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03/13/2015 12:21 9528733112 <br />Property address: 1145 Wyndmere Road - Orono <br />4. Soil Separation — Compliance c <br />Date of Installation: 6/1/1984 <br />(mm4dd wo <br />Shoreland/Wellhead protectionlrood beverage <br />lodging? <br />Compliance criteria: <br />For systems built prior to April 1, 1996, and <br />not located in Shoreland or Wellhead <br />Protection Area or not serving a food, <br />beverage or lodging establishment; <br />Drainfield has at least a two -foot vertical <br />separation distance from periodically <br />saturated soil or bedrock, <br />Non performance systems built April 1, <br />9996, orlaterorfornon performance <br />systems /coated in Shoreland or Wellhead <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" <br />systems built under pre -2008 Rules, Type IV <br />or V systems built under 2008 Rules (7080. <br />2350 or 708o,2400 (Advanced Inspector <br />License required) <br />,mponent #4 of 5 <br />[2 Unknown <br />❑ Yes No <br />L_] Yes ® No - <br />❑ Yes ONO <br />❑ Yes C No <br />Drainfield meets the designed vertical <br />separation distance from periodically <br />saturated soil or bedrock. <br />Any "no" answer above indicates the system is <br />failing to proteCt groundwater, <br />5. Operating Permit and Nitrogen BMP* — Com <br />Is the system operated under an Operating Permit? <br />Is the system required to employ a Nitrogen BMP? <br />PAGE 02/03 <br />inspector initials/Date: JS ±2/j <br />(mM1dd4Wy) <br />Verification method(s): <br />Soil observation does not expire. Previous soil <br />Observations by two independent parties are sufficient, <br />unless site conditions have been altered or local <br />requirements differ. <br />® Conducted soil observation(s) (Attach boring logs) <br />❑ Two previous verifications (Attach boring logs) <br />El Not applicable (Holding tank(s), no drainfreld) <br />❑ unable to verify (See Comments/6xpianation) <br />© Other (See CommentsICxplanation) <br />Comments/Explanation- <br />Boring, <br />1-22" 10YR 4/4 Loam <br />23-30" 10YR 2/2 Clay Loam <br />Heavy Mottles Q 24" <br />Indicate depths or elevations <br />A. Bottom of distribution media 24„ <br />B. Periodica <br />24" <br />Ll <br />u, rtUuwreo compuart010 separation* 1 24" <br />"May be reduced up to 15 percent if allowed by Local <br />Ordinance, <br />ante component #5 of 5 ® Not ani <br />❑ Yes ❑ No If "yes", A below is required <br />Q Yes n No If "fres", B below is required <br />,BMP = Best Management Practice(s) specified in the system design <br />If the answer to both questions is ono'; 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 proper functioning? Yes ©No <br />Any "no" answer indicates Noncompliance. <br />Upgrade RegUirements (Minn, Stat. § 115.55) An imminent throat to public health and safety (iTPHS) must be upgraded, replaced, orits use <br />discontinued within ten months of receipt of this notice or within a &hOrter period if required by local ordinance. If the system is failing to protect <br />ground water, 1he system must be upgraded, replaced, or its use discontinued within the time required by local ordinance. If an exlsting system <br />is not failing as defined in law, and has at least two feet Of design soil separation, then the systam need not be upgraded, repaired, replaced, or <br />its use discentlnued, notwithstanding any locat ordinance Met Is more sMet. This provision does not apply to systems in s Mp&and 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 651.296.6300'60-657-3864 TTY 651 282.5332 or 800 657.3864 <br />wq-wWfst94.31 . 3116112 * Available in altemdtive formats <br />Page 3 of 3 <br />