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�Prop�dl+address: , � d, �S� Sos:����''r� 1�1d� Inspector WtlalslDate: ' �� � "4���� <br /> 4. So�t Sepecation—Campliance component#4 of 5 <br /> � Date ot.lnstalistlon: � )oj�t 4� ❑�1n�+ VeMficatlon method{s): <br /> 8�dNVsllh�l Prot�onfFood 8awrap� �Yes �No SaA obaervatbn does not explre Prevfous ac1! <br /> ��"g? � observaNars by iwo utdepeadent pefies are s�rc+ent. <br /> Com Ilance ctltecia: un�ess slf�ca�dl�ons hav�been a�ered or loca! <br /> Forsyst�ms 6u1lt priorto Apd/t, 1Q98,artd ❑Yes ❑No �W��� <br /> rr�locaterJ Jn Shorefend or We�lheed ■ Conduc�ed soil observa�on(s)(Attacl►bov�bgsJ <br /> PrafecEian Area nr not ae�ving a food. ❑ T�ro pre�ious�{Attach bor�logsl <br /> beve�s er lodg�ng estab�ishmenf: [� Nflt appHceble(Molding taMc(s),n�d�aMfleldl <br /> DraiM'ieid haa et teest a two-foot vertEcsl [] Unabl�to verlty{See Co,rur►�r�tsE,cp�ar�ou,) <br /> seperation�s�from periodic�lry ❑ pther fSse c�s,rt�irPrsr,eda�) <br /> satu�ated soU or bedroc�c. <br /> lV�n-,perfo►mance syabma bWlt�prr7 f, �Yes ❑No (aoriurrents/EScplsna�orr. <br /> 1996,orls�er�rfa�nc»-pedqrtr+aric� <br /> sysfems locat+e�!!n Sho�nd ot'Wrsdhead <br /> Protection A�as crseMng a f+ood, <br /> beve�ge,orMdgirr$esta6�nt: . . <br /> Dreinfietd haa a three-foot vertical <br /> � aepsr�atlon attstar�ce firom periodicalty � <br /> satu�ated soi!or bednodc'� <br /> "Expertmentel","Other, or 'P�Aamance"� ❑Yes ❑No fndM.ate de of.�svatlons <br /> syste,►�stwlttu,xferpre-aooeRu�a;TypeJU s��� ,�+�:, : •�'S;�. <br /> or V 8ystems bt►Nf urnler 2008 Rules(7Q�0 A. eottom od d�lributlon madta s�8 f a ro . �l.�`sr� <br /> 2350 or 7080.2400 (Advanced Inspec�or • s���r7 �.�g' <br /> UOense requit� B. Pe seturated aoillb�drock SKs s a�• 3.�3, <br /> �� 1 5. 5! '�"': <br /> Drsirdield meets fhe dedgned+rerlical C. n � <br /> �ep�ratt�on distemoe from pei9odic�diy �" <br /> safurated soi{or bedrodc. p. utred oom � 3'v <br /> Any"no"answer a6ovs Int�Icates#he syatetn!s" �ey be neciuce�up to�s percent if ai�awed�by�.ocat <br /> Falling to Protect Groundwater. ordh►ar�ce. <br /> 5. Operating Permit and Nittrogen BMP'k—Compl�noe component�5 of 5 �Not appticable <br /> . la the sysbem operated under an Oporadng Pe�nnit? ❑Yes ❑No N"yea",A belo�w�r+eqqlrod . <br /> Is the system required#o empfoy a Nit�agen BMP7� �]Yes ❑No !f"yas".B baloMt�nquired <br /> BMP�Be�t Mana�ement P►�celal�ed�the system deal��r► <br /> K�fte answer�+o bo�hh que�ans�s"ao;thla sectfon d�a not r�sed�o be comp/et+�ad. , <br /> Com Ilance criteria <br /> s. Opersting Pem►�number: ❑Y� ❑Na <br /> Have the 0 n �Pem�it ulremeMs besn met? <br /> b. Is the lred n BMP in and fundton' � Yes No <br /> Any"no"snswer Inapcatea Noncompllance. <br /> Upgra�ReqWireme�(A�Nnr►.srat$41a68}a,tmmMent�ar ta pubdre tleafth end se�My!l7P.,f+s1 me,�be up�„aded�eplacsa.or ns uao <br /> dlsc�nlJnered wRlrbf te»mond�a af r�d fhls nodlos or wllhh�a ei�orloarPs�lcd!f reqad�d by loael ordinan(�a.ff ths sy�em is fa�inp b p�bed <br /> gr�water,tbe ayatem muat be upgra�Jed,rep�osd�or ira uae�aoontlnu�d wl�fn t�s I�ns requbsd by�ocal adlnar�os.lt en existhp system <br /> Ja nat faNJng sa d'e0ned l►r lew,�rid hes at fea�t Iw�o 1f�et�de�i�t ea�ae�d�o!!.�►e++ihe ayatem nsed tat be up�eded.r+epeb�d,replaced.ar <br /> fts rree�ocrHbruoed���Y�a�dManr:e thet la moro�IcL Thls provJsJan tbes not ap�pJy to sysdems kr ahorat�rnd erve�, <br /> Wi11�Aead Wntedior��4+�aa.or tl►oes u�ed�n oor�►iec�on wof�►1bo�bsvsrsD'a.and b��ts as deNned 1n law. <br /> www.pca.st�te.mn.us • �5�•Z�b�o • eflo��5r-3e6� • rn 65�2�t•33�or�oo-�3ea4 . a�,�ie�a�ema�e fa�►aa <br /> wp+�w�sw-�� • i/141!2 � ' <br />