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Property Address: 460 Orchard Park Road, Orono <br />Business Name: _ Rusty Olson Soll &percolation Testing _ __ <br />L. Impact on public health — Compliance component #1 of 5 <br />Compliance criteria: <br />System discharges sewage to the ❑ Yes- ® No <br />ground surface <br />System discharges sewage to drain ❑Yes No <br />tile or surface waters. <br />System causes sewage backup into I'❑ Yes" ®No <br />dwelling or establishment. <br />Any `yes" answer above indicates the system Is en <br />imminent threat "public health and safety. <br />Describe verification methods and results: <br />Visual. Nothing was found <br />Date: 6/4/2025 <br />Attached supporting documentation: <br />❑ Other: <br />® Not applicable <br />2. Tank integrity —Compliance component #2 of 5 <br />Compliance criteria: <br />System consists of a seepage pit, ❑ Yes1r® No <br />cesspool, drywell, leaching pit, <br />or other pit? <br />Sewage tank(s) leak below their �❑Yes, ®No <br />designed operating depth? <br />Ifyes, which sewage tank(s) leaks: 1 <br />Any "yes" answer above Indicates the system <br />is falling to protect groundwater. <br />Describe verification methods and results: <br />Kothrade Sewer,Water &Excavating pumped the tanks. <br />https://www. pca,state. m n. us <br />wq-wwists4.31b 4/28/2021 <br />Attached <br />supporting documentation: <br />❑ Empty tank(s) viewed by inspector <br />Name of maintenance business: <br />License number of maintenance business: <br />Date of maintenance: <br />® Existing tank integrity assessment (Attach) <br />Date of maintenance 6/3/2025 <br />(mm/dd/yyyy): (must be within three years) <br />(See form instructions to ensure assessment complies with <br />Minn. R. 7082.0700 subp. 9 8 (1)) <br />❑ Tank is Noncompliant (pumping not necessary -explain below) <br />❑ Other: <br />• 661-296-6300 800-657-3864 Use your preferred relay service Available in alternative formats <br />Page 2 of 4 <br />