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03/04/2015 13: 58 9528733112 PAGE 03/04 <br /> � <br /> �rop�rry address: 2515 Count 51de qrive-Orono Inspe�tor initialsJDate: JS 3/3/2014 <br /> � (mm/dd/yyyyJ <br /> 4. Soil Se aratior�— Compliance component#4 of 5 <br /> Dafie oF installatlon: 5/1/1984 [] Unknown Veri#ication metk�od(s): <br /> (mmiddipyyy) Sor'1 observafiDn daes not expir�s. Prevtous sorl <br /> Shoreland/Welihead proteetlonJFood be�e�age � Yes � No ebservafions by two independent partres are suHicient, <br /> lodgfng? unless sii�R Conditlons hav�be�n altered or IoCal <br /> Com li�nce criterla: requirements differ. <br /> For sysfems built prior to Apr/l T, 1986, ar�d �Yes 0 NO �Conducted sail observatian(s)(Attaclt boring/ogs) <br /> not locsted in Shonsland or WeUhead 0 Twp previous verifiCations(Attacn bo+�ng loys) <br /> Profection Ar9�or not serving a foorJ, <br /> beverage or lodging estabflshment: I �] Not applicable (Holding tank(s),no d�alnfie�d) <br /> Drainfield has at teast a Ywo-foot vert��al [�Unable to verify(See Commanrs/Explanat;on) <br /> separation distance from periodically ❑ pther(See Comments/Explanatron) <br /> saturated soil or bedrock, <br /> Non-parfarmance systems built Apn! 1, I ❑ Yes ❑No CommentslExplanation: <br /> 1996,or later or lor non-performance Boring: <br /> Systems Jocated in ShorAland or WelJhead <br /> Arotectfon Areas or Serving a food, 1-9" 10YR 212 Loam <br /> beverage, or lodgir+g�stablrshment: <br /> 10-24" 10YR 4/4 Clay I�oarn <br /> Draintield has a three-foot vertical <br /> separatlon distance from periodlcally No Motts <br /> saturated soil or bedrack.�' <br /> "Experiment�l", "Other;or "Pertormance' ❑ Yes ❑No Irldicat� dQp#hs or elevations <br /> systems built under pre-2008 Aules; Type IV <br /> or V systems built under2008 Au18S(7080. A. Bottom af distribut'ion medla I plus 12"or more <br /> 235n or 7080.2400 (Advanced Inspector � <br /> License required) B. Perfodlcall saturated SOflPoedrock I over 24" <br /> Drainfi�ld meets the designed�ertical C. Svstem separation 36"plus <br /> separation distance from periodically "'�" — <br /> satura,t�d sqil or bedrock. , p. Requlred compliance se aratlon' 24" <br /> ARY "no"answe�'above indicat�s tl�e system is 'May be reducBd up to 15 percent if allowed by Local <br /> faflfng to proteaf groundwat�r. Ordinance, <br /> 5. Operati�n� Permit and Nitrogen BMP'�T Compliance component#5 of 5 �Not applicable <br /> Is the system operated under an Opera#ing Permit7 0 Yes []No If"yes",A below is requfred <br /> Is the system naquired to employ a Nitrogen BMP7 ❑ YeS ❑ No If"`yes", B b�low is required <br /> BMP=Best M�nagement Practrce(s)sp9cified in the system das�gn <br /> !f the answer to both questions 1s "no°; this section does nof n�ed io be co►npleted. <br /> Compliance crlterla __ <br /> a, Operating Permit numbec= 0 Yes ❑ No <br /> Have the Qp9rating Permit re uiremsnts been met? <br /> b. IS the requlred nitrogen BMP in_place and properly funCtioni�7 ❑Yes [�No____� <br /> ,A,ny "no"answer I�dicate�Nancomplfance. <br /> Upgt'ede�tequirements(Mfrtn.Stxt. §915,55)A»�mmin�nt threat to publ�heafth and sal�ty(lTPHS)must be upgradad, replacod,or its use <br /> dlsconttnued witY�r17 tEn InOnihs o/racefp!of this rtofiCe or wr7hln a shortarperfod if fE+quil'ed by IPGa!ordlnance, !l the sysfER1 is idiling to proiect <br /> ground wafer,the sysiPm mUst b9 upgraded,replaced,or its use dlsconrinued wlthrn the time required by local ordinance.If an exrsti»g system <br /> rs not faf7ing as deffned in law,&nd h�5 At leasl nvo feet of desrgn sor!Separatron,therr!he system need not be upgrdded,repalred,replaced, or <br /> rts uee dJ�conNnued,nofw�thstanding any local or�lnanca[hat Is more striCt. Thrs provfsr'on do�s not apply to systems rn shpreland ar�as, <br /> WellhBad Protectlon AreaS,or tftose used in Connec8on wlth food,beverage,&»d lodging establlsltmenfs as defined rn l8w. <br /> www.pca.sta[.e.mn.us • 651•296•6306 • 800,657-3864 • TlY 651-28Z-533Z or 804•857,3864 • Available in altemative formats <br /> wq-wwists4-31 • 3116/71 Page 3 of 3 <br />