, � 3:06 7634988290 F�2US'i-Y5 PERC TESTING PAGE ��.
<br /> 01/2�/2012 1
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<br /> Par��1 number. 03�117•23��-t�t110 _�,._ System staAus= �Compif�rrt ❑ Noncomplie�t
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<br /> ��r�auli� �'sr�rrnanc+� �nd Other��npl�ae� �,� ,.:�,
<br /> �r�r��lianz� Issu� #9 af�� ' '
<br /> C7ut�tr�obs+e�vetfan: 1/20/92 Reeson for obs�rv�tfon: Pro Tr�nsfe� _, _ _.___,.-_
<br /> '1`t�l�#'br�n expires upon ne�R inspaction or in three yeers,uvFtichever oCcur�fsrst: 1/2DI2015 �,._., .._.__
<br /> �i�:�91ar1r.�c������srJcritsr�' (�equired) ��rifiCiltiOn Method': (O�tional) _
<br /> __�Check the app�fe box) � •-- (Check the epProPriatv box)
<br /> Ua�s��'�+�systern discharge sm���e to the ❑Yes � Wo � Sea�ched for surtace outi�t
<br /> �rou.�cii�urfac�7 .
<br /> . ❑ Perfnm►�hydreulic ta�,st
<br /> �3�s�{i�sys�sem dfsche�ge st�uvsge to drain ❑lf� � ��
<br /> tiil�ra��u�aoe w�ters? r _-w_...__ � Searched for seeping in yard
<br /> Ct���e sys9err�ceu�e serwage bacicup ❑j'u.� �P10 I�1 Chedced ior badcup in hame
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<br /> I�n��:w�lling or est9bt6shment? _ ,,�;I=" _ _
<br /> _��_� ,_ ❑ �Exoessive pondfng in soii system/D-bo�e's
<br /> l7�c r�s��r situafions�xiat th�Y ha�ve the ❑�°�3$ ��n ❑ Homeawner tes�fmony
<br /> pu4c�r��4al to immedi�tely�nd adv�rs�ly
<br /> I�p�t or threaten ublic health or safety LL,. _ _ .__ ; , � �'�mined for surg�n j :` '
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<br /> �n"ye�sp��,�r lrnil��syatom!s an�'r�a»Onern '' � S la em re uire�e�mfl di�pert3�l�`��stehi
<br /> �t�. ncal,u s:�fe c.�ver� etc. 7
<br /> �D�^�2 a6o pecb!(�he�IPh arrd� ❑ 5/$ Q �t'per�c�'pumping
<br /> „r.__.___.�_ M.... ----- .r ❑ Perfvmned dye t��t
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<br /> g � ter fl� �•,,descrd�the conditian a�tod: . . .
<br /> f�e�.a�a9� " ; y :, . , � .,a:: � . ; �Ado starrdeid prutocd ezists. 7'his.list/s rrot exh�ia:�li�a,. ..
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<br /> —__ i�r srtquar�Bel ader, nor c�oes iP indicate which
<br /> ;��,qr#�����M�� rg:��d.,.r��r,�r i;, b�u �� i-::: , .�_�_� �`��rrbfnaefons are n�c�s�ty,#u make this deterrr�;nati��i.
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<br /> �u�ryt&S'ESi'YYt i�tU l�i�Afl1���Ad:'e�ttt��attached to the Saamm�ry 1=orm of the�t4innesot�Pollution Control A�ency's(NIPCA)Corro;�3u:���
<br /> 1���'6071�eTn+l�+flf EXI��iPI��UI38UI�ace 3ewa�e Tt�s�finent Sys�rns.dbservations, interpie�tations;'arid cflnclusions rr�uur h�
<br /> car�;�i�ted by�n inspector. Completeci form must be subrnitted to the local unit of government,w�tp�(�n;�;�;�y�.
<br /> Pra�;�r�y-o`wrrtiar��arr+�(s):. � ��J�si�n��ree� '� � �,������41r�� �c�ie ��i��:���� � ����,�,;�-:;
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<br /> 3��Y�,^��.�rty a��r��d��t�'�E�eier�): ' 14508 MC Girrty i�oad W.Minnetonke,MN 55391 °' �ro1 �tt., ;*`:t:��,i�
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<br /> csr��_ 852-932�2
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<br /> �re�eby certlfy ttret 1�ersonelly made�the observations,tnt�ipreta�ions,and concfusions report�d�n this fomr and that they e�
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<br /> ��::�,;,;�: �����t�J:��sa�ti '` _._. _ �, CsrtiAcatbnnumbeP: 5256
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<br /> " $�►��me�nd numb�r: Rusty Olson s�ii en�rca�letion testing Lic#810 __ __�,„� _ �r
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