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Home My WebLink AboutBig Island Campsite_58000030012001_Septic System Permits_V.https://onegov.co.ottertail.mn.us/admst/viewcard.php?card=2&app=83301/4/2019 OTTER TAIL COUNTYf Land & Resource Managemen%)k*^(^l^^ L.|Q Phone (218) 998-8095 xjrPERMIT NUMBER 26288PERMIT TYPE Sewage Treatment System Permits Lp/5/Wo PROPERTY OWNER Bic Holdings Lie LAKE INFORMATION S Turtle 377DNR ID(S) LOCATION Parcel(s): 58000990362001 Township Name: Tordenskjold Township Property Address(es): 21539 BIG ISLAND CAMP RD Section/Township/Range: Sect-03 Twp-132 Range-041 Legal: THE BIG ISLAND LOTS 12, 21 & 22 BLK 1 LIFEEST TO MARIE BIENIEK WORK AUTHORIZED Install two new tanks: 2500 and a 2500/2 Installing a commercial filter on outlet end of tank Jessica Fosberg 11/04/2019 04:04 PM 5cbd654ba 1 eed041 f3327f85baa39c65 8b36c88ac4320fde4bf3981f33d2012c 11/04/2019 11/04/2020 DATE EXPIRESLand and Resource Management Official/Date ISSUE DATE NOTE: • This permit must be placed in a conspicuous place not more than 6 feet above grade on the premises on which work is to be done, and must be maintained there until completion of such work. • If the terms of this permit are violated, the entire permit may be revoked and the owner/contractor may be subject to legal prosecution. • Property Owner is legally responsible for all surface water drainage which may occur. • No part of the Septic System shall be covered until it has been inspected or approved. • Notify Land & Resource Management when job is ready for inspection, requests for inspection must be called in no later than 4pm the day prior to inspection. (218) 998-8095. will be ready for inspection onThis System ___, the year of ----------- Time Received a.m Date Received L & R Official 1/1. https://onegov.co.ottertail.mn.us/admst/viewcard.php?carcl=2&app=8330 r Land & Resource Permit Applications11/4/20,19 .1 L Land & Resource Management Government Services Center 540 Fir Avenue West Fei^us Falls MN 56537 Phone: 218-998-8095 i' OTTCR TfllloopATT-nitiaiieifl Sewage Treatment System Permit Application Sewage Treatment System Permits Permit # 26288, App. # 1272, UID # 8330 Valid: 11/04/2019 -11/04/2020 Applicant Information Applicant Information:Name: Scott M Ellingson Phone: (218 )205 -1667 Email Address: scottssepticpermit(^gmail.com Mailing Address: 201 Meadow Circle 201 Meadow Circle Ashby MN 56309 Agent/DesignerI am the: Is (his Sewer Permit Application for a No Collector System? Work Performed By ContractorWork to be performed by: Contractor's Contact InformationV Contractor Information:Name: Don Schmidt Company or Business Name: Don Schmidt Excavating Contractor License Number: 2173 Phone: (218 ) 282 - 0815 Email: donianeschmidt@gmail.com Address: 35207 235th ST Battle Lake MN 56515 Property Owner's Contact Information Property Owner Contact Information: Name: BIC Holdings LLC Phone: (952 ) 292 - 2749 Email Address: dbienlek@lvcinc.com Mailing Address; 21539 Big Island Camp RD Underwood MN 56586 Property Information Project Location:Primary Name/AddressLegal DescriptionProperty AddressProperty Attributes CityLegal Description Primary Address Line 1NameLegal DescriptionParcel #Property Address City Legal Description UNDERWOOD21539 BIG ISLAND CAMP RD EST TO MARIE BIENIEK BICUNDERWOODTHE BIG ISLAND LOTS 12. 21 &22 BLK 1 LIFE 58000990362001 21539 BIG ISLAND CAMP HOLDINGS LLCRD Is the property Developed Developed or Undeveloped? Is the property Shoreland located in the Shoreland or Non- Shoreland area? 1/3https://onegov.co.ottertail.mn.us/view.php?id=8330#option-results Land & Resource Permit Applications11/4/2019 I. Shoreland Information Associated Lakes; Lake Name DNR ID Lake Class LR CD S Turtle’377 RD 56-377 No ■Bluff: Project Information Other Establishment - ReplacementType of Installation; Design Flow;1 to 2,499 Gallons Per Day TygeJ Gravity System Type: Efluent Distirbution: System Components Tank OnlyType I Components; Depth of Well: Number ofBedrooms: Deep Feet 0 YesAbatement: NoGarbage Disposal: Ejector:H2. 2Number of Tanks: Number of Lifts: Nurhber of Soil Treatment Areas; 2 . 2 Septic/Holdinq Tanlt(s) 5000 GallonsTotal Capacity of Septic/Holding Tank(s): 100+ FeetSetback to Nearest Well; Setback to Ordinary High Water Level;100+ Feet NA FeetSetback to Bluff: 40 Feet 100+ Feet Setback to Dwelling: Setback to Non-Dwelling; Setback to Nearest Lot Line: Setback to Road Right-of-Way; - 100+ Feet 100+ Feet Documentation 1Attach Supporting Documentation;[File 1: ^Complete_Design_for_Septic_Tanks_Replacement.pdf J Applicant Approval ■ Ellingson, Scott MApplicant Signature; Date Signed; Please check to approve: 10/16/2019 I understand that checking this box constitutes a legal signature JessicaAttention: We are just replacing bad tanks that leak ONLY .Comments: We are at DLI for permitting right now also Terms 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 accordance with Sanitation Code of Otter Tail County, Minnesota. Applicant agrees that the Attached Documentation 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. Note Once a permit is approved it is valid for a period of twelve (12) months from the date of approval unless otherwise indicated on permit. Inspections need to be called in by 4pm the day prior. A sewer permit does not include the building sewer (sewer line). Invoice #6347 (11/01/2019) TotalCost QuantityCharge Tank Only Permit added 11/01/2019 4:30 PM $175.00$175.00 X 1 Grand Total $175.00Total $175.00Payment 11/02/2019 $0.00Due Approvals SignatureApproval Emma Barry -10/17/2019 8:10 AMe77f37ea23ce42d4ebal7eebd31f44644fifl42ccedc48f737b56ba0a72bcl4b #1 Received and Assigned #2 Application Review Kyle Westergard -10/17/2019 8:50 AM ■ https://onegov.co.ottertail.mn.us/view.php?id=8330#option-results 2/3 ( A 4267f5el561e22f058e4bd5389fe2bl0 2236a9ef283b6bc3elfa8ef511c3277e Land & Resource Permit Applications11/4/2Q19 #3 Application Approval Jessica Fosberq -11/04/2019 4:04 PM5cbd654baleed041f3327f85baa39c658b36c88ac4320fde4bf3981f33d2012c Public Notes Text: ]File(s):L Internal Notes Text: 2: ]File(s):[ Print View 3/3https://onegov.co.ottertail.mn.us/view.php?id=8330#option-results s PARCEL «S8aX>^^O50>S( OQ / YEAR isao/*? SCALE /'* -*fo^ ,gptic 'mrniDm, LLC \Scott Ellingson 201 Meadow Circle, Ashby. MN 56309 218-205-1667 SKETCH OF PROPERTY ^ V---------------------------------------------------- ^ 100 5P^ - ^3(X)5ps( ^ si-{cs /56P^5 - H^(3Sb<^ I - ^soo fSi S!'<v^k-^oXnS^^K'*^ ■?0<' <*L ^o\oJi SfOOO 63tTiw^Y'CoJ O*^ OWU^fe'f <5d'0r\tff £!ft»vip^roc4jA£$niii's is Ihorf Inaz a bad S'^p-lic ^/>K^ , (a)^ OAS, reloccdii^ 5epr{ic dovil^ qcross drii/^u^^ and^ recohn-^c^i’piq J-/b eK/S'fjio^arOJA) Preliminary Evaluation Worksheet MINNESOTA POLLUTION CONTROL AGENCYmi) V 04.02.20191. Contact Information Date Completed: 10/13/2019.Property Owner/Client: BIC Holdings LLC Project ID:Site Address: 21539 Big Island Camp RD 952-292-2749Phone:Email: dbieniek@lvcinc.com Mailing Address: 21539 Big Island Camp RD Underwood, MN 56586-9576 Legal Description: THE BIG ISLAND ALL OF BLKS 1,2 & 3 £t,■ 132 3 RNG:Parcel ID: 58000990362000 a 001 41SEC:TWP: 2. Flow and General System Information A. Client-Provided Information Project Type: □ New Construction Project Use: □ Residential □ Other Establishment: □ Expansion □ Repair0 Replacement Camp Ground Dwelling Sq.ft.:Unfinished Sq. Ft.:Residential use: # Bedrooms: # Children:# Teenagers:# Adults: If yes, describe:In-home business (Y/N): □ Hot Tub* □ Sump Pump* □ Self-Cleaning Humidifier* □ Other: □ Garbage Disposal/Grinder Water-using devices: □ Sewage pump in basement (check all that apply) 0 Large Bathtub >40 gallons D Iron Filter* □ Clothes Washing Machine □ High Eff. Furnace* * Clear water source - should not go into system □ Dishwasher □ Water Softener* Additional current or future uses: Anticipated non-domestic waste: /o/^?>/zof9The above is complete ft accurate: Client signature & date B. Designer-determined flow Information Attach additional information as necessary. Design Flow: 1552 GPD ResidentialAnticipated Waste Type: 2560170 mg/L TSS Oil & Grease mg/Lmg/LBOD: Well Depth Casing Depth (ft.) Confining Layer STA Setback SourceMn.ID#(ft.)Description# Deep Well1 2 3 4 Additional Well Information: .4 Preliminary Evaluation Worksheet MINHESOTA POLLUTION CONTROL AGENCY NoSite within 200' of noncommunity transient well (Y/N)Yes, source: NoSite within a drinking water supply management area (Y/N)Yes, source: NoSite in a Well Head Protection inner wellhead management zone (Y/N)Yes, source: NoBuried water supply pipes within 50 ft of proposed system (Y/N) Yes, name: South TurtleYesB. Site located in a shoreland district/area? Elevation of ordinary high water level:ft Source: Classification: RD Tank Setback:100+ft. STA Setbk: NA ft. NoC. Site located in a floodplain?Yes, Type(s): ft Source:Floodplain designation/elevation (10 Year): Floodplain designation/elevation (100 Year):ft Source: D. Property Line Id / Source: 13 Owner □ Survey 0 County CIS □ Plat Map □ Other: E. ID distance of relevant setbacks on map: □ water □ Easements 0 Well(s) 0 Building(s) 0 Property Lines 0 OHWL □ Other: 4. Preliminary Soil Profile Information From Web Soil Survey (attach map & description) Slope Range:%Map Units: List landforms: Landform position(s): Parent materials: Depth to Watertable:Depth to Bedrock/Restrictive Feature:in in Septic Tank Absorption Field- At-grade: Map Unit Ratings Septic Tank Absorption Field- Mound: Septic Tank Absorption Field- Trench: 5. Local Government Unit Information Name of LGU: Ottertail County L&R Chris LeClairLGU Contact: LGU-specific setbacks: LGU-specific design requirements: LGU-specific installation requirements: Notes: Installing new replacement septic tanks :uw>wniar«iocOT* Onsite' ImmwProgram:, MINNESOTA POLLUTIONif I lu CONTROL AGENCYDesign Summary Page 1. PROJECT INFORAAATION V 04.02.2019 Property Owner/Client: BIC Holdings LLC Project ID: ,10/13/19Site Address: 21539 Big Island Camp RD Date: Email Address: dbieniek@lvcinc.com 952-292-2749Phone: 2. DESIGN FLOW a WASTE STRENGTH Attach data / estimate basis for Other Establishments 1552 Anticipated Waste Type:ResidentialDesign Flow:GPD 170 60 mg/L 25 mg/LOil a Grease:BOD:mg/L TSS: CTreatment Level:Select Treatment Level C for residential septic tank effluent 3. HOLDING TANK SIZING Minimum Capacity: Residential =400 gal/bedroom, Other Establishment = Design Flow x 5.0, Minimum size 1000 gallons Code Minimum Holding Tank Capacity: Recommended Holding Tank Capacity: Gallons Tanks or Compartments Tanks or Compartments (Set @ 75% tank capacity) in Gallons in Type of High Level Alarm: Comments: 4. SEPTIC TANK SIZING A. Residential dwellings: Number of Bedrooms (Residential): Tanks or Compartments Tanks or Compartments Code Minimum Septic Tank Capacity: Recommended Septic Tank Capacity: Gallons in Gallons in Model/Type:Effluent Screen & Alarm (Y/N): B. Other Establishments: 3 I Days Hyd. Retention Time Tanks or Compartments Tanks or Compartments GPD XGravity1552Waste received by: Code Minimum Septic Tank Capacity:4656 1GallonsIn 5000 3GallonsRecommended Septic Tank Capacity:In Yes Model/Type:Effluent Screen & Alarm (Y/N): 5. PUMP TANK SIZING Pump Tank 2 Capacity (Minimum): Pump Tank 2 Capacity (Recommended): ]gPM Total Head 1 Dose Vol: GalPump Tank 1 Capacity (Minimum): Pump Tank 1 Capacity (Recommended): IgPM Total Head Gal Gal Gal ftftPump 2Pump 1 Supply Pipe Dia.Supply Pipe Dia.GalDose Vol:galin :inmi»/T»o^aaa»u Onsite ■!«««"”! 1---^--- MINNESOTA POLLUTION CONTROL AGENCYDesign Summary Page‘?l 6. SYSTEM AND DISTRIBUTION TYPE Project ID: Distribution Type:Soil Treatment Type: Elevation Benchmark:ft Benchmark Location: Distribution Media:MPCA System Type: Type III/IV Details: 7. SITE EVALUATION SUMAAARY: Describe Limiting Condition: Layers with >35% Rock Fragments? (yes/no)| | If yes, describe below: % rock and layer thickness, amount of soil credit and any additional information for addressing the rock fragments in this design. Note: Depth Depth Elevation Limiting Condition: Minimum Req'd Separation: inches ft ft Critical for system complianceinchesftElevation Code Max System Depth:inches This is the maximimum depth to the bottom of the distribution media. Negative Depth (ft) means it must be a mound. ft ft Soil Texture: 2 Percolation Rate:Soil Hyd. Loading Rate:MPIGPD/ft Contour Loading Rate: Measured Land Slope: Note: %Note: Comments: 8. SOIL TREATMENT AREA DESIGN SUMMARY Trench:i. ft^ Sidewall Depth Trench Width ftDispersal Area in No. of Trenchesft Code Max. Trench Depth inTotal Lineal Feet Min. Length ft Designed Trench Depth inContour Loading Rate ft Bed: ft^ Sidewall Depth Bed Length Maximum Bed Depth inDispersal Area in Designed Bed Depth inft ftBed Width Mound: ft^Bed Width ftBed Length ftDispersal Area Absorption Width Upslope Berm Width Total System Length ft Berm Width (0-1%)ftftClean Sand Lift Endslope Berm Width Contour Loading Rate ftft Downslope Berm System Width ft ftft gal/ft Project ID: Onsite . yn■Treatment■ 3iL'. MINNESOTA POLLUTION■ B I y CONTROL AGENCYDesign Summary Pager^- At-Grade: ftBed Width ft ft Finished Height Downslope Berm System Width Bed Length gal/ft Upslope Berm ft System Length ft ftContour Loading Rate Endslope Berm ft ft Level & Equal Pressure Distribution No. of Laterals ftPerforation Spacing Perforation Diameter in in Min Dose Volume galLateral Diameter gal Max Dose Volume Non-Level and Unequal Pressure Distribution PipeElevationPipe Size Pipe Perf Size Spacing SpacingVolume (gal/ft)(ft)Length (ft)(ft)(in) (in)(in)Minimum Dose VolumeLateral 1 Lateral 2 gal Lateral 3 Lateral 4 Maximum Dose VolumeLateral 5 Lateral 6 gal Additional Info for At-Risk, HSW or Type IV Design9. A. Starting BOD Concentration = Design Flow X Starting BOD (mg/L) X 8.35 t 1,000,000 mg/L X 8.35-r 1,000,001 =gpd X lbs. BOD/day B. Target BOD Concentration = Design Flow X Target BOD (mg/L) X 8.35 t 1,000,000 mg/L X 8.35 T 1,000,001 =gpd X lbs. BOD/day Lbs. BOD To Be Removed: ‘Must Meet or Exceed Target ‘Required for Levels A & B PreTreatment Technology: Disinfection Technology: C. Organic Loading to Soil Treatment Area: ft^Ibs./day/ft^gpd X 8.35 T 1,000,000 Tmg/LX 10. Comments/Special Design Considerations: Installing new replacement septic tanks I hereby certify that 1 have completed this work in accordance with all applicable ordinances, rules and laws. 10/13/2019Scott Ellingson 3947 (Date)(Designer)(Signature)(License #) •'3 University OF Minnesota Septic System Management Plan for Below Grade Systems The goal of a septic system is to protect human health and the environment by properly treating wastewater before returning it to the environment. Your septic system is designed to kill hai’inful organisms and remove pollutants before the water is recycled back into our lakes, streams and groundwater. 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 maintainer or service provider. However, it is YOUR responsibility to make sure all tasks get accomplished in a timely manner. The University of Minnesota's Septic System Owner’s Guide contains additional tips and recommendations designed to extend the effective life of your system and save you money over time. Proper septic system design, installation, operation and maintenance means safe and dean water! BIG Holdings LLC dbieniek@lvcinc.comProperty Owner Email Property Address 21539 Big Isisnd CdPTip RD 58000990362000 & 001Property ID 218-205-1667System Designer Scott'S SoptiC ServiCOS ,LLC Contact Info Contact Info 218-282-0815System Installer Don Schmidt Excavatipg Service Provider/Maintainer Contact Info Permitting Authority OttOftail COUPty L&R 218-998-8095Contact Info Permit #Date Inspected Keep this Management Plan with your Septic System Owner’s Guide. The Septic System Owner’s Guide includes a folder to hold maintenance records including pumping, inspection and evaluation reports. Ask your septic professional to also: • Attach permit information, designer drawings and as-built of your system, if they are available. • Keep copies of all pumping records and other maintenance and repair invoices with this document. • Review this document with your maintenance professional at each visit; discuss any changes in product use, activities, or water-use appliances. For a copy of the Septic System Owner’s Guide, visit www.bookstores.umn.edu and search for the word "septic” or call 800-322-8642. For more information see http://septic.umn.edu Version: August 2015 - 1 - University OF Minnesota Septic System Management Plan for Below Grade Systems Your Septic System □ □.Oeanout ^Manhole _ Ground surface Soil treatment trench (Mstribtrtion media Septic tvA .! Septic System Specifics System Type: 0 ' Q ” O O O (Based on MN Rules Chapter 7080.2200 — 2400) I I System is subject to operating permit* I I System uses UV disinfection unit* Type of advanced treatment unit________*Additional Management Plan recjiiired Well ConstructionDwelling Type Well depth (ft); _______ □ Cased well Casing depth: □ Other (specify): _ Distance from septic (ft); Is the well on the design drawing? Y N Number of bedrooms: Existing System capacity/ design flow (gpd): Average daily flow (gpd): Comments_________________________________ Business? 0Y N What type? Campground 100+ Septic Tank □ First tank Tank volume: ^500 Does tank have two compartments? Y N □ Second tank Tank volume: 2500-2 gallons □ Tank is constructed of Concrete □ Effluent screen:0Y 0N Alarm □ Pump tank (if one) ______ □ Effluent pump make/model: Pump capacity TDH gallonsgallons GPM Feet of head 0Y Qn OvO□ Alarm N Location Soil Treatment Area (STA) [^[Gravity distribution Trenches: Existing total lineal feet □Pressure distribution Cleanouts Number of trenches:feet eachat I Inspection I I '----ports I-----1ft X ftSTA size (width x length): Location of additional STA:Additional STA not available Type of distribution media:Surface water diversions -2- University OF Minnesota Septic System Management Plan for Below Grade Systems Homeowner Management Tasks These operation and maintenance c/ctivities are your responsibility. Chart on page 6 can help track your activities. Your toilet is not a garbage can. Do not flush anything besides human waste and toilet paper. No wet wipes, cigarette butts, disposal diapers, used medicine, feminine products or other trash! The system and septic tanks needs to be checked every 36 months Your service provider or pumper/maintainer should evaluate if your tank needs to be pumped more or less often. Seasonally or several times per year • Leaks. Check (listen, look) for leaks in toilets and dripping faucets. Repair leaks promptly. • Soil treatment area. Regularly check for wet or spongy soil around your soil treatment area. If surfaced sewage or strong odors are not corrected by pumping the tank or fixing broken caps and leaks, call your service professional. Untreated sewage may make humans and animals sick. Keep bikes, snowmobiles and other traffic off and control borrowing animals. • Alarms. Alarms signal when there is a problem; contact your service professional any time the alarm signals. • Lim filter. If you have a lint filter, check for lint buildup and clean when necessary. If you do not have one, consider adding one after washing machine. • Effluent screen. If you do not have one, consider having one installed the next time the tank is cleaned along with an alarm. Annually • Water usage rate. A water meter or another device can be used to monitor your average daily water use. Compare your water usage rate to the design flow of your system (listed on the next page). Contact your septic professional if your average daily flow over the course of a month exceeds 70% of the design flow for your system. • Caps. Make sure that all caps and lids are intact and in place. Inspect for damaged caps at least every fall. Fix or replace damaged caps before winter to help prevent freezing issues. • Water conditioning devices. See Page 5 for a list of devices. When possible, program the recharge frequency based on water demand (gallons) rather than time (days). Recharging too frequently may negatively impact your septic system. Consider updating to demand operation if your system currently uses time, • Review your water usage rate. Review the Water Use Appliance chart on Page 5. Discuss any major changes with your service provider or pumper/maintainer. During each visit by a service provider or pumper/maintainer • Make sure that your service professional services the tank through the manhole. (NOT though a 4" or 6" diameter inspection port.) • Ask how full your tank was with sludge and scum to determine if your service interval is appropriate. • Ask your pumper/maintainer to accomplish the tasks listed on the Professional Tasks on Page 4. -3 - University OF Minnesota Septic System Management Plan for Below Grade Systems Professional Management Tasks These are the operation and maintenance activities that a pwnper/maintainer performs to help ensure long-term performance of your system. At each visit a written report/record must be provided to homeowner. Plumbing/Source of Wastewater • Review the Water Use Appliance Chart on Page 5 with homeowner. Discuss any changes in water use and the impact those changes may have on the septic system. • Review water usage rates (if available) with homeowner. Septic Tank/Pump Tanks • Manhole lid. A riser is recommended if the lid is not accessible from the ground surface. Insulate the riser cover for frost protection. • Liquid level. Check to make sure the tank is not leaking. The liquid level should be level with the bottom of the outlet pipe. (If the water level is below the bottom of the outlet pipe, the tank may not be watertight. If the water level is higher than the bottom of the outlet pipe of the tank, the effluent screen may need cleaning, or there may be ponding in the soil treatment area.) • Inspection pipes. Replace damaged or missing pipes and caps. • Baffles. Check to make sure they are in place and attached, and that inlet/outlet baffles are clear of buildup or obstructions. • Effluent screen. Check to make sure it is in place; clean per manufacturer recommendation. Recommend retrofitted installation if one is not present. . Alarm. Verify that the alarm works. • Scum and sludge. Measure scum and sludge in each compartment of each septic and pump tank, pump if needed. Pump Pump and controls. Check to make sure the pump and controls are operating correctly. Pump vault. Check to make sure it is in place; clean per manufacturer recommendations. Alarm. Verify that the alarm works. Drainback. Check to make sure it is draining properly. Event counter or elapsed time meter. Check to see if there is an event counter or elapsed time meter for the pump. If there is one or both, calculate the water usage rate and compare to the anticipated use listed on Design and Page 2. Dose Volume;gallons; Pump run time; na MinutesNA Soil Treatment Area • Inspection pipes. Check to make sure they are properly capped. Replace caps and pipes that are damaged. • Surfacing of effluent. Check for surfacing effluent or other signs of problems. . Gravity trenches and beds. Check the number of gravity trenches with effluent ponded in distribution media. Identify the percentage of the system in use. Determine if action is needed. • Pressure trenches and beds - Lateral flushing. Check lateral distribution; if cleanouts exist, flush and clean at recommended frequency. • Vegetation - Check to see that a good growth of vegetation is covering the system. All other components - evaluate as listed here: -4- University OF Minnesota Septic System Management Plan for Below Grade Systems Water-Use Appliances and Equipment in the Home Management TipsImpacts on SystemAppliance • Use of a garbage disposal is not recommended. • Minimize garbage disposal use. Compost instead. • To prevent solids from exiting the tank, have your tank pumped more frequently. • Add an effluent screen to your tank. • Uses additional water. • Adds solids to the tank. • Finely-ground solids may not settle. Unsettled solids can exit the tank and enter the soil treatment area. Garbage disposal • Choose a front-loader or water-saving top-loader, these units use less water than older models. • Limit the addition of extra solids to your tank by using liquid or easily biodegradable detergents. Limit use of bleach-based detergents and fabric softeners. • Install a lint filter after the washer and an effluent screen to your tank • Wash only full loads and think even - spread your laundry loads throughout the week. • Washing several loads on one day uses a lot of water and may overload your system. • Overloading your system may prevent solids from settling out in the tank. Unsettled solids can exit the tank and enter the soil treatment area. Washing machine • Use gel detergents. Powdered detergents may add solids to the tank. • Use detergents that are low or no-phosphorus. • Wash only full loads. • Scrape your dishes anyways to keep undigested solids out of your septic system. • Powdered and/or high-phosphorus detergents can negatively impact the performance of your tank and soil treatment area. • New models promote “no scraping". They have a garbage disposal inside. Dishwasher • Expand septic tank capacity by a factor of 1.5. • Include pump monitoring in your maintenance schedule to ensure that it is working properly. • Add an effluent screen. • Finely-ground solids may not settle. Unsettled solids can exit the tank and enter the soil treatment area. Grinder pump (in home) • Avoid using other water-use appliances at the same time. For example, don’t wash clothes and take a bath at the same time. • Use oils, soaps, and cleaners in the bath or shower sparingly. • Large volume of water may overload your system. • Heavy use of bath oils and soaps can impact biological activity in your tank and soil treatment area. Large bathtub (whirlpool) Management TipsImpacts on SystemClean Water Uses High-efficiency furnace • Re-route water directly out of the house. Do not route furnace recharge to your septic system. • Drip may result in frozen pipes during cold weather. • These sources produce water that is not sewage and should not go into your septic system. • Reroute water from these sources to another outlet, such as a dry well, draintile or old drainfield. • When replacing, consider using a demand-based recharge vs. a time-based recharge. • Check valves to ensure proper operation; have unit serviced per manufacturer directions • Salt in recharge water may affect system performance. • Recharge water may hydraulically overload the system. Water softener Iron filter Reverse osmosis • Water from these sources will overload the system and is prohibited from entering septic system. Surface drainage Footing drains -5 - University OF Minnesota Septic System Management Plan for Below Grade Systems Homeowner Maintenance Log Track maintenance activities here for easy reference. See list of management tasks on pages Sand 4. Activity Date accomplished Check frequently: Leaks: check for plumbing leaks * Soil treatment area check for surfacing ** Lint filter: check, clean if needed Alarms ** Check annually: Water usage rate (max gpd: Caps: inspect, replace if needed Water use appliances - review use Other: * Monthly ** Quarterly Bi-Annually* * * Notes: "As the owner of this SSTS, 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 this 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." fo/f3/ZJQ>f9Property Owner Signature:Date Scott Ellingson CertificationManagement Plan Prepared By: Ottertail CountyPermitting Authority: i")20\5 Regents of the University of Minnesota, All rights reserved. The University of Minnesota is an equal opportunity educator and employer. This material is available in alternative formats upon request. Contact the Water Resources Center. 612-624-9282. The Onsite Sewage Treatment Program is delivered by the University of Minnesota Extension Service and the University of Minnesota Water Resources Center, -6- r SEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTS r STA (SeintBOmentAwa) OUTHOUSE lENCH REDUCTIONHOLDING SEPTIC TANK LIFT TANKCATEGORY inchesRod( trenc^sCapacityFT*GLS.GLS. py of sidewall (or %Setback from Nearest Well FT ft*py reduction / equivalent toSetback from Burled Water Suctlott Pipe FTFT STA CALCULATION Tteatment Area) Setback from Buried Pipe DIstributInfl Water Under Pressure kv*L FTFTFT Setbadt from OHWL (lake &/or river)ft FT FT FC .Ft. Setback from Bluff FTFT FI* <^'2- ftSetback from Dwelling FT MOUND / AT-GRADEFT ^ROCK BEDSetback from Non-Dwelling FTFT ‘2ocs^ FTSetback from Nearest Property Line FT FT Ft X Ft XiSetback from Right-of-Way FT FT FT Ft* Elevation above Restrictive Layer FT FT FT SAND IN MOUNDINSTALLERS COMMENTS Holding Tank / Lift Alarm ^YES ONO SEPTIC TANK(S) # Tanks Installed Model Qld^SysfenrrPuiinpStMrDestrayea •gY'ES-----g-NO-Weep Holes' Manuf.tSffiraTPipe SizeNumber of Laterals-#'IN Perforation Spacing -Perforation Diameter Size iN Galions Per Minute [FILTERS j^YES □ NOPUMPSFeet of Total Head Inspector's Comment: . L/Sketch: As of_________ the above described sewage system installation was found to be compliant with the provisions of the Sanitation Code of Otter Tail County. Oete Init ‘aROMdal Land & Resource Management Offidat Form No. BK — 04-2014-08 aS7^43 • Victor LuAdoon Co.. Pitntor* • Pemua Faua 11/4/;j019 hnps;//onegov.co.uiic'-tail.nin,us/admst/viewcard.php?card-2&ai3p=8330 OTTER TAIL COUNTYI Land & Resource Management Phone $218) 998-8095 PERMIT TYPE Sewage Treatment System Permits PERMIT NUMBER 26288 PROPERTY OWNER Bic Holdings L!c LAKE INFORMATION S Turtle DNR ID(S)377 LOCATION Parcel(s): 58000990362001 Township Name: Tordenskjold Township Property Address(es): 21539 BIG ISLAND CAMP RD Section/Township/Range: Sect-03 Twp-132 Range-041 Legal: THE BIG ISLAND LOTS 12, 21 & 22 BLK 1 LIFEEST TO MARIE BIENIEK WORK AUTHORIZED InL^^Gl! tvvG r.Gw tGnka: 2£00 and a 25CyO/2 Installing a corr riercial filter on outlet end of tank Jessica Fosberg 11/04/2019 04:04 PM 5cbd654ba 1 eed041 f3327f85baa39c65 8b36c88ac4320fde4bf3981f33d2012c 11/04/2019 11/04/2020 Land and Resource Management Official/Date ISSUE DATE DATE EXPIRES NOTE: This permit must be placed in a conspicuous place not more than 6 feet above grade on the premises on which work is to be done, and must be maintained there until completion of such work. If the terms of this permit are violated, the entire permit may he revoked and the owner/contractor may be subject to legal prosecution. Property Owner is legally responsible for all surface water drainage which may occur. No part of the Septic System shall be covered until it has been inspected or approved. Notify Land & Resource Management when job is ready for inspection, requests for inspection must be called in no later than 4pm the day prior to inspection. (218) 998-8095. https;,'/onegov.CO. ottertail.mn.us/admst/viewcard.php?c3i‘d=3-Sapp=8330 h’i /' // r' r ■■ T*PARCEL # ‘^03(£>9. oq I YEAR c^O/9________, SCALE ■ a nScott Ellingson 201 Meadow Circle, Ashby, MN 56309 218-205-1667 SKETCH OF PROPERTY t;/ ^ /3CG nps*)5sM^ X fOO^'P ^ /55^^To4ai Vi: 155^^3 -5iptic 1- <;i5CO 33ifi |- ^5^0" a 4o4uiL oP B,oco ^0 ,Tor ;!V 6sm /v\ 'f■' J OvJ' id"' Sn ijf C^^ iSs5 «K';St‘Vci, •|jO.'/V'^rc«.yj4 j I .j""*1^*3 is iS'-'A IhQ-f has a bo,d S'^;q . hi <3/1$, re ^oCiSrf/ 3€<Cr^’!C /■ 8 i;■j- /"e CT > y^QqO^OSS <3 *'' ‘3c Ov via (t'f. 'rf.J■fo €A/5'?m3r /■ /i Shipping Tkt No: BROWN-WILBERT TANK INSTALLATION INSTRUCTIONS SITE CONDITIONS The site must be accessible to large heavy trucks. Be free of items like trees, stumps, overhead wires and buildings that could interfere with delivery or installation. The trucks must be able to within three to six feet of placement excavation. EXCAVATION Excavation should be approximately 12” minimum larger than tank size to allow for adequate back fill: this may vary with soil conditions. Excavation shall have a level bottom so the weight bears on the outside walls of the tank. BEDDING Proper use of bedding materials is important to ensure service life of tht tank structure. Bedding must be capable of bearing the weight of the tank. Bedding material shall have the ability of 100% to be able to pass through a screen. Bedding thickness shall be 4” minimum compacted (thickness may vary with existing soil conditions). JOINT SEAL Joint surfaces must be clean and proper placement of sealant according to manufactures recommendations. WATER TABLE Tanks being placed where water levels can potentially be higher than the elevation of the tank cover must be brought to the attention of Brown- Wilbert, Inc. Either an alternate location should be considered or a waterproof coating applied to tank. BACKFILL MATERIAL Sidewalls of tanks require dry backfill materials that have the ability of 100% to be able to pass through a 2” screen and have a minimum of 12” on all sides from bottom to top of tank. Backfill material shall be placed in a manner to avoid impact loads on the sidewall of tank. COVER MATERIAL Cover material shall be dry soil, sand or gravel and have the ability of 100% to be able to pass through a 4” screen. Cover material shall be mounded over tank and around risers to direct run-off away from both. INLET & OUTLET Pipe not to exceed I” past interior wall of tank where a baffle is used. FINAL INSPECTION □ Passed □ FailedBURIAL DEPTH Tanks not to e.xceed the maximum burial depth of each model’s specifications. Model #: 2500 2C Model #: 2500 ST Model U: 1___Date of Mfg: 1___Date of Mfg: Liquid Capacity: 1731/839 Liquid Capacity: 2615 Liquid Capacity: __________ Max. Burial Depth: Max. Burial Depth: Max. Burial Depth: 6 FT Qty Qty4 FT Date of Mfg:Qty Customer: Don SchmidL Exc.6/3/20 11:00amDate & Time to Deliver: Delivery Address: Big Island Campground Underwood, MN Tanks Item 2500 2C 2500 5T Returned QtvQty Sent 1 >1 Q All Other Supplies SUPPLIES Directions: !S Customs with 6" holes Returned Qtv• Qtv Sent Black Plastic Riser1 625 Filter1 1 Green tracer . *cojCDU-g ^L.O>oj >I *TO *a ' .1J. m Otter Tail County Land & Resource Management Subsurface Sewage Treatment System Inspection FormOTTER TAIL COUNTY • MINNESOTA □ Non-Shoreland Permit No. © "Installer/MPCAVIIIIVMPCAType /' □ At-GradeType of System □ Trench □ Pressure Bed~TtX<r~\U- W>p\ t\,t Other Inspection: □ MoundReplacement □ Other□ New □ Repair Soil Treatment Area Inspection Final InspectionTank Inspection of InspectorDateInspectorDateDateInspectorDateInspector Corrections Y NCorrectionsY N Corrections Y NCorrectionsY N MOUNDS/AT-GRADETREATMENT MEDIA Percent SlopeAt-Grade□ MoundDrainfield Rock □ Registered Treatment MediaTREATMENT MECT Sand Below Bed on Upslope Side(in):Registered Treatment Media:Bed Length(RJ?Bed Width(ft): SEWAGE/HOLDING TANKS Upslope(ft):Sii TO:Downslope(ft): Capacity (Gallons) Manufactuer Model No. Rock Below Pipe(in): □ Existing □ Combo2^01st Tanl<:PRESSURE DISTRIBUTION Existing ^ral Spacing(ft) Lateral Dia(in)□ New □ombo Number of Laterals:16002nd Tank: Perforation Spacing(ft) Cleanouts: Y N□ New □ Existing □ Combo Perforation Dia(in)Pump Tank1 PUMP INFOTRENCHES/PRESSURE BEDS Pressure Bed□ Pump T rench□ Drop Box End Fed □ Dist Box □ Gravity Pump Manufacturer/Model No: Rock Below Pipe(in)□ Drop BdihQenter Fed Flow Measurement Reading:□ Event Counter □ Run-Time Clock ,□ 6 □ 12 □ 18 □ 24 SETBACKST4TsT2T3Trench Depth (in)1 Dwelling Non-DwellingDwelling Non-DwellingT5T,T2 T3 T4 Building(s) to STA(ft)Trench Length (ft)Bulldlng(s) to tanks(ft) \0(>^Surface water(ft)Trench Depth (in)T,oTeTyTa Well(s)Sensitive Well VProperty lines(ft)looi'Trench Length (ft)BluffTgTeTyTeRoad R.O.W. Vertical Separation Provided(in):Depth of Restriction(in):Depth of System(in): ~Bed Length(ft):Bed Width(ft):Pressure Bed Dimensions 'L n-cvvl \ay\Y'S^ f^\\f ✓ ^ Ccvnirh-p Comments: •V Final Inspector SignatureSSTS Inspection Form 04-28-2020 • PT-873169 • Victor Lundeen Co., Printers • Fergus Falls, MN ■ 1-800-346-4870 r Department of\•4 LAND AND RESOURCE MANAGEMENT OTTER TAIL COUNTY Government Services Center - 540 West Fir Fergus Falls, MN 56537 PH: 218-998-8095 „ OTTER Tail County’s Website: www.cootter-tail.mn.us 10/03/2013 Blase Bieniek Tst Et Al 21539 Big Island Camp Rd Underwood MN 56586 9576 RE; Primary Owner; Blase Bieniek Tst Et Al Sewage Treatment System Servicing Tax Parcel Number; 58000990362001 Sec 03 Twp Tordenskjold Twp Sect-03 Twp-132 Range-041 THE BIG ISLAND LOTS 12, 21 &22 BLK 1 LIFE Described as; Lake; 56-377 S Turtle As of 10/02/2013 the sewage treatment system (Sewage Treatment Installation Permit # 22283B servicing your property was determined to be in compliance with the provisions of the Sanitation Code of Otter Tail County for a 7 sites. If you have any questions regarding this matter, please contact our office. Sincerely Eric Babolian Inspector SCANiMfcD r ; application for permit to install sewage treatment system LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095) GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 www.co.otter-tail.mn.us WI^ITE - OfTice YELLOW -L&R Inspector PINK - Owner / Contractor (after issue) APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED Permit No. LAKE/RIVER CLASS SECTION TWP NO.RANGE TWP NAMELAKE/RIVER NAMELAKE NUMBER HI3/3:K E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROADPARCEL NUMBER (S) OF PROPERTY BEING SERVICED :k/^39 legal^^cr™ ^ ^ 72> / Daytime Phone No.Mailing AddressFirstInitialLast Name n/szt S/i- /.'.L/lJJ iAA/A ^Property Owner UaJ3€/3cAP£)OA. MjJ ^i^^^i^ Contractor Lie.#hwji. MfJ ms THIS SPACE FOH OFFICE USE ONLY A.M. P.M., the year of at.>■ This System will be ready for inspection on A.M. P.M. L&R OfficialTime ReceivedDate Received SEWAGE TREATMENT SYSTEM DESIGN DATA AS SHOWN ON DRAWING TYPE OF NSTALLATION (circle one) _-Qllier Est. (E) (Fyne^acement CollectorResidential (A) New (B) Replacement (C) New (D) Replacement Soil Treatment AreaJ'/TT /LiftTank Desigo-ElQw (Gallons/Day) 1 — 2^4^ Efflwnt Distribution (V) Gravity { ) Pressure GIsGIs(H) 230iT— 4,999 (I) 5,000 — 10,000 Size Setback To Nearest Well Ft.Ft.Type IIType I -A ^ (27) Rapidly Permeable(20) Trench, Rock 73'^^-Ft.Setback To OHWL 7^(21) Trench, Gravelless (28) Rood Plain ^2) Trench, Chambe^(29) Privies Ft.____ Ft..____ Ft.Setback To Bluff (30) Holding Tank ( ) Monitoring/Disposal Contract (23) Bed (24) Mound Ft.Ft.Setback To Dwelling /OType III(25) At Grade Setback To Non-Dwelling Ft.Ft.Ft.(31) Other/Problem Soils/<12" Soil(26) Greywater /o Type IV Setback To Nearest Lot Line Ft.Ft.Ft./D/O(32) Public Domain & Proprietary Technologies Depth of Wei I ,> HO Setback To Road Right-Of-Way Ft.Ft.Ft.70 /OType VTotal # Bedrooms (33) Performance Elevation Above Restrictive Layer ,____ Ft.3Ft.Y /(^Garbage Disposal Y/7^JAbatement PERCTEST DATA Cp/Highest RateDate of TestLicense #Designer Agreement: The undersigned hereby makes application tor 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). DC asi/a Permit Fee $MiDate: Signature of Property Owner/^ent for Owner !HL 9L71 M ■ Rec. No..Date: \nd & Resource ManagemenfVfficial ^ 171c.Dale StampComments: Form No. BK — 07-2011-06 [^Isw’wkI. 345.197 • ViclOf Lundoen Co.. Printers * Fergus Falls, Minnesota L&R Initial , -^ifitPPLlCATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095)GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 11? www.co.otter-tail.mn.usWHITE - Office YELLOW - L & R Inspector PINK - Owner/ Contractor (after issue)X- Z-Z-z£l^Permit No.APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED i TWP NO.RANGE TWP NAMESECTIONLAKE/RIVER CLASSLAKE/RIVER NAMELAKE NUMBER •V/ E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROADPARCEL NUMBER (S) OF PROPERTY BEING SERVICED V 1 LEGAL DESCRIPTION , , , j ^yyy r//y /SLi4a/’J /A, a/ r ^ OrC Cty Daytime Phone No.First Initial Mailing AddressLast Name ‘Uri'L yiCAJ/i'U CyProperty Owner sc9tM/-rr /YriContractor Lie.#—' 9/75 THIS SPACE FOR OFFICE USE ONLY /fpH7 IttL A.M. P.M., the year of► This System will be ready for inspection on . P.M. L & R OfficialTime ReceivedDate Received SEWAGE TREATMENT SYSTEM DESIGN DATA AS SHOWN ON DRAWING NSTALLATION (circle one)TYPE OF Collector Other Est. (E) New) (F) Replacement Residential (A) New (B) Replacement (C) New (D) Replacement Soil Treatment Area /J /'ft-LiftTank/Effluent Distribution ( . ) Gravity ( ) Pressure Design Flow (Gallons/Day) (G) 1 — 2,49>. (HT'2:500—'4,999 (I) 5,000 — 10,000 GIs GIs Ft.Size Setback To Nearest Well ^ Ft.., Ft.V yType IIType I !(27) Rapidly Permeable(20) Trench, Rock • Ft.Ft.Ft.Setback To OHWL(21) Trench, Gravelless (28) Flood Plain / C (22) Trench, Chamber (29) Privies Ft.Ft. Ft.Setback To Bluff(23) Bed"(30) Holding Tank ( ) Monitoring/Disposal Contract(24) Mound Ft.Ft.Ft.Setback To Dwelling (25) At Grade Type III Setback To Non-Dwelling , Ft.Ft.Ft.(31) Other/Problem Soils/<12" Soil(26) Greywater Type IV Setback To Nearest Lot Line Ft.Ft.Ft.V'>(32) Public Domain & Proprietary Technologies Depth of Well /L Setback To Road Right-Of-Way , Ft.Ft.Ft.Type VTotal # Bedrooms A (33) Performance Elevation Above Restrictive Layer Ft.Ft.___Ft.Garbage Disposal Y / NAbatement Y / N ,) PERC TEST DATA /Date of Test jli Highest Rate • ^ LLicense #Designer 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.Thls permit is vaiid for a period of six (6) months. 2.This permit does not inciude the buiiding sewer (sewer line). C L■'n I//7/!i')7\- Ai L 9L7 Permit Fee $Date: Signature of Property Owner/fi^/ent for Owner Rec. No..Date:4.2Resource Management dfficial i. /•' .' / / ? // 7 ^^ i!Comments:A SCANNED 11 A' 5 y i/- / i f /' j/J ; L- /i 1 Form No. BK — 07-2011-06 345.197 • Vk:tor LundMn Co.. Printors • Fergus Felis, Minnesota ,.(. -.V Luit. ' V* ■ "■'S I ,SEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTS Inspector must make all measurements SOIL TREATMENT AREA HOLDING SEPTIC TANK OUTHOUSELIFT TANKCATEGORY ^ (/06h GLS.Capacity FT2 FT2GLS. ftFT*ZOC>-^ FTSetback from Nearest Well FT Setback from Buried Water Suction Pipe FTFT FT FT Setback from Buried Pipe Distributing Water Under Pressure 10^FTFTFT FT 4.ftft FTSetback from OHWL (lake &/or river) FTFTSetback from Bluff FT FT -FTFTFTSetback from Dwelling FT ft10^ ft FTSetback from Non-Dwelling FTI S ^ ^ FT^ FT^0 FTSetback from Nearest Property Line svf- ft 60 FTFTSetback from Right-of-Way FT 3 FTFT FTElevation above Restrictive Layer FT Holding Tank/Lift Alarm NO /VAOld System Pumped & Destroyed NOYES TRENCH REDUCTIONSOIL TREATMENT AREA CALCULATION MOUND / AT-GRADEFILTERSEPTIC TANK(s) # Tanlja Installed ✓ ROCK BED Beck trenebes with.inches □ YES Tc 6Manuf. Model#ltnoT2 of sidewall for.%Ft.Ft. X Ft Ft. X^NO ft*reduction / equivalent to Soil Treatment Area,M_FPFP liy'OQ CP Inspector's Comments: iketch: 1 ^0 ^0- HO r» HO C----- lii h I TiT I /o —■> I ( \\ \1 0<3 /0P5> I y ^ Inhial / L A R Official /oiz//3 TuneDate bid NT As of Code of Otter Tail County. , the above described sewage system installation was found to be compliant with the provisions of the Sanitation V Land S Resource Management Offidat Form No. BK — 07-2011-06 345,197 « t/lctor Lund««fi Co., ^rlntor* « Forgut F«lli, Minnesota S/r^ / -7 ^/a//725 • i.OSTP Design Summary Worksheet v University OF MinnesotaMinnesota Pollution Control Agency 11.3.28 Blase Bieniek - Big Island CampgroundProperty Owner/Client: 21539 Big Island Camp Road, Underwood, MN 56586Site Address; 1. AVERAGE DESIGN FLOW: 700 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. A.Design Flow:Gallons Per Day (GPD) 1500B. Septic Tank capacity:Gallons 1 OptionalC. Number of Septic Tanks or Compartments: f. Type of Soil Treatment and Dispersal Area* Effluent Screen Et Alarm ? _ Type of Distribution* O Mound O At-GradeTrenchesOBed {§) Gravity Distribution O Pressure Distribution-Level O Pressure Distribution-Unlevel O Drip Distribution O None - Holding Tanks Only Benchmark Elev =* Selection Required ft System Type Benchmark Location; Type of Distribution Media:0Typel OTypell nTypelll □ Type IV OTypeV high capacity chambers 2. SITE EVALUATION: 84 7.0 ftA. Depth to Limiting Layer:inches Elevation of Limiting Layer: 14.0B. Measured Percent Land Slope:%0.0 Medium Sand 0.55C. Soil Texture:Minutes per InchPercolation Rate; 1.20 GPD/ft^D. Soil Hydraulic Loading Rate:E. Contour Loading Rate Gal/ft 3. DESIGN SUMMARY Trench Design Summary 470 ft^12 36Absorption Area Sidewall Depth Trench Widthin in 157 |ft 4Total Lineal Feet 48Number of Ttenches Maximum Trench Depth in 48Designer's Max Trench Depth in Bed Design Summary ft^Absorption Area Media Below Pipe Bed Lengthin ft Bed Width Maximum Bed Depth Designer's Max Bed Depthftin in Mound Design Summary ft=Absorption Area Bed Length Bed Widthft ft Clean Sand LiftAbsorption Width ft ft Berm Width (slope 0-1 %)ft Upslope Berm Width Downslope Berm Widthft Endslope Berm Widthft ft Total System Length Total System Widthft ft At-Grade Design Summary Absorption Bed Width Absorption Bed Lengthft System Heightft ft ft^ Upslope Berm WidthAbsorption Bed Area Downslope Berm Widthft ft Endslope Berm Width System Length System Widthftft ft OSTP Design Summary Worksheet v University OF MinnesotaMinnesota Pollution Control Agency 11.3.28 Pressure Distribution Summary No. of Perforated Laterals Perforation Spacing Perforation Diameterft in Supply Pipe Diameter in Minimum Dose Volume 0Lateral Diameter in Flow Rate Total HeadGPM ft Maximum Dose Volume 175 Holding Tanks Only Number of Holding Tanks Total Volume of Holding Tanks gallons High Level Alarm? ORGANIC LOADING (if pretreatment is being used)4. Organic Loading to Pre-Treatment Unit = Design Flow X Estimated BOD in mg/L in the effluent X 8.35 ■=■ 1,(XX),000 mg/L X 8.35 ^ 1,000,000 =gpd X lbs BOD/day Calculate System Organic Loading: lbs. BOD/day -f Bottom Area = Ibs/day/ft^ Ibs/day/ft^f^ =Ibs/day Comments/Special Design Considerations: I hereby certify that I have completed this work in accordance with alt applicable ordinances, rules and taws. Bill Schueller L2945 06/01/13 (Designer)(Signature)(License #)(Date) \ •OSTP Trench & Bed Design Worksheet University OF MinnesotaMinnesota Pollution Control Agency V 11.3.28 1. SYSTEM SIZING; A. Desisn Flow (Design Sum. 1A):700 48B. Maximum Depth":inchesGPD ‘Depth to limiting condition(Design Sum.2A) ■ 3 ft 3 ft separation may be reduced for Trt. Level A or B D. Required Bottom Area: Design Flow (1.A) ^ Loading Rate (1.C) = Initial Required Bottom Area 1.20 GPD/ft^C. Soil Loading Rate (Design Sum.2D): GPD/ft^=ft^1.20 583700GPD- □ Rock B Other Approved Media □ Pressure (required for rapidly permeable soils) □ Gravity-Drop Box 0 Gravity-Other E. Select Dispersal Media: High Capacity Chambers F. Select Distribution Method: lamber to chamber - serial di; G. Select Dispersal Type: □ Trench - Rock 0 Trench - Registered Product:High capacity chambers □ Bed - Rock □ Bed - Registered Product: 2. TRENCH CONFIGURATION: (Rock or equivalent media) Initial required trench bottom area (ft^): (from 1.D) Sidewall Absorption (inches) A.Design trench bottom area Bottom Area Reduction Bottom Area Multiplier Cover 6 to 11 0%1 583 o...Distribution 12 to 17 20%0.8 467 583 Sidewall18 to 23 34%0.66 385 24 40%0.6 350 Width121.0B. Select Sidewall Height:inches ft ft^470C. Design Bottom Area (2.A): 3.036D. Select Trench Width :inches ft E. Total Designed Trench Length: Bottom Area (2.C) t Trench Width (2.D) = Total Required Trench Length ft^ -i-470 3.0 157ft =ft 10F. Select Trench Spacing :ft (typically 5 - 12 ft from center to center) G. Calculate Lawn Area: Trench Length (2.E) X Trench Spacing (2.F) = ft^ lawn area 157 10 ft^ lawn area1567ft X ft = H. Calculate Minimum length based on Contour Loading Rate: Design Flow(IA) - CLR (Id) = SPd - I. If using rock, select Depth Required to Cover Distribution Pipe: 700.0 #DIV/0!gal/ft ft ft (0.33 for pressure, 0.5 for gravity) scm’iD , 'J. Calculate Media Volume: (Sidewall Height (2.B) + Depth to Cover Pipe (2.1)) X Bottom Area (2.C) = cubic ft. ft^ft^ =1.00 470 470ft) X Divide ft^ by 27 ft^/yd^ to calculate cubic yards: ft +( ft^yd^470 1727 48 4 ft.K. If using a registered product, enter the Component Length:^ 12in. L. Number of Components = Total Length Required (2.E) divided by Component Length (2.K) (Round up) 401574■T 3. BED CONFIGURATION: (for sites with less than 6% slope) 1.0 = pressurized 1.5 =A. Select size Multiplier:gravity (not allowed in rapidly permeable soils) ft^B, Req'd Bottom Area (1.D): ft^Designed Bottom Area: Maximum width = 25 ft. (pressurized) Maximum width = 12 ft. (gravity)ftC. Select Bed Width: D. Calculate Bed Length: Designed Bottom Area (3.B) r- Bed Width (3.C) = Bed Length ft^ V ft =ft E. Select Sidewall Absorption:inches below the pipe =ft 3F. Calculate Media Volume: (Media Depth (3.E) + depth to cover pipe) X Designed Bottom Area (3.B) = ft ft^ =ft'ft)ft X( Calculate Volume in cubic yards: Media volume in cubic feet (3.F) t 27 = cubic yards yd'ft' i 27 = G. If using a registered product, enter the Component Length:T 12 ft.in. H. If using a registered product, enter the Component Width:^ 12 ft.in. I Number of Components per Row = Bed Length (2.E) divided by Component Length (2.K) (Round up) f J. Number of Rows = Bed Width (2.E) divided by Component Width (2.K) (Round up) Adjust Bed Width (3.C) until this number is a whole number T K. Total Number of Components = Number of Components per Row X Number of Rows X OSTP Pump Selection Design Worksheet University OF Minnesota V 11.3.28 Minnesota Pollution Control Agency 1. PUMP CAPACITY I (§) Gravity O PressureA. Pumping to Gravity or Pressure Distribution:Selection required 301. If pumping to gravity enter the gallon per minute of the pump:GPM 2. Is the pump for the treatment system or the collection system: I ^ Treatment System O Collection System 3. If pumping to a pressurized treatment system, what part or type of system: B Soil Treatment Unit □ Media Filter □ Other 4. If pumping to a pressurized distribution system: (Line 11 of Pressure Distribution or Line 10 of Non-Level or enter if Collection System) Selection required GPM 2. HEAD REQUIREMENTS Soil treatment system A po^t of discharge353. Elevation Difference between pump and point of discharge: ft NOTE: IF system is an individual subsurface sewage treatment system, complete steps 4-9. If system is a Collection System, skip steps 4, 5, 7 and 8 and go to Step 10. 54. Distribution Head Loss:ft ft (due to special equipment, etc.)5. Additional Head Loss:hy-Frictiort Loss in Plastic Pipe per 100 ft (C=130)Distribution Head Loss Nominal Pipe DiameterGravity Distribution = Oft Flow Rate fGPMI 1V4 in 2 31Pressure Distribution based on Minimum Average Head Value on Pressure Distribution Worksheet:10 9.11 3.08 1.27 0.31 Minimum Average Head Distribution Head Loss 12 12.77 4.31 1.78 0.441ft5ft1416.99 5.74 2.36 0.582ft6ft 16 7.35 3.03 0.75 0.105ftlOft 18 9.14 3.76 0.93 0.13 2.06. A. Supply Pipe Diameter:in 20 11.11 4.58 1.13 0.16 25 16.79 6.92 1.71 0.24190B. Supply Pipe Length:ft 30 9.69 2.39 0.33 7. Based on Friction Loss in Plastic Pipe per 100ft from Table I:35 12.90 3.18 0.44 40 16.52 4.07 0.57 2.37 ft per 100ft of pipeFriction Loss =45 5.07 0.70 50 6.16 0.868. 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 (6.6) X 1.25 ^ Equivalent Pipe Length 55 7.35 1.02 60 8.63 1.20 65 10.01 1.39190237.5ftX 1.25 ft 70 11.48 1.60 9. Calculate Supply Friction Loss by multiplying Friction Loss Per 100ft (Line 6) by the Equivalent Pipe Length (Line 7) and divide by 100. Supply Friction Loss = 2.37 ft per 100ft 237.5 ft 5.6X100 ft+ OSTP Pump Selection Design Worksheet University OF Minnesota V 11.3.28 Minnesota Pollution Control Agency Equivalent Length Factors (ft.) for PVC Pipe Fittings10. Equivalent length of pipe fittings. Section 10 is for Collection Systems ONLY and does NOT need to be completed for individual subsurface sewage treatment systems. Quantity X Equivalent Length Factor = Equivalent Length Pipe Diameter (in.)Fitting Type 1%2 3 Gate Valve 2.041.07 1.38 90 Deg Elbow 7.674.03 5.17 Equivalent Length Factor Equivalent Length (ft) 45 Deg Elbow 2.15 2.76 4.09QuantityFitting Type Tee - Flow Thru 5.112.68 3.45 Tee - Bl anch Flow 10.30 15.30XGate Valve Swing Check Valve 17.20 25.5013.40 Angle Valve 20.10 25.80 38.40X90 Deg Elbow Globe Valve 45.60 58.60 86.90X45 Deg Elbow Butterfly Valve 7.75 11.50 XTee - Flow Thru XTee ■ Branch Flow NOTE: Equivalent length values for PVC pipe fittings are based on calculations using the Hazen-Williams Equation. See Advanced Designs for SSTS for equation. Other pipe material may require different equivalent length factors. Verify other equivalent length factors with pipe material manufacturer. XSwing Check Valve XAngle Valve XGlobe Valve XButterfly Valve NOTE: System installer should contact system designer if the number of fittings varies from the design to the actual installation. XValve 10 XValve 11 ftA. Sum of Equivalent Length due to pipe fittings: Hazen-Williams Equation for h B. Total Pipe Length = Supply Pipe Length (5.B) + Equivalent Pipe Length (9.A.)10.5hj. =^ Dft +ft =ft 4.87 C. Hazen-Williams friction loss due to pipe fittings and supply pipe (hf); (10.5 i Pipe Diameter'* ®^) X ( Flow Rate -t Constant)' ®^ X Total Pipe Length (10.B) Qin gpm L in feet D in inches C = 130 in^«^) X ( 11. Total Head requirement is the sum of the Elevation Difference (Line 3), the Distribution Head Loss (Line 4), Additional Head Loss (Line 5), and either Supply Friction Loss (Line 9 ), or Friction Loss from the Supply Pipe and Pipe Fittings for collection systems (Line 10.C) NOTE: Supply Friction Loss (Line 8) need ONLY be used if NOT a collection system. NOTE: Friction Loss from the Supply Pipe and Pipe Fittings (Line 9.C) need ONLY be used if system is a collection system. gpm-130)’ “® X(10.5 4 ft ft 35,0 5.0 5.6 45.6 ftftftftft =++ 3. PUMP SELECTION 30 46A pump must be selected to deliver at least GPM (Line 1 or Line 2) with at least feet of total head. Pump typeComments: V 11.3.28\ 'OSTP Pump Tank Sizing, Dosing, Float, and Timer Setting Design Worksheet University OF MinnesotaMinnesota Pollution Control Agency DETERMINE AREA AND/OR GALLONS PER INCH 1. A. Rectangle area = Length (L) X Width (W)Width 41,35.5 7.5X ftft B. Circle area = 3.14r^ (3.14 X radius X radius)■> Length 2 ft^3.14 X ft Radiu!C. Tank model and manufacturer (optional): ft'D. Get area from manufacturer E. Get gallons per inch from manufacturer 2. Calculate Gailons Per Inch: There are 7.48 gallons per cubic foot. Therefore, multiply the area from 1.A, 1.B, or 1.C by 7.48 to determine the gallons per foot the tank holds. Then divide that number by 12 to calculate the gallons per inch. Gallons per inch (Area X 7.48 gallons/ft')/(12 in/ft) = 41.0 ft' X 7.48 gal/ft' f 25.612 in/ft Gallons per inch TANK CAPACITY 10003. Enter the Designed Pump Tank Capacity (minimum provided in the table below);Gallons 4. Calculate Total Tank Volume A. Depth from bottom of inlet pipe to tank bottom:39 in B. Total Tank Volume = Depth from bottom of inlet pipe (Line 4.A) X Gallons/Inch (Line 2) in X 25,6 Gallons Per Inch 996.739 Gallons 5. Calculate Volume to Cover Pump (The inlet of the pump must be at least 4-inches from the bottom of the pump tank ft 2 inches of water covering the pump is recommended) (Pump and block height + 2 inches) X Gallons Per Inch (ID or 2) in + 2 inches) X 25.610 307Gallons Per Inch Gallons DOSING VOLUME 0.06. Minimum Pumpout Volume - 5 X Volume of Distribution Piping:Gallons - Line 17 of the Pressure Distribution or Line 11 of Non-level 7. Calculate Maximum Pumpout Volume (25% of Design Flow) 700 GPD X 1750.25Design Flow:Gallons 1308. Select a pumpout volume that meets both items above (Line 6 & 7): 9. Calculate Doses Per Day = Design Flow t Dosing Volume 700 gpd 4 130 gal = 5?4 10. Calculate Drainback: A. Diameter of Supply Pipe = Gallons Doses 2 inches 190B. Length of Supply Pipe = C. Volume of Liquid Per Lineal Foot of Pipe = D. Drainback = Length of Supply Pipe X Volume of Liquid Per Lineal Foot of Pipe 190 Iftxl 0 170 |gal/ft = feet 0.170 Gallons/ft 32.3 Gallons 11. Total Dosing Volume = Dosing Volume (Line 8) plus Drainback (Line 10.D) 130 gal-r 32.3 gal = 162.3 Gallons 12. Minimum Alarm Volume = Depth of alarm (2 or 3 inches) X gallons per inch of tank (Line 1 or 2) Gallons3in X 25.556667 gal/in 76.67 :■« % ‘V 11.3,28OSTP Pump Tank Sizing, Dosing, Float, and Timer Setting Design Worksheet University OF MinnesotaMinnesota Pollution Control Agency TIMER or DEMAND FLOAT SETTINGS O Tmer @ Demand DoseSelect Timer or Demand Dosing: A. Timer Settings 13. Required Flow Rate: A. From Design (Line 11 of Pressure Distribution or Line 10 of Non-Level*):‘Note: This value must be adjusted after field measurement & calculation. GPM B. Or calculated: GPM = Change in Depth (in) x Gallons Per Inch (Line 1 or 2) / Time Interval in Minutes gal/in Tin X min =GPM 14. Choose a Flow Rate from Line 13.A or 13.B above. 15. Calculate TIMER ON setting: Total Dosing Volume (Line 11)/GPM(Line 14) gal f 16. Calculate TIMER OFF setting: GPM Minutes ONgpm = Minutes Per Day (1440)/Doses Per Day (Line 9) - Minutes On (Line 15) 1440 min f doses/day - 17. Pump Off Float ■ Measuring from bottom of tank; Distance to set Pump Off Float=Callons to Cover Pump (Line 5) / Gallons Per Inch (Line 1 or 2): min Minutes OFF gal/in = 18. Alarm Float - Measuring from bottom of tank: Distance to set Alarm Float = Tank Depth(4A) - Alarm Depth (Line 13) in = gal T Inches in in B. DEAtAND DOSE FLOAT SETTINGS 18. Calculate Float Separation Distance using Dosing Volume. Total Dosing Volume (Line 12)/Gallons Per inch (Line 2) gal T 19. Measuring from bottom of tank: A. Distance to set Pump Off Float = Pump Height + Block Height (Line 5) + Alarm Depth (Line 13) in + B. Distance to set Pump On Float=Distance to Set Pump-Off Float (Line 19.A) *■ Float Separation Distance (Line 18) in + C. Distance to set Alarm Float - Distance to set Pump-On Float (19.B) + Alarm Depth (2-3 inches) in = I 24 [inches 162.3 25.6 6.4gal/in =Inches in = I 15 [inches123 = I 21 [inches156.4 in 21 3.0in + FLOAT SETTINGS DEAAAND DOSING TIAAED DOSING ] _L m Alarm Depth 24 in~]~ Pump On 21 Pump Off 15 in Alarm Depth in 77 Gallons 162.3 Gallons Pump Off in/ s a 383.35 Gallons «*•SITE DATA WORKSHEET LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 218-998-8095 www.co.otter-tail.mn.us Sewage Treatment System Permit #OWNER: LAST NAME FIRST MIDDLE TELEPHONE NUMBER ADDRESS: /SLAJd /IaMA STR./RT.CITY STATE ZIP CODE J, 6<d)3Z77 /3A LAKE/RIVER NO.LAKE NAME SEC.RANGETWP.TWP. NAME LEGAL DESCRIPTION:t /6CA^£^ UrT r, , SOIL BORING LOG COLOR a MUNSELL NO. DEPTH (INCHES)TEXTURE STRUCTURE PLATY PRISMATIC NONE/^/ V/U>AM.S(^ood9907>C^±(^£>I PARCEL NUMBER 3j/d> /U/upA:!BLOCKY PLATY PRISMATIC iPAMi E-911 Address or Directions From Nearest Public Road 7 AAlPi/'Te.S d-NUMBER OF BEDROOMS BLOCKY PLATY PRISMATIC kbCKY PLATY PRISMATIC GARBAGE DISPOSAL: YES WELL: CASING DEPTH~f SEWER LINE SEPARATION:"/ ^ft. FLOODPLAIN: YES BLUFF: YES <55^ VEGETATION: AQUATIC T^RESTRjAb SLOPE AT INSTALLATION SITE: ItT. /Oy/^ OjS BLOCKY PLATY PRISMATIC flNONE^ /y % TYPE OF OBSERVATION: Probe Pit PARENT MATERIAL: ORIGINAL SOIL: No Outwash Loess Bedrock Alluvium Date of Soil Boring. (^)COMPACTED SOIL: Yes zDEPTH OF BORING (To T or restrictive layer):ft.Date of Perc Test PERC TEST #1 PERC TEST #2- TWO TESTS ARE REQUIRED - INTERVAL (MINUTES)WAT^DEPTH WATER PROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE77STARTSTARTrisLTTIMEDROPPERCTIMEDROP PERC TIME INTERVAL (MINUTES!WAT DEPTH WATER DROP PERC RATE w-INTERVAL (MINUTESl WATER DEPTH WATER DROP PERC RATEWifREFILL « REFILL Ll.r/— = DROPTIMEDROPPERCTIME PERC WAT^ DEPTH INTERVAL (MINUTES)WATER DEPTHINTERVAL (MINUTES)WATER DROP PERC RATE TIME WATER DROP PERC RATETIME77VREFILLRffILLS' =_L^.5:.I/-PERC DROP PERCTIMEDROPTIME WATER DEPTH WATER DROP PERC RATEINTERVAL (MINUTESl WA^ DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)oREFILL REFILL I.f TIME DROP PERC TIME DROP PERC WATER DEPTH PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATETIMEINTERVAL (MINUTES)WATER DROP ~C7 kREFILL REFILL 1.DROP PERCTIMEDROPPERCTIME WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATETIMEINTERVAL (MINUTES)REFILL REFILL TIME DROP PERC TIME DROP PERC WATER DEPTH WATER DEPTH WATER DROPINTERVAL (MINUTES)WATER DROP PERC RATE TIME INTERVAL (MINUTES)PERC RATETIME REFILLREFILL -r ^----- =TIME TIME DROP PERCDROPPERC INTERVAL (MINUTESl WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATETIME REFILLREFILL DROP PERCTIMETIMEDROPPERC PROPOSED DESIGN: A PRESSURE DIST..HOLDING TANK. GRAVITY DIST..MOUND.BED.ATGRADE.TRENCH. SPECIFY:.OTHER.OUTHOUSE.SEWER LINE. — SYSTEM DESIGN ON BACK — ' * *System design must be to scale and must include the proposed location of the sewage systern,, alf existing/proposed buildings, property lines, the ordinary high water level of the water body, wetlands, 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 jnch(es) equalsfeet, or feetScale: MPCA LICENSE #: DESIGNED BY:LICENSE CATEGORY: FIRM NAME:DATE:SchueHef's Septic Solutions 23725 240th Avenue Fergus Falls, MN 56537ADDRESS:SIGNATURE: MiAJidUm uJrf5 %T /2' /OCOtAL p — UAT h- 9^/ mo LT7 /V ] ‘/£>' 1 9o' io* 'TAaJ!( ^ Afj M'uJ/U^ u/^c?/d /AJirTA LL^r/£:>/J ^ OUAi' Ai4Q^A'1'}fJ(e> AumAS //J BK — 1003 — 029 315.904 • Victor Lundeen Co., Printers •. Fergus Falls. MN • 1-800-346-4870 Department of LAND AND RESOURCE MANAGEMENT OTTER TAIL COUNTY Government Services Center - 540 West Fir Fergus Falls, MN 56537 PH; 218-998-8095 Otter Tail County’s Website: www.co.ottbr-tail.mn.us 07/25/2013 Blase Bieniek Tst Et Al 21539 Big Island Camp Rd Underwood MN 56586 9576 RE: Primary Owner: Blase Bieniek Tst Et Al Sewage Treatment System Servicing Tax Parcel Number: 58000990362001 Sec 03 Twp Tordenskjold Twp Sect-03 Twp-132 Range-041 THE BIG ISLAND Described as: LOTS 12,21 &22BLK1 LIFE Lake: 56-377 S Turtle As of 07/24/2013 the sewage treatment system (Sewage Treatment Installation Permit # 22283A servicing your property was determined to be in compliance with the provisions of the Sanitation Code of Otter Tail County for a 4 RCU sites. If you have any questions regarding this matter, please contact our office. Sincerely, Mark Ronning Inspector APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095) GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 www.co.otter-tail.mn.usWHITE - Office YELLOW - L & R Inspector PINK - Owner / Contractor (after issue) Permit ^APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED RANGE TWP NAMELAKE/RIVER CLASS ,/fj SECTION TWP NO.LAKE NUMBER LAKE/RIVER NAME 3 PARCEL NUMBER (S) OF PROPERTY BEING SERVICED E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROAD LEGAL DESCRIPTION Daytime Phone No.First Initial Mailing AddressLast Name Property Owner lAA/deY^!>S:06 f MAy Contractor Lie.#aaaJ THIS SPACE FOR OFFICE USE ONLY A.M. P.M., the year of at.>■ This System will be ready lor inspection on AM. P.M. L & R OfficialTime ReceivedDate Received SEWAGE TREATMENT SYSTEM DESIGN DATA AS SHOWN ON DRAWING NSTALLATION (circle one)TYPE OF Collector r Est.Residential (A) New (B) Replacement (C) New (D) Replacement Soil Treatment Area (F) Replacement LiftTank (Gallons/Day)Effluent Distribution () Gravity ( ) Pressure /^oo (3?3S3 Ft.GIsGIsSize (I) 5,000— 10,000 Setback To Nearest Well Ft.50 Ft.Go Ft.Type I Type II 52? (27) Rapidly Permeable(20) Trench, Rock Ft.Ft.Setback To OHWL 'T GO(21) Trench, Gravelless (28) Flood Plain ^) Trench, Chambe^(29) Privies -—- Ft.-------Ft.Ft.Setback To Bluff(30) Holding Tank ( ) Monitoring/Disposal Contract (23) Bed (24) Mound ^Ft.Ft. Ft.Setback To Dwelling Type III(25) At Grade Setback To Non-Dwelling Ft.Ft.Ft.(31) Other/Problem Soils/<12" Soil(26) Greywater Type IV Setback To Nearest Lot Line Ft.Ft.Ft./D/o(32) Public Domain & Proprietary Technologies Depth of ! Setback To Road Right-Of-Way Ft.Ft.Ft.Type VTotal # Bedrooms (33) Performance Elevation Above Restrictive Layer ^ Ft.Ft.Ft.Garbage Disposal Y l(N^Abatement Y / PERC TEST DATA bh//%.Highest RateDate of TestLicense #Designer 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 sixJ6) months. 2.This permit does not include the building sewer (sewer line). oc.OS'-i^L 'ermit Fee $Date: t ^ t 5iqnatur&qf Property Owner/^ent for Ojvq^ ^ ^ \anQ& f^source Managemer)t Official Rec. No..Date: Date StampComment .1 j ‘ 3S 5'u(ct 2,/E/\ /C£4Uia'iSD ■ ^ L&R InitialForm No. BK — 07-2011-06 . 345,197 • Victor Lundeen Co., Printors • Fergus Falls. Minnesota ! I ^ -■APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095) GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 www.co.otter-tail.mn.us I; WHITE - Office YELLOW -L&R Inspector PINK - Owner/ Contractor (after issue) 1 I/I .1 " Permit Nci?S'SAPPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED TWP NO.RANGE TWP NAMELAKE/RIVER CLASS SECTIONLAKE/RIVER NAMELAKE NUMBER ni/drl'U V/('71^-/ E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROADPARCEL NUMBER (S) OF PROPERTY BEING SERVICED /ffij fy y V) ‘^^77/ ■ Z 7 Z7/C' LEGAL DESCRIPTION I~y/L /Zt7^\1 1Daytime Phone No.Initial Mailing AddressFirstLast Name l7la7/cM 'TZYC-f ‘ZcriitProperty Owner •i /o/a/■i i /.rJ/M/d-r ZZx/7.iContractor Lie.#^/^■rrur 'x/7^ THIS SPACE FOR OFFICE USE ONLY r^OR .^:Q0 A.M.¥-P.M., the year of> This System will be ready for inspection on ?'-i0 (gi) Time Received -------CTaly ID, aoi^ Bate Received P.M. L&R Official SEWAGE TREATMENT SYSTEM DESIGN DATA AS SHOWN ON DRAWING NSTALLATION (circle one)TYPE OF Other Est. (E) New (F) Replacement CollectorResidential (A) New (B) Replacement (C) New (D) Replacement Soil Treatment Area LiftTank Effluent Distribution ( ) Gravity ( ) Pressure Design Flow (Gallons/Day) ,tG) 1 — 2,499 (M>-&,&00^=^4,999 (I) 5,000— 10^00 / . GIs y r Ft.GIsSize Setback To Nearest Well y, , Ft., - Ft.Type I Type II (27) Rapidly Permeable(20) Trench, Rock Ft. Ft.Ft.Setback To OHWL(28) Flood Plain(21) Trench, Gravelless --4 (22) Trench, Chamber (29) Privies - - Ft.Ft.Ft.Setback To Bluff(30) Holding Tank ( ) Monitoring/Disposal Contract (23) Bed (24) Mound Ft.Ft.Ft.Setback To Dwelling y' /(25) At Grade Type III Setback To Non-Dwelling Ft.Ft.Ft.(31) Other/Problem Soils/<12“ Soil(26) Greywater .y'y Type IV Setback To Nearest Lot Line Ft.Ft. Ft.//^/'-■//(32) Public Domain & Proprietary Technologies Depth of WellN. Setback To Road Right-Of-Way ' Ft.Ft.Ft.Type VTotal # Bedrooms (33) Performance Elevation Above Restrictive Layer '/ Ft.^ - Ft.Ft.Garbage Disposal Y / N ■Abatement Y / N PERCTEST DATA •/y Highest RateDate of TestLicense # > ■' /Designer 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 j of the applicant for the permit to notify Land & Resource Management that the installation is ready for inspection.■I 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 i upon violation of the Sanitation Code. ;;l NOTE; I.This permit Is valid for a period of six (6) months. 2.This permit does not include the building sewer (sewer line). ' tkC.■; 1/ u , IJ.Signature of Property Owner/Agent tor Owner €an<rA Ffeswne Management Official Permit Fee $Date:1 ■\ Rec. No..Date: /Commenti z I u L Z) /Z/\ Lc /.A z /xtZZd^rfi/ec 0 Form No. BK — 07-2011-06 . 345,197 • Vidor Lundoen Co.. Printers * Fergus Falls, Minnesota V ,» 11 V „ »*SEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTS Inspector must make all measurements SOIL TREATMENT AREA HOEBmCS SEPTIC TANK OUTHOUSELIFT TANKCATEGORY 2 FT FT2Capacity/o^€!>FT2GLS.GLS. FTFTFTSetback from Nearest Well Setback from Buried Water Suction Pipe FTFTFTFT Setback from Buried Pipe Distributing Water Under Pressure FT FT FTFT Ip'^-4 4r ! 'h ft FTSetback from OHWL (lake &/or river)FT FT FTFTSetback from Bluff FT FT / 0-:f- FT FT FTFTSetback from Dwelling ( FT FTFTSetback from Non-Dwelling FT-M J~0 ^5~C»FTSetback from Nearest Property Line FT FT ^ FTFT FTFTSetback from Right-of-Way FT FTElevation above Restrictive Layer FT FT Holding Tank/Lift Alarm NO Old System Pumped & Destroyed YES NO SOIL TREATMENT AREA CALCULATION TRENCH REDUCTIONMOUND/AT-GRADEFILTERSEPTIC TANK(S) # Tanks Installed ROCK BED . -Ruult Ireiidrctl with of sidewall for___ reduction / equivalent tnj^t^O___ft* Soil Treatment Area. inches □ YESManuf.%Ft. X Ft. Ft. Ft*Ft* Inspector's Comments: yJ ^\'Lc^cA~^X-—a Sketch: 0 'o f'5 0 !! : IL\ o (Of i// oSZ W/y if :o ;o 1 Initial/L & R OfficialDateTime Code vt Otter Tail Cour^. the above described sewage system installation was found to be compliant with the provisions of the Sanitation Land A Resource Management Official fiSBFSForm No. BK — 07-2011-06 345,107 • Vtclor LundMn Co.. Prlnleri • Forgut FoHt, MInnocota ^ c4A//'rs OSTP Design Summary Worksheet v University OF MinnesotaMinnctsota Pollution Control Agency 11.3.Z8 Blase Bieniek - Big Island CampgroundProperty Owner/Client: 21539 Big Island Camp Road, Underwood, MN 56586Site Address: 1. AVERAGE DESIGN FLOW: 400 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 Per Day (GPD)A. Design Flow: 1000Septic Tank capacity:GallonsB. 1 OptionalEffluent Screen ft Alarm ?C. Number of Septic Tanks or Compartments: _ Type of Soil Treatment and Dispersal Area*______ Type of Distribution* O Mound O At-Grade ^ Gravity Disbibution O Pressure DistHbution-Levd O Pressure Distribution-Unlevel(§) Trenches O Bed O Drip Disbibution O None - Holding Tanks Only Benchmark Elev =* Selection Required ft System Type Benchmark Location: Type of Distribution Media:STypel nTypell □Typelll □ Type IV DTypeV high capacity chambers 2. SITE EVALUATION: 84 7.0 ftA. Depth to Limiting Layer:inches Elevation of Limiting Layer: 18.0B. Measured Percent Land Slope:%0.0 Medium Sand .80C. Soil Texture:Minutes per InchPercolation Rate: 1.20 GPD/ft^D. Soil Hydraulic Loading Rate:E. Contour Loading Rate Gal/ft 3. DESIGN SUMMARY Trench Design Summary Absorption Area 3^^267 ft^12 36Sidewall Depth Trench Widthin in 89 4Total Lineal Feet Number of Trenches 48Maximum Trench Depth in ClP i 48Designer's Max Trench Depth in Bed Design Summary ft^Absorption Area Media Below Pipe Bed Lengthin ft Bed Width Maximum Bed Depth Designer’s Max Bed Depthftin in Mound Design Summary fl=Absorption Area Bed Length Bed Widthft ft Absorption Width Clean Sand Liftft ft Berm Width (slope 0-1%)ft Upslope Berm Width Downslope Berm Widthft Endslope Berm Widthft ft Total System Length Total System Widthft ft At-Grade Design Summary Absorption Bed Width Absorption Bed Lengthft System Heightft ft ft^ Upslope Berm WidthAbsorption Bed Area Downslope Berm Widthft ft Endslope Berm Width System Lengthft System Widthft ft OSTP Design Summary Worksheet v University OF MinnesotaMinnesota Pollution Control Agency 11.3.28 Pressure Distribution Summary No. of Perforated Laterals Perforation Spacing Perforation Diameterft in Supply Pipe Diameter inLateral Diameter in Minimum Dose Volume Flow Rate Total HeadGPM ft Maximum Dose Volume 100 Holding Tanks Only Total Volume of Holding TanksNumber of Holding Tanks gallons High Level Alarm? ORGANIC LOADING (if pretreatment is being used)4. Organic Loading to Pre-Treatment Unit = Design Flow X Estimated BOD in mg/L in the effluent X 8.35 -f 1,000,000 mg/LX 8.35 ^ 1,000,000 =gpd X lbs BOD/day Calculate System Organic Loading: tbs. BOD/day Bottom Area = Ibs/day/ft^ Ibs/day/ft^ft^ =Ibs/day Comments/Spedal Design Considerations; I hereby certify that I have completed this work in accordance with all applicable ordinances, rules and laws. Bill Schueller L2945 06/01/13 (Designer)(Signature)(License #)(Date) SCANN[D OSTP Trench 6t Bed Design Worksheet University OF MinnesotaMinnesota Pollution Control Agency V 11.3.28 1. SYSTEM SIZING: 400 48A, Design Row (Design Sum. 1A):B. Maximum Depth*: ‘Depth to limiting condition(Design Sum.lA) - 3 ft 3 ft separation may be reduced for Trt. Level A or B D. Required Bottom Area: Design Flow (1.A) ^ Loading Rate (1.C) = Initial Required Bottom Area inchesGPD GPD/ft^1.20C. Soil Loading Rate (Design Sum.2D): GPD/ft^=ft^1.20 333400GPD □ Rock 0 Other Approved Media F. Select Distribution Method: □ Pressure {required for rapidly permeable soils) □ Gravity-Drop Box 0 Gravity-Other E. Select Dispersal Media: High Capacity Chambers lamber to chamber - serial di: G. Select Dispersal Type: □ Trench - Rock 0 Trench - Registered Product:High capacity chambers □ Bed - Rock □ Bed - Registered Product: 2. TRENCH CONFIGURATION: (Rock or equivalent media) Initial required trench bottom area (ft^): (from 1.D) Sidewall Absorption (inches) A.Design trench bottom area Bottom Area Reduction Bottom Area Multiplier jL. Cover 0%6 to 11 1 333 o Distribution 12 to 17 20%0.8 267 333 Sidewall18 to 23 34%0.66 220 0.62440%200 Width121.0B. Select Sidewall Height:inches ft ft^267C. Design Bottom Area (2.A): 3.036inchesD. Select Trench Width :ft E. Total Designed Trench Length: Bottom Area (2.C) ^ Trench Width (2.D) = Total Required Trench Length ft^ -f-267 3.0 89ft =ft 10F. Select Trench Spacing :ft (typically 5 - 12 ft from center to center) G. Calculate Lawn Area: Trench Length (2.E) X Trench Spacing (2.F) = ft^ lawn area 89 10 ft^ lawn area890ft X ft = H. Calculate Minimum length based on Contour Loading Rate: Design Flow(IA) t CLR (Id) = 8Pd - I. If using rock, select Depth Required to Cover Distribution Pipe: 400.0 #DIV/0! ftgal/ft ft (0.33 for pressure, 0.5 for gravity) ^SrANNFO J. Calculate Media Volume: (Sidewall Heisht (2.B) + Depth to Cover Pipe (2.1)) X Bottom Area (2.C) = cubic ft. ft) X I 267 I ft^ 267 Divide ft^ by 27 ftVyd^ to calculate cubic yards: 267 I ft' ^ 27 ft'1.00 ft +( yd'10 48 4 ft.K. If using a registered product, enter the Component Length:T 12in. L. Number of Components = Total Length Required (2.E) divided by Component Length (2.K) (Round up) 89 4T 3. BED CONFIGURATION: (for sites with less than 6% slope) 1.0 = pressurized 1.5 =A. Select size Multiplier:gravity (not allowed in rapidly permeable soils) ft'B, Req'd Bottom Area (1.D): ft'Designed Bottom Area: Maximum width = 25 ft. (pressurized) Maximum width = 12 ft. (gravity)ftC. Select Bed Width: D. Calculate Bed Length: Designed Bottom Area (3.B) ^ Bed Width (3.C) = Bed Length ft'^ft =ft inches below the pipe = F. Calculate Media Volume: (Media Depth (3.E) + depth to cover pipe) X Designed Bottom Area (3.B) = ft' ft' = E. Select Sidewall Absorption:ft ft'ft ft)X( Calculate Volume in cubic yards: Media volume in cubic feet (3.F) -f 27 = cubic yards yd'ft' T 27 = G. If using a registered product, enter the Component Length:T 12in.ft. H. If using a registered product, enter the Component Width:f 12in.ft. I Number of Components per Row = Bed Length (2.E) divided by Component Length (2.K) (Round up) T J. Number of Rows = Bed Width (2.E) divided by Component Width (2.K) (Round up) Adjust Bed Width (3.C) until this number is a whole number T K. Total Number of Components = Number of Components per Row X Number of Rows X V w*^ ■ OSTP Pump Selection Design Worksheet University OF Minnesota V 11.3.28 Minnesota Pollution Control Agency 1. PUMP CAPACITY I (§) Gravity O PressureA. Pumping to Gravity or Pressure Distribution:Selection required 301. If pumping to gravity enter the gallon per minute of the pump:GPM 2. Is the pump for the treatment system or the collection system: I ® Treatment System O Collectbn System 3. If pumping to a pressurized treatment system, what part or type of system: 0 Soil Treatment Unit □ Media Filter □ Other 4. If pumping to a pressurized distribution system: (Line 11 of Pressure Distribution or Line 10 of Non-Level or enter if Collection System) Selection required GPM 2. HEAD REQUIREMENTS 353. Elevation Difference between pump and point of discharge: ft NOTE: IF system is an individual subsurface sewage treatment system, complete steps 4-9. If system is a Collection System, skip steps 4, 5, 7 and 8 and go to Step 10. 54. Distribution Head Loss:ft 5. Additional Head Loss:ft (due to special equipment, etc.)hrFriction Loss in Plastic Pipe per 100 ft (C=130)Distribution Head Loss Nominal Pipe DiameterGravity Distribution = Oft Flow Rate fGPMI IViVA 2 31Pressure Distribution based on Minimum Average HeaKl Value on Pressure Distribution Worksheet:to 9.11 3.08 1.27 0.31 Minimum Average Head Distribution Head Loss 12 12.77 4.31 1.78 0.441ft5ft1416.99 5.74 2.36 0.582ft 6ft 16 7.35 0.753.03 0.105ft10ft 18 9.14 3.76 0.93 0.13 2.06. A. Supply Pipe Diameter:in 20 11.11 4.58 1.13 0.16 25 16.79 6.92 1.71 0.24130B. Supply Pipe Length:ft 30 9.69 2.39 0.33 7. Based on Friction Loss in Plastic Pipe per 100ft from Table I:35 12.90 3.18 0.44 40 16.52 4.07 0.572.37 ft per 100ft of pipeFriction Loss =45 5.07 0.70 50 6.16 0.868. 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 (6.B) X 1.25 = Equivalent Pipe Length 55 1.027.35 60 8.63 1.20 65 10.01 1.39130162.5ftX 1.25 ft 70 11.48 1.60 9. Calculate Supply Friction Loss by multiplying Friction Loss Per 100ft (Line 6) by the Equivalent Pipe Length (Line 7) and divide by 100. Supply Friction Loss = 2.37 ft per 100ft 162.5 3.9ftX100 ft OSTP Pump Selection Design Worksheet University OF Minnesota V 11 3 28 Minnesota Pollution Control Agency Equivalent Length Factors (ft.) for PVC Pipe Fittings10. Equivalent length of pipe fittings. Section 10 is for Collection Systems ONLY and does NOT need to be completed for individual subsurface sewage treatment systems. Quantity X Equivalent Length Factor = Equivalent Length Pipe Diameter (in.)Fitting Type 2 3 Gate Valve 1.07 1.38 2.04 90 Deg Elbow 4.03 5.17 7.67 Equivalent Length (ft) Equivalent Length Factor 2.15 2.76 4.0945 Deg ElbowFitting Type Quantity Tee - Flow Thru 2.68 3.45 5.11 10.30 15.30Tee - Branch Flow 8^ XGate Valve Swing Check Valve 25.5013.40 17.20 Angle Valve 20.10 25.80 38.40X90 Deg Elbow Globe Valve 58.60 86.9045.60X45 Deg Elbow Butterfly Valve 7.75 11.50 XTee - Flow Thru XTee - Branch Flow NOTE: Equivalent length values for PVC pipe fittings are based on calculations using the Hazen-Williams Equation. See Advanced Designs for SSTS for equation. Other pipe material may require different equivalent length factors. Verify other equivalent length factors with pipe material manufacturer. XSwing Check Valve XAngle Valve XGlobe Valve XButterfly Valve NOTE: System installer should contact system designer if the number of fittings varies from the design to the actual installation. XValve 10 XValve 11 ftA. Sum of Equivalent Length due to pipe fittings: Hazen-Williams Equation for h B. Total Pipe Length = Supply Pipe Length (5.B) + Equivalent Pipe Length (9.A.)10.5 *Lh. =^ Dft +ft =ft 4.87 C. Hazen-Williams friction loss due to pipe fittings and supply pipe (hf): (10.5 * Pipe Diameter"' *^) X ( Flow Rate 4 Constant)' *^ X Total Pipe Length (10.B) Q in gpm Lin feet D in inches C = 130 in“ ®" ) X (gpm -r 130)' *® X(10.5 4 ft ft 11. Total Head requirement is the sum of the Elevation Difference (Line 3), the Distribution Head Loss (Line 4), Additional Head Loss (Line 5), and either Supply Friction Loss (Line 9 ), or Friction Loss from the Supply Pipe and Pipe Fittings for collection systems (Line 10.C) NOTE: Supply Friction Loss (Line 8) need ONLY be used if NOT a collection system. NOTE: Friction Loss from the Supply Pipe and Pipe Fittings (Line 9.C) need ONLY be used if system is a collection system. 5.0 3.935.0 43.9ftftftft =ft++ 3. PUMP SELECTION 30 44 feet of total head.A pump must be selected to deliver at least GPM (Line 1 or Line 2) with at least Pump typeComments: V 11.3.28OSTP Pump Tank Sizing, Dosing, Float, and Timer Setting Design Worksheet University OF MinnesotaMinnesota Pollution Control Agency DETERMINE AREA AND/OR GALLONS PER INCH 1. A. Rectangle area = Length (L) X Width (W)Width 20.0 ft'4.0 5.0X ftft s B. Circle area = 3.141^ (3.14 X radius X radius)♦Length 2 ft'3.14 X ft C. Tank model and manufacturer (optional): ft'D. Get area from manufacturer Gallons per inchE. Get gallons per inch from manufacturer 2. Calculate Gallons Per Inch: There are 7.48 gallons f>er cubic foot. Therefore, multiply the area from 1 .A, 1 .B, or 1 .C by 7.48 to determine the gallons per foot the tank holds. Then divide that number by 12 to calculate tbe gallons per inch. (Area X 7.48 gallons/ft')/(12 in/ft) = 20.0 ft' X 7.48 gal/ft' V 12.512 in/ft Gallons per inch~ TANK CAPACITY 5003. Enter the Designed Pump Tank Capacity (minimum provided in the table below):Gallons 4. Calculate Total Tank Volume A. Depth from bottom of inlet pipe to tank bottom:39 in B. Total Tank Volume = Depth from bottom of inlet pipe (Line 4.A) X Galtons/lnch (Line 2) Gallons Per Inch3912.5 486.2Xin Gallons 5. Calculate Volume to Cover Pump (The inlet of the pump must be at least 4-inches from the bottom of the pump tank & 2 inches of water covering the pump is recommended) (Pump and block height + 2 inches) X Gallons Per Inch (ID or 2) in + 2 inches) X3 12.5 62Gallons Per Inch Gallons( DOSING VOLUAAE 0.06. Minimum Pumpout Volume - 5 X Volume of Distribution Piping: - Line 17 of the Pressure Distribution or Line 11 of Non-level Gallons 7. Calculate Maximum Pumpout Volume (25% of Design Flow) 400 GPD X 1000.25Design Flow:Gallons 808. Select a pumpout volume that meets both items above (Line 6 ft 7): 9. Calculate Doses Per Day = Design Flow t Dosing Volume 400 gpd -r 80 gal = 5.0 10. Calculate Drainback: A. Diameter of Supply Pipe = Gallons Doses 2 inches 130B. Length of Supply Pipe = C. Volume of Liquid Per Lineal Foot of Pipe = D. Drainback = Length of Supply Pipe X Volume of Liquid Per Lineal Foot of Pipe 130 ft X 0.170 Igal/ft = feet 0.170 Gallons/ft 22.1 Gallons 11. Total Dosing Volume = Dosing Volume (Line 8) plus Drainback (Line 10.D) Gallons8022.1 102.1gal +gal = SCANNED12. Minimum Alarm Volume = Depth of alarm (2 or 3 inches) X gallons per inch of tank (Line 1 or 2) 37.4 Gallons3in X 12.466667 gal/in V 11.3.281, OSTP Pump Tank Sizing, Dosing, Float, and Timer Setting Design Worksheet University OF MinnesotaMinnesota Pollution Control Agency TIMER or DEAAAND FLOAT SETTINGS O Timer ® Demand DoseSelect Timer or Demand Dosing; A. Timer Settings 13. Required Flow Rate: A. From Design (Line 11 of Pressure Distribution or Line 10 of Non-Level*):'Note: This value must be adjusted after field measurement 6 calculation. GPM B. Or calculated: GPM = Change in Depth (in) x Gallons Per Inch (Line 1 or 2) / Time Interval in Minutes gal/in T min =GPMin X 14. Choose a Flow Rate from Line 13.A or 13.B above.GPM 15. Calculate TIMER ON setting: Total Dosins Volume (Line 11)/CPM(Line 14) gal V Minutes ONgpm = 16. Calculate TIMER OFF setting: Minutes Per Day (1440)/Doses Per Day (Line 9) - Minutes On (Line 15) 1440 min doses/day - 17. Pump Off Float - Measuring from bottom of tank: Distance to set Pump Off Float=Gallons to Cover Pump (Line 5) / Gallons Per Inch (Line 1 or 2): min Minutes OFF gal/in = ___________ 18. Alarm Float - Measuring from bottom of tank: Distance to set Alarm Float = Tank Depth(4A) - Alarm Depth (Line 13) in = gal 4 Inches in in B. DEMAND DOSE FLOAT SETTINGS 18. Calculate Float Seporot/on Distance using Dosing Volume. Total Dosing Volume (Line 12)/Gallons Per Inch (Line 2) gal T 19. Measuring from bottom of tank: A. Distance to set Pump Off Float = Pump Height + Block Height (Line 5) + Alarm Depth (Line 13) 8 ^Inches B. Distance to set Pump On Float=Distance to Set Pump-Off Float (Line 19. A) + Float Separation Distance (Line 18) 16 I Inches C. Distance to set Alarm Float = Distance to set Pump-On Float (19.B) + Alarm Depth (2-3 inches) in = I 19 [inches 102.1 12.5 8.2gal/in =Inches 5 3in +in = 8 8.2in +in = 16 3.0in + FLOAT SETTINGS DEMAND DOSING TIMED DOSING ]] |T_ Alarm Depth 19 in Pump On 16''' Pump Off 8 in Alarm Depth in 37 Gallons 102.1 Gallons Pump Off in i! A'333333333333G SITE DATA WORKSHEET LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 218-998-8095 www.co.otter-tail.mn.us Z^3j\Sewage Treatment System Permit #OWNER: €'T At' FIRSTLAST NAME MIDDLE TELEPHONE NUMBER ADDRESS: MjJ/3LA/Jd STR./RT CITY J. /^A LAKE NAME STATE ZIP CODE fz5ZM. LAKE/RIVER NO.SEC. TWP.RANGE TWP. NAME LEGAL DESCRIPTION:SOIL BORING LOG iPT/'i., A. .COLOR a MUNSELL NO. DEPTH (INCHES)TEXTURE STRUCTURE/ PLATY PRISMATIC __NONE StOCxV PLATY PRISMATIC NONE 6e>oc3o^9o 3 h o-^IMMPARCEL NUMBER ?^}f^ 3? S/^ /6LA^Z AA/UA A6.6A£>mPaJ E-911 Address or Directions From Nearest Public Road 4 ^NUMBER OF BEDROOMS BLOCKY PLATY PRISMATIC rigOSb GARBAGE DISPOSAL: YES ft. SEWER LINE SEPARATION: FLOODPLAIN; YES BLUFF: YES VEGETATION: AQUATIC (^ERREST^^ WELL; CASING DEPTH /Dyz z/y BLOCKY PLATY PRISMATIC ^'j^ONE) 5rOJi BLOCKY PLATY PRISMATIC NONE SLOPE AT INSTALLATION SITE;% TYPE OF OBSERVATION: Probe Pit PARENT MATERIAL: ORIGINAL SOIL: (^Z) No Outwash Loess Bedrock Alluvium Date of Soil Boring, <£)COMPACTED SOIL: Yes 7_DEPTH OF BORING (To 7' or restrictive layer):.ft.Date of Perc Test PERC TEST # 1 PERC TEST #2- TWO TESTS ARE REQUIRED - WATE^EPTH WATER DROP PERC RATE INTERVAL [MINUTESi WAT^DEPTHTIMEINTERVAL [MINUTES)TIME WATER DROP PERC RATE77 sr _ START START5 /TIME DROP PERC TIME DROP PERC INTERVAL(MINUTES!WAT^DEPTH WATER DROP PERC RATE WATpjPEPTHTIMETIMEINTERVAL (MINUTES)WATER DROP PERC RATE017REFiaREFia3- ,0k?S’./././DROP PERC PERCTIME TIME DROP WATE^EPTH WATER DROP INTERVAL (MINUTES)WATER DEPTHE TIME INTERVAL (MINUTES)PERC RATE TIME WATER DROP PERC RATE77REFILLREFiair/W-TIME DROP PERC DROPTIME PERC INTERVAL (MINUTES)WATE^EPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATETIME o REFia REFILL 1.TIME DROP PERC TIME DROP PERC TIME WATER DEPTH PERC RATETIMEINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE INTERVAL (MINUTES)WATER DROPT7REFILLREFia T .D.TIME DROP PERCTIMEDROPPERC PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATETIMEINTERVAL (MINUTES)WATER DEPTH WATER DROP REFILLREFia TIME DROP PERC TIME DROP PERC WATER DEPTHINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DROP PERC RATETIME REFILLREFILL DROPTIMEDROPPERCTIME PERC TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATETIME REFILLREFia TIME DROP PERCDROPPERCTIME PROPOSED DESIGN: s/HOLDING TANK GRAVITY DIST..MOUND.ATGRADE.BED.TRENCH. SPECIFY:________________ — SYSTEM DESIGN ON BACK — OTHER.OUTHOUSE.SEWER LINE. 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, wetlands, bluff and all water wells within 150' of the sewage system. If there are any questions, see the University of Minnesota Site Evaluation worksheets. ^1 ' inch(es) equals '^O feetgrid(s) equalsScale:feet, or MPCA LICENSE #: LICENSE CATEGORY: SIGNATURE: DESIGNED BY: FIRM NAME: ADDRESS: DATE:SchueHers Sepfc Solutions 23725 240tti Avenue Fergus Falls, MN 56537 ■] sUOiLO \\ LAH^ \ APLAbH T^aJK I - X CTI /OOOML IL UAT /^£>rc\ U^O/J d^MAUT/P/U ^ AUl'UKJim/Jh hlMPi A A/: /V L/fr BK — 1003 - 029 315,904 • Victor Lundeen Co.. Printers •. Fergus Falls, MN • 1-800-346-4870 APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE 121 W. JUNIUS AVE. • SUITE 130 Phone:(218) 739-2271 • FERGUS FALLS, MN 56537 WHITE - Office YELLOW -L&R Inspector PINK - Owner / Contractor APPLICATION MUST BE COMPLETE IN ORDER TO BE PROCESSED Permit No. SECTION TWP NO.RANGELAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS TWP NAME I s, rT/2ri(f (J-L. \ HfJ PARCEL NUMBER (S) OF PROPERTY BEING SERVICED E-911 ADDRESS 5^S'Ooo^?oJCz. Ooo Ip- A —S LEGAL DESCRIPTION Daytime Phone No.Initial Mailing AddressLast Name First P//f/L/jA^i) cAfliP R.L ______rsr Property Owner Contractor Lie. HI A.M. the year of P.M.>■ This System will be ready for inspection on_.at. This space for office use only A.M. P.M. L&R OfficialTime ReceivedDate Received SEWAGE TREATMENT SYSTEM DESIGN DATATYPE OF INSTALLATION (CIRCLE ONE) DRAINFIELDTANK 7 FfGIs.SizeAdd-On/ Replacement (32) Tank, Septic (33) Tank, Lift (34) Trench, Rock (35) Trench, Graveiless (36) Trench, Chamber (37) Bed (38) Mound (39) At Grade (40) Combination New System (20) Trench, Rock (21) Trench, Gravelless (22) Trench, Chamber (23) Bed (24) Mound (25) At Grade Setback to nearest well ■X. ■X. Ft. Ft.Setback to OHWL (lake &/or river) Ft.Ft.Setback to wetland Setback to dwelling Ft.Ft.Collector System (26) Trench, Rock (27) Trench, Gravelless (28) Trench, Chamber (29) Bed (30) Mound (30) At Grade Ft. Ft.Setback to non-dwelling Ft.,Ft.Setback to nearest property lineOther (41) Tank, Holding (42) Outhouse <S3J>Sewer Line (44) Performance (45) Warrantied (46) Miscellaneous Ft.Setback to road right-of-way ■X. Ft.Ft.Elevation above restrictive layer ALL DISTANCES ARE SHORTEST DISTANCE BETWEEN NEAREST POINTS. ABSORPTION AREA FI lUNDS#BEDROOMSDEPTH OF WATER WELL GARBAGE^lSP-r/ SI EMEffT Y / N Ft 2HOLDING TANK MONITOR/ DISPOSAL CONTRACT ( )Yes^^^ ( ) N(R&R Can Not Process ABATEFFLUENTDISTRIBUTION (X) Gravity ( ) Pressure •Designer____ Designer Lie. # PERCOLATION TEST DATA Highest RateDate 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 accordance 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 con dition 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: This permit is valid for a period of six (6) months. A copy of the final Inspection Report wilTherve as thef^ertificate{(Li of Compliance for approved installations. c7 0Is j(Permit Fee $Date: Signature of Property Owner/Aaent for Owner X Rec. No.Date: Laf!d& Re^urce Management Office Comments: 305,392 • Victor Lundeen Co,. Printers • Fergus Falls, MinnesotaForm No. BK — 0201-003 \PPLiCAriONTOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENTOTTER TAIL COUNTY COURT HOUSE 121 W. JUNIUS AVE. • SUITE 130 Phone:(218)739-2271 • FERGUS FALLS, MN 56537 WHITE - Office YELLOW -L&R lm=oector PINK - Owner / Contractor -^Jj "ermit No.p.iAPPLICATION MUST BE COMPLETE IN ORDER TO BE PROCESSED TWP NO.RANGE TWP NAMESECTIONLAKE/RIVER CLASSLAKE/RIVER NAMELAKE NUMBER LMfi (ft E-911 ADDRESSPARCEL NUMBER (S) OF PROPERTY BEING SERVICED 0/c~ ts^A/^h PO^oj9oX:z. Ooo LEGAL DESCRIPTION 1' Daytime Phone No.Mailing AddressFirst InitialLast Name i^/cL /sAA/^o cA/^yJa(liGFA^ieU ______T^T /!l^ Property Owner /y/l/0 o a Q . '^(^S'ir'L Contractor Lic.« A.M.JLqo /the year of at>■ This System will be ready for inspection on. This space for office pse only P.M.0'A L&R OfficialTime Receivedlate Received SEWAGE TREATMENT SYSTEM DESIGN DATATYPE OF INSTALLATION (CIRCLE ONE) DRAINFIELDTANKT Ft“GIs.^SizeAdd-On/New System (20) Trench, Rock (21) Trench, Gravelless (22) Trench, Chamber (23) Bed (24) Mound (25) At Grade Replacement (32) Tank, Septic (33) Tank, Lift (34) Trench, Rock (35) Trench, Gravelless (36) Trench, Chamber (37) Bed (38) Mound (39) At Grade (40) Combination /Ft.Ft.Setback to nearest well /f Ft.Ft.Setback to OHWL (lake &/or river)/, i Ft. Ft.Setback to wetland '■C'v Ft.Ft.Setback to dwelling aCollector System (26) Trench, Rock (27) Trench, Gravelless (28) Trench, Chamber (29) Bed (30) Mound (30) At Grade Ft.Ft.Setback to non-dwelling Ft.,Ft.Setback to nearest property lineOther (41) Tank, Holding (42) Outhouse ;'(43) Sewer Line (44) Performance (45) Warrantied (46) Miscellaneous Ft.Setback to road right-of-way ■X. Ft.Ft.Elevation above restrictive layer ALL DISTANCES ARE SHORTEST DISTANCE BETWEEN NEAREST POINTS. ABSORPTION AREA FQR MOUNDS# BEDROOMS ^ ^ GARBAGE DISP^/ N ABATEMEf^T Y / N DEPTH OF WATER WELL DC Ft^HOLDING TANK MONITOR/ DISPOSAL CONTRACT ( )Yes ( ) No-L&R Can Not Process EFFLUENT DISTRIBUTION ( >■■) Gravity ( ) Pressure ■Designer____ Designer Lie. #. PERCOLATION TEST DATA Highest RateDate 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 accordance 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 con dition 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: This permit is valid for a period of six (6) months. A copy of the final Inspection Report will serve as the Certificate of Compiiance for approved installations. Permit Fee $Date:,/-• Signature of Property Owner/Aaent for Owner Rec. No.Date: Lat^ & Pe^urce Management Office ■y ■- sitiyP /t ~ c <Y/-' ^4. jv \Comments: -y 305,392 • Victor Lundeen Co.. Printers • Fergus Falls. MinnesotaForm No. BK — 0201-003 SEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTST Inspector must make all measurements HOLDING SEPTIC TANK OUTHOUSEDRAINFIELDLIFT TANKCATEGORY Capacity FT* FT*GLS. GLS. FTFT FT FTSetback from Nearest Well Setback from Buried Water Suction Pipe FTFTFT FT Setback from Buried Pipe Distributing Water Under Pressure FTFTFTFT Setback from OHWL (lake &/or river)FT FTFT FT Setback from Setback from Wetland FT FT FT FTz Setback from Dwelling FTFTFT FTSetback from Non-Dwelling ^FTFT FT //I ) ^<r FTSetback from Nearest Property Line FT FT FT Setback from Right-of-Way FT FTFT FT Elevation above Restrictive Layer FT FTFT FT Holding Tank/Lift Alarm YES NO Old System Pumped & Destroyed YES NO SEPTIC TANK FILTER Sewer Line to Well Separation DRAINFIELD CALCULATION /■^Cr'Actual Minimum FTX□ YESyManuf., .ft^Model #.□ NO FTFT20 MOUND CALCULATION MOUND /AT-GRADE ROCK REDUCTION Inspector’s Comments:. TO /g(Z (S')ABSORBTION AREA Rock trenches with inches of rock under pipe for %Ft. X ft* DRreduction / equivalent toFt2II Aa SKETCH: A o » > iob- /7/0 IAs of the Sewage Treatment System serving the previously described property is approved for use. »>*»-> Date Land & Resource Nt^agement OfficialInitial Time \Copy of Inspection Report Mailed to Applicant L & R Official / Date 0 ■ APPLICATiCnTFOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENTOTTER TAIL COUNTY COURT HOUSE 121 W. JUNIUS AVE. • SUITE 130 Phone: (218) 739-2271 • FERGUS FALLS, MN 56537 APPLICATION MUST BE COMPLETE IN ORDER TO BE PROCESSED WHITE - Office YELLOW -L&R Inf^qector PINK - Owner / Contractor I Permit No. LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS SECTION TWP NO.RANGE TWP NAME Sv~^77 S',/ / fO^D^A’ ^ hi AJ!&0 L/3L. PARCEL NUMBER (S) OF PROPERTY BEING SERVICED E-911 ADDRESS jr ^ojo'J'9oJC;z, ooo B/6-ISi-A/^r. vA/yiA'fiO LEG'LL DESCRIPTION ! P-~ ^ A ~~S~ O ('i 7'^-j 7zJ Last Name First Initial Mailing Address Daytime Phone No. Pif 0/Q. CAfli/^ PLProperty Owner rKi(^Aji£kL ______rsr Al^/y{A/0£/^u9ooO ^ fSAp'Contractor I Lie.# z\ y A.M.z.2-00 />• This System will be ready lor inspection on.the year of This space for Mice use only 0 P.M. late Received Time Received L&R Official SEWAGE TREATMENT SYSTEM DESIGN DATATYPE OF INSTALLATION (CIRCLE ONE) DRAINFIELDTANK Ft'’Size GIs.,Add-On/New System (20) Trench, Rock (21) Trench, Gravelless : (22) Trench, Chamber (23) Bed (24) Mound (25) At Grade /Replacement (32) Tank, Septic (33) Tank, Lift (34) Trench, Rock (35) Trench, Gravelless (36) Trench, Chamber (37) Bed (38) Mound (39) At Grade (40) Combination Setback to nearest well Ft./Ft./ /Setback to OHWL (lake &/or river)Ft.Ft./y;//Setback to wetland Ft.Ft./ / Setback to dwelling Ft. Ft./Collector System (26) Trench, Rock (27) Trench, Gravelless (28) Trench, Chamber (29) Bed (30) Mound (30) At Grade Setback to non-dwelling Ft. Ft. u-Setback to nearest property line Ft.Ft..Other (41) Tank, Holding (42) Outhouse ^PpttSewer Line (44) Performance (45) Warrantied (46) Miscellaneous 2Setback to road right-of-way Ft. 7Elevation above restrictive layer Ft.Ft. ALL DISTANCES ARE SHORTEST DISTANCE BETWEEN NEAREST POINTS. DEPTH OF WATER WELL ft BEDROOMS . GARBAGEglSR^/ N ABAT&MEIOt Y / N ABSORPTION AREA FQB..MOUNDS Ft 2EFFLUENT DISTRIBUTION (X) Gravity ( ) Pressure HOLDING TANK MONITOR/ DISPOSAL CONTRACT ( ( ) tkR&R Can Not Process ■0esigner____ Designer Lie. #. PERCOLATION TEST DATA Date of Test Highest Rate 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 accordance 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 con dition 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: This permit is valid for a period of six (6) months. A copy of the final Inspection Report wifT^rve as therTfertificate of Compliance for approved Installations. o O3^ —Permit Fee $Date: Signature of Property Owner/Aaent tor Owner La^& Resource Management Office 3311// Rec. No. / Comments: J-U i > 7 ~ irm No. BK — 0201-003 305,392 • Victor Lundeen Co.. Printers • Fergus Falls, Minnesota ■ SEWAGE TREATMENT SYSTEM PE.RMIT INSPECTION RESULio Inspector must make all measurements HOLDING SEPTIC TANK OUTHOUSEDRAINFIELOLIFT TANKCATEGORY ■r Capacity FT2 FT2GLS.GLS. FT FTSetback from Nearest Well FT FT Setback from Buried Water Suction Pipe FT FT FT FT Setback from Buried Pipe Distributing Water Under Pressure FT FT FT FT Setback from OHWL (lake &/or river) FT FT FT FT Setback from Setback from Wetland FT FT FT FTa/y ' . FTSetback from Dwelling FT FT FT Setback from Non-Dvyelling FT FT FT FT Setback from Nearest Property Line FT FT FT FT Setback from Right-of-Way FT FT FT FT Elevation above Restrictive Layer FT FT FT FT folding Tank/Lift Alarm YES NO )ld System Pumped & Destroyed YES NO SEPTIC TANK FILTER Sewer Line to Well Separation DRAINFIELO CALCULATION Actual Minimum >■ IA''I FTX□ YESManuf..!/ ^odel #□ NO FT FT20 MOUND CALCULATION MOUND /AT-GRADE ROCK REDUCTIONispector's Comments: ^ yo /2u s.y ABSORBTION AREA Rock trenches with inches7/ of rock under pipe for %Ft. X Ft 1 i .. -T . .,7-DF.reduction / equivalent toFP KETCH: .r. \ > A the Sewage Treatment Oyster i serving the previously described property is approver' for use Uj\iI Initial Land & Resource Management OfficialDate Time m Hohju\-v' a'y.> Copy of Inspection Report Mailed to Applica*'V L 4 R Official / Data^ ■ t ■I 1 4 1 ! I i^jy i !97i i'/ci (0 ^T/OP Jufet. ' / OOOST 3 //S^ ■4- Z^uaJ^/t»w-( 5/’r¥ /oS-7^ / 9 9C. H S^/S^CD /y^?r ^"O 6? ^ f2i/ S tXx^IH"Jo -<3-0^-^) A^o -5/'^/A-t>rr^/W 5" leo s /o^y ^ ^ro /o ;jup ~ S/^i¥-/o^^^~ r^ /r^/^ ^ 3 ^ >u^ //^77 '2- <^-e£^ /^/o-a^ 0 y :j^ /21/ i/^111 ic P r X 'I.! OiOViO ! V' !97i %3 //S”^ (o :r^p sJz^ ■ pp /o P(m^ t 4-/ov^.-■; S/^i^ /otys' / ooo ST^"6 o t-t/^T J 9 9G / 9^ H EyP (\/r9r 3"G^ L/^r~ ''. •k' /2l/ ; ,:.yJoj /^O ’i' 7^ JO - l’- 7 7 ;^ aXP /Tyrp,. J V- 1 >-/'o/^^0 \ J — T<^-^ /r^/z- ■fiV ■i-r i :j^ V i , v:/2.I/1^ pfl■i' -., r 2^Jj^5C :-: ... I i 1 1 1,fF 6> i rs: o I 7 i f y'> / Ck -t D 8 i 4I ■i!Q ] *\ !; i ■ ■■I ! ; 41^1 / 0 \ \ *.i\ \ i —r-.4^:;y^ (v 'y 1'^ :■ iy‘jfc ■Ifc i ’'■■•'■‘-'■‘■S- V*; ,, ^ -'o E /h: i •i;<fj .)j||ffi:-"--V9_•■* V*.f ■•• I ii ■’it I !t i I i ;! i !1- . ’ ' I® TJ'V ■ \-y<!r ■ i iuil i ‘*, -■■11 I • \ APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM % ^ WHITE — C^iceYellow -- Inspector Pink — Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218)739-2271 - FERGUS FALLS, MN 56537 7/^77C LEGAL Permit No. DESCRIPTION Abatement: (AND LOCATION LAKE NUMBER LAKE/RIVER NAME SECTIONLAKE/RIVER CLASSkh RANGETWP. NO.TWP NAME 3 j -hO- V7 PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER 0 OoO IDENTIFICATION: Please Print All Information Last Name First Initial Mailing Address — No. Street, City and State Zip Code Telephone No. ^OtP'b ^ /14 a) Property Owner 1 /h^rrSewage System Installer Name A.M. ► This System will be ready for inspection on , 19.P.M.at This space for office use oniy 3NUMBER OF BEDROOMS: A.M. (>C^YESP.M19 ( )N0GARBAGE DISPOSAL:Date Rec'd Time Rec'd Phone Call Rec'd By SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) Septic tank ( ) Lift Station (Alarm required) ) Drain field (^) Trenches ( ) Bed ( ) Mound ( ) Outhouse (^<^ Sewer liny -fQ TANK DRAIN FIELD Capacity SqFt./OOP /Soo GIs. Distance from nearest well Ft.SO Ft. Distance from lake or stream ■7S Ft.Ft.■7^ foAo/ oDistance from building Ft.Ft. Distance from property line /o Ft.Ft.!0 3>Distance from bottom to Water Table Ft.Ft. EFFLUENT DISTRIBUTION (^) Gravity ( ) Pressure Mi distances are shortest distance between nearest points PERCOLATION TEST DATA: WATER WELL DEPTH Perc Tester.Date of Perc Test IZ7//. ^ Rate of 1st Test Rate of 2nd Test Average Rate Agreement: The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in strict accordance with Ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minnesota Department of Health. Applicant agrees that plot plan sketches and specifications submitted herewith and which are approved by Shoreland Management Officical 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 responsibilty of the applicant for the permit to notify the County Shoreland Management that the job is re33dyv^or inspection. (T77DATE: Signature Permit: Permission is hereby granted to the above named applicant to perform tfhe work described in thp^bov^tat^ent. This p^^i^it is granted upon express condition that the person to whom it is granted, and his agent, employees and workmen shall confqj This permit may be revoked at any time upon violation of any said ordinances. /y' NOTE: Permit void if work is not commenced within six (6) months. jT /. \er all u lect^to the Ordinance of Otter Tail County, Minnesota. Issued Date:% (X>Land^^pg^urce Management OfficeSSFee $.Rec #. Comments: 277.212 • Victor Lundeen Co . Printers • Fergus Falls. MinreostaBK 0796-003 . fSystenT 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 and all water wells within 150' of the sewage system. GRID PLOT PLAN feet SKETCHING FORM / Scale:.grid(s) equals jnch(es) equals 7feet, or SIGNATURE; . DATE: ■ J75 SUBMITTED BY: FIRM NAME: /I S'A-. ^ -ADDRESS:MPCA LICENSE #: /A -5 V < ^ /LICENSE CATEGORY: jOO * ...■-■t- c ‘‘ ISci/ / /3^4 .I 7 -lOo» 4r die’s ^A po pu t ^ P t.j/ vf TBK - 0496 > 029 281.183 • Victor Lundeen Co.. Printer! • Fergus Falls. MN • 1-800-346-4670 SITE DATA r , LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, MN 56537 OWNER: c LAST NAME FIRST MIDDLE TELEPHONE NUMBER ADDRESS:}) /*<r A STR/RT CITY STATE ZIP CODE 3■rr c'/. LAKE/RIVER NO.LAKE NAME SEC.TWP.RANGE TWP. NAME LEGAL DESCRIPTION:SOIL BORING LOG COLOR & MUNSELLNO. DEPTH (INCHES)TEXTURE STRUCTURE BLOCKY PLATY PRISMATIC NONEPARCEL NUMBER J BLOCKY PLATY PRISMATIC NONE FIRE NUMBER 3NUMBER OF BEDROOMS BLOCKY' PLATY PRISMATIC NONE "4^ GARBAGE DISPOSAL: J^S'’ NO WELL CASING DEPTH: p / (^Nb‘ VEGETATION: AQUATIC TERRESTRIAL ;j ft. BLOCKY ~ 'PLATY PRISMATIC NONE FLOODPLAIN: YES BLOCKY PLATY PRISMATIC NONE SLOPE AT INSTALLATION SITE:% TYPE OF OBSERVATION: Probe Pit Boring PARENT MATERIAL: ^’iir:; Outwash Loess Bedrock Alluvium COMMENTS:, X- /<"ORIGINAL SOIL: No fZ/Z /jc-^/PCOMPACTED SOIL;Yes No -;:r" DEPTH OF BORING:.ft. PERC TEST #1 PERC TEST #2- TWO TESTS ARE REQUIRED - WATgR DEPTHTIMEINTERVAL tMtNUTES)WATER DROP PERC RATE TIME INTERVAL <MINUTES>WATER DEPTH WATER DROP PERC RATE77^ZZIL jZcA-l.Z•7 ...yy...START "7^/XJ.C,:r.*“perTTIME DROP TIME DROP PERCTIMEINTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATE TIME INTERVAL IMINUTESI WATER DEPTH WATER DROP PERC RATEjyyjrn7___1-1—nREFia,zl^JL=L1 TIME DROP -oU:o■.L(PERC TIME DROP PERCTIME JryT-.INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE-j-2— I V REFIU7 1-Z--•'7 /6/srTIMEDROPPERCTIMEDROP PERCTIMEINTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEREFiaREFILL TIME DROP PERC TIME DROP PERCTIMEINTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATEREFILLREFILL =TIME DROP PERC TIME DROP PERCTIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATEREFiaREFia TIME DROP PERC TIME DROP PERCTIMEINTERVAL (MINUTES)WATER DEPTH WATER PROP-PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEREFiaREFia TIME DROP PERC TIME DROP PERCTIMEINTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEREFiaREFia TIME DROP PERC TIME DROP PERC PROPOSED D GN: TRENCH.BED ATGRADE.MOUND.HOLDING TANK.GRAVITY DIST.PRESSURE DIST. ^ /'/SEWER LINE.OUTHOUSE.OTHER.SPECIFY:. — SYSTEM DESIGN ON BACK — f7 ^/X-/-s7 APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM WHITE — Office Yellowy— tfispSttor Pink — Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218)739-2271 - FERGUS FALLS, MN 56537 LEGAL Permit No. DESCRIPTION Abatement: ( ) Yes (NoAND LOCATION LAKE NUMBER LAKE/RIVER NAME SECTIONLAKE/RIVER TWP. NO.RANGE TWP NAME ¥•/Sir- 577 PARCEL NUM8ER(S)SJhM) -oaO 36 - Tuv t1^ FIRE OR LAKE ASSOCIATION NUMBER IDENTIFICATION: Please Print All Information Last Name _____ Mailing Address — No Street, City and State ~pT( ^uiDv u^ M ^ r; ^ First Initial Zip Code Telephone No. Property Owner Sewage System Installer Name A.M. This System will be ready for inspection on , 19.P.M.at This space for office use only NUMBER OF BEDROOMS: A.M. 19 P.M GARBAGE DISPOSAL: ( ) YES (NODate Rec’d Time Rec'd Phone Call Rec’d By SEWAGE TREATMEHT.Sy§TEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) ( ^ Septic tank (%^) Lift station (Alarm required) I Draii^eld O^Trenches TANK DRAIN FIELD mi,oooCapacity GIs.Sq Ft. sviooDistance from nearest well Ft.Ft.(37Distance from lake or stream Ft.Ft. 70( ) Bed ( ) Mound ( ) Outhouse ( ) Sewer line Distance from building Ft.Ft. 7C7laDistance from property line Ft.Ft. 3Distance from bottom to Water Table Ft.Ft. EFFLUENT DISTRIBUTION (J>h(Gravity ( ) Pressure All distances are shortest distance between nearest points PERCOLATION TEST DATA: WATER WELL DEPTH H-Perc Tester.ate of Perc Test \sRate of 1st Test Average Rate Agreement: The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in strict accordance with Ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minnesota Department of Health. Applicant agrees that plot plan sketches and specifications submitted herewith and which are approved by Shoreland Management Officicai shali 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 responsibilty of the applicant for the permit to ngtify the County Shoreland Management that the job is ready for inspection. . DATE: Signature Permit: Permission is hereby granted to the above named applicant to perform tie 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 Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of any said ordinances. NOTE: Permit void if work is not commenced within^ix (6) months. Lb3Issued Date; 3S^d 4 Resource Management Office Fee $.Rec #. Comments: 277.212 • Victor Lundeon Co . Printers • Fergus fells. MinneosteBK 0795-003 APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM 1WHITf_ - office Yellow — Inspector Pink — Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218)739-2271 - FERGUS FALLS, MN 56537 lo31 •7 LEGAL Permit No. DESCRIPTION Abatement: ( ) Yes (NoAND LOCATION V RANGE ItWP name\CLMLAKE NUMBER LAI A LAKE/RIV CLASS ' SECTION TWP. NO. cZ ( U V f K PARCEL NUMB^R(S)FIRE OH LAKE ASSOCIATION NUMBERI IDENTIFICATION; Please Print All Information Last Name First Initial Mailing No. ItlL (IC^LODVcy’ M N \ y I I'l I e (eProperty Owner i IC'CL 'J7ZFFSewage System Installer Name This System will be ready for inspection on.. 19. ~Uf 13, fC-TV'-pW-H'L -rrt lUc S? This space for office use only NUMBER OF BEDROOMS: AJ 19 P.M iAGARBAGE DISPOSAL: ( ) YES NOTime Rec’d Phone Cali Rec’d By / SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTS >TYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) ( M Septic tank (Y^) Lift station (Alarm required) ( Y-) Drain {ield TANK DRAIN FIELDJ .000XCapacity ^ ' ■■ ■' ' \ Distance from nearest well GIs.Sq Ft. ‘o6\[coFt.Ft. 5Y ^6 +Distance from lake or stream Ft.Ft. Z2) Bed ( ) Mound ( ) Outhouse ( ) Sewer line Distance from building Ft.Ft.c: ralaDistance from property line Ft. Ft. 3Distance from bottom to Water Table Ft.Ft. EFFLUENT DISTRIBUTION ( >.)^ Gravity ( ) Pressure All distances are shortest distance between nearest points PERCOLATION TEST DATA: WATER WELL DEPTH ^'^1 Perc Test L/UPerc Tester. I./.(IS__ Average RateRate of 1st Test Rate of 2nd Test Agreement: The undersigned hereby, makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in strict accordance with Ordinances of the Courfty of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minnesota Department of Health. Applicant agrees that plot plan sketches and specifications submitted herewith and which are approved by Shoreland Management Officical 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 responsibilty of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. / 1 "£DATE:6Signature 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 Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of any said ordinances. NOTE: Permit void if work is not commenced within six (6) months.I I /Issued Date: d & Resource Management Office .^3 -Fee $.Rec ft. •tComments: 277.212 • Victor Lurtdeen Co. Printers • Fergus Falls. MinneosiaBK 0796-003 t,. INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS DRAIN FIELDHOLDING SEPTIC TANK Uotj Prc/V''« lOCXi GLS. LIFT TANKCATEGORY Actual Minimum SF 4^8 SF^GO GLS.Capacity FTFT FTDistance from Nearest Well FT Distance from Buried Water Suction Pipe FT FT FTFT50 Distance from Buried Pipe Distributing Water Under Pressure lo’" FTlo’'FT FT 10 FT ft^9.Distance from Lake or River (OHWL)FT FT FT Ml FT 10/20 FTDistance from Nearest Building FT FT \oo^ ft1 Oo^ ft FTFTDistance from Nearest Property Line 10 -\U FT FT FT FTDistance from Bottom to Water Table 3 YESHolding Tank/Lift Alarm YES NOOld System Pumped & Destroyed Sewer Line to Well Separation DRAINFIELD CALCULATIONINTERPRETATION OF ABBREVIATIONS GLS. = Gallons SF = Square Feet FT = Linear Feet Actual Minimum FTX V^OO FT FT20 SF / ///<\ Lto ''Inspector’s Comments: . I H' pS’ G-CyO^ft. OOtrA. All onCc^s ar/r^,<r-a^sc aicTcI^ SKETCH: C Vo’ Ms M‘ % \rw sector's Signature Y-36-Mgfci'* ■E5£7 I *a?e of Inspection 'ft V.ooft Time of InspectionTo * Owtii GRID PLOT PLAN SKETCHING FORM — (Must Be To Scale) // / ■Scale: Each grid equals feet/ Inches fsDated:19 "Signature Please sketch your lot Indicating setbacks from road right-of-way, lake and sideyard for each building currently on lot and any proposed structures. 7 I /r C»fA ^ ' uJ- ■& ■o TA^K 5> rA^oe 5 3f\i c> Ip--‘pefi jj(/ ^ • 7S<r ' vu ot-cp fifi- i £T5 > V> I r PERCOLATION TEST DATA LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, MN 56537 4 OWNER: jSi^ Ml ^ TELEPHONE NUMBERMIDDLEFIRSTLAST NAME ADDRESS: .mB^a /Sf f if-tUOOAr/t/c- ZIP CODESTATECITYSTR./RT. 3 -UM-fwp. Mange377 TWP. NAME ^SEC.LAKE NAMELAKE/RIVER NO. LEGAL DESCRIPTION: PARCEL NUMBER r NUMBER/BEDROOMSFIRE NUMBER — TWO TESTS ARE REQUIRED — TEST HOLE NO. 2^ ^T HOLE NO. 1 37 inches inches; Diameter of HoleDepth To Bottom of Hole.inches inches; Dianteter of Hole.Depth To Bottom of Hole. 5^3-fr 1919DateDateSoil Texture ,Soil TextureDepth, Inches E)epth. Inches A3.Percolation Test By____ Firm Name ____ Percolation Test By Firm NamelA Si y*>5 A P'0 “5a Address Address Otter Tail County License No. Otter Tail County License No. PERC TEST # 2PERC TEST # 1 IIWTBRVALn»gNirrBS> m mCAATH w,WATBRDKOPpnatVALfMiNinTOWater depth WATER IMM PERC RATETIME RCRATE 7\W —1±...lO^ / ft|>M ^ PROP PERC START-3 /O 7^2— WATER PERC RATE TIME IKTERVAL<MIWinES3 WATER DROP*wraj^gTH-Wi[NTERVALfl>nWUTHy> STTPf TIMH * DROP I^HRC1 y7..n'p-'nklU DROP PBRC WATER DROP PERC RATE WATER^PTM interval OflNUTBS)WATER DEPTH T»>IE IMTERVAL IMlNirrB13 WATER DROP jo^yj TIMB ^ DROP ^BRCw"./o. Z. I,Y TO»m DROP PHRtf $7^LRB7"jP73 ;J INTERVAL IMIWUTBm WATER DROP TIME INTBRVrtL vV OONUTSS)WATER DEPTH WATER DMP PBRC RATEreRCRATB f7 !■ y 6tOP #HRC .■3^. IlMU bkbp PBRC —j--y-77T WATER DROP PERC RATE TIME mTBRVALrMPRHERIPfTERVALIMPnrrBS^WATER DBPIH WATER DEPTH w/mpn9P PBRC RATEtime REFILLREFILL •f 'IIMB” DROP PBRC 'HMH’ CROP' PBRC PBRC RATE TIME INTERVAL 0»«TNUTBS^INTERVAL IMINOTBS3 WATER DR<yWATBRDBPTH WATER nepTH WATER DROPTIME FBRCRATB REFILLREFILL ♦ '11MU DROP PERC 'nWL DROP PERb PERC RATE TIME INTERWALIMIMinEaPnBRVALftCWUrBft WATER DEPTH WATER nR|pp WATBRDBPTHTIME WAIBRDROP PERC RATE RBFILLREFILL TIMU DROP PERC”TD3B~ CROP' PERCTIMEPBICRATE WATER DR<y INTERVAL <M!Nl/TESITTiigINTERVAL rfcfTMirrgy>WATER DBPTH WATER DEPTH WATER DROP rote RATERBFILLRBFILL kTIKtfi^ " DRCSF PERC TIME Crop” perc <( KS<COMMENTS/CALCULA TIONS: T Sf/ ^ /. . K MKL — 0390 - 005 250.615 — Victor Lundeen Co., Printers. Fergus Falls. Minnesota a E',*r’0'vvXY>c5LIT SU^rsfYp > O T~ W „s A g* C-c:\vV\'p^V5 SiV-^^ ! ^s> Z' 4. 7r 75^2 IX(oOQ ^ /*£" ^oo / Oovr^p S"o |?avj^y 3Z. St I r^mcla^_> ^ )(. ^3 33Z- Sc^ \^\~ '^V'y.Vv , ? i 7^^ ^^/!Yor (TVs/- (^WCc> 7«c--/^A,k. 7)4 <J '-/ ^^ ^~i~L> Clc^ US^' ■ha >M "7TS * '"■ 4' APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM** 41 ^0 wHi:^ Yellow — Inspector Pink — Owner Office LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218)739-2271 - FERGUS FALLS. MN 56537 lOAl T>. LEGAL Permit No.Can‘-p^/£DESCRIPTION Abatement: ( ) Yes (NoAND LOCATION LAKE NUMBER SECTIONLAKE/RIVER NAME LAKE/RIVER T) 3 RANGETWP. NO.TWP NAME 7 f LT V fc jO-^CLy PARCEL NUMBER(S)5 J'Oi/0 -Y/-03^^ ~ooo FIRE OR LAKE ASSOCIATION NUMBER IDENTIFICATION: Please Print All Information Last Name First Initial Mailing Address — No. Street, City and State Zip Code Telephone No. y Ii y I < n / « (eProperty Owner I ^ U (iC ^ilLlfc'ct i\S m-C !Sewage System Installer Name This System will be ready for inspection on . 19.at I a CO GARBAGE DISPOSAL: ( ) YES ( /^NO This space for office use only NUMBER OF BEDROOMS:772LML. P.M Time Rec'd '------Phone Call Rec’d By /T SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTS iTYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) ( ^ Septic tank (K( ) Lift Station (Alarm required) T TANK DRAIN FIELD SiX) Ujx-'r/,s<-'0Capacity GIs.Sq Ft.I n/LCf —Distance from nearest well ) Ft.Ft. i^eld )Trenches ) Bed ( ) Mound ( ) Outhouse ( ) Sewer line 7 ) /j 0 S-iDistance from lake or stream Ft.Ft. 73Distance from building Ft.Ft. \olaDistance from property line Ft.Ft. Distance from bottom to Water Table Ft. Ft. EFFLUENT DISTRIBUTION All distances are shortest distance between nearest points{'>4^ Gravity PERCOLATION TEST DATA:) Pressure( WATER WELL DEPTH Perc Test. fII ’ I ( Perc Tester. I././ fRate of 1st Test Rate of 2nd Test Average Rate Agreement: The undersigned hereby.makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in strict accordance with Ordinances of the Courlty of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minnesota Department of Health. Applicant agrees that plot plan sketches and specifications submitted herewith and which are approved by Shoreland Management Officical 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 responsibllty of the applicant for the permit to notify the County Shoreland Management that the job is ready for Inspection. ,( . Signature I 1</'llDATE: ! 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 Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of any said ordinances. NOTE: Permit void if work is not commenced withjp six (6) months.C U--R-n /Issued Date:f /d & Resource Management Office\±mi3S^/ Fee $.Rec #. •lComments: 277.212 ■ Victor Lundoon Co.. Printers • Fergus Falls. MinneosteBK 0796-003 / /lINSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS •» DRAIN FIELDHOLDING SEPTIC TANK loco GLS. LIFT TANKCATEGORY Actual Minimum B SF H°I8 SFCapacityGLS. FT9vOO^ FTDistance from Nearest Well FT FT Distance from Buried Water Suction Pipe FT FT FT 50 FT Distance from Buried Pipe Distributing Water Under Pressure I o’" FTlo"FT FT FT10 ^9.Distance from Lake or River (OHWL)FT FT FT FT 111HI ftDistance from Nearest Building 10/20 FTFTFT 100^1 ^Distance from Nearest Property Line FT FT FT10 w ~\u B.SDistance from Bottom to Water Table FT FT FT FT3 YESHolding Tank/Lift Alarm YES NOOld System Pumped & Destroyed Sewer Line to Well Separation DRAINFiELD CALCULATIONINTERPRETATION OF ABBREVIATIONS GLS. = Gallons SF = Square Feet FT = Linear Feet Actual Minimum FTX FTV^OO FTFT20 SF toInspector’s Comments:5s OOtrft. onLc^S aT/f<ciioJL%£ a)c7c1> SKETCH: Vo' I'li ■7 7' I In: pector's Signature^Hou/fc ft V 5o-HgE50, late of Inspection V' 00 Time of Inspection 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 White — Office Yellow — Inspector Pink — Owner Permit No,,LEGAL DESCRIPTION AND Ul "rtTracn^kgo 3 I3Z-LOCATION ^5Lake No.Lake Classif.Lake Name Sec.TWP Range TWP Name IDENTIFICATION: Please Print All Information. Mailing Address — No. Street, City and StateLast Name InitialFirst Zip No.Tel. No. vx Njn&g V40QO yv^tJ£iLOWNER T i\oyoSEWAGE SYSTEM INSTALLER a_vvName. This SKSfem will be ready for inspection on., 19. This space for office use only 19 Date Rec'd Time Rac'd Phone Call Rec'd By Owner or Agent Signature 1*^ C.cxTV\ps \V<tsSNUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD Sq. Ft.GIs.Sq/Ft.Capacity X ¥Ft.Ft.Ft.Distance from nearest well Is-Ft.Distance from lake or stream Ft.Ft.t!zloFt.Distance from occupied building Ft.Ft. |oDistance from property line Ft.Ft.t. FODistance from bottom to Water Table Ft. AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on 19 , Time PERCOLATION TEST DATA:Date of First Test 49^ Date of Second Tesi 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 I understand that I have been granted a sewage system site permit in accordance with the requirements of the Shoreland Management Ordinance of Otter Tail County. I understand i must contact my township in order to determine whether or not any addi tional permits are required by the township for my proposed project.Signature Permit: condition that the person to whom it is granted, and his agents, empioyees and workmen shaii conform in aii respects to ordinances of Otter Taii 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 q-Issued Date; thoreland Managen^M Office ZoFee $Rec # Comments: Form No. MKU332085 237.443 — Victor Lundeen Co.. Printors. Fergus Falls, Minnesota APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM SHORELAND MANAGEMENT — COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 • Fergus Falls, MN 56537White — Office Yellow Inspector Pink — Owner miPermit No..LEGAL tr IT S L J o iTYMps'l-l-1 ■( DESCRIPTION AND 7K Q -II T k ..5 o < V'-ar3 7'l 17?-LOCATION f 1i TLake No.Lake Name Lake Classif.Sec.TWP Range TWP ISfame IDENTIFICATION: Please Print All Information. Mailing Address — No, Street, City and StateLast Name First Initial Tel. No.Zip No jiiiL\ . V-\ V V >'J ocrfel y\\JiOWNER T . s V V / _,V', ciV"\ ' ■ V L>\\SEWAGE SYSTEM INSTALLER Name 1 9- ^This System will be ready for inspection on., 19. This space for office use only '9KA Phone Call Rec'd By 4'on Time Rec^c 9-U Date Rec'd Owner or Agent Sidni NUMBER OF BEDROOMS:WESTIMATED COST: T SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK \ SEEPAGE PIT DRAIN FIELD Sq. Ft. /\Sq/Ft.GIs.Capacity s-o Ft.Ft.Ft.Distance from nearest well XIs-h r Ft.Ft.Distance from lake or stream Ft.7^d) o /S'Ft.Distance from occupied building Ft.Ft. 77n.VI oDistance from property line Ft.Ft. .\f/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 JVI By PERCOLATION TEST DATA:Date of First Test -1^.. Date of Second TesX-19 Rate 1st Test Taken By 1First 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. I understand that I have been granted a sewage system site permit in accordance with the requirements of the Shoreiand Management Ordinance of Otter Tail County. I understand I must contact my township in order to determine whether or not any addi tional permits are required by the township for my proposed project.Signature Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon expressPermit: 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. "N / ~ k 5 / --------"Shoreland Manager^rit Office \ Issued Date:J oO XU JFee $Rec #ciR r iss(j£nComments: Form No. MKL-032085 237,443 ~ Victor Lundeen Co.. Printers, Fergus Falls, Minn^ota r » ’ ^f tiji/U/;4 N.iWt INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORYActualShould Be Actual Should Be Should BeActual Capacity 2.— \Soo ~iPC)0 GIs.GIs.S F S F S F S F i-3ooDistance from Nearest Well F F F F F F A-\ a~oDistance from Lake or Stream F F F F F F 2-0Distance from Occupied Building F F F F F F 1IffDistance from Property Line F F F F F F Distance from Bottom to Water Table 3 3FFFFF F Inspector’s Comments: Vx'wvV Sf tAlA.«/X V:. SA-nJW \\tl- Lcvrx^A^ S3\rO C\r us< tj- Date of Inspection 5nOOTime of Inspection M Signature of /nspicfor \ INTERPRETATION OF ABBREVIATIONS GIs = Gallons SF = Square Feet F = Linear Feet Job Title MKL • 032085 > Backar Agency : \ • . ojj.-r .lx .'-«J M,-- ■=fejr cr■V-Ji'"' I*"': S'i . , H..• • \\\ 'L..-* • V:Kf-i' \ ■\>".-^■1:V*. V^«!!,'•A :*t.ft-;;i \tv* •>■ '-''K :;t‘.;.■/.r-: .' ■ r'* '.• , ‘■-. v :-kvS'W/k . - ;i,«..‘•'r • zsiw: "Mm .V ■it■V i»',1 )i: 1 --■*- jja -^3C 'V* '..W>- p^iSrit f ‘-Iv’J'tr :.-j,^- >'fu .'-'•;i-^-''-j?v-.?T,'( ? ■ r^r;- 'TZo , AN ORIGINAL POLAROID’ LAND PHOTOGRAPH SUBJECT DATE 3^1J ^ C*/ ^ J*.NAME r:. )clnADDRESSr& I r\ REGULAR SIZE COPIES For your convenience when ordering copies, indicate the number of copies desired in the appropriate box for the size(s| you select. You can get quality work by Polaroid Copy Service through your dealer or by mail. P558B1 4/72 WALLET SIZE COPIES 5x7 ENLARGEMENTS 8x 10 ENLARGEMENTS 35mm SLIDES Printed m U.S.A. SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 - Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYUTFM White — Offjce YelJaw — ^spector ‘ Pirfk Card Owner Owner X I4 ^3 Permit No..LEGAL Date DESCRIPTION AND sr^-37?3_ V/ TWP Name LOCATION Lake No. Lake Name Lake Classif.Sec.TWP Range IDENTIFICATION; Please Print All Information. First Initial Mailling Address —No. Street, City and StateLast Name Zip No.Tel. No. OWNER A SSa^I lOe )SEWAGE SYSTEM INSTALLER Name, This System will be ready for inspection on... 19. This space for office use only ,19 ,M Date Rec'd Phone Call Rac’d ByTime Rec'd Owner or Agent Signature NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD JZRKK Sq. Ft. -cT-q__^ GIs.SiS. Ft.Capacity Ft.Ft.Distance from nearest well s~o Ft.Ft.>S~ Ft.Distance from lake or stream 7Ft.Distance from occupied building Ft.7C1 Ft. 7Distance from property line /C>Ft.Ft./O Ft.7 VFt.Ft.Distance from bottom to Water Table Ft. AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on „ 19 , - ....M ...J9 ...vj..,/. ■/PERCOLATION TEST DATA:Date of First Test Rate J..3d.Date of Second Test RateAy r 1st TestM"aken By L±■3. >Z....9First Test -t- 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.) Signature U Dated, 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 Issued Date: eland Management Office /Oo00 o •Fee $Surcharge $ rJtOjQ i ^7 t^.Ci 1 7 dc4 t; Comments:. is-n Form No. MKL-0771-003 y... .158906vicToa uiaaeiH * e*.. Miaraaa. pcaava p*«.La. SHORELAND MANAGEMENT - COUNTY QF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 - Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM White - Office . Yellow — .inspector PIfTk -- Owner Card Owner /I, ^-3 9^Permit No..LEGAL Jy,tjj8>'T'Ae Date DESCRIPTION AND r,\-^V-377 T /-2.LOCATION TWP NanSeLake No.Lake Name Lake Ciasslf.Sec.TWP Range IDENTIFICATION: Please Print All Information. Mailling Address —No, Street, City and StateFirstInitial Zip No.Tel. No.Last Name v_OWNER SEWAGE SYSTEM INSTALLER Name, This System will be ready for inspection on., 19. This space for office use only .19 M Phone Call Rac'd ByDate Rac'd Time Rac'd Owner or Agent Signa.ture NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD GIs.Sq. Ft.fSq. Ft.Capacity Ft.Ft.Ft.ODistance from nearest well > 1>'Ft.Ft.Ft.Distance from lake or stream ' ■ .r'" '/O Ft.Ft.Ft.Distance from occupied building /(ODistance from property line Ft.Ft.Ft. Ft.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 / yPERCOLATION TEST DATA:Date of First Test 9' ""3 19 Rate — y!Date of Second Test Rate( !' ' ' 1st Test Taken By !33 >/. ?^ . OI/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.) 7Dated, Signature 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. Permit: A'^ ^Plrafeland Management Office A-o ^ ^ c/ecu. ./y, I / /Issued Date; . -5 ^(-■O Fee $Surcharge $ %rfo rComments:. f,.~ro Oi"' Ifr } r 1 Form No. MKL-0771-003 1SB906 ViCTPa kUHPCCH 4 C0.. PPIMUII*. rCKUl FALLt. MIMM INSPECTION RESULTS Inspector must make all measurements ■ ii- /VA ^ SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORY Should VeShould beActual Actual Actual Should bef Capacity GIs.GIs.S F S F S F Distance from Nearest Well 7F F F F Distance from Lake or Stream F F F F F /DO F 500% Distance from Occupied Building 10 2020FFF F F /\oDistance from Property Line 10 10FFF F 4^Distance from Bottom to Water Table 4 4FFF F F Inspector's Comments: % - V" I a/} y I ha ill* €A-----; n 1 /otx. R v-t/ft______jq> <* C CL^rl. S T /S'19.^5^ Date of Inspection *1* Time of Inspection, Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs ~ Gallons SF “ Square Feet F * Linear Feet Job Title (Vie 0ic> r li -Cr<?AgencyMKL-0771-003-Backer A / prof) •(• d/fetCQ. i. rt ^V.•iA /OTO (4323^ £> r