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Property Address: <br />Business Name: �} -� ✓•(E �l 1 ► L. date: <br />3, Other compliance conditions — Compliance component #3 of 5 <br />3a. Maintenance hole covers appear to be structurally unsound (damaged, cracked, etc.), or unsecured? <br />❑ Yes* 0 No ❑ Unknown <br />3b, Other issues (electrical hazards, etc.) to immediately and adversely impact public health or safety? ❑ Yes" [g No ❑ Unknown <br />*Yes to 3a or 3b - System is an imminent threat to public health and safety. <br />3c. System is non -protective of ground water for other conditions as determined by inspector? ❑ Yes* No <br />3d. System not abandoned in accordance with Minn. R. 7080.2500? ❑ Yes* ❑ leo <br />*Yes to 3c or 3d - System is failing to protect groundwater. NJ <br />Describe verification methods and results: <br />Attached supporting documentation: [] Not applicable ❑ <br />4, Operating permit and nitrogen BMP* — Compliance component #4 of 5 Not applicable <br />Is the system operated under an operating Permit? <br />❑ Yes ❑ No If "yes", A below is required <br />Is the system required to employ a Nitrogen BMP specified in the system design? ❑ Yes ❑ No If "yes", 8 below is required <br />BMP = Best Management Practice(s) specified in the system design <br />If the answer to both questions is "no", this section does not need to be completed - <br />Compliance criteria: <br />a. Have the operating permit requirements been met? ❑ Yes ❑ No <br />b. Is the required nitrogen BMP in place and properly functioning? ❑ Yes ❑ No <br />Any "no" answer indicates noncompliance. <br />Describe verification methods and results: <br />Attached supporting documentation: ❑ operating permit (Attach) ❑ <br />https://www.pca.state.mn.us 651-296-6300 8Q0-657-3864 Use your preferred relay service Available in alternative formats <br />wq-wwists4-316 • 4/2812023 Poge 3 of 4 <br />