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Mar 17 2017 09:55AM HP FaxRusty Olson 7634988290 page 4 Property address: 1Q03 Cox Farm Road,Orono,MN Inspector Initiais/Date: J. 0.3/10/17 4. 5011 Sepa�ati011—Compliance component#4 of 5 Date of instaltatlon: 8/17/94 ❑ Unknown Verificatian method(s): ShorelandNlfelihead pro2octioNFood Bevera8e �yes ❑ No Sa!observa6on does not expire.Previous soil Lodging� p,bservatrons by hvo independent parties are sufficient, Compliance criEeria: unJess site conditior►s have been alterBd orlocal For systems built prior ta ApriJ 1, 1996, and ' ❑Yes ❑No �7uirements dlffer. »�t located in Sirorelsnd or Wellhead � Conducted soil obsenration(s}(attaeh boring logs) Prof�ction Area ornafsenring a food, ! ❑ Two previous verifications(Attach bwinglogs) beverage or lodging establishment� � ❑ Not applicable(liokting tank(s),no dre;nfield) Drainfield has at least a two-foot vettical � ❑ Unabie to verify(See Commerrts/Explanation) separetion distance from periodically � saturated sdl or bedrock. ❑ Other(See Comments/Explanation) IVon-perfomtance systems builf Aprif 1, � �Yes ❑ No CommentslFxplanaHon: 1996,or later or for nan-performance i systems located in Shor�eland or Wellhead � Protection Ar�as or serving a food, � bever�ge,or lodging establishment_ i Drainfield has a three-foot vertical separation distance from periodically i saturated soil or bedrodc."` I "Experimental; �arner;or Perlorrnanae" � ❑Yes ❑ No Indicate de ths of elevations systems built under pie-2008 Rules;Type I V ' or V systems built under 20'08 Rulas(7080. � A. Bottom of distrlbutian media 'f 05.9 2350 or T080.2400 (Advanced Inspector ' License required) j 8. Perioditall saturated soil/bedrodc 103.2 Drainfield meets the designed verlical C. System separation 2.7 separation distance from periodically ; � — saturated soil or bedroCk. I D. Required compllance separation' I 2.6 Any"no"answer above indlcates the system is *May be reduced up to 15�ercerit if allowed by Local Faflirtg to Profect Groundwater. Qrdinance. 5. Operating Permlt and N�trogen BMP''-Compliance component#s af 5 � Not applicable Is the system operated under an Qperating Permit? ❑Yes ❑ No If"yes",A below is required Is the system required to empby a Nitrogen BMP? ❑Yes ❑ No H"yes",B below is required BMP=Best Management PracUce(s)specified in the sysfem design !f the answer to both quesilons is"no'; this secUo»does not need to be completed. Cornpliance criteria a. Operating PeRnit nurnber: i ❑Yes ❑No Have the Operatina Permii requiremer�ts been met? � b. Is the required nitroqen BMP in place and properly functioninq? ; ❑Yes ❑ No Arty"no"answer indicates Noncompliance. Upgrede Requlrements(Minn.Stet§ i 95.55)An imminent threat to public heslth and safety(ITPHS)must be upgraded,repleced,or its use discontinued within ten mpntbs of roceipt of this notice or withrn a sho�ter pedod N required by/oca!ortfinsnce.!/the system is failing to protect ground water,ti�e system must be upgredetl,replaced,or its ase discontinued witbin the time requirad byloca!ordinance.If en existing system !s notfeiling as defined in 1ew,and bas at least hvo lset of design soll separetion,then the system need not be upgreded,repeired,replaaed,or its use discontinr�ed,notwithstanding eny/oca!ordinance thet is more strict.This provision does nat apply to systems in shoralend eneas, WoNheed Prafection Areas,a those used in connection wrth food,6everage,and fodging establishmerrts as defined in law. www.pta.state.mn.us • 651•296-6300 • 800-657•3864 • TTY 651-282-5332 or 80D-657-3864 • Available in alternative formats wR-wwlsts4-31 . f/24/i2 Poge 3 ot 3