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5. Soil separation — Compliance component #5 of 5 <br /> Date of installation ❑ Unknown -" <br /> (mm/dd/yyyy) <br /> Shoreland/Wellhead protection/Food ❑ Yes No Attached supporting documentation: <br /> beverage lodging? <br /> El Soil observation logs completed for the report(Attach) <br /> Compliance criteria (select one): ❑Two previous verifications of required vertical <br /> 5a.For systems built prior to April 1, 1996, IC Yes separation (Attach) <br /> and not located in Shoreland or Wellhead ❑ No` <br /> ❑ Not applicable(No soil treatment area) <br /> Protection Area or not serving a food, � I <br /> beverage or lodging establishment.' M 3,'� ❑ <br /> Drainfield has at least a two-foot vertical <br /> separation distance from periodically <br /> saturated soil or bedrock. <br /> 5b.Non-performance systems built April 1, ❑ Yes ❑ No' <br /> 1996, or later or for non-performance Indicate depths or elevations <br /> systems located in Shoreland or Wellhead ' �a, I r,,4 <br /> A. Bottom of distribution media s�� ^-, ��, , x�- „ <br /> Protection Areas or serving a food, <br /> B. Periodically saturated soil/bedrock Sha14 t n 1, <br /> beverage, or lodging establishment: <br /> C. 'i; 3.) <br /> System separation <br /> Drainfield has a three-foot vertical5 3,0 <br /> separation distance from periodically D. Required compliance separation* 9,0 <br /> saturated soil or bedrock.* <br /> *May be reduced up to 15 percent if allowed by Local <br /> Ordinance. <br /> 5c."Experimental, "Other", or "Performance" ❑Yes ❑ No* <br /> systems built under pre-2008 Rules; <br /> Type IV or V systems built under 2008 <br /> Rules 7080. 2350 or 7080.2400 <br /> (Advanced Inspector 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 /> Describe verification methods and results: <br /> Upgrade requirements:P9 q ements: (Minn. Stat. § 115.55)An imminent threat <br /> to public health and safely(ITPHS)must <br /> or its use discontinued within ten months of receipt of this notice or within a shorter period if required by local oerdinance d the replaced, <br /> system is failing to protect ground water, the system must be upgraded, replaced, or its use discontinued within the time required by <br /> local ordinance. If an existing system is not failing as defined in law, and has at least two feet of design soil separation, then the <br /> system need not be upgraded, repaired, replaced, or its use discontinued, notwithstanding any local ordinance that is more strict. <br /> This provision does not apply to systems in shoreland areas, Wellhead Protection Areas, or those used in connection with food, <br /> beverage, and lodging establishments as defined in law, <br /> https://www.pca.state.rnn.us • 651-296-6300 • 800-657-3864 • Use your preferred relay service • Available in alternative formats <br /> wq-wwists4-31b • 1/11/21 <br /> Page 4 of 4 <br />