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May 02 2015 09:44AM HP FaxRusty Olson 7634988290 page 4 Property add ess: 180 Big Island, Orono MN _ Inspector initials/Date: J. O.4l26/15 4. SOiI S paretiotl —Cornpliance camponent#4 of 5 Date f installation: 10/10l03 ❑ Unknown Verification methad(s): Shorela d1YYellhead protectionlFood Beverage Lodgin � �Yes ❑ No Soi!observafion does nof expire. Previous soil � obse�vations by two rndependent parties ar�suficient, Comp�iance criteria: unless site conditrons heve been altered orloca! I requiremenfs differ. For sys ems built prior to Apri!1, f 995, and � ❑ Yes ❑ No not loc fed in Shoreland or Wellhead � � Conducted soil observation(s)(Attach bonng logs) Profecf n Area ornot serving a food, , ❑ Two previous verifications(Attaeh boring iogs) bevera�e or lodging establishment: I ❑ Not applicable(Holding tank(s),no drainheld) Drainfi Id has at least a two-foot vertical I ❑ Unable to verify(See CommentsiExplanat;on) separat on distance irom periodically , ❑ pther(See Comments/Explanation} saturat d soil or bedrack. Non-pe ormance systems builf April 1, i � Yes ❑ No CommentslExplanafron: 9996, o laterorfornon-performance i system located in Shoreland or We!lhead ' Protect n Areas orserving a food, bevera e, or lodging establishment: �i Drainf d has a three-foot vertical �' separa�on dislance from periodicafly I, saturat d soil or bedrock.' , � "Experrro�ental'; °Othe�'. or "Performance" � ❑ Yes ❑ No Indicate depths of elevations sysfem$built under pr�-2008 Rufes; Type!V � or V sy tems burlt under 2008 Rules(7080. , A. gottom o'distribution media 95.8 2350 or�7080.24�0 (Advanced Inspector I ; Licensel requited) � B. Periodicall saturated soil/bedrock 93.2 Drainfie d meets the designed vertical G S stem se aration 2.6 separat on distance from periodically saturat d soil or bedrock. j D. Required cornpliance separation" ; 2.6 Any " o"answer above indicates the system is •May be reduced up to 15 percent if allowed by Local Failin to Protect Groundwater. Ordinance. 5. Oper ting Permit and Nitrogen BMP*- compiiance component#5 ot 5 � Not applicable Is the sy em operated under an Operaiing Permit? ❑ Yes ❑ No If"yes",A below is required Is the sy em required to employ a Nitrogen BMP? ❑ Yes ❑ Na If"yes", B below is required BM Besf Management Practice(sJ specifred in the system design !f fhe answer to both quesfions is "na", this section does not need to be comp/eted. Compliaince criteria a. Op�rating Permit number: ' ❑ � Hav�e the Operating Permit requirements been met? Yes ❑ No b. Is t e re uired ritro en BMP in place and properiy functioning? I ❑ Yes ❑ No Any "n "answer indicates Noncomp/iance, Upgrade equ irements (M,inn. Stat. §115 55)An imminent threat to public health and safety(1TPKS)must be upgraded,replaoed,or rts use disconfinu d within ten months of receipf of this notice or within a shorter period if required by local ordinance.!f the system is failing fo protect ground we er, the system must be upgradeU,replaced, or its use discontinued within the 6me required by loca!ordinance.!f an existing system is not failin as defined in law,and has at least two(eet of design soi!separation,then tne system nsed not be upgraded,repaired,replaced.or its use di ntinued,notwithstanding any loca!ordinance that is more str�cf. This provision does no;apply to systems in shoreland areas, Wellhead rotection Areas,or ihose used in conneCtion with food,beverage,and lodging eslablishments es defined in law. www.pcas[ate.�n.us • 651-296-6300 • 800-657-3864 • TTY 651•282-5332 or 800•657-3864 • Available in alternative formats wq-wwists4-31 U24/12 Page 3 of 3