SSTS Permitting

Compliance Inspection Compliance Inspection Compliance Inspection # CI-2023-3530, Submission # Submission-2023-3739, UID # 46570
Status: System Replaced

System Status

System status on date:

06/02/2023

System Status:

Noncompliant

System - Noncompliant

Reason(s) for noncompliance:

Impact on Public Health (Compliance Component #1) - Imminent threat to public health and safety

Soil Separation (Compliance Component #4) - Failing to protect groundwater

Property Information

Property Information:

Compliance Status		Property Record		Property Address								Property Owner	Property Attributes
Compliance Expiration	Compliance Status	Parent GeoCode	PIN	Site Address	Building Number	Street Name	Type	Dir	City	Municipality	zip	Owner	Lot	Block	Plat	Year Built	Property Hold
			1402820310017	15 BAILLON LN, CITY OF ST MARY'S POINT	15	BAILLON	LN		LAKELAND	CITY OF ST MARY'S POINT	55043	O'BRIEN MATTHEW T & MARY B	11	1	BAILLON'S ST MARY'S POINT ADD	2000	No

Owner's representative:

Name:

Matt O'Brien

Phone:

(123

) 456

- 7890

Email:

noemail@noemail.com

Impact on Public Health

System discharges sewage to the ground surface:	Yes	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:

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.:	No
Drainfield meets the designed vertical separation distance from periodically saturated soil or bedrock.:	No
Verification method(s):	Not applicable (Holding tank(s), no drainfield) 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:	File 1: 15_Baillon_Ln.pdf

Certification

Inspector:

Name	License Number	Phone Number	Address	Maintainer	Installer	Service Provider	Designer	Inspector
Midwest Sewer Services	L2896	651-492-7550	6616 Indian Wells Trail Grant, MN 55110	Yes	Yes	Yes	Yes	Yes

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 #9137 (06/02/2023)

Charge	Cost	Quantity	Total
Non-Taxable
2025 Compliance Inspection Fee added 06/02/2023 12:57 PM $47 Flat Fee	$45.00	x 1	$45.00
Subtotal			$45.00 0
Grand Total
Total			$45.00
Payment 06/20/2023			$45.00
Due			$0.00

Action: Print

Approvals

Approval	Signature	Options
Applicant	Brian Humpal - 06/02/2023 12:57 PM 6420a5662ecd4f8964451c399819d931 b06973a06f8130b212baa3510f31ba35
#1 Compliance Inspection Accepted	Sarah Borrell - 06/21/2023 2:33 PM 5fcdc52d5989ded5f0e020e05d7bf603 f610a2edb038c69ce7fb954d72a8bbe1

Inspection has been approved. All signatures have been obtained.

Public Notes

Text:
File(s):

Internal Notes

Text:
File(s):

Create Letter

Compliance Letter Type:	Imminent Threat, Abatement Notice and Order	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:	Noncompliant

Letter of Compliance

Certificate of Compliance:

Letter of Non-Compliance

Letter of Non-Compliance: