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Prop�rtyaddress: �_��J c�a���o�� U��*�%-' InspectorinttlaislDate:'��7 4�)3�1.5� <br /> q, Soil Separation--Compllance component#4 of 5 <br /> Date of.installatlon: )`�°l2- ❑Unknown ' Veriflcaflon method(s): <br /> 3horelandlWeflhaad protectioNFocd$ev�rage (�YBS �No Soll obsarvatlon does not expire.Previous soil <br /> �od9i�9� observations by two tndependent parNes ere sufficlent <br /> Com fianca critesia: unfeas slte crondrtiorrs have been altered or local <br /> requfrements d3ffer. <br /> For systems buift pdor to ApAI l,4896,and �Yes �No qonducted solf obaervaUon s g <br /> not tocafad in Shoreland or Wephead � ( )(Attach borfn togs) <br /> Pmtec6orr Area or not serving a food, ❑ Two previous veriflcations(Aftach bodng Iogs) <br /> baverage or lodgtng establishment: ❑ Not appl(cahle(Noldfig tenk(s),no drelnfield} <br /> Drainfield has at Eeast a two-foot vertfcal [] Unabla to vedfy(See Comments�ExplenaGon) <br /> saparatlon d(stance from periodicaily Q Other(Sea Comments/ExpfanationJ <br /> saturated aoii or badroc�Cc. <br /> Non-pedomtance systams bu1R Apri11, 0 Yos �No Comments/F-�cplanaHon: <br /> 1996,orlaterorfornon-perlormance <br /> systems lacated In Shoreland o�Wefthsad <br /> Protectlon Areas or sarving a food, <br /> 6everage,or fodging esta6llshmenf: • <br /> Dreinfleld has a three-foot vetticai <br /> separatton dtstance from pedodically <br /> saturated so1(or bedrock.' <br /> °Experimenfal;'Othe�;or 'PeAormancs' ❑Yes ❑No IndiCate de thp s af eievittfolls <br /> systems 6ulJt u�der pre-2008 Ru1es;Type!V 5cs� .�"?�7�5� <br /> or V sysfems butk undar 2008 Rules(T080. A. Bottom of tlisMbuUon media ,�•� �,.S.-� .,3's+� <br /> 2350 or 7080.2400 (Advanr.ad lnspector <br /> License requiredj B, pedodkal satureted eolUbedrark $����� <br /> Dreinfieid meets the designed ve�ticat C. S atem se arntbn +3���{ . '' <br /> separaUon distance from periodfcally <br /> saturated soil or bedrock. o. R uirod can uance sa aratlon• ��d I <br /> Any"no"answer a6ove Jnd/cates the system ts- •Mey be reduced up to 15 percent If ailowed by Local <br /> Fallfng fo Protecf Groundwater. ord�nance. <br /> 5. Operating Permit and Nitrogen BMP`-CompUance camponent#s oi s �(Not appUcable <br /> is the syatem apareted under an Qperatlng Pertnit? ❑Yes ❑No� if"yea",A betow Is requfred <br /> is the system required to empiay a NiUogen 8MP?• �Yes ❑Nd if"yas",8 6elo�x Is required <br /> 8MP=Best Management PrsoBce(s)spacllted!n!hs system destgn <br /> if ihe answer to both quesUona is"no",th�s sec!(on does nof nesd!o be completed. <br /> . � <br /> Com itanee crite�ia <br /> a. OperaUng Permit number. <br /> Have the O era8n Permtt r uirementa been met? 0 Yes ❑No <br /> b. is the re uired nitr en 8MP in lace and ra eri functbnin ? Yes No <br /> Any"no"answerindlcates Noncompllanca. <br /> Upgrade Requlroments(Mlnn.Sfet§115.35)An Imminent threst to publfc t+ealfh and safety(ITFHS)m�st bs upgraded,replaced,or fts use <br /> dlsconGnuad wtthln fen monfhs oliscelpt of thts notke w wlthln a shortorperfod Il requ(red Dylocal ordlnance.tl the system 1s lalling to protect <br /> ground wate�the system muat be�pCraded,�aPfeced,or Hs�u dlsconflnued wlthin tha Nme requlrod by lacai ordMance.1!an exlstfng ayatem <br /> !s not(alifny as deflnad Irt law,antl has at best hvo laet of design eofl sepereUaL�n fhe sysfem need rwt be upgreded,repaired,rapleced,or <br /> Its use dlsconGnued,nohwfhstenUmg any locef onlinartce tAet!s maro etrh�.7Afs provfalon does noYeppfy to systems(n shoretand areas, <br /> Wetlhead Profection Areas,or those used!n connect�On x9th h�od,bevere9e,end 1cdDln9 establlshmenta as deflned Jn lew. <br /> W1VIY,PCd.state.filll,US � 651•296�6� � 800•b51-38b4 + TKY 651•292-5332 oc 6fl4-657-3864 • Avallable tn attemattve tocmats <br /> i <br /> ; <br /> � <br /> I. <br />