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Property address: 2.D.5 0,s..c7 6-1{44S1.141.1.¶64'-' c-S Inspector initials/Date: °JP > r.-" J-)c . <br /> 4. Soil Separation—Compliance component#4 of 5 <br /> Date of installation: g-A ,-9c> 0 Unknown • Verification method(s): <br /> ShorelandMleilhead protection/Food Beverage 0 Yes ®No Soil observation does not expire.Previous soil <br /> Lodging? observations by two independent parties are sufficient, <br /> Compliance criteria: unless site conditions have been altered or local <br /> requirements differ. <br /> For systems built prior to April 1, 1996, and ❑Yes 0 No <br /> not located in Shoreland or Wellhead M Conducted soil observation(s) (Attach boring logs) <br /> Protection Area or not serving a food, 0 Two previous verifications(Attach boring logs) <br /> beverage or lodging establishment: <br /> ❑ Not applicable(Holding tank(s),no draintield) <br /> Drainfield has at least a two-foot vertical ❑ Unable to verify(See Comments/Explanation) <br /> separation distance from periodically <br /> saturated soil or bedrock. 0 Other(See Comments/Explanation) <br /> Non-performance systems built April 1, SI Yes 0 No Comments/Explanation: <br /> 1996, or later or for non-performance <br /> systems located in Shorelend or Wellhead <br /> Protection Areas or serving a food, <br /> beverage, or lodging establishment: <br /> Drainfield has a three-foot vertical <br /> separation distance from periodically • <br /> saturated soil or bedrock.* <br /> "Experimental", "Other", or 'Performance' 0 Yes 0 No indicate depths of elevations <br /> systems built under pre-2008 Rules;Type IV 5e• S-°+a r.z •�: sa..< <br /> or V systems built under 2008 Rules(7080. A. Bottom of distribution media sem'to-941.1. <br /> 2350 or 7080.2400 (Advanced Inspector ss•- 2• S' <br /> License required) B. Periodically saturated soiVbedrock $13"4 t . <br /> Drainfield meets the designed vertical Ss <br /> w <br /> separation distance from periodically C. System separation 5 s v <br /> saturated soil or bedrock. D. Required compliance separation' '(? <br /> Any"no"answer above indicates tile system is *May be reduced up to 15 percent if allowed by Local <br /> Failing to Protect Groundwater. 1 Ordinance. <br /> 5. Operating Permit and Nitrogen BMP*-Compliance component#5 of 5 IN Not applicable <br /> . Is the system operated under an Operating Permit? 0 Yes 0 No If"yes",A below is required <br /> Is the system required to employ a Nitrogen BMP? 0 Yes 0 No If"yes",B below is required <br /> BMP=Best Management Practices)specIfld in the system design <br /> If the answer to both questions Is "no", this section does not need to be completed. <br /> • <br /> Compliance criteria <br /> a. Operating Permit number: <br /> Have the Operating Permit requirements been met? ❑Yes ❑ No <br /> b. Is the required nitrogen BMP in place and Properly functioning? 0 Yes 0 No <br /> Any"no"answer Indicates Noncompliance, <br /> Upgrade Requirements(Minn. Stat.§115.55)An imminent throat to public health and safety(ITPHS)must be upgraded,replaced,or its use <br /> discontinued within ten months of receipt of this notice or within a shorter period if required by local ordinance.If the system is falling to protect <br /> ground water,the system must be upgraded,replaced,or Its use discontinued within the time required by local ordinance.If an existing system <br /> is not falling as defined in law,and has at least Iwo feet of design soil separation,then the system need not be upgraded,repaired,replaced,or <br /> its use discontinued,notwithstanding any local ordinance that is more strict. This provision does not apply to systems in shoreland areas, <br /> Wellhead Protection Areas,or those used in connedibn with food,beverage,and lodging establishments as defined in law. • <br /> ww,i4.pca.statesr n.IIs • 651.196.6300 • 800.657.3864 • TTY 651.282.5332 or 800-657.3864 • Available in alternative formats <br />