Compliance Inspection Compliance Inspection Compliance Inspection # CI-2016-0424, Submission # Submission-2016-0434, UID # 5252
Status: System Replaced
 

System Status

System status on date: 09/19/2016 System Status: Noncompliant

System - Noncompliant

Reason(s) for noncompliance:
Tank Integrity (Compliance Component #2) - Failing to protect groundwater

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
32028212400017340 GLEN RD, CITY OF WOODBURY7340GLENRDWOODBURYCITY OF WOODBURY55129NEZAMI FARHAD1960
Owner's representative:
Name:
Roberta Bertrand
Phone:
(651459 - 4333
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:
Yes
Sewage tank(s) leak below their
designed operating depth:
Yes
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):
Not applicable (Holding tank(s), no drainfield)
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 #1416 (09/30/2016)

Charge Cost Quantity Total
Non-Taxable
added 09/30/2016 2:02 PM

$40 Flat Fee

$40.00 x 1 $40.00
Grand Total
Total $40.00
Payment 10/10/2016$40.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantBrian Humpal - 09/30/2016 2:03 PM
4c1c70e5f5c0f7c41974b2ad1f67739c
ed8b74e83e3d0ee855f8c03d93cec93a
 
#1 Compliance Inspection AcceptedChristopher W. LeClair REHS - 10/12/2016 10:44 AM
7259bd66c6375502dcd81d98686164c7
c4727494ee330c924b7102e4852829c7
 
Inspection has been approved. All signatures have been obtained.
Text:
File(s):
    Text:
    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:
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