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Property address: 1200 Phdhps_Dr Orono Mn 55356 ___ Inspector initials/Date: JS �_7/28l2Q16 __ ._.._..� _ ----..._. ._._ ____ __. (mm/dd/YYYY) __ 4. Soil Separation —Compliance component#4 of 5 Date of instaQation: 5/26/1994 ❑ Unknown Verification method(s): __ _ _ _ _._.. __ (mm/dd/yyyy) Soil observation does not expire. Previous soil ShorelandlWelihead protection/Food beverage � Yes � No observations by two independent parties are sufficient, iodging? unless site condifrons have been altered or foca/ Compliance criteria: requirements differ. _ _ . . For systems built prior to April 9, 1996, and � Yes ❑ No � Conducted soil observation(s)(Arracn bor;ng iogs) nof located in Shorefand or Wel/head ❑ Two previous verifications(Attach boring logs) Protection Area or not serving a food, beverage or Jodging eslablishment: , ❑ Not applicable(Hotd;ng rank(s).no drainfie�d) Drainfield has at least a two-foot vertical ❑ Unable to verify(5ee CommenrsiExpJanation) separation distance from periodically ❑ Other�See CommentsiExp�anarion) saturated soil or bedrock. Non-performance systems built April 1. ❑ Yes ❑ No CommentslExplanation: 1996, or later or for non-performance systems located in Shoreland or We/lhead Boring: Protection Areas or s�rving a food, 1-10"10YR 2/2 Loam beverage, or lodging establishment: 11-18"10YR 4!4 Clay Loam Drainfield has a three-foot vertical separation distance from periodically Motts @ 18" saturated soil or bedrock." _ ___ :_ _. . _ "Experimenta!", "Other': or "Performance" , ❑ Yes ❑ No Indicate depths or elevations sysfems built under pre-2008 Rules; Type IV ' _.,_..----- --._-- _ __..... __._.__ _ . ___ or V systems bui(t under 2008 RuleS(7080. , A. eottom of distribution media +12" _ __ _ _ 2350 or 7080.2400 (Advanced Inspector ' License required) B. Periodically saturated soillbedrak 18" _. . ___ __ Drainfield meets the designed vertical separation distance from periodically C System separation 18 _ _ ___ __-__ _. . .. ..._ .. .. _. saturated soil or bedrock. ' D. Required compliance 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 Il�anagemenf Practice(s)specified in fhe system design If the answer to both questions is "no'; this section does not need to be compteted. Compliance criteria __.. _. _.... __ _ _.__ . __.__ __ __ a. Operating Permit number. _. _ _ ❑ Yes ❑ No Have the Operating Permit requirements been met? b. Is the required nitrogen BMP in place and properly functioning? ❑ Yes ❑ No Any "no"answer indicates Noncompliance. Upgrade Requirements(Minn.Stal.§115.55j An imminent threat to pubJic health and safety(ITPHS)must be upgraded,replaced,or ds use discontinued wrthin ten months oi receipt of this notrce or wdhfn a shorter period i(required by local ordinance.If the sysfem is failing to protect ground water.!he systertt r»ust be upgraded.replaced.or its use discontinued within the time required by local ordinance.!f an existing system is not�ailing as delined rn law.and has at least two feet of design sorl separation,U�en the system need not be upgraded.repaired.�eplaced,or ifs use discontinued.notwdhstanding any focaf ordinance tRat rs more strict. This provision does rtot apply to systems in shoreland areas. WelJhead Protection Areas,or fhose used in connection with lood.beverage,and lodging establishments as defined in law. _ www.pca.state.mn.us • 657-296-6300 • 800-657-3864 • TTY 651•282•5332 or 800-657-3864 • Available in al[ernative formats wq•wwrs[s4-31 • 3/?6/12 Paqe 3 of 3