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09/e5/2e67 10:36 7634988290 RUSTYS PERC TESTING PAGE 03 <br /> 1/29/02 Wabs/Wa�ewab���.31 <br /> . • Complianoe Inspection Form �or Existing � M�� Paiutlon <br /> Individual Sayvage TneOb�ne�rt��M� �,��,«,c�, <br /> �or,arara ao�m�ms mr�,nr►.v�a�"• s�.�»�.�f�oo'�end Mw�nsaom R d�. ro�eo��na1. �� <br /> eo tnoal o�drnanoea tar atl� � �D1f � a��� <br /> i <br /> � <br /> peb of Li■p�c�tlon: �t�L07 p���'� - <br /> �p�t�� TeMpAo�»( ).. <br /> Rarson�q�eq�� ._'�,5�!'!s!► TaN�hor�pe�3) 47s-�ti� <br /> �loe�eee� cJql: a�ono �coe��s�s _ <br /> FMe No,l P�+c�l No• Ca�j►: ���eoln Ti�lp: <br /> tapd D�o� <br /> ���e�bpry Autho�lly;a!v d Oraa <br /> prr Na�oonrtn�cb� iei�ii� ��an In Sharland Ara��no ��tn In WNihesd <br /> Pr+�ac�ion A�a�: yes� �s�m�1n0�MOH Yoe�ved fac�Nhl� Y'a�i.�oc�l Pe�tnit�(if anY)�_ <br /> gyy�rns bWlt pripr m Apr1 i, 1996�d�ot locabad ln 9�rs0ert�s l0�ed In Shore�and or Wel�eeA Piv6ectlon <br /> 9�o�land or we�ie�d P�oGedfon�►r�or serv�n�a r•aod, Arees or Seivkig e wod, 8e�eraqe or l.,odg�n9 <br /> �age or t.cdgM�g F�ta� ��er►t, o�sYs6en�s 8u�t afber <br /> Marth 31 1996 <br /> �(a�s ares�r�av�ITPM�S syste►f�) g.�L(�1�av��!c an ITPM�S sy�arnJ <br /> -oP�d,arge af sew�pe m tt�prw�d a,rfaoe7 YEs No -oi�a�arye cf sewe�e 6o tf�e grv�xb surfaaea �rEs <br /> -pi9d�rge d�rape tn drakN�e or wrfaoe vraber�'T 1fES NO -Df�dvsrpe d�ewaqe try dreintlle or s�rtdoe w�s?YE5 <br /> _���p��q� Ye5 I�q -5ew�ge l�aclaip Ir�dwdlh�9? YE5 <br /> -Sid�tlo�n wdfi tl�e po�berd�t tn immedlabdr ard -Sltuakion w�fi Ifie po6Q�d ro Imme�elY and <br /> adMer�ely frtip�d or tfx'eaben PibYc hes�fi vr ��eh impe�a'tl�reabr�Publk hea�ld�or � <br /> ,� Y� Np �y� YES <br /> a yes arrsw�er ts a�sysYem) (a yes ans�r[s a feNNa►9 SYst�m� <br /> -tess tf�n'11N0 Ib�af vertical separation between -l�tt�an 111REE lbet of vertica�se�aration betwcen <br /> sy�ern bottom snd��od or bedrodc? 1'�S NO sy�eQn botL�m end safvra�d�oli or bedrvdc? YES <br /> -A 9eepa9e P�.�P�e�'Y�,ar IeaClting plt? Ye5 NO -A see�e Plt.oe�pool,d�ywd�,a leachl�9 P�? YES <br /> -is the sy�em repuMtied under a monft+�ing plen� - Is the sys�em regulebed under � monitoring plan or <br /> �9 P� f��.8p�P�Z) 1'�5 rro op�radng pennk't(lf no, �a to Pa�e 21 � � <br /> If y+es, �1"�� <br /> -Has the required moniboring taken ptace? � NO - Has the required moni0�ring teken plece? YES NO <br /> (►f nn,me syade+n 1e non�oarr�pry�rp) (►�ra.fhe syabm is n���') <br /> -The moni0o�ing in0ic�e Itmt tlie sya�em mests -Th�monlborlrp indic�e that tfie spstem meets <br /> P��� � Ho periom�os�ec�ort�? �Es No <br /> (II na me srserm le nar�ow��pJy�►rg) (If n�n, eh�a�e►n fa na►s�un�P1y►►+p'1 <br /> Page i of 2 wq-wwist�4.31 <br />