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Nov 11 2016 09:08AM HP FaxRusty Olson 7634988290 page 4 <br /> Property address: 2990 So_merset Lane Orono MN _ Inspector initials/Date: J. 0, 10l27h6 <br /> 4. SOiI S2pa�ation—Compliance component#4 of 5 <br /> Date of installatlon: 5/25/1995 Q unknown Ve�liication method(s}: <br /> Lh�orelandlWelihead protectiaVFood Beverage �Yes � No Sor!observa6on does not expire. P�vrous soi! <br /> a' e <br /> observaHons by two independent partles are suffrcient, <br /> CompliarlCe C�'ite�ia: unless site condifions have been affeied or loca! <br /> i� requiiements differ <br /> For sys[ems 6uilt prior to April 1, 1996, and I �Yes ❑No <br /> not locatod in Shoreland or Wellhead ' � Conducted soil observation(s)(Attach bonng fogs) <br /> Protection Area or not serving a food, ; ❑ Two previous verifications (Attach bwinglogs) <br /> beverage or lodging establishment• i <br /> ❑ Not applicable(Hokting tank(s),no drainfield) <br /> Drainfiefd has at least a two-foot vertical ❑ Unable to veriiy(see CommentsiExptenavon) <br /> separation distance from periodically ; <br /> saturated soil or bedrock. � ❑ Other(Sse CommentsiEup/anat�on) <br /> Non-peAormance systems builf April 1, i ❑Yes ❑No Commer+ts/Explanation: <br /> 199B,orla�erorfornon-performance I <br /> systems Jocated in Shoieland or WeNhead � <br /> Protectia►Areas orserving a food, <br /> beverage, orlodging esfabflshment: i <br /> i <br /> Drainfield has a three-foot vertical <br /> separation distance from periodicaly <br /> satureted sa!or bedrock.* i <br /> `Experimental" "Othe�;or "Performance" i ❑Yes ❑ No Indicate depths of elevations <br /> systems buiJt under pre-2008 Rules; Type!V I <br /> or V systerns built under 2008 Ru1es(7080. A. eottom of disiribution madia 106.5 <br /> 2350 or 7080.2400 (Advanced tnspector ' <br /> License required) I B. Periodicau saturated soillbedrock I 103.5 <br /> Drairrfield meets ihe designed vertical C. S stem se araUon 3.0 <br /> separation distance fram penodieally i <br /> saturated soii or bedrock. <br /> D. Required oompliance separation• I 2.0 <br /> AI9y"no"answerabove indicates the sysfem is •May be reduced up to 15 percent if allowed by Local <br /> Failin to Protect Groundwater. Ordinanoe. <br /> 5. Operating Permit and Nitrogen BMP'"—Compliance component#5 of 5 � Not applicabfe <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",6 below is required <br /> BMP=Best Management Prscdce(s)spe�ed in ths system design <br /> N the answer[o both questions Is "no", this sect/on does net need i�o be completed. <br /> Compliance criterla <br /> a. Operating Permit number: <br /> Have the O eratin Permit r uirements besn met? ! ❑Yes ❑No <br /> b, _ Is the requi�ed nitrogen BMP in place and properly functioning7 ❑Yes ❑ No <br /> Any"no"answer indicafes Noncompliance. <br /> Upgrade Requirements(Minn. Stat§115.55)An immirrent threat to public health end satey(lTPHS)must be upqraded,repla�d,or its use <br /> dlsconlinued within ten monfhs of receipt oi this nottca a'within a shorter period ii required by bce!�nence.!f the system is failing to profect <br /> ground water,the system must be upgraded,replaced,or its use discontinued within the time required by loca!prClinence.ff an existing system <br /> is not faifiny as defined in law,and hes at least h+vo feet of desigvr soif sepe�tion,then the system need nat be upgraded,r�paired,replaced,or <br /> its use discontinued,nohnrith�arxling eny loce!ordlnanCe that!s more strict. This pmv/slort does not apply to systems in shaeland aleas, <br /> We1/head Pmtectlon Areas,or those used in connecSun wlth food,bev�srage,end lodging establishmenfs as defirted in law. <br /> www.pca.state.rnn.us • 651-2%•6300 . 840-657-3864 . TTY 651-282-5332 or 800-657-3864 • Available in altemative formau <br /> wR-�sts4•31 • 1/14/12 <br /> Aage 3 oj 3 <br />