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Property address: 888 Dakota Ave-Orono Inspector initials/Date: J8 � 5/21/2014 (mm/dd/yyyy) 4. Soil Separation —Compl€ance component #4 of 5 Date of installation: 5/18/1988 __ ❑ Unknown Verification method(s): (mm/d�/yyyy) Shoreland/Wellhead protectioNFood beverage Soi!observation does nof expire. Previous soil lodging? � Yes ❑ No observations by two rndependenf parties are sufficient, unless sife co�ditions have been a![ered or loca! _Compliancecriteria: _ requirementsdifter. For systems built prior to Apri! i, 199&, and i ❑ Yes ❑ No �Conducted soil observation(s) (Attach boring logs) not facated in Shoreland or We!lhead Protection Area or not servrng a food, I ❑Two previous verifications(Attach bor;ng logs) beverage or lodging establishment: ❑ Not applicable (Hording tank(s), no drainl;eld) Drainfield has at least a two-foot vertical ❑ Unable to verify (See Comments/Explanation) separation distance from periodically ❑pther(See Commenrs/Explanatron) saturated soil or bedrock. Non-performance systems built April r, �Yes ❑ No Comments/Explanation: i996, or lafer or for non-performance systems located in Shoreland or Wellhead Boring: Protectron Areas or serving a food, 1-12" 10YR 2/2 Loam beverage, or lodging establrshment: 13-19" 10YR 4/4 Loam Drainfield has a three-foot vertical separation distance from periodically 20-24" 10YR 4/6 Sandy Loam saturated soil or bedrock.` No Motts "Experimental'; "Other'; or "Performance" ❑ Yes ❑ No Indicate de ths or elevations systems built under pre-2008 f3ules; Type l V or V systems built under 20(J8 Rules(7080. A. Bottom of distribution media lus 12" 2350 or 7080.2400 (Advanced Inspector L+cense required) B. Periodicall saturated soiUbedrock 24" lus Drainfield meets the designed vertical C. System separation 36" lus separation distance from periodically — saturated soil or bedrock. __ __. __ _ ! __� _D. Required compliance se aration' 36" Any "no"answer above indicates the system is 'May be reduced up to 15 percent if allowed by Local failing to protect grvundwater. Ordinance. 5. Operating 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 system required to employ a Nitrogen BMP? ❑Yes ❑ No If"yes", B below is required BMP=Best Management Practice{sJ specified in the system design If the answer to both questions is "no'; this section does not►teed to be comp/eted. Compliance criteria a. Operating Permit number: Have the Operatinq Permit re uirements been met? ❑Yes ❑ No b. Is the re uired nitro en BMP in lace and ro erl functionin ? ❑ Yes ❑ No Any "no"answer indicafes Noncompliance. � Upgrade Requirements (Minn. Stat. § i i5.55)An imminent threat to public health and safety(ITPHS)must be upgraded,replaced, or its use discontinued wrthrn ten months ol receipt of�his notice or within a shorfer period if required by local ordrnance. /f the system rs failrng to protect ground wafer, the system must be upgraded, replaced, or its use disconfinued within the time repuired by loca!ordinance. ll an existing system is not faDrng as defrned in law,and has at least two leel of design sor!separation, then!he system need not be upgraded, repaired, replaced, or rts use drscontinued, notwithstanding any loca/ordrnance that is more strict. This piovisron does not apply to systems in shoreland areas, WeJlhead Protection Areas,or those used in cannection wifh lood, beverage, and lodging establishmenfs as deiined in law. www.pcastate.mn.us . 651-Z96•6300 • 800-657-3864 • TTY b51-282-5332 or800-657•3864 • AvailabEe in at[ernative formats wq-wwists4-31 • 3/16/12 Page 3 of 3