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, <br /> Property a�ness: 2990 Somerset La� Oronc MN Inspedor inidalslDate: J.O. 10f27J16 <br /> 4. Soi I Separation—Compiianc�cx�mponent�a o�5 <br /> Date of i�tailation: 5125N995 ❑Unknowm VeNfFcatbn n»thal�s�: <br /> Shore�anmlMalit�pro�ectioNFood esverapa �Yes �No Sai!obsenration does not explra.Previous s�Jl <br /> Lodpin{}� <br /> observetiar►.s by Nvo independenf pafiea are sulfrcient, <br /> Com lianC!Ctlto�is: unless s�e coriditi�s havg bsen afterad orlocal <br /> Forsystems bullt,ptia�b A�ril t, 19�', and �Yes ❑No ����nts dilfer. <br /> not tocated in Shonetand or Wetlhead � Conducted sai observation(s}(Attedr bwing�logsl <br /> P�te�on Area or rwt senrir►g a h�od, , ❑ Two previous verifications(Ana�h t�ii9lags) <br /> beversgre orlodgnng estet�lishrr�nt.• I <br /> ° ❑ Not applicable(Notdingr tenk(s).no drainteld) <br /> Drainfield has at�t a two-foaR veRicai ' ❑ Unab�to verify(See Cwrrn►entstExplanat�a►) <br /> seperatio�distance irom p�riaiicalty E <br /> saturated soii or bedrock. j ❑ Other(See CanmentslEacptanatbn) <br /> Non-petforrrrance Systems built�4�url�, � ❑Yes ❑No CommentslExplanetia�: <br /> 1996,or later or ior non-perforinan�e � <br /> systems loc�ted in Sha+elanQ or WeNhead ', <br /> Protectiott Areas or serving a f�d. <br /> beverage,orloa�ing estab%shment: ! <br /> Drainfiefd has a thr�-foot vertical � <br /> separation distarK;e from periodically ' <br /> saturated sal or bedrodc." � <br /> � � <br /> Experimental" "Other",Ar f+erformance" �Q Yes ❑No indicate Rlepths of eleVstiOns <br /> systems built under pre-2�JU8 Ru�s;Type!V P <br /> or V syst�ms bu/tt uruier 2�8 Rules(70�. � A. eottan of distributan m�ia ' 1�.5 <br /> 2350 or 7080.2400 (Advanced Inspector " <br /> License re+quired) � B. Pe�iodicaily saturated saiil4edrocic � 103.5 <br /> Drainfiefd meets the tiesigned vsrticai ; <br /> separation distanae fran periodic�l � C. �����ron ; 3.0 <br /> saturated soil or bedrodc. � { i <br /> D. Requirodc�mPiiance__ ration' � 2A <br /> Any"no"answer aboire In�cst6�S the System l� •M�y p��uc�ed up to 95 pe�csnt if ailow�d by�ocal <br /> _Fa1/ing to Prote�t Groundr�ater: Or�narxx�. <br /> 5. Operating Permit and Nitro�en BMP*—ca„pN�nc�e camponent#5 of� �Nbt appiicable <br /> ts the system operated under an Operating Permit? ❑Yea ❑No If"yes",A below N nquired <br /> Is the system requirod�o empby a Nitrogen BMP? ❑Yes ❑No If"yss",B below is requlred <br /> BMP--Best Manegement Pr�cGlce(s)spsc�"re�d in the sys�Eern cfe.sigrn <br /> Jf the answer to both qu�sHc►�s f�"nd°;thfs soc�ore dass not need�o�comp/etod. <br /> Compliance criteria <br /> a. Operating Pe�rnit number: <br /> Have the 0 ' Pemiit r uiremerKs been met? �Yea ❑No <br /> 3 <br /> b. Is the required nitrogen BMP in piscc�and Property functtroni�? � ❑Yg8 ❑No <br /> Any"na"answ�indYcat�ss Noncompti�nce. <br /> Uppnd�Raquf rem�ob(Ma►n.Stat§1 f 5.55)An lrrunlr�ent d�reat ta pubYc heaHt►ar�d safery(17PNS)m�rst be upg�adetl,rep/sasd,�Jts u� <br /> disconNnued wlUdn�n months ot ro�ipt d lfria nol�e ar wdh�n a st�afisr p�rc�d if required by focaf adYnem�e.N ffie syatem is hailkrg to pvviect <br /> g►ound wster,Me By�em muat be up�repJea�ed,or its u4e discontinutd wiM�r►�tlme requfred by bca!adl�rance.!f an ex1�H►g syatem <br /> ts t►otla�ing es defined in 18w,erld has�teast h�av Aret af des�r►��pBr�t6ori,M�r the sy8fem need not be up$ta�cleal,repairsd,roptaced,or <br /> its Lse dlscOrrtirtuetl,ri�fst�rp�y bCBI orpWtBr�cs that is mo/�B�Ttus provt8kut doea�wt eppfy to sy8tem8!tr sharelBAd a+�ees, <br /> Weubesd Pratec�on Areas,ar thos�t�d!n co»m4ctJon wdth food,bsvierege,a�rd Jod�n9 eslablfshments as rlefii�ed in law. <br /> www.pca.state.mn.us • 651-246-6300 • 800�b57-38b4 • TTY 651-282-5332 or 800-657-3864 • Available in altemative formats <br /> wq-wwlsts�-3f � i/24/12 Page 3 of 3 <br />