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Property address: 2555 Fox Street,Orono Inspector initials/Date: JS I 2!2?J2017 <br /> (mm/dd/YYYY) <br /> _4. Soil Separation—Compiian�e component#4 of 5 <br /> Date of inatallation: 8l1I2012 ' ❑ Unknown Verification method{s): <br /> fmm/daVYYYy) �' <br /> ShorelandNVellhead proboctioNFood beverage So1!ObseNatiot7 does nof expin9.Previous SOiI <br /> ����� �Yes ❑No observaHons by iwo independent parties ene sufficlent, <br /> untess site condfHons have been altered or local <br /> Com Itance criteria: riequi�ments diiler. <br /> For systems built prior to Apri!1, 1996, a�d ❑Yes ❑ No �Conducted soil observation(s)(Attach boring 1ogsJ <br /> not located in Shareland or Wellhead ' <br /> Protection Aiea or not serving e food, ❑Two previous verifications(Attach boring�ogs) <br /> beverage or lodging establishment: ❑Not applicable(Holdirrg tank(s),no drafrrf'�eld) <br /> Drainfield has at least a two-foot vertical ❑ Unable to verify(See CommentsiExp/anation) <br /> separation distance from periodicalty ❑Other(See CommentsiExpianatia►) <br /> saturated soil or bedrock. <br /> Non-pertormance systems builtApril i, �Yes ❑No Commenta/Explanation: <br /> 1996,or later or for non pe�formance <br /> systems located in Shoreland or Wellhea4l Boring: <br /> Protection Areas orserving a food, 1-16"10 YR 2/2 Loam <br /> beverage,or Jodging establishment: <br /> Drainfield has a three-foot vertical <br /> 17-3610 YR 4/4 Clay Loam <br /> separation distance from periodically No Redox <br /> saturated soil or bedrock.* <br /> Experimental; "Othe�; or Perlonnance? ❑Yes ❑No IndIC2lte de ths Or elevations <br /> sysfems builf under pre-20U8 Ruler, Type:N <br /> or V systems built under 2008 Ru/es(70�. A. Bottom of distribution media at rade <br /> 2350 or 7080.2400 (Advanced Inspector' <br /> License required) e. Periodical saturated soil/bedrock 3g" lus <br /> Drainfleld meets fhe designed vertical G. S stem se aration 38° <br /> separatiorr dlstsnce ftom periodic�lly <br /> saturated soil or bedrodc. <br /> D. R uired com Gance se aration` 36" <br /> Any"no"answer above indicates the system Is "May be reduced up to 15 percent if allowed by Local <br /> failing to protect groundwater. ` ordinance. <br /> 5. Operating Permit and Nitrogen BMP*—Compliance component#5 of 5 � Not applicable <br /> ►s the system operated under an Oper�ting Permit? ❑Yes ❑No !f"yss",A below is requfred <br /> Is the system required to employ a NitrQgen BMP? ❑Yes ❑No !f"yes",B below is required <br /> BMP=Best Management Practice(s)specl�red In the system design <br /> If ff►e answer to botf�questions!s"no", fhis sectlon does not neeol to be comp/eted. <br /> Com liance cHteria <br /> a. Operating Permit number: <br /> Have the O ratin Permit uirements been met? ❑Yes ❑ No <br /> b. Is the re uired nit en BMP in I�ce and ro rl fundianin ? ❑Yes No <br /> Any"no"answer indicates Noncompliance. <br /> Upgrade Requirementa(Mfnn.Stat.§!1�.55)An fmmineM threat to public hea/d►and sffiety(►7PNS)must be upgraded,replecer/,or��S us� <br /> disc�ntinued within ten months of r�eceipt of thls r►otice or wiq�fn a short+ar period if�equired by loca/o�nar►r�./f the system is failing to prutect <br /> ground water,the system must be upg�ade�t,';rapleced,or lts use discarBnued yviqz)n the dme nsqulred by IacaJ ordfnem;e.li an existing system <br /> Is rrot felling as defrned in law,and has at lea;st two feet of deslgn so!!separation,then the system need not,f�e upg�ader!repaired r�ap/��. <br /> its use disconSnuect,noha/thstanding any loc�i o►r/fnence thaf is mon sMct THis pmvrs�on does not apply to systems in shor�sJend areas, <br /> Weqhead Protectlon Arsas,or thase used in tbnnection wlth food,,bevaerege,and lodgirrg�establishments as deNned in lew. <br /> www.pca.state.mn.us • 651-Z96-63� • $00-657•3$64 • TTY 651-282-5332 or�0-657-38�4 . Avaitabte in altemative formats <br /> wq-wwlsts4-3f • 3/!6/12 <br /> Pnge3of3 <br />