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, <br /> ; <br /> , <br /> , Pro�erty address: 290 HaUander'.Road Orono,MN' lnspector initials/Date: �� ``''l'7 �� <br /> ': (mMdd/YYYY) <br /> i <br /> 4. Soil Separatian—Co�npliance component#4 0#5 <br /> Date of installation: 10/3111990 p Unknown VeMtication method(Q;a <br /> ����� Sail observa6on does rrot expi�.Previous soil <br /> ShorelBndlWellhead protectloNFqod beverage �Y� ❑�n observations b fwo inde ende�rt arties aie svh5cien#, <br /> �°dging? i un/ess site conditions have been�ered or/a�a! <br /> Com liance criteria: �quiiements differ <br /> For sys#ems builf pRor to April 7,i 1996,and ❑Yes ❑No �Conducted soit observation(s)(Atfach boRng logs) <br /> not/ocated in Shore/and or Welilhead` ❑Two preVious verifications(Attac6 bori►rg logs) <br /> Protsction A�a or not seiving a�ood, <br /> beverage or fodging establishmer►t: ❑Not applicable(Holdirrg tank(s),rro drainTrek� - <br /> Drainfield has at(east a two-foot�vertical ❑Unabie to verify{See CommenfslExp/anaSon) <br /> separation distanoe from periodi�ally ❑Other(See Comments�Exptanation) : <br /> saturated soit or bedrock. , <br /> Non�erformance systems 6uilt April?, ❑Yes �.No CanmentslExplanatian: <br /> 1996,or fater or for non perfqim�nce <br /> systems located in Sho►aeland oriWeUhead <br /> Protection A�as ocseiving a fiood, <br /> beverage,or lodsing esta6►ishment.- <br /> Drainfield has a three-foot vertic�l <br /> separation distance from periodi�ally= <br /> saturated soil or bedrock" i <br /> � <br /> °Expe►rmental", "Othe�;or `Per�ormance": ❑Yes ❑No Indicate de ths or elevatiOns <br /> systems buitt under pre-2008 Rules;Type N <br /> orV systerr►s built under 2008 R�rles(7080_ A. Bottom of distribution media 23 inch <br /> 2350 ar7080.2400. (Advanced tnspedor <br /> License requirec� � B. Feriodicau saturated soillbedrodc 38 inch <br /> Drainfie{d meets the designed veatical C. S stem se aration 15 inch <br /> separation`distance from periaiiv�aiiy <br /> saturated soil or bedroek. ; <br /> � D. Re uired com liance se aration" 36 inch <br /> Any"no"answer aboue i�ndicates the system is `May be redueed up to 15 percent if allowed by Locaf <br /> faiting to protect grou�rrhivatee: ordinance. <br /> 5. Opecating Permit �nt� Nitl�o�en BMP*—Compliance component#5 of 5 �Not applicable <br /> Is the system operated under�an Operating Permit? ❑Yes �No If"yes",A'below is required <br /> Is the system required to empNoy a Nitrogen BMP? ❑Yes �No If"yes",B below is required <br /> BMP=Sest Managemen#Practice(s)specifisd in the system design <br /> If the answer:to both que,stions is"no'; this section does not need to be comp/eted <br /> Com liance criteria � <br /> a. OperaEing Permit numbec <br /> tiave the O ratin Perr�it r uirements been met? 0 Yes ❑No <br /> b. Is the r uired n' !en¢MP in lace and ro ert functionin ? Yes No <br /> , , <br /> Any "no"answer indic�tes Noncompliance. <br /> Upgrade RequiremeMs(Minn.'Sfat§115.55)An:imminentihieat to public health and safety pTPHS)mustbe upgraded,`replaced,or its use <br /> discontinueal within ten months of�ceipt of this not�e or within a shorter period if repuiied by loca!ordinance.If�e system is failing to piotect <br /> ground water,the system must be�upgraded,replaced,or its use discantinued wtd�in the time requi,ad by la:a!orsiinance.If an exlsHng system <br /> is not failing as deflned in law,an has at least iwo feet of design soi!separa6on,then the'system need not be upgreded,repairorl,replacecl,or <br /> its use disaontinued,nohaithskan�{'qg any loca!ordinance that i§more stxt This provision does not apply ta systems in Shoreland areas, <br /> Wellhead Protection Aress,'or tho�e used in connectron with food,beverage,and lodying establishmerrts as tlef+rre�in law. <br /> www.pca.state.mn.us • 651-296 6300 • 800-657-3864 • TTY b51-282-5332 or SOQ-65T-3864 • Availabte in attemative formats <br /> wq-wwists4-31b • 6/4/14 ' Page 3 of 3 <br />