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Property address: 1925 Fox Street,Wayzata, MN Inspector initials/Date:l-T 11 <br /> 4. Soit Separation — Compliance component#4 of 5 <br /> Date of installation: 8/26/2012 ❑ Unknown Verification method(s): <br /> (mmldd/yyyy) <br /> Soil observation does not expire. Previous soil <br /> Shoreland/Wellhead protection/Food beverage ® Yes ❑ No observations by two independent parties are sut!;c crn <br /> lodging? <br /> unless site conditions have been altered or loci! <br /> Compliance criteria: requirements differ. <br /> For systems built prior to April 1. 9996. and ❑ Yes ❑ No ❑ Conducted soil observation(s)(Attach boring logs; <br /> not located in Shoreland or Wellhead <br /> Two previous verifications(Attach boring <br /> Protection Area or not serving a food, logs, <br /> beverage or lodging establishment. ❑ Not applicable (Holding tank(s), no dra+nfietd) <br /> Drainfield has at least a two-foot vertical ❑ Unable to verify(See CommentslEx)rlanatian) <br /> separation distance from periodically ❑ Other(See CommentsiExpianation) <br /> saturated soil or bedrock. <br /> Non-performance systems built April 1. ®Yes ❑ No Comments/Explanation: <br /> 1996, or later or for non-performance <br /> systems located in Shoreland or Wellhead See attached soil borings from orginal design. <br /> Protection Areas or serving a food, <br /> beverage, or lodging establishment. <br /> Drainfield has a three-foot vertical <br /> separation distance from periodically <br /> saturated soil or bedrock." <br /> 'Experimental", "Other', or "Performance" ❑ Yes ❑ No Indicate depths or elevations <br /> systems built under pre-2008 Rules: Type IV <br /> or V systems built under 2008 Rules(7080. A. Bottom of-distribution media 12 <br /> 2350 or 7080.2400 (Advanced Inspector <br /> License required) B. Periodically saturated soilibedreck 26 inches <br /> Drainfield meets the designed vertical C. System separation >36 inchee <br /> separation distance from periodically <br /> saturated soil or bedrock. D. Required compliance separation' 31 inches <br /> Any "no"answer above indicates the system is 'May be reduced up to 15 percent if allowed by Lecai <br /> failing to protect groundwater. Ordinance. <br /> 5. Operating Permit and Nitrogen BMP*— Compliance component #5 of 5 ® Not applicable <br /> Is the system operated under an Operating Permit? ❑ Yes ❑ No If"yes", A below is required <br /> Is the system required to employ a Nitrogen BMP? ❑ Yes ❑ No If"yes", B below is required <br /> BMP =Best Management Practice(s)specified in the system design <br /> /f the answer to both questions is "no", this section does not need to be completed. <br /> Compliance criteria <br /> a. Operating Permit number: <br /> ❑ Yes ❑ No <br /> Have the Operating Permit requirements been met? <br /> b. Is the required nitrogen BMP in place and properly functioning? ❑Yes ❑ No <br /> Any "no"answer indicates Noncompliance. <br /> Upgrade Requirements;?vtinn Stat § 115.55)An imminent threat to public health and safety(iTPHS)must oe upgrades, re, aced, r ;c. <br /> discontinued within ten months of receipt of this notice or within a shorter period if required by local ordinance If the system is rai +.p to <br /> ground water, the system most be upgraded, replaced, or its use discontinued within the time required by local ordinance. If a; r, �tiny s�irrr <br /> is not failing as defined in iaw, and has at least two feet of design soil separation, then the system need not be upgraded, repai,ed reprr,r ear' o. <br /> its use discontinued notwithstanding any local ordinance that is more strict. This provision does not apply to systems in shoreiand are<<s, <br /> Wellhead Protection Areas. or those used in connection with food,beverage, and lodging establishments as defined in law <br /> www.pca-state..rr,n.us 651 296-6300 800-657-3864 TTY 651 282-5332 or 800-657-3864 Avaitabie in alternativ< <br /> wq-wwists4 31 • 3/16l i2 r,-e <br />