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, Property address: 4440 Bayside Road,Orono Inspecto�initials/Date: JS �; 5/30/2017 <br /> (mrNdd/yYYY) <br /> 4. 5oil Separation—Compliance component#4 of 5 <br /> Date of installation: 8/4/2004 ❑ Unknown Verification method(s): <br /> �m��� Soi!observation does not expire.Previous soi! <br /> ShorelandlWellhead pratecUonlFood beveraae �yes � No observations b two ind ndent afies are su�cient, <br /> lodging? unless sife condiaorts haeve been altered''vr loca! <br /> Com liance criteria: requirBments dif!'er. <br /> For systems built prior to April 1, 1996, and ❑Yes ❑ No �Conducted soil obsenEation(s)(Attach tmring logs) <br /> not located in Shoreland or Wellhead <br /> Protection Area or not serving a i�od, ❑T�p��ous verifications{Attach boring logs) <br /> beverage or lodging establishment: ❑ Not applicabie(Nolding tank(s),no drairrfreld) <br /> Drainfield has at least a two-foot vertical ❑ Unable to verify(See Comments�kp/anatron) <br /> separation distance from peri�ically ❑Other(See Commenta/Exp/anettnn) <br /> saturated soil or bedrodc. <br /> Non pe�formence systems built April 1, �Yes ❑ No Comments/Explana�on: <br /> 9996, orlaferorfornony�erforma�ce Borin <br /> systems locai�d In Shore/and or Wellhead 9� <br /> Prr�tection Aress or senring a food, 1-15"10yr 2/2 Loam <br /> beverage,orlodgfng establishment.• <br /> 16-26'10 YR 4/4 Ciay Loam <br /> DraiMield has a three-foot vertical <br /> separation distance from periodically Redox�24" <br /> saturated soil or bedrodc" <br /> "Experimental; "Othe�; or "Performance° ❑Yes ❑ No IndiCate de hs or elsvations <br /> systems buflt unafer p►�-2�8 Rules;Type!V <br /> or V systems built under 2008 Rules(7080. A. Bottom of distribution media lus 12"or more <br /> 2350 or 7080.2400 (Advanoed inspedor , <br /> License required) B, Pe�iodicall saturated soiUbedrock 24" <br /> Drainfield meets the designed vertical C. S tem se a�atlon 36"+ <br /> separation distanoe from periodically . <br /> saturated soil or bedrock. D. R uired com ianoe se ration* 36" <br /> Any"no"answer above indicates the system Is "�ay be reduoed up to 15 percent if allrnnred by Local <br /> failing to protect groundwater: Ordinance. <br /> 5. Operating Permit and Nitrogen BMP*—Compliance component#5 of 5 � Not applicable <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 required <br /> BMP=Best Management Practice(s)specified Jn fhe system design <br /> If the answer to both questlons/s "no';thls sect�on does not neeal to be comp/eted. <br /> Com liance crtteria <br /> a. Operating Permit number. <br /> Have the O ratin Permit re uiremerrts been met? ❑Yes ❑No <br /> b. Is the r uired n' en BMP in lace and ro e�l functionin ? Yes ❑No <br /> Any"no"answerindlcates Noncompllance. <br /> Upgrade Requirements(Minn. Stat§115.55)An immirrent threat to puWic hea/th and s�fery pTPHS)must be upgraded,rep/aced,or Its use <br /> discontlnued wlthln ten months of r�ipt of this nodoa or withln a shorter period if requl�ed by l�a/o�fnance.If the system 1s fa!ling to protect <br /> grround water,dte system mast be uparader/,rt�plaoBd,or 1ts use dlscontinued within the drtte requfred by/oca/oMMance.lf an existing system <br /> is not feiltng as detrned in/aw,and hes st/esst Mro feef of desigrt soi!separadon,then the system nesd�t be upgred�ed,cepaired,replaoecl,or <br /> its use discaontinued,notwithstanding any/oca!wdlnam,e that is mae sMCt Thls provls/on does not apply to systems In stia+alarrd areas, <br /> WeUhead Protecflon Areas,or those used!n connection►tith food,beveregre,and/odging esteblishments es deNned!n law. <br /> www.pca.state.mn.us • 651-246-6300 • 500-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in aitemative formats <br /> wq-wwlsts4-31 • 3/f6/12 Poge 3 of 3 <br />