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Nov 12 2015 0924PM HP FaxRusty Olson 7634988290 page 4 Proper;y address: 2995 Deer Run Trail,Orono,MN Inspector InitialslDate: J. 0. 10l30/15 4. SOiI Sepafation -Compliance companent#4 of 5 Date of installation: 8/20f1998 ❑ Unknown Verificatian method(s): Shoreland/Wellhead protectionlFood Beverage Lodging? ❑Yes � No 5oi1 observab'on does not expire. Prevrous soi! observations by two independent parfies are suffrcrent, Compllance Criteria: unless site conditions have been altered orloca! requi�ements differ. Forsysfems built pnorfo Apnl 1, 9996, and ' ❑Yes ❑ No not locafed in Shoreland or Wel)head �I � Conducted soil observation(s)(anach bor,ng togs) Protection Area or nof serwng a tood, ❑ Two previous verifications (Arracn bonng logs) beverage orlodging establishment ❑ Not applicabl2(Holding tank(sJ,no drainfield) Drainf�efd has at least a two-foot vertical ', ❑ Unable to verrfy(See Comments�planation) separation distance from periodically I salurated soil or bedrock. ' ❑ Other(See Comments/Explanatior) Non-performance systems built Apri!1, �Yes ❑ No CommentslFxpJanation: 199fi,or later or for non-performance sysrems located in Shoreland or Wellhead Profecfion Areas or serving a food, , beverage, orlodging establishmenf: Drainfeld has a three-foot vertical � separation distance from periodically I saturated soil or bedrock." -— — - ----�-- "ExpenmentaP; "Other'; o� "Performence° , ❑Yes ❑ No Indicate depths of elevations systems builf under pre-2Q08 RuJes; Type IV I or V systems bui7t under 2008 Rules(7080. I A. Bottom of distribution media l 102.1 2350 or 7080.2400 (Advanced Inspector � License required) B. Periodically saturated soilJbedrock 99.1 Drainfeld me2ts the designed vertical ' C. System separation ' 3.0 separation distance from periodically ! - saturated soil or bedrock. _ ___ _ D Required com�Iiance se aration' 2.6 Any "no"answer above rndieates the system is 'May be redu�d up to 15 percent it allowed by Local _Failing to Pratect Groundwater. ordinance. 5, Operating Permit and Nitrogen BMP*—compiiance component#5 of s � Not applicable Is the syslem operated under an Operating Permit? ❑Yes ❑ No If"yes",A below is requi red Is tne system required to employ a Nitrogen BMP? ❑Yes ❑ No If"yes",B below is required BMP=Best Management Practice(s)specified in the system des+gn If the answei io both questions is "no", ihis section daes nof need to be completed. Compliance criteria a. Operating Permit number: ❑Yes ❑ No Have the Operating Permit re�uirements been met? � b. Is the required nitrogen BMP in place and properly functioninp? ��Yes ❑ No Any "no"answer indicates Noncompliance. Upgrade Requirements(Minn. Stal. 3 115.55)An rmminent threat to public health and safety(lTPHS)must be upgreded,replaced,or rts use disconflrrued within ten months of receipt of this notic�e or wilhin a shorter penod if requfred by loca!ordinance If the systern is failing fo protect qround water,the sys[em must De upgraded,replaced,or i!s use discontinued within lhe time required by loca!orrlinance.If an existrng system is not failrng as de/ined in faw,and has at least hvo feet of design soil separation,then the system need no►be upgraded,repair�d,replaced,or its use discontinued, noiwithstanding any locaJ ordinance!hat fs more strict. This pravrsion does not apply to systems in shoreland areas, Wellhead Protection Areas,or those used in connecfion with food, beverage,and lodging establishments as dehned in la�.v. www.pca.state.mn.�s • 651-296-6300 • 500-657-38b4 • TTY bSi-282-5332 or 800-657•3864 . Available in altemative formats wq•wwists4•31 . 1/14/12 Poge 3 of 3