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04/OS/2016 8 : 54AM FAX 9328733112 C�0003/0004 <br /> Propertyaddress: 140 South Brown Road,Orono, Mn Inspector fnitialslDate: JS 4/6/2016 <br /> (mm/dd/YYYYJ <br /> 4. Soil Separatiqn,Compliance cornponent#4 of 5 <br /> Date of installation; � Unknown Verffication methad(s): <br /> (mm/dd/yYYY) <br /> Shorelandlweilhead rotection/Footl bevera e Sal observafron does not expire.Previous sorl <br /> iodging? p 9 ❑Yes � No observations by two independent paKles are sufflclent, <br /> unless site conditions have beon altered orlocal <br /> Compliance criteria: requlremenfs drffer_ <br /> � -- <br /> For systems bulk privr to Apri!9, 1996, end ❑ Yes ❑ No �Conducted soll observatlon(s)(qttach boring�ogsJ <br /> not located in Shoreland or We!lhead <br /> Protection Ar�a or not serving a food, ❑rWo previous verifications(Attach bo�;ng logs) <br /> beversge orlodging establishment: ❑ Not applicable(Maa��g tank(sJ,no drainfisld) <br /> Drainfield has at least a two-foot vertical [] Unable to verify(Soe Comments/Fxpianation) <br /> separation distance from periodically <br /> saturaced soil or bedrock, ❑Other(See Comments/ExpJanationJ <br /> Non-performance systoms buitt April i, �Yes ❑ No Comments/Explanation: <br /> 9996,or later or f�r non-porforrrrance <br /> systems located In Shoreland orWellhead 8oring; <br /> Protectron Areas or serving a food, I 1-6"10YR 2/2�oam <br /> beverage, or lodging establishment: <br /> Drainfield has a fhre�foot verfical 7-��"10YR 4/4 Clay Loam <br /> separatlon distance from periodically Motts cQ 16" <br /> saturated soil or bedroCk,' <br /> "Experimental'; "Other" or "Performance" ❑Yes ❑ No Indicate depth5 or elevatfplls <br /> sysfems built under pre-2008 Ru/es; ]'ype IV --r— - <br /> or V systcros bullt undo�2008 RulOs(7080. A. Bottom oF distribuNon media 17"" <br /> 2350 or 7080.2400 {Advanced Inspector - <br /> License required) <br /> B. Periodlcal[y saturated soiubedrock 15" <br /> Drainfield meets the designed verticai <br /> separation distance from periodic211y C. System separation 3g^ <br /> saturated soii or bedrock. — <br /> D. Requlred compliancosaparation' 36" <br /> Any "no"answer abov�indicat�s fhe sy�tem is 'May be reducad up to 15 parcent ff allowec!by Local <br /> failing to profect groundwafer. ord�nance. <br /> 5, Operating Permit and Nitrogen BMP�`—Compliance component#5 of 5 � Not applicabfe <br /> Is the system operated under an�perating Permit7 ❑ Yes ❑ No If"yes",A below is required <br /> !s the system required to employ a Nllrogen BMP7 ❑Yes ❑ No li"yes",B bslow Is required <br /> BMP=Best Managemenf PI'�Ctice(s)specffied in the system design <br /> If the�nswer to boih questions is "no", this a6ction dogs not need to he cpmpleted. <br /> Compliance crlteria <br /> a. Operating Permit number: — <br /> Nave the Operating Permit repuirements been met7 �Yes ❑ No <br /> b. Is the required nitro9en BMP in p12Ce and properl fy unctianln ? �]Yes ❑ No <br /> Any"no"answer indicates Noncompliance. <br /> Upgrade Requiromants(Mlnn.Stat.§1 i 5.55J An immr'nent threal ro publrc heal�h and sa/ety(fTaHSJ must be upgraded,replaced,or its use <br /> dlscentfnued withln�e»months of reoeipt ol thfs notice or within a shorEar period if required by/oeal ordinance.!f the system is failrng to protect <br /> gmune water,tho sysfem must be upgradea,replaced,or;ts use d/scontinued w;fnin the tlme required by/ocal ordinanco.rsan exlsting system <br /> /s no!faifing as daf;ned in law,and hes at least two teet of design soll seperatlon,ihen the system need nol be upgraded,repaired,ro�laced,or <br /> its use d/seonfinued,notwithstanding any local ordlr,artce that is more striet. This provis;on doas not apply to systems in shoreland areas, <br /> wellhead Prvtecfion Arcas,or those used in conncetron with h�od,beverage,and lodg/ng establishments as deflnaU in law, <br /> www.pca.state.mn.us • 651-296-6300 • 800•657-38b4 • TTY 651-z82-5332 or 800-657-3864 • Available in alternative formats <br /> wq•wwists4-31 • 3116l92 <br /> Page3of3 <br />