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; Properry address: 1070 Hunter Drive Inspector initials/Date: RLP � 7/20/2017 (mm/dd/yyyy) 4. Soil Separation—Compliance component#4 of 5 Date of installation: 7/20/2017 ❑ Unknown Verification method(s): (mMdd/yyyy) ShorelandNVeilhead protection/Food beverage Soil obseiva6on does not expir�e. P�vious soil lodging� ❑Yes � No obseivations by hvo independent parties are sufficient unless site conditions have been altered or/ocal Com liance criteria: �quirements differ. For systems built prior to Apri11, 1996, and ❑Yes ❑ No ❑ Conducted soil observation(s)(Attach boring►ogs) not/ocated in Shoreland or Wellhead Protec6on Area or not serving a food, ❑Two previous verifications(Attach boring logs) beverage orlodging esfablishment: ❑ Not applicable(Holding tank(s),no drainfield) Drainfield has at least a two-foot vertical ❑ Unable to verify(See Comments/Explanation) separation distance from periodically ❑Other(See Comments�Explanation) saturated soil or bedrock. Non-pertom►ance systems built Apri11, �Yes ❑ No Comments/Explanation: 1996, or later or for non-peiformance systems located in Shoie/and or Wellhead New Installation Protecdon Areas or se►ving a food, beverage, or lodging establishment: Drainfield has a three-foot vertical separation distance from periodically saturated soil or bedrock." Experimental; "Othe►'; or Ferfo►mance" ❑Yes ❑ No IndiCate de ths or elevations systems built under pre-2008 Rules; Type IV or V systems built under 2008 Rules(7080. A. Bottom of distribution media 2350 or 7080.2400 (Advanced Inspector LiCense required) B. Periodicall saturated soiUbedrock Drainfield meets the designed vertical C. S stem se aration separation distance from periodically saturated soil or bedrock. D. Re uired com liance se aration* Any"no"answer above indicates the system is "May be reduced up to 15 percent if allowed by Local failing to protect groundwater. Ordinance. 5. Operating Permit and Nitrogen BMP*—Compliance component#5 of 5 � Not applicable Is the system operated under an Operating Permit? ❑Yes ❑ No If"yes",A below is required Is the system required to employ a Nitrogen BMP? ❑Yes ❑ No If"yes",B below is required BMP=Best Management Practice(s)specified in the system design If the answer to both questions is "no'; this section does not need to be completed. Com liance criteria a. Operating Permit number: Have the O eratin Permit r uirements been met? ❑Yes ❑ No b. Is the re uired nitro en BMP in lace and ro erl functionin ? ❑Yes ❑ No Any"no"answer indicafes Noncompliance. Upgrade Requirements(Minn. Stak§115.55)An imminent thieat to public health and safety(ITPHS)must be upgraded,replaced,or its use discontinued within ten months of receipt of this notice or within a shorter period if required by local ordinance.If the system is failing to protect ground water,the system must be upgraded,replaced,or ifs use discontinued within the time iequi�ed by local ordinance.If an existing system is not failing as defned in law,and has at least fwo feet of design soil separation,then the system need not be upgraded,repaired,�eplaced,or its use discontinued,notwithstanding any local ordinance that is more strict This provision does not apply to systems in shoreland areas, Wellhead Protection Areas,or those used in connection with food,beverage,and lodging establishments as defined in law. www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in altemative formats wq-wwists4-316 • 6/4/14 Poge 3 of 3