SSTS Permitting

Compliance Inspection Compliance Inspection Compliance Inspection # CI-2020-2130, Submission # Submission-2020-2195, UID # 27183
Status: System Replaced

System Status

System status on date:

03/16/2020

System Status:

Noncompliant

System - Noncompliant

Reason(s) for noncompliance:

Soil Separation (Compliance Component #4) - 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
			2703220240008	13552 MAYBERRY TRL N, CITY OF SCANDIA	13552	MAYBERRY	TRL	N	SCANDIA	CITY OF SCANDIA	55073	JESSICA R SARDAS TRS				1988

Owner's representative:

Name:

Vernet Larson

Phone:

(123

) 456

- 7890

Email:

noemail@noemail.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

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):	Probed tank(s) bottom Examined construction records Other methods not listed (See Comments/Explanation)
Comments/Explanation:	Lowered underwater camera into tank - baffles and tank walls OK.

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
System is non protective of groundwater for other conditions as determined by the inspector:	No

Date of Install

Date of install known:	Yes
Date of installation:	01/01/1988

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 meets the designed vertical separation distance from periodically saturated soil or bedrock.:	No
Verification method(s):	Conducted soil observation(s) (Attach boring logs)
A. Bottom of distribution media:	3.75 Decimal Feet
B. Periodically saturated soil/bedrock:	3.5 Decimal Feet
C. System separation:	0 Decimal Feet
D. Required compliance separation:	2 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: 13552_Mayberry_Trail.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 #5324 (03/19/2020)

Charge	Cost	Quantity	Total
Non-Taxable
Compliance Inspection Fee added 03/19/2020 2:47 PM $41 Flat Fee	$41.00	x 1	$41.00
Subtotal			$41.00 0
Grand Total
Total			$41.00
Payment 03/20/2020			$41.00
Due			$0.00

Action: Print

Approvals

Approval	Signature	Options
Applicant	Brian Humpal - 03/19/2020 2:47 PM c3bdb8ef6754cb9ac1c92d2b6c878bb6 d9b48d5895867701cb8c19031e4b703e
#1 Compliance Inspection Accepted	Barbara Pena - 04/16/2020 10:58 AM 77265f619c3c3f0e9cbe212c9f801a45 8a4615d7d2833814ff54057933f55419

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, Separation	Who's signature should be on the letter?	Barbara Pena	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: