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� <br /> Property address: 1270 Fre�ch Creek Drnre.,Orono,MN ____ Inspector initials/Date: J.O.01/09/14 <br /> 4. SOiI Stpd�atloh—Comptiance component#4 of 5 <br /> Date of installation: 7/27/89 _ ❑ilnknown Verification method(s): <br /> �grelandMleli6ead protectionlFood Beverage �Yes ❑ No <br /> Soil observation does not expire.Previous soi! <br /> obse�va6ons by two independent parties are sulficient <br /> COmplianCe cttite�ia;`_ _ unless site conditions have been altered orlocaJ <br /> For systems built prior to April 1, 1996, and ❑Yes ❑No �Qu��ments di(fer. <br /> not located in Shoreland or Wellhead � Condu�ted soil observation(s)(Attach boring/ogs) <br /> Protection A�a or not serving a food, � <br /> beverage orlodging establishment: ❑ T+'�P►�evious verifications(Attach borirrg togs) <br /> ❑ Not applicable(Holding tank{s),no drainfreld} <br /> Drainfield has at least a twafoot vertical ` <br /> separation distance from periodically � ❑ Unab�e to verify(See CommentsiExplanetion) <br /> saturated soil or bedrock. ❑ Other(see commenrsiEirp�ana6on) <br /> Non performance sysfems built April i, � ❑Yes �No Comments/ExplanaGon: <br /> 1996,or(ater or for non perfom►ance <br /> sysfems loceted in Shoreland or Wellhead <br /> Protection Areas or serving a food, <br /> beve►age, or lodging establishment: <br /> Drainfield has a three-foot vertica! <br /> separation distance from periodicafly <br /> satt�rated soil or bedrodc.* <br /> Experimental; 'Other; or Ferfomrance" � <br /> ❑Yes ❑No Indicate depths of elevations <br /> systems built under pre-2008 Rules; Type IV -- — — <br /> or V systems built under 2008 Rules(7080. A_Bottom of distribution media g7,2 <br /> 235Q or 7080.2400 (Advanced Inspector -- <br /> LicenSe reqUired) B, Periodically saturated soi!lbedrpdc 95.6 <br /> Drainfield meets the designed vertical �` <br /> separation distance from periodically C__System separation 1.6_ <br /> saturated soil or bedrock. <br /> � D. Re uired com liance se aration• 2.6 <br /> Any"no"answer above indicates the system is *May be reduced up to 15 percent if allowed by Local <br /> Faili�o Protect Groundwater. Ordinance. <br /> 5. 4perating Permit and Nitrogen BMP"—Comptiance component#5 of 5 �Not applica6te <br /> Is the system operated under an Operating Permit? ❑Yes ❑ No If"yes",A below is required . <br /> Is the system required to employ a Nitrogen BMP? ❑Yes ❑No tf"yes",B below is required <br /> BMP=Best Managemenf Practice(s)specified in the sysfem design <br /> If the answer to both questfons is "no`; this section does not need to be comp/eted. <br /> Campliance criteria <br /> a. Operating Permit number: <br /> Have the Operatin Permit requirements been met? ��Yes ❑ No <br /> b. ts the required nitro en BMP in place and properly functioning? � ❑Yes ❑No <br /> Any"no"answer indicates Noncompliance. <br /> Upgrade Requirements(Minn. Stat.§115.55)An imminent threat to pubfic hea/th and safety(fTPHS)must be upgraded,replaced,or its use <br /> discarWttnued wilfiin ten mo�rths of retaeipf of thrs notice or withirt a shorter period it requirsd by locat ordinance.If the system is failing ir�profect <br /> ground water,the system must be upgraded,replaced,or its use discontinued within the dme►�qui�ed by local ordinance.ff an exisfing system <br /> is rat feiling es defrned in law,and has at least two feet of design soil sepsration,fhen the system need nof 6e upgraded,repafmd,rep�aced,or <br /> Ifs use discontinued,notwifhstanding any local ordinance that is more sfict. This provision does rt�t apply to systerrrs in shoreland areas, <br /> Wel/head Protection Areas,or those used in connectton with food,beverage,and/odging establishments as defined in law. <br /> www.pca.state.mn.us •��651•296-6300 • ^800-b57-3864 • TTY 651-282-5332 or 800-657-3864 • Available in atternative formats <br /> wq-ww15ts4-31 . t/I4/f1 <br /> Poge3of3 <br />