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Mar 28 2017 10:22AM HP FaxRusty Olson 7634988290 page 4 <br /> Property address: 1805 Sixth Ave. N.,Orano,MN Inspector initials/Date: J. 0.3/20l17 <br /> 4. $011 Separati011—Compliance component#4 of 5 <br /> Date of instatlatlon: 7/10/2006 ❑Unknown Verification m�thod(s�: <br /> 3horefarldNUellheed protaCtlonlFOod B6v9rage �Yes � No Soil abservation does not ex re.Prevlous soi! <br /> Lodging4 obseroations by two independent parfies are scrh9clen� <br /> Com lianCe Criteria: un�ess site condltlons have been altered orloca! <br /> requiraments dif/�r. <br /> For systems built priar ta Apri!1, 1998,and ❑Yes ❑No <br /> nof�ocaled in Shoreland or Weflhead � Conducted soil obsenra6on(s)(Anach bo►inglogs) <br /> Protectlon A�a ornotseiving a food, ❑ Two previous ver�cations(Attach bonbylogs) <br /> beve�nge orlodging establishmenf.• <br /> i ❑ Not applicable(Hokiingr tank(s),no drainiield) <br /> Drain6eld has at least a two-foot vertiCal � ❑ Unsble to verify(Sse Commer►ts/Explenatlon) <br /> separation distanoe from periodically ❑ p�er(See Comrnents/Exp/anacia�) <br /> saturated soil or bedrodc. <br /> Non-peAWmance systems built ApriJ 1, �Yes ❑ No Comments/ExpJanatron: <br /> 1996,or later or fornon-periormence <br /> systems located in Shoreland or WeNhead <br /> Protection Areas arserving a fbod, <br /> beveraga,or lodging establishment• <br /> Drainfield has a thr+eo-ieot vertical <br /> separation dista�ce from periodically <br /> saturated soil or bedrock` <br /> °Experimenta!" "Othe�;or "Pertormance" � ❑Yes ❑ No Indicate de ths of elevatlons <br /> syatems built under pr�-2008 Rules,�Type IV <br /> or V systems bullt under 2008 Rules(7080. A. 8ottan of dlatrlbution media 105.6 <br /> 2350 or 7080.2400 (Advanc�d Inspedor � <br /> License required) B. Penodicall aaturated soiUbedroCk 1Q2.8 <br /> Dreinfield meets the designed vertical C. tem se eraton 3.0 <br /> separatian distance from periodicafly <br /> saturated soil or bedroCk. D. uired com liartoe ratan' 2.8 <br /> A►'�y"no"�RswerabOve indic8te5 the system 1s •May be reduced up to 15 percent if allowed by Local <br /> Failing to Protect Groundwat�er. Ordinance. <br /> 5. Operating Permit and Nitrogen BMP"—Compiiance cornponent#5 of 5 �Not applicable <br /> Is the system operated under an Operating Permit? ❑Yes ❑ No If"yes",A below is <br /> requl red <br /> Is the system required to employ a Nitrogen BMP? ❑Yes ❑ No If"yes",B below is required <br /> 8MP=8esf Management Practioe(s)specified in the system design <br /> If the answer tn both questlons!s "no'; thls section does nct nood to be comp/eted. <br /> Compliance crite�la <br /> a. Operating Permit number: I <br /> Have the Operating Permit requirements been meY? � ❑Yes ❑No <br /> b. Is ihe required nitrogen BMP in place and properly fanctioning� ' ❑Yes ❑No <br /> Any "no"answer indicates Noncompliance. <br /> upgraae Requ�remenrs(n�linn.stet.§f 15.ss)A„Jmmrnenr mreat ro poalFc neand snd satery pTnr�s1 musr ne upqraded,ieplaced,or Rs use <br /> discontinued wi(Mn ten months of roceipt of thls notiae or within a shater period il raqu/red byloce/orCinance.If U►e system is feifrng to prot�ct <br /> ground watBr,8he system must be upgraded,r9pleCeCl,or its us9 disCOnlinued within the drne requir�d by(ocel ordirtance.!f an existing system <br /> is rrot failing as defined in law,and has st leasf fwo fsef af dasign aod s�eparation,then tfte System naed not be upgraded,repafred,rt9placed,or <br /> ils use dr'sr.ontln ued,notwithstarrding arryloce!ord�nance that is mor�sirict.Thls piovisian does not epRly to systems in shoreland ardas, <br /> Wellhead Protection Areas,pr those used in connection with food,beverage,and lodgirp astablishments as defined!n law_ <br /> www.pca.state.mn.us • 651-296-6300 • 800-657-3864 . TTY 651-282-5332 or 800-657-3864 • Available in altemative formats <br /> wq-wwJsts4-31 • 1/241 i2 Aqqe 3 of 3 <br />