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Property address: 395 Sussex Lane, Orono, MN Inspector initials/Date: <br />4, Soil Separation —Compliance component #4 of 5 <br />Date of installation: 11/19/2001 ❑ Unknown <br />Shoreland/Wel Ihead protectionlFood Beverage ❑ Yes ® No <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 />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 <br />systems built under pre -2008 Rules, Type IV <br />or V systems built under 2008 Rules (7080. <br />2350 or 7080.2400 (Advanced Inspector <br />License required) <br />Drainfield meets the designed vertical <br />separation distance from periodically <br />saturated soil or bedrock. <br />❑ Yes ❑ No <br />® Yes ❑ No <br />❑ Yes [:]No <br />Any "no" answer above indicates the system is <br />Failing to Protect Groundwater. <br />Verification method(s): <br />J. O. 12/20/2020 <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 observation(s) (Attach boring logs) <br />❑ Two previous verifications (Attach boring logs) <br />❑ Not applicable (Holding tank(s), no drainfield) <br />❑ Unable to verify (See Comments/Explanation) <br />❑ Other (See CommentsfExplanation) <br />Comments/Explanation: <br />Indicate depths of elevations <br />A. Bottom of distribution media I 100.2 <br />B. Periodically saturated soilibedrock 97.65 <br />C. System separation 2.55 <br />D. Required compliance separation" 1 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 />Comoliance criteria <br />a. Operating Permit number: <br />-- E-1 Yes [-]No <br />Have the Operating Permit requirements been met? <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 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.pea.state.mn.us 651-296.6300 800-657-3864 TTY 651-282-5332 or 800-657.3864 • Available in alternative formats <br />wq-wwists4.31 • 1124112 Pose 3 of 3 <br />