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Jun 07 2016 07:47AM HP FaxRusty Olson 7634988290 page 4 Property address: 1260 French Creek Circle.,Orono, MN Inspector initials/�ate: J 0. 5/96/16 4. Soll $epdfatio�-Cornpfiance component#4 of 5 Date of installation: _7I19l88 __ ❑ Unknown Verification method(s): ShoreJand/Wellhead protectioNFood 8everage � Yes ❑ No Soi!observafion does nof ex rre. Previous soil Lodging? obse�vabons by two inde�dent pa�ties are sufficient, ComplidnCe Cfiteria: unless site condiSons have been altered or loca! ___- -_ -- requirements differ. Forsystems builtpnorto Apnl 1, 1996, and � ❑Yes ❑ No notlocated in Shoreland orWellhead I � Conducted soil observation(s)(Attach boringlogs) Protection Area or not se�ving a food, ❑ Two previous verifications(Attach boring/ogs) beverage or lodging establishmenf: ❑ Not applicable(Nofding tank(s},no drainFeld) Drainfield has at least a hvo-foot vertical ❑ Unable to veri separation distance from penodically r}+(See Comments�xplanation) seturated soit or bedrock. � ❑ Other(See Comments/Explenatron) Non-performance systems built Apri!1, � �Zf Yes ❑ No Commenfs/Explanafron: a 996, or tafer or for non-performance ' systems locafed rn Shorefand or Wellhead ' Protection Ar�as orserving a food, ' beverage, o�lodging establishmenf: � Drainfield has a three-foot vertical separation distance from periodically ', saturated soil or bedrock.` i "ExpenmentaP; "Ofher', or "Perfo�rnance" I ❑ Yes ❑ No IndiCdte depths of ele�ations systems built under pre-2008 Rules; Type IV ' — or V systems built under 2008 Rules(7080. ', A. Bottom of distribution media 99.8 2350 or 7080.2400 (Advanced Inspedor '� - License required) ' B. Periodical saturated soiUbedrock 97.1 � ___ _ __- � Drainfield meets the designed vertical C. S stem se aration I� 2 7 separat�on distance from periodically — saturated soil or bedrock. D. Required compliance separation' 2.6 Any "no"answer a6ove indicates the system is 'May be reduced up to 15 percent if aliowed by Local Failing fo Proteci Groundwater, ordinance. 5. Operating Permit and Nitrogen BMP*—Compliance component#5 of 5 � Not appllcable Is the system operated under an Operating Permit? ❑Yes ❑ No If"yes",A below is requi red Is the system required to emp�oy a Nitrogen BMP? ❑Yes ❑ No If"yes",B below is required BMP=Best Management Practice(s)specifred in the sysfem design If the answer to both questions is "no", this section does not need to be completed. Compliance criteria a. O eratin permit ng mber. q � p 9 �i ❑Yes ❑ No Have the 0 eratin Permit re uirements been mei. i b. Is the required nitroqen BMP in piace and pro erl functioning? ❑ Yes ❑ No Any "no"answer indicafes Noncompliance. Upgrade Requiretttents (Mrnn. Sfaf. §115.55)An imminent threat to public health and safery(1TPHS)must be upgraded,replaced,or its use disconirnued within ten months of receipt of this no6ce or within a shoRer period if required by local ordinance.If the sysfern is feilrng to profect groz'nd wafer Ihe system must be upgraded,replaCed, or its use discortinued within the time required bylocaf ordinance. !f an existing system is not failing as deBned in iaw,and has atleast two feet of desrgn soif separation,then the sysfem need not be upgraded,repaired,replaced,or its use disconfinued,nohvithstanding any local ordinance that is more sfnct. Th�s provrsron does nol epply to systems in shorefand areas, Wellhead Protection Areas, or those used in cbnnection witY+tood,be verage,end lodging esfablishmenfs as defined in law. www.pca.state.mn.us • 651-296-6300 - 800-657-3B44 • TTY 651-282-5332 or 800-657-3$64 . Available in altemative formats wq-wwistsd-31 . 1/24(12 Page 3 of 3