06-04-2013 Septic Compliance - Laserfiche WebLink

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� Fro�e�rty address: ��O �,� �� 'f�, ,�,p ' ' Inspector initials/�ate: �/ ., G at3 , 4. Soil SepdrBtion—Compliance component#4 of 5 Date of instaliation: � ❑Unknown Shoreland/Wellhead protection/Food Bevere e Verification method(s): Lodging? g ❑Yes �o Soi/observa6on does not expire. P�vious soil Com liance criteria: obseivations by two independent partres are s�cient, un/ess site conditions have been alter�d or local For systems built prior to April 9, 19g6, and ❑Yes ❑No �9uirements difier. not located in Shor�land or Wel/head I�Conducted soil observation(s)(Attach boring logs) Protecfion A�a or not senring a food, beverage orlodging establishment.• ❑ Two previous verifications(Attach boring logs) Drainfield has at least a two-foot vertical ❑ Not applicable(Holding tank(s);no drainfield) separation distance from periodically ❑ Unable to verify(See CommentsiExplanation) saturated soil or bedrock. ❑ Other(See Comments✓Explanation) Non perf�nnance systems built April 1, Yes 1996, or later o�for non pertormance ❑No Comments/Explanation.• C systems/ocated in Shore/and or Wellhead ' �•,��,� �(a�� ,pA�, Protection Areas or serving a food, beverage, orlodging establishment.� t�,K �S"� �4 �,0�,.✓ Drainfield has a three-foot vertical n� separation distance from periodically �� `µ f Q,£,�D saturated soil or bedrock.* � � 'Experimental'; "Other; or Pertormance" ❑Yes ❑ No systems built unde�pre-2008 Rules; Type 1V Indicate de ths of elevations or V systems built under 2008 Rules(7080. A. Bottom of distribution media K�� 2350 or 7080.2400 (Advanced Inspector License required) ! � u Drainfield meets the designed vertical • B• Periodicall saturated soil/bedrock separation distance from periodically C. S stem se aration 38 �� saturated soil or bedrock. �/ „ D. Re uired com liance se aration' �� Any "no"answer above i�dicates the system is * Failing to Protect Groundwater. May be reduced up to 15 percent if allowed by Local Ordinance. 5. Operating Permit and Nitrogen BMP*—comp�iance com onent#s of s ❑Not applicable Is the system operated under an Operating Permit? �� » ❑Yes o If yes ,A below is required Is the system required to employ a Nitrogen BMP? ❑Yes 10 If"yes", B below is required BMP=Best Management Practice(s)specified in the system design lf 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 re uirements been met? ❑Yes ❑ No b. Is the re uired nitro en BMP in lace and ro erl functionin ? ❑Yes ❑ No Any"no"answer indicates Noncompliance, Upgrade Requirements(Minn. Stat.§115.55)An imminent thieat to public health and safety(ITPHS)must be upgraded,replace.d,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 its use discontinued within the time required by local ordinance.If an existing system is not failing as defined in law, and has at least Iwo feet of design soil separation, then the system need not be upgraded,repa)r�d,rep�aced,or its use discontinued,nolwithstanding any/oca/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 defrned in law. www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats wq-wwists4-31 • 1/24/1.2 _. - __ _ - Page 3 o f 3