Compliance Inspection Compliance Inspection Compliance Inspection # CI-2020-2227, Submission # Submission-2020-2343, UID # 28497
Status: System Replaced
 

System Status

System status on date: 06/22/2020 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
300292024000712477 18TH ST N, TOWN OF WEST LAKELAND1247718THSTNLAKE ELMOTOWN OF WEST LAKELAND55042LINDAU AMANDA & JACK102HORSESHOE ACRES1982
Owner's representative:
Name:
Robert Pribnow
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):
Searched for surface outlet
Searched for seeping in yard/backup into home
Excessive ponding in soil system/D-boxes
Homeowner testimony (See Comments/Explanation)
"Black soil" above soil dispersal system
Comments/Explanation:
A soil boring over the drainfield indicated no signs of black/grey soils or ponding

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
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: Yes
Date of installation: 11/30/1981

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: 3.08 Decimal Feet
B. Periodically saturated soil/bedrock: 2.5 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:

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 #5672 (06/24/2020)

Charge Cost Quantity Total
Non-Taxable
added 06/24/2020 5:01 PM

$41 Flat Fee

$41.00 x 1 $41.00
Grand Total
Total $41.00
Payment 06/26/2020$41.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantBrian Humpal - 06/24/2020 5:01 PM
03c032890637ecdee5b656e1b2deb9be
bbd584f21187b5571bd9b6df09fb99fb
 
#1 Compliance Inspection AcceptedBarbara Pena - 07/01/2020 6:08 PM
a7379fd1e47da0e9118208af37ebf0a2
4aacefc43b7f20f1ae2e69a81182c368
 
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, 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:
      Certificate of Compliance:
        Letter of Non-Compliance:
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