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Jun 05 2016 09:30AM HP FaxRusty Olson 7634988290 page 4 <br /> Properly address: 155 Wear Lane., Orono, MN _ Inspector initials/Date: J. O.5/31/16 <br /> 4. Soil Separation-Compliance component#4 of 5 <br /> Date of installation: 10/20/93 ❑ Unknown Verification method(s): <br /> Shoreland/Wellhead protection/Food Beverage 0 Yes ®No Soil observation does not expire. Previous soil <br /> Lodging? <br /> observations by two independent parties are sufficient, <br /> Compliance criteria: unless site conditions have been altered or local <br /> For systems built prior to April 1, 1996, and ®Yes ❑No requirements differ. <br /> not located in Shore/and or Wellhead ® Conducted soil observation(s)(Attach boring logs) <br /> Protection Area or not serving a food, ❑ Two previous verifications(Attach boring logs) <br /> beverage or lodging establishment: <br /> ❑ Not applicable(Holding tank(s),nc drainfield) <br /> Drainfield has at least a two-foot vertical ❑ Unable to verify(See Comments/Explanation) <br /> separation distance from periodically <br /> saturated soil or bedrock. 10Other(See Comments/Explanabon) <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, o'rlodging establishment: <br /> Drainfeld has a three-foot vertical <br /> separation distance from periodically <br /> saturated soil or bedrock.* <br /> "Experimental' "Other, or 'Performance" ❑Yes ❑ No Indicate depths of elevations <br /> systems built under pre-2008 Rules; Type IV <br /> or V systems built under 2008 Rules(7'080. A. Bottom of distribution media _j 106.0 <br /> 2350 or 7080.2400 (Advanced Inspector <br /> License required) B. Periodically saturated soil/bedrock 103.2 <br /> Drainfield meets the designed vertical C. System separation 2.8 <br /> separation distance from periodically <br /> saturated soil or bedrock. <br /> D. Required compliance separation' 2.0 <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 Practices)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 /> Have the Operating Permit requirements been met? ,❑ Yes ❑ No <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`ailing as defined in law,and has at feast 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 800.6573864 • Available in alternative formats <br /> wq-wwists4.31 • 1124/12 <br /> Page 3 of 3 <br />