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3. Other <br />conditions — Compliance <br />3a. Maintenance hole covers appear to be structurally unsound (i <br />❑ Yes' ® No ❑ Unknown <br />3b. Other issues (electrical hazards, etc.) to immediately and adven <br />*Yes to 3a or 3b - System is an imminent threat to public <br />3c. System is non -protective of ground water for other conditions <br />3d. System not abandoned in accordance with Minn. R. 7080.25( <br />*Yes to 3c or 3d - System is failing to protect groundwate <br />Describe verification methods and results: <br />Inspected <br />Attached supporting documentation: ® Not applicable <br />4. Operating permit and nitrogen BMP* — Comp <br />Is the system operated under an Operating Permit? <br />Is the system required to employ a Nitrogen BMP specified in the <br />BMP = Best Management Practice(s) specified in the systel <br />If the answer to both questions is "no" this section do <br />Compliance criteria: <br />a. Have the operating permit requirements been met? <br />b. Is the required nitrogen BMP in place and properly function <br />Any "no" answer indicates noncompliance. <br />Describe verification methods and results: <br />Attached supporting documentation: ❑ Operating <br />nent #3 of 5 <br />cracked, etc.), or unsecured? <br />impact public health or safety? ❑ Yes* ® No ❑ Unknown <br />dth and safety. <br />determined by inspector? ❑ Yes* ® No <br />❑ Yes* ® No <br />of 5 ® Not <br />❑ Yes ❑ N If "yes", A below is required <br />design? ❑ Yes ❑ N If "yes", B below is required <br />not need to be <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />(Attach) ❑ <br />https://www.pca.state.mn.us 651.296-6300 800-657-3864 Use your preferred relay service Available in alternative formats <br />wq-ww1sts4-31b • 1/11/21 Page 3 oJ4 <br />