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Property address: 387 Orono Orchard Road S, Orono Inspector initials/Date: JS i <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) <br /> Shoreland/Wellhead protection/Food beverage Soil observation does not expire. Previous soil <br /> lodging? ❑Yes ElNo observations by two independent parties are sufficient, <br /> unless site conditions have been altered or local <br /> Compliance criteria: requirements differ. <br /> For systems built prior to April 1, 1996, and ❑Yes ❑ No ❑ Conducted soil observation(s)(Attach boring logs) <br /> not located in Shoreland or Wellhead ❑Two previous verifications(Attach boring logs) <br /> Protection Area or not serving a food, <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 Boring: <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. A. Bottom of distribution media <br /> 2350 or 7080.2400 (Advanced Inspector <br /> License required) B. Periodically saturated soil/bedrock <br /> Drainfield meets the designed vertical C. System separation <br /> separation distance from periodically <br /> saturated soil or bedrock. <br /> D. Required compliance separation* <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 ❑ 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 /> ground water,the system must be upgraded,replaced,or its use discontinued within the time required by local ordinance.If an existing system <br /> is not failing as defined in law,and has at least two feet of design soil separation,then the system need not be upgraded,repaired,replaced,or <br /> its use discontinued,notwithstanding any local ordinance that is more strict. This provision does not apply to systems in shoreland areas, <br /> Wellhead Protection Areas,or those used in connection with food,beverage,and lodging establishments as defined in law. <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-wwists4-31 • 3/16/12 Page 3 of 3 <br />