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4 of 11 <br /> Property address: 1235 Lyman Avenue, Orono, MN 55356 Inspector initials/Date: 5/16/201800 <br /> 4. Soil Separation -Compliance component#4 of 5 <br /> Date of installation: 1984 ❑ Unknown Verification method(s): <br /> Shoreland/Wellhead protection/Food Beverage ❑ Yes ® No Soil observation does not expire. Previous soil <br /> Lodging? <br /> 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 ❑ No <br /> not located in Shoreland or Wellhead ® Conducted soil observation(s) (Attach boring logs) <br /> Protection Area or not serving a food, ❑ Two previous verifications(Attach boring logs) <br /> beverage or lodging establishment: <br /> ❑ Not applicable(Holding tank(s),no drainfield) <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. ® Other(See Comments/Explanation) <br /> Non-performance systems built April 1, ❑Yes ❑ No Comments/Explanation: <br /> 1996, or later or for non-performance <br /> systems located in Shoreland or Wellhead Reviewed previous compliance inspection from April <br /> Protection Areas or serving a food, 2018. <br /> beverage, or lodging establishment: Reviewed limited records. <br /> Drainfield has a three-foot vertical <br /> separation distance from periodically <br /> saturated soil or bedrock.* <br /> "Experimental", "Other", or "Performance" ❑Yes ❑ No Indicate depths of elevations <br /> systems built under pre-2008 Rules; Type IV <br /> or V systems built under 2008 Rules(7080. See Attached <br /> 2350 or 7080.2400 (Advanced Inspector A. Bottom of distribution media Boring Log(s) <br /> License required) <br /> Drainfield meets the designed vertical B. Periodically saturated soil/bedrock <br /> separation distance from periodically C. System separation <br /> saturated soil or bedrock. <br /> D. Required compliance separation* <br /> Any "no"answer above indicates the system is *May be reduced up to 15 percent if allowed by Local <br /> Failing to Protect Groundwater. Ordinance. <br /> 5. Operating Permit and Nitrogen BMP*-Compliance component#5 of 5 ® Not applicable <br /> Is the system operated under an Operating Permit? ❑Yes ® No If"yes",A below is required <br /> Is the system required to employ a Nitrogen BMP? ❑Yes ® No If"yes", B below is required <br /> BMP=Best Management Practice(s)specified in the system design <br /> If the answer to both questions is "no", this section does not need to be completed. <br /> Compliance criteria <br /> a. Operating Permit number: <br /> ❑ Yes ❑ No <br /> Have the Operating Permit requirements been met? <br /> b. Is the required nitrogen BMP in place and properly functioning? ❑ Yes ❑ No <br /> Any "no"answer indicates Noncompliance. <br /> Upgrade Requirements(Minn. Stat.§ 115.55)An imminent threat 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 failing 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 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 <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 connection with food,beverage, and lodging establishments as defined in law. <br /> www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats <br /> wq-wwists4-31 • 1/24/12 Page 3 of 3 <br />