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Oct 10 14 12:08p Joseph Olson 763-498-8290 p.6 Property address: 26�5 Countryside Dri�e W., Orono, MN _ Inspedor initialslDate: J. O. 10/07194 4. SOiI Sepdt'atiOn—Compliance componer�t#4 of 5 Date of installation: 1112119 _ ❑ Unknown Verifica#ion method(s): 5horelandM/ellhead protectionlFood Beverage todging? ❑ Yes � M1�o Soil observafion does nof expire. P�vrous soi! observations by two independent parties are suffrcient, Compliarece Criteria: unless srte condrtions have been altered orlocaf i � � T— requir�ments ditfer. For systems built prror to Apn/1, 1996, and �' � Yes ❑ No notlocated in 5horeland orWellhead � Corfducted soil observation(s) (Attach 6oringlogs) Protecfron Area ornotservinq a food, ❑ Two previous venfications(Ah'ach boring logs) beveraga orlodging estab/rshmenf: � ❑ Not appliC2bfe(Holding tank(sJ,no drairrr7eld) Drainfield has at least a two-foot vertical I ❑ Unable to verify(See Comments�Explanation) separation distance from periodically saturated soil or bedrock. Q other(See Comments/Exp�anation) Non-performance systems built Apri!9, ❑Yes ❑ No Comments/Explanatlon: 1996, or later or for non perfonnance � sysfems Jocated in Shoreland or We/Ihead Proteclion Areas o�serving a food, beverage, or lodging establisflment_ j Drainfield has a three-foot verlical separation distance from periodically saturated soil or bedrock'� �Expe,imenfal'; aOther�,or "Performance" ❑Yes ❑ No Indicate depths of elevations systems built under p�-200&Rules; Type IV I - — ---- or V systems built under 2008 Rules(7080. A. Bottom of distribution med�a 99.0 2350or7080.24D0 (Advanced lnspector ! LiCense requfred) �I B, Pertodicaily sat�rated soillbedrock 98.0 Drainfiefd meets the designed vertical � C. System separation 2.7 separation distance from penodically I saturated soil or hedrocEc. D. Recruired comp�iance separation' 2.0 AfJy "!)O"answer above indicates fhe system is *May be reduced up to '15 percent if allowed by Local Failing to Profect Groundwater. Ordinance. 5. Operating Permit and Nitrogen BMP*— Cornpliance component#5 of 5 � Notapplicable Is the system operated under an Operating Permit? ❑Yes ❑No If"yes", A be�ow is required Is the system required to employ a Nitrogen BMP? ❑Yes ❑ No If"yes", B be[ow is required BMP=Best Managemenf Practice(s)specified in the system design lf the answe�to both questrons is "no'; fhis section does not need to be completed Compliance criteria a_ Operating Permif nurnber — . []Yes ❑ No Have 2he dperating Permit requirements been met? b. Is#he required nitrogen BMP in�lace and pro�nc#ioning? ❑Yes ❑ No Any "no"answer indicates Noncompliance. Upgrade Requirements(Minn.Stat §'115.55)An imminent threat to putrlic heafth and sa(ety(f'fPHS)mus�be upqraded,replaced,orits use dfscontrnUed sv,�thin ten monfhs of�eceipt of fhis rroilce o�wifhin a shonerperiod if reqvrred by local orriinanae. !f Ihe system is failing to profect ground water,the system mustbe upgraded, repfaced,orits use discon6nued withrn the(rrrre requ�red bylocal ordinance. Jf an exisirng system is nof faiGng as def+rred in law, and has at least two feet of design soii separation,then the system rreed not 6e upgraded,repaired,replaced,or its use discontinued, nolwithstar�ding any loca!orr/inance fhat is more stricf. This pravision does rrot apply to syst�ms rn shoreland areas, WelJhead Protection Areas, or those used in connect�orr with food,beverage,and lodging esfablishments as defined in law. vrvvw.pca.state.mn.us . 651-2%-b300 • 800-657-3864 • TTY 651-282-5332 or 800-657•3864 • Avai�abte in alternative formats wq-wwists4-31 - 1/24/f2 Poqe 3 af 3