Compliance Inspection Compliance Inspection Compliance Inspection # CI-2020-2044, Submission # Submission-2020-2138, UID # 26339
Status: Compliance Inspection Accepted
 

System Status

System status on date: 12/31/2019 System Status: Compliant

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
22028201100063185 ST CROIX TRL S, CITY OF AFTON3185ST CROIXTRLSAFTONCITY OF AFTON55001DORGAN KRISTA J & STEVEN G48AFTON
Owner's representative:
Name:
Gary Maas
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? No
Drainfield has at least a three-foot vertical separation
distance from periodically saturated soil or bedrock.:
Yes
Drainfield meets the designed vertical separation
distance from periodically saturated soil or bedrock.:
Yes
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
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 #5138 (01/06/2020)

Charge Cost Quantity Total
Non-Taxable
added 01/06/2020 10:37 AM

$41 Flat Fee

$41.00 x 1 $41.00
Grand Total
Total $41.00
Payment 01/13/2020$41.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantBrian Humpal - 01/06/2020 10:37 AM
e904415bd8f26bb93ee38919fe9311fa
8bd2b3857de1b3d86313a7badaee4554
 
#1 Compliance Inspection AcceptedDenise Lange - 01/14/2020 11:32 AM
6fe4cee5c66d1021b5a31dd1eee776ac
c1043f8a1fe31ae53c7468ebb91a009f
 
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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