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Property address: 2915 Somerset Lane,Orono,MN ____ _ Inspector initials/Date: J.O.8/08/18 4. SOl( Sepat'etiOn—Compliance component#4 of 5 Date of installation: 10/29/02 ❑Unknown Verification method(s): ShorelandANellhead prote�tioNFood Beverage �Yes �No Soil observafion does not ex ire. Pr+evious soil Lodging? observa6ons by two inde�dent parties are suff'icient, ComplianCe Criteria: un/ess site conditions have been altered orlocal For systems built prior to Apri11, 1996, and I ❑Yes ❑No �4uirt4ments differ. nof located in Shore/and or Wellhead � Conducted soil observation(s)(Attach baing logs) Protec6on Area or not serving a footl, ❑ Two previous veriflcations(Attach bori»g Iogs) beverege or lodging establishment: ❑ Not applicable(Holding tank(s),r►o drain6eJd) Drainfield has at least a two-foot vertical ❑ Unable to verify(See CommentsiExp/anatfon) separation distance from periodically saturated soil or bedrock. ❑ �ther(See Comments/Explana6on) Non-performance systems built April 1, �Yes ❑No Comments/Fxplanation: 1996,or/ater or for non-perfo►mance systems located in Shoreland or Wellhead , ProtecHon A�as or serving a food, beverage, or lodging establishmenf: ' Drainfield has a three-foot vertical separation distance from periodically saturated soil or bedrock." _ _.___ . i "Experimental" "Othe►'; or "Perfom►ance" ` ❑Yes ❑No IndiCate depths of elevations systems built under p►B-2008 Ru/es;Type IV � — T- or V systems built under 2008 Ru/es(7080. A. Bottom of distribution media 100.0 2350 or 7080.2400 (Advanced Inspector License required) , B. Periodically saturated soiubedrodc 97.3 -- - __ ___� — Drainfield meets the designed vertical C. System separation ! 2.7 separation distance from periodically ' -- -----+---- saturated Soil Or bedrock. D. Repuired complianoe separation' ' 2.6 _ _ _ ___ Any "no"answer above indlcates the system is *May be reduced up to 15 percent if allowed by Local FaI�f�9 fo Profect Groundwater. Ordinance. 5. Operating Permit and Nitrogen BMP'`—Comp�iance component#5 of 5 �Not applicable Is the system operated under an Operating Permit? ❑Yes ❑No If"yes",A below Is roqufred Is the system required to employ a Nitrogen BMP? ❑Yes ❑No If"yes",B below is required BMP=Best Management Prac6ce(s)speciBed in the system design If the answer to both questions is "no'; this section does nof need to be completed. Compliance criteria --- _ __-- a. Operating Permit number: Have the Operating Permft requirements been met? � ❑Yes ❑No —�------ b. Is the required nitrogen BMP in place and properly functioning? i ❑Yes No Any"no"answer Indfcates Noncompllance. Upgrade Requlrements(Minn.Stat.§115.55)An imminent thieat fo public health and satety(ITPHS)must be upgraded,replaced,or its use discontinued within ten months of recsipt of fhis notice or wlthln a shorter perlod it required by local ordinance.lf the system is failing to protect ground water,the system must be upgraded,replacad,orlts use dl�tinued wlthin the time required by loca/adinance.If en existing system is not failing as defined in law,and has at least two feet of deslgn so!!separation,then the system need not be upgreded,ropeirod,rt9p/eCed,or its use discontinued,nolwithstanding any loca!ordlnaiK:e that Is mo�e sbtct. Trils provlslon does not epply to Systems!n Sh0►@IAlld en998, Wellhead Protection Areas,or those used in connectan wlth food,beverage,and lodging establishments as defined in law. _ -- - — _.. www.pca.sWte.mn.us • 651-296•6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-38G4 . Available in altemative formatr wq-wwists4-31 • 1/24/12 Poge 3 of 3