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Feb 22; 2016 04:35PM HP FaxRusty Olson 7634988290 page 4 •xi� ; r �4�� Property address: 2811 Fairoiew Lane, Orono, MN Inspector initials/Date: J. O.2/20l16 4. Soll Sepa►'dtioll —Compliance component#4 of 5 Date of installation: 8l06/1987 ❑ Unknown Verification method(s}: ShorelandlWellhead protectioNFood Beverage �Yes � No Soi/observa6on does not ex ire. Previous sorl Lodging? observafions by two independent parties ar�sufficient, COmpllarlCe Criteria: unless site Conditions have been altered orlocal requi�ments differ. Forsystems builf pnorto Apn!1, 1996, and , �Yes ❑ No not located in Shoreland or Wellhead � Conducted soil observation(s)(Attach boring logs) Protection Area ornotserving a food, ❑ Two previous verifications (Attacn bo.inglogs) beveraqe orlodging establishment.� I ❑ Not appliCable(Holding tank(s),no drai�rfretd) Drainfeld has at least a two-foot vertical � Unable to verify(See Comments/Fxplanation) separation distance from periodically ❑ Other(See CommentsiExplanationJ saturated soil or bedrodc. Non-performance systems buift Aprr!1, ❑ Yes ❑ No Comments/Explanation: 1996, or Iater or for non-performance sysferns locafed in Shore/ard or Weflhead �i Protection Areas or serving a food, I beverage, or lodging estabGshment Drainfield has a three-Foot vertical separation distance from periodically saturated soil or bedrock.' � `Expenmenta!" °pther�, or `Performance" ❑Yes � No IndiCate depths of elevations sysfems built under pre-20Q8 Rufes; Type IV 'i � or V systems 6uilt under 2008 Rules(7080. ' A. Bottorn of distribution media ' 92.9 2350 or 7080.2400 (Advanced Inspector I LiCense fequi�ed) B. PeriodicaRy saWrated sollbedrock I' 90.9 Drainfield rneets the designed vertical C. S tem se aration 2.0 separation distance from periodically saturated soil or bedrock I D. Required compliance separation" 2.0 Any "f10"answer above indieates the systern 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 sysiem 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 Pracfrce(s)specified in the system design If fhe answei to both questions is "no", this section does not need to be completed. Compliance criteria a. Operating Permit number: j ❑Yes ❑ No �lave the Operating Permit requirements been met? ` I b Is the required nitrogen BMP in place and properly functioning? ' ❑Yes ❑ No Any "no"answer indicates Noncompliance. Upgrade Requirements(Minn. 5tat. §11b.55J An�mminent threat tn public health artd safety(1TPl-IS)must be upgreded, raplaced,or its use disContinued within ten months o!receipt of thrs notice or within a sho�ter period if requrred by local ordinance.If the system rs faiJing to protec! ground water,fhe system must be upgraded, replaced,or its use disaontinued within the time required by local ordinance. If an existing system is not failing as deh"ned in law,and has at least hvo feet of desrgn soi!separation,then the system need nol be upgraded,repaired,replaced,or its use disconhnued,notwithstartding any loca!ordinance that is more strict. this provisron d�es not apply to systems in shoreland areas, Wellhead Protection Areas,or fhose used in connecrron with food,beverage,and lodging estatrlishments as defined in faw. www,pca.state.mn.us • 651-296-6300 - 800-657•3864 • TTY 651-262•5332 or 800-657-3864 • Available in alternative tormats wq-wwists4-31 . i124/12 Page 3 of 3