Compliance Inspection Compliance Inspection Compliance Inspection # CI-2022-3407, Submission # Submission-2022-3600, UID # 43893
Status: Compliance Inspection Accepted
 

System Status

System status on date: 10/26/2022 System Status: Compliant

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
100302023000110745 STONEBRIDGE TRL N, TOWN OF STILLWATER10745STONEBRIDGETRLNSTILLWATERTOWN OF STILLWATER55082RICHARD FEARING REV TRS & DONNA FEARING REV TRS2003
Owner's representative:
Name:
Dean
Phone:
(000000 - 0000
Email:
no@no.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:
None of the above.

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:
None of the above.

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:
None of the above.
System is non protective of groundwater for other
conditions as determined by the inspector:
No
Explain:
None of the above.

Date of Install

Date of install known: Yes
Date of installation: 06/30/2004

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):
Conducted soil observation(s) (Attach boring logs)
Other (See Comments/Explanation)
Comments/Explanation:
None of the above.
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 #8664 (11/03/2022)

Charge Cost Quantity Total
Non-Taxable
added 11/03/2022 2:56 PM

$47 Flat Fee

$44.00 x 1 $44.00
Grand Total
Total $44.00
Payment 11/30/2022$44.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantBrian Humpal - 11/03/2022 2:57 PM
b570ef03beedfe383ff2fa5770bbc8ca
bf047a4f1466d5008c7327b4a74011cb
 
#1 Compliance Inspection AcceptedSarah Borrell - 12/23/2022 1:17 PM
d5137d1f0491f7292183e8d3156f85e5
43c33821ba7f5988cd185dd0f5691103
 
Inspection has been approved. All signatures have been obtained.
Text:
File(s):
    Text:
    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:
          Powered by