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. . � ��t�`2�; ' �� Property address: 755 Femdal Rd.N Orono,Mn '�� lnspedor initialsJDate: 11/2/2015 � (mm/dd/YYYY) 4. Soil Separation—Compliance component#4 of 5 Date of installation: »/02/2075 ❑ unknovm Ve�cation mothod(s): (mm/dd�YYYY) ShorelarMlWellh�d promctloNFood be�verage Sal�rvation does not expire.Previous soil ��i� ❑Yes � No obseivations by iw�o independent pe►ties a�suli�aent, unless site oonditions hav�e been altened or local Compliance criteria: �equ;remerrts dilter. For systems built prior to Ap�l t, 1996,and ❑Yes � No �Conducted soil observation(s)(Attach bonng iogs) not Iocated in Shoreland or Wellhead ❑Tw�o previous verifications(Attach borrng logs) Protection A►ea or not servir►g a food, beverage or lodging establishmerrt: ❑ Not applicable(Holding tardc(s},ia drainfielcn Drair�feld has at least a two-foot vertical ❑Unable to verify(See Canments�Explanatia►) separation distance from periodlcatlY ❑Other(See CommentsiExplanadon) saturated soil or bedrock. Non-performance systems builtAprill, ❑Yes ❑No Commenls/E�lanation: 1996, or later or for non-pe�►manoe systems bcated in Shoreland or We!lhead Protection Areas or se�ving a f�od, beverage, or lodging establishment: Drainfield has a three-foot vertical separaUon distance from periodicatly saturated soil or bedrodc_: Experimental'; "ON►er', or P�rformance" ❑Yes ❑No indiCBte de ths or elevadons systems built under pre-20U8 Rules;Type!V or V systems built under 2008 Rules(7080. A. eottom of distribution media 36" 2350 or 7080.2400 (Advanced Insperxor LJ(�'(15C fEqUl�'2d� B. P@nOdlCa Sahlfated SOIIIbCdrOdc 42"S(ld 4fi" Orainf�ld meets the designed vertical �, g se ration 6"and 10" separation distance from periodicalty saturated soil o�bedrodc. D. uired cam ianoe ration' 24" Any "no"answer above indicates the system is '�Y��up to 15 peroent if allowed by Local failing to protect groundwater. ordirrance. 5. Operating Permit and Nitrogen BMP*—Compliance component#5 of 5 � Not applicable Is the system operated under an Operating PermiY? ❑Yes ❑ No ff"yes",A befo�w is r+�quired Is the system required to empby a Nitrogen BMP? ❑Yes ❑ No if"yes",B below is nequir+ed BMP=Best Management Practice(s)specified in the system design If the answer to bott►questions is"r►o",this secHon does not need to be completed. Com liance criteria a. Operating Permit number. �Yes ❑Na Have the O Permit r uirements been met? b. Is the uired n' en BMP in ce and r1 furx:tioni ? ❑Yes ❑ No Any"no"answer indicates Noncompliance. Upgrade Requiremerns(Minn.Stat§115.5�M immi►►ent threat to public health snd sefety(ITPHS)must be upgraded,replaced,or its use dis[�n6nued withirt ten months of receipt af fhis r►otice or widtin a staRer periai if required by loca!ordrtance.H tlte system is failing b protect ground water,N►e system must be upgraded,relMaQed,a its use drsoontinued wifhin the time requi�ed by bcal o�►ar►oe. !f an exishng system is not failing as defrr►ed in Isw,and has at least twn leet of design soil separa6ar,tl►en the sysbem need not be upg�aded,►ePai►ed.replaoed,or its use disco�nued,notwM/►standaig any bca/o+m►►ance H►at is more sbric* This prtivisinn does not appty to systems in siareland areas, Wel/head Protec6on A►eas,or fhase eised in cor►nec�or►wid►food,beve►age,a►►d lodgir�9�►r►er►Ls as de�ined in law. •--- -- --- «. ,.,< <�„�, _ �cc�_��. . nv RS�-�R�-5�37 rr�657-3864 • Available in altemative formats