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qj� <br />Property address: 150 North Shore Dr. W Orono, MN Inspector initials/Date: 9/6/2018 <br />(mrNddhryyy) <br />_4. Soil Separation — Compliance component #4 of 5 <br />Date of installation: 1/1/1998 ❑ Unknown Verification method(s): <br />(mmfdd'yyyy) Soil observation does not expire. Previous soil <br />ShorelamMelibeed protection/Food beverage ❑ Yes ® No observations by two independent parties are suftient, <br />lodging? unless site conditions have been altered orlocal <br />Compliance criteria: _ _._ requirements differ. <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 />Drainfieid has at least a two -foot vertical <br />separation distance from periodically <br />saturated soil or bedrock. <br />Non 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 />Drainfieid has a three-foot vertical <br />separation distance from periodically <br />saturated soil or bedrock." <br />°Experimental", "Other", or "Performance" ❑ Yes ❑ No <br />systems burl under pre -2008 Rules; Type IV <br />or V systems buAt 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 />Any "no" answer above indicates the system is <br />failing to protect groundwater. <br />® Conducted soil observation(s) (Attach boring logs) <br />❑ Two previous verifications (Attach boring togs) <br />❑ Not applicable (Hokting tank(s), no drain/tekg <br />❑ Unable to verify (See CommerrW&ptanation) <br />❑ Other (See Comments/Explanation) <br />Comments/Explanation: <br />Indicate deaths or elevations <br />A. Bottom of distribution media <br />12" <br />B. Periodically saturated soillbedrock <br />-24" <br />C. System separation <br />36" <br />D. Required compliance separation* <br />36" <br />'May be reduced up to 16 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? Q Yes ❑ No If "yes", B below is required <br />BMP = Best Management Pradice(s) specified in the system design <br />K the answer to both questions /s "no", this section does not need to be completed. <br />a. Operating Permit number: 10 Yes ❑ No <br />Any "no" answer indicates Noncompliance. <br />Upgrade Requirements (Minn. Stat § 115.55) An imminent threat to public health and satiety (f7PHS) must be upgraded, replaced, or its use <br />discontinued within ten months of receipt of this notim or within a shorter perbd if requbed 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 boat ordinance. if an existing system <br />is not failing as defused in law, and has at least two feet of design soil separation, then the system need not be upgraded, repaired, mphwed or <br />its use discontinued, notwithstanding any local ordinance that is more strict This provision does not appy to systems in shore/and areas, <br />Wellhead Protection Argas, 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 TTY 651-282-5332 or 80D-657-3864 • Available in attemattve formats <br />wq•wwists4-31b • 614114 Page 3 of 3 <br />