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i , � � Property address: �O�j Q. �p� � � Inspector initials/Date: 7 4. Soil Separatio►l—Compliance component#4 of 5 Date of installation: Q �� ShorelancUWe��head protectioNF ❑Unknown Verification method(s): Lodging? �d Beverage ❑Yes No Soil obseivation does not expir�. Previous soil Com 7118nCe Criteria: obseivations by fwo independent parties a�e suficient, unless site condifions have been altere�f orlocal For systems built prior to April 1, 1996, and � not located in Shoreland or We//head ._. 'es ��o �QU��ments difier. Protection A�a ornot senring a food, ��nducted soil observation(s)(Attach boring logs� beverage or lodging establishment.• �'�wo revio s verifications(Attech boring bgs) Drainfield has at least a twafoot vertipl ❑ Not appli�ble(yolding,tank(s);no drainfreld) separation distance from periodically ❑ Unable to verify(See CommentsiExp�anallon) saturated soil or bedrock. ❑ Other(See Comments/6cplanah'on) Non perfpm�ance systems built April i, >996, or later or for non perfoimance ❑Yes �o Comments/Explanation: systems located in Sho�land or Wellhead ProtecSon Areas orseiving a food, beverage, orlodging establishment.� Drainfield has a three-foot vertical separation distance from periodically saturated soil or bedrock.' 'Experimental'; "Other'; or "I'ertormance" systems built under pre-2008 Rules; Type/V �Yes [�No Indicate de ths of elevations or V systems built under 2008 Rules(7080. 2350 or 7080.2400 (Advanced Inspector A• Bottom of distribution media License required) Drainfield meets the designed vertical . B• Periodicatl saiurated soi�lbedrock I separation distance from periodically saturated soil or bedrock. �• S stem se aration Any "rro"answer above i�dicates the system is �• Re uired com liance se aration' �y N Fai/in to Protect Groundwater. May be reduced up to 15 percent if allowed by Local Ordinance. �y �L�f a.£ i°w4 � �• ,r �%�� 5. 0perating Permit and Nitrogen BMP*-Compliance component#5 of 5 � , Is the system operated under an Operating Permit? �-, '°"`aPN��cable Is the system required to emp►oy a Nitrogen BMP? �Yes [� �f��yes",A below is required BMP=6est Manaqem�nt Pracfice(sJ specifred in fhe sys�tem desig�n� If"yes", B below is required lf the answer to both questions is "no'; this secfion does not need to be completed. Com liance criteria a. Operating Permit number: Have the O eratin Permit re uiremenfs been met? ❑Yes ❑No b. Is the re uired nitro en BMP in lace and ro erl functionin ? Any "no"answer indicates Noncompliance. �Yes ❑No Upgrade Requirements(Minn. Staf.§115.55)An imminent threat fo public healfh and safety(/TpHS)must be u discon6nued within ten monri�s of recelpt of this notice or within a shoiter perioUr if ground water,the system must be u o � required by local ordinance. lf the�em�ap g ro pro ct� is not failing as defined in law,and has at least Iwo feet of design soil separation, then the system need not be upgraded,re a)re P9� er1,ioplaced,or its use discontinued within the time nquired by loca/ordinance.lf an existing system its use disconNnued,nohvithstanding any local ordinance that is more strict This provision does not app/y to systems in shoreland areas We/lhead Protection A�eas,or those used in connection with food,beverage,and lodging establishments as defined in law. p d�p�aced,or ro.pca.state.mn.us • 651-296-6300 e ��.,:..._., �, .,... 800-657-3RFe . ,�„.... ---