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May 24 2015 04:15PM HP FaxRusty Olson 7634988290 page 4 Property address: 1250 French Creek_dnve, Orono MN _ _ Inspector initialslflate� J �. 5/19I15 _f 4. S011 SepdratiOfl —Compliance component#4 of 5 Date of installation: 10/6187 _ ❑ Unknown Verification method(s): ShorelandlWellhead protectioNFood Baverage �Yes ❑No Soil observafion does not exp+rc. Previous sorl Lodging? obseivations by two independent partres are su�cienf, Compliance criteria: _ _ unless site conditions have been altered orlocaf — -- requirernents differ. Forsysfems built priorto Apnl 1, i996, and ❑ Yes ❑ No not located in Shoreland or We!lhead � Conducted soil observation(s)(Attach boring iogs) Protec6on Area or not serving a food, ❑ Two previous verifications(Attach bonng logs) beverage or lodging establishment. ❑ Not appl�cable(Holding tank(s),no dreinfreld) Drainfield has at least a two-foot vertical ❑ Unable t0 verify(See Comments/Explana:ion) separation distance from periodically �, ❑ Other(See Comments/Explanation) saturated soil or bedrock._ __�_ __ Non-pedom►ance systems built April 1, g� Yes ❑No Commenfs/Explanation: i996,orlaterorfornon-performance systems locafed in Shorefand or Wellhead Protection Areas orsen�ing a food, i beverage, or lodging establishmenf: prainfleld has a ihree-foot vertical ' separation distance from periodically sat�rated soil or bedrock.' "Experrmental", "Othe�', or °Performance" ❑Yes ❑ No Indicate depths of elevations systems built under pre-2008 Rules; Type N , --- � or V systems built under 2008 Rules(708�. A. Bottom of distribution media �_ 100.5 2350 or 7080.2400 (Advanced Inspector License required) e. Periodica ly saturaied soiVlbedrock�97.5 _ Drainfield meets the designed vertical , C. System separation 3.0 separation distance ftom periodically I saturated soil or bedrock D. Re uired com liance se aration' li 2.6_ _ --- --. ARy "no"answer above indicates fhe system is •May be reduced up to 15 percent if allowed by Local Failing to Protect Groundwafer. _ _ ordinance. 5. Operating Permit and Nitrogen BMP"—Compliance component#5 of 5 � Not applicabte 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 Pracfice(s)specifred in the system design !f the answer!o both questions is "no", this section does rtot need to be comp/eted. Compliance criteria ___ _ ___ a. Operating Permit number: ___ — �Yes ❑ No Have the Operating Permit re uirernents been mei? ! b. Is the required nit�ogen BMP in place and properly functionin�? ❑ Yes ❑ No _ Any "no"answer indicates Noncomplia»ce. Upgrade Requirements(Mrnn. Staf. §115-55)An imminent threat to pub�ic hesKh�nd safety(lTPHS)musr be upgraded,replaced,orits use drscontinued wifhin ten months ot receipt of thrs notice or within a shorter period if requi�d by foca/ord�nanee.If the system is tailing to protect ground wafer, the sysfem must be upgraded.�eplaced,or its use diSCOntinued withrn the time required by local ordrnance. !f an existing sysfem is not f8iling as dehned in law, and has at least two feet of design soil seperation,then fhe system need not be upgraded,reperred,repfaced,or its use discrontinued, nohvithstandrng any local ordinance that is more strrct. Thrs provrsion does not apply to systems in shoreland areas, Wellhead Prolecticn Areas,or those used in connection with fcod,beverage, and lodgrng establishments as defined in law. _ __ —- - www.pca.state.mn.us • 651-296-630o • 800-657•3664 • T7Y 651•282-5332 or 804-657-3864 • Availabte in altemative formats wq-wwists4-31 • T/24!11 Page 3 of 3