Compliance Inspection Compliance Inspection Compliance Inspection # CI-2022-3325, Submission # Submission-2022-3529, UID # 42718
Status: System Replaced
 

System Status

System status on date: 08/31/2022 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
15030212300049130 96TH ST N, CITY OF GRANT913096THSTNST PAULCITY OF GRANT55115BROWN ERIN & NATHANIEL181VICTORIA STATION1978
Owner's representative:
Name:
Kelly Vallangingham
Phone:
(123456 - 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):
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):
Examined Tank Integrity Form (Attach)
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
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: No
Date of installation: 01/01/1978

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 has at least a three-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)
Other (See Comments/Explanation)
Comments/Explanation:
See Report
A. Bottom of distribution media: 3.6 Decimal Feet
B. Periodically saturated soil/bedrock: 2.1 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 #8470 (09/05/2022)

Charge Cost Quantity Total
Non-Taxable
added 09/05/2022 1:53 PM

$47 Flat Fee

$44.00 x 1 $44.00
Grand Total
Total $44.00
Payment 09/28/2022$44.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantBrian Humpal - 09/05/2022 1:54 PM
d2af0c9002f4d2d35664278e625d51d2
80209be823f979158ecc16b36b80e3a2
 
#1 Compliance Inspection AcceptedTyler Dale - 09/29/2022 2:15 PM
dab428be8a51c727ee1ab3213b5d1e99
fd77726fcf214baa700206af10e0d34d
 
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? Tyler Dale Permit number to reference in "No Replace" letter:
      Was the letter sent? Yes Compliant/Non-Compliant: Noncompliant
      Certificate of Compliance:
        Letter of Non-Compliance:
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