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Jul 11 13 06:45a Joseph Olson 763-498-8290 p.4 ti Property address: 1100 Town Line Road,Orono,MN Inspector initialsAlate: J.0.7111113 4. Soil Separation–Compliance component#4 of 5 Date of installation: 7120106 — El Unknown Verification ntethod(s): ShorerandNVollhead protectioNFood Beverage ❑Yes ® No Soil observation does not expire.Previous soil Lodging? observations by two independent parties are sufficient, Compliance criteria: unless site conditions 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 fogs) Protection Area or not serving a food, ❑ Two previous verifications(Attach boring logs) beverage or lodging establishment: ❑ Not applicable(Holding tank(s), no drainfield) Drainfield has at feast a two-foot vertical ❑ Unable to verify(See CommenwExpianation) separation distance from periodically saturated soil or bedrock. ❑ Other(See Comments/Explanation) Alondrerformance systems built April 1, ®Yes ❑No Comments/Explanation: 4996,or later or for non-performance systems located in Shoreland or Wellhead Protection Areas or serving a food, beverage, orlodging establishment: Drainfield has a three-foot vertical separation distance from periodically saturated soil or bedrock' 'Experimental' "Other", or Performance" ❑Yes ❑No Indicate depths of elevations systems built under pre-2008 Rules;Type IV or V systems built under 2008 Rules(7080. A. Bottom of distribution media 102.8 2350 or 7080.2400 (Advanced Inspector License required) B. Periodically saturated soilfbedrock 100.0 Drainfield meets the designed vertical C. §ptem separation 2.8 separation distance from periodically saturated soil or bedrock. D. Required compliance separation* 2.6 Any"no"answer above indicates the system is — *May be reduced up to 15 percent if allowed by Local FaMog 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 Practice(s)specified in the system design If the answer to both questions is "no", this section does not need to be completed. Compliance criteria a. Operating Permit number. �T —"� E]Yes ❑ No Have the Operating Permit requirements been met? b. is the required nitrogen BMP in place and To rl functionin ? ❑Yes ❑ No Any"no"answer indicates Noncompliance. Upgrade Requirements(Atm.Stat§115.55)An imminent threat to public health and safety(fTPHS)must be upgraded,replaced,or its use discontinued within ten months of receipt of this notice or within a shorter period if required by local ordinance.if the system is falling to protect ground water,the system must be upgraded,replaced,or its use discontinued within the time required by local ordinance.If an existing system is not failing as defined in lain,and has at least two feet of design soil separation,then the system need not be upgraded,repaired,replaced, or its use discontinued,notwithstanding any local ordinance that is more strict. This provision does not apply to systems in shorefand areas, Wellhead Protection Areas,or those used in connection with food,beverage,and lodging establishments as defined in law. www.pca.state.ntn.us • 651-2%-6300 • B00-657.3664 TTY 651-282-5332 or 806-657-3864 • Available in alternative formats wq•wwf5ts4-3f • 1124112 Page 3 of 3