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07/28/2015 9: 17AM FAX f�0003/0004 I • property address. 710 Big lsland�Orono,MN 55331 _ Inspactor initlals/bata: JS � 7/28/2015 I (mm/dd/yyy�� 4. Soil Separation— Compliance component#4 of 5 ' D�te of insta[lation: _ _ � Unknpwn Vel'ification method(s): (mm/dd/yyyy) ShorelandlWel[head rotectlon/Food bevera e Spi/ObselVetion d0es not expire.Pl�eVious soil P g �Yas ❑No observafions b lWo inde endent erties arg Sufficientf IQdgingT Y P P unle5s Slte Co»ditionS have been altered orlocal Com Ilance criteria: requ;�ements di(fer. � For systems builf pnor to Aprll 9, 9996,and ❑Yes [J No �Conducted soil observation(s)(Attach boring logs) npt locefed in 5ho�eland or Wellhead �Two previous verifications(Arrach boring logs) Protection Area or not serving a food, beveraga or lodging est�blishment: ❑Not applicable(Holding rank(sJ,no drai�tf]eld) Drainfleld has at le�St a tW0-foot vertiCal ❑Undhle to verify(See Comm�nts/Explanallon) I sep�iration distance trom periodically ❑ Qther(See Comments/Explanalion) ' saturated soil or bedrock_ i Non-perlormance syStems built April 1, �Yes q No Comments/Explanation: f986,orlater or for non-perfo�mance systems loc�ted in Shore/and or'WellheaU Boring: , Protection Areas orserving a food, 1-14"10YR 2/2 Loam mixed SOils ' beverdge,orlodgingestablfshment 15-60"10YR 4/4 Clay Loam Drainfield has a three-foot verticat � separafion distance from periodically Light mottiing at 57" saturated soil or bedroCk." "Experrmental; "Other°or "Parformsnce" ❑Yes Q No Indicate de ths or elevations sysiems buJk under pre-2008 Rules; Type IV , pr V sysfems built under 2008 Rules(7080. A_ gottom of cllstri6ut�on media 20" 2350or7080_2q00 (Advanced InSpector — License requfred) B. Periodically saturated aoilPoedrock 60" Drainfield meets thp designed vertical C, S stem se aration 36" separation dlstence from periodlcally safurated soil or bedrock. _ D. Required com liance se arstion' 36" Any"no"answer above Indicatetis the system!s °May be reduced up to 15 percent iP allowed by Local; fall►ng to protecf groundwater. o�d�r,a�,�e. i 5. Operatin Permit and N9trogen BMP*-- Compliance component#5 of 5 � Not appllcable Is the system operated under an Operetfng Permit? ❑Yes ❑ No If"yes",A below is requ(red Is the system requlred to employ a Nitrogen eMP7 ❑Yes ❑Na If"yes",B below is required BMP=Best Management Practicg(SJ specrfied in d�e system design !f fhe answer to both puestions Is "no'; this section does npt need to be completed. Compliance critetia a. �psrating Permit number: ❑Yes ❑No Have the Qperaling Permit reqUiYements been met? b. Is the requfred nitrogen BMP In place and properly functioning? ❑Yes ❑No Any"rro"answer Indicates Non�ompliance. ' Upgrade Requlrements(M/nn_StaL§195.55)An lmminent throat to public heafth and sefety(lTPHS)must be upgraded,replaceci,or its use discontlnued within ten months nfrece;pf of this notica or wrthin a siiorter penod if iequlrad 6y local oro'inance.!f the system Is falJing h�protect ground wafer.the system ntust be upgraded,replaced,or its use discontlnuad within the tlme required byloca!ordinance.!f an exlsling system is not fai(ing as dcllned in law,and has at least hvo(eet o/design soi!separatlon,then the system need not be upgraded,repaired,replaced,ar !ts use d7scontinued,nohvlthsfanding anyloca!o,dinance tltai!s mae stnct. Thls prov;sion does nvt apply�o systerns In shoreland aroas,; WeAhead Protection Areas,ur thosB used I�i Connecfion with fDOd,bcverage,end lodglqg establighll'IBl1fS�S defined In!&W. www.pca.state_mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 . Availablein alternative fonnats wq-wwiscs4-.3f • 3/ibl 12 Page 3 of 3