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Property address: 525 Femdale Road N Orono Inspector initials/Date: JS I 5/10/2017 <br /> (mm/dd/YriY1 <br /> 4. Soil Separation—Compliance component#4 of 5 <br /> Date of installatfon: 6/1/1953 ❑ Unknown Verification method(s): <br /> (mM�y� Sofl obsenraHon does not expiro. Previous soi! <br /> ShorelandlWallhead protectloNFood beverage �Yes �No observations by(wo independent parties are sufhclent, <br /> ��9��g� unless site c�onditions have been alter�d or bcaJ <br /> Com liance criteria: requirvments dilfer. <br /> For systems built prior to April 1, 1996,and ❑Yes � No �Conduded soil observation(s)(Attad►bortng logs) <br /> not located in Sho�land or Wellhead ❑Two previous verifications(Attach baing Ibgs) <br /> Protecaon Area or nof serving a food, <br /> beverage or lodging establishment: ❑Not appticable(Holding tank(s),rm dreinheld) <br /> Drainfield has at least a two-foot vertical ❑Unable to verify(See Commants/Explsnetion) <br /> separation distance from periodicaliy ❑pther(See Can�ntsiExplanation) <br /> saturated soil or bedrock. <br /> Non�e►fom►ance systems built April 1, ❑Yes ❑No CommentslExplanation: <br /> 1996,or later or for non pe►fom►ance <br /> systems located in Sho�sland or Wellhead Boring: <br /> Protection Areas orserving a food, 1-8"10 yr 2/2 loam <br /> beverege, orlodgingesteblishment: <br /> 9-22"10yr 4/4 silty clay loam <br /> Drainfield has a three-foot verticai <br /> separation distance from periodically redox-20" <br /> saturated soil or bedrodc." <br /> "Experimental; `Othe�', or °Performence" ❑Yes ❑No Indicste de hs or elsvations <br /> systems built under pr�-200B Rules; Type!V <br /> or V systems built under 2008 Ru1es(7080. A. Bottom of distribut�n media 24" <br /> 2350 or 7080.2404 (Advanoed Inspector <br /> License required) B. Periodical saturated soiUbedrodc 22„ <br /> Drainfieid meets the designed ve�tical C. S tem aration 0 <br /> separation distance from periodically <br /> saturated soil or bedrock. D. R uired r,om Ilance se ration• 24" <br /> Any"no"answer above indicates the system is *May be reduced up to 15 percent if allowed by Locai <br /> failing to protect groundwater. Ordinance. <br /> 5. Operating Permit and Nitrogen BMP*—Compliance component#5 of 5 � Not appflcable <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 If"yes",B below is requirod <br /> BMP=Best Management Practice(s)specif'ied in the system design <br /> If the answer to both questions ls "no'; this sectlon does not need too be comp/eteaf. <br /> Com Ilance cHteria <br /> a. Operating Permit number: <br /> Have the O ratin Permit uirements been met? ❑Yes ❑ No <br /> b. Is the uired ni en BMP in lace and ro erl fun+ctionin ? Yes ❑ No <br /> Any"no"answer Jndlcates Noncompliance. <br /> Upgrade Requirements(Minn.Stat§115.55)An imminent thr�af to publk hesJth ancf safety(ITPHS)must be upgraded,repleoed,or its use <br /> discontinued within ten morrtha of receipt of thls notioe or wlGhin a shorter period!f requfred by bca!obinence.1f the system!s feflfng to proted <br /> ground water,the system must be upg►�ded,neplecec!or fts use disaa►Hnued wlthin the flme nsquired by local ordinanoe.ff an exlsting system <br /> Is not faNing as deflned in law,and has et least t�o teet of deslgn sof!separet/an,then the system need not be u�ropa/red,repleced,or <br /> lts use dlscoMlnued,rrohNlthstanding any bca/ordinanre thst is more sM�t. fiis provlabn does nof apnfy to systems fn shoreland areas, <br /> Wellhead ProtecSon Areas,or d�o�used in connectJar wlth food,bever�e,arnf bdgfng establishments as defined in law. <br /> www.pca.state.mn.us • 651-296-6300 • 800�657-3864 • TTY 651-282-5332 or 800•657-3864 • Avaitable in altemative formats <br /> wq-wwrsts4-31 • 3/16/f2 Poqe 3 of 3 <br />