955 Cliff Rd - Septic Maintenance Form 2024-01-23SSTS COMPLIANCE MAINTENANCE & MONITORING REPORT
For OPERATING PERMIT #
To be completed by a Service Provider
(Please Print) n
Property Owner Name: R, I III' I" �tiy PID#
System Location: �� � flA
Address
City
What is the Design flow for the system Gallons/Day
551
WE
3
For this Operating Permit period: Maintenance, Monitoring & Service activities performed:
Description
Date(s)
Do you have a service agreement for this STS? UL Yes- expiration date: ✓` Ld"� []No
Flow Monitoring via: ❑ event counter ❑ H2O meter ❑elapsed time meter
What is the average daily flow being dispersed into the system Gallons/Day
Please note any problems with system and actions Proposed or Taken to correct:
In your opinion have the Operating Permit monitoring requirements been met? ❑Yes ❑ No
Please identify any recommended revisions to the maintenance/monitoring plan of this
system: /V4.'W,-(-C,
I hereby certify with my signature below that the above information is accurate and a reflection on the
actual conditions existing on the above referenced property based upon the supporting documentation:
/`'�V=,xco �� ��� 5bf�, I'If6A
Licensed Business Name Phone# Date
'Be
Certified Professional (print name) License # Sig ature
REQUIRED ATTACHMENTS: Inspection, Monitoring, Maintenance reports for this Operating Permit period
SSTSOPMaintMonitReport16
UC LABORATORY Laboratory Results PHONE- (507)234-5835
PO BOX 551
JANESVILLE, MN 56048
Date Received: 1/23/2024 13:10
Date Printed: 1/29/2024
REPORT TO: Advanced Septic
36180 183rd Ave As Received Temperature 1 deg C
Montgomery, MN 56069 Location: Phillip Perry
Laboratory Report # 45314.259
Advanced Septic
Date/Time
Date/Time
4NALYSES
Sample ID
Result
As Received
Units
Method
RL
Sampled
Anal ed
1/23/2024 15:09
Lab #
45314.259
Analyst
CAC/MK
CBODS
Effluent
< 0.5 "
mg/L
SM 5210 B-2016
0.5
1/23/2024 11:00
<3
mg/L
USGSI-3765-85
3
1/23/2024 11:00
1/23/202415:31
45314.259
LB/HU
TSS
Effluent
Colilert&18 (Fecal Coliforms)
10
1/23/2024 11:00
1/23/2024 13:40
45314.260
TW/TW
Fecal Coliform
Effluent
< 10
MPN/100ML
Fecal Coliform was analyzed 2.7 hour(s) after collection. The holding time for Fecal Coliform is 8 hours.
-The GGA for the data set of Effluent sample was not within range.
1/29/2024
This report was reviewed and approved by
This report cannot be reproduced, except in full, without written approval from UC Laboratory.
The results in this report apply to the samples analyzed in accordance with the Chain -of -Custody record.
UC Laboratory certifies that the test results meet all of the requirements of NELAC.
Unless otherwise noted in the report, the sample conditions at time of receipt met the laboratorys acceptance policy and regulatory requirements.
Your contact person is Amy Schreader
IA Certification # 180 MN Certification # 027-161-186 EPA ID # MN00068
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