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Property Address: 2790 White Oak Circle <br />Business Name: Rusty Olson Soil & percolation Testing <br />5. Soil separation — Compliance component #5 of 5 <br />Date of installation 9/24/2015 ❑ Unknown <br />{mm/dd/yyyy) <br />ShorelandNVellhead protection/Food ❑ Yes ® No <br />beverage lodging? <br />Compliance criteria (select one): <br />5a. For systems built prior to April 1, 9996, and ❑ Yes ❑ 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 />5b. Non-performance systems built ® Yes ❑ No" <br />April 1, 1995, or later or for non- <br />performance systems located in Shoreland <br />or Wellhead Protection Areas or serving a <br />food, 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" ❑ 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 />(intermediate Inspector License required 5 <br />2,500 gallons per day; Advanced Inspector <br />License required a 2,500 gallons per day) <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 />Date: 8/21/2022 <br />Attached supporting documentation: <br />❑ Soil observation logs completed for the report <br />❑ Two previous verifications of required vertical separation <br />❑ Not applicable (No soil treatment area) <br />Indicate <br />or elevations <br />bution media 971.5 <br />B. Periodically saturated soil/bedrock 1968.5 <br />C. System separation <br />D. Required_compliance separai <br />3.0 <br />*May be reduced up to 15 percent if allowed by Local <br />Ordinance. <br />Upgrade requirements: (Minn. Stat. § 915.55) An imminent threat to public health and safety (1TPHS) 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-wwists4-31b • 4/28/2021 Page 4 of 4 <br />