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jan Lts LUl b U 1:U4F" HN FaxRusty Olson 7634988290 page 4 Property address: 2576Thor-ogghbred Lane Orono MN Inspector initials/Date: J-0-J. 0, 1127/16 4. Soil Separation—Compliance component#4 of 5 Date of installation: 6127197 ❑ Unknown Verification method(s): ShorelandWallhead protecdoNFood @overage ❑Yes ®No Lodging? Soil observation does not expire.Previous soil observations by two independent parries are sufficient, Compliance criteria: unless site oori tions have been altered or local For systems built prior to April 1, 1996,and ❑Yes ❑No requirements differ. not located in Shoreland or Wellhead ® Conducted soil observation(s)(Attach boring lops) Protection Area or not serving a food, ❑ Two previous verifications(Attach boring logs) beverage or lodging establishment ❑ Not applicable(Hoding tank(s),no drainfreld) Dralnflald has at least a two-foot vertical ❑ Unable to verify(See Commentsexplanation) separation distance from periodically ❑ Other(See commentslExplanafion) Non-performance systems built April 1, i ®Yes ❑ No CommentsiExplanation: 1996,or later or for non-pedhrmanrae systems located in Shoreland or Wellhead Protection Areas or serving a food, beverage,or lodging establishment Drainfield has a three-foot vertical separation distance from periodically saturated soil or bedrock.* Experimental; *Other,or Performance" ❑Yes ❑ No Indicate depth*of elevations systems built under pre-2008 Rules, Type 1V or V systems built under 2008 Rules(7080. A. Bottom of distribution media 101.0 2350 or 7080.2400 (Advanced Inspector License required) B. Periodically saturated soiubedrock 98.2 Drainfield meets the designed vertical separation distance from periodically C. System separation 2.8 saturated soil or bedrock. D. uired compliance se ration" 2.6 Any "no"answer above/ndlcatea the system is *may be reduced up to 15 percent if allowed by Local Falling 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 Prwhw(s)specified in the system design N the answer to both questions is -no",this secdon does not need to be completed. Compliance criteria a. Operating Permit number: Have the Operating Permit requirements been met? i ❑Yes ❑No b. Is the required nitrogen BMP in place and properly functioning? ❑Yes ❑No Any"no"answer Indicates Noncompliance. Upgrade Requirements(Minn. Stat§115.55)An imminent threat to public health and safety(1TPHS)must be upgraded,replaced,or its use discontinued withinin tan ten months of receipt of this rrotice of within a shorter period if required by local ordinance.ff the system is failing to protect ground water,the system must be upgrad&A replaced,or its use discontinued within the time required by Axel ordinance.If an existing system it not I dsc as defined to theaw,and has at feast twc feet of design soil separation,then the system need not be upgraded,repaired,replaced,or its use dhscontlnued,notwtthstarhding any ioca!ordinance that is More stnct This provision does not apply to systems in shoreland areas, WW#wd 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 • Available in alternative formats wq-wwists4-31 . 1124112 Paye 3 of 3