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request.pdf https://word-view.officeapps.live.com/wv/WordViewer/request.pdf?F... ('�ooerty address 43`L5 Chippewa Lane. Jrono, MN 55359 Inspector indials/Date d�d ; 1UI18;2C12 -- {�rinVdcifYYYYi 4. Soil Separation— Compliance component#4 of 5 Date of installation: t992 ❑ Unknown Verification method�s): �mMdl}/YYYY) Soil observatron does noi expire Previous soiJ ShorelandNVeUhead protectioNFood beverage �Yes ❑ No observ�tioris by two+ndependent panres are suflicienl. lodging? un/ess site corlditions have been altered or local Compliance criteria: requirements dif/er. For systenis built pnor to April 1. 1996. and ❑Yes ❑ No ❑Conducied soil observation(s)(Attach boring fogs) not located in Sho�etand o�Weflhead ❑ Two previous verifications(Attach bormg logs) Protection Area or not se►vrr�g a food. beveiaye or lodgn�g estabGshment: ❑ Not applicable(Holdrng tank(s},no dramfie►d) I Drainfield has at least a two-foot vertical � ❑ Unable to verify(See Comments/Exp►anation) separat�on distance from periodicalty � Other(See CommenlsiExplanalro��) saturated soil or bedrock. Nor�-perfom�ance systems bu�lt Apnl 1, � Yes Q No CommentslExplanation: 1996, orlater orfornon-�e�forrnance Soif seperation conf�med by Orono Septic System systems located in Shoreland or Wellhead Inventory Form-attached for reference. System may r>e in Protectron Areas orse�vinr a food. wellhead protection area. System would need 3 feet of beverage, or todgrng estabbshment vertical seperation as verified by Inventory Form. Dramfield has a three-foot vertical separation distance from periodically saturated soil or bedrock.` -Expenr►,ental", �Ot1�er". or "Performance" ❑Yes ❑ No Indicate depths or elevations systems huilt ur�der p�e-2008 Rules: Type N or V systems buift under 2008 Ru1es(7080. A eottom of d�stnbu6on media . 2350 or 7080.2=F00 (Advanced Inspector License required) B Periodically saturated soiUbedrock Drafnfield meets the designed verticat C system separat�on 36 separation distance from periodicafly saturated soil or bedrock. D Reqwred compliance separation'_ 36 _ _ Any "no"answer above indicates the system is 'May be reduced up to �5 percent if allowed by Local failing to protect groundwafer. ordinance. 5. Operafiing Permit and Nitrogen BMP*— Compliance component#5 of 5 � Not applicable Is the system operated under an Operating Permit? ❑ Yes ❑ No If"yes",A below is required Is the systern required to employ a Nitr�yen BMP? ❑Yes ❑ No If"yes", B below is required BMP=Best Management Practice(s)specified in the system design If the answer to both questians is "no", this section does not need to be comp/eted. Compliance criteria a Operating Permit number. � �] Yes ❑ No Have the Operating Permit reqwrements been met? b. Is the required nitrogen BMP in place and properiy functioning? U Yes ❑No Any "no"answer indicates Noncompliance. Upgrade Requirements(M�nn Sta! § 115 55J An imrnment threat to pubbc health and salery(ITPHS)must be upgraded, replaced.or its use discontmued�vdh�n ten months of receipt of fhis notice or w�thin a shorter penod if required by local ordinance. !f the system is failing fo protec! ground wafer. the syslern rnust be up,qraded, ieplaced, or ds use d�scontinued within the time�etluved by Ivca1 urdinance. ll an existmg sysfem is no!tailing as ciefined�n law. arrci has at least nvo/eet of Ues�gn soil separatron, then the system need nof be upgraded. repa�red. replaced, or its use discontinued,notwirhsfanding any loca!ordinance thai rs more stricL This provision does n�t app/y to systerns�n shore/and aieas. Wellhead ProtecGon Areas,or those used�n connectron wifh Jood,beverage. and todgmg establishments as defined m�aw. ___ __ _ _------ ------__--____ _ ._ wvnv.�ca.state.mr..us • 651-296 6300 • 800-657-3864 • TTY 651 282 5332 of 80L'-657-3864 • Available in alternative formats wc.�-wwists-i�j: - �i 1bl f� Pn;r��of.� 5 of 7 3/25/2013 6:(2 PM