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May 0812 04:13p 763-213-0695 p.3 <br /> Property address: f� �O�j ��/'�S �.f� O�0/VO , _ Inspector initialsJDate:�WI� �-�l- /a <br /> ���1.� <br /> 4. SO�I Sepol'atiOrl-Gompliance cornponenf#4 of 5 <br /> Date of installation: J 9�'� Q Unknown veri�ication method(s): <br /> Shore�artdlwellhead prot�wvFood Baverage �yes No <br /> Lodging't � Soi►�servation does not expire. Pnevious so;! <br /> observa6ons by h�ro irxlependent pafies are su�cient, <br /> Com liance criteria: unless site condr6ions have been a�ter+ed orloca/ <br /> For s stems built requir+ernents diA►er. <br /> Y pRor to April 1, 1996, and �Yes ❑ No <br /> not�ocafedin Shoreland orWeqhead � Conducted sail observation(s) (Attech boring�oys) <br /> ProfecGon Araa or not serving a food, ❑ Two previous verifications(Atfach boring/ogs) <br /> beverage orlodging establishmen�: � <br /> Q Not applicable(Holdng tenk(s),no drair�efd) <br /> Drainiield has at least a two-foot vertical Q Unable io verify(See Cvmmeni�Euplanatron� <br /> separation distance from periodicaFl <br /> saturated soil or bedroctc. y ❑ 01her(See Comments/Explana6on) ' <br /> Norr-performance syshems hur7t Aprrl 1, ❑Yes ❑ No CommentslExplsnation: <br /> 9996, orlat+�rorfornon-performan�ce <br /> systems Ibcated in Sho�eland or Wellhead <br /> f'�Uection A�eas oiserving a f+�oal, <br /> beverage,orlodging establ�shmenh <br /> Drainfield has a three-foot vertica! <br /> separation distance irom periodically <br /> saturated soil or bedrodc.' <br /> "Experimental" "Oriier', or "Performance' �Yes ❑ No I�IdiCate depths of eleveti011s <br /> systems buflt under pne-2008 Rules;Type IV — <br /> or V syshems built under 20a8 Ru/es(7080. a►. Boiltorn af distribution media �1 � <br /> 2350 or70�0.2400 (Advanced�nspector <br /> License reqt�ired) , <br /> B• Periodical sa urabed soil/bedrock 8 <br /> Drai�e(d meets the designed ve�pl C, S ratan , � <br /> separation dstance from periodically <br /> salurated soil or bedrock. � � t <br /> D. Re uired oom liance se ara(ion"' <br /> a t <br /> i4l1y "no"answer above indicates fhe systern is �y be reduced up to 15 percent if allowed by Loca! <br /> FailiR9 to Protect Gmvndwater, ordinance. <br /> 5. Operating Permit and Nitro�Cen BMP"—compiianoe component#5 ot� �JVot applicabte <br /> Is the sysbem operated underan Op�ating Permit? ❑Yes �No If"yes",A below is required <br /> Is the system requfred to employ a Nitrogen 8MP? ❑Yes �No If"yes",B below is r�uired <br /> BMP=Besf Ma�agem�enf Preclice(s)speafied in the system design <br /> N fhe answer t�o both quesfiorrs is "no', fhis section does not need to be comp/eted. <br /> Com lia�ce criteria <br /> a. Opereting Permit number: <br /> HaVe the O erati Pertnit re iremerrts been me1? ❑Y� ❑No <br /> b. Is fhe required nitrogen BMP in place and prope�ly fu�ctic�ing� ❑Yes ❑No <br /> Any "no"answer in�cai�es Noncompliance. <br /> Upg rade Requiremerrts(MPnn. 57aL§J 15.55J An imm/nent fhreat ta publrc heal5�r and safeiy(ITpHSJ must be u�pgraded,replaced,or its use <br /> discor►t�'nued withr►r t�en mondrs of rece+pl of this notice or w'rfhin a shorter pe►!od it required by loca/o�il�noe!f the sy5tem is fei/Nrg!o pri�tect <br /> ground wefer, the system must be upgraded, r+�placed, or rts use d/aoon6nued w/thin fhe fime requi�ed by loca!ordina►ICe. If an�cisting system <br /> is not feilinq as�ned in law,and has st laast hvo feet of deslgn svil separatl�vn,then[ha system need not be upgraded, ►�eile�n9placed,or <br /> �7s use dlsconBnued,rrorivl�hstand/n�any Wce!adlnan�ce thai/s more shrct This provlslo�r does not ap�y(p sys6ems fi shore/and anea� <br /> INf�Hhea�!ProlscGbn Aroas or fhose used in oonne�cLion with faod,bey�erage, end lodg/ng estaWishrnents as defined in law. <br /> www.pca.state.mn.us • 651-296-6300 • 8D0•657-3864 . TrY 651•zB2-5332 or 800-657-3aea • hvaiiahls+/n alrornerti..e s......�» <br />