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Oct 20 14 10:59a Joseph Olson 763-498-8290 p.4 Property address: 725 Qickey Lake Road,Orono, Mhf _ _ Inspector initials/Date: J.O. 8/01/14 4. $oil Sepatet10r1—Compliance component#4 of 5 Date of installation: 6/27/86 ��_ ❑ Unknown Verification method(s): ShorelandMfellhead protectionlFood Beverage �yes []No Sal observatron does not expire. Previous soil Lodging7 obse►vat�ons 6y rivo independent parfies are s�cienf, GOm�lianCe criterie: unless site concirtions ha✓e been alfered orlocal For systems builtpnor to April 1, 9996, a� ❑ Yes ❑ No �puirements differ. not located in ShorelaRd or Wellhead � Condu�ted soil obseroation(s)(Attach borinq logs) ProteeSon Area ornot se�ving a food, ❑ Two previous verifications(Attach boringlogs) beverage orlodging esfablishmenL� 0 Not appliCable (Hofding tank(s),no drainfield) Drainfield has at least a two-foot�ertical ❑ Unable to verify(See Comments/Expfanation) separation distance from periodical€y saturated so€I or bedrock_ ❑ �her(Seo Comments/Explanat;on) hlon-performance systems builtAprrll, �Yes ❑ No � Comments/Explanatron� 1996, or later or fo�non-performance systems located in Shoreland orWe!lhead Profecfron Ar�as or serving a food, beverage, or lodging establishment Orainfeld has a three-foot vertical separa9ion distance from periodically ' saturated soi�or bedrock* i 'Experimental; "Ofher; or "Performance" ❑Yes ❑ No Indicate de ths of elevations systems built under pre-200B Rules;Type!V ---- - --�— -- or V sysfems built under 20�8 Rufes(7080. A. Bottom of distribu6on media 103.3 2350 or 7080.2400 (Aduanced Inspector License required) I 8. Periodically saturaled soiUbedrock 100.7 Dra€rtfield meets lhe desigr�ed vertical C• System seoaration 2.6 separation distance irom periodically � — .— sa#urated soil or bedrock. D. 12equFred compliance se�aration' 2_6 Any "no"answer above indicates the sys2em is "May be reduced up to 15 percent if aflowed by Local Failin�to Protect Groundwarer. _ _ _ _ ordinance. 5. Operating Permit a�d Nitrogen BMP*—compiianee component�5 of 5 � Not appficable Is the system aperated under an Operating Permil? �Yes ❑ No If"yes",A below is required Is the system required fo employ a hlitragan BMP? ❑Yes ❑ No If"yes",B below is required BMP=Best Management Prac6ce(s)spec�fred!n the system design lf LI�e answer fo both guestions is "no", ihis seci�on does not need to be completed. Corn liance criteria _— P_^---- a. Operating Permit number. T�� , � �u — — ' ❑ Yes ❑ No _Have_the Operatinq Permit requirements been met? b- Is the reguired nitrogen BMP in�lace and pro erl functionin ? ❑Yes ❑ No ` Any "no"answer indicates Nancompliance. Upgrade Requirements(Minn. SYat§115.55J An rmminent threat to pubfic healfh and safety(JTPHS)must be upgraded,replaceC,orits use drscont+nued wifhin Pen months ofreceipt of this notice or wrthin a sltorter perio�if requi�d by focal ordlnance.If the system is failrng to protect ground water,the system must be upgraded, replaced, or ifs use drscontinued wilhin the Line requi�d by loca!ordinance. !f an existir.g system is not failing as deflned ir/aw,and has at least(wo ieet of design soil separatron,then the system need not be upgraded,repaired,replaced,or rts use discontinued.notwithstanding any bca!ordinance thaf is more stnct 7his provision does not appJy to sysfems in shoreland areas, VVellhead Protection Areas,or those use�l in conner,tion wifh food, beverage, and lodging esiablishments as defined ic law. www.pCa.State.mn.u5 • 657-29h-6300 .� 500-657-3864 • TTY 65�-28Z-5332 or 800-657-3864 - Availab�e in aEtemative formats wq-wwists4-31 • i 1T4/12 Page 3 o f 3