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Property address: 2890 Fox St Orono,MN Inspector inifrats/Date: � ��'�J 6'�3 (mMdd/yyyy) 4. Soil Separation—Compliance component#4 of 5 Date of installation: �Unknown Verification method(s): (mm/ddly�yp} Soil observafion does not expire.P�vious soil ShorelandnNellhead protectioNFood beverage �Yes ❑No obse�vations by iwo independent pa�ties a►e suffrcient, �°dgi�g? unless site conditions have 6een a/tened or local Com liance criteria: requirements differ. For systems built prior to April 1, 1996, and ❑Yes ❑No �Conducted soil observation(s)(Attech boring logs) not located in Shoreland or Wellhead ❑Two previous verifications(Attech baing logs) Protection Aiea or not serving a fooal, beverage or lodging establisi►menfi ❑Not applicable(Holding tank(s),no drainfield) Drainfield has at least a two-foot vertical ❑Unable to verify(See Comments/Expianation) separation distance from periodiqlly ❑Other(See Comments/Explanatan) saturated sal or bedrodc. Non�erfonnance systems built Apri11, �Yes ❑No Comments/Explanation: 1996, or later or for non-perfom►ance systems located in Shoreland or Wellhead Protection A►eas or serving a food, beverage, orlodging establishment Drainfield has a three-foot vertical separation distance from periodically saturated soil or bedrock.' Experimental; "Other", or "Pe►fom►ance" ❑Yes ❑No Indicate de hs or elevations systems 6ui(t under pre-2008 RWes;Type(V or V systems built under 2008 Ru/es(7080. A. Bottom of distribution media 24 inch sand 2350 or 7080.2400 (Advanced Inspedor License required) B. Periodical saturated soiUbedrock 22 inch Drainfield meets the designed vertical C. S tem se ration 46 inch separation distance from periodically saturated soit or bedrock. D Required compliance separatan* � 36 inch Any"no"answer above lndicates the system is 'May be reduced up to 15 percent if allowed by Local iailing 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 fs the system required to emptoy a Nitrogen BMP? ❑Yes �No tf"yes",B below ia required BMP=Best Management Practice(s)specifled in the system design !f the answer to both questfons is"no'; thls section does not need to be comp/eted. Com liance criteria a. Operating Permit number: ❑Yes ❑No Have the O eratin Permit r uiremeMs been meY? b. Is the r uired nitro en BMP in lace and ro erl functionin ? Yes No Any"no"answer indicates Noncompliance. Upgrade Requlrements(Minn.Stat.§115.55)An imminent threat to public health and safety(lTPHS)must be upgraded,�oplaced,or its use discontinued within ten months of receipt of this notice or wifhin a shorter period if required by local ordinarrce.If the system is failing to protect ground water,the system must be upgraded,raplaced,or ifs use dis�aontinued within the time required 6y local ordinance.H an existing system is not faifing as defined in law,and has at least two feet of design sal separation,then the system need rrot be upgraded,repaired,replaced,or its use discorrtinued,nohvithstsnding any loca!adinance that is more strict This provision does not apply to systems in shoreland aieas, We!lhead Protection Ariaas,or those used in connecUon with food,6everage,end lodging establishments as defrned in law. www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in altemative formats wq-wwists4-3f • 3/16/f2 Pvge 3 of 3