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� 4of9 Property address: 315 Hollander Rd, Orono, MN 55391 Inspector initials/Date: 7/27/2017�i� 4. SOII S2pdrdt1011—Compliance component#4 of 5 Date of installation: � Unknown Verification method(s): Shoreland/Wellhead protection/Food Beverage � Yes ❑ No Soil observation does not expire. Previous soil Lodging? observations by two independent parties are sufficient, Com liance criteria: unless sife conditions have been altered or local requirements differ. For systems built prior to April 1, 1996, and ❑Yes ❑ No not located in Shoreland or Wellhead � Conducted soil observation(s)(Attach boring logs) Protection Area or not serving a food, ❑ Two previous verifications(Anach boring logs) beverage orlodging establishment: ❑ Not appliCable(Holding tank(s),no drainfield) Drainfield has at least a two-foot vertical ❑ Unable to verify(See Comments/Explanation) separation distance from periodically saturated soil or bedrock. ❑ Other(See Comments/Explanation) Non-performance systems built April 1, �Yes ❑ No Comments/Explanation: 1996, or later or for non-performance systems locafed in Shoreland or Wellhead Protection Areas or serving a food, beverage, or lodging establishment: Drainfield has a three-foot vertical separation distance from periodically saturated soil or bedrock.* "Experimental", "Other", or "Performance" ❑ Yes ❑ No Indicate de ths of elevations systems built under pre-2008 Rules; Type IV or V systems built under 2008 Rules(7080. See Attached 2350 or 7080.2400 (Advanced Inspector A. Bottom of distribution media Borin Lo s License required) Drainfield meets the designed vertical B. Periodicall saturated soiubedrock separation distance from periodically C. S stem se aration saturated soil or bedrock. D. Re uired com liance se aration* Any "no"answer above indicates the system is •May be reduced up to 15 percent if allowed by Local Failing to Protect Groundwater. ordinance. 5. Operating Permit and Nitrogen BMP*—compiiance comPonent#5 of s � Not applicable 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 Practice(s)specified in the system design If the answer to both quesfions is "no", this section does not need to be completed. Com liance criteria a. Operating Permit number: ❑ Yes ❑ No Have the O eratin Permit re uirements been met? b. Is the re uired nitro en BMP in lace and ro erl functionin ? ❑Yes ❑ No Any "no"answer indicates Noncompliance. Upgrade Requirements(Minn.Stat.§ 115.55)An imminent threat to public health and safety(ITPHS)must be upgraded,replaced,or its use discontinued within ten months of receipt of this notice or within a shorfer period if required by local ordinance.If the system is failing to protect ground water,the system must be upgraded,replaced,or its use discontinued within the time required by local ordinance.lf an existing system is not failing as defined in law,and has at least two feet of design soil separation,then the system need not be upgraded,repaired,replaced,or its use discontinued,notwithstanding any local ordinance that is more strict. This provision does not apply to systems in shoreland areas, Wellhead Protection Areas,or those used in connection with food,beverage,and lodging establishments as de£ned in law. www.pca.state.mn.us • 651-296-6300 • 800-657•3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats wq-wwists4-31 • 1/24/12 Page 3 of 3