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Explain: <br /> See soil separation <br /> Property address: 20 Wear Lane S Orono MN Inspector initials/Date: _[4/28/2015 <br /> (mm/dd/yyyy) <br /> 4. Soil Separation—Compliance component#4 of 5 <br /> Date of installation: Ej Unknown Verification method(s): <br /> (mm/dd/yyyy) Soil observation does not expire.Previous soil <br /> SharelandlWellhead protection/Food beverage Q Yes ® No observations by two independent parties are sufficient, <br /> lodging? unless site conditions have been altered or local <br /> Compliance criteria: — _ requirements differ. <br /> For systems built prior to April 1, 1996,and Q Yes ® No Conducted soil observation(s)(Attach boring logs) <br /> not located in Shoreland or Wellhead 0 Two previous verifications(Attach boring logs) <br /> Protection Area or not serving a food, <br /> beverage or lodging establishment: Q Not applicable(Holding tank(s),no drainfreld) <br /> Drainfield has at least a two-foot vertical El Unable to verify(See Comments/Explanation) <br /> separation distance from periodically Q Other(See Comments/Explanation) <br /> saturated soil or bedrock. <br /> Non-performance systems built April 1, Q Yes 0 No Comments/Explanation: <br /> 1996, or later or for non-performance <br /> Soil Boring <br /> systems located in Shoreland or Wellhead I <br /> Protection Areas or serving a food, 0-22" Loam 10YR2-2 <br /> beverage,or lodging establishment: <br /> 22-24" Clary 10YR5-4 <br /> Drainfield has a three-foot vertical <br /> separation distance from periodically Mottled soil at 12" <br /> saturated soil or bedrock.* <br /> "Experimental'; "Other", or `Performance" Q Yes Q 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 28" <br /> 2350 or 7080.2400 (Advanced inspector <br /> License required) B. Periodically saturated soil/bedrock 12" <br /> Drainfield meets the designed vertical C. S stem se aration -16" <br /> separation distance from periodically <br /> Y....-------�.._._..__.__..--__---_---.__. <br /> saturated soil or bedrock. <br /> a Required compliance separation* 24"_ <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? El Yes El No If"yes",A below is required <br /> Is the system required to employ a Nitrogen BMP? 0 Yes 0 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: 0 Yes Q No <br /> _ Have the Operatingfermit_requirements been met? <br /> b. Is the required nitrogen BMP in place andproperly functioning? Q Yes 0 No <br /> Any "no"answer indicates Noncompliance. <br /> Upgrade Requirements(Minn.Stat.§115.55)An imminent threat to public health and safety(lTPHS)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 attemative formats <br /> wq-wwists4-31b • 6/4/14 Page 3 of 4 <br />