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• <br /> Explain: <br /> Property address: 460-Orchad Park Dr., Orono, Minn- Inspector initials/Date: RAK 15/25/2015 <br /> (mm/dd/yyyy) <br /> • <br /> 4. Soil Separation—Compliance component#4 of 5 <br /> Date of installation: 6/19/1992 0 Unknown Verification method(s): <br /> (mm/dd/yyyy) <br /> Shoreland/VVellhead protection/Food beverage Soil observation does not expire. Previous soil <br /> lodging? g 0 Yes ® No observations by two independent parties are sufficient, <br /> unless site conditions have been altered or local <br /> Compliance criteria: requirements differ. <br /> For systems built prior to April 1, 1996, and j ®Yes 0 No ® Conducted soil observation(s)(Attach boring logs) <br /> not located in Shore/and or Wellhead <br /> Protection Area or not serving a food, ®Two previous verifications(Attach boring logs) <br /> beverage or lodging establishment: ❑ Not applicable(Holding tank(s),no drainfield) <br /> Drainfield has at least a two-foot vertical 0 Unable to verify(See Comments/Explanation) <br /> separation distance from periodically <br /> saturated soil or bedrock. 0 Other(See Comments/Explanation) <br /> Non-performance systems built April 1, 0 Yes 0 No Comments/Explanation: <br /> 1996, ogater or for non-performance <br /> systems located in Shore/and or Wellhead S.B.# 1 (done of the mound system)-t./p54.1)P C <br /> Protection Areas or serving a food, Mottled soil was at 48 inches(4.0 ft.) <br /> beverage, or lodging establishment: <br /> Drainfield has a three-foot vertical S.B.#2(done in the org. soil profile) <br /> separation distance from periodically Mottled soil was at 29 inches(2.4 ft.) <br /> saturated soil or bedrock.* <br /> "Experimental" "Other" or "Performance" 0 Yes ❑ No Indicate depths or elevations <br /> systems built under pre-2008 Rules; Type IV <br /> or V systems built under 2008 Rules(7080. A. Bottom of distribution media 103.7 <br /> 2350 or 7080.2400 (Advanced Inspector <br /> License required) S.B.# -100.8 <br /> B. Periodically saturated soil/bedrock S.B.#2--100.4 <br /> Drainfield meets the designed vertical <br /> separation distance from periodically ! Qsfi, 07 q <br /> saturated soil or bedrock. <br /> C. System separation S.B.#2----3.3 ft. <br /> D. Required compliance separation' 2.0 ft. <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 /> • <br /> 5. Operating Permit and Nitrogen BMP*—Compliance component#5 of 5 ❑ Not applicable <br /> Is the system operated under an 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: I ,` <br /> Have the Operating Permit requirements been met? ❑Yes ❑ No <br /> b. Is the required nitrogen BMP in place and properly functioning? 0 Yes 0 No <br /> Any "no"answer indicates Noncompliance. - <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 • 3/16/12 <br /> Page 3 of 4 <br />