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Property address: 545 Lakeview Parkway Inspector initials/Date: RLP <br />4. Soil Separation — Compliance component #4 of 5 <br />Date of installation: 05/28/2020 ❑ Unknown <br />(mm/ddlyyyy) <br />Shoreland/Wellhead protection/Food beverage ❑ Yes ❑ No <br />lodging? <br />Compliance criteria: <br />For systems built prior to April 1, 1996, and ❑ Yes M No <br />not located in Shoreland or Wellhead <br />Protection Area or not serving a food, <br />beverage or lodging establishment: <br />Drainfield has at least a two -foot vertical <br />separation distance from periodically <br />saturated soil or bedrock. <br />Non-performance systems built April 1, ❑ Yes ❑ No <br />1996, or later or for non-performance <br />systems located in Shoreland or Wellhead <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 <br />systems built under pre -2008 Rules, Type IV <br />or V systems built under 2008 Rules (7080. <br />2350 or 7080.2400 (Advanced Inspector <br />License required) <br />Drainfield meets the designed vertical <br />separation distance from periodically <br />saturated soil or bedrock. <br />Any "no" answer above indicates the system is <br />failing to protect groundwater. <br />Verification method(s): <br />05/28/2020 <br />(mm/ddlyyyy) <br />Soil observation does not expire. Previous soil <br />observations by two independent parties are sufficient <br />unless site conditions have been altered or local <br />requirements differ. <br />❑ Conducted soil observation(s) (Attach boring logs) <br />M Two previous verifications (Attach boring logs) <br />❑ Not applicable (Holding tank(s), no drainfield) <br />❑ Unable to verify (See Comments/Explanation) <br />❑ Other (See Comments/Explanation) <br />Comments/Explanation: <br />Benchmark: Survey <br />Indicate depths or elevations <br />A. Bottom of distribution media <br />994.1 <br />B. Periodically saturated soil/bedrock <br />991.1 <br />C. System separation <br />31 <br />D. Required compliance separation* <br />31 <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 />If 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 Ooeratino Permit requirements been met? <br />b Is the required nitrogen BMP in place and properly functioning? I L Yes LI No <br />Any "no" answer indicates Noncompliance. <br />Upgrade Requirements (Minn. Stat. § 115.55) An imminent threat to public health and safety (ITPHS) must be upgraded, replaced, orits use <br />discontinued within ten months of receipt of this notice. If the system is failing to protect ground water, the system must be upgraded, replaced, <br />or its use discontinued within three years of receipt of this notice. If an existing system is not failing as defined in law, and has at least two feet <br />of design soil separation, then the system need not be upgraded, repaired, replaced, or its use discontinued. This provision does not apply to <br />systems in shoreland areas, Wellhead Protection Areas, or those used in connection with food, beverage, and lodging establishments as <br />defined in law. <br />Page 3 of 3 <br />