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94/15/2019 11:58 7634988290 RUSTYS PERC TESTING PAGE 95 <br /> -�---- � . > <br /> - i <br /> Pe��nber: 311192312000� Sy8'eem stalus: �I ComPli�nt ❑�� <br /> , (as de�errrpned bY fhis 1�cmi1 <br /> Soll �atlou Coe�pilance and OthNr Con�pli�nce <br /> Compliance Issue�#3 af 4 <br /> Qe�e of observa�ion: Mi08N0 Reason Tor obsetvatlon: Propert�l Tren� <br /> 71�is bybrrr�v►r on ti�a l bnr►cloes not eurpirs_ <br /> �a q��;�q�� V4rifl�atlon Metliod"�(OP�) <br /> qie (Chedr tlie apaoiprfah bacl <br /> For syslems built pria�April 1.1906�and no# � Conducmd w�o�K$)(���bOs) <br /> IoCa�ed in Shaelsnd or WdFbad Probec�ion ❑ T��veriflcations(a�tect�bodn9 bgs) <br /> Mea or nok serving a�ood,bsMe�age a <br /> lod�in8�ab�f�ent ❑ Othee <br /> Does tl�e sysb�m have at ka�a two-lbot <br /> vertiwl separa�lon dist�ance from pe�iodicaMr <br /> •o�or bedrodc? Yee IVc <br /> For non-parfon'nanoe sYslen�s DuNt AprM�• � <br /> 1996�Or le�or fw rwn-pe�fom�enos system8 Sod vbesrvaAlon does nOt exp�e.Provfous obee�va�Or�s <br /> bcs�9d in SNorsland or Welhead P�otedion �by�wo indepe�dent pertles ero sul�icient�uMess ai�9 <br /> A�eas or ssivkg a iood.be+re�BQe or lo�inp con�Uons hav�e been 8ltered. <br /> establmhmen� <br /> Doss 1he system hev�e a IF+ree-�oo�veNcal <br /> �aepara�fon�� hom Pe�iodic�►satur�d <br /> Yes No <br /> For reduoed��sye�ams(I.e.. • Mpy be reducsd Dy up[e t S peroent!f eYawied in la.:al <br /> �'eyeterr�s under vld 7080.0178 or <br /> 7ypa IV o�V syatem unds�new 7080.2350 or aof�nenoe. <br /> 7090.2�00): "No standa►�p►otvod e�dsts. 7his dst�s not exheusdv+�, <br /> Ooes f�e eys�ern meet Ihe dssi�ned ve�fical 1hn�sq�►a�ar�r,nw cJoes!t NMlca(+�wl�ch <br /> aeperation dstarwe from Pe�1od�I�saburatad oorr�inadons eie neaessery b meke Has <br /> sol or rock�' Yee No ���. <br /> Any'rw"+ins�rr NidcaMs tl»t tAe syae�n ts�1�P� <br /> �� <br /> C@I'�HG��1�1 . <br /> 17,k ronn is tio be oorn�eted acb aAtaa�ea�n the s�►Fvrm of�he IWn�e�ots Poauuon cona�o�Agenc�e(MPCPa complfano. <br /> Inspedipn Fann for E�dsfino Subsurfa�re Saw�s TrotOnMK SYsbma.Ob�rvatlons�k�xp�ns,and vondusio�e muet be <br /> oorr�e�d br a�i��a de�ener•ComP�torm trn�st bs submi!!ed to the locsl unil of govetnment within 1S dnya. <br /> praparty owr�nemo(aj: AAidtae!6 Rebeoca Nelsen <br /> prvpe�ty addre�: 4Z80 5oclh Ave N Ora�o,'MN 563I0 <br /> Prcpertr c�wners addiess(�da�e�enq: <br /> Cour�ty: Hen ' Phone: <br /> I hereby�q►�I permn►re�y msd��e qb�ssnrstlons,iKe►Rnatsd�oves,�d oorKaltisio�ns►eporlsd on NMs Ifomi and tl+st d►ey ere <br /> ocned <br /> N�ne: Jo�eph J Olson __ C.ertll�io�number 1Z56 <br /> 6usinees Noense nartis snd nurr�her. . Rt�l Olson's so�and Oa+cule�ian�Uc�810 � <br /> Neme of bcal und o�F . , , of Oro� <br /> ���: .. ' DeEe: �1/'IZ/10 <br /> � <br /> wq-wwist�/-31 " '[qrhpllance I►�spectlaf Form for ExlsNng SSTS <br /> 4/4/0B , <br /> . <br />