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Property address: 1000 Cox Farm Road, Long Lake, MN 55356 4. Soil Separation —Compliance component #4 of 5 Date of installation: 1996 _ ❑ Unknown 5horeland/Wellhead protectionlFood Beverage ❑ yes ® No Lodging? Compliance criteria: For systems built prior to April 1, 1996, and ❑ Yes ❑ No not located in 5horeland or Wellhead Protection Area or- not serving a food, beverage or lodging establishment: Drainfield has at least a two -foot vertical separation distance frorn neriodically saturated soil or bedrock. Non-performance systems built April 1, ® Yes [:]No 1996, or later or for non-performance systems located in Shoreland or Wellhead Protection Areas or serving a food, bcveragge. orlodgfng establishrrlenl. Drainfield has a three-foot vertical separation distance from periodicaliy saturated soil or bedrock." "Experimental. "Other", or "Performance" ❑ Yes ❑ No systems built under pre-2008 Rules; Type iV or V systems built under 2008 Rules (7080. 2350 or 7080.2400 (Advanced Inspector License required) Drainfield meets the designed vertical separation distance from periodically F saturated soil or bedrock. Any "no" answer above indicates the system i8 Failing to Protect Groundwater. _ Inspector inilialslDate: 5-12-14 Verification method(s): Soil observation does not expire. Previous soil observations by two independent parties nm sufriciont unless site conditions have been altered or local requirements differ. ® Conducted soil observation(s) (Attach boring logs) ❑ Two previous verifications (Attach boring logs) ❑ Not applicable {Holding tank(s), no drainfield) ❑ Unable to verify (See Cornrnents/1 .eplanationJ ❑ Other (See Comments/Explanation) CommentslExplanation: Indicate depths of elevations A Bottom of distribution media 101.5_ B. Periodically saturated soillbedrock 98,5 C. System separation 36 inches 0 Required compliance separation.• 36 inches 'May be reduced up to 15 percent if allowed by Local Ordinal icc. 5. Operating Permit and Nitrogen BMP* —Compliance component #5 of 5 ❑ Not applicable Is the system operated under an Operating Permit? ❑ Yes ❑ No if "yes:", A below Is required Is the system required to employ a Nitrogen BMP? ❑ Yes ❑ No If "yes", B below is required BMP=Best Management Practice(s) specified in the system design If the answer to both questions is "no", this section does not need to be completed, Compliance criteria a. Operating Permit number, -- n Yes ❑ No Have the Operatiqg_Permit requirements been met? b. Is the required nitrogen BMP in )glace and properly functioning? ❑ Yes ❑ No Any "no" answer indicates Noncompliance. Upgrade Requirements (Minn. Stat. § 115 55) An imminent threat rn public health and safety (ITPHS) must be upgraded, replaced, or its use discontinued svrihin ten months of receipt of this notice or within a shorter period if required by local ordinance. if the system is failing to protect ground water. the system must bo upgraded, replaced, or its use discontinued within the time required by local ordinance tf an existing system is not tailing as defined in law, and has at least twa feet of design soil separation, then the system need not be upgraded, repaired, replaced, or its use discontinued, notwithstanding any local ordinance that is more strict. This provision does not apply to systems in shoreland areas, Wotfhcad PrWoclicn Areas. or those used in connection v.4tt food, beverage, and lodging establishments as defined in law. www.oca.state.mn.us • 651-296-6300 - 800.657-3864 TTY 651-282-5332 or 800-657-3864 Available in alternative formats wq-wwists4-31r • f124112 Page 3 of 3