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' Pro�rty address: 575 Kokesk Farm Road Orono MN _ Inspector initiais/Date: J.�.5/04/17 <br /> 4. Soil Sepat'ation—Compiiance component#4 af 5 <br /> Date of installation: 11/08l02 �Unknown Veri�c�tion metha!(s)� <br /> ShorelandANslihaad proteeti�lFoad Bevenige �Y88 �NO SOi!Ob$@NetiOfl dOeS tlOt BX !ri°.Ft�ViOUS Sdi! <br /> ��,�? observat�ns by two inde�dent paRies arg sufflcienf, <br /> COmpIiBnCe Criteris: unJess site conditions have been altered orlocal <br /> For systems built prior to April 1, 1996, and �9U�r�rr►ents difRer. <br /> i ❑Yes ❑No <br /> not tocated in Shoreland or We/ihead ' � Cor�ducted soii observation(s)(Attach boring lags) <br /> Protecdon Area or not serving a food, ` ❑ Two previous verifications(Attech bo�ng�ogs) <br /> beverege or/odging establishment: ❑ Not epplicaibie(Holding tank(s).rro drainfield) <br /> Drainfield has at least a Mro-foct vectical ; ❑ Unabie to verify(�ee Comments/Explanation) <br /> separation distance from periodicaily ' � �f(��,�nrs/Exptanatian) <br /> saturated soil or bedrock. ' <br /> Non-perforrnance systems builf Apri/1, ' �Yes ❑No CommentslEx�anation: <br /> 1996,or later or for non-perfarmance ' <br /> systems located in Shoreland or We/Ihesd ' <br /> Pratecffon Areas or serving a food, ' <br /> beverage,orlodging establishment: <br /> Drainfield has a three-fooi ver�cal <br /> separation distance from periadically <br /> saturated soil or bedrodc.* ! <br /> "Experimental; "Othe�', or Performance" ' ❑Yes p No I�dicats depths of elevations <br /> systems built underpr+a-2008 Ru/es;Type tV ': , <br /> or V systems bui/t under 20Q8 Rules(7080. ``: A eottam of distribution media 104.2 <br /> 2350 or 7080.24� (Advanced inspector <br /> License required) B. Periodicailv�turated soiubedrodc ' 101.6 <br /> Drainfield meets the designed vertical C. System seaar�tion ' 2.6 <br /> separation distance from periodically ------ <br /> saturated soil or bedrock. ' D. ReQuired compliance separation' ' 2.6 <br /> Any "no"�nswer above indicates the systst»is �May be reduced up to 15 perc�nt if ailowed by L�al <br /> Failing to Protect Groundwate�: p�;t,a,�, <br /> 5. Operatin� Permit and Ni#rogen BMP"-Compliance component#5 of 5 �N�t appiicabis <br /> ts the system operated under an Operating Pennit? ❑Yes ❑No if"yes",A below is <br /> required <br /> is ihe system required to employ a Nitrogen BMP? ❑Yes ❑No If"yes",B belaiv is required <br /> BM�Sesf Manage�nent Piact/ce(s)speafied in the system desigr► <br /> N the answer to bobr questlans fa "no'; thfs se�on does not ne�to bs camplete�at. <br /> Compliance criter�a <br /> a. Operating Permit number. <br /> Nave the Operating Permit requirements been met'� � ❑Yes ❑No <br /> b. !s the required nitrogen BMP in place and txopedy functioning? ` ❑Yes ❑No <br /> Any "no"answer indfcates Noncompliance <br /> Upgrade Rsquirome�ts(Mirtn. Stet.§115.55)M imminent th�t ta pubNc hesKh and safety(tTPHS)must be upgraded,repleced,or its use <br /> tliscontinued within ten rrwnths of recefpt of this noG�e or within a s1►ortsr periad if requlred by/a�a!ordinarnae.!f the system is feiling to protecf <br /> ground water,the syst�m musi be upgiacied.�ep/aceal,or its use dlsoontinueri witryin ri�e lirrie ret�uired by locet adinence.lf an exiating system <br /> is not faiJing as dofrnsd i»law�and hes at lee�tw�twet of�s�grt a�a!s�pxati�,then dre syst�m r►eed not be upgreded,repeired,nsplaced,or <br /> its us�e disc�r►t+ht�ed,norivithstand�rtg any bea!adinance that is mae�. This provi�on d9oes not appJy ro systems in shorelend areas, <br /> Wetihead ProteCGon A�ees.or those used ia oonnecGia�with Aood,be+�s9rpge,anc!btl�ng eateWfshments es defined fn lew. <br /> www.pcastate,mn.us • 651-296-8300 • 800-657-3864 • TTY 651-282-5332�800-657-38b4 • Avaitatrle in attemative formats <br /> wq•wwisis4-31 • 1/24/12 , �� <br /> ^--- - <br />