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Property address: 2555 Fox Street, Orono, MN 55391 _ Inspector initials/Date: �,��Z 3 ) Z 4. SOII $epdrdtlOn -Compliance component#4 of 5 Date of installation: 1993 ❑ Unknown Verification method(s): ShorelandNVellhead protection/Food Beverage �Yes Lodging't � No Soil observation does not expire. Previous soil observations by two independent parties are sutficient, Compliance criteria: unless site conditions have been a/tered or local requirements differ. For systems built prior to April 1, 1996, and ❑Yes ❑ No not/ocated in Shoreland or Wellhead � Conducted soil observation(s)(Attach boring logs) Protection Area or not serving a food, ❑ Two previous verifications(Attach boring logs) beverage or lodging establishment: i ❑ Not applicable (Holding tank(s),no drainfield) Drainfield has at least a two-foot vertical I ❑ Unable to venfy(See Comments/Explanation) separation distance from periodically saturated soil or bedrock. ❑ Other(See Comments/Explanation) Non-performance systems built April 1, i ❑Yes � No Comments/Exp/anation: 1996, or later o�for non-performance I systems located in Shoreland or Wellhead Protection Areas or serving a food, beverage, or lodging establishment: Drainfield has a three-foot vertical separation distance from periodically saturated soil or bedrock.* "Experimental'; "Other'; or "Performance" ❑Yes ❑ No IndiCate depths of elevations systems built under pre-2008 Ru/es; Type IV or V systems built under 2008 Ru/es(7080. 24-30 inches 2350 or 7080.2400 (Advanced Inspector A. Bottom of distribution media from surface License required) � 42 inches from Drainfield meets the designed vertical B. Periodicall saturated soil/bedrock surface ___ separation distance from periodically less than 16 saturated soil or bedrock. C. System separation inches � __ D. Required compliance separation' � 36 inChes AI1y "no"answer above indicates the system 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 system 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 Practice(s)specified in the system design lf the answer to both questions is "no", this section does not need to be completed. Compliance criteria a. Operating Permit number: - ❑Yes ❑ No Have the Operating Permit re uirements been met? __b__Is the reguired nitrogen BMP in�lace and_�r�e�functionin ? ❑Yes ❑ No Any "no"answer indicates Noncompliance. Upgrade Requirements(Minn. Stat. §115.55)An imminent threat to public health and safety(ITPHS)must be upgraded,replaced,or its use discontinued within ten months of receipt of this notice or within a shorter period if required by local ordinance. If the system is failing to protect ground water,the system must be upgraded,replaced,or its use discontinued within the time required by local ordinance. If an existing system is not failing as defined in law,and has at least two feet of design soil separation, then the system need not be upgraded,repaired,replaced, or - - - - -.. -- -- ------- __ .__- —- --- --... _ ____ _---- -.___- --_ __ _ _ __---------____ www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats wq-wwists4-31 • 1/24/12 Pa3e 3 of 4