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Parcel number. 27-118-23-44-0007 System status: ❑Compliant �N�compliant <br /> (as determined by this(oim) <br /> pperating Permit Campliance and Nitrogen BMP Compliance <br /> Comptiance Issue#4 of 4 <br /> Applicability: <br /> Is the system operated under an Operating Pemdt? ❑Yes �No If"yes",then compiste�em A,below <br /> Is the system required to employ a nitrogen BMP? ❑Yes �No tf"yes",then complete�em B,below <br /> !f the answer to 6oth quesGons is"no",then tbis form does not need to be completed. <br /> Compllance questionslcriteria:(Required) <br /> (Check the appropriate box) <br /> A. For systems with operating permits: <br /> Has atl the required mo�itoring and mai�tenance taken place and does the monitoring indicate compliance with the <br /> pertnit thresholds? <br /> ❑Yes ❑No <br /> B. For a system that has a required nitrogen reducing BMP and does not have an operating permit: <br /> Is the nitrogen BMP in-place and appears to be properly opera6ng? ❑Yes ❑No <br /> Any"no"answers indicates noncompllance <br /> Date of observation: Reason for observation_ <br /> Operating permit number. <br /> This form eupires upon next inspection or in three years,whichever occurs first: <br /> Certification <br /> This form is to be completed�d attached to the Summary Form of the Minnesota Pollution Control Agency's(MPCA)Compliance <br /> Mspection Fam for Existing Subsurface S�rage TreatmeM Systems_Observations,interpretations�d oonGusions must be <br /> completed by an advanced inspector,service provider,or maintainer(mair►tainer for holding tanks only).Completed fotm must be <br /> submitted to the bcal unit of govemment within 15 days. <br /> Property owner name(s): RICHARD W.PERKINS <br /> Property address: 16991VORTH FAI2M RD-ORONO <br /> Property owner s address(if difterent): <br /> County: HENNEPIN P�e� <br /> !hereby certify that I personalfy made the observatiorts,�terprefations ar►d conclusions reporfed on this form and that they are <br /> correct <br /> Name: Mark J Hayes _ Cefification number: R5013 <br /> Business license name and number: Minnesota Geoted�nical Services �LC MPCA#L3203 a� <br /> Name of local unit of government: Wright Couniy <br /> Signature: M�J�'Wieb Date: 7/12/9 __ <br /> wq-wwis[s4-31 Compliance Inspection Form for Exlsting SSTS <br /> 4/4/08 <br />