Compliance Inspection Compliance Inspection Compliance Inspection # CI-2018-1237, Submission # Submission-2018-1281, UID # 15181
Status: System Replaced
 

System Status

System status on date: 05/15/2018 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
30029203300061161 MANNING AVE N, TOWN OF WEST LAKELAND1161MANNINGAVENLAKE ELMOTOWN OF WEST LAKELAND55042SCHAFER KJELL C1981No
Owner's representative:
Name:
Amy Goerwitz
Phone:
(123456 - 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):
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:
See Report

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: 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):
Conducted soil observation(s) (Attach boring logs)
Other (See Comments/Explanation)
Comments/Explanation:
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:
See Report
amy@goerwitz.com
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 #3240 (05/16/2018)

Charge Cost Quantity Total
Non-Taxable
added 05/18/2018 8:31 AM

$40 Flat Fee

$40.00 x 1 $40.00
Grand Total
Total $40.00
Payment 05/18/2018$40.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantBrian Humpal - 05/18/2018 8:31 AM
261e6d2e7903c2cda07c7257169b23f5
b3e0941b00cf1d2570496adf9e667ac7
 
#1 Compliance Inspection AcceptedTyler Dale - 05/30/2018 2:24 PM
b4ab882c8a3710dfdf75197d514dda92
dd3905ec49975018d30926c9ca11fa1d
 
Inspection has been approved. All signatures have been obtained.
Text:
File(s):
    Text:
    Second notice sent 3/25/2019
    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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