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3a. Maintenance hole covers appear to be structurally unsound (damaged, cracked, etc.), or unsecured? <br />❑ Yes" ® No ❑ Unknown <br />3b. Other issues (electrical hazards. etc.) to immediately and adversely impact public health or safety? ❑ Yes` ® No ❑ Unknown <br />'Yes _o a,., c,,r 3b c y t i E ",s an imams¢ n "n ee t€,.� .,,.tet v h.;,,. f.., an, safe-, <br />3c. System is non -protective of ground water for other conditions as determined by inspector? <br />3d. System not abandoned in accordance with Minn. R. 7080.2500? <br />... ..';. or 3 fir. b.,mF, is fs P <br />Describe verification methods and results: <br />Inspected <br />Attached supporting documentation: ❑ Not applicable ❑ <br />❑ Yes ® No <br />❑ Yes, ® No <br />4. Operating permit and nitrogen BMP* — Compliance component #4 of 5 E] Not applicable I <br />Is the system operated under an Operating Permit? ❑ 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", B 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 />,v Cates <br />Describe verification methods and results: <br />Attached supporting documentation: ❑ Operating permit (Attach) ❑ <br />iittps://www,pca,state.inn.us 651-296-6300 800-657-3864 Use your preferred relay service Available in alternative formats <br />wq-wwists4-31b o 1/11/21 Page 3 of 4 <br />