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Jun 28 2015 03:47PM HP FaxRusty Olson 7634988290 page 4 Property address: 2780 Silver Vew D�ive.,Orono,MN Inspedor initials/Date: J. O.6/28l15 4. SOII S@pd�dtl0� —Campliance component#4 of 5 Date cf installation: 1Q/04/1988 ❑ Unknown Yerification method(s): ShoralandlWelthead pro6ectbNFood Beve�age �Yes � No Lodging? Sal o6servation does nof expire.Pnsvious soil observations by two independanf parties ar�s�cienf, _CompJidnCe C�Iteria: r unless slte cnnditions have been alten�o►orlvcal For systems built pnor to April 1, 1996,and ' ❑Yes �No �Quirements differ. not located in Shon9Jand or Weflhead � Conducted soil observation(s)(Attach bonng fogs) Protection Area or not serving a faod, � ❑ Two previous verifications(Attach boring logs) beverage orlodging establishment: i ❑ Not applicable(t+ordir,q tank(s),no drainfield) Drainfield has at least a two-foot verlical ': ❑ Unable to verify(5ee Comments�xpianatron) separatian dlstance from periodically saturated soil o�bedrock. ❑ �ther(See CommentsiExplananon) Non-peiformance systems builtApriJ 1, I ❑ Yes ❑No Comments/Explanation: f 996,or later oi for non performance � systems loceted in Shoreland or WeNhead Protecfion Ar�sas orserving a food, beverage,or lodging establishment: Drainfield has a th�ee-foot vertical separation distance from periodically i saturated soil or bedrock.* i � "Experimenfal" "Other'; or "Perinrmance" ' ❑ Yes ❑ No Indicate dapths of elevations sysfems built under pre-2008 Rules; Type!V j - or V systems builf under 2008 Rules(708�. i A. Bottom of distribution med ia l 93.0 2350 or 7080.2400 (Advanced inspector Llcense required) � i B. Periodicall saturated soiUbedrodc 94.2 Drainfield meets the designed vertical j 0 0 separatior'�distance from periodically C. SYstem separation saturated soil or bedrodc. � � D. Required compliance separation" ; 2 D A/1y "l10"answer above indfeafes the system is *May be reduced up io 15 percent it allowed by Local Failing to Protec!Groundwater. ordinance. 5. Operating Permit and Nitrogen BMR*-Compliance component#5 af 5 � Not applicable Is the sysiem operated under an Operating Permit? ❑Yes ❑ No If"yes", A below is required is the system required to empby a Nitrogen BMP? ❑ Yes ❑ No If"yes", B below is required 8MP=8est Management Practice(s}speci(red in the system design !f the answer to both quas[ions is "no', th;s section does nor need to be completed. Com liance criteria a. Operating Permit number: I Have the O eratin Permft r uirements been met? j ❑Yes ❑ No b. Is the re uired nitro en BMP in lace and o erl functionin ? � ❑Yes ❑ No Any"no"answer fndicates Noncompllance. Upgrade Requireme�ta(MJnn. Stat.§115.55)An imminent threat to public heslth and saiety(17'PHSJ must be upgr�sded,replaced, pr its use discontinued within ten months of receipt of thls notice or within a shoRer penod if requlred by local ordinance.If the system!s fsilirrg to protect ground water,the system must be upgreded,nBpfBced,or its use discontrnued within the time required by lacel ordinance.1i an ezisUng system is not failing as defined In law,and has at least Mro feet of design soil separatlon, then the system need not be upgreded,repaired,repfaced,or its use�iscontinued,notwithstanding any local ordinan�that is more shr�ct. This/�rovision does not app/y tn systams in shoreland areas, We!lhead Protection A�eas,or those used in connection with fopd,beverage,and lodging esfablishments as defined in law. www.pca.state.mn.us • 651•246-6300 • 800-657-3864 . TTY 651•282•5332 or 800-657-3864 . Availabte in alternative formats� wq•wwists4•31 • 1/1d/11 Pnge 3 of 3