:
See Report

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:
Tank to be replaced, failed system

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:
Yes
Explain:
Hydraulically failed system
System is non protective of groundwater for other
conditions as determined by the inspector:
Yes
Explain:
Hydraulically failed system

Date of Install

Date of install known: No

Soil Separation

Shoreland/Wellhead Protection/Food, beverage, lodging? Yes
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:
Hydraulically failed system
See report
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:
Hydraulically failed system, system replacement is imminent.
Tanks are being pumped every 2 week to prevent back-up.
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 #3036 (02/09/2018)

Charge Cost Quantity Total
Non-Taxable
added 02/09/2018 11:33 AM

$40 Flat Fee

$40.00 x 1 $40.00
Grand Total
Total $40.00
Payment 02/09/2018$40.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantBrian Humpal - 02/09/2018 11:33 AM
844bffa9eb5d083ace1c40da6dee7235
a78917ab2314cfc9194e81b9c9b8c442
 
#1 Compliance Inspection AcceptedChristopher W. LeClair REHS - 02/09/2018 2:37 PM
7f324aba0c379cef7793dcc118827d8a
a39f80e1ee5295d11d4feeae221158e2
 
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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