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Property Address: 3580 Watertown Road <br />Business Name: Rusty Olson Soil 8 percolation Testing <br />1. Impact on public health — Compliance component #1 of 5 <br />Compliance criteria: <br />System discharges sewage to the <br />ground surface <br />❑ Yes` ® No <br />System discharges sewage to drain ❑ Yes` ® No <br />tile or surface waters. <br />System causes sewage backup into ❑ Yes' ® No <br />dwelling or establishment. <br />Any "yes" answer above indicates the system is an <br />imminent threat to public health and safety. <br />Describe verification methods and results: <br />Visual. Nothing was found <br />Date: 5/1112022 <br />Attached supporting documentation: <br />❑ Other: <br />® Not applicable <br />2. Tank integrity — Compliance component #2 of 5 <br />lance criteria: <br />System consists of a seepage pit, <br />cesspool, drywell, leaching pit, <br />or other pit? <br />Sewage tank(s) leak below their <br />designed operating depth? <br />Attached supporting documentation: <br />❑ Yes" ® No ❑ Empty tank(s) viewed by inspector <br />❑ Yes` ® No <br />Any "yes" answer above indicates the system <br />is failing to protect groundwater. <br />Describe verification methods and results: <br />Elmer J. Peterson pumped the tanks. <br />https://www.pca.state.mn.us 651-296-6300 <br />wq-wwist54-31b • 4/.28/2021 <br />Name of maintenance business: <br />License number of maintenance business: <br />(Date of maintenance: <br />Existing tank integrity assessment (Attach) <br />Tate of maintenance 5/9/2022 <br />(mmlddlyyyy): (must be within three years) <br />(See form instructions to ensure assessment complies with <br />Minn. R. 7082.0700 subp. 4 B (1)) <br />❑ Tank is Noncompliant (pumping not necessary -explain below) <br />❑ Other: <br />• 800-657-3864 Use your preferred relay service Available in alternative formats <br />Page 2 of 4 <br />