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S. Soil separation — Compliance component #5 of 5 <br />Date of installation 7/4/2003 ❑ Unknown <br />(mm%ddlyyyy) <br />ShorelandMellhead protection/Food ® Yes ❑ No <br />beverage lodging? <br />Compliance criteria (select one): <br />5a. For systems built prior to April 1, 1996, ❑ 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 bedrock. <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" ❑ Yes ❑ No" <br />systems built under pre -2008 Rules; <br />Type 1V 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 />Boring <br />1-11" 10yr 312 loam <br />12-25" 10yr 414 clay loam <br />Redox @ 24" <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 />Indicate depths or elevations <br />A. Bottom of distribution media 14" <br />B. Periodically saturated soil/bedrock 22" design <br />C. System separation 36" <br />D. Required compliance separation" 36" <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-wwists4.31b • 1/11/21 <br />Page 4 of 4 <br />