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Property address: 560 Kokeah Farm Road Orcmo MN Inspector initiais/Date: _J.O.6/02/17 <br /> 4. Soil Sepa�ation—Compliance cqmpanent#4 of 5 <br /> Oate ot installation: 7/27/04 ❑Unkncrim Verification method(s): <br /> ShonlandlWMihe�d pr�sctioNPood ew� ❑Yes �No Soi!observation does not exptf'i9.Previous&01! <br /> LOda�? observations b [►Mo i <br /> y ndependent pa�fies s�sulflcient, <br /> Com liancs criteris: unless site conditions have been altened or�Ocai <br /> For syshems 6uilt p►iw to April 1, 18A8,and ❑Yes ❑No re9'ui�ements difi'far. <br /> not bcated in Shore/end or Wellhead ; � Conducted sal observadQn(s)(Attadr bairg bgs) <br /> Protecdion Area or not serving a food, ❑ Two p�evious verificadons(Attac�►bortng 1v,Qs) <br /> beirerage or tod�ng esteblishment: � ❑ Not applic�ble(Hotdtrrg tank(s),rro dreinfrehi) <br /> Drair�ield has at leasf a two-foot uertical j ❑ Unable to verify(See Comr►rentsiExplanaGor►) <br /> separation disianc�e from periodically <br /> satu�eted soil or bedrodc. ❑ Other(See Comme�►ts/Exp�ana�) <br /> Non pe�fiwmance sysfiems built Aprif�, ° �Yes ❑No Comments�F�c�ar►ei�cx►: <br /> 1996,or later or/or non-perfnrr»a�e <br /> systems bcated in Shoreland or Wetlhead i <br /> Protecb'on Arees or serving a fiooal, � <br /> bever�qe,orlodging estabtlshment ; <br /> Drainfield has a thre�-foot vertical ( <br /> separation distanoe Trom periodicaly a <br /> saiurated sal or bedrodc.' <br /> "Experimental" "Othe�',or °Psrfamance' ❑Yes ❑No IndlC�to de ths of slev#tions <br /> systems buitt under p�e-2008 Rules;Type lV <br /> or V syshems built under 2008 Rutes(7�. A. eottom of d�ibution media 109.5 _....._.. <br /> 2350 or 7080.?400 (Advanced Inspector <br /> License required) � B. Periodicall saturated soiUbedrodc 1Q8.9 <br /> � <br /> Drainfietd meets tl�e designed v�rtical ' C. S te�n ae ration 2.8 <br /> separation dista�oe from periodicaly ; <br /> saturated soil or bedrock. ; D. ReQuirod C�»qliaf�ce seDat8ti0n• � 2.6 <br /> Any"no"answer above ina�catas the aystem fs •Mey pe,�educ;ed up to 15 percerrt N allowed by Loca1 <br /> Failing to Protect Groundwat�v: Ordinanoe. <br /> 5. Operating Permit and Nitra�en QMR*-ccxnp�iance component#5 of 5 �Not applicable <br /> Is the syatem opereted under an Operating Pennit? ❑Yes ❑No If"y�",A bslow is required <br /> Is the system required to empby a Nitrogen BMP? ❑Yea ❑No If"y�",B belcw is required <br /> BMP=Best Management Pr�6Pce(s)specfied fn(t►e sys�+em design <br /> !f d�e ansrrer to bodr quos�ons Js"no';�is soctfon does not need i�o bo complst�ed. <br /> Complisnce criterla <br /> a. Operating Permit number: � <br /> Have the Operating Permit requirerran�been met? a �Y� ❑No <br /> ; <br /> b. Is the required nitrogen BMP in plac�and propedY functianing? ❑Yes ❑No <br /> Any"no„answer indicatea NoncompUance. <br /> Upg�RequinmsMs(Muu►.StaG§115.5��imml►�snt mreat to p�bNic hea/hb end set�ty(lTPHS)must be upgraBed,r�placad,or its use <br /> discor�in�sd wKtun ten rrwr►ths M rewipt�'d�is notkse ot witf►rt e aNarDer per�af N requirad by bca/adVner�ce.If die syatem Js fallfrrQ to p�tect <br /> ground wsA�r,die syst�m must be upqradsd,reA�eced,or lts r�dfso�nued�tt►in tlie time required by bcel adinance.!P an ex�dr�sysfem <br /> is not fa�fi►g es dsflned ln/aw,�d has�lsa�tt�o taM9t at dss�gn�!sep+�s6on,fhen the syalem need rx�t be upgm�ed,ropeir�sd,r+eplaced,or <br /> its u�e�ntinued,no�ithstandbag arty Ibcat otdinartce thaf is m�e sh�iCL This A�vi�doea not apply to systems!n�oretsnci er�as, <br /> Wel�head Protection Arees,ar ttto�e u�i in vwtne�ction►v#t►faod,bev+erag�e,arni/odgir►g es�bllsluner�ts as deflired fn law. <br /> www.pca.state.mn.us • 651-296-63pp • 800-657-38b4 • 'TT'Y 65t-282-5332 a 800-657-3864 • Availat�in attemative formats <br /> wq-wwists4-3f • fl24/1Z Poge 3 of 3 <br />