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Property address: 645 Femdale Road,Orono,MN Inspector initials/Date: _ ' b `/ I (mm/dd�yyyy) 4. Soil Separation—Compliance component#4 of 5 Date of installation: 9/19/2008 ❑ Unknown Verification method(s): (mm/dd/YYYYJ ShoretandNYel)head protectioNFood beverage Soil observafion does not expire.Pr�vious soil ��9��? ❑Yes �No observafions by two independenf parfies are su�cient, unless site conditions have been altered or local Com liance criteria: requirements differ. Forsysfems builf priorto April 1, 1996,and ❑Yes ❑ No � Conducted soil obsenration(s)(Attach boring iogs) not/ocated in Shoreland or Wellhead ❑Two previous verifications(Attach boring logs) Pmtecfion Area or not serving a food, beverage or lodging estabfishment.� ❑Not applicable(HolrSing tank(s),no drainfield) Drainfield has at least a two-foot vertical ❑ Unable to ver'rfy(See Comments✓Explanation) separation distance from periodically ❑Other(See Comments/Exp/anafion) saturated soil or bedrock. Non�erformance systems builtApril 1, �Yes ❑ No Comments/Explanation: 1996,or later or for non-performance systems located in Sho�land or Wellhead Protecfion Areas or serving a food, beverage, orlodging esfablishmenf: Drainfield has a three-#oot vertical separation distance nom periodically saturated soil or bedrock.* "Experimental'; "Other; or "Performance' ❑Yes ❑ No IndiCate de ths or elevations systems buiff unaler pre-2008 Rules;Type!V or V sysfems built under 2008 Rules(7080. A. Bottom of distribution media 14 inch sand 2350 or 7080.2400 (Advanced Inspector License required) B. Periodicall saturated soiubedrodc 26 inch Drainfield meets the designed vertical C. S stem se aration 40 inch separation distance from periodically saturated soif or bedrock. D. R uired com liance se aration` 36 i►ich Any "no"answer above indicates the system is 'May be reduced up to 15 percent if allowed by Local failing tQ 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 empfoy a Nitrogen BMP? ❑Yes � No If"yes",B below is required BMP=Best Management Practice(s)specified in the system design If the answer to both questions is "no", this section does not need to be comp/eted. Compliance criteria __ _ a. Operating Permit number: ❑Yes ❑ No Have the O eratin Permit re uirements been met? b Is the required nitroqen BMP in place and properiy functioninq� ❑Yes ❑ No Any"no"answer indicates Noncompliance. Upgrade Requirementa(Minn. Stat§115.55)An imminent threat to public hea/th and sefety{ITPHS)must be upgraded,replaced,or its use disconGnued within ten months of receipt of this notice or within a shorter period if required by local orrlinance.If the system is failing to protect ground water,the system must be upgraded,rep/aced,or its use discontinued within the time r�quired by/oca/ordinance./f 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 6e upgraded,repaired,rep/aced,or its use discontinued,notwithstanding any loca/ordinance that is more strick This provision does not apply to systems in shoreland aroas, 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