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Property address: 560 Kokesh F�rm Road Orono MN Inspedor initials/Date: J.O,8J02/17 <br /> 4. Soil Sepa�ation—Compliance component#4 of 5 <br /> Date ot Installation: 7/27/04 ❑unknown Verification m�thod(s): <br /> $hO�'"�'�'�p��O°��"/°� ❑Yes �!Vo sat observaban does nor expire.Previous saMl <br /> L��? ObS6N8SOt1S by IWO/Il�I9Q61K�@At�8/fl@S 8!9 SfII�ICl9flf <br /> ComplianCe criteria: unless site ca�dditians h�ve been altered or bca! <br /> For sysGems built pria to Apri11, 1986,and ; ❑Yes ❑No �uiiements dit�er. <br /> not bcated in Shore/arM or VYeNheed I � Conducted sal observation(s)(Att�r�r baing togsJ <br /> Protection Area ornot servir�a food, i ❑ Two previous verifications(Atrach bortng logs) <br /> beirera�e or bdg�r�e�stablishment.• I ❑ Nat applicabie(HWding tank(s),ra drelr►field) <br /> f <br /> Drainfreld has at legst a t+aro-foot vertical ' <br /> separatiar�disiance from periodicaliy � ❑ Unabie to verify(See Comments�Ex�er:a6on) <br /> saturated s0il or bedrodc. ❑ �ther(See commsr►rs/L�cpranaaa,) <br /> Nony�e�fOrrnance systems built,4prfl 1, ' �Yea ❑No CanmentS/Exp/anation: <br /> 1996,or later or for na►-perfom�ancs ; <br /> systems bcated in Shore/end or WeNhead � <br /> Protection Areas or serving a fiood, <br /> bevergge,orlodg/ng estaWist�r►ent: ; <br /> Drainfield has a thr�-foot verNcal 1 <br /> separation distence trom periadicaly i <br /> saturated sal or bedrodc.` <br /> � <br /> "Experimental" "Othe�',o� "Performenc�e" ❑Yes ❑No IndlC�te da ths of elevations <br /> systems buitt w�der pre-200aB Rules;Type IV <br /> Or V syst+ems buiJt under 2Q08 Rules(70�. ; A. Bott�n c�distribution media 109.5 . __. <br /> 2350 or 7080.24Q0 (Advanc�d Inspec;tor j . <br /> Lic�nse required) ' B. Peradically saturated soiubedrodc J 108.9 <br /> Drainfieid meets the designed vertical , <br /> separstion distance from periodica{hr i C. System separation � 2.8 <br /> saturated sal or bedrock. � D. Reouirod canplianoe ss�ara�tion• I 2.6 <br /> Any"no"answer above Ina�cates fhe syst�m fs •�y p��uc�d up to 15 percertt if allowed by Local <br /> Feiling to Protect Groundwate/: Ordinanc�. <br /> 5. Operating Permit and Nitrogen BMP*—Canp�iance component#5 of 5 �Not applicable <br /> la the syatem operated under an Operating Pertnit? ❑Yes ❑No If"y�",A bNa�r�required <br /> Is the system required to empioy a Nitropen BMP? ❑Yea ❑No If"y�",B b�aw is r+equired <br /> BMP=Best Management Prec�ce(s)spscil7ed in the syst�sm�sig�t <br /> lf the anawer to both quastJons is "no';thia s�ct3on d�s rrot rteed to be com�et�ed. <br /> Compliance criterfa <br /> a. Operating Permit number. € <br /> Have the Operating Permft reQuiremeMs been met? ? ❑Yes ❑No <br /> f <br /> b. Is the required nitrogen BMP in plac:e and propedy functioning� ❑Yes ❑No <br /> Any"no"answer indicate�s NoncomplJance. <br /> Upg�ade Rsquiromenb(M'um.StaG§t f 5.5�An imrninsnt Mueet to p�bN�c hea/th and sefiety(lTPHS)must be upgnacied,rmpdaced.cr its uae <br /> discor�inusd wXhin Gsn ma►tha o/recefpt o1 ti►is notkae ot w#hm e ahort�sr pe�od if roquirod Dy bca/or�nerxae.If the syatwm Js faillnQ to pro� <br /> ground we�r,the syatam must be upgraded,reA�ed,cu tts ute discon�nued wi�►in tl�Gane requimd by tOce/ardinar�ce.!f an ex�system <br /> rs n�r�as deni,ed a►iaw,�d nas�rea�nMo�r�c�ss�,►�se�aor,,nren me sysrem need r►or be u�raded,reve�r�d,rer�aaad,or <br /> its use dlaoa�ntinued,notwithstendenp�►ty bcaJ ord'marx:e that ia rm�e� Thls provisia►does not ap�ly to sy�ems in shore/erld�, <br /> W�l/head PrGtection Arees.or thase t�ed fi�►nrectlort with food,beverage.end bargk�g estab/Tshments es deflned!n/aw. <br /> www.pca.state.mn.us • 651-296-G300 • 800-l►57-386q • TTY 651-282-5332 or 800-657-3864 • Availabte in attemative formats <br /> wq-wwists4•3t • 1/24/12 Aose 3 of 3 <br />