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• Property address: '46 SO ' ©'-'o Aotri 'Brise Inspector IrdtlaisiDate: Ste 3`3o-1 • 4. Soil Separation—Compliance component#4 of 5 Date of Installation: l ot.1 lr 0 Unknown Verification method(s): ShoralsndIWelltrexd P* Q °°d Beverage ❑Yea ■No Soil observation does root expire.Previous soil 1-W91W • observations by two independent parties.am sufficient Compliance criteria: unless ails conditions have been altered or local For systems built prior to April 1. 1998,and 0 Yes ❑No requirements differ.not located in Shoreland or Wellhead ■ Conducted soil observation(,)(Attach batng logs) Protection Area or not serving a food 0 TWO previous w cations(Attach boring logs) beverage orladg+g establishment ❑ Not toticable(Haling tank(,),no dralMbtd) Drainfleeld has at least a two-foot vertical ❑ Unable to verify(See Comments/Explanation) separation Move from periodically 0 Other(See Camments/Exptanatbn) saturated soil or bedrock. Non-performance systems built MO 1, I Yes 0 No Coni nentslExplanation: • 1996,or later or for non-performance systems located In Shoreland or Whelhead Protection Ames or serving a.bod, beverage,or lodging establishment: Draintbld has a three-foot vertical sepostion distance from periodically • saturated soil or bedrock.' `Experimenter, `Other",or 'Performance" 0 Yes ❑No Indicate depths of elevations systems built under pre-2008 Rules;Type IV se 0l- w 3••S ° r,'7'BAs.N,, or V systems built under 2008 Rules(7080. A. Bott m of distribution maths 54411.-to 3.4, a,$°sal 2350 or 7080.2400 (Advanced inspector sR 4 I u,k."• License required) . B. Perk:40=1r saturatedsoli/bedrock Siv a. I.o Drainfield meets the designed vertical O. System sarearationrits, 3 5 separation distance from periodically saturated soil or bedrock. D. Re nuked compliance separstinn• o•0 Any"no"answer above Indicates the system is- .May be reduced up to 15 percent If aliowed.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 Opera**Penult? 0 Yet 0 No If ayes",A below is required Is the system required to employ a Nitrogen BMP?• ❑Yee 0 No If"yes",B below,,required BMP=gest Management Practice(s)specified kr the system design If the answer to both questions is"no", this section does not need to be completed. Compliance criteria a. Operating Permit number: ❑Yes 0 No Have the Operating Permit requirements been met? b, Is the required nitrogen BMP hi place and properly functioning? ❑Yes 0 No Any"no"answer Indicates Noncompliance Upgrade Requirements(Wirer.Stat §118.55)An Imminent threat to peek aseirb and safety )must be upgraded.replaced,or Its use cfaconth,ued within ten months ofreceipt of this notice or Whin a shot*Wad ilregked by local ordinance.If the system is telling to protect wound water,the system must be upgraded replaced ores use discontinued within the lima mucked by local curare*.If an existing system Ls not keg as defined in law,end has#t least too feet of designer seprgM►on,then the system need not be upgraded.repaired,replaced,or Its use dscongnued,notwithatencIng any localomben ce that's mom sidert This prcvfsb n does not epptyio systems in shoetami areas, Wellhead Protection Areas,ar those used in connection hcrttfh food beverage.end lodging esteblishmerts as defined kiwi. WV!► ,tiltdl ,Ul 651.1%.6101 ' riii5A64 i 1TY 6i1•l&333 o' 7,3I64 ' Avallitle h s cathe flxmati .........r...._�. . 41141+)