SSTS Permitting
Compliance Inspection Compliance Inspection Compliance Inspection # CI-2022-3034, Submission # Submission-2022-3230, UID # 39904
Status: Compliance Inspection Accepted
Status: Compliance Inspection Accepted
System Status
	| System status on date: | 03/15/2022 | System Status: | Compliant | 
Property Information
	| Property Information: | |||||||||||||||||
| Owner's representative: | 
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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 Homeowner testimony (See Comments/Explanation) | 
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): | Examined Tank Integrity Form (Attach) | 
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: | 07/13/2000 | 
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): | Two previous verifications (Attach boring logs) | 
| A. Bottom of distribution media: | 2.5 Decimal Feet | 
| B. Periodically saturated soil/bedrock: | 5.5 Decimal Feet | 
| C. System separation: | 3 Decimal Feet | 
| D. Required compliance separation: | 3 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: | Revision attached due to typo on pg 2. | 
| Attach Files: | 
 | 
Certification
	| Inspector: | Please search for and choose SELF/OTHER if what you need does not appear in the list | 
| Inspector Email Address: | drufusb1@yahoo.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 #7844 (03/22/2022)
	| Charge | Cost | Quantity | Total | 
|---|---|---|---|
| added 03/22/2022 10:53 AM $47 Flat Fee | $44.00 | x 1 | $44.00 | 
| Grand Total | |||
| Total | $44.00 | ||
| Payment 03/22/2022 | $44.00 | ||
| Due | $0.00 | ||
Action: Print  
Approvals
	| Approval | Signature | Options | 
|---|---|---|
| Applicant | David R. Brown - 03/22/2022 10:53 AM 9bbf08c8b7de11c551ed9c65d6eb30ef 2a1ce1625c2e31fdbfb1c7001e7e4a08 | |
| #1 Compliance Inspection Accepted | Sarah Borrell - 03/31/2022 8:27 AM 5adc314b93eec7f718f5ed4a1d8e391f e7ac377db47a51898b52bbb595b7f553 | 
Inspection has been approved. All signatures have been obtained.
| Text: | |
| File(s): | 
| Certificate of Compliance: | 
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		[ Search Result Limit:  116600_Leeward_Revised.pdf
 116600_Leeward_Revised.pdf