Compliance Inspection Compliance Inspection Compliance Inspection # CI-2023-3686, Submission # Submission-2022-3572, UID # 43227
Status: Compliance Inspection Accepted
 

System Status

System status on date: 09/29/2022 System Status: Compliant

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
24029214300182134 LEGION LN N, CITY OF LAKE ELMO2134LEGIONLNNLAKE ELMOCITY OF LAKE ELMO55042BENESCH PAUL G & JENNIFER A BROOM-BENESCH33EDEN PARK1978No
Owner's representative:
Name:
Jennifer Benesch
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):
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

Soil Separation

Shoreland/Wellhead Protection/Food, beverage, lodging? Yes
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):
Conducted soil observation(s) (Attach boring logs)
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

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 #8554 (10/06/2022)

Charge Cost Quantity Total
Non-Taxable
added 10/06/2022 9:51 AM

$47 Flat Fee

$44.00 x 1 $44.00
Grand Total
Total $44.00
Payment 10/24/2022$44.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantBrian Humpal - 10/06/2022 9:51 AM
45b70841a4134f516db6fbcf70c785d8
26c4535d737f919f1d6412bf0fdc84d5
 
#1 Compliance Inspection AcceptedSarah Borrell - 10/25/2023 4:35 PM
8ab1b7e84791e1a5cd30d1fc6df71e76
5e5598810bd6c7c97e754a6fa6368601
 
Inspection has been approved. All signatures have been obtained.
Text:
Soil discrepancy resolved.
File(s):
Text:
11/15 (SB) Jennifer Broom called, wondering if they sell home in next 12 months if COC from 2022 is still valid or if they need a new one. Called her back and left her a vm that the determination is valid for 3 years.
10/23 (SB) received additional boring log and write up resolving differences between two professionals. Attached. Accepted report.
10/3 (SB) Soil discrepancy to be completed by independent parties on 10/5 - hopefully they met as it was a great day for soils
Spoke with Midwest over phone, they did not know there was another compliance inspection. Emailed 5/19 for update.
Saturated soil discrepancy with 2019 report from another inspector. Attempts were made to meet onsite between inspectors in 2022, but there was a short window due to weather and onset of winter. Would like to look at site with ideal conditions in the spring 2023.
File(s):
Compliance Letter Type: Certificate of Compliance Who's signature should be on the letter? Sarah Borrell Permit number to reference in "No Replace" letter:
Was the letter sent? Yes Compliant/Non-Compliant: Compliant
Certificate of Compliance:
    Letter of Non-Compliance:
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