07-25-16 Septic Compliance - Laserfiche WebLink

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. � � Property address: 795 Lakeview Parkway Inspector initials/Date: RLP � 7/25/2016 (mm/dd/yyyy) 4. Soil Separation—Compliance component#4 of 5 Date of installation: 7/25/2016 ❑ Unknown Verification method(s): (mMdd/yyyy) ShorelandNVellhead protection/Food beverage Soil observa6on does not expi►e. Previous soil lodging� ❑Yes � No observa6ons by two independent parties are su�cient, unless site conditions have been altered or/oca/ Com lianCe Criteria: requirements differ. Forsystems built prior to Apri!1, 1996, and ❑Yes ❑ No ❑Conducted soil observation(s)(Attach boring logs) not located in Shoie/and or Wellhead Protecfion A�a or not serving a food, ❑Two previous verifications(Attach boring logs) beverage or lodging establishment: ❑ 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 performance systems builtApril 1, �Yes ❑ No Comments/Explanation: 1996, or later or for non performance systems/ocated in Shorieland or Wellhead New Installation Protection A�as or serving a food, beverage, or lodging establishmenf: Drainfield has a three-foot vertical separation distance from periodically saturated soil or bedrock* Experimental; �Other", or Peifo►mance" ❑Yes ❑ No IndiCate de ths or elevatlons systems built under pre-2008 Ru/es; Type IV or V systems built under 2008 Rules(7080. A. Bottom of distribution media 2350 or 7080.2400 (Advanced Inspector License requir'ed) B. Periodicall saturated soil/bedrock 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 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 threat 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 sho►ter period if required by local ordinance.lf the system is failing to protect ground water,the system must be upgraded,replaced,or its use disaontinued within the time required by local orclinance.If an existing system is not failing as defined in law,and has at least two feet of design soil separation,then the system need not be upgraded,repaired,replaced,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-wwists4-31b • 6/4/14 Pnge 3 of 3