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Property address: 521 N. Stream Road„ Orono, MN Inspector initials/Date: <br />4. Soil Separation —Compliance component #4 of 5 <br />Date of installation: 7/31/1995 <br />❑ Unknown Verification method(s): <br />ShorelandlWellhead protection/Food Beverage ® Yes ❑ No <br />Lodging? <br />Compliance criteria: <br />For systems built prior to April 1, 1996, and ❑ Yes ❑ No <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 />!don -performance systems built April 1, ® Yes [:]No <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 has a three-foot vertical <br />separation distance from periodically <br />saturated soil or bedrock.* <br />"Experimental"; "Other", or "Performance" ❑ Yes ❑ No <br />systems built under pre -2008 Rules; Type Ill <br />or V systems built under 2008 Rules (7080. <br />2350 or 7080.2100 (Advanced Inspector <br />License required) <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 />J. O. 11/12/2020 <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 observations) (Attach boring logs) <br />❑ Two previous verifications (Attach boring logs) <br />❑ Not applicable (Holding tank(s), no drainfield) <br />❑ Unable to verify (See CommentsfExplanation) <br />❑ Other (See Comments/Explanation) <br />Comments/Explanation. <br />Indicate depths of elevations <br />A. Bottom of distribution media 100.3 <br />B. Periodically saturated soil/bedrock 97.6 <br />C. System separation 2.7 <br />D. Required compliance separation* i 2.55 <br />*May be reduced up to 15 percent if allowed by Local <br />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 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: <br />Have the Operating Permit requirements been met? _ _ ____ <br />❑ Yes ❑ No <br />_ b. Is the required nitrogen BMP in place and properly functioning? I ❑ 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 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 <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 T7Y 651-282.5332 or 800-657-3864 • Available in alternative formats <br />wq-ww1sts4.31 • 1124112 !sage 3 of 3 <br />