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Property address: 120 Truffula Trail Orono MN Inspector initials/Date: .J.O.5112/17 4. Soil Separation—Compliance component#4 of 5 Date of installation: 6/15/95 ❑Unknown Verification msthod(s): ShorelandNVellhead protection/Food Beverage Lodging? El Yes ®No Sal observation does not expire.Precious soil 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 logs) Protection Area or not serving a food, ❑ Two previous verifications(Attach boring logs) beverage or lodging establishment ❑ Not applicable(Holding tank(s),no draimeld) Drainfield has at least atwo-foot vertical ❑ Unable to verify(See Commentsexplanation) separation distance from periodically ❑ Other( Comments/Exanatioh) saturated soil or bedrock. Non-performance systems built ApM 1, ❑Yes ❑No CommentslExp/anation: 1996,or later or for non-performance 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 depths of elevations systems built under pre-2008 Rules;Type/V -or V systems built under 2008 Rules(7080. 1 A- Bottom of distribution media 101.2 2350 or 7080.2400 (Advanced Inspector License required) S. Periodically saturated soil/bedrock 99.7 south end Drainfield meets the designed vertical separation distance from periodically C. System separation _ 1.5 saturated soil or bedrock. D. Required compliance separation* 2.0 Any "no"answer above indicates the system is *May be reduced up to 15 percent if allowed by Local Failing to Protect Groundwater. pro; 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. _ Have the Operating Permit requirements been met? ❑Yes ❑No E b. Is the required nitrogen BMP in place and properly functioning? ❑Yes ❑No Any "no"answer indicates Noncompliance. Upgrade Requirements(Minn.Stat.§11555)An imminent threat to public health and safety(ITPHS)must be upgraded replaced,or its use discontinued within ten months of receipt of tills notice or mthin a shorter period if required by local o finance.If the system is failing to protect ground water,the system must be upgraded replaced,or its use disc ontinued wgthu i the time required by local orlinance.if an existing system is not failing as defined in law,and has at least twin fleet of design soil separation,then the system need not be upgraded,repaired,replaced,or its use discontinued,notwithstanding any lotsl ordmOnrre that is more strict This provision does not apply to systems in shoreland areas, Wellhead Protection Areas,or those used in connection with l rood,beverage,and lodging estsblimmonts as defined in law. www.pca.state.mn.us - 651-2%-6300 • 800-657-3864 TTY 651-282-5332 or 800.657-3864 - Available in alternative formats wq-wwists4-31 - 1124112 -