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03106I2012 13:25 7634988296 RUSTYS PERC TESTING PAGE 64 <br /> I'roPerty address: 1465�iox St_ Orono MN Inspector Inidals/pate: J.O.318✓12 <br /> 4. Soil Separation—Compliance component#�t of 5 <br /> Date o1 Installa�Ion: 11/05/99 ❑ Unknown Ve�lflcatlon method�s): <br /> 9horolaneLWsllhead pr�oteetioelFood Bwsr�pe <br /> �a�p� �Ye8 ❑ No Sodl ob�ervad�on does not eurpirs. P�evious so!l <br /> observa6ans by tw�independent perties are sulffcient, <br /> COmpliwnce Crlt9r18: uMess site cond/Hons have been al(�red orlocal <br /> Fnr sysi�ms built prior t,o April 1, 1986, end ❑Yes ❑ No ���eMs dirfer. <br /> not�ocated!n Sfwrelend or Wellhead � Conducted soil obeervation(s)(Atfach poring/oga) <br /> bProtection�Aree or not seiving a/ood, ❑ Two previous verifications(Aftach Donng Mp� <br /> 9e lodgi►�g est�bllshment <br /> ❑ NM appliceble(Holding tank(s),rro dralnflefd) <br /> Dreinfield hes et least a tw�-foot vertical ❑ Uneble to verify(See CanmentsiErp�enetion) <br /> sepa�ation distance fr�am penodlrally <br /> saturated soil w bedrodc. O Other(s■e commsntsiEzplenevon) <br /> nio►�n��ce sysre�,s�rn aR,u�� �Yes ❑No Cormrr�ntslExplana�+o�n: <br /> 1998,oor leter or for nan�pe►formence <br /> sYs�ms bcated in Shoreland or Vl�head <br /> Protecffon A�as or serving e foocl, <br /> beverage, orlodging establishment <br /> DralnTield hes a three-foot vertic�l <br /> eeparatio�dlstance from periodlcally <br /> saturated soil or bed►aodc.• <br /> Experim�entel; "Othe�; or °P�rfwmar,oe• ❑Yes ❑No Indkate de ths of elevations <br /> sysi�sms auilt unafer p�-2008 Rules;Type/V • <br /> w V sysl�9ms bullt under 200�Q Rules(7080. A. Bottom of dl�tnb�rtion media 101.5 <br /> 2350 or 7080.,240p (Advanoad Inspedor <br /> Lioense r+equired) B_ Pe�oaicaUy saturaoed soiUbodrodc 88.5 <br /> Drainfleld meets the designed vertical C. S bam se eration 3.0 <br /> seperetlon distanoe frvm pe�lodically <br /> satur�ted svil or bedrodc. <br /> O. Rs,gui�d comQllQnce aratioM 2,B <br /> Any •,no•,answer�bov�e indlcat�ss the syatarr►la =nnay t��a�oed uP co�g��r,c;r aurn�►ea by�i��--- <br /> Falling to Pnot�e�ct Groun�ah�ral+er. o�dinenoe_ <br /> 5. Operati�g Permit and Nitrogen BMP'—Complianoe component#5 of 5 � Not applicable <br /> I�d�e syetem operated under an Operating Permlt? ❑Yes ❑No If"yss��,A below is requlred <br /> Is the'sy�tem required bo employ e Nltrogen BMP? (]Yes ❑No If"yss", B below is requlred <br /> BMI�Be�t MeneQerr�nt Prscdce(s)spedlled in the syat�m olesign <br /> H the enswer to both qaesGions/s "no", th/s sect/on does no!nood t�be comp/eted, <br /> Compliance c�iteria . <br /> a. OpereUng PermR number. <br /> Have the OperaOnp Permit re_quirementa been met? ❑Yes ❑ No <br /> b. la the required nitrogen BMP in plaoe and fundioni ? Yea No <br /> A►fy"no"anawer indicates Noncompllancs. <br /> Up�rads Rsqulrements(Mirtn. St9�§115.65)An Imminent Mreat to pubUc hea/th end aefelyr(ITPHS)must be upQraded,iep/sced,w its use <br /> dlscorK/nued wiGhin ten months o/rgogipt o�tlris noGlca or wiy�in e shorter pei/od N�quli9d by loce/adinance. ll Me 8y8tem is iailing to pvoteot <br /> g�vunQ weter,the sy�ts�lr must be upgreded,replpoed,orits use dis�oont/nued w!d►in the time requl�pd by local oNinenca.ff an ex(stlr►g system <br /> is nat(ailing as ab8nsd in lew,erM has et besf two feet of dasJgn soN aepa►Bt/o�n,tlren Ihe syatem noed►rot De upg�ded,r�pelred,repl9Aad�or <br /> �fa use dVi�oontlnusd,nofwr"thstend'v►g any 1op9/ordinerx�e thet fs mnrs aLrkY. 7'hi8 provision abea riot spiWy b aystems in shor�land eree8, <br /> IMellhead ProAaCtlo�r►Aress,or d►o�e used in oonnecbon wlfh lb�od,Deveiage, and bdg�rq eafaWlsltments as defined/n/ew. <br /> www.pcd.state.mn.us . 651-296-6300 . �00-657-396/ • TTY 651•282-5332 ar 80o-6S7•3864 • Available in altemattve formats <br /> wq-w►Ns[�4-3f . 1/21/11 ar..e a,.s a <br /> I <br />