HomeMy WebLinkAboutBells Resort_56000040016000_Septic System Permits_Compliance Inspection FormMinnesota Pollution
Control Agency
520 Lafayette Road North
St. Paul, MN 55155-4194
Existing Subsurface Sewage Treatment Systems (SSTS)
Doc Type: Compliance and Enforcement
es:Inspection results based on Minnesota Pollution Control Agency (MPCA)
requirements and attached forms - additional local requirements may also apply.
Submit completed form to Local
within 15 days (NUV 02 2016UG) and system owner
land 8 RESOURCE
System Status
System status on date (mm/dd/yyyy): ^ ^
□ Compliant - Certificate of Compliance Noncompliant - Notice of Noncompliance
(Valid for 3 years from report date, unless shorter time t f'See Upgrade Requirements on page 3.)
frame outlined in Local Ordinance.)
Reason(s) for noncompliance (check all applicable)
□ Impact on Public Health (Compliance Component #1) - Imminent threat to public health and safety
□ Other Compliance Conditions (Compliance Component #3) - Imminent threat to public health and safety
*^^^;ank Integrity (Compliance Component #2) - Failing to protect groundwater
□ Other Compliance Conditions (Compliance Component #3) - Failing to protect groundwater
□ Soil Separation (Compliance Component #4) - Failing to protect groundwater
D Operating permit/monitoring plan requirements (Compliance Component #5) - Noncompliant
Property Information
Property address: 9578 Co Hwy 41 Dent, MN 56528
Property owner: Zaundra Bina et al_____________
Parcel ID# or Sec/Twp/Range: 56000040016000
_____________ Reason for inspection: permit
_____________ Owner’s phone: 218-298-2716
or
Owner’s representative: Ron Bina
Local regulatory authority: Land & Resource Management
Brief system description: three 800 gallon tanks, 20 x 100 gravity bed
Comments or recommendations:
Representative phone: 701-371-9746
Regulatory authority phone: 218-998-8095
Certification
/ hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No
determination of future system performance has been nor can be made due to unknown conditions during system construction,
possible abuse of the system, inadequate maintenance, or future water usage.
Inspector name: Wayne Johnson
Business name: Super Septic & Excavation
Inspector signature:
Necessary or Locellly Required Attachments
^ Soil boring logs
□ Other information (list):
Certification number: C2520______
License number: 901________
Phone number: 218-863-3373
^ Forms per local ordinanceE System/As-built drawing
TTY 651-282-5332 or 800-657-3864 • Available in alternative formats
Page 1 of 3
www.pca.state.mn.us • 651-296-6300 • 800-657-3864
wq-wwists4-31 • 3/16/12
Inspector initials/Date: //[/r\Property address: 9578 Co Hwy 41 Dent, MN 56528
1. Impact on Public Health - Compliance component #1 of 5
Verification method(s):
^I^Searched for surface outlet
Searched for seeping in yard/backup in home
□ Excessive ponding in soil system/D-boxes
Q Homeowner testimony (See Comments/Explanation)
□ “Black soil” above soil dispersal system
□ System requires “emergency” pumping
□ Performed dye test
□ Unable to verify (See Comments/Explanation)
D Other methods not listed (See Comments/Explanation)
Compliance criteria: _____
System discharges sewage to the
ground surface.______________
System discharges sewage to drain □ Yes I^No
tile or surface watej;s.
System causes sewage backup into □ Yes |^sNo
dwelling or establishment.
Any “yes” answer above indicates the
system is an imminent threat to public
health and safety.
□ Yes ^ No
Comments/Explanation:
2. Tank Integrity - Compliance component #2 of 5
Compliance criteria:Verification method(s):
-0-Probed tank(s) bottom
□ Examined construction records
D Examined Tank Integrity Form (Attach)
'^Observed liquid level below operating depth
□ Examined empty (pumped) tanks(s)
□ Probed outside tank(s) for “black soil”
D Unable to verify (See Comments/Explanation)
D Other methods not listed (See Comments/Explanation)
□ Yes n NoSystem consists of a seepage pit,
cesspool, drywell, or leaching pit.
Seepage pits meeting 7080 2550 may be
compliant if allowed in local ordinance.
Sewage tank(s) leak below their
designed operating depth.
If yes, which sewage tank(s) leaks: _____
Any “yes” answer above indicates the
system is failing to protect groundwater.
^Yes □ No
Comments/Explanation:
(P=^ AJO L/9't .
3. Other Compliance Conditions - Compliance component #3 of 5
a. Maintenance hole covers are damaged, cracked, unsecured, or appear to be structurally unsound. □ Yes* E No □ Unknown
b. Other issues (electrical hazards, etc.) to immediately and adversely impact public health or safety. □ Yes* H No □ Unknown
*System is an imminent threat to public health and safety.
Explain:
c. System is non-protective of ground water for other conditions as determined by inspector. □ Yes* S No
*System is failing to protect groundwater.
Explain:
TTY 651-282-5332 or 800-657-3864 • Available in alternative formats
Page 2 of 3
www.pca.state.mn.us • 651-296-6300 • 800-657-3864
wq-wwists4-31 • 3/16/12
I
(mm/dd/yyyy)
Inspector initials/Date:Property address: 9578 Co Hwy 41 Dent, MN 56528
4, Soil Separation - Compliance component #4 of 5
Date of installation: /Q-' □ Unknown
(mm/dd/yyyy)
ShorelandAAtellhead protection/Food beverage
lodging?
Compliance criteria:_____________
Verification method(s):
Soil observation does not expire. Previous soil
observations by two independent parties are sufficient,
unless site conditions have been altered or local
requirements differ.
0 Conducted soil observation(s) (Attach boring logs)
□ Two previous verifications (Attach boring logs)
r~l Not applicable (Holding tank(s), no drainfield)
CH Unable to verify (See Comments/Explanation)
D Other ("See Comments/Explanation)
□ Yes □ No
□ Yes □ NoFor systems built prior to ApriH, 1996, and
not located in Shoreland or Wellhead
Protection Area or not serving a food,
beverage or lodging establishment:
Drainfield has at least a two-foot vertical
separation distance from periodically
saturated soil or bedrock.
^ Yes □ NoNon-performance systems built April 1,
1996, or later or for non-performance
systems located in Shoreland or Wellhead
Protection Areas or serving a food,
beverage, or lodging establishment:
Drainfield has a three-foot vertical
separation distance from periodically
saturated soil or bedrock.*
Comments/Explanation:
Boring Log
0-4 Loamy sand 10yr3/1
4-12 loamy sand 10yr4/3
12-72 sand 10yr6/4
□ Yes □ No“Experimental”, “Other", or “Performance"
systems built under pre-2008 Rules; Type IV
or V systems built under 2008 Rules (7080.
2350 or 7080.2400 (Advanced Inspector
License required)
Drainfield meets the designed vertical
separation distance from periodically
saturated soil or bedrock.
Indicate depths or elevations
36A. Bottom of distribution media
+72B. Periodically saturated soil/bedrock
+36C. System separation
D. Required compliance separation* 36
‘May be reduced up to 15 percent if allowed by Local
Ordinance.Any “no” answer above indicates the system is
failing to protect groundwater.
5. Operating Permit and Nitrogen BMP* - Compliance component #5 of 5 ^ Not applicable
n Yes □ No If “yes”, A below is required
n Yes □ No If “yes”, B below is required
Is the system operated under an Operating Permit?
Is the system required to employ a Nitrogen BMP?
BMP = Best Management Practice(s) specified in the system design
If the answer to both questions is “no”, this section does not need to be completed.
^mpliance criteria ________________
a. Operating Permit number:
Have the Operating Permit requirements been met?
b. Is the required nitrogen BMP in place and properly functioning?
Any “no” answer indicates Noncompliance.
□ Yes □ No
□ Yes □ No
Upgrade Requirements (Minn. Stat §115.55) An imminent threat to public health and safety (ITPHS) must be upgraded, replaced, or its use
discontinued within ten months of receipt of this notice or within a shorter period if required by local ordinance. If the system is failing to protect
ground water, the system must be upgraded, replaced, or its use discontinued within the time required by local ordinance. If an existing system
is not failing as defined in law, and has at least two feet of design soil separation, then the system need not be upgraded, repaired, replaced, or
Its use discontinued, notwithstanding any local ordinance that is more strict. This provision does not apply to systems in shoreland areas,
Wellhead Protection Areas, or those used in connection with food, beverage, and lodging establishments as defined in law.
TTY 651 -282-5332 or 800-657-3864 • Available in alternative formats
Page 3 of 3
www.pca.state.mn.us • 651-296-6300 • 800-657-3864
wq-wwists4-31 • 3/16/12
Department of
LAND AND RESOURCE MANAGEMENT
OTTER TAIL COUNTY
Government Services Center - 540 West Fir
Fergus Falls, mn 56537
PH: 218-9Qa-8095
OTTER Tail County’s website: www.cootter-tail.mn.us
OTTER Tflll
ODVEtl ■iMCIIOTa
Otter Tail County Compliance Inspection Form Addendum
This form is a required attachment to MPCA Compliance Inspection Form for all Existing Subsurface Sewage
Treatment Systems in Otter Tail County as of June 1,2011.
Property Information
56000040016000Parcel Number:
Township:
Property Owner Name(s): Galaxy Resort Zaundra Bina
Property Address:
Reason for Inspection: Sale of Property
Section: ^Star Lake
39578 Co Hwy 41
Yes@-
Number of Bedrooms: 1888
r □In Shoreland Area?
Lake/River Name, Number, & Class Star Lake 56-385 GD
No
System Compliance Stati^_^ Compliant
Non-CompliantX
XDoes the soil treatment area have less than 3 feet of vertical separation?
Is the septic tank located less than 50 feet from any well?
Is the soil treatment area located less than 50 feet from any deep well?
Is the soil treatment area located less than 100 feet from any shallow well?
Yes No
X.N0Yes
Yes NoA.
AYes No
"Yes" indicates that the system is failing to protect ground water
and is noncompliant. If "Yes", describe the condition noted:
Required Attachments: System drawing to scale on next page.
Completed MPCA Compliance Inspection
I hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of
future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system,
inadequate maintenance, or future water usage.
Name: Wayne Johnson
Certification Number: C2520
Business License Name & Number: Super geptic & Excavation
Signature:
#901
Date:
X
Page 1 of 2Excel/Compliance Form for OTC 4/30/2014
otter Tail County Compliance Inspection Form Addendum (cont.)
56000040016000Parcel Number:
Date & Initial;
System Drawing
The system drawing must be to scale and include all septic/holding/lift tanks, drainfields, welK'vWffin 100 feet of system (indicate depth of
wells), dwelling and non-dwelling structures, lot lines, road right-of-ways, easements, OHWLs, wetlands, and topographic features (i.e.
bluffs).Star Lake7'/
/
r'/
1 /Zaundra6ina& Tonya Munn
39578 Co Hwy 41
Dent, MN 56528
Parcel #56000040016000
I
1 /
/^3gu^
/
/I
/1
/
I /
I /new 1000 gallon lift tank1 /
/
/1
house SrestuiafA /t
<S>//\
h^anjiesliiiait'
^seiticaiea /'\I /\
' S'CP ^
//jf
/
1 /\
existnghedI\o ““I15x65lAIi\I
i I
\ 1 \ \\ \ \ I V i
/
Scale 1"=100 feet/i
\ 1 /I 100.00'/
/SettackLine
— - LotUne
— Sewer Line i Drain Rek)
— Structures
1
/
I /
/Super Septic & Excavation
38992 183rd Ave
Pelican Rapids, MN 56572
License #901 218-863-3373______
/
/Additional Comments:
/
Page 2 of 2Excel/Compliance Form for OTC 04/30/2014
OTTER TAIL COUNTY
LAND & RESOURCE MANAGEMENT
PUBLIC WORKS DIVISION
WWV CO.OTTER-TAIL MN.US
GOVERNMENT SERVICES CENTER
540 WEST FIR AVENUE
FERGUS FALLS, MN 56537 218-998-8095
FAX: 218-998-8112
12/7/2016
Ronald J Bina
39578 County Highway 41
DentMn 56528 9221
RE: Primary Owner: Zaundra Bina & Tonya Munn
Sewage Treatment System Servicing Tax Parcel Number: 56000040016000
Described as:Sec 04 Twp Star Lake Township
Sect-04 Twp-135 Range-041
6.00 AC
TRI TR ON E SIDE CAR#41 & SEC
Lake: 56-385 Star
As of 11/30/2016 the lift tank and 4 septic tanks (Sewage Treatment Installation Permit #
24426 servicing your property was determined to be in compliance with the provisions of
the Sanitation Code of Otter Tail County.
Please be advised that this certification is only valid for five years from the date of this
inspection 11/30/2021.
If you have any questions regarding this matter, please contact our office.
Sincerely,
Eric Babolian
Inspector Q3::::..
APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM
LAND & RESOURCE MANAGEMENTGOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537
218-998-8095
www.co.otter-tail.mn.usSCANNEDOTTER TflII WHITE - Office YELLOW -L&R Inspector PINK - Owner / Contractor (after issue)coHnTY-ainncfOTii
APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED Permit No.
LAKE/RIVER
CLASS
PARCEL NUMBER (S) OF PROPERTY BEING SERVICE'D E-911 ADDRESS OR dIrECTIONS FROM NEAREST PUBLIC ROAD
5G-cco-iO-y-OO/^-OOP____________________________________
LAKE NUMBER LAKE/RIVER NAME SECTION TWP NO.RANGE TWP NAME
LEGAL DESCRIPTION
Last Name First Initial Mailing Address Daytime Phone No.
Property
Owner
9/^/ \rf// ^
Contractor
Lie.#
THIS SPACE FOR OFFICE USE ONLY
A.M.
>■ This System will be ready for inspection on , the year of P.M.at
A.M. P.M.
Date Received Time Received L&R Official
TYPE OF NSTALLATION (circle one)SEWAGE TREATMENT SYSTEM DESIGN DATA
AS SHOWN ON DRAWINGResidential
(A) New
(B) Replacement
(C) Add on
Collector Other Est.
Soil
Treatment
Area
(D) New
(E) Replacement
(F) Add on
(G) Ne
epiacement J Tank ^I) Add on LiftDesign Flow (Gallons/Day)
(J)0
( TKTl—2,49^)
■^t-1 L,oui) — 4^9
(M) 5,000 — 10,000
Effluent Distribution
(^) Gravity
GIs Ft.( )Size
Setback To
Nearest Well tO)*Type I Type II Ft.Ft.
(20) Trench, Rock (27) Rapidly Permeable
[d£-imFt. Ft.Ft.Setback To OHWL(21) Trench, Gravelless (28) Flood Plain
(22) Trench, Chamber (29) Privies Ft.Ft.Setback To Bluff(23) Bed
(24) Mound
(30) Holding Tank
(Contract Required)
f
lOFt. Ft. Ft.Setback To Dwelling
(25) At Grade Type III
Setback To Non-Dwelling /O(26) Greywater (31) Other/Problem Soils/<12” Soil Ft. Ft. Ft.IDType IV(34) Tank Only Setback To Nearest
Lot Line ILL5-(On.Ft.Ft.(32) Public Domain &
Proprietary Technologies^______i
(33) Performance _____________
Garbage Disposal / Y / N
(35) Other
Depth of Well Setback To Road Right-Of-Way /O Ft.Ft.Type
Total # Bedrooms Elevation Above
Restrictive Layer yWFt.Ft. Ft.Abatement Y /
<rPERC TEST DATA
Designer /,( J, /Highest Rate ^' 'PLicense # / ^ V Date of Test
Agreement: The undersigned hereby makes application for permit to Install, alter, repair or extend Sewage Treatment System herein specified, agreeing to do all such work in strict accor
dance with Sanitation Code of Otter Tail County, Minnesota. Applicant agrees that the Site Data Worksheet submitted herewith and which is approved by a Land & Resource Management
Official shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and approved for use. It shall be the responsibility
of the applicant for the permit to notify Land & Resource Management that the installation is ready for inspection.
Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person
to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Sanitation Code of Otter Tail County, Minnesota. This permit may be revoked at any time
upon violation of the Sanitation Code.
NOTE: I.This permit is valid for a period of six (6) months. 2.This permU does not include the building sewer (sewer line).
Signature offifopertyOwna^gent forOwne^
/9J-Date:Permit Fee $
NOV 02 »
Date:
Land &Tte^uTce Management Olticiat
Q\ CQLb^T^'s ^—(605 Date StampComments:
L&R InitialForm No. BK — 04-2014-06 . 357.243 • Victor Lundeen Co., Printers • Fergus Falls. Minnesota
4
i.APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM
LAND & RESOURCE MANAGEMENT
GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537
IZ}l/eI'..
218-998-8095
www.co.otter-tail.mn.us
OTTER TRIl WHITE - Office YELLOW -L & R Inspector PINK - Owner / Contractor (after issue)coniTT-aiaiiiiOTii
APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED Permit No.
LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER
CLASS
SECTION TWP NO.RANGE TWP NAME
/ ie ' I I
E-911 ADDRESS OR DIRECTIONS FI^OM NEAREST PUBLIC ROAD
A/
PARCEL NUMBER (S) OF PROPERTY BEING SERvfcEDr 1 n
-u^ 6 -{jno 2.
LEGAL DESCRIPTION
Last Name First Initial Mailing Address Daytime Phone No.
Property
Owner
2,y
7
■>
■r^yy/'/. yContractor
Lie.#
y
( V';!C'C'
THIS SPACE FOR OFFICE USE ONLY \x9ttjsi2Hii122>■ This System will be ready for inspection on , the year of at
\M\i0
Date Received *^4^P.M.
Time Received L & R Official
TYPE OF NSTALLATION (circle one)SEWAGE TREATMENT SYSTEM DESIGN DATA
AS SHOWN ON DRAWINGResidential
(A) New
(B) Replacement
(C) Add on
Collector Other Est.
(D) New
(E) Replacement
(F) Add on
(G) New
, fH) Replacement'y
■(I) Addon-----------Soil
Treatment
Area
Tank LiftDesign Flow (Gallons/Day)
(J) 0_
■ (K) T— 2,499 ')
■ 2;500--^'4;g99
(M) 5,000— 10,000
Effluent Distribution
( Gravity
( ) Pressure Ft.- a^C 'LlySize
Setback To
Nearest WellType I Type II Ft.Ml Ft.(y
(20) Trench, Rock (27) Rapidly Permeable
, Ft.
' i ,
Setback To OHWL Ft.(21) Trench, Gravelless (28) Flood Plain
■ ./ -! ((22) Trench, Chamber (29) Privies —Ft.~._ft.----- Ft.Setback To Bluff(23) Bed (30) Holding Tank
(Contract Required)
' Sc
(24) Mound Ft.// ) Ft.Setback To Dwelling Ft.
(25) At Grade Type III 4..
Setback To Non-Dwelling(26) Greywater (31) Other/Problem Soils/<12” Soil //9Ft.Ft.hType IV(34) Tank Only Setback To Nearest
Lot Line 42!!:Ft.(32) Public Domain &
Proprietary Technologies
(35) Other
Setback To Road Right-Of-WayDepth of Well /'•) Ft.yL'Ft.Ft.Type V 4.9. /
Total # Bedrooms (33) Performance Elevation Above
Restrictive Layer Ft.Ft.Ft.-4Abatement Y / N Garbage Disposal Y / N
PERC TEST DATA
I' ~P(/) Highest Rate ^^ ^/ ■
fDesigner
Agreement: The undersigned hereby makes application for permit to instali, alter, repair or extend Sewage Treatment System herein specified, agreeing to do aii such work in strict accor
dance with Sanitation Code of Otter Taii County, Minnesota. Appiicant agrees that the Site Data Worksheet submitted herewith and which is approved by a Land & Resource Management
Official shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and approved for use. It shall be the responsibility
of the applicant tor the permit to notify Land & Resource Management that the installation is ready for inspection.
License #Date of Test
Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit Is granted upon express condition that the person
to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Sanitation Code of Otter Tail County, MinndSota. This permit may be revoked at any time
upon violation of the Sanitation Code.
NOTE: I.This permit is valid for a period of six (6) months. 2.This permit does not include the building sewer (sewer line).
;
/2£.2.
Signature of Puiperty Owner/Agent for Ownhr y /
Date; //>■-■2 Permit Fee $
---------^^
\
Date:Rec. No..
Land & Restfurce Management Official
■j
■IfComments:-22 .-3
i
■
357,243 • Victor LundMn Co., Printers * Fergus Falls, MinnesotaForm No. BK — 04-2014-06
SEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTS
STA (Soil Treatmnt Area)
OUTHOUSE
HOLDING
SEPTIC TANK
TRENCH REDUCTIONLIFT TANKCATEGORY
Rock trenches with inchesCapacityI ooO GLS.FT2GLS.
of sidewall for %FT FTIZo’FTSetback from Nearest Well
reduction / equivalent to fPSetback from Buried
Water Suction Pipe FT FT
Setback from Buried Pipe
Distributing Water Under Pressure
STA CALCULATION
(Soil Treatment Area)
_____Ft. X ________
FT FT FT
I L=>Cf FTSetback from OHWL (lake &/or river)FT FT Ft.
Setback from Bluff FT FT FT Ft*
Setback from Dwelling FT FT/ O >FT MOUND / AT-GRADE
Y-ROCK BEDSetback from Non-Dwelling FT FT FT/OO
Setback from Nearest Property Line FT FT FT Ft. X Ft.
Lv C /tirj FT/Setback from Right-of-Way FT FT/O Ft*
Elevation above Restrictive Layer FT FT FT
SAND IN MOUND FtINSTALLERS COMMENTS ps. ps SI
SEPTIC TANK(s)Holding Tank / Lift Alarm [^ES □ NO Oc^Ac/Mr Ktf
# Tanks Installed _Weep HolesOld System Pumped & Destroyed ^0^S □ NO
Manuf.Lateral Pipe SizeNumber of Laterals #IN 2Model #Perforation Spacing Perforation Diameter SizeFt.IN
"o^or^^er ^ute — Feet of Total Head FILTERS □ YES □ NOPUMPS
IInspector's Comments:
Sketch:m
L
K\
1
As of It / //U . the above described sewage system installation
was found to be compliant with the provisions of the Sanitation
Code of Otter Tail County.TimeDate Irmi/LSR Official
V
Land & Resource Management Official
357.243 • Victor Lundoon Co., Printers • Fergus Falls, MinnesotaForm No. BK — 04-2014-06
Wf
APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM
LAND & RESOURCE MANAGEMENTGOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537
218-998-8095
www.co.otter-tail.mn.us
OTTER Tflll WHITE - Office YELLOW -L&R Inspector PINK - Owner/ Contractor (after issue)COUATT-ailMllfOTII
APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED Permit No.
LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER
CLASS
SECTION TWP NO.RANGE TWP NAME
fIPARCEL NUMBER (S) OF PROPERTY BEING SERVICED E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROAD
LEGAL DESCRIPTION
Last Name First Initial Mailing Address Daytime Phone No.
Property
Owner
Contractor
Lie.#■?
THIS SPACE FOR OFFICE USE ONLY
AM.
> This System will be ready for inspection on , the year of P.M.at
r:'
A.M. P.M.T Date Received Time Received L&R Official
TYPE OF NSTALLATION (circle one)SEWAGE TREATMENT SYSTEM DESIGN DATA
AS SHOWN ON DRAWINGResidential
(A) New
(B) Replacement
(C) Add on
Collector Other Est.
(D) New
(E) Replacement
(F) Add on
(G) New
(H) Replacement
(I) Add on a Soil
Treatment
Area
Tank LiftDesign Flow (Gallons/Day)
(J) 0
(K) 1 — 2,499
(L) 2,500 — 4,999
(M) 5,000— 10,000
Effluent Distribution
( ) Gravity
( ) Pressure GIs GIs Ft.Size
Setback To
Nearest WellType I Type II Ft.Ft.Ft.
(20) Trench, Rock (27) Rapidly Permeable
Ft.Setback To OHWL Ft.Ft.(21) Trench, Gravelless (28) Flood Plain
(22) Trench, Chamber (29) Privies Ft.Ft. Ft.Setback To Bluff(23) Bed (30) Fielding Tank
(Contract Required)(24) Mound Ft.Ft.Setback To Dwelling Ft.
(25) At Grade Type III
Setback To Non-Dwelling(26) Greywater (31) Other/Problem Soils/<12" Soil Ft.Ft.Ft.
Type IV(34) Tank Only Setback To Nearest
Lot Line Ft. Ft.Ft.(32) Public Domain &
Proprietary Technologies(35) Other
Setback To Road Right-Of-WayDepth of Well Ft. Ft.Ft.Type V
Total # Bedrooms (33) Performance Elevation Above
Restrictive Layer Ft.Ft. Ft.Abatement Y / N Garbage Disposal Y / N
PERC TEST DATA (
iDesigner
Agreement: The undersigned hereby makes application for permit to install, alter, repair or extend Sewage Treatment System herein specified, agreeing to do all such work in strict accor
dance with Sanitation Code of Otter Tail County, Minnesota. Applicant agrees that the Site Data Worksheet submitted herewith and which is approved by a Land & Resource Management
Official shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and approved for use. It shall be the responsibility
of the applicant for the permit to notify Land & Resource Management that the installation is ready for inspection.
Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person
to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Sanitation Code of Otter Tail County, Minnesota. This permit may be revoked at any time
upon violation of the Sanitation Code.
NOTE: I.This permit is valid for a period of six (6) months. 2.This permit does not include the building sewer (sewer line).
License #Date of Test Highest Rate ■1
I
Date:Permit Fee $
Signature of Property Owner/Agent tor Owner
Date:Rec. No..
Land & Resource Management Official
Comments:
Form No. BK — 04-2014-06 357,243 • Victor Lundeen Co., Prlrtiers ■ Fergus Palls, Minnesota
SEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTS
STA (Soil Treatment Aiva)
OUTHOUSE
HOLDING
SEPTIC TANK
TRENCH REDUCTIONLIFT TANKCATEGORY
H'ZOOO GLS.inchesRock trenches withCapacityFT2GLS.
of sidewall for %12,ft FT FTSetback from Nearest Well
reduction / equivalent to fPSetback from Buried
Water Suction Pipe FT FT FT
Setback from Buried Pipe
Distributing Water Under Pressure
4-STA CALCULATION
(Soil Treatment Area)
____Ft. X _______
10 FT FT FT
Zoo'^ FTSetback from OHWL (lake &/or river)FT FT Ft.
Setback from Bluff FT FT FT Ft*
IS9^ ftSetback from Dwelling FT FT MOUND / AT-GRADE
+ROCK BEDSetback from Non-Dwelling FT FT FT
^0'*' ftSetback from Nearest Property Line FT FT Ft.Ft. X
'izt FTSetback from Right-of-Way FT FT Ft*
Elevation above Restrictive Layer FT FT FT
SAND IN MOUNDINSTALLERS COMMENTS
SEPTIC TAN K(s)Holding Tank / Lift Alarm □ YES □ NO
# Tanks Installed__Weep Holes [Old System Pumped & Destroyed □ YES □ NO
Manuf.Number of Laterals #Lateral Pipe Size IN
Model #Perforation Spacing Ft.Perforation Diameter Size IN
Gallons Per Minute Feet of Total Head [FILTERS □ YES □ NOPUMPS
It stieptor's Comments:
oi 'ketcl
a
QcrV.-
fLr o 0
o\+-
t
s of I J** 1St' A , the abo 'e described sewage system installation
as found to be complia it with the provisions of the Sanitation
Code of Otter Tail County.
I
[Ijilial/L iROHiditDateTime
Land & Resource Management Offidai
pissForm No. BK — 04-2014-06 357,243 • Victor Lundeen Co.. Printers • Fergus Falls. Minnesota
System design must be to scale and must include the proposed location of the sewage system, all existing/
proposed buildings, property lines, the ordinary high water level of the water body, bluff and all water wells
within 150' of the sewage system. If there are any questions, see the University of Minnesota Site Evaluation
worksheets.
grid(s) equals feet, or inch(es) equals feetScale:
901MPCA LICENSE #;
Wayne JohnsonDESIGNED BY:LICENSE CATEGORYAdvanced Designer
FIRM NAME:loi^lDj
DATE:
38992 183rd Ave------—
Pelican Rapids. MN 56572
ADDRESS:SIGNATURE:
7^ Star Lake /
/
r ■ ■
jTgiies^I
ZaundraBina& Tonya Muin
39578 Co Hwy 41
Dent, MN 56528 \Pared# 56000040016000 V
I
' 1
I
\1
|39u^X
I
1
^Sgiie^I
t
I
1
I /
/I
house &restuiant /1
\
\//\/I \I lioiiifaiidresliijiit' ^\\I Scale 1" = 100 feet\;I
///\100.00'/" ~r- BusSogtantelolieatento'%\
%\
1 /
' Setback Line
— - LotLine
— Swer Lines Drain Reid
— Shiclures
I existing Oed __Ji.be.used__/\o
'PrL ~“i15x85I /I\
/1
\ 1 \ Ir 1I I
Super Septic & Excavation
38992 183rd Ave
Pelican Rapids, MN 86572
License #901
218-863-3373
/1
\ I /t
/
/
/
/
/
1 /
/1
BK — 04-2014 — 029 . R’-ii'-tcis • f-ergijb Polls MN •6C0-346-487C.'.4
• Vl' .It I I III I Jrlr-r I ■/I
SITE DATA WORKSHEET
LAND & RESOURCE MANAGEMENT
GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537
218-998-8095
www.co.otter-tail.mn.usOTTCR TflllcoviTT-aiaiiiioTi
Sewage Treatment System Permit #OWNER:
758-2841Galaxy Resort 701-371-9746Zaundra Bina
TELEPHONE NUMBERLAST NAME FIRST MIDDLE
ADDRESS:
56528MNDent39578 Co Hwy 41
CITY ZIP CODE___STR./RT STATE
414 Star Lake135Star Lake 56-385 GD56-385
RANGE TWP NAMELAKE/RIVER NO.LAKE NAME SEC. TWP.
COLOR &
MUNSELL NQ._
LEGAL DESCRIPTION:SOIL BORING LOG
6.00 AC
TRI TR ON E SIDE CAR#41 & SEC LINE BET SEC 3 & 4 &
LAKESHORE LIFE ESTATE RONALD BINA
DEPTH
(INCHES)STRUCTURE
Cblocky^
PLATY
PRISMATIC
NONE____
BLOCKY
PLATY
PRISMATIC
NONE
TEXTURE
56-000-04-0016-000 .o-YPARCEL NUMBER
^ /oy^
39578 Co Hwy 41
E-9V Address or Directions From Nearest Public Road
NUMBER OF BEDROOMS BLOCKY
PLATY
PRISMATIC
NONE
GARBAGE DISPOSA
WELL: CASING DEPTH ft. SEWER LINE SEPARATION:.ft.BLOCKY
PLATY
PRISMATIC
NONE
BLOCKY
PLATY
PRISMATIC
N0NE„
FLOODPLAIN: YES^flsi^ BLUFF: YE
VEGETATION: AQUATIC TERRESTRIAL
SLOPE AT INSTALLATION SITE:%
*
TYPE OF OBSERVATION: Probe Pi
PARENT MATERIAL: Till Outwash Loess Bedrock Alluvium
ORIGINAL SOIL:No Date of Soil Boring
(3PCOMPACTED SOIL: Yes tr
~DEPTH OF BORING (To T or restrictive layer):.ft.Date of Perc Test
PERC TEST #2PERC TEST # 1 - TWO TESTS ARE REQUIRED -
PERC RATEPERC RATE WATER DEPTFj______WATLH DROPTIMEINTERVAL (MINUTESI WATER DEPTH WA1LH DROP TIME INTERVAL (MINUTES!START START
TIME DROP PERCTIMEDROPPERC
WATER DEPTH WATER DROP PERC RATEITFR>1INUTI WATER DEP-^ATER DROP PERC RATE TIME INT£8VAi. 1MINUT£SI.REFILL REFILL
PERC TIME DROP PERCDROPIE
PERC RATEWATER DEPTH PERC RATE TIME WATER DEPTH WATER DROPTIMEINTERVAL (MINUTES)/ATEFI DROP__INTERVAL (MINUTES)REFILL REFILL
PERCTIMEDROPTIMEDROPPERC
WATER DROP PERC RATEINTERVAL (MINUTES! REFILL WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES) REFILL WATER DEPTHTIME
TIME DROP PERCTIMEDROPPERC
WATER DEPTH WATER DROP PERC RATETIMEINTERVAL IMINUTESI WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES! REFILLREFILL
DROP PERCDROPPERCTIMETIME
PERC RATEWATER DEPTH WATER DROP PFRC RATF TIME WATER DEPTH WATER DROPINTERVAL (MINUTES!INTERVAL(MINUTES!
REFILL
TIME
REFILL
-h------- =TIME DROP PERCTIMEDROPPERC
PERC RATEWATER DEPTH WATER DROPTIMEINTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES!REFILL REFILL
PERCDROPTIMEDROPTIMEPERC
PERC RATEWATER DROP PERC RATE TIME WATER DEPTH WATER DROPINTERVAL (MINUTES! REFILL WATER DEPTH INTERVAL tMINUTESl REFILL
TIME
DROP PERCTIMEDROPPERCTII^
SEPTIC TANK MANUFACTURER:
PROPOSED DESIGN:
HOLDING TANK PRESSURE DIST.ATGRADE.MOUND.GRAVITY DIST.TRENCH BED.
OUTHOUSE.OTHER. SPECIFY:.SEWER LINE,
— SYSTEM DESIGN ON BACK —
OSTP Design Summary Worksheet University
OF MinnesotaMinnesota Pollution
Control Agency
V 07.14.15Project ID:Property Owner/Client: Galaxy Resort
Date: 11/2/16Site Address: 39578 Co Hwy 41 Dent, MN 56528
1. DESIGN FLOW AND TANKS
Note: The estimated design flow is considered a peak flow rate
including a safety factor. For long term performance, the average
daily flow is recommended to be < 60% of this value.
Gallons, in
1888 Gallons Per Day (GPD)A. Design Flow:
B. Septic Tanks:
2Minimum Code Required Septic Tank Capacity:7552 Tanks or Compartments
Recommended Septic Tank Capacity:8000 Gallons, in 4 Tanks or Compartments
Effluent Screen:Alarm:n y
C. Holding Tanks Only:
Minimum Code Required Capacity:Gallons, in Tanks
Designer Recommended Capacity:TanksGallons, in
Type of High Level Alarm:
Gallons2000Pump Tank 2 Capacity (Code Minimum):GallonsD. Pump Tank 1 Capacity (Code Minimum):
Gallons1000GallonsPump Tank 2 Capacity (Designer Rec):Pump Tank 1 Capacity (Designer Rec):
GPM Total Head30.0 GPM Total Head 21.4 ft ftPump 2Pump 1
150.0 gal Supply Pipe Dia.Supply Pipe Dia. 2.00 in in Dose Volume:galDose Volume:
2. SYSTEM TYPE
® Gravity Distribution O Pressure Distribution-tevel O Pressure Distribution-Unievei
* Selection Required Benchmark Elevation:
O Trench ® Bed Q Mound O At-Grade
O ilrip O Holding Tank O Other ft
Benchmark Location:
System Type Type of Distribution Media:
I 1 Drainfield Rrxk [7] Registered Treatment Media:
□ TypeV0 Type I □ Type II □ Type III O Type IV
3. SITE EVALUATION:
I 6.0 I ft 2.072B. Measured Land Slope %:%Depth to Limiting Layer:inA.
sandSoil Texture:Elevation of Limiting Layer:D.C.depth of boring
GPD/ft^1.20east end of bedLoc. of Restricive Elevation:Soil Hyd. Loading Rate:F.E.
36 MPI3.0 ftG. Minimum Required Separation:in 1.2Perc Rate:H.
]in Comments: existing gravity bedI. Code Maximum Depth of System:36
4. DESIGN SUAAA«ARY
Trench Design Summary
ft^Trench WidthSidewall Depth ftDispersal Area in
Code Maximum Trench DepthNumber of TrenchesTotal Lineal Feet inft
Designer's Max Trench Depth inContour Loading Rate ft
Bed Design Summary
1573 36.0Code Maximum Bed DepthDepth of sidewall 12.0Absorption Area inin
36.0Designer's Max Bed DepthBed Length 104.9 ftBed Width 15 inft
OSTP Design Summary Worksheet University
OF MinnesotaMinnesota Pollution
Control Agency
Mound Design Summary
ft^Bed WidthAbsorption Bed Area Bed Length ft
Berm Width (0-1%)Absorption Width Clean Sand Liftft ft ft
Endslope Berm WidthUpslope Berm Width ft ftft Downslope Berm Width
Total System Length Total System Width ft Contour Loading Rate gal/ftft
At-Grade Design Summary
Absorption Bed Width Absorption Bed Length System Heightftft ft
gal/ft Upslope Berm Width Downslope Berm Widthft ftContour Loading Rate
System Length System WidthEndslope Berm Width ft ft ft
Level & Equal Pressure Distribution Summary
No. of Perforated Laterals Perforation Spacing Perforation Diameterft in
gal galLateral Diameter in Min. Delivered Volume AAaximum Delivered Volume
Non-Level and Unequal Pressure Distribution Summary
Elevation Pipe Volume
(gal/ft)
Pipe Length Perforation Size
(ft)Pipe Size (in)(ft)Spacing (ft)Spacing (in)(in)
Lateral 1 Minimum Delivered Volume
galLateral 2
Lateral 3
Lateral 4 Maximum Delivered Volume
galLateral 5
Lateral 6
5. Additional Info for Type IV/Pretreatment Design
A. Calculate the organic loading
1. Organic Loading to Pretreatment Unit = Design Flow X Estimated BOD in mg/L in the effluent X 8.35 t 1,000,000
mg/L X 8.35 + 1,000,000-gpd X lbs BOD/day
2. Type of Pretreatment Unit Being Installed:
3. Calculate Soil Treatment System Organic Loading: BOD concentration after pretreatment + Bottom Area = Ibs/day/ft^
f^-Ibs/day/ft^mg/L X 8.35 + 1,000,000 +
Comments/Special Design Considerations:
We are using the existing compliant gravity bed, installing a new 1000 gallon lift tank with dual alternating pumps, pumping to four
2000 gallon tanks then gravity flowing back to the existing bed.
I hereby certify that I have completed this work in accordance with all applicable ordinances, rules and laws.
11/02/16901Wayne Johnson, Super Septic
(License #)(Date)(Designer)
OSTP Basic Pump Selection Design
Worksheet University
OF MinnesotaMinnesota Pollution
Control Agency
1. PUMP CAPACITY Project ID:
® Gravity O PressurePumping to Gravity or Pressure Distribution:Selection required
30.0 GPM (10 ■ 45 gpm)1. If pumping to gravity enter the gallon per minute of the pump:
2. If pumping to a pressurized distribution system:GPM
3. Enter pump description:
Soil treatment system i & point of discharge I2. HEAD REQUIREMENTS
A. Elevation Difference
between pump and point of discharge:
14 ft
nlet pipe
B. Distribution Head Loss:0 ft
C. Additional Head Loss:ft (due to special equipment, etc.)
Table I.Friction Loss In Plastic Pipe per 100ft
Distribution Head Loss Pipe Diameter (inches)Flow Rate
(GPM)Gravity Distribution = Oft 1.25 1.5 21
Pressure Distribution based on AAinimum Averaeje Head
Value on Pressure Distribution Worksheet:
10 9.1 3.1 1.3 0.3
12 12.8 4.3 1.8 0.4
Minimum Average Head Distribution Head Loss 17.0 5.7 2.4 0.614
1ft 5ft 0.721.8 7.3 3.0162ft6ft9.1 3.8 0.9185ft10ft2011.1 4.6 1.1
25 16.8 6.9 1.7
23.5 9.7 2.430D. 1. Supply Pipe Diameter:2.0 in
35 12.9 3.2
2. Supply Pipe Length:250 ft 16.540 4.1
45 20.5 5.0
E. Friction Loss in Plastic Pipe per 100ft from Table I:50 6.1
55 7.32.37 ft per 100ft of pipeFriction Loss =60 8.6
F. Determine Equivalent Pipe Length from pump discharge to soil dispersal area discharge
point. Estimate by adding 25% to supply pipe length for fitting loss. Supply Pipe Length
(D.2) X 1.25 = Equivalent Pipe Length
10.065
70 11.4
75 13.0
85 16.4250312.5ftX 1.25 ft 95 20.1
G. Calculate Supply Friction Loss by multiplying Friction Loss Per 100ft (Line E) by the Equivalent Pipe Length (Line F) and divide by 100.
Supply Friction Loss =
2.37 312.5 7.4ft per 100ft ft 100 ftX
H. Total Head requirement is the sum of the Elevation Difference (Line A), the Distribution Head Loss (Line B), Additional Head Loss (Line C), and
the Supply Friction Loss (Line G )
14.0 0 7.4 21.4ftftft +ft =ft++
3. PUMP SELECTION
30.0 21.4A pump must be selected to deliver at least GPM (Line 1 or Line 2) with at least feet of total head.
Comments:
Using two alternating pumps to reduce lift tank size
Galaxy Resort flow calculations
gallons per day per guest50
cabin #flowguests
6 3001
2 6 300
1503 3
3 1504
3 1505
6 4 200
20047
20084
9 2004
Guest Total 185037
I & I for 4 inch pipe 38
total flow 1888
OSTP Pump Tank
Design Worksheet University
OF MinnesotaMinnesota Pollution
Control Agency
Project ID:DETERAAINE TANK CAPACITY AND DIMENSIONS V 07.14.15
18881.A. Design Flow (Design Sum. 1A)GPD:
10002000B. Min. required pump tank capacity:Gal C.Recommended pump tank capacity:Gal
using two alternating pumps to reduce tank sizeD. Pump tank description:
MEASURED TANK CAPACITY (existing tanks):
2. A. ' Rectangle area = Length (L) X Width (W)Widthft^ft X ft
B. Circle area = 3.14r^ (3.14 X radius X radius)
3.14 X 2 ft^ft
Length
C. Calculate Gallons Per Inch. Multiply the area from 1.A or 1.B, by 7.5 to determine the gallons per foot
the tank holds and divide by 12 to calculate the gallons per inch.
~| ft^ X 7.5 gal/ft^ 4 12in/ft Gallons per inch
D. Calculate Total Tank Volume
Depth from bottom of inlet pipe to tank bottom:
Total Tank Volume = Depth from bottom of inlet pipe (Line 4.A) X Callons/Inch (Line 2)
Gallons Per Inch =
in
31.0X Gallonsin
AHANUFACTURER'S SPECIFIED TANK CAPACITY (when available):
Note: Design calculations are based on
this specific tank. Substituting a
different tank model will change the
pump float or timer settings. Contact
designer if changes are necessary.
brown wilber3. A. Tank Manufacturer:
1000 low pro tankB. Tank Model:
1000C. Capacity from manufacturer:Gallons
31.0D. Gallons per inch from manufacturer:Gallons per inch
33.0E. Liquid depth of tank from manufacturer:inches
DETERMINE DOSING VOLUME
4. Calculate Volume to Cover Pump (The inlet of the pump must be at least 4-inches from the bottom of the pump
tank 6 2 inches of water covering the pump is recommended)
(Pump and block height + 2 inches) X Gallons Per Inch (2C or 3E)
in + 2 inches) X10 31.0 372Gallons Per Inch Gallons(
5. Minimum Delivered Volume = 4 X Volume of Distribution Piping:
- Line 17 of the Pressure Distribution or Line 11 of Non-level
6. Calculate Maximum Pumpout Volume (25% of Design Flow)
Design Flow:
Gallons (minimum dose)
1888 0.25 472GPD X Gallons (maximum dose)
1507. Select a pumpout volume that meets both Minimum and Maximum:
8. Calculate Doses Per Day = Design Flow -f Delivered Volume
gpd V
Gallons
- Volume of Liquid in
gal =1888 150 12 :Doses
9. Calculate Drainback:
A. Diameter of Supply Pipe =Liquid
Per Foot:
(Gallons)
u Pipfe '
Diameter
2 inches
250Length of Supply Pipe =feetB.,C(inches)
0.170 Gallons/ftC.Volume of Liquid Per Lineal Foot of Pipe =1 0.045
Drainback = Length of Supply Pipe X Volume of Liquid Per Lineal Foot of Pipe
42.5 Gallons
D.1.25 0.078250ft X 0.170 gal/ft =1.5 0.110
10. Total Dosing Volume = Delivered Volume plus Drainback
gal +
0.1702
150 42.5 gal =193 Gallons 0.3803
11. Minimum Alarm Volume = Depth of alarm (2 or 3 inches) X gallons per inch of tank
in X 0.6614231.0 gal/in =62.0 Gallons
OSTP Pump Tank
Design Worksheet University
OF MinnesotaMinnesota Pollution
Control Agency
TIMER or DEMAND FLOAT SETTINGS
Select Timer or Demand Dosing;
A. Timer Settinsp
12. Required Flow Rote;
A. From Design (Line 12 of Pressure, Line 10 of Non-Level or Line 6 of Pump*):
B. Or calculated: GPM = Change in Depth (in) x Gallons Per Inch / Time Interval in Minutes
in X
O Timer ® Demand Dose
GPM
'Note: This value must
be adjusted after
GPM installation based on
pump calibration.
gal/in V min =
GPM13. Flow Rate from Line 12.A or 12.B above.
14. Calculate TIMER ON setting:
Total Dosing Volume/GPM
gal V Minutes ONgpm =
15. Calculate TIMER OFF setting:
Minutes Per Day (1440)/Doses Per Day • Minutes On
1440 min 'jdoses/day -
16. Pump Off Float - Measuring from bottom of tank:
Distance to set Pump Off Float=Gallons to Cover Pump / Gallons Per Inch:
gal T
17. Alarm Boat - Measuring from bottom of tank:
Distance to set Alarm Float = Tank Depth(4A) X 90% of Tank Depth
in X0.90 =
Minutes OFFminT—
gal/in =Inches
in
f- .B. DEMAND DOSE FLOAT SETTINGS
18. Calculate Float Separation Distance using Dosing Volume.
Total Dosing Volume /Gallons Per Inch
193 gal v
19. Measuring from bottom of tank:
A. Distance to set Pump Off Float = Pump + block height + 2 inches
in +
B. Distance to set Pump On Float=Distance to Set Pump-Off Float + Float Separation Distance
in +
C. Distance to set Alarm Float = Distance to set Pump-On Float + Alarm Depth (2-3 inches)
in -I-
gal/in =6.231.0 Inches
12102in =Inches
18126.2 in =Inches
20182.0 in =Inches
FLOAT SETTINGS
TIAtED DOSINGDEAAAND DOSING
]1
Inches for Dose:6.2 in
inAlarm DepthAlarm Depth 20.2 in
Pump On 18.2 in
Pump Off 12.0 jn
62 Gal
Pump Off193 Gal in j
A a372 Gal
J
Goulds Water Technology
Wastewater
PERFORMANCE CHARTS
These charts show actual system performance with friction loss factored in for various discharge pipe lengths.
Calculations and performance based on a system with 2" PVC, schedule 40 plastic pipe (Cl 50), (4) 90° elbows, (1)
check valve and (1) shut-off valve. Wastewater requires a minimum scouring velocity of 21 gpm for 2" pipe. Shad
ed areas do not provide min. scouring velocity - use only for gray water with no solids.
PSA
GPMPipeVertical Head (Feet)Length 18 202468101214 16
33 2425 96 88 82 54 43 1474 65
30 13837063 38 2250775647
1368624942352821757456
19 1262 39 33 2610067575145
39 34 29 23 17 11150 57 53 48 44
31 26 22 1020051474339 35 16
21 102504643 39 36 33 28 24 16
919 1530043 39 37 34 30 27 23
PS5
224681012141820
35 252510599918475 65 55 45
40 32 245090 85 78 71 63 56 48
75 80 74 69 62 57 50 37 30 2244
211007267 62 57 52 46 40 34 28
181505854 49 45 40 35 31 2561
200 54 51 48 40 36 32 28 23 1744
50 30 26 21 1625047 40 37 3444
31 24 20 1530043 40 37 3446
METERS FEET
30 MODELS: PS4. and PS5.
SIZE: 2" SOLIDS
RPM: 3400 HP: .40, .50
7.5 5 GPM
Q<HIX
aZ 5<z>-Q
<I-oI-2.5
0 100 120 GPM i-to
25 m3/h 300510 15 20
CAPACITY
PAGES
OSTP Final Permitting Flow
Worksheet University
OF MinnesotaMinnesota Pollution
Control Agency
V 07.14.15
From either existing and new
development worksheet08Pd1. Flow from Dwellings Flow from Dwellings
From either Measured or Estimated-
OE worksheet
2. Flow from Other
Establishments
Permitting Flow from Other
Establishments 1850 SPd
Design flow must include 200
gallons of infiltration and inflow
per inch of collection pipe
diameter per mile per day with a
minimum pipe diameter of two
inches. Flow values can be further
increased if the system employs
treatment devices that will
infiltrate precipitation.
a) Total Length of Collection
Pipe:250 feet
3. Flow from Collection
System
b) Diameter of Pipe
(Minimum of 2 in):4.00 inches
c) Flow from I8t I in
Collection System:38 gpd
1888 Sum of 1, 2 and 3c.4. Final Permitting Flow gpd
Subsurface Sewage Treatment System Management Plan
Sewage Treatment System Permit Number:
Property Owner Galaxy Resort Zaundra Bina Parcel Number: 56-000-04-0016-000
Lake Name / Numbe Star Lake 56-385 GD Township Name Star LakeSection 4
E-911 Address: 39578 Co Hwv 41
This management plan will identify the operation and maintenance activities necessary to ensure long-term
performance of your septic system. Some of these activities must be performed by you, the homeowner. Other
tasks must be performed by a licensed septic service provider.
Homeowner Management Tasks:
_Leaks - Check (look, listen) for leaks in toilets and dripping faucets. Repair leaks promptly.
_Surfacing sewage - Regularly check for wet or spongy soil around your soil treatment area.
_Alarms - Alarm signals when there is a problem. Contact a service provider any time an alarm signals.
_Vegitative cover - Establish and maintain a vegitative cover over your treatment system.
Professional Management Tasks: every 24 months or less if needed.
_Check to make sure tank is not leaking
_Check and clean the in-tank effluent filter
_Check the sludge/scum layer levels in all septic tanks
_Recommend if tank should be pumped
_Check inlet and outlet baffles
_Check the drainfield effluent levels in the rock layer
_Check the pump and alarm system functions
_Check wiring for corrosion and function
_Check manhole covers (accessibility, security, damage) and inspection pipe caps (broken or missing)
_Provide homeowner with list of results and any action to be taken
_Flush and clean laterals if cleanouts exist (pressure distribution only)
_Record event counter reading
“I understand it is my responsibility to properly operate and maintain the sewage treatment system on this
property, utilizing the Management Plan. If requirements in the Management Plan are not met, I will promptly
notify the permitting authority and take necessary corrective actions. If I have a new system, I agree to
adequately protect the reserve area for future use as a soil treatment system.”
11/01/2016Property Owner Signature:Date:
H- 7-H:>'frc Date:Received by:
For more informantion go to www.septicandexcavation.com or search for "MN septic system owners guide"
Plan prepared by: Wayne Johnson, Super Septic and Excavation, Phone: 218-863-3373 MPCA License # 901
CERTIFICATE OF COMPLIANCE
SEWAGE SYSTEM
E %
mnr[’"119_^15th Januaryday of_This certificate has been issued thisa \/A mto certify compliance with regidations of Shoreland Management Ordinance, Otter Tail County, Minnesota.
s.
The premises covered by this certificate are legally described as:
star LakeTwp. 135 Range 41Sec__4 Twp. Name.Lake No. 56-385ft fmI
L'.'Wl
I Galaxy Resort and Lounge
m-.
m.Owner: Name.Dan flumphrey
Address.ficnt, M-tnnpgnta
m/A
ij 56528Zip No.
Permit No. SP_4073
Signed by:.
M^olm K. Lee, Shoreland Administrator
Otter Tail County, Minnesota
MKL-0871-009
/\
159035 v<eret uiMi >U.*. «ia
SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL
COUNTY COURT HOUSE
Phone 218-739-2271 - Fergus Falls, Mn. 56537
APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM
W :te — Office
V low — Inspector Pii.. — OwQe/
Card — Owner
Permit No.___LEGAL
y- ^Date
DESCRIPTION
AND
^ ^ J£_ 111LOCATION
Lake Classif.TWP NameSec.TWP RangeLake No. Lake Name
IDENTIFICATION: Please Print AM Information.
Tel. No.MaiMing Address —No. Streej, City and Statedi^2/ m:Zip No,Last Name First Initial
/) -----------OWNER
//
ZL A
SEWAGE
SYSTEM
INSTALLER
Name
This System will be ready for inspection on.
This space for office use only
, 19.
,19 .M
Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signature
NUMBER OF BEDROOMS;ESTIMATED COST:
SEWAGE DISPOSAL SYSTEM DATA:
SEPTIC TANK SEEPAGE PIT DRAIN FIELD
30C? GIs./ysf^ Sq. Ft.Sq. Ft.Capacity
Ft.Ft. Ft./ rr~iiDistance from nearest well
Ft.Ft.Ft.Distance from lake or stream
/ O Ft.Ft.Ft.Distance from occupied building
Distance from property line Ft.Ft.Ft.
rFt.Ft.Ft.Distance from bottom to Water Table
AH distances are shortest distance between nearest points
RECORD OF TESTS:
Inspection was made on , 19 , Time M By
PERCOLATION TEST DATA:Date of First Test , 19 , Rate
Date of Second Test 19 , Rate
First/ Test........
1st Test Taken By .
-I- 2nd Test 2 Rate2nd Test Taken By
The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work inAgreement:
strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn
esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi
cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the
responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspectipo. (Call or use attached mailer notice.)
/q)
Signature ^
Dated
is hereby granted to the above named applicant to perform the work described in the above statement. This pa^ nit is granted
condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota.
This permit may be revoked at any time upon violation of any said ordinance.
NOTE: Permit void if work is not commenced within six (6) months.
PermissionPermit:
upon express
7-7’-S^
Issued Date:/Shoreland Management Office
Fee $Surcharge $
Comments:.
^ /?c - ^0
Form No. MKL-0771-003 vicroa LUMDECH « CO., peiartat. rfacua maa
158906
SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL
COUNTY COURT HOUSE
Phone 218-739-2271 - Fergus Falls, Mn. 56537
APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM
W te — Office
V low — Inspector Ph..
Card -- Owner
Owner
r.)
A._.Permit No.,LEGAL
Date
DESCRIPTION
AND
/LOCATION
Lake No.Lake Name Lake Classif.TWPSec.TWP NameRange
IDENTIFICATION: Please Print All Information.
InitialLast Name First Mailling Address —No. Street, City and State Zip No.Tel. No.
OWNER
SEWAGE
SYSTEM
INSTALLER
Name,
This System will be ready for inspection on.
This space for office use only
!*
.19_____
Date Rec'd TOTime Rec'd Phone Call Rec'd By
NUMBER OF BEDROOMS;ESTIMATED COST:
SEWAGE DISPOSAL SYSTEM DATA:
SEPTIC TANK SEEPAGE PIT DRAIN FIELD
GIs.Sq. Ft.Capacity Sq. Ft.
Ft.Ft.Ft.Distance from nearest well
Ft.Ft.Distance from lake or stream Ft.
Distance from occupied building Ft.Ft.Ft.
Distance from property line Ft.Ft.Ft.
Ft.Distance from bottom to Water Table Ft.Ft.
AH distances are shortest distance between nearest points
RECORD OF TESTS:
Inspection was made on ,, 19 , Time ,JV1 By
PERCOLATION TEST DATA:Date of First Test 19 r Rate
Date of Second Test,19 ,, Rate
1st Test Taken By
First Test + 2nd Test 2 Rate2nd Test Taken By
The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work inAgreement:
strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn
esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi
cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the
responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. (Call or use attached mailer notice.)
Dated
Signature
Permit:
condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota.
This permit may be revoked at any time upon violation of any said ordinance.
NOTE: Permit void if work is not commenced within six (6) months.
Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express
-7
Issued Date:
Shoreland Management Office
Fee $Surcharge $
Comments:.
Form No. MKL-0771-003 @ VICTO* LUI 158906CO..
I. FEI
INSPECTION RESULTS
Inspector must make all measurements
SEWAGE DISPOSAL SYSTEM STATISTICS
SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORY
Actual Should be Actual Should be Actual Should be
Capacity •7c)OC)/^OOsFGIs.GIs.S F SF S F
Distance from Nearest Well L2o±_l/IQ F 75F 50FF F
Distance from Lake or Stream F F F F F
Distance from Occupied Building 10 2020FFFF F
Distance from Property Line 10 10 10FFF F F
Distance from Bottom to Water Table 4 4FFFF F
L2o^^cJr^ gr-trPuInspector's Comments:
Date of Inspection
Time of Inspection,M
/
Signature of InspectorINTERPRETATION
OF ABBREVIATIONS
GIs ■* Gallons
SF “ Square Feet
” Linear Feet
Job TitleF
AgencyMKL-0771-00 3-Backer
\
< •V
f
♦ .
minnesota department of health
717 s.e. delaware st. minneapolis 55440
(612) 296-5221
JUi ^
**«so
July ISt 1980
Ripley^ Xbc.Erhar^i, Miii»«aota 56534
Gentlemftat
R«t S«wag« DlspoMl for Galaxy Retort
TowBshipt Otter tail County
Wa are ancloaiiig a copy of our taport eoaarli^
ipacificatioiui on aboaa*4eaignata<i project. Also mtclmmd la a copy of tha
report and transmittal letter to be forwarded to the project owner.
The plana and apecificatlona appaar to be la
standards of this Department. When t!w pro|ect te completed, please cemmunieete
with D. Aetnq> <w G. Bo^e, SMiterlaas in
Fergus Falls, in order that they may make final tespeetloa.
A aet el the identified plans end i^dficetioM is being returned to
have any questions in regard to the information contained in this rmpmtf pleeee
contact Dick Clark at (61Z) 296*5327.
it and Star tiako
OKamlnatien of plane
e'li/A.with the ■ ■
t 4West Central District Office In5
-■ i--'
U rm
r'
•> ‘ f. f
&'■Yours v«y truly,
-V',
\,^r->'.r-v G«ry L. I^glund, P.E., CU^
Section of Wetor Supply r'»-
ccj Owner
Shorelend Maaegomont
Ccmnty of Ottortall .V
i■ ■■1 -•i • •
■4
>san equal opportunity employer
‘ ■■ -i"■/■■f
/MINNESOTA DEPARTMENT OF HEALTH
Division of Environmental Health
REPORT ON PLANS
Sewage Disposal for Galaxy Resort RestaurantPlcins and Specifications on
and Lounge
IStar Lake Township, Ottertail CountyLocation
July 14, 1980Date Examined
Ripley's, Inc. Erhard, Minnesota 56534Prepared and submitted by
A-5117July 11, 1980Date Received Plan File No.
Not AvailableOwnership -
Scope - This report includes the design of the sanitary features of a sewage
disposal system.
Type - Sanitary. Designed to collect and treat domestic sewage and basement
drainage only. Storm-water connections should not be made.
Treatment Two 1500 gallon septic tanks
Final Disposal - 45' x 27' seepage bed
Recommendations - (Over)
Soil absorption type sewage disposal systems are considered a temporary
method of disposal suitable only until such time as arrangements can be made
to connect to a community sewerage system. If the system fails before a
connection can be made, the plumbing fixtures should not be used until
additional soil absorption capacity can be provided. Connection should be
made to the municipal sewerage system as soon as it becomes available.
Conclusion
These plans and specifications are in general accordance with the requirements of
the Minnesota Department of Health, and are recommended for approval with the
understanding as stated in the preceding paragraphs, and with the usual reservations
as stated on the appended sheet entitled, "Information Relative to Plan Examination."
7
Richard D. Clark, P.E.
Public Health Engineer
Section of Water Supply
and General Engineering
5
V
Requirements -%
A variance is granted to allow placing the drainfield up to 10 feet
from the cabin.
/
MINNESOTA DEPARTMENT OF HEALTH
Division of Environmental Health
Information Relative to Plan Examination
The examination of plans and specifications for water supply and sewerage systems
(Regulation MHD 136(a)), plumbing systems (Regulation MHD 139(a)(1)), and
swimming pools (Regulation MHD 141(c)), is made to provide information concerning
the sanitary features of projects presented for consideration in accordance with
the above regulations of the Commissioner of Health. The approval of such plans
is given upon the supposition that the survey and other data on which the design
is based are correct, and that necessary legal authority has been obtained to
construct the project. The responsibility for the design of structural features
and the efficiency of equipment must be taken by the engineer or architect who
designs the project.
Water supply plans are examined with regard to the location, construction and
operational features of the design and maintenance of all parts of the system which
may affectj the safety and sanitary quality of the water. Examination is based on
the standards of this Department.
Plans of spwage disposal systems considered by this Department are limited to those
systems that can utilize soil absorption. They are examined with regard to the
features of design which concern location, construction, operation and maintenance
of the system and which may affect the public health. The examination is based
upon information contained in the bulletins entitled "Tentative Standards for
Design of Small Sewage Works," July 1962, and the recommended "Ordinance and Code
Regulating Individual Sewage Disposal System," 1971.
Plans on plumbing systems are examined only insofar as the provisions of the
Minnesota Plumbing Code apply.
Swimming pool plans are examined with regard to the features of location and design
which may affect the safety and sanitary quality of the water for public bathing.
The examination is based upon Regulation MHD 141, Public Swimming Pools.
The Commissioner of Health reserves the right to withdraw his approval of plans if
construction of the project is not undertaken within a period of two years. The
fact that plans have been approved by the Commissioner of Health does not
necessarily mean that recommendations for alterations or additions may not be
offered at some later time when changed conditions or advanced knowledge make
improvements necessary.
PERCOLATION TEST DATA Price $ 1.00 per pad.
SHORELAND MANAGEMENT
OTTER TAIL COUNTY
Fergus Falls, Minnesota 56537
Gprn Pkre.u______
Last Name »
Ph. No.^/^'
Owner:Mailing Address:
tievuAcx-y k CL. ><!■<-
St. & No.
T-
TWP.
/y)/ Ni .*J, S(rSJL ^
First Middle City State Zip No.Legal
Description:rR ->V/-W A
LAKE OR RIVER NO.SEC.NAME RANGE TWP NAME
TEST HOLE NO. 2TEST HOLE NO. 1
r//riVDepth to Bottom of Hole inches; Diameter of HoleDepth To Bottom of Hole,Jnchesinches: Diameter of Hole inches
Data<?j[ *7, 19 ^0 7Depth, inches Soil Texture 19Depth, I nches Soil Texture Date LA
S/K. ci.'r fc A,'r ko-C-Percolation
Test By___
Percolation
Test By____0.ilCUj
J^(Xyr^-X^
C-C&AAJ;-
jyxjp-^- 3L->‘'Firm
Name.,fFirmName.D
ouicc
i 'TTUl^ •LUAddress.QC Address
<
COOtter Tail County License No..rfrap Otter Tail County License No^Omf ________
Beptfrin Water
Level, inches
I-CO
UJMeasurement,
Inches____In Water
Level, Inches
I-Measurement,
InchesTimeRemarksTime Remarks
II /6 ' '/S
ill /l!Lit’It
ci ^ -f-Q
f-i -iti / j?
i?^F‘U io /j"11^'91o"it • 'V 0 11
3//"» if it ISIt ■ St /
iM_/a I S'/S'A A/// ic /Jl"ft Pi ll /lA '/I > 00 H : OS
^<i.P >ll -Ao <9-''3^/1/Lhl/Q n '•^iiff -h>n ■ iO
HrXo K^h<fl io '3i
f- ill it
Re.^At/1 j~6 Si7 "H io "// • IS
V"K^Atfl Ao />ft // • S5 Lny/W6 r'gs 7n
ff // if- siOn ■ ss Ml
T7\U u
MKL-0871-028
See Booklet, "How to Run a Percolation Test" by Agriculture Ext Service, Un. of Minn.
/ ^ -
X/
a
\
t
PERCOLATION TEST DATA
SHORELAND MANAGEMENT
OTTER TAIL COUNTY
Fergus Falls, Minnesota 56537
Mailing Address:7^~F~-224 IPh. No.Owner:
R f)'l h c K HC Pi k' k:“D t-. M I PlK 21Last Name Fir,?t Middle St. & No.City State Zip No.Legal '-<<21 r
Description:.!^ ^ J /5-6 LRKhA-
LAKE OR RIVER NO.NAME SEC.TWP.RANGE TWP NAME
TEST HOLE NO. 2TEST HOLE NO. 1
<-4Depth to Bottom of Hole inches; Diameter of HoleDepth To Bottom of Hole.inchesinches; Diameter of Hole inches
//21.ZlDepth, Inches Soil Texture Depth, Inches Soil TextureDate.19 Date 19
7_tL X ^Percolation
Test By____
Percolation
Test Bv^o /LUFirm
Name.CC Firm
Name.D
olU
DC
V...UJ ■y^Address.(T Address
<
Otter Tail County License No..Otter Tali County License No^H
coLUMeasurement,
Inches Drop In Water
Level, iTKhes
Drop In Water
Level. Inches
Measurement,
InchesTimeRemarksTime Remarks
o yro-5 Z45I-
r/=^tc
7.f / /y
9'/?
r' /6 10-7-C1
f'-x-o /
f rJi
//
f ::*4
TEH UP (r
.-c lit£7
7t-
MKL-0871-028183818LuaeccH 4 CO rRianaa. rtjvut r^£t.See Booklet/'How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn.
ob!>2^
§wWm^
SHORELAND MAfSIAGEIViENT
Phone 218-739-2271
3ffl
'te-1
OPERATING PERMIT
for
.Sx-7aTin * 9 Hfllavy Rpqnrf OTTER TAIL COUNTY
Fergus Fails, Minn.Im
*)illH?t»jl
This Permit Issued To;
mla
my-^i
Owner.AddressRaymnnH H. Swann R.R. I, Dent, ftN 56528
AddressOperator■9amp
Lake Name.Lake No.Class nn Sen 3 Twp 1,35 Rg__^Star
fti^ifd
ms4H ¥§
i'
Twp. Name .star T.akpr
For;10 Cabins with water and sewage system
1 Cabin without water and sevrage system
Boat rental service and live bait sales
Restaurant
,r‘f'
' *7
SM ■ y
• , .1 ■>
’'t
mk i - >•<Date Issued May 3, j.978MM :>
JM ><,
\..AMalcolm K. Lee, Administrator
I
1 (Not transferable as to person or place)
■i,i.I.>>i.CJ^ i -1^it-itorH:r, A
— POST CONSPICUOUSLY-T'Sfe^'^ -^ • 'MKL-0473-036
y^'
166435-A@
SHORE!,AND MANAGEMENT
OTTER TAIL COUNTY
t
Phone 218-739-2271 Fergus Falls, Minn. 56537
OPERATING PERMIT APPLICATION
AddressSlO M K) s G OLpiy V Tele.NO.
Name of Business
H.SiorkIM 11 f IName of Owner
l I '' aI fMarne of Operator ___________
Lake No. o 6* 5 Lake Name Twp. 1 3.S Rg. t// Twp. Name STP)RClass G~D Sec. 3.STR R
Location
Minn. Dept. Of Health License No. j ?> C- 3 G Operation:Seasonal It) f'} P)'l I O I TYear-around
(give months)
/ c-No. of Sites:Cabins with water and sewage system
Cabins without water and sewage system
Recreational travel campsites with water and sewage system
Recreational travel campsites without water and sewage system
Mobile home sites with water and sewage system
Mobile home sites without water and sewage system
Yes
ri)L
O A- fc.
/y C' /V t
K C r- L~
A-' C A-' Ic
No
Do you have:Boat rental service ?
live bait sales? __
Retail store? (groceries etc.)
Ice fishing access?
No. of units
A
Do you provide sewage disposal service for inboard marine toilets?
^ L' iZ R (V “What other services do you provide?
& r rLake frontage feet
Number of acres in resort area
/
c-iLd'’
Signature of OwnerMKL-O473-O38
SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL
COUNTY COURT HOUSE
Phone 218-739-2271 - Fergus Falls, Mn. 56537
APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYUTeM
W te - Office
V low — Inspector Pli.. — Owner Cerd — Ow'ner
Permit No.,Xp SC>r ^
C.L
LEGAL
9Date
DESCRIPTION
/
AND
r^n>/3^TWP
LOCATIDN
Lake No.Lake Name Lake Classif.Sec.Range TWP Name
IDENTIFICATION: Please Print All Information.
Last Name First Initial Mailling Address —No. Street, City and State Zip No.Tei. No.
nooAi {.i /~)o yX>r^OWNER
SEWAGE
SYSTEM
INSTALLER
Name.
This System will be ready for inspection on., 19.
This space for office use oniy
.19 .M
Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signa^ture
NUMBER OF BEDROOMS: f 5ESTIMATED MST:
SEWAGE DISPOSAL SYSTEM DATA:
SEPTIC TANK SEEPAGE PIT DRAIN FIELD
3C:Oi(;^ GIs.o Sq- Ft.Capacity . Ft.
Ft.Ft.Ft.Distance from nearest well 6~~0 To
Ft.Distance from lake or stream Ft.Ft.
Distance from occupied building f O Ft.Ft.Ft.
Distance from property line >0 Ft.Ft.Ft./O
itDistance from bottom to Water Table Ft.Ft.Ft.
AH distances are shortest distance between nearest /joints 7
RECORD OF TESTS:
Inspection was made on ., 19 , Time .........JVI By.
19,..>d3.
, 19....?.^...,
PERCOLATION TEST DATA:Date of First Test Rate
Date of Second Testp y~Rate
1st Test Taken
//(First Test + 2nd Test 2'Rate2nd Test Taken By
The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do ali such work inAgreement:
strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individuai Sewage Disposai Code Minimum Standards set forth by Minn
esota Department of Heaith. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi-
ciai shail become a part of the permit. Appiicant further agrees that no part of the system shaii be covered untii it has been inspected and accepted. It shall be the
responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. (Call or use attached mailer notice.)e joD isj;£aay tor inspection. lUall oi
L.i' Signature ^
yDated
Permit:Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express
condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota.
This permit may be revoked at any time upon violation of any said ordinance.
NOTE: Permit void if work is not commenced within six (6) months.
9Issued Date:
Shoreland Management Office
Fee $____ Surcharge
^ 9/0
S ^ ,T /
Comments:.C ^6^ C
/t\ ^ cje_____i j)njs /I I A ^
Form No. MKL-0771-003 vietea lumdee* 4 e» . enaua*. rcaeus rsa.i.4 158906
SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL
COUNTY COURT HOUSE
Phone 218-739-2271 - Fergus Falls, Mn. 56537
APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM
W ;te — Office
V low
Pii.. - Card — Own^r
— Inspector * Owner'
Permit No.,LEGAL
Date
DESCRIPTION
AND
LOCATION
Lake No.Lake Name Lake Classif.Sec.TWP Range TWP Name
IDENTIFICATION: Please Print All Information.
Last Name Initial Mailling Address —No. Street, City and StateFirst Zip No,Tel. No.
JLtr\Or^OWNER
SEWAGE
SYSTEM
INSTALLER
Name.
This System will be ready for inspection on.
This space for office use only
.19 M
Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signature
NUMBER OF BEDROOMS:ESTIMATED COST:
SEWAGE DISPOSAL SYSTEM DATA:
SEPTIC TANK SEEPAGE PIT DRAIN FIELD
GIs.Sq. Ft.Capacity Sq. Ft.
Ft.Ft.Ft.Distance from nearest well
Ft.Distance from lake or stream Ft.Ft.
Ft.Distance from occupied building Ft.Ft.
Distance from property line Ft.Ft.Ft.
Ft.Distance from bottom to Water Table Ft.Ft.
AH distances are shortest distance between nearest points
RECORD OF TESTS:
Inspection was made on ,, 19,, Time ,JV1 By
PERCOLATION TEST DATA:Date of First Test 19 . Rate
Date of Second Test 19 , Rate
1st Test Taken By
First Test ■I- 2nd Test "i Rate2nd Test Taken By
The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work inAgreement:
strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn
esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi
cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the
responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. (Call or use attached mailer notice.)
Dated
Signature
Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express
condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota.
This permit may be revoked at any time upon violation of any said ordinance.
NOTE: Permit void if work is not commenced within six (6) months.
Issued Date:
Shoreland Management Office
\sFee $Surcharge $
Comments:.
Form No. MKL-0771-003 vicToi kwaptCH 4 CO . otiMTcaa. rcoous r«LLt.
0.0.158906
My INSPECTION RESULTS
Inspector must make all measurements
SEWAGE DISPOSAL SYSTEM STATISTICS
SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORY
Actual Should be Actual Should be Actual Should be
Capacity SFGIs.S F S F S FC
Distance from Nearest Well F F 50FF F
Distance from Lake or Stream F F F F F F
Distance from Occupied Building 10 20FFFFF F
Distance from Property Line 10 10 10FFFFF F
Distance from Bottom to Water Table 4 4FFFFF F
L2Inspector's Comments:
_________Ctzi__hr)
s~y ^/(i
^ O. J /V-*
/4
Date of Inspection 19^
Time of Inspection.M
Signature of I nspectorINTERPRETATION
OF ABBREVIATIONS
GIs = Gallons
SF “ Square Feet
* Linear Feet
Job TitleF
AgencyM KL-0771-003- Backer
UP S'!3 /
^)o CiLcf
5H0PEI.AND MANAGEMENT
OTTER TAIL COUNTY r
Phone 218-739-2271 Fergus Falls, Minn. 56537
/9 7COPERATING PERMIT APPLICATION
Address Tele.Nd.
7S'',V - /\/Ji‘'c.kL/\ H 5 /^^50fZf-
c^f '9 /j jA^
A io uc-_____________
A'J /M ^-t-Name of Business
V(Name of Owner / (
7((((Name of Operator /
Lake Name 5*7^/^ ^AKt^ Class Twp. Name S lAt pLake No.Sec.Twp.Rg.
M/ 5 Coc/Aj/^y /Pc// 4 4 /^/ ^ /] <y / o ~ ocuLocation
Dept. Of Health License No. AMinn.Operation: Year-around Seasonal
(give months)
No. of Sites:Cabins with water and sewage system __
Cabins without water and sewage systein
Recreational travel campsites with water and sewage system
Recreational travel campsites without water and sewage system
Mobile home sites with water and sewage system
Mobile home sites without water and sewage system
Yes
/J C A.'
A/O it'
/^,U' It'ii-
No
y No. of units
A u
A c>
Do you have:Boat rental service ? ______
live bait sales? ______
Retail store? (groceries etc.) ___
Ice fishing access? ______A y'
//oDo you provide sewage disposal service for inboard marine toilets?
/Za/C y /f^s/uWhat other services do you provide?
oLake frontage feet
r TNumber of acres in resort area
(signature of OwnerMKL-0'473-038