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11/05/2015 12:23PM FA;t 1�0003/0004
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<br /> � J Prope a�dr6ss; 425 Ferndale Road NorEh 01'Ono ' � �i,
<br /> �' � _ _ Inspectorinitials/Date: JS 11/4/201� _', '.
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<br /> „ 4. S�il 5eparat�on—Compliance component#4 of 5 � . .: ��
<br /> ''; ' Date of I�stallation: 5/31/9s90 ❑ Unknown Verification method(s): �
<br /> I (mm/dcl/YYYY)
<br /> Shorelan�ellh�ad protectioNFood beverage Soll phserva�on does not exprie.PrevioUs SOrI ,; 6���.;,�;��
<br /> �odg��ap L�Yes � No observations by twp independent p�rtigs a�e:��cre�� :�
<br /> y. I unle8s site conditions have bean aitered or/oca/
<br /> 13 �
<br /> , Compliance crlteri�: roquir�ments diifer. �
<br /> Forsysferr�s built p»orto Apnl i, 1996, and �Yes ❑ Na �ConduCted soil observatfon(s)(Attech boringlogsJ.1 i�
<br /> notlocated in Shoreland or Wellhe&d � �. '
<br /> Protecfion IArea or not seiving a food, ❑Two prevfous verifications(Attach bonng logs) � ; -�i
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<br /> beverage orlodging est�b!lshment: ❑ Not applicable(Hold�ng tank(s),no dreinfield) ;' � t, ; �
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<br /> ' ' � , Drainfield itas at least a fwo-foot vertical ❑ Unable to�erify(See CommentsiE,rplanaflon) � � i
<br /> � separation distance from perlodiC&Ily ❑Other(See Comments/Fxp/anatia») �
<br /> saturafed�oil or bedrack.
<br /> Non- erformance S Stems builf A ril 7, ` ' `'��'' �
<br /> A y p ❑Yes ❑ No CommentslExplanation, `'", �r, ;
<br /> 1996, ar l8ter or ior non-perfOrmance . • ? , �
<br /> systems/ocated rn Shpr�land or Wellhead Boring: I �
<br /> ��i Protection Areas or serving a food, 1-14"10YR 2I2 Loam � �
<br /> beverage, 'orlodgJng establishment: '. i
<br /> 15-24" 10YR 4/4 Clay Loam .".;� '
<br /> Drainfield IiaS a three-foot vertical " ,
<br /> separefionidistance from periddiC�lly No Redox � ��y �'%'�
<br /> saturated spil vr badrock." ,';;: � 3�1' ;
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<br /> ��"i �'' "�xpenmer�ta!'; "Other'; or "Perfarmance" ❑Yes �No Indicate depths or elevationg
<br /> ` � syste�s bu,lt under p�-2008 Rul�s,-(ype!V — ::� ��
<br /> or V s ster�is built under 2008 Rules 7080. A. Bottom of distribution media lus 12" 'r °
<br /> 2350 or 7080.2400 (AdvanCed Inspector �
<br /> -. LiCense required) � B. Periodically saturated soiUbedrock Over 24`.'. " �•
<br /> Drainfield meets the design�d�ertical � ` �
<br /> ;` ,� separation�distance from periodlcall y ��tem se aration 36" lus , i
<br /> saturated SOiI or bedrock. ;.', :: `;c,'.:' 1 '
<br /> D. Re ufred com liance se arat(an' 24" �}:� 1I
<br /> Any"nvy'answer above indlcates the s,y�tem is *May be reduced up to 15 percent if allowed by,�ocal ' �' i'��fi� {;' ,!
<br /> failing td protect groundwater, ord�nance. ;j
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<br /> 5. Operating Permit and Ni�rog�n BMP"—Com liance com onent#5 � ' ' �
<br /> p p o f 5 � N o t a p p l i c a b l�e,�,:,�.,,::,�,,�Y�,i,,
<br /> !s the system operated under an Operafing PermiY? ❑Yes ❑No If"yes',',A below is requlred ' ' F '� �",:�
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<br /> Is the system requfred to employ a Nltrogen BMP? ❑Yes 0 No lf , �
<br /> �a'' _ '"yes",B below is rec{uired '
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<br /> BMP�Best Management Pracfice(s)speclfied in the system deSign �
<br /> If the a�svver tn bolh uesfions/s"no" t 's �
<br /> q , hi sectlon daes not need tn be comp/eted. c a;,,;
<br /> ::� , �I
<br /> Compliance criterla
<br /> ; ; a. ORerating Permlt number: .— � ' ,
<br /> H�Ive the Operaling Perrnit requirements baen met7 O Yes ❑ No , �
<br /> , - � < <a
<br /> b. Is�he reguired nitrogen BMP in place and properly functioning? ❑Yes L]NO ' !�
<br /> � ' Any "rio"answer indicates Noncomp/iance. � ' �'' ` � '
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<br /> Upgradel Requirements(Minn.Stat.§115,55)An imminent threat to public haalth and selery(lTPHS)mustba upgrsded,r�place�l,qrlts use y T �
<br /> diseorttln�ed within ten months of rt�ceipt af this noflee ar within a shorter period if required by/oeal atYmence.If ths system!s falGng to Qra�e"r�f,� � �
<br /> qround wat�r,ths system must be upgreded,replaced,or its use dlscontinued within the tfine r�quired by laca!onilnence.If an�acistjng�ysEe�n� s i �
<br /> is not f�ili�tg es deBned in law,and hdS�t least hao feet of design soi!separdf/pn,thBn the system need not be upgreded,repalr�d.:r9�laced;;;or �' � �
<br /> its use dlacontinued,notwifhstandfng eny loc�l ordlnance that is more strlct. This provision does noi spply m systerns!n shoreland.'are�s .- '
<br /> Fi ;': Wellhead�Protectlon AreBs,ar those usep fn Connection with Pood,beversge,andlodging estedllshments as defJned/n lew. � � E
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