Compliance Inspection Compliance Inspection Compliance Inspection # CI-2018-1275, Submission # Submission-2018-1328, UID # 15424
Status: Compliance Inspection Accepted
 

System Status

System status on date: 06/05/2018 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
21029213300088006 22ND CT N, CITY OF LAKE ELMO800622NDCTNLAKE ELMOCITY OF LAKE ELMO55042CASWELL JEFFREY K & VICTORIA101TORRE PINES1996
Owner's representative:
Name:
Jeff Caswell
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
jeff.caswell33@gmail.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 #3347 (06/07/2018)

Charge Cost Quantity Total
Non-Taxable
added 06/08/2018 9:52 AM

$40 Flat Fee

$40.00 x 1 $40.00
Grand Total
Total $40.00
Payment 06/08/2018$40.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantBrian Humpal - 06/08/2018 9:52 AM
1dfa3935d3e51212d69373c835c1c124
53c7c4f3c2c4e6f45ef6d0bb5432c7f3
 
#1 Compliance Inspection AcceptedTyler Dale - 06/14/2018 2:13 PM
6823a7737076c4495393a810c1a7b4eb
54ca294386db531af97daaf8816cf5ec
 
Inspection has been approved. All signatures have been obtained.
Text:
On Aug 27 2018, we met with Ed Eklin on site. We conducted 2 soil borings outside the zone of influence and found that the system has adequate soil separation. Orders are rescinded. see .pdf 9-10-2018
File(s):
Compliance Letter Type: Certificate of Compliance Who's signature should be on the letter? Tyler Dale 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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