Compliance Inspection Compliance Inspection Compliance Inspection # CI-2016-0468, Submission # Submission-2016-0466, UID # 5587
Status: Compliance Inspection Accepted
 

System Status

System status on date: 10/11/2016 System Status: Compliant

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
260272122000210176 EAST POINT DOUGLAS RD S, CITY OF COTTAGE GROVE10176EAST POINT DOUGLASRDSCOTTAGE GROVECITY OF COTTAGE GROVE55016JOHNSON MARC & VENETIA1920
Owner's representative:
Name:
Mary Heldman
Phone:
(000000 - 0000
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? 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:
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 #1480 (10/14/2016)

Charge Cost Quantity Total
Non-Taxable
added 10/14/2016 10:41 AM

$40 Flat Fee

$40.00 x 1 $40.00
Grand Total
Total $40.00
Payment 10/20/2016$40.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantBrian Humpal - 10/14/2016 10:41 AM
8806c689f5d9e5355cac6fade3c320af
058c074069da16ab13e227ba8cb258a7
 
#1 Compliance Inspection AcceptedKati Hallermann - 11/17/2016 2:22 PM
9a941f69dcf60a6994876e9a2767575d
6909cebe4896e04393cb255ba8ed031a
 
Inspection has been approved. All signatures have been obtained.
Text:
File(s):
    Text:
    12-03-2020: Missed call from property owner Marc Johnson at 2:48p.m. PMO
    12-04-2020: Called Marc at 8:34a.m. No answer. Left message requesting a call back and provided cell #. Marc called me at 9:03a.m. Marc stated he would like to convert a outbuilding into a living space for his mother. Marc was curious whether the existing SSTS could be connected. I told Marc that the existing system would first need to be identified as compliant or non-compliant. System past inspection in 2016. Total bedrooms in house is 3. I told Marc it might be possible to add additional tank capacity and extend the existing drainfield, but compliance status would need to be determined before this could be considered. We discussed contractors and he stated discussions and an onsite visit was done by Dave Brown, but Dave has not followed up. I told Marc that there are other contractors he might want to consider working with. Call ended at 9:13a.m. PMO
    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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