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, Property a�ress: 2755 CouMrysiti�Driv+a W.prono.MN inspector initialslDate: J.0.6116117 <br /> 4. Soil Seperation-Comp�iance component#�o#5 <br /> Date of instAtlation: 5/01197 ❑Unkrtown Yeriflcation rnethod(a). <br /> ShoniandtwNihad pnot�ctloNFs�od ewanpe ❑Yes �No Soll obServatton does not expire.Prevfot�soll <br /> Lodpin�? <br /> Complfance criteria. unles,sNsite bvaidi�tions�l�n ��local � <br /> For s sigms built �4+��nts diA'sr. <br /> Y pricH'b April 1, 19�, and � ❑Yes ❑No <br /> not bceted in Shaeland cu!Kellheed � � Conducted soil observation(s)(Attech barn9 bgs) <br /> Protecdott Area or n�servir�a l�rod, <br /> beverage or todg�+►g estab/ishment: ❑ Two previous veriflcations(Attad►borrrp/ags) <br /> � ❑ Not applica�e(HoJdir►9 tankfs7,�a drai�leW) <br /> Drainfteld haa at least a M+afoot verticai i ❑ Unable to <br /> verifY(Sse CommenislE�rpdenetion) <br /> separ�tion distaru:e from periodicsily ❑ O#�er(See Comments�Expiana�n) <br /> satutated soii or bedrock. <br /> Non perfo�rnance systems built Apii!1, ; �Yes ❑No CornrnentslExpmlanativn; <br /> 1996,oriaterorh�rnon�erfo►mance <br /> systems/ocated in Shr��land ar WeNlhesd <br /> Protection A�as or serving s ibod, <br /> beverege,or lodging estaWishment: <br /> Drainfield has e�ree-foot verticai <br /> separa6�diatanoe fran periodicaliy <br /> 88tU(8t@f�80I�Of�1'OC�(.' <br /> "Experimental; �Otha+�,or "Asrlbrmence� ❑Yea ❑No Indicat�s dsp�s ot elevations <br /> systems bullt ur�der pr+e-20Q�B Ru�es;Type lV <br /> or V systems built urrde�2008 Ru1ea(T�. A. eeuar►ot d�ut�n media � 101.7 <br /> 2350 or 7080.240� (Advanc�d Inspedor <br /> License required) 6. P�riod�l saturated soiubedrodc 98.8 <br /> Drainfield meets the designed veRic�l � �. S �ation 2.8 <br /> separaticn dist�tnoe fram pe�iodicaly � <br /> saturated soil�"bedrodc. � D. Reauired�nciiar�ce ss�'ation' 2.6 <br /> Any"no�anaw�above inc�cA�the syst+�n fs ,May be reduoed up�015 percent if atlowed by local <br /> Fajling to Protec#Groundwai+sr. oroinanc�. <br /> 5. Operat9ng Pernnit and Nitrogen BMP*—Compli�nce component�5 of 5 � Not applicable <br /> is ther system operated under an Opera�r�Permit? ❑Yes ❑No if"yes",A below�requirod <br /> IS the System reqUiroci to employ s Nitrogen BMP? ❑Yes ❑Pio if"yes",8 below is requirsd <br /> BMP=8est Manegemenf Prectice(sj�eci�ed in the system� <br /> !f the answsr ie both queatlons!s "no", th/s sectlon�not neeal�Go be comp/eted. <br /> Com l�ance criteri� <br /> a. OperaUng Pertnit number: <br /> Mave the O Permit uiramertt8 been met? ❑Yes ❑No <br /> b. Is the required nitro��BMP in pl�ce s�nd prop�e[iy functicr�ino? � ❑Yes ❑No <br /> Any"rro"answ�fna�c�tes Noncomplfance <br /> Upgra�Rsqui�wnsntt(MNr». Stat§i 15.S5)M immir�nf t�eat to pubA�c h�slth�d a�ery(lTFHS)must be up�ed,replaaed,or f(�� <br /> dis�tued�M ter►rrwr►d►8 e�f n�eeJpt af thls�tx w�tin e shov�r period�roqt�i�d by tocel a+dF�ar�ce.tf ti�e syst�em is f�tinp b puotect <br /> �ound water,tbe systsm must be uppndrd,repl�d,a lts uae�soaa6tnwd w�h�i►1F�s�rna�squi�s�Dy bcat o��na»ae.ff an sxia�l sf�si�sm <br /> fs�ot fedH»p as ate�l�n laN,and l�es t�lsa�t�n�bet c�'a��►►sON then Me Eysbm need not be up�dsd,�spaired��or <br /> its u�di�oar�nwd,»otN�hstsnaW�g enY bcal o►r�tar��8t is mai!sbic�771�p�rovislon Gk�ees not epprjr t�o sya�ma in sharefand a�6as, <br /> weanesd Pfct�Nor�aeas,or arose uaed M oorrnecdarr wltl,lbad,be�regs,ana�odgrr,g e��lrsNmer►ts as d.flned;n law. <br /> www.pca.state.mn.us • b51•295-6300 � 800-657•38/�a • TT1f 6S1•2�'l-5332 a��-b57-3864 • Availabte in altemative formats <br /> wq-wwists�l-3! • f/24/11 <br /> a,.__�_�� <br />