SSTS Permitting

Compliance Inspection Compliance Inspection Compliance Inspection # CI-2019-1615, Submission # Submission-2019-1672, UID # 20798
Status: System Replaced

System Status

System status on date:

04/09/2019

System Status:

Noncompliant

System - Noncompliant

Reason(s) for noncompliance:

Tank Integrity (Compliance Component #2) - Failing to protect groundwater

Property Information

Property Information:

Compliance Status		Property Record		Property Address								Property Owner	Property Attributes
Compliance Expiration	Compliance Status	Parent GeoCode	PIN	Site Address	Building Number	Street Name	Type	Dir	City	Municipality	zip	Owner	Lot	Block	Plat	Year Built	Property Hold
			1602921410006	3412 JAMACA AVE N, CITY OF LAKE ELMO	3412	JAMACA	AVE	N	LAKE ELMO	CITY OF LAKE ELMO	55042	KINNEY KEVIN				1965	No

Owner's representative:

Name:

Mark Van Scyoc

Phone:

(123

) 456

- 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):	Searched for surface outlet Searched for seeping in yard/backup into home Excessive ponding in soil system/D-boxes Other methods not listed (See Comments/Explanation)	Comments/Explanation:	See Report

Tank Integrity

System consists of seepage pit, cesspool, drywell, or leaching pit:	Yes
Sewage tank(s) leak below their designed operating depth:	No
Verification method(s):	Probed tank(s) bottom 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:

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):	Not applicable (Holding tank(s), no drainfield) 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
Attach Files:	File 1: 3412_Jamaca_Ave_N.pdf

Certification

Inspector:

Name	License Number	Phone Number	Address	Maintainer	Installer	Service Provider	Designer	Inspector
Midwest Sewer Services	L2896	651-492-7550	6616 Indian Wells Trail Grant, MN 55110	Yes	Yes	Yes	Yes	Yes

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 #4183 (04/10/2019)

Charge	Cost	Quantity	Total
Non-Taxable
Compliance Inspection Fee added 04/11/2019 10:02 AM $41 Flat Fee	$41.00	x 1	$41.00
Subtotal			$41.00 0
Grand Total
Total			$41.00
Payment 04/12/2019			$41.00
Due			$0.00

Action: Print

Approvals

Approval	Signature	Options
Applicant	Brian Humpal - 04/11/2019 10:02 AM 07ab7fd538575328d0bc148fec3531cd a4d31a693a519918aa35d9c038fdb3b8
#1 Compliance Inspection Accepted	Tyler Dale - 04/12/2019 2:24 PM 57b11a69b38655f4759b76f3f52f0d9f f85464c585ec11da4bf5286fb6e97740

Inspection has been approved. All signatures have been obtained.

Public Notes

Text:
File(s):

Internal Notes

Text:
File(s):

Create Letter

Compliance Letter Type:	Failed System, Notice and Order to Comply, Cesspool	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:

Letter of Compliance

Certificate of Compliance:

Letter of Non-Compliance

Letter of Non-Compliance: