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Compliance Inspection Compliance Inspection UID # 41610
Status: In Progress
 

System Status

System status on date: 06/24/2022 System Status: Compliant

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
350292032003716211 5TH ST N, CITY OF LAKELAND162115THSTNLAKELANDCITY OF LAKELAND55043HAGER RONALD L & ANITA M183LAKELAND HILLS1978
Property Owner's Mailing Address
(if different than property address):
Owner's representative:
Name:
Erica J Herink
Phone:
(715) 821 - 3404
Email:
herink@att.net

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
 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 empty (pumped) tank(s)




Comments/Explanation:








	





	
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:





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



Explain:








	





	
Date of Install

	


Date of install known:
No



Date of installation:







	





	
Soil Separation

	


Shoreland/Wellhead Protection/Food, beverage, lodging?




Drainfield has at least a three-foot vertical separation
 distance from periodically saturated soil or bedrock.:		




Drainfield meets the designed vertical separation
 distance from periodically saturated soil or bedrock.:		




Verification method(s):




Comments/Explanation:





A. Bottom of distribution media:
 Decimal Feet



B. Periodically saturated soil/bedrock:
 Decimal Feet



C. System separation:
 Decimal Feet



D. Required compliance separation:
 Decimal Feet






	





	
Operating Permit and Nitrogen BMP

	


Is system operating under an Operating Permit:




Is the system required to employ Nitrogen BMP:







	





	
Comments and File Attachments

	


Comments or recommendations:





Attach Files:

    		

    

    

    
	
    

    

    
	
    Certification
    
	
    

    Inspector:


    
	
	
	
	
    None
    

    

    Please search for and choose SELF/OTHER if what you need does not appear in the list
    
    		

    

    Inspector Contact (If 'self/other' is selected from the Inspector Lookup):


    

    Inspector Email Address:


    

    

    
	
    

    

    
	
    Invoice #8259 (07/01/2022)
    
	
    

    


    
	
	Charge
	Cost
	Quantity
	Total
	

    

    
	Grand Total

    
	Total
	$0.00

    Due$0.00
    This Application has not been submitted, so you may not pay for this Invoice.
    Action: Print  
    


    
	
    

    

    

    


    

    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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