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<br /> �'roperty a8dress. 151C1 Green Tioe Road Inspector initials/Date: JS 5/17/2013
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<br /> Irnm,�dd/yYvy!
<br /> 4. Soi! Separation -� Compliance component#�i of 5
<br /> Date of installation_ 1p/15/1992 _ �_j Unknown VerifiCatio� methoci(s):
<br /> (mm/dd1Yy.YyJ
<br /> ;h�rwland/WeHhpad�rotection/Fovd beverape � �Oi/observ�iron dnes rro!exprre. Prnvrpus SOiI
<br /> Io�J rn,7 ���'�`-'s �� r10 �n�ervefions�y hvo independenf parties are suN;clpnl.
<br /> � n U/7ICSS S%lF'CAl1CJl�lOI75 II%3V9 bB@r1 Alrol3C}Of IOC?I
<br /> _ Compliance c�ite�ia' ��yuir�ments OrNpr.
<br /> F�rsysf�ms Duilfprio�fo Ap�il 'f, �996, and 1 j Yes i. J No � COnduCted soil Observation(s)(QttacJ�DannoloqsJ
<br /> no�locafed in Si�orBland or Welfhead �
<br /> 1'rotar,fion Area ornot servinq a food, :�TWO p��viouc verifications (Attach boriny loas;
<br /> beve�age or lodginy establisJ�rnenf.� I I] Not applirable (Holding tank(a),no dreinfreld)
<br /> C�rainfield h:�s 3t least a fao-fx�t vertical j [j Unab(A io verify(See Comm9nrs•�xplanation)
<br /> separation dist�nCe(rom perir�di�ally r] Oiher(See Comments�ExpinnAlionJ
<br /> :aturated soil ar bedrpck, I
<br /> N��n-per(ormance�vstemsbuilrAFri! 1, �,] Yes ( � No Comments/Explanatlon:
<br /> 199G, or l�fer or for non-perfnnnancc
<br /> sysiems lo<:af�;d in Shorelend or V6'e!lhe�d �oring• 0-15 Sandy Loam 10YR 7J2
<br /> /'rvtecfinn flre�s orservrng�-� fond, 1G-7.1"Sandy Clay 1DYr n/a
<br /> h�i��erage, or lorlging estr�blrshment:
<br /> �J�ainheid has a thrPe- 25+ Sandy Gravel mix
<br /> ioot v�•rtical �
<br /> sep�ration distance trom prriodically I
<br /> saturated s�il or bedrocY. '
<br /> "Fx,oerrmenla!". "Othrr'. or "F'er�om�ancr," [-' Yes [:) No Indicate depths orelevations
<br /> sys(ems huilt underprr-200B f?u1r_s,- 7v1�^lV - --- _-i----- _ .
<br /> or�/,,y.sfem,Duilf undPr 2G08!-2ules j70R0. ' _�1. Bottom of distributfon medir � 20"
<br /> Z3��O Or�'JBU."Zt00 {AdvanCCd InRpe�or _...._......._. __._... __
<br /> i
<br /> l IC�flse r�quired) t1. F`?iiodicall 98iU�a�eC 3011lGeCrock
<br /> , —_�__Y—_—._.___ -�----_ - —
<br /> f7rainfield mc�ts thN designed verlic�l C System separatian i 36"+
<br /> �eparation distance frorn pericxlically ---— -- -------- ------
<br /> saturated:oi;or bedroch. � _ D. Reqvired compliance seearation' 36"
<br /> _._. __.... .._._---�------ -—�_�___... ._ _�� ------ -
<br /> Any "no"answer above fndicates the System is 'May be reduced up to ?5 percenl if allowed bV Local
<br /> failing to profect grour�dwater, ord�nance.
<br /> 5. Operatina Pe�mit_and Nitrogen BMP" -- Gompli�n�A component�s5 of 5 Q Not applicable
<br /> Is th�: sy,tem operatad under an Uperatiny f'crmit^ _j Yes �'a Nu If"yes",A beiow is required
<br /> Is ,he systern required to empiny a Nitroge.n BMP^ ��`/�s I}� No If"yes", f3 below Is required
<br /> F�MP-6est Manager�tcr�l Yr:�cfice(sJ spcciTiqc,'in Ihe sy5fem da,srqn
<br /> N tNP. af7SWRSr�O tJOfI7 l�U8Sf10RS is "no", this section does not nepd to be cnmpleted,
<br /> Com liance critPria
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<br /> a. O eralin P� - -�-•--
<br /> p g rmit number� _ I
<br /> ❑Yss � No
<br /> ____f lave th�:Qperating F�errnit requirernents beeri met?
<br /> •---- -
<br /> b.__Is lh�requirecf nitruuen GtV1P in�2ce and properly�imCtioning7 [7 Yes_.❑ No
<br /> Any "no"answer indreates Noncompliance,
<br /> Upgc:ide Requirements (n.tr'nn. Sta1. § i 1i.55)An irnminpnl fhreat to pr;blic healfh snri safefy(l7pHS)musf b�upvrr�deQ, repltic�d.or rts r�se
<br /> Ui�c.nrtln��ad�+ithin;en monfAs o(mr_r,rpi of thi:r;utice vr wrthrn a shn�t�r pgrrod ii ro0vimd hylvcal ordin�nce_!l ttre syal!am;s Ieiling lo Frot�ct
<br /> o.^C�und weter fAe syst�m must pe upr�n�rleJ,r+aplaced.or l(s w^R!1rsConf�nur:U within th�timn required by f�ir_al onJrnance. Il en existrno system
<br /> is not feilinq.9g UOrinnQ in fe�i, er,d heF.3f�Fti;f(Wo(6r}7f da�iqrr ooil 8ep9rBtlOn, !1 iBf7 lhP.GyC1E7n�tCCU r10f UC uQfjnJBd,rFipaired, �9pL9r,?!1, pr
<br /> +fs v.:w Jiscunfinurd, r�oruvrh5tend�ny�rty lor�l orNqrarrr.a tn,41�s ,nn,���nrt Ih�s pro;•rsion Ur�ps nor a�pfy rn sy�Iems�n snor�p�and:-ro�s,
<br /> wour,aau�;�r�a���n���Hs,t�r fl;o:e�lsr��i rn�:nrnAcfron�.vj�h 1pOR. bry.�1�3?�.7rld IVdli�lU!�.^-fabl�;hment.:as deTined ir,lgw.
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<br /> �++.pCa.�kat•�,mn,u: • 55i-2�r-53UU • 500-65'•�A(,n . --:r'tY h51-282-5332 or y00-b57-385�1 • Availahtr in attFrnarive !c,�m�t:
<br /> wn-ntivic�cd-'i} . ;�A�i?
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