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� r� � Property address: 4720 NORTH ARM DRIVE WEST,ORONO Inspector initials/Date: � � 10/15/2012 - !mm/d�YYYY) 4. Soil Separdtion—Compliance component#4 of 5 Date of installation: 8/27/1990 _ ❑ Unknown Verfication method(s)� (m��y} Soil observation does nof expire.Previous soil Shoreland/Wellhead protectioNFood 6everage �Yes �No obse►vations b hao ind endent arties are sufficient, lodging? Y �P P unless site conditions have been alte�d or local Compliance criteria: requiiements differ. For sysfems built prior to Apri11, 1996, and � �Yes ❑No �Conducted soil observation(s)(Attach boring rogs) not located in Shoreland or Wellhead ❑Two previous verifiqtions(Attach boring�ogs) Protection Area or not serving a food, beverage or lodging esfablishment: ❑Not applicable(Ho�ding tank(s),no drair►feld) Drainfield has at least a two-foot vertical � ❑ Unable to verify(Ses Commer+tsiExplanation) separation distance from periodicalty saturated soil or bedrock. ❑ Other(See CommentsiExpranation) Non-perfomrance systems builtApril 1, , ❑Yes ❑No Comments/Explanation: 1996, or later or for non-pedormance systems located in Shoreland or Wellhead � Protec6on Areas or serving a food, I beverage, orlodging establishment: Drainfield has a three-foot vertical separation distance from periodically saturated soil or bedrock" "Experimental'; "Othe�; or Performance" , ❑Yes ❑No IndiCate depths or elevations systems built under pie-2008 Rules; Type I V ! or V systems built under 2008 Rules(7080. A. Bottom of distribution media 99 0" 2350 or 7080.2400 (Advanced Inspector License required) B. Periodica�ly seturated soiUbedrodc 96'8" Drainfield meets the designed vertical C. System separation 28" separation distance from periodically saturated soil or bedrodc. _D. R uired cornpliance separation• 24" Any "no"answer above indicates the system is "May be reduced up to 15 percent if allowed by Local failing to protect groundwater. Ordinance. 5. Operating Permit and Nitrogen BMP'�—Compliance component#5 of 5 � Not applicable Is the system operated under an Operating Permit? ❑Yes ❑ No If"yes",A below is required Is the system required to employ a Nitrogen BMP? ❑Yes ❑No If"yes", B below is required BMP=Best Managemenf Prac6ce(s)specified in fhe system design If the answer to both questions is "no", thls section does not need to be comp/eted. Compliance criteria a. Operating Permit number: Have the O eratin Permit r uirements been met? � ❑Yes ❑ No b. Is the required nitrogen BMP in place and properly functionin ? ❑Yes ❑No Any "no"answer indicates Noncompliance. Upgrade Requirements(Minn.Stat§115.55)An immrnent threat to public health and safety(lTPHS)must be upgraded,replaced,or its use discontinued within ten months of receipt of this notice or wRhin a shorter period if required by loca/ordinanoe.If the sysfem is failing to protecf ground water,the system must be upgraded,replaced,or rts use discontinued within the time required by local ortiinance.If an existing system is not failing as de�ned in/aw,and has at least two feet of design soil separation,then the system need not be upgraded,repaired,rep/aced,or its use discontinued,norivithstanding any loca!ordinsnce thet is more strrct This provrsion does not apply to systems in shore/and areas, Wellhead Protection Areas,or those u�d in connection with food,beverage,and lodging establishments as defined in law. www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTN 651-282-5332 or 800-657-3864 • Available in altemative formats wq-wwists4-31 • 3/f 6/12 Paqe 3 of 3