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Jan 28 14 05:34p Joseph Olson 763-498-8290 p,4 <br /> Property address: 4245 Ba side Road,Orono,MN I <br /> --- Inspector initiafslQate: J. O. 1/16/14 <br /> 4. Soil Separation—ComRlian�e componer�f#4 of 5 <br /> �ate of instaElation: 6/28/88 ❑ Unknown Verificafion method(s�: <br /> ShorelandANellhead protecttoNFood Beverage � Yes <br /> l.odging? � No Soi!observafion does not expi�, previous soi! <br /> o6serva6ons by two independent partres are sufi'cient, <br /> COIt1 lianCe Ctiteria: unless site condfions have been alfered orlocal <br /> For sysfems built prior to Apri!1, 7996, and ❑Yes ❑ I�o �qu����ts differ. <br /> nof located in Shoreland vr Wellhead � Conducted soil observation(s)(Attach bonrrg rogs) <br /> Pratection Area vr nof serving a food, <br /> beverage orlodging establrshment: ❑ �Wo previous venfications(Aetach boring Jogs) <br /> ❑ Not applicable(Nolding tank(s),no drainfieldj <br /> €�rainfield has at feast a two-fooi vertical � <br /> separation distanoe from periodically ❑ Unable to verify(See CommentslFxplanalion) <br /> saturated soil or bedrock. _ 0 Other(See Comments✓Explanation) <br /> Non perfo�mance systems built,4pril 1, �Yes ❑No Cornmerrts/Explanation.• <br /> �996,or fater or for non perforrnance <br /> systems located in Shor�fand or tNellhead <br /> Protectron Ar�as orserving a fooct, <br /> beverage, orlodgingestablishment <br /> Drainfield has a three-foot�ertical <br /> separation distance from periodicalfy <br /> saiurated soil or bedrock.* <br /> '�xperimerrtal'; 'Other'; or Pe�ormance" ' ❑Yes 0 No lndicate de ths of elevations <br /> sysferns built under pre�-2008 Rules; Type IV <br /> or'V systems built under 2008 Rules(708U. . BoStom of distr+bution media 100.0 <br /> 2350 or 7080.2Q00 (Advar�ced Inspector — <br /> License required) . Periodicall saturated soiUbedrock 97.0 <br /> Drainfield meets the desFgned vertical <br /> separation distance from pe�iodicaliy - stem se aretion __ _ 3.0 <br /> saturated soil or bedrock. <br /> . Re uired com liance se aration` 2.6 <br /> Any "no"answer above indicates the system is �ay be reduced up to 15 percerrt'rf altowed by E�ocal <br /> Failin to Protect Grot�ndwafer. Ordinance. <br /> 5. Operatin� Permit and Nitrogen BMP'�—Compliance co ponent#S of 5 � Not app�icable <br /> Is the system operated under an Operating Permit? Q Yes ❑ N If`yes",A betow is r�quired <br /> Is tfie system required to employ a Nitr�gen BMP? ❑Yes ❑N if"yes",8 below is required <br /> BMP=6es1 Managemenf Prac�ce(s)specifi�ed in the systerr�design <br /> !f the answer to boih questions is "no", this section daes n need to be cempleted, <br /> Compliance criteria <br /> a. Operating�ermit number. <br /> Ftave the O eratin Permit r uirements been met? � ❑Yes ❑ N� <br /> b. Is the required nitroqen BMP in�lace and properl functionin ? ❑Yes ❑No <br /> Any"no"answer indicates Noncornp/iance. <br /> iJpgrade 12equiremertts(Minn. Stat.§115.55)Rn imminenf threat to public hea h and safely(ITPHS}musl be upgraded,r2placed,or its uSe <br /> drscontinved within ten monlhs ofreceipf of lhis nolice or wiUrin a sho�fer oeriod if uir�d hy loca!ordinance.!f fhe syslerrr is failing to proh;ct <br /> graund water,the sysfem must be upgraded,replaced,or its use drsconiirrued ovit n the fime required by local orrlinance. If an enisting system <br /> is not failirtg as defrned in 1a w, and has at Je2st Iwo ieet of desig�sa!separatron,t en the system Reed not be upgraded,repafred,repfaced,or <br /> its use discont/nued,nofwifhstandiny any locaf ordrnance ffiat rs mae slrrcL This p vision does not apply to systems in shorefand areas, <br /> We!lhead Protection A�as,or fhose used in connection Hritry food,heverage,and/ ging establrshments as defined i�law. <br /> www.pca.state.rnn.us • 651-296-b300 • 800-b57-3864 • TTY 651-282 5332 or 800-657-3864 • Avaitable in altemaiive formats <br /> wc7-wwists4-3t • i/24/11 AQge 3 of 3 <br />