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03/13/2015 12:21 9528733112 PAGE 02/03 Property address. 1145 Wyndmere Road--Orono _ Inspector initialslDate: JS 13/11/2015 (mmldd,yWy) 4. Soll Separation—Compliance component#4 of 5 Date of installation: 6/1/1984 ❑ Unknown Verification method(s): (mm/dd/yyyy) ShorelandWellhead proteetionVFood beverage Soil observation does not expire. Previous soil lodging? ❑Yes [3 No observations by two independent parties are sufficient, unless site conditions have been altered or local Compliance criteria: requirements differ. For systems built prior to April 1, 1996, and ❑Yes ®No _ ®Conducted soil observation(s)(Attach boring logs) not located in Shore/and or Wellhead ❑Two previous verifications Protection Area or not serving a food, (Attach boring logs) beverage or lodging establishment ❑ Not applicable(Holding tank(s),no drainfield) Drainfield has at least a two-foot vertical ❑Unable to verify(See Comments/Explanation) separation distance from periodically ❑Other(See Comments/exptanation) saturated soil or bedrock. Non-perfonnance systems built April 1, [:]Yes [3 No Comments/Explanation- 1996,or later or fornon-performance Bonn systems located in Shoreland or Wellhead Boring'. Protection Areas or serving a food, 1-22"10YR 4/4 loam beverage, or lodging establishment: Drainfield has athree-ioof vertical 23-30"10YR 2/2 Clay Loam separation distance from periodically Heavy Mottles @ 24" saturated soil or bedrock.* "Experimental', "Other" or "Peffotmance" ❑Yes ❑No Indicate depths or elevations systems built under pre-2008 Rules;Type IV or V systems built under 2008 Rules(7080. A. Bottom of distribution media 24" 2350 or 7080.2400 (Advanced Inspector - License required) B. Periodically saturated sollibedrock 24" Drainfield meets the designed vertical C. System separation 0 separation distance from periodically - -saturated soil or bedrock. D. Required oorrpllanoe se oration• 24" Any "no"answer above indicates the system is "May be reduced up to 15 percent if allowed by Local failing to protect groundwater. Ordinance. 5. Operating Permit and Nitrogen BMP*—Compliance component#5 of 5 ® Not applicable Is the system operated under an Operating Permit? ❑Yes ❑ No if"yes",A below is required Is the system required to employ a Nitrogen BMP? ❑Yes ❑ No If"yes",8 below is required SMP=Best Management Practice(s)specified in the system design !f the answer to both questions is "no" this section does not need to be completed. Compliance criteria a, Operating Permit number. Have the Operating Permit requirements been met? ❑Yes El No ee b. Is the required nitrogen BMP in place and prope!ly functioning? Ye$. ❑No Any"no"answer indicates Noncompliance. Upgrade Requirements(Minn,Stat,§f 15.55)An imminent threat to public health and safety(ITPHS)must be upgraded,replaced,orits use 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 ground water,the system must be upgraded,replaced,or its use discontinued within the time required by Wet ordinance.If an existing system 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 ita use diacvntinued,nelwiritstanding any locat ordinenoe that is more strict, This provision does not apply to systems in shomiand areas. Wellhead Protection Areas,or those used in connection)with food,beverage,and lodging establishments as defined in law. www.pca.stdte.nln.us - 651.296.6300 800-657-3864 TTY 651-282.5332 or 800-657.3864 - Available in atternative formats wq-wwists4.31 . 3116112 Page 3 of 3