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Property address: 4785 Creekwood Trafl,Orono,MN Inspector initials/Date: J.O.4/23/13 4. SOiI Sepd1'dtioll—Compliance component#4 of 5 Date of installatton: 8/08/90 ❑Unknown Verification meth�d(s): Shoreland/Wellhead protectfonlFood Beverage �Yes �No Soil obseivation does not ex Ire.Prsvious soil Lodging7 p observatlons by hvo independent parties are suffrcient, Com lianCe criteria: unless sifs conditions have been altered orfoca! For systems built prror to April i, 1996, and requirements differ. �Yes ❑No notlocated in ShoreJand orWe!lhead � Conducted soil observation(s)(Attach boringlogs) Protec6on A�a ornot seiving a food, ❑ Two previous veriRcations(Aftach boringlogs) beverage orlodging estab//shment: ❑ Not appliqble(Ho/ding tank(s),no dralnfreld) Drainfield has at least a two-foof vertical ❑ Unable to verify(Sae Comments/Exp/enation) separation dlstance irom periodically� saturated soil or bedrock. ❑ Other(See Comments/Explanafion) Non pe►fom►ance systems built Apri11, ❑Yes ❑No CommentslExplanatlon: 1996,orlaterorfornon-perfo�rr►ance systems locafed!n Shoroland or Wellhead Protectron Ar�as orserving a food, bever�ge, orlodgJng establishment: Drainfield has a ihree-foot vertical separation distance from periodically saturated soil or bedrock." Experimental; 'Othe�;or "Pedon►rance" ❑Yes ❑No Irtdicate de ths of etevations systems builf under pne-2008 Rules;Typs IV or V systems built under 2008 Rules(7080. A. Bottom of distribution media 100.3 2350 or 7080.2400 (Advanced Inspector LiCense required) B. Periodicall salurated so(Ubedrock 97.5 Drainfield meets the designed vertical C. S stem se aration 2.8 separation distance from periodically saturated soil or bedrock. D. Re uired com lia�ce se ration' 2.0 Al1y"no"answer above indlcates fhe system is �May be reduced up to 15 percent if ailowed by Local Falling to Protect Groundwater. ordinance. 5. Operating Permit and Nitrogen BMP*—Comp�iance component#5 of 5 �Not appltcable i Is the system operated under an Operating Permit? ❑Yes ❑No If"yes",A below is required ' Is the system required to employ a Nitrogen BMP? ❑Yes ❑No If"yes",B below Is required '�, BMP=Best Management Pracflce(s)specified in the system design If the a»swer to both questions!s "no'; thfs sect/on does nof need to be comp/eted Com Ilance criteria a. Operating Permit numbe�: , Have the O eratin Permit r uirements been met? ❑Yes ❑No i b. Is the re uired nitro en BMP in lace and ro erl functionin ? Yes ❑No Any "no"answer indicates Noncomplfance. Upgrade Requirements(Minn.Stat§115.65)An fmmfnent threat to public health and sefefy(ITPNS)must be upgreded,�eplaced,or ils use dlscontinued wlfhln ten monlhs of receipt oI this not/ce or within a shorter pedod!f required by Iocal orc/inance_!f the system!s feiling to protect ground water,the system must be upgraded,naplsced,or lts use disconUnued wifhin the time required by local orrlinance.!f an exisfing sysfem � !s nof fa!ling as defined ln law,a►xi has at/east lwo feat of deslgn soil separetion,then the system need not be upgraded,ispaired,replaced,or Its use dlscontinued,notwllhstanding eny local ord(nance that!s more slrict. This provlslon does not app/y fo systems In shore/snd areas, Wellhesd Piotection Areas,or those used in oonnection with tood,beverage,and loafging astablishments as deflned in law. www.pca.state.mn.us . 651•296-6300 • 800-657-3864 • TTY 651-282•5332 or 8U0-657-3664 • Available in altemative formats I wq-wwlsts4-31 • i/24/12 Page 3 of 3