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Property address: 710 Big Island, Orono Inspector initials/Date: PJB � 6/24/2016 (mm/dd/yyyy) 4. Soil Separation— Compliance component#4 of 5 Date of installation: 07/22/08 ❑ Unknown Verification method(s): (mm/dd/yyyy) ShorelandNVelihead protection/Food beverage Soil Observation does not expire. Previous soil lod m � � Yes ❑ No observations by two independent parties are su�cient, 9 g� unless site conditions have been altered or local Com liance criteria: requirements differ. For systems built prior to April 1, 1996, and �Yes ❑ No � Conducted soil observation(s) (Attach boring logs) not/ocated in Shore/and or Wellhead ❑Two previous verifications (Attach boring/ogs) Protection Area or not se►ving a food, ; beverage or lodging establishment.� !I ❑ Not applicable(Holding tank(s),no drainfield) Drainfield has at least a two-foot vertical ❑ Unable to verify(See CommentsiExplanation) separation distance from periodically saturated soil or bedrock. ❑ Other(See CommentsiExplanation) Non-pe►formance systems builtApril1, �Yes ❑ No Comments/Explanation: 1996, or/ater or for non-performance systems located in Shoreland or Wellhead Protection Areas or serving a food, beverage, or lodging establishment: Drainfield has a three-foot vertical i separation distance from periodically saturated soil or bedrock.* "Experimental'; "Other'; or "Performance" �Yes ❑ No IndiCate de ths or elevations systems built under pre-2008 Rules; Type/V or V systems built under 2008 Ru/es(7080. A. Bottom of distribution media 91.75 2350 or 7080.2400 (Advanced Inspector LiCense required) B. Periodicall saturated soil/bedrock 32 Drainfield meets the designed vertical �� C. S stem separation 14 separation distance from periodically I saturated soil or bedrock. D. Re uired compliance separation"` 12 Any "no"answer above indicates the system is "May be reduced up to 15 percent if allowed by Local failing to protect groundwater. 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(s)specified in the system design lf the answer to both questions is "no", this section does not need to be completed. Compliance criteria a. Operating Permit number: To be tested in the fall Have the O eratin 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 indicates Noncompliance. Upgrade Requirements(Minn. Stat.§ 115.55)An imminent threat to public health and safety(ITPHS)must be upgraded,replaced,orits use discontinued within ten months of receipt of this notice or within a shorter period if required by local ordinance. If the system is failing to protect ground water, the system must be upgraded, replaced, or its use discontinued within the time required by local ordinance. If an existing system is not failing as defined in law, and has at/east two feet of design soil separation, then the system need not be upgraded, repaired,replaced, or its use discontinued, nohvithstanding any local ordinance that is more strict. This provision does not apply to systems in shoreland areas, Wellhead Protection Areas, or those used in connection with food,beverage, and lodging establishments as defined in law. www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats wq-wwists4-316 • 6/4/14 Page 3 of 3