Compliance Inspection Compliance Inspection Compliance Inspection # CI-2019-1732, Submission # Submission-2019-1814, UID # 21779
Status: System Replaced
 

System Status

System status on date: 06/12/2019 System Status: Noncompliant

System - Noncompliant

Reason(s) for noncompliance:
Tank Integrity (Compliance Component #2) - Failing to protect groundwater

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
20029204100122474 OAKGREEN AVE N, TOWN OF WEST LAKELAND2474OAKGREENAVENSTILLWATERTOWN OF WEST LAKELAND55082KEYPORT JUSTIN L & ANNA M P51SCREATON ADD NORTH1968
Owner's representative:
Name:
Sandy Haapala
Phone:
(000000 - 0000
Email:
no@no.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
None of the above found.

Tank Integrity

System consists of seepage pit,
cesspool, drywell, or leaching pit:
Yes
Sewage tank(s) leak below their
designed operating depth:
Yes
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: No
Date of installation: 01/01/1968

Soil Separation

Shoreland/Wellhead Protection/Food, beverage, lodging? No
Drainfield has at least a two-foot vertical separation
distance from periodically saturated soil or bedrock:
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)
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:

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 #4468 (06/14/2019)

Charge Cost Quantity Total
Non-Taxable
added 06/14/2019 3:20 PM

$41 Flat Fee

$41.00 x 1 $41.00
Grand Total
Total $41.00
Payment 06/17/2019$41.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantBrian Humpal - 06/14/2019 3:20 PM
a2d4f96a51d609bf40fc4d2ecfdda3c8
dfbc30c301b720a3223522ae5422ed28
 
#1 Compliance Inspection AcceptedTyler Dale - 06/24/2019 11:26 AM
3e77a35e4af704943775026fdecf2546
f81a01b88e6b07c4e037a94acde6cc0c
 
Inspection has been approved. All signatures have been obtained.
Text:
File(s):
    Text:
    File(s):
      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:
      Certificate of Compliance:
        Letter of Non-Compliance:
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