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Nov, 6, 2 12 12;47PM No, 1056 P. 5 <br /> , <br /> ° Property addr s: a0�0 S�Q����� .�� Inspeqor initials/Dete: �,f'�• /��5�2. <br /> 4. SOi I Se d�dt1011—Compliance component#4 of 5 <br /> Date vf Ilation: D�� O Unknown Ve�ification method(s); <br /> s�ren allhead probecnoNFood 9ew�ape �Yes ❑No Soil obsenratiron does not expire.F'►evlous soll <br /> e � obse►v�dons by two i�dependentpaiiies are sW�rNenf, <br /> Corn I nce c��teria: unless site cand/tlats have been aQ�ered or Ixe! <br /> Forsys s buill prrorfo Apd11, 199f�and ❑Yea ❑No ����diller. <br /> not loca in Sha�lsnd or Wellhead � Conducted soil observadon(s)(Aftach bom►g�oas) <br /> Protec' Araa or not senring a Mal, ❑ 7wo prevfous verifir,ations(A(tec�boring/ogs) <br /> beva�a or lodging eata6lishmenL• <br /> ❑ Not epplicable(Floldlnq tenlc(s1,no drep�flsi� <br /> Drai�fiel has at least a lwv-foot veiticel ❑ Unable to verity(See f.bmments/F.�cplenatior,) <br /> separati distence from periodically ❑ pther(See Canments/Fxplanaticn) <br /> saturated soil or bed�odc. <br /> Nor�-peri ance syst�ems bullt Ap�19, ❑Yes �No Comments/Exp►a�adon: <br /> 1996, or fer or for norrpeiiormence <br /> systems eted in Sho�eland or WeNhead ' <br /> P�ote ' Aiee$oPSetYJn�a food. <br /> beverag orlodging establlshment- <br /> Drainfiel has a three-foot vertical <br /> separatio distence irom periodically , <br /> saturated soil or bedrock.' <br /> 'Experim ntal" "Othe�', or �erlormanoB" �Yes ❑No IndiCate de S of elevat10t1s <br /> syst�ems uilt under pre-2009 Rules;Type IV F� <br /> or V sys ms builf under 2008 Ru/ea(7080. A. Bottom ot distribution msdi� . � � <br /> 2350 or �.2400 (AdvBnoed�Inspedor �� �� <br /> License uired) 9. Periodicalf seturated soiVbedrook �0 b a'�1 <br /> Dralnfiel meets the designed vertical C. S tem aradon }.►.d y�. <br /> separati distance from periodically <br /> saturat soil or bedrock. � p. uired com liance se aratbn• �'� <br /> Any"n "answer above indicat�s�he syslem is »�y be�uoed up l015 percont If allowed by Local <br /> Failin Protec!Groundwater. OrdinancB. <br /> 5. Opera ng Permit and Nitrogen BMP'�—Compliance component#5 of 5 �Not applicable <br /> Is the sys m opereted under an Operating Petmit? ❑Yes [� No If"yes",A belaw is requfred <br /> Is the sys m requir�ed to employ a Nitrogen BMP? p Yes ❑No If'�yes",B below is nequtred <br /> BMP� sst Mairegement Pisc�f/ce(s)sioecif+ad�in the syslO�m desi� <br /> If the a r to 6oth quesHons is"no'; this sectlon does not need to be comp/eted, <br /> Com lia ce crlCerla <br /> a. Ope inp Permi�number: <br /> Have the O ratln Pertnit uirements been met? ❑Yes ❑No <br /> b, Is th ulred nitro n BMP in lace and ro funcHorii ? Yes Q No <br /> Any"no 'answer lndfcates No�cvmpliance. <br /> Upgrade ul�anlsoCs(A�lim.Stef.§115.55)An lmmh►�nt�reet to publk healbh and selbty pTP.HS)must be�de�rapleoed,or lts use <br /> a�acontlnue wRhln te�►monfhs of reoeipt d this nobce or wlthln e aho�ter period,Y,equired 6y local ordtnar�oe.!f the sy�tem la fell�f�do p�otect <br /> ground we ,the syatem muat be�g�ded,replewd,or i�usa dl�aonHnued wifhfi f/re 6me�w►ed by local a�nanoa If an exlsGng aystem <br /> is not loil►ny deflrrad In leW,end hes et�est!Wo Iraet o�design soll seAe►aflon,then ehe sYsten►need rwf 6a upgrnded,repai�ed,rep�aoed,a� <br /> its usa � dnwd,nolwl�hsMnding arq�kcal ad/nence thetls more sMct Thla pr�Wa/on daes not eppy to systema!n aAoreland e►eas, <br /> wlauhved " n Areas,or thoae uaed M oonrtection with food,bev�e�ge,and bdging esteblisbr►rent�as de�iired In/aw. <br /> •.���.���� �L��� ..� Ir• �{I�I I1I�R AM/�111�I• �w�i�• ��� ���� ��� .�r��.. . �. .. . . . - <br />