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04/22/2016 11 :48AM FAX 9528733112 f�0003/0004 Property address: 1820 Fox 5treet Orono,Mn 55391 _ lnspector initials/pate: JS � 4/21/2016 (mm/dd/yyyy) 4. 5oil SeparaHon —CompEiance component#4 of 5 Date of installation: _ � Unknown VerffiCation method(s): (m�rvdc�rrrr) ShoralandlWellhead protection/Faod bevarage Soil obSelvallon doas not expire. PrgyfpUs soil lodging� ❑Yes � No obServatipns by tWo independent pe�'ties are Su�Cleni, unless site cond!llons have been eltered or loca/ Complianae crfteria: raqurrements diffar. For systems buift pnor to Apn!9, 9996,and ❑Yes �{ Nq ❑ConduCted soil observation(s)(Attech boring logs) not loc�ted in Shoreland or Wellhead Protecfron Area or not s�rving a tood, ❑Two previous verifications(Arracn nonng logs) beverage or lodging establlshment; ❑ Not appliCable(Holding tank(s),no tlreinfield) Drainfield has al least a tWo-foot vertical ❑ Unable to verify(Seo CommentslExplanatJan) separation distance from periodically ❑ �{heI'(5se Comments/Explanatfon) saturated soil or hedrock. Non-performanCe systems bulR Apri!9, �Yes ❑ No Cammentsl�xplanation: 9996,or later or fi�r non-performance systems located in Shorefend or WeUhead Soring. Protection Areas or serving a food, 1-12"10YR 2/2 LoBm beversge,or lodgfng estab�ishment: Drainfield has a thre�foot vertical �3-29"10YR 4/4 Clay Loam separation distance from periodically Motts�29" saturated soil or bedrock.* "Experimenfa!" "Other'; or "Performancw" ❑Yes 0 No IndlCate depths or elevations systoms builf under pre-200$Rules; Type!V , - � or V systems built under 2008 Rufps(7080. A. 8ottorn of distributlon med;a +�2" 2350 or 708Q.2400 {Advanced Inspector � - - — L1Cen5e requlfed) e_ Periodlcally ssturated soiUbetlrock 28" Dralnf,eld ms�ts the designed vertical C, Systam separation 4�" separation distance from periodlcally - ssturated soil or bedrock. _D. R9quired CompllanCe seperation' 38" Any "no"answer above indicates the sysf�em is 'May be reduced up to 15 percent if aflowed by Local failing to protect groundwater �rdinance. 5. Operating Permit and Nitrogen BMP"—Compliance component#5 of 5 � Not applicable Is the system operated under an Operating Perrnit? ❑Yes ❑ No If"yes",A below is requlred Is the systam required to employ a Nitrog�n 8MP7 ❑Yes 0 No If"yes",B below is requlred BMP=�est Managoment Practico(s)speclfied fn rhe system des�gn !f the answ�r fo bofh questions/s "no", this s�ction does not need M be Completed. Cornpliance criteria a. Opereting Permit number: Have the Operating Permft requirements been met7 �Y� ❑ No b. Is the required nitrogen BMP in pfgce and properly functipning? ❑Yes ❑ No Any"no"answer Indicates Noncompllance. Upgrade Requirements(Minn,Stat.§115.55)An Imminant threat to public health antlsafety(1TPMS)must be upgraded,replAced,or its use dlscontinued within ten months of recolpt of this notice or w;thin a shoner perrod if roquired 4y loca!ordinance.!f the syslem ia faiUng to pratect ground water,the sysfom must be upgradad,rep/aced,or ets use dlscontinued withln 8�s time requlred by/oca!orclinanee.lJan existing system Is not fail;ng as doflned in law, and has at least hvo feet of deslgn sor!separatlon,tiren the system naed not be upgraded, repaired,replaced,or rts use dlscon�inued, notwkhstandinq any local ominance that is more strkt 7Hrs provislon does not appy to systems rn shanland areas, lNellhead Protecilan Areas,oi those used in connaclion with food,beverage,and lodging esta66shments as deflneC rn lew. www-pca.state.mn.us • 651-296-63op • 8Q0-657-3864 • TlY 651•z82-5332 or BQO-657-3864 . Available in akCernative formatr wq•wwists4-31 • 3/16I12 Page3oJ3