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05/22/2013 08:45 9528733112 PAGE 03/04 Property address: 1380 French Creek Dr, . Inspector initials/Date; JS � 5/17/2013 — .._ _ . . _ _ - (mm/dd/yYYY) 4. Soil Se aration —Campliance component#4 of 5 Date uf installation: �Unknown VerifNcation method(s): (mmiddiyyyy) $pif obse�vation does not expire. Previous soi! Shoreland/weilhead protectionlFood beverage �Yes �No observations by two Independent parties aia sufficient, lodging? unless site cond;tions have been altered or Jocal Com li� 'anc� criteria: __ rgquirements dlffer. Forsysfems built prior to Apn!1, 7996, and ❑Yes ❑ No � Conducted svil abservatian(s)(Attach borirtg logs) rrof loceted rn Shoreland or Wellhaad ❑Two previous verifications{Attach baring JogsJ Protection A�a or nof serving a food, beverage orlodging estabrishment: I ❑NDt applicable (Ho�ding tank(s), no drainfierd) Drainfield has at least a two-foot vertical I � Unable to verify(See Comments/Explanation) separation distanoe from periadiCatly I ❑Other{See Gomm�nt,siExplanaUon) seturated s�+l or bedrock. �_ Non�performance syst�ems built ApRI 9, �Yes ❑ No Commentsl�xplanatlan: 1996, or lafer vrfor non�perfonnanCe Bpring� 0-20 Sandy Loam 10YR 2/2 systems located r'n Shorefand orWelJhead Proteciian Ar�as or serving a food, 21-58"Sandy Clay 10Yr 4/4 beverage, orlodgrng establishment� Drainfield has a three-fnot vertical separ�tion distance from peri0dically saturated soil or bedrock.x "ExpenmentaP', "Othar', or nPerfermance" ❑Yes ❑ No Indicate depths or elevations -- _ . .... 5ystems built under pre-2008 Rules;Type!V � Or V systems built under 2008 Rules(7080. A. Bottom of distribution media � 20" --�-- . — 2350 or 7080.2400 (Advanced Inspector I License reqUired) I B: Perfodically saturatad soil/bedroCk _. __ Dralnfield meets the designed vertical C, System separetion __ 3B"+ separatio� distance from periodically s8turated 5of1 or bedroek. D. Required eompliance separatioct' I 36" -- Ar1y "no"answer above indicates the system is "May be reduced up to 15 percent if allowed by l,ocal faili�g to profect groundrvater. ord�nance, 5. fJperating Permit ar�d Nitrogen BMP*—Compliance component#5 of 5 � Not applicable �s the system operated under an Operating Perrnit? �Yes � No If"yes'°,A below is required Is the system required to employ a Niiragen BMP? []Yes � No If"yes", B belaw is requlred BMP=8est Menagemenf practiCe(s)specl�ed in the system design !f the answer to both questioRs is "no", thls section does nof need to be completed. Com�liance criteria a. Operating Permit number ❑Yes ❑ No Have the Dperatin,g Perm�t requirernents been met? _ .-- b_ Is the required nitrogen BMP in place and prpperly functioning? ❑ Yes ❑ No Any "no"answer indicates Noncompliance. Upgrdde Requl rements (Minn. Stat. §1?5,55}An lmminent thre6t to publk heelth and safety(fTPHSJ must be u,ogreCed, repfaced,or its use dfsconfrnued within tBn monChs of receipt of this notrCe or wr}h!n a shorter peri�l i(�puired by locsl ordinpnC2.If Phe system is fsilinq fo protect ground water, rhe system must se upgraded,repleCad,or its use tlrsConCrnued wlthln the time requrr8d by focal ord�nanCe.!f an oxisting system is not failrng eS dBfin2d!n few,and hss at leasf hn+o fe8�ol design soil sepdr�ti0n,1Hen the system qeeU nOt be upgraded, rep&ir6d,ngplaced, or lts use discontrnu9d,r+otwithstsnding any loca!onli»enc�thaf fs more strrct- Th�s provisfon doos not apply ro systems fn shore!lend sreas, Wellhead Profectip»Arees,or those used in conneCfrOn with food,beversge,dnd IodgJng establishmerlfs�s deflnad in law. --...... _._ .. _ _ _. www.peastate mn.us • 651-296-6300 • 800•657-3864 • TTY b51•28z•5332 or 800•657•3864 � Avallabte in altemdt'rve fOrmats wq-wwtsts4-31 • 3!16/1Z Page 3 of 3