Compliance Inspection Compliance Inspection Compliance Inspection # CI-2016-0221, Submission # Submission-2016-0220, UID # 3125
Status: System Replaced
 

System Status

System status on date: 05/31/2016 System Status: Noncompliant

System - Noncompliant

Reason(s) for noncompliance:
Impact on Public Health (Compliance Component #1) - Imminent threat to public health and safety

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
250322111000410155 199TH ST N, CITY OF FOREST LAKE10155199THSTNFOREST LAKECITY OF FOREST LAKE55025HANSEN STEVEN & GINA42ROLLING RANCHLAND ESTATES1987No
Owner's representative:
Name:
Bob Lund
Phone:
(000000 - 0000
Email:
noemail@noemail.com

Impact on Public Health

System discharges sewage to
the ground surface:
Yes 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
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
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):
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

Attach Files:

Certification

Inspector:
Name:
Brian Humpal
MPCA License #:
2896
Business Name:
Midwest Soil Testing
Phone:
(651492 - 7550
Email:
brian@midwestsoiltesting.com
Address:
PO Box 383
Hugo MN 55038

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 #942 (06/08/2016)

Charge Cost Quantity Total
Non-Taxable
added 06/08/2016 9:26 AM

$40 Flat Fee

$40.00 x 1 $40.00
Grand Total
Total $40.00
Payment 06/20/2016$40.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantBrian Humpal - 06/08/2016 9:26 AM
b2b97e7fa8bb1ff0a74f36d3868e4358
fb44d614b613a404f892cf6083b5651d
 
#1 Compliance Inspection AcceptedChristopher W. LeClair REHS - 06/27/2016 10:12 AM
c271ab35d00dd515fddb14cb1e10db38
7bc09e7a02ea6d9a19ebb1e45fbe43a2
 
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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