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5. Soil separation — Compliance component #5 of 5 <br />Date of installation 10/24/1989 ❑ Unknown <br />(mn✓dd/yyyy) <br />Shoreland[Wellhead protection/Food <br />beverage lodging? <br />Compliance criteria (select one): <br />5a. For systems built prior to April 1, 1996, <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 />5b. Non-performance systems built April 1, <br />1996, or later or for non-performance <br />systems located in Shore/and 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 /V 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 />G Nm <br />❑ Yes ❑ No* <br />® Yes ❑ No* <br />❑ Yes ❑ No* <br />*Any "no" answer above indicates the system is <br />failing to protect groundwater. <br />Describe verification methods and results: <br />Boring <br />1-10" 10yr 3/2 loam <br />11-14" 10yr 4/4 clay loam <br />Redox @ 12" <br />Upgrade requirements: (Minn. Stat. § 115.55) An imminent threat to F <br />or its use discontinued within ten months of receipt of this notice or with <br />system is failing to protect ground water, the system must be upgraded <br />local ordinance. if an existing system is not failing as defined in law, an <br />system need not be upgraded, repaired, replaced, or its use discontinue <br />This provision does not apply to systems in shore/and areas, Wellhead <br />beverage, and lodging establishments as defined in law. <br />https://www.pca.state. mn.us 651-296-6300 800-657-3864 <br />wq-wwists4-31b • 1/11/21 <br />Attached supporting documentation: <br />® 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 />Fl <br />Indicate depths or elevations <br />or use d b <br />A. Bottom of distribution <br />media <br />24"+ <br />B. Periodically saturated <br />soil/bedrock <br />12" <br />C. System separation <br />36" <br />D. Required compliance <br />separation* <br />36" <br />*May be reduced up to 15 <br />percent if allowed by Local <br />Ordinance. <br />blic health and safety (ITPHS) <br />must be upgraded, replaced, <br />i a shorter period if require{ <br />by local ordinance. if the <br />re /aced its d' t'h <br />d 7h' th t' <br />p scon a ue w m e ema require y <br />has at least two feet of design soil separation, then the <br />d, notwithstanding any local ordinance that is more strict. <br />'rolect/on Areas, or those used in connection with food, <br />Use your preferred relay service I • Available in alternative formats <br />Page 4 cf4 <br />