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• <br /> Property address: 825 Old Crystal Bay Road S.,Orono, MN inspector initials/Date: J. O, 11/26/17 <br /> 4. Soil Separation—Compliance component#4 of 5 <br /> Date of installation: 10/12/95 ❑Unknown Verification method(s): <br /> Shoreland/Wellhead protection/Food Beverage ®Yes 0 No Soil observation does not expire.Previous soil <br /> Lodging? <br /> observations by two independent parties are sufficient, <br /> Compliance criteria: unless site conditions have been altered or local <br /> For systems built prior to April 1, 1996,and 0 Yes ❑No requirements differ <br /> not located in Shoreland or Wellhead ® Conducted soil observation(s)(Attach boring togs) <br /> Protection Area or not serving a food, <br /> 0 Two previous verifications(Attach boring logs) <br /> beverage or lodging establishment: <br /> ❑ Not applicable(Holding tank(s),no drainheld) <br /> Drainfield has at least a two-foot vertical ❑ Unable to verify(See Comments/Explanaton) <br /> separation distance from periodically <br /> saturated soll or bedrock. 1 ❑ Other(See Comments/Explanation) <br /> Non-performance systems built April 1, ®Yes 0 No Comments/Explanation: <br /> 1996,or later or for non-performance <br /> systems located in Shoreland or Wellhead <br /> Protection Areas or serving a food, <br /> beverage, or lodging establishment: <br /> Drainfield has a three-foot vertical <br /> separation distance from periodically <br /> saturated soil or bedrock' <br /> "Experimental", 'Other",or "Performance" ❑Yes 0 No Indicate depths of elevations <br /> systems built under pre-2008 Rules;Type IV <br /> or V systems built under 2008 Rules(7080. A. Bottom of distribution media 100.0 <br /> 2350 or 7080.2400 (Advanced Inspector 1 <br /> License required) I B. Periodically saturated soil/bedrock 98.4____ <br /> Drainfield meets the designed vertical j C System separation 2.6 <br /> separation distance from periodically <br /> saturated soil or bedrock. <br /> Required compliance separation* 2.6 <br /> Any "no"answer above indicates the system is May be reduced up to 15 percent if allowed 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 en Operating Permit? 0 Yes 0 No If"yes",A below is required <br /> Is the system required to employ a Nitrogen BMP? 0 Yes 0 No If"yes",B below is required <br /> BMP=Best Management Practice(s)specified in the system design <br /> If the answer to both questions Is "no",this section does not need to be completed. <br /> Compliance criteria <br /> a. Operating Permit number: <br /> Have the Operating Permit requirements been met? ❑Yes ❑No <br /> b. Is the required nitrogen BMP in place and properly functioning? ❑Yes 0 No <br /> Any"no"answer indicates Noncompliance. <br /> Upgrade Requirements(Minn,Stat §115.55)An imminent threat to public health and safely(17PHS)must be upgraded,replaced, or its use <br /> discontinued within ten months of receipt of this notice or within a shorter period if required by local ordinance If the system is failing to protect <br /> ground water,the system must be upgraded,replaced,or its use discontinued within the time required by local ordinance If an existing system <br /> is not failing as defined in law,and has at least two feet of design soil separation then the system need not be upgraded.repaired,replaced, or <br /> its use discontinued,notwithstanding any local ordinance that is more strict. This provision does not apply to systems in shoreland areas <br /> Wellhead Protection Ames,or those used in connection with food, beverage and lodging 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 • Available In alternative formats <br /> wq-wwists4.31 • 1/24/12 <br /> Page3of3 <br />