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• <br /> r . <br /> • <br /> .Property Address::.1675 Foie Street• .. .' <br /> gusinessName: `Rusty Olson-$oil b Iatian Testi ., • .. <br /> ;Date ttu28i2p21 . <br /> 1.: impact nn public health Conpiiance:component#1 of 5. <br /> Cart ,fiance criteria .. .._ <br /> :: Attachedfsupt itt documentation <br /> System discharges_sewageta'the. '`lp Yes' .No <br /> l� . <br /> ground surface: .. Ot?er .`�. <br /> . •. .•. N Nofapplicable <br /> System discharges Sewage to drain i•0 Yss# !aka.. <br /> • <br /> 'tile or surface waters. : <br /> system causes sewage backup..into ' C Yes`: 2 No <br /> dwelli. or establishment.:. .. <br /> Any'yes"artas+rerabove indicates`the syra ad'i is an <br /> Imminentthri*f td.public heaitfi aotl stifotk '. • <br /> Describe verifitiii on methods and results;: t • <br /> VistiaL Nothing was found <br /> • <br /> • <br /> • <br /> • <br /> j <br /> tankintegrity Compliance component#2 of 5 : • . <br /> :.fit .liaat;e:criteria:` • <br /> tie suppor rig dbt umentatfsin <br /> Syste►►f consists of a see {-- _ .---,- •—. • <br /> Less col,d page pit O Yes .O Na ' <br /> p ryweli,leading pit,:. • Freely°tank()r�•ewed.by trrspector <br /> '..tit other it? • <br /> Name of maintenance b anusiness <br /> •Sewage tank(s)leak below their p.Yes" �Nc <br /> designed operating depth? • License nymber of malntenanee bysinesir �_ <br /> lat+~,of maintenance <br /> Existing tank`Integrity assessment(Attach}.., • .. <br /> if es:which se. a t. .. s leaks Date of maintenanOe.. 1t)/l12021 • <br /> • <br /> (mm/e yyyy) • (must ba wdliin hree:years) <br /> Any"yes"answer above Indicates:the system .(See tloje rnstnicitons to ensure assessment.complies <br /> is failing to protect titer Mini..R:7082 0700 ubp 48(1)1 .: <br /> 0 T8nk is NoncximpIt nt(pumping_not s.necessary eifpiain below) <br /> Ll Other <br /> Describe verification methods and results::.. <br /> Albrn's Septic Pumping:pumped the ititi.kt. <br /> S . . <br /> • • • <br /> bttps//www:pw.state.irrn:us 651-39600 .` . <br /> wq-wwistc4.33b'.4/28/201 8D065�- t4 • tlse,yourpreferredreWysenrit4., Au �Wbie::makemadveformats <br />