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Nov 30 2015 07:27PM HP FaxRusty Olson 7634988290 <br />page 4 <br />Property address: 1980 Sixth Ave. N Orono MN inspector inibals/Date: J. 0. 11t30/15 <br />4. Soil Separation —Compliance component#4 of 5 <br />Date of insUllation, 1111f2010 ❑ Unknown <br />Sh relandlWelihsad protect w000d sevsrap Yes <br />Lodging? <br />0No <br />Gompliance criteria: <br />For systems built prior to April 1, 1996, and ❑ Yes <br />❑ No <br />not located in Shomland or Wellhead <br />Proteofion Area ornotserv/ng 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 <br />1996, or later or for non-performance <br />❑ No <br />systemslocated in Shoreland or We#head <br />Protection Areas or serving a food, <br />beverage, or lodging establishment: <br />Drainfield has a three-foot vertical <br />separation distance from periodicaily <br />i <br />saturated soil or bedrock." <br />Experimental", -Other, or Performance" ❑ Yes <br />❑ 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 />Dratnfield meets the designed vertical <br />aeperation 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 orlocal <br />requirements differ. <br />Conducted soil observation(s) (Attach boring tops) <br />❑ Two previous verifications (Attach boringtogS) <br />❑ Not applicable (Holding tanhys), no dralmisid) <br />❑ Unable to verify (sae comment&Explenation) <br />❑ Other (See CommentsiLxplanatton) <br />CommentsiExplanadon: <br />indicate depthg of elevations <br />A, Bottom of distribution media 99.4 _ <br />B. Periodically saturated soiybadrodc 98.4 <br />C. System separation 3.0 <br />D. Ratluired comallance separation* 2.8 <br />"May be red uced up to 15 percent if allowed by Local <br />Ordinance. <br />5. Operating Permit and Nitrogen BMP* —Compliance component #5 of 5 E Not applicable <br />Is the ayatem operated under an Operating Permit? ❑ Yes ❑ No If "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 Practices) speed in the system design <br />if the answer to both questions is "no", this section does not need to be completed. <br />a. Operating Permit number. <br />❑ Yes ❑ No <br />Any "no" answer Indicates Noncompliance. <br />Upgrade Requirements (Minn. Stet. § 115.55) An imminent threat to pubdo health and safety (iTPHS) must be upgraded, replaced, or its use <br />diulOntinued within ten months of raceipt or this nctke or within a shorter period if requlrad by local ordinance, irthe system is felling to petty d <br />ground water, the system must be upgraded, replaced, or its use dfsocrWnued within the time required by local ordinance. /fan existing system <br />11 not f disc as tuad, din law, and has at least two feet of design soil saparat7on, then the system need not be upgraded, ropaksd, replaced, or <br />its use discor#inuad, trotwithstandkrg any local ordinance that is mote sbicL Tole provlsiat does not apply to Systems in shoneland areas <br />VMH*ad Protection Areas, or those used in connection with food, beverage and bdgin j establishmards as derined in law. <br />www.pca.state.mn.us - 651.296.6300 - 800-657.3864 TrY 651-292.5332 or WO.657-3864 - Available in alternative formats <br />wq-ww1sts4-31 - 1124112 <br />Page 3 of 3 <br />