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Property address: 2985 Watertown Rd Orono, MN Inspector initials/Date: Ael <br /> (mm/dd/yyyy) <br /> 4. Soil Separation—Compliance component#4 of 5 <br /> Date of installation: ® Unknown Verification method(s): <br /> (mm/dd/yyyy) Soil observation does not expire.Previous soil <br /> Shoreland/Wellhead protection/Food beverage 0 Yes ® No observations by two independent parties are sufficient, <br /> lodging? <br /> unless site conditions have been altered or local <br /> Com•liance criteria: requirements differ. <br /> For systems built prior to April 1, 1996, and 0 Yes ❑ No ®Conducted soil observation(s)(Attach boring logs) <br /> not located in Shoreland or Wellhead <br /> Protection Area or not serving a food, ❑Two previous verifications(Attach boring logs) <br /> beverage or lodging establishment: ❑ Not applicable(Holding tank(s),no drainfield) <br /> Drainfield has at least a two-foot vertical ❑ Unable to verify(See Comments/Explanation) <br /> separation distance from periodically ❑ Other(See Comments/Explanation) <br /> saturated soil or bedrock. <br /> Non-performance systems built April 1, ®Yes ❑ No Comments/Explanation: <br /> 1996, or later or for non-performance <br /> systems located in Shoreland or Wellhead <br /> Protection Areas or serving a food, <br /> beverage, or lodging establishment: <br /> Drainfield has a three-foot vertical <br /> separation distance from periodically <br /> saturated soil or bedrock.* <br /> "Experimental", "Other", or `Performance" ❑Yes ❑ No Indicate depths or elevations <br /> systems built under pre-2008 Rules; Type IV <br /> or V systems built under 2008 Rules(7080. 24 inch sand north <br /> 2350 or 7080.2400 (Advanced Inspector mouund, 18 inch <br /> License required) A. Bottom of distribution media sand east mound <br /> Drainfield meets the designed vertical <br /> 18 inch north <br /> separation distance from periodically mound,20 inch <br /> saturated soil or bedrock. B. Periodically saturated soil/bedrock east mound <br /> 42 inch north <br /> mound, 38 inch <br /> C. System separation east mound <br /> D. Required compliance separation* I 36 inch <br /> Any "no"answer above indicates the system is *May be reduced up to 15 percent if allowed by Local <br /> failing to protect groundwater. Ordinance. <br /> 5. Operating Permit and Nitrogen BMP*—Compliance component#5 of 5 ® Not applicable <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 C. No If"yes",B below is required <br /> BMP=Best Management Practice(s)specified in the system design <br /> If the answer to both questions is "no", this section does not need to be completed. <br /> Compliance criteria _ <br /> a. Operating Permit number: <br /> ❑Yes ❑ No <br /> Have the Operating Permit requirements been met? <br /> b. Is the required nitrogen BMP in place and properly functioning? ❑Yes ❑ No <br /> Any"no"answer indicates Noncompliance. <br /> Upgrade Requirements(Minn. Stat.§115.55)An imminent threat to public health and safety(ITPHS)must be upgraded,replaced,or its use <br /> discontinued within ten months of receipt of this notice or within a shorter period if required by local ordinance.If the system is failing to protect <br /> www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats <br /> wq-wwists4-31b • 6/4/14 Page 3 of 4 <br />