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Property Address: 1300 yG <br />Business Name: c, . Q p 9.3 <br />5. Soil separation —Compliance component #5 of 5 <br />Date of installation ) Qlq % ❑ Unknown <br />(mm/dd/yyYy�MS���� <br />tiA�S9 �� <br />ShorelandlVVellhead protection/Food ® Yes ❑ No <br />beverage lodging? <br />Compliance criteria (select one): <br />5a. For systems built prior to April 1, 1996, and <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 />5b. Non-performance systems built <br />April 1, 1996, or later or for non- <br />performance systems located in Shoreland <br />or Wellhead Protection Areas or serving a <br />food, beverage, orlodging 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 />(Intermediate Inspector License required <_ <br />2,500 gallons per day; Advanced Inspector <br />License required > 2,500 gallons per day) <br />Drainfield meets the designed vertical <br />separation distance from periodically <br />Date: <br />Attached supporting documentation: <br />IN Soil observation logs completed for the report <br />❑ Two previous verifications of required vertical separation <br />❑ Yes ❑ No' ❑ Not applicable (No soil treatment area) <br />® Yes ❑ No* Indicate depths or elevations `'°` t� .Ks''' ' <br />A, Bottom of distribution media 5,6 Pr-q,!t,lv <br />L <br />B. Periodically saturated soil/bedrock f) VA a 4. - q s <br />C. System separationstep - k <br />_ D. Required compliance separation* <br />*May be reduced up to 15 percent if allowed by Local <br />Ordinance. <br />❑ Yes ❑ No'* <br />*Any "no" answer above indicates the system is <br />failing to protect groundwater. <br />Describe verification methods and results: <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, orits use discontinued within the time required by <br />local ordinance. If an existing system is not failing as defrned 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 />httpsWwww.pca.state.mn.us 651-296-630D 800-657-3564 Use your preferred relay service Available in alternative formats <br />wq-wwisrs4-31b • 412812021 Page 4 of 4 <br />