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Jan 09 2017 01:07PM HP FaxRusty Olson 7634988290 page 4 <br /> Property address: 2705 White Oak Circle.,Orono, MN Inspector initials/Date: J. 0. 1/06/17 <br /> 4. Soil Separation -Compliance component#4 of 5 <br /> Date of installation: 9/30/2015 El unknown Verification method(s): <br /> ShorelandlWellhead protection/Food Beverage ®Yes <br /> lodging? ❑ NO Soil observation does not expire.Previous soil <br /> observations by two independent parties are sufficient, <br /> Compliance criteria: unless site conditions have been altered or local <br /> requirements differ. <br /> For systems built prior to April 1, 1996, and ❑Yes ❑ No <br /> not located in Shoreland 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),no drainfreld) <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. ❑ Other(See Comments/Explanation) <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 <br /> stablishment.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 of elevations <br /> systems built under pre-2008 Rules; Type IV <br /> or V systems built under 2008 Rules(7080. A. Bottom of distribution media 101.2 <br /> 2350 or 7080.2400 (Advanced Inspector <br /> License required) B. Periodically saturated soilibedrock 98.2 <br /> Drainfield meets the designed vertical C. System separation 3.0 <br /> separation distance from periodically <br /> saturated soil or bedrock. D. Required compliance separation' j 2.6 <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? ID Yes 1] 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 safely(ITPI-fS)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 falling 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 • 600.657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats <br /> wq-wwists4-31 • 1124/12 Page 3 of 3 <br />