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11/29/2611 18:57 7634988290 RUSTYS PERC TESTING PAGE 03 <br /> Parcel number. 3311823440040 System status: ®Compliant ❑Noncompliant <br /> (es determined by this form) <br /> Hydraulic Performance and Other Compliance <br /> Compliance Issue#1 of 4 <br /> Data of observation: 11/2 MI I Reason for observation: Property Transfer <br /> This form awres upon next Inspection or in three years,whichever occurs fust 118912014 <br /> Compliance questionsiddtoda: (Required) Verification Method': (Opdonaq <br /> cheat the to tax <br /> (Check are q*mp late box) <br /> Does the system discharge sewage to the ❑Yes ®No M'Searched for surface outlet <br /> round surface? i <br /> Does the system discharge sewage to drain [IYes ®No [3 Performed hydraulic test <br /> isch <br /> file or surface waters?_. �I Searched for seeping in yard <br /> Door,the system cause sewage backup ❑Yes ® No ® Checked for backup in home <br /> "into*W,4111 'q or estabiishmenCT <br /> ❑ Excess ive ponding in soil systemlD-tourer, <br /> Do other situations exist that have the ❑Yes ®No ❑ Homeowner testimony <br /> poral to Immediately and adversely <br /> impact or threaten public health or safety ❑ Examirwd for surging in tank <br /> electrical unsafe covers etc.7 ❑ •wac k soy above soil dispersal system <br /> Any"yes"nn war kxUb las trial the syatrm Is an ivw*w rt <br /> d~to public henNh sad safety. ❑ System requires"emergency'pumping <br /> ❑ Pwbmwd dye test <br /> Does the system pose a dreat to ground ❑Yes ® No <br /> water for any condldorrs deemed noo- <br /> Protective <br /> ❑ Other <br /> as determined by the <br /> "Yes"indicafsa VW tyre sysftn is faking to pro art <br /> ground water.N "yea;describe the condition noted: <br /> `No standard protocd exists Thio list in not exhaustive, <br /> in sequential order,nor does it indicate which <br /> oornb#mftns are necessary to make this detwMatikxr. <br /> Certification <br /> This form is to be completed and attached to the Summary Form of the Minnesota Pollution Control Agency's(MPCA)Compliance <br /> Inspection Foran for Existing Subsurface Sewage Treatment Systems.Observations,interpretations,and conclusions must be <br /> completed by an Inspector.Completed form must be submitted to the local unit of govemmerd within 15 days. <br /> Property owner name(s): Tim Corrigan <br /> Property address: _ 155 Truffala Trail,Orono,MN 553513 <br /> Property owner's address(Ir 4lltsnsnt): <br /> County: Hennepin Phone: 952-475-0881 <br /> I hereby cerMy that I personally made Me obseryadoms, interpretations, and conclusions reported on this form and that they are <br /> correct <br /> Name: Joseph J.Olson Certification number- 1255 <br /> Business license name and number. Rusty Ohm's soil and pen:uladon t_efti Lice 810 or <br /> Name of local i r of Orono <br /> Signature: Date: I U2912011 <br /> wq-wwfsts4.31 Compliance Inspection Form for Existing SS75 <br />