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Ptoperty address: 625 Spnng Hill Road,Orono,MN ___ inspector initials/Dete: J_Q_3/12/17 4. SOiI Sepa1'BtiOl1—Compliance component#4 of 5 Date of inatallation: 9104/94 ❑Unknown Verification method(s�: sh°nis"dNVN�Mad proactl°NF°°d e°v°r�g° �Yes ❑No Sa/observa6on does not expine. Pievious�i! �O�i�� observadons by haro indepen�nt parties are suKrcient Compliance criteMa: unless site catdifwns have been altered or lacat ��- �equiiements dilKer. For sysiems built prior to April 1, ?996,and , ❑Yes ❑Na not locat�ed in Shorelend or Wefihesd � Conducted soil observation(s)(Attacn don!ng�ogs) Protection Area or not senrir►g e food, ❑ Two previous verifications(Attach 6aing lags) beve�age or lodging establish�nent: ❑ Not applicable(Hddirtg tank(s),r�draiMieldj Drair�field has at least a two-foot vertical I ❑ Unable to verify(See Corrrments�E'�cpJanatio�y separation distance from periodicaily setureted 5oi1 Or bedroCk. ❑ �het(See Carrmentsl�xpienation) Non perfomtance systems built ApRI 9, '' �Yss ❑No CommentslEJcp/anation: 1996,or later or ior non-perfomrance systems bcated M Shore/and or Wellhead Protec6on Areas or serving e food, bevergge, or bdging esteblishment: Drainfield has a three-foot vertical separation distance hom periodically ' saturated soil or bedrodc.* -- _..... _..._..— _�—._ . ___.____...._ "Experimental" "Othe�; or Pe►formance" '; ❑Yes ❑No Indicate depths of elevatlons systems built underpre-2008 Rufes;Type/V ; or V systems buik under 20Q8 Rules(7080. ' A. eottwn of distribution media ' 90.6 2350 or 7080.2400 (Advanced Inspedor ' License required} ', B. Periodically saturated soivbedrock � 87.6 _ Drainfield meets the designed vertical C. System sevaration � 3.0 separation distance from periodicelly ' __.................. saturated soil or bedra�c. j D. Required c�mDliance separation' ,. a.._2.6 _.___..__ Any"no"answer above lndfcates the syst�rr Is •May be reduced up to 15 percent if allov�d by Local Fa/l�ng to Protect Groundwater. Ordinance. 5. Operating Permit and Nitragen 8MP*—compiiance component#5 af 5 �Not applicabls 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? ❑Yss ❑No If"yes",B below is required BMP=Best Management Prectice(s)specified in the sysfiem design li the answer to both questlons is "no'; this secUon doea nvt need to be comp/eted. Compliance criteHa a. Operating Permit number: __...__._._ ❑Yes ❑No Have the Operating Perrnit requirements been met? ; _.b. Is the required nitro.gen BMP in place and properiy fundioning? ? ❑Yes �No_ Any"no"answer indicates Noncompliance. Upgrade Requlromenb(Minn.Stat§115.55)An immir►eret threat to publ�hestth and se�ety(ITPHS)must be up,qraued,repleced,or its use dis�onNnued within bn rnonths of receipt of this notioe or within�shorfer period if requaed 6y bca!adinenc�.!f the sysd9rtt�s fel�/ng to protect gr�ur►d water,Ure system must be upgraded,re�eced,or its usa disoonUnued w+thin the tin�raqaired by foca!oNinarnrn�.!f an exi�ing system is rrot falNng es defrned in law,and hes at 1ea�Mro feet af des�n soil sep8r8tion.then bre sysi�m need not be upgraded,repaired,rspleced,or its use disc�tinued,+rofwithstanding any lacal adlnance that is mae strict. This pm�sior►does m�t apQ/y to systems in�lend sreas, Wellf�ed Protectior+Areas,or those used in c�+nection with fooal,beverage.�nd lodging establishments es dei►ned in law. _..___.__ _ _. _._....__...-- --_._. ..___ _ _..--- www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY b5t-282-5332 or 800-65?-3864 • Avaitable in alternative formats wq-wwists4-31 . 1/24112 Pege 3 of 3