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Jul. �5. 2012 3: 08PM No, 0718 P. 6 <br /> Property adciress: J 1 a.S 1�J����- �p�e,�J�, Inspector iNtials/Det�: . �' ' � (o- <br /> 4. Soil Sepa�atiOn—Compliance component#4 of 5 <br /> Date of installatbn: � � -�-b S� _ C1 Unknown Verlflcatlon mathod(s): <br /> ShorelandnNellhaad protedionlFood 8everape p Yes �No Soil obse►vation does not explle.Priavlous soq <br /> �'0de��9? obaenrations 6y iwo independent perties aR 8ulficien� <br /> Com liance criteria: unless slte conclilrons hav+�been altered or local <br /> For systema buitt prior b Apn�1, 19g6,and ❑Yec (]No �4uirements ditl�er. <br /> not/ocafed In Shonslend or Wellhead � Conducted soil observetion(s)�Attac►,bo►ing bgs) <br /> ProtecGion Area ornotserving a faod, ❑ Tvwo previous verifica6ons(A[tedr borirn�rog� <br /> 6everaqe orlodg'mg establishment ❑ Not applicable(Hold;►'►p tenk(sl,rro drairr�e�d) <br /> Drsinfield has et lesst a iwo-toot ve�ticel 0 Unable to veNfy(Ses CommentslFicplena�on) <br /> separadon distanc�from periodfcelly ❑ Other(See Corrunentsr�xprenation) <br /> saturated soil or bedrock. <br /> Non pedormance systems 6uilt Ap►111, �Yes ❑N� CommentslExplanation: <br /> 9998,or later or for qor�-perfqnnence <br /> systems looated in Shareler►d or Wellhead <br /> I�fecYron A►sas o�s�rving a food, <br /> 6eve�e,orlodgir�esteblishment.• <br /> DreiMfeld has a thnee-foot vertical <br /> separatlon dlstance irom penodlcally <br /> sstursted soil or bedrodc.' <br /> �xpedmental", �Othe�, or �Performanoe" ❑Yes ❑No Indlcate de ths of elevaticns <br /> systems bullt underpre-2008 RWes;Type/V <br /> or V systems 6uilt under 2008 Rules(?080. A. Bottom of dlsMbution medie q q�'�� <br /> 2350 or 7090.2400 (Advanoed Inspector <br /> License require� B. Periodical �alu�a6ed salWedrodc �.S��� <br /> Drainfield meets the designed vefical C. S stem se pon ���� <br /> sepa�a�on disEanoe from peri�ically <br /> satUreted soil or bedrodc. , � , � � <br /> D. uired com liance so fadon <br /> Any uno"answe�above indicafes the system is 'M2y be reduCed up to 15 perCell#1f ellOwed by L,OC�II <br /> Failing to Protect Groundwater. Ordinant�. <br /> 5. Operati�g Permit and Nitrogen BMP*—Compliance oomponent#5 of 5 � Not applica6le <br /> Is the system operated undor an Operadng Permlt? ❑Yes ❑No If"yes"�A belaw is roquired <br /> Is the sys�em required to employ a Nflrogen BMP? ❑Yes ❑No It"yes",B below is requirod <br /> BMPsBest 1Nerragoment Pr�cct�cce(s)spec/Red in d�e syslem design <br /> If the answer to both questlons is"no';this setdon does no!need�c be comp/eted. <br /> ; <br /> Com liance Griteria <br /> a. Operating Permit number: <br /> Have Ihe 0 ratin Permit re uiremer�ts been met7 ❑Yes C]No <br /> b. Is the re uired en MP in lece and ri func�ioni Yes No <br /> Any pno"answer indicates Noncompliance. <br /> Upgrade Requlrements(A�Inrt.Stet§115.5�M imminent tiueet to publlc heel�and serMy pTP.HS)musf be upyraded,replaced,or ifs use <br /> dlsc�o►�inwd w►�hin'tem m�rtlhs of recelpt ol d►►s nodos or w►bhln a sho►te►'pedod if requ�red by lo�,'�l praliten0e,lf fhe syst�m Is faDlnp to protect <br /> ground weler,the sys�em�nust bs upgvedsd.rap►aced.•or ifs use di�oDntfnued withfn d�e�me�squNed by foC�l�fnalic9.!!en exlsfing sysbem <br /> is not feilMg es deNned/n law.end hos at leesf/wo fbet of desi8n sa7 saperef�on.fhen the sYsbem need not be uppradsd�epei�ad.�pfaoed.a <br /> Its uso disour�tinued,notw�dinq arry lbcel oMlnarwe N►at fs mas ab�Act lri/a provfalon doea not epply ro sys�ems m shorel�ne arees, <br /> W�llhead Prubecfion Areas,a d►ose used in oonnecl�on wRh�+ood,be�renge�.end/odging esleWlahments es delNad In/aw. <br />