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Property address: 45fi5 Bayside Road,Orono,MN -- _____ InspectorinitialslQate: J.O. 9l17/14 4• 5Oil Sepd�dtiOn—Gompliance component#4 of 5 [?ate of instaitation: 11/01J89 ❑unknown Verifica#�on method(s). Shoreland/Weiihead protectioNFood Beverage �odging? ❑Yes �No Soii observation does not expir�. Previous soil Complaance cri#eria_ observa6ons by fwo independent parties are s�cienl, —� __ _ unless site condi#ians have been altered orloca/ For sysfems buitt prior to Apri11, 9J96, and �_ r�9�«menfs diffier. , ❑Yes ❑No notlocated in Shoreland or U'�ellhead I � Conducted soii observation(s){Attach borieg logsj Protecfion Area or not serving a food, beverage orlodging estab/rshment� ❑ Two previous venfications(Attach bonnglogs) i ❑ Not applicable(Halding tar�k(s),na drarn{reld) �rainfield has at least a two-foof verticai � separation distance from periodically ' ❑ Unable to verify(See Comments/Enplanation) _saturated soil or bedrock.__ ` ' ❑ Other{See Comments��xplanatian) IVon-perfonnance systems built Apri!7, ! �Yes ❑No Comments/Explanatior�_ 1996; orlater or for non-performance systems located in Sitoreland or Welthead P�atection Areas or serving a food, 6everage, orlodging establishment.� Drainfield has a three-foot verfical separation distance from periodically saturatecf soif or bedrock.'` � "Experrmentar'; "Other'; or "Perforrnance" ❑Yes ❑ No Indica#e depths of elevations systems built under p�-2008 Rules; Type IV ! -- ;----- or V Systems buil(unde►'2008 Rufes(7080. ' A_ Sottam of distribution media __ �`_y$.4 2350 or 70g0.24Q0 (Advanced Inspector , ----__ ___ License required) � B. Periodiratly saturated soil/bedroak__� 95.6 __..___.__.__.__. _ — raintipld meets tha designed vertica! ' i – separation distance from periodically I �. System separation__ _ _ �.g _ _ . -- saiurated soil or bedrock i — D. Required compliance separation'_ 2.6 Any "no"answer above mdicates the sysfem is nna ae reduced u to�5 Fai/in _to Protecf Groundrvater. � Y P percenf if allowed by L�caf ----�------ Ordinance. 5. Operating Permit and Nitrogen BMP*—Comp�iance cornponent#5 of 5 � Not applicable Is the system operated under an Clperating Permit? ❑Yes ❑ tVo If"yes",A beiow is required ls the system required to empioy a f�itrogen BMP? �Yes ❑ No Ifi"yes",B below is required BMP=Best Management Practice(sJ specifred in fhe system desrgn If the answer to both questions is "no; this section does not need to be completed_ Com Iiance criteria ---�-------_------____- ------- - ---- ----_.____.Y__---- a. Operating Permit number: i ------ __-- _ ---_ Have the O rati Petmif � Yss ❑No ________� ___._Pe_, � r�equirements been met. _b. ts the required nitm�en BMP in place and�roperly functioning? i ❑Yes ❑No Any"nv"answer i»dicates Noncampliance. Upgrade Requiremenls{Minn. Stat§i 15.55J An imminent threat to pLblic hea/M anct safery(ITPfiS)must be upgradeci,replaced,or its use discontinueci wiihin ten mond�s of receipt of this rrotice or within a shorter period if�equired by loca!ordinance.lf the system is failing to protect gmurrd water,fhe system must be upgraded,replaced,or its use discarrtinued within fhe time�qui�d by locaJ ordinance.lf an exisSng system is rtot failing as defined in law,and has at teast iwo feet of design soi!separation,then the system need nof be upgradeof,repai�d,replaced,or its use disconbnued, notwithstanding any loca/ordinance that is more sfriet This provision does not appfy to systems in shoreland a�as, We!lhead Protection Areas,or those used in connection with food,beverage,and lodging establishmenfs as defrned in law. --__---- ____ __ _ .__ ____. __ .__ ___ ___ _--- __ www.pca_state.mn.us - 651-296-6300 • 800-557-3864 • TTY 651-282-5332 or 800-657-3864 • A�ailable in aitemative formats wq-ww►st54-3f • 1/14112 Pa�e 3 of 3