Laserfiche WebLink
12J68/2010 09:57 7634988296 RUSTYS PERC TESTING PAGE 05 <br /> � Paroei number: Sysbem slaUus: �ComP�r�t ❑NonCdnpliant <br /> (es aletemWned br this fo�m1 <br /> soil �sp�ion co�N�liance �d Otl�sr Co�wp�l�n�� <br /> Compliance Issue #3 of 4 <br /> Date ob�ervation: 12J03R010 Reeaon for abeeN�: P T�sier <br /> TMs' ' or�this fo►m does not expi�- <br /> Com�lianos qu�stlonelcei�sri�- �Re�uh� V�Iflcatlon M�Ihod"': (Op�O�a�) <br /> }/ie te bax (Check the apruopAete box) <br /> FOt sy�ems buik pri0rto Aplil 1,�9�,and not � conducted son oeservetion(s�(at����a) <br /> lOcated m Shoreland or WeUheed Protsct(on ❑ T��y�s verificatlons(aKach bori�9 I�) <br /> Area qr not servfnp a food,bevero8e or <br /> lodgir�g e�tablisfiment ❑ Other. <br /> poes�e system have at le�st e iwo-foot <br /> ve�l separe�iion distance irom pe�iodic�lip <br /> � ��a��� Yea No <br /> Fcr non-perforn�anoe syste�ns built Aprs 1, <br /> 1996,or la�er or�r non-perfamanoe systems Shc observs�on does not e�ire.Previous observado►� <br /> loca�in Shoreland or WeNhesd Protectlan �����t��$�sulRCie�t,unle�sf�e <br /> Areas or servin9 a food,beve�s9e or lodging oonditfons hsve been elte�ed- <br /> establ'�hment <br /> Does Ihe eystem heve a three-f�ot.veKical <br /> sepacation distsnce fr�om Periodicel�r wturaeed <br /> �i����� Ye6 No <br /> For redtu�id eeperatlOn distanCe sYe�em6 C.e., � �y�reduced by up to 15 perr,ent if allow�ed in locsl <br /> `peiiormsnce"�yst�ns un4er old 7080.0179 or ��. <br /> Type N ar V sysiein under new 7080•2350 or <br /> 7060_2400): "No star►da►d protocaol exists. Thia list Is not exhaus�'ve� <br /> �oes the systt�mm meet the deaigned vertkel in sequev�el ader,nor doas k indica�whiah <br /> yS c�ornDlr�a�ons ere r�eoesss►r ro►►�ake m�s <br /> seperaticn distance trom period�icallY se� Yes No determinBdQn. <br /> sa1 or bedrock�'' <br /> Any'�o"answ�r�dk�l��tlis s�n Is�1n�9 m P'�� <br /> I g►ound� <br /> Certfftcation <br /> This fom�;a to be cvmpleted end attad�ed to ri�e Summery Form of the Mlnnesot8 PaNution Corrtrol Agency's(MPCA)Complia�e <br /> Inspscdon Form for ExisUng Subsurlaca Sewag�Trsabnent Sysboms.Obae�s,inl�Pretetions,and condusions must be <br /> oompleped hy an inspec:tor vr dssigner.Completed i�drm must be aubmi�e�d eo the Ivr,al unit of govomment within 15�ys. <br /> property owner name(s)= Malt&Carrie VsnSlooten <br /> properly addrees: 36,0 Jaoobs MiN Raad Orono AAN 56358 <br /> Prpperty ownsr's 8ddresa(if Q�I�srenU: - -- <br /> ��. � Phon� 612-30�h0�?Z <br /> I1 hereby c�idfy that 1 personaay mede the obseNeEiona i►�te►pnsteSor�end corrclUsions�epo►ted on this form end that d�ey ere <br /> oo►►ecf. <br /> Name: Joseph J Olson , ����� 12� <br /> Busir�ess lic�enac nama and number. , Rusty Olson's soll end pe�ula�on tesfinq„Lic#810 � <br /> Nsme d local unit Cihr of Orono <br /> g���- Dete: 1?JOHH 0 <br /> •-.-- �- �ti»dtmx.e Insnettlon Form for Ex1sHnQ SSTS <br />