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5. Soil separation -- Compliance component #5 of 5 <br />Date of installation ❑ Unknown <br />(mm/dd/yyyy) <br />Shoreland/Wellhead protectionlFood ❑ Yes Q No <br />beverage lodging? <br />lance criteria (select one): <br />5a. For systems built prior to April 1, 9996, ❑ Yes ❑ No* <br />and 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 bedrnrk <br />5b. 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 />5c. "Experimental", "Other, or "Performance" <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 />❑ Yes ❑ No* <br />*Any "no" answer above indicates the system Is <br />failing to protect groundwater. <br />Describe verification methods and results: <br />Attached supporting documentation: <br />FW Soil observation logs completed for the report (Attach) <br />❑ Two previous verifications of required vertical <br />separation (Attach) <br />❑ Not applicable (No soil treatment area) <br />El <br />:Q cw UJO Sbom <br />Indicate depths or elevations <br />A. Bottom of distribution media 4� wyh - •3' �� <br />B. Periodically saturated soil/bedrock s 0 <br />C. System separation F 0 <br />i <br />D. Required compliance separation* <br />*May be reduced up to 15 percent if allowed by Local <br />Ordinance. <br />Upgrade requirements: (Minn. Stat. § 115.55) An imminent threat to public health and safety (ITPHS) must be upgraded, replaced, <br />or Its use discontinued within ten months of receipt of this notice or within a shorter period if required by local ordinance. if the <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.mn.us 651-296-6300 800-657-3864 Use your preferred relay service Available in alternative formats <br />wq-ww1sts4-31b • 1/11/21 Page 4 of 4 <br />