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Compliance Inspection Compliance Inspection Compliance Inspection # CI-2016-0389, Submission # Submission-2016-0387, UID # 4874
Status: Permit Issued
 

System Status

System status on date: 08/09/2016 System Status: Noncompliant

System - Noncompliant

Reason(s) for noncompliance:
Impact on Public Health (Compliance Component #1) - Imminent threat to public health and safety
Tank Integrity (Compliance Component #2) - Failing to protect groundwater
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
21030214100018252 JAMACA AVE N, CITY OF GRANT8252JAMACAAVENSTILLWATERCITY OF GRANT55082PAL JACQUELINE S & PRIMEPARES G1951
Owner's representative:
Name:
Craig Van Ausdall
Phone:
(612) 599 - 7775
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: 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.:		 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: 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 #1327 (09/02/2016)

Charge Cost Quantity Total
Non-Taxable
added 09/02/2016 10:05 AM

$40 Flat Fee

 $40.00 x 1 $40.00
Grand Total
Total $40.00
Payment 09/19/2016$40.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantBrian Humpal - 09/02/2016 10:05 AM
df373dec101066b1ab863f15f29e4034
f1e934a7252964282fb9eb75f27929d6		 
#1 Compliance Inspection AcceptedChristopher W. LeClair REHS - 09/20/2016 3:04 PM
f055dfcda09cfc15da24efd346cbf449
aa829a17a47a50e59252a2c6b6709fc5		 
Inspection has been approved. All signatures have been obtained.
Text: 




File(s):

    		

    

    

    

    

    


    

    Text:

    This inspection did not show up on the dashboard in RT vision until 9/20/2016.  CWL 
See email, 10/1/21 SB.  He was not aware until recently there was a noncompliant system on the property.  Midwest was out there recently and was going to send him plans. Hoping to install a new system in the spring, but still working on design. Primepares Pal doesn't plan to be back to area until after Easter.  He thinks any prior communication was sent back.

10/6/21 Homeowner mail address is: 613 Cadiz Rd, Venice, FL 34285; requesting any future correspondence to be mailed here.
    		

    

    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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