SSTS Permitting
Compliance Inspection Compliance Inspection Compliance Inspection # CI-2016-0513, Submission # Submission-2016-0503, UID # 6040
Status: Compliance Inspection Accepted
Status: Compliance Inspection Accepted
System Status
System status on date: | 11/02/2016 | System Status: | Compliant |
Property Information
Property Information: | |||||||||||||||||
Owner's representative: |
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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: |
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Certification
Inspector: |
Please search for and choose SELF/OTHER if what you need does not appear in the list
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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 #1565 (11/04/2016)
Charge | Cost | Quantity | Total |
---|---|---|---|
added 11/08/2016 3:55 PM $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 - 11/08/2016 3:55 PM 686146be3e2721fc939c6be7ef8c1a5d 2cdea0de1b40414d2f4d9d3c63fc0a41 | |
#1 Compliance Inspection Accepted | Kati Hallermann - 12/15/2016 8:05 AM abb601801126cd4eb44e1bd16482856a 2b90e495075e44028a2db0764a7fd311 |
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: |