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Property address: 225 Old Crystal Bair Road S., Orono, MN Inspector initials/Date: J. O. 7120I18 <br />4. Soil Separation —Compliance component #4 of 5 <br />Date of installation: _ _ Z Unknown <br />ShorelandNVellhead 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 />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 />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 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 />Any "no" answer above indicates the system is <br />Failing to Protect Groundwater. <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 />❑ Not applicable (Holding tank(s), no drainfield) <br />❑ Unable to verify (See Comments/Explanation) <br />❑ Other (See Comments/Explanation) <br />Comments/Explanation: <br />Indicate depths of elevations <br />A._ Bottom of distribution media 991.5 <br />B. _Periodically saturated soilibedrock 988.4 <br />C._ System separation 3.1 <br />D. Required compliance separation" 2.6 <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 It "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 />_Nave the Operating Permit requirements been met? <br />b. Is the required nitrojen BMP in place and -Properly functioning? <br />Any "no" answer indicates Noncompliance. <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Upgrade Requirements (Minn. Stat: § 115.55) An imminent threat to public health and safety (1TPHS) must be upgraded. replaced, or its use <br />discontinued within ken months ofreceipt 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.pcastate.mn.us 651-296-6300 840-657-3864 TTY 651.282-5332 or 800-657.3864 Availabte in alternative formats <br />wq-wwists4-31 • 1124112 <br />Page 3of3 <br />