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Property Address: <br />Business Name: c <br />3. Other compliance conditions — Compliance component #3 of 5 <br />Date: .5"-q <br />3a. Maintenance hole covers appear to be structurally unsound (damaged, cracked, etc.), or unsecured? <br />❑ Yes' I!I'] No ❑ Unknown <br />3b. Other issues (etectrtcalhazards, etc) to immediately and adversely Impact public health or safety? ❑ Yes' ® 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? V1 Yes • 0No Nf A <br />`Yes to 3c or 3d - System Is falling to protect groundwater. <br />Describe verification methods and results: <br />Attached supporting documentation: ❑ Not applicable ❑ <br />4. Operating permit and nitrogen BMP* —Compliance component #4 of 5 R Not applicable <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 6MP 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 />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 8OM57-3864 Use your preferred relay service Available to alternative formats <br />wq-ww1sts4-31b • 412812021 Page 3 of 4 <br />