SSTS Permitting
Compliance Inspection Compliance Inspection Compliance Inspection # CI-2016-0533, Submission # Submission-2016-0502, UID # 6026
Status: Compliance Inspection Accepted
Status: Compliance Inspection Accepted
System Status
| System status on date: | 10/31/2016 | System Status: | Compliant |
Property Information
| Property Information: | |||||||||||||||||
| Owner's representative: |
|
||||||||||||||||
[
]
[ Search Result Limit: 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? | Yes |
| 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: |
|
120_Old_Wildwood_Rd.pdfCertification
| Inspector: |
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 #1557 (11/03/2016)
| Charge | Cost | Quantity | Total |
|---|---|---|---|
| added 11/04/2016 8:11 AM $40 Flat Fee |
$40.00 | x 1 | $40.00 |
| Grand Total | |||
| Total | $40.00 | ||
| Payment 11/19/2016 | $40.00 | ||
| Due | $0.00 | ||
Action: Print
Approvals
| Approval | Signature | Options |
|---|---|---|
| Applicant | Brian Humpal - 11/04/2016 8:11 AM c7f412a7d0b46c799eeb818587ea31d2 516ac5b0c132355ea5c9e34708313f91 | |
| #1 Compliance Inspection Accepted | Kati Hallermann - 12/27/2016 2:56 PM e6a742c4d583c459b06eee7e64f0258f cb741d45b83bc318580a097977ae12ea |
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: |
| Letter of Non-Compliance: |