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l a Property address: 1540 Sixth Ave N,Orono, MN 55356 Inspector initials/Date: � � 10/24/2016 — — — — -- — --_ _ _ - (mm/dd/yyyy) 4. Soil Separation— Compliance component#4 of 5 Date of installation: 09/17/1993 ❑ Unknown Verification method(s): (mm/dd/YYYY) — — ShorelandlWellhead protection/Food beverage Soil observation does not expire. Previous soil lodging? ❑Yes � No observations by two independent parties are su�cient, unless site conditions have been altered or local _Com�liance Crlteria: requirements differ. — -- _ - . __ For systems built pnor to April 1, 1996, and i �Yes ❑ No � Conducted soil observation(s) (Attach boring logs) not located in Shore/and or Wellhead ❑Two previous verifications(Attach boring logs) Protection Area or not serving a food, beverage or lodging establishment: ❑ Not applicable(Holding tank(s), no drainfield) Drainfield has at least a two-foot vertical I ❑ Unable to verify(See Comments✓Explanation) separation distance from periodically ❑ Other(See Comments/Expianation) saturated soil or bedrock. I, Non-performance systems builtAprrl 1, � ❑Yes ❑ No Comments/Explanation: 1996, or later or for non-perfoimance ' 12 inches of sand under rockbed systems located in Shoreland or Wellhead Protection Areas or serving a food, beverage, or lodging establishment: � Drainfield has a three-foot vertica� separation distance from periodically saturated soil or bedrock.* s s ems built under re-2008 Rules; T e IV "Ex enmental", "Othe►", or "Pe�formance" i ❑Yes ❑ No Indicate de�ths or elevation8 - _ -- - - _ Y P YP ' or V systems built under 2008 Ru/es(7080. i A. Bottom of distribution media 12 inches of sand - _ - - - - - _ 2350 or 7080.2400 (Advanced Inspector License required) B. Periodically saturated soil/bedrock 24 inches — — --- -- —_ . _ _ _ _ Drainfield meets the designed vertical C. S sy tem se�ation 1 _ 36 inches separation distance from periodically � — - -- -- — — -- - - saturated soil or bedrock. I D. Re uired com liance se aration' I 31 inches _ _ _ _ - -- - .._- - -= -— -— — — _9_ P— � _ _ _ __ _ _ _ Any "no"answer above indicates the system is `May be reduced up to 15 percent if allowed 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 Operating Permit? ❑ Yes ❑ No If"yes",A below is required Is the system required to employ a Nitrogen BMP? ❑Yes ❑ No If"yes", B below is required BMP=Best Management Practice(s)specified in 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 ❑ No Have the OperatincZPermit re uirements been met? b. Is_the required nitrogen BMP in place and�roper�functionin�? ❑Yes ❑ No _ _ _ — - -- . Any "no"answer indicates Noncompliance. Upgrade Requirements(Minn. Stat.§115.55)An imminent threat to public health and safety(ITPHS)musf be upgraded,replaced. or its use discontinued within ten months of receipt of this notice or within a shorter period if required by local ordinance. lf the system is failing to protect ground water, the system must be upgraded, replaced, oi its use discontinued within the time required by local ordinance H an existing system is not failing as defined in law,and has at/east two feet of design soil separation, then the system need not be upgraded,repaired, replaced,or its use discontinued,notwithstanding any/ocaf ordinance that is more strict. This provision does not apply to systems in shoreland areas, Wellhead Protection Areas,or those used in connection with food,beverage, and lodging establishments as defined in law. - _ __ ___ -- ----- -- - __ _ — _ __ — www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Avaitable in alternative formats wq-wwists4-31 • 3/16/12 Page 3 of 3