Loading...
HomeMy WebLinkAboutFrank's Lodge & Campground_56000090057000_Septic System Permits_LAND & RESOURCE MANAGEMENT OTTER TAIL Government Services Center 540 West Fir Avenue Fergus Falls, MN 56537COUNTY - MINNESOTA February 21, 2020 Parcel No. 56000090057000 56000090057001Frank's Lodge & Campground LLC John Frank 30570 Lodge Loop Dent, MN 56528-9227 NOTICE OF NON-COMPUANCE The Otter Tail County Land & Resource Management office administers the regulation of subsurface sewage treatment systems (SSTS) in Otter Tail County. On August 10, 2015, the office received a Notice of Non- Compliance from Stoll Inspections for the SSTS located at 30570 Lodge Loop in Dent, Minnesota, Parcel No. 56000090057000/56000090057001. The inspection report from Stoll Inspections indicates that the SSTS is noncompliant. A system that is deemed noncompliant is in violation of Section 4, Subp. 3(C) of the Otter Tail County Sanitation Code which states: The SSTS must be protective of groundwater. A system that is not protective is considered a system failing to protect groundwater. At a minimum, a system that is failing to protect groundwater is a system that is a seepage pit, cesspool, drywell, leaching pit, or other pit; a system with less than the required vertical separation distance described in item E; and a system not abandoned in accordance with Minnesota Rules, Chapter 7080.2500. Since Stoll Inspections has issued a Notice of Non-Compliance for the SSTS located at30570 Lodge Loop, the Otter Tail County Sanitation Code requires: 1. The system must be replaced within 24 months of receipt of this Notice; and, 2. The owner of the system must obtain a permit to replace the system within 12 months of receipt of this notice. A permit was applied for and issued on January 12, 2016. This permit was extended multiple times to allow for the installation. Since the system was not installed, new soil work must be completed, and a new design must be submitted to our office for review. Financial assistance in the form of grants and low interest loans are available to assist in the costs of replacing the SSTS. Please contact the office at 218.998.8095 for more information. Please contact our office to set up a meeting with Chris LeClair to discuss this matter by March 15, 2020. Sincerely, Christopher W. LeClair, Director Land & Resource Management 218.998.8105 cleclair@co.ottertail.mn.us (@) ottertailcountymn.us218-998-8095 OTTER TAIL COUNTY IS AN EQUAL OPPORTUNITY EMPLOYER Department of LAND AND RESOURCE MANAGEMENT"ceived OTTER TAIL COUNTY iai. aGOVERNMENT SERVtCES CENTER - 540 WEST TtR JAN 0 7 FERGUS Falls, MN 56537 ^ PW: 218-998-8005 l_AN>D & ^coq. Otter Tail County's Wi^isite: www.co.otter-tail.mn.us '‘-'J'-'UKCtOTTCR Tflil eoaiti ■i*aii9Ti Otter Tail County Compliance Inspection Form Addendum This form is a required attachment to MPCA Compliance Inspection Form for all Existing Subsurface Sewage Treatment Systems in Otter Tail County as of June 1, 2011, Property Information Parcel Number: oooo 9<sa /) Township: _________ Property Owner Name(s): Property Address: jirsrffe /^o/) ( /} j ^ Section: Reason for Inspection: ^Pe£?njLtLu 1 Number of Bedrooms:4^Nol I\9In Shoreland Area? Lake/River Name, Number, & Class System Compliance Status: ^Compliant 6f^ly Non-Compliant Yes NoDoes the soil treatment area have less than 3 feet of vertical separation? Is the septic tank located less than 50 feet from any well? Is the soil treatment area located less than 50 feet from any deep well? Is the soil treatment area located less than 100 feet from any shallow well? Yes Yes Yes Yes No No No "Yes" indicates that the system is failing to protect ground water and is noncompliant. If "Yes", describe the condition noted: Required Attachments: System drawing to scale on next page. Completed MPCA Compliance Inspection I hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. Name:y^^;^ Certification Number: Business License Name & Number: ^^ANficD Signature:! '•j.: v;Date; - '..-'f' ■■ ; %■ • Excel/Compliance Form for OTC 4/30/2014 Page 1 of 2 ; •: \ •i'. ■s ‘ 1 • ■; L 1 r- I t f ! \ ‘i? I ! ' [ 1, I 3 Minnesota Pollution - Control Agency 520 Lafayette Road North St. Paul, MN 55155-4194 Compliance Inspection Formas Existing Subsurface Sewage Treatment Systems (SSTS) Doc Type: Compliance and Enforcement For local tracking purposes;Inspection results based on Minnesota Pollution Control Agency (MPCA) requirements and attached forms - additional local requirements may also apply. Submit completed form to Local Unit of Government (LUG) and system owner within 15 days System Status System status on date (mm/dd/yyyy):9/26/2015 □ Noncompliant - Notice of Noncompliance (See Upgrade Requirements on page 3.) Compliant - Certificate of Compliance (Valid for 3 years from report date, unless shorter time frame outlined in Local Ordinance.) Reason(s) for noncompliance (check all applicable) □ Impact on Public Health (Compliance Component #1)- Imminent threat to public health and safety □ Other Compliance Conditions (Compliance Component #3) - Imminent threat to public health and safety □ Tank Integrity (Compliance Component #2) - Failing to protect groundwater □ Other Compliance Conditions (Compliance Component #3) - Failing to protect groundwater □ Soil Separation (Compliance Component #4) - Failirig to protect groundwater Q Operating permit/monitoring plan requirements (Compliance Component #5) - Noncompliant i Property Information Property address: Property owner; Franks Lodge Parcel ID# or Sec/Twp/Range: 56000090057000 i Reason for inspection: building permit Owner’s phone: __________________ 30543 Lodge Loop Dent, MN 56528 V or Representative phone: Regulatory authority phone: Owner’s representative:i 998-8095Local regulatory authority: Ottertail County Brief system description: collector system Comments or recommendations: Certification / hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. Inspector name: Randy Anderson Business name: Anderson On-Site Inspector signature: ____________ Certification number: 3044_______ License number: 634________ Phone number: 218-849-3072)• :TTY 651 -282-5332 or 800-657-3864 • Available in alternative formats Page 1 of 4 www.pca.state.mn.us • 651-296-6300 • 800-657-3864 wq-wwists4-31b • 6/4/14 !■ t Necessary or Locally Required Attachments S System/As-built drawing K Forms per local ordinance□ Soil boring logs □ Other information (list): I 9/26/2015Inspector initials/Date:Property address: 30543 Lodge Loop Dent, MN 56528 (mm/dd/yyyy) 1. Impact on Public Health - Compliance component #1 of 5 Verification method(s): K Searched for surface outlet K Searched for seeping in yard/backup in home D Excessive ponding in soil system/D-boxes S Homeowner testimony (See Comments/Explanation) □ “Black soil" above soil dispersal system □ System requires “emergency" pumping □ Performed dye test n Unable to verify (See Comments/Explanation) O Other methods not listed (See Comments/Explanation) Compliance criteria: □ Yes ^ NoSystem discharges sewage to the ground surface.______________ □ Yes S NoSystem discharges sewage to drain tile or surface waters. □ Yes ^ NoSystem causes sewage backup into dwelling or establishment. Any “yes" answer above indicates the system is an imminent threat to pubiic heaith and safety. I Comments/Explanation: 2. Tank Integrity - Compliance component #2 of 5 r Verification method(s): S Probed tank(s) bottom G Examined construction records □ Examined Tank Integrity Form (Attach) □ Observed liquid level below operating depth □ Examined empty (pumped) tanks(s) □ Probed outside tank(s) for “black soil" G Unable to verify (See Comments/Explanation) G Other methods not listed (See Comments/Explanation) Compliance criteria:I G Yes G NoSystem consists of a seepage pit, cesspool, drywell, or leaching pit. Seepage pits meeting 7080.2550 may be compliant if allowed in local ordinance. ! V G Yes G No>Sewage tank(s) leak below their designed operating depth. If yes, which sewage tank(s) leaks: Any “yes” answer above indicates the system is failing to protect groundwater. ;!Comments/Explanation: camera ■; I, 3. Other Compliance Conditions - Compliance component #3 of 5 i-a. Maintenance hole covers are damaged, cracked, unsecured, or appear to be structurally unsound. □ Yes* ^ No □ Unknown b. Other issues (electrical hazards, etc.) to immediately and adversely impact public health or safety. □ Yes* S No □ Unknown *System is an imminent threat to public health and safety. Explain: ;■ I, :■ t c. System is non-protective of ground water for other conditions as determined by inspector. □ Yes* S No *System is failing to protect groundwater. TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 2 of 4 www.pca.state.mn.us • 651-296-6300 • 800-657-3864 wq-wwists4-31b • 6/4/14 Explain: Inspector initials/Date:I 9/26/2015Property address: 30543 Lodge Loop Dent, MN 56528 (mm/dd/yyyy) 4. Soil Separation - Compliance component #4 of 5 •: ^ UnknownDate of installation:Verification method(s): So// observation does not expire. Previous soil obsen/ations by two independent parties are sufficient, unless site conditions have been altered or local requirements differ. D Conducted soil observation(s) (Attach boring logs) O Two previous verifications (Attach boring logs) 13 Not applicable (Holding tank(s), no drainfield) □ Unable to verify /See Comments/Explanation) □ Other (See Comments/Explanation) (mm/dd/yyyy) Shoreland/Wellhead protection/Food beverage lodging?□ Yes □ No Compliance criteria: □ Yes □ NoFor systems built prior to April 1, 1996, and not located in Shoreland or Wellhead Protection Area or not serving a food, beverage or lodging establishment: Drainfield has at least a two-foot vertical separation distance from periodically saturated soil or bedrock. □ Yes □ NoNon-performance systems built April 1, 1996, or later or for non-performance systems located in Shoreland or Wellhead Protection Areas or serving a food, beverage, or lodging establishment: Drainfield has a three-foot vertical separation distance from periodically saturated soil or bedrock.* Comments/Explanation; only checking tanks □ Yes □ No Indicate depths or elevations“Experimental", “Other'’, or “Performance" systems built under pre-2008 Rules; Type IV or V systems built under 2008 Rules (7080. 2350 or 7080.2400 (Advanced Inspector License required) Drainfield meets the designed vertical separation distance from periodically saturated soil or bedrock. A. Bottom of distribution media B. Periodically saturated soil/bedrock C. System separation D. Required compliance separation* ‘May be reduced up to 15 percent if allowed by Local Ordinance. Any “no” answer above indicates the system is failing to protect groundwater. 5. Operating Permit and Nitrogen BMP* - Compliance component #5 of 5 lEI Not applicable D Yes D No If “yes”, A below is required □ Yes □ No If “yes”, B below is required Is the system operated under an Operating Permit? Is the system required to employ a Nitrogen BMP? BMP = Best Management Practice(s) specified in the system design If the answer to both questions is “no”, this section does not need to be completed. Compliance criteria a. Operating Permit number:_____________________ Have the Operating Permit requirements been met? □ Yes □ No □ Yes □ Nob. Is the required nitrogen BMP in place and properly functioning? iAny “no” answer indicates Noncompliance. Upgrade Requirements (Minn. Stat § 115.55) An imminent threat to public health and safety (ITPHS) must be upgraded, replaced, or its use discontinued within ten months of receipt of this notice or within a shorter period if required by local ordinance. If the system Js failing to protect TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 3 of 4 651-296-6300' • 800-657-3864www.pca.state.mn.us • wq-wwists4-31b • 6/4/14 f I ground water, the system must be upgraded, replaced, or its use discontinued within the time required by local ordinance. If an existing system is not failing as defined in law, and has at least two feet of design soil separation, then the system need not be upgraded, repaired, replaced, or its use discontinued, notwithstanding any local ordinance that is more strict This provision does not apply to systems in shoreland areas. Wellhead Protection Areas, or those used in connection with food, beverage, and lodging establishments as defined in law. [■ 1; j',(■ V-!www.pca.state.mn.us • 651-296-6300 • 800-657-3864 wq-mvists4-31b • 6/4/14 TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 4 of 4t i ■ OTTER TAIL COUNTY LAND & RESOURCE MANAGEMENT PUBUC WORKS DIVISION WI.W CO.OTTER-TAIL MN.U5OTTER TflII GOVERNMENT SERVICES CENTER 540 WEST FIR AVENUE FERGUS FALLS, MN 56537 21S-998-8095 FAX; 218-998-8112 10/23/2015 Frank's Lodge & Campground Lie 30570 Lodge Loop DentMN 56528 9227 RE; Primary Owner Frank's Lodge & Campground Lie Result of Onsite Sewage System Inspeetion, Non-Compliant Pareel(s) Lake Name Star 56000090057000 56000090057001 Lake No 56-385 Class GD Dear Frank's Lodge & Campground Lie; As part of Otter Tail County’s ongoing Sewage System Inspeetion Program, our Offiee inspeeted your sewer system loeated at 30543 LODGE LOOP on 8/18/2015 and agreed with Stoll Inspeetions. At that time, we found your sewage system to be non-eompliant for the following reason(s): Failed eomplianee inspeetion on system #4 Please eontaet our Offiee by 11/23/2015, at 218-998-8095, so that this matter ean hopefully be resolved. Sincerely Scott Ellingson Inspector OTTER TAIL COUNTY LAND & RESOURCE MANAGEMENT PUBUC WORKS DIVISION WWW.CO OTTER-TAIL MN US9mm\\ GOVERNMENT SERVICES CENTER 540 WEST RR AVENUE FERGUS FALLS, MN 56537 218-996-6095 FAX: 216-998-6112 10/23/2015 Frank's Lodge & Campground Lie 30570 Lodge Loop DentMN 56528 9227 RE: Primary Owner Frank's Lodge & Campground Lie Result of Onsite Sewage System Inspection, Non-Compliant Parcel(s) Lake Name Star 56000090057000 56000090057001 Lake No 56-385 Class GD Dear Frank's Lodge & Campground Lie: As part of Otter Tail County’s ongoing Sewage System Inspection Program, our Office inspected your sewer system located at 30543 LODGE LOOP on 8/18/2015 and agreed with Stoll Inspections. At that time, we found your sewage system to be non-compliant for the following reason(s): Failed compliance inspection on system #2 Please contact our Office by 11/23/2015, at 218-998-8095, so that this matter can hopefully be resolved. Sincerely, Scott Ellingson Inspector -rr 'c tufjL 33 lO t+- ‘f'»-IS' S£H s 4^ (^\-Lt^\-^o£,gt>C (OOcjlOrJ --6<ztJr~ -{q/— /^ 2,Ckr^ j|t'2^ (-I2.-/U A - £ ci iL 2 »• 5 0 ^_2 — ^'. ~2^A IDOOc^pf](ooo I-ii^a3S-3Lt I 'iZ-l\^(^^(ikrvcc ^ V$'(9 1/93u-^S‘13tr — \t>f\x-~j-^^j hikf\ j^k(^ ^QoI on -t ik ST> 7)c^c>^^ r: — I ! ^(/2 2c/^/V- t M__*|e0 -7^/ "7 'tT5:-Jg20._....V (s' 0t - W ^.1 I zoOl>_Acuu_^d^ 7 / 7q (jj/ 0 c£t- ^3 3S'c?^ - ^ 3-38" 3- <7 ^ ilio i-ii-ij. □□ i w4 Department of LAND AND RESOURCE MANAGEMENT OTTER TAIL COUNTY Govcrnmcnt Services Center - 540 West Fir Fergus Falls, MN 56537 PH: 210-998-6095 Otter Tail County s Website, www.co otter-tail.mn.us OTTER Tflil receivede e t ■ V 1 • 1 a • t f 9 T • Otter Tail County Compliance Inspection Form Addendum ' - j This form is a required attachment to MPCA Compliance Inspection Form for all Existing Subsurface Sewage^ ^^ESOUfJCE Treatment Systems in Otter Tail County as of June 1,2011. Property Information Parcel Number: S^OOOO^OoS ~70DO Township: ~~ Property Address: jOSJO Lad(\e LoOi') ben'f. MKJ Reason for Inspection: ^ Section: ^ Property Owner Name(s): Number of Bedrooms: iz. x icDc,AjJL«^ =. rzcc m □In Shoreland Area? Lake/River Name, Number, & Class Lo,fC^ Yes No 0System Compliance Status:Compliant Non-Compliant XDoes the soil treatment area have less than 3 feet of vertical separation? Is the septic tank located less than 50 feet from any well? Is the soil treatment area located less than 50 feet from any deep well? Is the soil treatment area located less than 100 feet from any shallow well? Does any part of the septic system fail to meet the minimum OHWL setback requirements for the public water classification? Yes Yes No No yYes Yes No Z No Yes No "Yes" indicates that the system is failing to protect ground water and is noncompliant. If "Yes", describe the condition noted: Required Attachments: System drawing to scale on next page. Completed MPCA Compliance Inspection I hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. Name:Phil Stoll Certification Number:7526 Business License Name & Number: Signature: Stoll Inspections 2982 Date: Excd/Compliance Form for OTC 1/15/2014 Page 1 of 2 Otter Tail County Compliance Inspection Form Addendum (cont.) Parcel Number: S^OoQ 0 Date & Initial: ~7-2^-lS'____________ System Drawing The system drawing must be to scale and include all septic/holding/lift tanks, drainfields, wells within 100 feet of system (indicate depth of wells), dwelling and non-dwelling structures, lot lines, road right-of-ways, easements, OHWLs, wetlands, and topographic features (i.e. bluffs). aIc uJ<j/s lot \iy^' al a Additional Comments: Excel/Compliance Form for OTC 1/15/2014 Page 2 of 2 D /_o6(9£S L W f Compliance Inspection FormMinnesota Pollution Control Agency 520 Lafayette Road North St. Paul, MN 55155-4194 Existing Subsurface Sewage Treatment Systems (SSTS) Doc Type; Compliance and Enforcement For local tracking purposes:Inspection results based on Minnesota Pollution Control Agency (MPCA) requirements and attached forms - additional local requirements may also apply. Submit completed form to Local Unit of Government (LUG) and system owner within 15 days System Status System status on date (mm/dd/yyyy): 7/28/2015 G Noncompliant - Notice of Noncompliance (See Upgrade Requirements on page 3.) G Compliant - Certificate of Compliance (Valid for 3 years from report date, unless shorter time frame outlined in Local Ordinance.) Reason(s) for noncompliance (check all applicable) □ Impact on Public Health (Compliance Component #1)- Imminent threat to public health and safety □ Other Compliance Conditions (Compliance Component #3) - Imminent threat to public health and safety □ Tank Integrity (Compliance Component #2) - Failing to protect groundwater □ Other Compliance Conditions (Compliance Component #3) - Failing to protect groundwater □ Soil Separation (Compliance Component #4) - Failing to protect groundwater □ Operating permit/monitoring plan requirements (Compliance Component #5) - Noncompliant Property Information Property address: 30570 Lodge Loop, Dent MN 56528 Property owner: John Frank_____________________ Parcel ID# or Sec/Twp/Range: 56000090057000 _____________Reason for inspection: Permit _____________ Owner’s phone: ____________ or Owner’s representative:_______________ Local regulatory authority: Ottertail County Representative phone: ________________ Regulatory authority phone: 218-998-8095 Brief system description: 1500 gal septic tank to 1500 gal Lift to 1680 sq.ft, rock and trench drainfield.______________ Comments or recommendations: Certification I hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or Mure water usage. Inspector name: Phil Stoll______ Business name: Stoll Inspections Inspector signature: _______ Certification number: 7526_______ License number: 2982_______ Phone number: 218-839-1849 2: Necessary or Locally Required Attachments □ System/As-built drawing V wT‘iJ «11 tiW^ Soil boring logs □ Other information (list): S Forms per local ordinance vww.pca.state.mn.us • 651-296-6300 • 800-657-3864 wq-wwists4-31 • 3/16/12 TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 1 of 3 ■ Property address: 30570 Lodge Loop, Dent MN 56528 Inspector initials/Date: PJS | 7/28/2015 (mm/dd/yyyy) 1. Impact on Public Health - Compliance component #1 of 5 Compliance criteria: System discharges sewage to the ground surface. System discharges sewage to drain □ Yes S No tile or surface waters. System causes sewage backup into □ Yes S No dwelling or establishment. Any “yes" answer above indicates the system is an imminent threat to public health and safety. Verification method(s): S Searched for surface outlet 0 Searched for seeping in yard/backup in home □ Excessive ponding in soil system/D-boxes □ Homeowner testimony (See Comments/Explanation) □ “Black soil” above soil dispersal system □ System requires “emergency” pumping □ Performed dye test n Unable to verify (See Comments/Explanation) n Other methods not listed (See Comments/Explanation) □ Yes S No Comments/Explanation: 2. Tank Integrity - Compliance component #2 of 5 Compliance criteriaj__________ System consists of a seepage pit, cesspool, drywell, or leaching pit. Seepage pits meeting 7080.2550 may be (x>mpiiant if allowed in iocal ordinance. Verification method(s): S Probed tank(s) bottom ^ Examined construction records □ Examined Tank Integrity Form (Attach) □ Observed liquid level below operating depth □ Examined empty (pumped) tanks(s) S Probed outside tank(s) for “black soil” r~l Unable to verify (See Comments/Explanation) r~l Other methods not listed (See Comments/Explanation) □ Yes S No □ Yes S NoSewage tank(s) leak below their designed operating depth. If yes, which sewage tank(s) leaks: Any “yes” answer above indicates the system is faiiing to protect groundwater. Comments/Explanation: 3. Other Compliance Conditions - Compliance component #3 of 5 a. Maintenance hole covers are damaged, cracked, unsecured, or appear to be staicturally unsound. □ Yes* * S No □ Unknown b. Other issues (electrical hazards, etc.) to immediately and adversely impact public health or safety. □ Yes* H No □ Unknown *System is an imminent threat to pubiic health and safety. Explain: c. System is non-protective of ground water for other conditions as determined by inspector. □ Yes* H No *System is failing to protect groundwater. Explain: www.pca.state.mn.us • 651-296-6300 • 800-657-3864 wq-wwists4-31 • 3/16/12 TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 2 of 3 Propferty address; 30570 Lodge Loop, Dent MN 56528 Inspector initials/Date: PJS | 7/28/2015 (mm/dd/yyyy) 4. Soil Separation - Compliance component #4 of 5 Date of installation: j\M2y2003___ (mm/dd/yyyy) Shoreland/Wellhead protection/Food beverage lodging? Compliance criteria: ___ □ Unknown Verification method(s): Soil observation does not expire. Previous soil observations by two independent parties are sufficient, unless site conditions have been altered or local requirements differ. S Conducted soil observation(s) (Attach boring logs) □ Two previous verifications (Attach boring logs) □ Not applicable (Holding tank(s), no drainfield) S Yes □ No □ Yes □ NoFor systems built prior to April 1, 1996, and not located in Shoreland or Wellhead Protection Area or not serving a food, beverage or lodging establishment: Drainfield has at least a two-foot vertical separation distance from periodically saturated soil or bedrock. □ Unable to verify (See Comments/Explanation) □ Other (See Comments/Explanation) □ Yes □ NoNon-performance systems built April 1, 1996, or later or for non-performance systems located in Shoreland or Wellhead Protection Areas or serving a food, beverage, or lodging establishment: Drainfield has a three-foot vertical separation distance from periodically saturated soil or bedrock.* Comments/Explanation: iC'i'' I|C □ Yes □ No“Experimental”, “Other", or “Performance" systems built under pre-2008 Rules; Type IV or V systems built under 2008 Rules (7080. 2350 or 7080.2400 (Advanced Inspector License required) Drainfield meets the designed vertical separation distance from periodically saturated soil or bedrock. Indicate depths or elevations 20"A. Bottom of distribution media >Sfc"B. Periodicaliy saturated soil/bedrock >36"C. System separation D. Required compliance separation* 36" *May be reduced up to 15 percent if allowed by Local Ordinance. Any “no” answer above indicates the system is failing to protect groundwater. 5. Operating Permit and Nitrogen BMP* - Compliance component #5 of 5 ^ Not applicable □ Yes □ No If “yes”, A below is required □ Yes □ No If “yes”, B below is required Is the system operated under an Operating Permit? Is the system required to employ a Nitrogen BMP? BMP = Best Management Practice(s) specified in the system design If the answer to both questions is “no”, this section does not need to be completed. Compliance criteria a. Operating Permit number;___ Have the Operating l^erm^it requirements been met? b. Is the required nitrogen ^MP in place and properly functioning? Any “no” answer indicates Noncompliance. □ Yes □ No C ccak:jeo□ Yes □ No Upgrade Requirements (Minn. Stat § 115.55) An imminent threat to public health and safety (ITPHS) must be upgraded, replaced, or its use discontinued within ten months of receipt of this notice or within a shorter period if required by local ordinance. If the system is failing to protect ground water, the system must be upgraded, replaced, or its use discontinued within the time required by local ordinance. If an existing system is not failing as defined in law, and has at least two feet of design soil separation, then the system need not be upgraded, repaired, replaced, or its use discontinued, notwithstanding any local ordinance that is more strict. This provision does not apply to systems in shoreland areas. Wellhead Protection Areas, or those used in connection with food, beverage, and lodging establishments as defined In law. TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 3 of 3 www.pca.state.mn.us • 651-296-6300 • 800-657-3864 wq-wwists4-31 • 3/16/12 Department of LAND AND RESOURCE MANAGEMENT OTTER TAIL COUNTY Government Services Center - 540 West Fir Fergus Falls, mn 56537 PH: 218-99S-S095 OTTER Ta*. County's website: www.co.otter-tail.mn.us OTTER TRIl coaaTT aiaaifOTa ;Otter Tail County Compliance Inspection Form Addendum This form is a required attachment to MPCA Compliance Inspection Form for all Existing Subsurface Sewage Treatment Systems in Otter Tail County as of June 1,2011. Property Information Parcel Number: S^OQOO^QO.S TfOOO Township: STcvr|c\Ke -Section: ^ . \nlh A F~ro^n tCProperty Owner Name(s): Property Address: 30^lO L Reason for Inspection: pvqi-)- Number of Bedrooms: |2 % looc^fd = izt'Cipt LoO|^ ^‘cv\ ^ □In Shoreland Area? Lake/River Name, Number, & Class Yes No <;Trxr L^fce S(o-3^ BSystem Compliance Status:Compliant Non-Compliant Does the soil treatment area have less than 3 feet of vertical separation? Is the septic tank located less than 50 feet from any well? Is the soil treatment area located less than 50 feet from any deep well? Is the soil treatment area located less than 100 feet from any shallow well? Does any part of the septic system fail to meet the minimum OHWL setback requirements for the public water classification? XYes XYes Yes Yes XYes "Yes" indicates that the system is failing to protect ground water and is noncompliant. If "Yes", describe the condition noted: Required Attachments: System drawing to scale on next page. Completed MPCA Compliance Inspection I hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. .•AMfi’rrj V' Ji ij •< < tnllrrName:Phil Stoll Certification Number:7526 Business License Name & Number: Signature: Stoll Inspections 2982 7-ZMSDate: Excel/Compliance Form for OTC 1/15/2014 Page 1 of 2 Otter Tail County Compliance Inspection Form Addendum (cont.) Parcel Number: 540000*^ 0 O S7000 Date & Initial: ~1-ZZ')S______________ System Drawing The system drawing must be to scale and include all septic/holding/lift tanks, drainfields, wells within 100 feet of system (indicate depth of wells), dwelling and non-dwelling structures, lot lines, road right-of-ways, easements, OHWLs, wetlands, and topographic features (i.e. bluffe). Sti AfUclopc/ Additional Comments: Excel/Compliance Form for OTC 1/15/2014 Page 2 of 2 N s .<A HI it t. ■ «•3 t. ODDDIir/» T. ,■ St f Compliance Inspection FormMinnesota Pollution Control Agency 520 Lafayette Road North St. Paul, MN 55155-4194 Existing Subsurface Sewage Treatment Systems (SSTS) Doc Type: Compliance and Enforcement For local tracking purposes:Inspection results based on Minnesota Pollution Control Agency (MPCA) requirements and attached forms - additional local requirements may also apply. Submit completed form to Local Unit of Government (LUG) and system owner within 15 days System Status System status on date (mm/dd/yyyy): 7/28/2015 ^ Noncompliant - Notice of Noncompliance (See Upgrade Requirements on page 3.) O Compliant - Certificate of Compliance (Valid for 3 years from report date, unless shorter time frame outlined in Local Ordinance.) Reason(s) for noncompliance (check all applicable) O Impact on Public Health (Compliance Component #1)- Imminent threat to public health and safety □ Other Compliance Conditions (Compliance Component #3) - Imminent threat to public health and safety Kl Tank Integrity (Compliance Component #2) - Failing to protect groundwater □ Other Compliance Conditions (Compliance Component #3) - Failing to protect groundwater □ Soil Separation (Compliance Component #4) - Failing to protect groundwater □ Operating permit/monitoring plan requirements (Compliance Component #5) - Noncompliant Property Information Property address: 30570 Lodge Loop, Dent MN 56528 Property owner: John Frank_____________________ Parcel ID# or Sec/Twp/Range: 56000090057000 _____________ Reason for inspection: Permit _____________ Owner’s phone: ____________ or Owner’s representative: _____ Local regulatory authority: Ottertail County Brief system description: Concrete septic tank to rock and trench drainfield. Comments or recommendations: Probed tank and found hole in bottom just below the inspection pipe. Tried to probe for drainfield location and could not locate it. Representative phone:________________ Regulatory authority phone: 218-998-8095 Certification / hereby certify that all the necessary infomiation has been gathered to determine the compliance status of this system. No determination of future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. Inspector name: Phil Stoll___ Business name: Stoll Inspections Inspector signature: Certification number: 7526_______ License number: 2982_______ Phone number: 218:::839-1849 ^ A ■’‘IDNecessary or Locally Required Attachments □ System/As-built drawing^ Soil boring logs □ Other information (list): S Forms per local ordinance www.pca.state.mn.us • 651-296-6300 • 800-657-3864 wq-wwists4-31 • 3116112 TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 1 of 3 Property address: 30570 Lodge Loop, Dent MN 56528 Inspector initials/Date: PJS | 7/28/2015 (mm/dd/yyyy) 1. Impact on Public Health - Compliance component #1 of 5 Compliance criteria:_______ System discharges sewage to the ground surface. System discharges sewage to drain □ Yes H No tjle or surface watery System causes sewage backup into □ Yes S No dwelling or establishment. Any “yes” answer above indicates the system is an imminent threat to public health and safety. Verification method(s): S Searched for surface outlet S Searched for seeping in yard/backup in home □ Excessive ponding in soil system/D-boxes im Homeowner testimony ("See Comments/Explanation) □ “Black soil” above soil dispersal system □ System requires “emergency” pumping □ Performed dye test D Unable to verify (See Comments/Explanation) CU Other methods not listed (See Comments/Explanation) □ Yes SNo Comments/Explanation: 2. Tank Integrity - Compliance component #2 of 5 C^ompliance criteria:_________ System consists of a seepage pit, cesspool, drywell, or leaching pit. Seepage pits meeting 7080.2550 may be compliant if allowed in local ordinance. Verification method(s): □ Probed tank(s) bottom □ Examined construction records □ Examined Tank Integrity Form (Attach) □ Observed liquid level below operating depth □ Examined empty (pumped) tanks(s) □ Probed outside tank(s) for “black soil” □ Unable to verify (See Comments/Explanation) □ Other methods not listed (See Comments/Explanation) □ Yes □ No □ Yes □ NoSewage tank(s) leak below their designed operating depth. If yes, which sewage tank(s) leaks: only one there Any “yes” answer above indicates the system is failing to protect groundwater. Comments/Explanation: 3. Other Compliance Conditions - Compliance component #3 of 5 a. Maintenance hole covers are damaged, cracked, unsecured, or appear to be structurally unsound. □ Yes* * 0 No □ Unknown b. Other issues (electrical hazards, etc.) to immediately and adversely impact public health or safety. □ Yes* B No □ Unknown *System is an imminent threat to public health and safety. Explain: c. System is non-protective of ground water for other conditions as detemnined by inspector. □ Yes* S No *System is failing to protect groundwater. Explain: Dy i :il .* I W www.pca.state.mn.us • 651-296-6300 • 800-657-3864 wq-wwists4-31 • 3/16/12 TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 2 of 3 property address: 30570 Lodge Loop, Dent MN 56528 Inspector initials/Date: PJS | 7/28/2015 (mm/dd/yyyy) 4. Soil Separation - Compliance component #4 of 5 S UnknownDate of installation:Verification method(s): Soil observation does not expire. Previous soil observations by two independent parties are sufficient, unless site conditions have been altered or local requirements differ. Q Conducted soil observation(s) (Attach boring logs) D Two previous verifications (Attach boring logs) CD Not applicable (Holding tank(s), no drainfield) n Unable to verify (See Comments/Explanation) O Other (See Comments/Explanation) (mm/dd/yyyy) Shoreland/Wellhead protection/Food beverage lodging?S Yes □ No Compliance criteria^ For systems built prior to April 1, 1996, and not located in Shoreland or Weilhead Protection Area or not sen/ing a food, beverage or lodging establishment: Drainfield has at least a two-foot vertical separation distance from periodically saturated soil or bedrock. □ Yes □ No O Yes □ No Comments/Explanation:Non-performance systems built April 1, 1996, or later or for non-performance systems located in Shoreland or Wellhead Protection Areas or serving a food, beverage, or lodging establishment: Drainfield has a three-foot vertical separation distance from periodically saturated soil or bedrock.* □ Yes □ No“Experimental", “OtheF’, or “Performance" systems built under pre-2008 Rules; Type IV or V systems built under 2008 Rules (7080. 2350 or 7080.2400 (Advanced Inspector License required) Drainfield meets the designed vertical separation distance from periodically saturated soil or bedrock. Indicate depths or elevations A. Bottom of distribution media B. Periodically saturated soil/bedrock C. System separation D. Required compliance separation* ‘May be reduced up to 15 percent if allowed by Local Ordinance. Any “no” answer above indicates the system is failing to protect groundwater. 5. Operating Permit and Nitrogen BMP* - Compliance component #5 of 5 ^ Not applicable □ Yes 0 No If “yes”, A below is required □ Yes E No If “yes”, B below is required Is the system operated under an Operating Permit? Is the system required to employ a Nitrogen BMP? BMP = Best Management Practice(s) specified in the system design If the answer to both questions is “no”, this section does not need to be completed. Compliance criteria _ _______________ a. Operating Permit number: ____________ Have the Operating Permit requirements been met?________ b. Is the required nitrogen BMP in place and properly functioning? Any “no” answer indicates Noncompliance. □ Yes □ No □ Yes □ No ED Upgrade Requirements (Minn. Stat § 115.55) An imminent threat to public health and safety (ITPHS) must be upgraded, replaced, or its use discontinued within ten months of receipt of this notice or within a shorter period if required by local ordinance. If the system is failing to protect ground water, the system must be upgraded, replaced, or its use discontinued within the time required by local ordinance. If an existing system is not failing as defined in law, and has at least two feet of design soil separation, then the system need not be upgraded, repaired, replaced, or its use discontinued, notwithstanding any local ordinance that is more strict. This provision does not apply to systems In shoreland areas, Wellhead Protection Areas, or those used in connection with food, beverage, and lodging establishments as defined in law. www.pca.state.mn.us • 651-296-6300 • 800-657-3864 wq-wwists4-31 • 3/16/12 TTY 651 -282-5332 or 800-657-3864 • Available in alternative formats Page 3 of 3 Department of LAND AND RESOURCE MANAGEMENT OTTER TAIL COUNTY Government Services Center - 540 West Fir Fergus Falls, MN 56537 F>H: 2ie-99S-BOQ5 OTTER Tab. County's Website: www.co.otter-tail.mn.us OTTER Tflll o e • It « I ■ I « • ( I o t • Otter Tail County Compliance Inspection Form Addendum This form is a required attachment to MPCA Compliance Inspection Form for all Existing Subsurface Sewage Treatment Systems in Otter Tail County as of June 1, 2011. Property Information Parcel Number: Township: Section: Property Owner Name(s): Property Address: 'So5~70 Reason for Inspection: V Number of Bedrooms: oy> Lndaf L»op MfJ S&SZg □In Shoreland Area? Lake/River Name, Number, & Class Yes No S4<vr L^s/cjg- System Compliance Status: ^ Compliant Non-Compliant >cDoes the soil treatment area have less than 3 feet of vertical separation? Is the septic tank located less than 50 feet from any well? Is the soil treatment area located less than 50 feet from any deep well? Is the soil treatment area located less than 100 feet from any shallow well? Does any part of the septic system fail to meet the minimum OHWL setback requirements for the public water classification? Yes No iYes No Yes No XYes No XYes No "Yes" indicates that the system is failing to protect ground water and is noncompliant. If "Yes", describe the condition noted: Required Attachments: System drawing to scale on next page. Completed MPCA Compliance Inspection I hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. Name:Df APhil Stoll Certification Number:7526 Business License Name & Number: Signature: Stoll Inspections 2982 Date; Excel/Compliance Form for OTC 1/15/2014 Page 1 of 2 Otter Tail County Compliance Inspection Form Addendum (cont.) Parcel Number: f^^OQOO^^OOS^OQD Date & Initial: ____________ System Drawing The system drawing must be to scale and include all septic/holding/lift tanks, drainfields, wells within 100 feet of system (indicate depth of wells), dwelling and non-dwelling structures, lot lines, road right-of-ways, easements, OHWLs, wetlands, and topographic features (i.e. bluffs). 'Se£ X3 u lL>fb£ih Additional Comments: Excel/Compliance Form for OTC 1/15/2014 Page 2 of 2 N J4^ S fRAhJKSt ft •S?. C3i~i -------;T I**□ D'’(lire <;-u- f Compliance Inspection FormMinnesota Pollution Control Agency 520 Lafayette Road North St Paul, MN 55155-4194 Existing Subsurface Sewage Treatment Systems (SSTS) Doc Type: Compliance and Enforcement For local tracking purposes;Inspection results based on Minnesota Pollution Control Agency (MPCA) requirements and attached forms - additional local requirements may also apply. Submit completed form to Local Unit of Government (LUG) and system owner within 15 days System Status System status on date (mm/dd/yyyy): 7/28/2015 G Noncompliant - Notice of Noncompliance (See Upgrade Requirements on page 3.) G Compliant - Certificate of Compliance (Valid for 3 years from report date, unless shorter time frame outlined in Local Ordinance.) Reason(s) for noncompliance (check all applicable) □ Impact on Public Health (Compliance Component #1) - Imminent threat to public health and safety □ Other Compliance Conditions (Compliance Component #3) - Imminent threat to public health and safety □ Tank Integrity (Compliance Component #2) - Failing to protect groundwater □ Other Compliance Conditions (Compliance Component #3) - Failing to protect groundwater □ Soil Separation (Compliance Component M) - Failing to protect groundwater □ Operating permit/monitoring plan requirements (Compliance Component #5) - Noncompliant Property Information Property address: 30570 Lodge Loop, Dent MN 56528 Property owner: John Frank_____________________ Parcel ID# or Sec/Twp/Range: 56000090057000 _____________ Reason for inspection: Permit _____________ Owner’s phone: ____________ or Representative phone: ________________ Regulatory authority phone; 218-998-8095 Owner’s representative: _______________ Local regulatory authority: Ottertail County Brief system description: 2-1000 gal septic tanks, gravity flow to 930 sq.ft, chamber trench drainfield. Comments or recommendations: Certification I hereby certify that all the necessary informabon has been gathered to determine the compliance status of this system. No determination of future system performance has been nor can be made due to unknown conditions during system constmction, possible abuse of the system, inadequate maintenance, or future water usage. Inspector name: Phil Stoll Business name: Stoll Inspections Inspector signature; Certification number: 7526 License number: 2982 Phone number: 218-839-1849 Necessary or Locally Required Attachments □ System/As-built drawing S Forms per local ordinanceS Soil boring logs □ Other information (list): TTY 651 -282-5332 or 800-657-3864 • Available in alternative formats Page 1 of 3 651-296-6300 • 800-657-3864www.pca.state.mn.us • wq-wwists4-31 • 3/16112 Property address; 30570 Lodge Loop, Dent MN 56528 Inspector initials/Date; PJS 1 7/28/2015 (mm/dd/yyyy) 1. Impact on Public Health — Compliance component #1 of 5 Compliance criteria:_______ System discharges sewage to the ground surface._____________ Verification method(s): E Searched for surface outlet S Searched for seeping in yard/backup in home □ Excessive ponding in soil system/D-boxes □ Homeowner testimony (See Comments/Explanation) □ “Black soil” above soil dispersal system □ System requires “emergency” pumping D Performed dye test n Unable to verify (See Comments/Explanation) O Other methods not listed (See Comments/Explanation) □ Yes 0 No System discharges sewage to drain □ Yes 0 No tile or surface waters^ System causes sewage backup into D Yes S No dwelling or establishment. Any “yes” answer above indicates the system is an imminent threat to pubiic health and safety. Comments/Explanation: 2. Tank Integrity - Compliance component #2 of 5 Compliance criteriaj__________ System consists of a seepage pit, cesspool, drywell, or leaching pit. Seepage pits meeting 7080.2550 may be (ximpliant if allowed in local ordinance. Verification method(s): ^ Probed tank(s) bottom ^ Examined construction records □ Examined Tank Integrity Form (Attach) □ Observed liquid level below operating depth □ Examined empty (pumped) tanks(s) S Probed outside tank(s) for “black soil” n Unable to verify (See Comments/Explanation) r~l Other methods not listed (See Comments/Explanation) □ Yes S No □ Yes E NoSewage tank(s) leak below their designed operating depth. If yes, which sewage fank(s) leaks: Any “yes” answer above indicates the system is failing to protect groundwater. Comments/Explanation: 3. Other Compliance Conditions - Compliance component #3 of 5 a. Maintenance hole covers are damaged, cracked, unsecured, or appear to be structurally unsound. □ Yes* * H No □ Unknown b. Other issues (etectrical hazards, etc.) to immediately and adversely impact public health or safety. □ Yes* 0 No □ Unknown *System is an imminent threat to public health and safety. Explain: c. System is non-protective of ground water for other conditions as determined by inspector. □ Yes* 0 No *System is failing to protect groundwater. Explain: www.pca.state.mn.us • 651-296-6300 • 800-657-3864 wq-wwists4-31 • 3/16/12 TTY 651 -282-5332 or 800-657-3864 • Available In alternative formats Page 2 of 3 ■ Property address: 30570 Lodge Loop, Dent MN 56528 Inspector initials/Date: PJS | 7/28/2015 (mm/dd/yyyy) 4. Soil Separation — Compliance component #4 of 5 Date of installation:□ Unknown Verification method(s): Soil observation does not expire. Previous soil observations by two independent parties are sufficient, unless site conditions have been altered or local requirements differ. 13 Conducted soil observation(s) (Attach boring logs) □ Two previous verifications {Attach boring logs) □ Not applicable (Holding tank(s), no drainfield) O Unable to verify (See Comments/Explanation) [~~l Other (See Comments/Explanation) (mm/dd/yyyy) ShorelandyWellhead protection/Food beverage lodging?3 Yes □ No Compliance criteria;_________ For systems built prior to April 1, 1996, and not located in Shoreland or Wellhead Protection Area or not serving a food, beverage or lodging establishment: Drainfield has at least a two-foot vertical separation distance from periodically saturated soH or bedrock. ______ Non-performance systems built April 1, 1996, or later or for non-performance systems located In Shoreland or Wellhead Protection Areas or serving a food, beverage, or lodging establishment: Drainfield has a three-foot vertical separation distance from periodically saturated soil or bedrock.* □ Yes □ No I -i/r-i l‘^,6 Hf' 3 Yes □ No Comments/Explanation: iC^r- I ■' % ClyiM-Se- (<3 Hr' Ue □ Yes □ No“Experimental". “Other", or “Performance” systems built under pre-2008 Rules; Type IV or V systems built under 2008 Rules (7080. 2350 or 7080.2400 (Advanced Inspector License required) Drainfield meets the designed vertical separation distance from periodically saturated soil or bedrock. Indicate depths or elevations 28"A. Bottom of distribution media >64"B. Periodically saturated soil/bedrock C. System separation______>36" 36"D. Required compliance separation* "May be reduced up to 15 percent if allowed by Local Ordinance. Any “no” answer above indicates the system is failing to protect groundwater. 5. Operating Permit and Nitrogen BMP* - Compliance component #5 of 5 ^ Not applicable □ Yes 3 No If “yes”, A below Is required □ Yes 3 No If “yes”, B below is required Is the system operated under an Operating Permit? Is the system required to employ a Nitrogen BMP? BMP = Best Management Practice(s) specified in the system design If the answer to both questions is “no”, this section does not need to be completed. Compliance criteria ____________________ a. Operating Permit number: Have the Operating Permit requirements been met?__________ b. Is the required nitrqg^ BMP in^lace and properly functioning? Any “no” answer indicates Noncompliance. □ Yes □ No 4ZscAtm□ Yes □ No Upgrade Requirements (Minn. Stat. § 115.55) An imminent threat to public health and safety (ITPHS) must be upgraded, replaced, oritsuse discontinued within ten months of receipt of this notice or within a shorter period if required by local ordinance. If the system is failing to protect ground water, the system must be upgraded, replaced, or its use discontinued within the time required by local ordinance. If an existing system is not failing as defined in law, and has at least two feet of design soil separation, then the system need not be upgraded, repaired, replaced, or its use discontinued, notwithstanding any local ordinance that is more strict. This provision does not apply to systems in shoreland areas. Wellhead Protection Areas, or those used in connection with food, beverage, and lodging establishments as defined in law. www.pca.state.mn.us • 651-296-6300 • 800-657-3864 wq-wwists4-31 • 3/16/12 TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 3 of 3 Department of LAND AND RESOURCE MANAGEMENT DECEIVEDOTTER TAIL COUNTY Government Services Center - 540 West Fir Fergus Falls. MN 56537 PW: ai8-998-e095 Otter Tail County's Website: www.co.otter-tam..i>«m.us OTTER TRII Otter Tail County Compliance Inspection Form Addendurn ^ This form is a required attachment to MPCA Compliance Inspection Form for all Existing Subsurface Sewage Treatment Systems in Otter Tail County as of June 1, 2011. Property Information Parcel Number: S6CXX>O^00S70OO Township: ~ RS_____ Property Owner Name(s): ______________________ Property Address: ^oS7D LooL^t Looj^ ^ A1A/ Reason for Inspection: ^ 'y, Number of Bedrooms: ^ oy\ In Shoreland Area? Lake/River Name, Number, & Class Section:__^ □Yes No L-O'iC^ System Compliance Status:Compliant ^ Non-Compliant ^YesDoes the soil treatment area have less than 3 feet of vertical separation? Is the septic tank located less than 50 feet from any well? Is the soil treatment area located less than 50 feet from any deep well? Is the soil treatment area located less than 100 feet from any shallow well? Does any part of the septic system fail to meet the minimum OHWL setback requirements for the public water classification? No Yes No Yes No Yes No )cYes No "Yes" indicates that the system is failing to protect ground water and is noncompliant. If "Yes", describe the condition noted: Required Attachments: System drawing to scale on next page. Completed MPCA Compliance Inspection I hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. Name:Phil Stoll Certification Number:7526 Business License Name & Number: Signature: Stoll Inspections 2982 7-ZS-ISDate: Excel/Compliance Form for OTC 1/15/2014 Page 1 of 2 Otter Tail County Compliance Inspection Form Addendum Parcel Number: Sto0QD^00^7O0O Date & Initial: _________MSSystem Drawing The system drawing must be to scale and include all septic/holding/lift tanks, drainfields, wells within 100 feet of system (indicate depth of wells), dwelling and non-dwelling structures, lot lines, road right-of-ways, easements, OHWLs, wetlands, and topographic features (i.e. bluffs). Additional Comments: Excol/Compliance Form for OTC 1/15/2014 Page 2 of 2 N s $ ii 0 c.O]CZJ C7 DDDOury C» n f Compliance Inspection FormMinnesota Pollution Control Agency 520 Lafayette Road North St Paul, MN 55155-4194 Existing Subsurface Sewage Treatment Systems (SSTS) Doc Type: Compliance and Enforcement For local tracking purposes;Inspection results based on Minnesota Pollution Control Agency (MPCA) requirements and attached forms - additional local requirements may also apply. Submit completed form to Local Unit of Government (LUG) and system owner within 15 days System Status System status on date (mm/dd/yyyy): 7/28/2015 Q Compliant - Certificate of Compliance (Valid for 3 years from report date, unless shorter time frame outlined in Local Ordinance.) ^ Noncompliant- Notice of Noncompliance (See Upgrade Requirements on page 3.) Reason(s) for noncompliance (check all applicable) □ Impact on Public Health (Compliance Component #1) - Imminent threat to public health and safety □ Other Compliance Conditions (Compliance Component #3) - Imminent threat to public health and safety □ Tank Integrity (Compliance Component #2) - Failing to protect groundwater □ Other Compliance Conditions (Compliance Component #3) - Failing to protect groundwater E Soil Separation (Compliance Component #4) - Failing to protect groundwater □ Operating permit/monitoring plan requirements (Compliance Component #5) - Noncompliant Property Information Property address: 30570 Lodge Loop, Dent MN 56528 Property owner; John Frank____________________ Parcel ID# or Sec/Twp/Range: 56000090057000 _____________ Reason for inspection: Permit _____________ Owner’s phone: ____________ or Owner’s representative: _______________ Local regulatory authority: Ottertail County Representative phone: _________________ Regulatory authority phone: 218-998-8095 Brief system description: 1500 gal. Concrete septic tank to 80 gal. Lift to 30x39 pressure bed drainfield. Approx.1170 sq.ft. Comments or recommendations: System #4 on Map. Certification / hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. Inspector name: Phil Stoll______ Business name: Stoll Inspections Inspector signature: Certification number: 7526_______ License number; 2982_______ Phone number; 218-839-1849 Necessary or Locally Required Attachments □ System/As-built drawing scAf]::ED^ Soil boring logs □ Other information (list); S Forms per local ordinance www.pca.state.mn.us • 651-296-6300 • 800-657-3864 wq-wwists4-31 • 3/16/12 TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 1 of 3 Property address: 30570 Lodge Loop, Dent MN 56528 Inspector initials/Date; PJS | 7/28/2015 (mm/dd/yyyy) 1. Impact on Public Health - Compliance component #1 of 5 Compliance criteria:________ System discharges sewage to the ground surface.______ _______ System discharges sewage to drain □ Yes Kl No tile or surface watery System causes sewage backup into □ Yes S No dwelling or establishment. Any “yes” answer above indicates the system is an imminent threat to public health and safety. Verification method(s): S Searched for surface outlet ^ Searched for seeping in yard/backup in home □ Excessive ponding in soil system/D-boxes nH Homeowner testimony (See Comments/Explanation) □ “Black soil” above soil dispersal system n System requires “emergency” pumping n Performed dye test □ Unable to verify (See Comments/Explanation) n Other methods not listed fSee Comments/Explanation) □ Yes SNo Comments/Explanation: 2. Tank Integrity - Compliance component #2 of 5 Conipliance criteiiaj__________ System consists of a seepage pit, cesspool, drywell, or leaching pit. Seepage pits meeting 7080.2550 may be compliant if allowed in local ordinance. Verification method(s): □ Probed tank(s) bottom □ Examined construction records □ Examined Tank Integrity Form (Attach) □ Observed liquid level below operating depth □ Examined empty (pumped) tanks(s) □ Probed outside tank(s) for “black soil” □ Unable to verify (See Comments/Expianation) □ Other methods not listed (See Comments/Explanation) □ Yes □ No □ Yes □ NoSewage tank(s) leak below their designed operating depth. If yes, which sewage tank(s) leaks: Any “yes” answer above indicates the system is failing to protect groundwater. Comments/Explanation: Inspected inside of pumped tank and lift with camera. Both tanks in compliance. 3. Other Compliance Conditions - Compliance component #3 of 5 a. Maintenance hole covers are damaged, cracked, unsecured, or appear to be structurally unsound. □ Yes* * S No □ Unknown b. Other issues (electrical hazards, etc.) to immediately and adversely impact public health or safety. □ Yes* 0 No □ Unknown *System is an imminent threat to pubiic heaith and safety. Explain: c. System is non-protective of ground water for other conditions as determined by inspector. □ Yes* H No *System is failing to protect groundwater. Explain: www.pca.state.mn.us • 651-296-6300 • 800-657-3864 wq-wwists4-31 • 3/16/12 TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 2 of 3 Property address: 30570 Lodge Loop, Dent MN 56528 Inspector initials/Date: PJS | 7/28/2015 (mm/dd/yyyy) 4. Soil Separation - Compliance component #4 of 5 Date of installation: 11/14/2003 (mm/dd/yyyy) Shoreland/Wellhead protection/Food beverage lodging? Compliance criteriaj______________ For systems built prior to April 1, 1996, and not located in Shoreland or Wellhead Protection Area or not sen/ing a food, beverage or lodging establishment: Drainfield has at least a two-foot vertical separation distance from periodically saturated soil or bedrock. S Unknown Verification method(s): Soil observation does not expire. Previous soil obsen/ations by two independent parties are sufficient, unless site conditions have been altered or local requirements differ. I3 Conducted soil observation(s) (Attach boring logs) □ Two previous verifications (Attach boring logs) O Not applicable (Holding tank(s), no drainfield) n Unable to verify (See Comments/Explanation) □ Other (See Comments/Explanation) S Yes □ No □ Yes □ No lO'ir- □ Yes S No Comments/Explanation:Non-performance systems built April 1, 1996, or later or for non-performance systems located in Shoreland or Wellhead Protection Areas or serving a food, beverage, or lodging establishment: Drainfield has a three-foot vertical separation distance from periodically saturated soil or bedrock.* h|h Itl'^r 5S" □ Yes □ No“Experimental", “Other”, or “Performance" systems built under pre-2008 Rules; Type IV or V systems built under 2008 Rules (7080. 2350 or 7080.2400 (Advanced Inspector License required) Drainfield meets the designed vertical separation distance from periodically saturated soil or bedrock. Indicate depths or elevations 38"A. Bottom of distribution media >58'B. Periodically saturated soil/bedrock >20"C. System separation 36"D. Required compliance separation* *May be reduced up to 15 percent if allowed by Local Ordinance. Any “no” answer above indicates the system is faiiing to protect groundwater. 5. Operating Permit and Nitrogen BMP* - Compliance component #5 of 5 ^ Not applicable □ Yes S No If “yes”, A below is required D Yes El No If “yes”, B below is required Is the system operated under an Operating Permit? Is the system required to employ a Nitrogen BMP? BMP = Best Management Practice(s) specified in the system design If the answer to both questions is “no”, this section does not need to be compieted. Compliance criteria a. Operating Permit number: Have the Operating Permit requirements been rnet?__________ b. Is the required nitrogen B^IP iri place and properly functioning? Any “no” answer indicates Noncompliance. □ Yes □ No □ Yes □ No Upgrade Requirements (Minn. Stat. §115.55) An imminent threat to public health and safety (ITPHS) must be upgraded, replaced, or its use discontinued within ten months of receipt of this notice or within a shorter period if required by local ordinance. If the system is failing to protect ground water, the system must be upgraded, replaced, or its use discontinued within the time required by local ordinance. If an existing system is not failing as defined in law, and has at least two feet of design soil separation, then the system need not be upgraded, repaired, replaced, or its use discontinued, notwithstanding any local ordinance that is more strict. This provision does not apply to systems in shoreland areas, Wellhead Protection Areas, or those used in connection with food, beverage, and lodging establishments as defined in law. www.pca.state.mn.us • 651-296-6300 • 800-657-3864 wq-wwists4-31 • 3116112 TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 3 of 3 Department of LAND AND RESOURCE MANAGEMENT OTTER TAIL COUNTY GovcRNMEtsrr Services Center - S40 West Fir Fergus Falls. MN 56537 PH: 218-996-6095 Otter Ta«_ County's Website: www.co.otter-tail.mn.us OTTER TflIIoo»a?i Otter Tail County Compliance Inspection Form Addendum RECEIVED This form is a required attachment to MPCA Compiiance Inspection Form for all Existing Subsurface Sfewage ^‘=S0Uf!C- Treatment Systems in Otter Tail County as of June 1, 2011. ~ " “ Property Information %0Q0Q^OO5 7000 Township: - I^S .NoKo prcn/c_______ Parcel Number: Section: ^ Property Owner Name(s): Property Address: /_oc/ao Reason for Inspection: i \~ Number of Bedrooms: ^ LjpojS (uicihtul t (M. pri m □In Shoreland Area? Lake/River Name, Number, & Class Yes No SWr Ld^ICp System Compliance Status: ^ Compliant J Non-Compliant Does the soil treatment area have less than 3 feet of vertical separation? Is the septic tank located less than 50 feet from any well? Is the soil treatment area located less than 50 feet from any deep well? Is the soil treatment area located less than 100 feet from any shallow well? Does any part of the septic system faii to meet the minimum OHWL setback requirements for the public water classification? Yes No Yes Yes Yes No No No )<Yes No "Yes" indicates that the system is failing to protect ground water and is noncompliant. If "Yes", describe the condition noted: Required Attachments: System drawing to scale on next page. Completed MPCA Compliance Inspection I hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. Name:Phil Stoll Certification Number: 7525 Business License Name & Number: Signature: Stoll Inspections 2982 Date: Excel/Compliance Form for OTC 1/15/2014 Page 1 of 2 Otter Tail County Compliance Inspection Form Addendum (cohf.) Parcel Number: S4>OOQC^OOSiqQO Date & Initial: ______________ System Drawing The system drawing must be to scale and include all septic/holding/lift tanks, drainfields, wells within 100 feet of system (indicate depth of wells), dwelling and non-dwelling structures, lot lines, road right-of-ways, easements, OHWLs, wetlands, and topographic features (i.e. bluffs). 5^ /A"H^(XcWcl n<?\p> /I Additional Comments: Excei/Compliance Form for OTC 1/15/2014 Page 2 of 2 N S 4 ODODOD . [JDno 1717 <5^ Ino f Compliance Inspection FormMinnesota Pollution Control Agency 520 Lafayette Road North St. Paul, MN 55155-4194 Existing Subsurface Sewage Treatment Systems (SSTS) Doc Type: Compliance and Enforcement For local tracking purposes:Inspection results based on Minnesota Pollution Control Agency (MPCA) requirements and attached forms - additional local requirements may also apply. Submit completed form to Local Unit of Government (LUG) and system owner within 15 days System Status System status on date (mm/dd/yyyy): 7/28/2015 ^ Compliant - Certificate of Compliance (Valid for 3 years from report date, unless shorter time frame outlined in Local Ordinance.) O Noncompliant- Notice of Noncompliance (See Upgrade Requirements on page 3.) Reason(s) for noncompliance (check all applicable) □ Impact on Public Health (Compliance Component #1) - Imminent threat to public health and safety □ Other Compliance Conditions (Compliance Component #3) - Imminent threat to public health and safety □ Tank Integrity (Compliance Component #2) - Failing to protect groundwater D Other Compliance Conditions (Compliance Component #3) - Failing to protect groundwater □ Soil Separation (Compliance Component #4) - Failing to protect groundwater □ Operating permit/monitoring plan requirements (Compliance Component #5) - Noncompliant Property Information Property address: 30570 Lodge Loop, Dent MN 56528 Property owner: John Frank____________________ Parcel ID# or Sec/Twp/Range: 56000090057000 _____________Reason for inspection: Permit _____________ Owner’s phone: ____________ or Owner’s representative: __ _________ Local regulatory authority: Ottertail County Brief system description: 1000 Concrete septic tank to rock and trench drainfield. Comments or recommendations: Representative phone: ________________ Regulatory authority phone: 218-998-8095 Certification / hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. Inspector name: Phil Stoll Business name: Stoll Inspections Inspector signature: Certification number: 7526 ____ License number: 2982_______ Phone number: 218-839-1849 Necessary or Locally Required Attachments □ System/As-built drawing scA;;:;tOE Soil boring logs □ Other information (list): 0 Forms per local ordinance www.pca.state.mn.us • 651-296-6300 • 800-657-3864 wq-wwists4-31 • 3/16/12 TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 1 of 3 Property address: 30570 Lodge Loop, Dent MN 56528 Inspector initials/Date: PJS | 7/28/2015 (mm/dd/yyyy) 1. Impact on Public Health - Compliance component #1 of 5 Compliance^riteria: System discharges sewage to the ground surface. ___________ System discharges sewage to drain tile or surface waters. ______ System causes sewage backup into dwelling or establishment. Verification method(s); S Searched for surface outlet 0 Searched for seeping in yard/backup in home □ Excessive ponding in soil system/D-boxes [H Homeowner testimony fSee Comments/Explanation) □ “Black soil” above soil dispersal system □ System requires “emergency” pumping O Performed dye test □ Unable to verify (See Comments/Explanation) CD Other methods not listed (See Comments/Explanation) □ Yes lEI No □ Yes S No □ Yes ^ No Any “yes” answer above indicates the system is an imminent threat to pubiic heaith and safety. Comments/Explanation: 2. Tank Integrity - Compliance component #2 of 5 Compliance criteria: ______ System consists of a seepage pit, cesspool, drywell, or leaching pit. Seepage pits meeting 7080.2550 may be cqmpiiant if allowed in local ordinance. Sewage tank(s) leak below their designed operating depth. If yes, which sewage tank(s) leaks: Any “yes” answer above indicates the system is failing to protect groundwater. Comments/Explanation: Verification method(s): E Probed tank(s) bottom E Examined construction records □ Examined Tank Integrity Form (Attach) D Observed liquid level below operating depth □ Examined empty (pumped) tanks(s) H Probed outside tank(s) for “black soil” CD Unable to verify (See Comments/Explanation) CD Other methods not listed (See Comments/Explanation) □ Yes 0 No OYes H No 3. Other Compliance Conditions - Compliance component #3 of 5 a. Maintenance hole covers are damaged, cracked, unsecured, or appear to be structurally unsound. □ Yes* * 0 No □ Unknown b. Other issues (electrical hazards, etc.) to immediately and adversely impact public health or safety. □ Yes* S No □ Unknown *System is an imminent threat to public health and safety. Explain: c. System is non-protective of ground water for other conditions as determined by inspector. □ Yes* E No *System is failing to protect groundwater. Explain: www.pca.state.mn.us • 651-296-6300 • 800-657-3864 wq-wwists4-31 • 3/16/12 TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 2 of 3 Inspector initials/Date: PJS | 7/28/2015 (mm/dd/yyyy) Property address: 30570 Lodge Loop, Dent MN 56528 4. Soil Separation - Compliance component #4 of 5 E UnknownDate of installation: 6/5/1985 (mm/dd/yyyy) Shoreland/Wellhead protection/Food beverage lodging? Compliance criteria:_________________ For systems built prior to April 1, 1996, and not located in Shoreland or Wellhead Protection Area or not serving a food, beverage or lodging establishment: Drainfield has at least a two-foot vertical separation distance from periodically saturated soil or bedrock. Verification method(s): Soil observation does not expire. Previous soil observations by two independent parties are sufficient, unless site conditions have been altered or local requirements differ. ^ Conducted soil observation(s) (Attach boring logs) □ Two previous verifications (Attach boring logs) n Not applicable (Holding tank(s), no drainfield) Q Unable to verify (See Comments/Explanation) O Other (See Comments/Explanation) E Yes □ No □ Yes □ No -^)5cnl ^2^\0^r' Vz. 2S-'' S Yes □ NoNon-performance systems built April 1, 1996, or later or for non-performance systems located in Shoreland or Wellhead Protection Areas or serving a food, beverage, or lodging establishment: Drainfield has a three-foot vertical separation distance from periodically saturated soil or bedrock.* Comments/Explanation: cU^MHIBH'' Hu*'7^“ □ Yes □ No“Experimental”, “Other”, or “Performance” systems built under pre-2008 Rules; Type IV or V systems built under 2008 Rules (7080. 2350 or 7080.2400 (Advanced Inspector License required) Drainfield meets the designed vertical separation distance from periodically saturated soil or bedrock. Indicate depths or elevations 36"A. Bottom of distribution media >72"B. Periodically saturated soil/bedrock >36"C. System separation D. Required compliance separation* 36" *May be reduced up to 15 percent if allowed by Local Ordinance. Any “no” answer above indicates the system is failing to protect groundwater. 5. Operating Permit and Nitrogen BMP* - Compliance component #5 of 5 ^ Not applicable □ Yes S No If “yes”, A below is required □ Yes 0 No If “yes”, B below is required Is the system operated under an Operating Permit? Is the system required to employ a Nitrogen BMP? BMP = Best Management Practice(s) specified in the system design If the answer to both questions is “no”, this section does not need to be completed. Compliance criteria a. Operating Permit number:_________ ___________ Have the Operating Permit requirements been met? □ Yes □ No □ Yes □ Nob. Is the required nitrogen BMP in place and properly functioning? Any “no” answer indicates Noncompliance. Upgrade Requirements (Minn. Stat §115.55) An imminent threat to public health and safety (ITPHS) must be upgraded, replaced, or its use discontinued within ten months of receipt of this notice or within a shorter period if required by local ordinance. If the system is failing to protect ground water, the system must be upgraded, replaced, or its use discontinued within the time required by local ordinance. If an existing system is not failing as defined in law, and has at least two feet of design soil separation, then the system need not be upgraded, repaired, replaced, or its use discontinued, notwithstanding any local ordinance that is more strict This provision does not apply to systems in shoreland areas. Wellhead Protection Areas, or those used in connection with food, beverage, and lodging establishments as defined in law. www.pca.state.mn.us • 651-296-6300 • 800-657-3864 wq-wwists4-31 • 3/16/12 TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 3 of 3 Department of LAND AND RESOURCE MANAGEMENT OTTER TAIL COUNTY Government Services Center - S40 West Fir Fergus Falls. MN 56537 PH: 218-998-8095 Otter Tail County's Website: www.co.otter-tail.mn.us received OTTCR Tllll Otter Tail County Compliance Inspection Form Addendum^^ & Resource This form is a required attachment to MPCA Compliance Inspection Form for all Existing Subsurface Sewage Treatment Systems in Otter Tail County as of June 1, 2011. Property Information Parcel Number: S^CXDQ &OS~7C)00 Township: S Property Owner Name(s): ^\oV>o Prc^YilC Section: ^ /Looj^ bCO'f' I S4SZ-^ crtn P^rt^iTReason for inspection: Number of Bedrooms:tL UtiitJ ^/7/KAr//^ pJeelutJo El □In Shoreland Area? Lake/River Name, Number, & Class Yes No System Compliance Status: ^ Compliant J Non-Compliant Does the soil treatment area have less than 3 feet of vertical separation? Is the septic tank located less than 50 feet from any well? Is the soil treatment area located less than 50 feet from any deep well? Is the soil treatment area located less than 100 feet from any shallow well? Does any part of the septic system fail to meet the minimum OHWL setback requirements for the public water classification? Yes No Yes Yes Yes No No No XYes No "Yes" indicates that the system is failing to protect ground water and is noncompliant. If "Yes", describe the condition noted: Required Attachments: System drawing to scale on next page. Completed MPCA Compliance Inspection I hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. Name: Phiistoii rrf,M«?prj Certification Number:7526 Business License Name & Number: Signature: Stoll Inspections 2982 Date: Excel/Compliance Form for OTC 1/15/2014 Page 1 of 2 Otter Tail County Compliance Inspection Form Addendum (cont.) Parcel Number: ^60000^00.5 ~70OQ Date & Initial: ~l-Z%'\S______________ System Drawing The system drawing must be to scale and include all septic/holding/lift tanks, drainfields, wells within 100 feet of system (indicate depth of wells), dwelling and non-dwelling structures, lot lines, road right-of-ways, easements, OHWLs, wetlands, and topographic features (i.e. bluffs). Mo\p> $ Additional Comments: Excel/Compliance Form for OTC 1/15/2014 Page 2 of 2 #Minnesota Pollution Control Agency 520 Lafayette Road North St. Paul, MN 55155-4194 Compliance Inspection Form Existing Subsurface Sewage Treatment Systems (SSTS) Doc Type: Compliance and Enforcement For local tracking purposes:Inspection results based on Minnesota Pollution Control Agency (MPCA) requirements and attached fomns - additional local requirements may also apply. Submit completed form to Local Unit of Government (LUG) and system owner within 15 days System Status System status on date (mm/dd/yyyy): 7/28/2015 ^ Compliant - Certificate of Compliance (Valid for 3 years from report date, unless shorter time frame outlined in Local Ordinance.) O Noncompliant - Notice of Noncompliance (See Upgrade Requirements on page 3.) Reason(s) for noncompliance (check all applicable) □ Impact on Public Health (Compliance Component #1) - Imminent threat to public health and safety D Other Compliance Conditions (Compliance Component #3) - Imminent threat to public health and safety □ Tank Integrity (Compliance Component #2) - Failing to protect groundwater □ Other Compliance Conditions (Compliance Component #3) - Failing to protect groundwater □ Soil Separation (Compliance Component #4) - Failing to protect groundwater □ Operating permit/monitoring plan requirements (Compliance Component #5) - Noncompliant Property Information Property address: 30570 Lodge Loop, Dent MN 56528 Property owner: John Frank_____________________ Parcel ID# or Sec/Twp/Range: 56000090057000 _____________ Reason for inspection: Permit _____________ Owner’s phone: ________ or Owner’s representative: _______________ Local regulatory authority: Ottertail County Brief system description: 1000 Concrete septic tank to rock and trench drainfield. Comments or recommendations: Representative phone:_______________ Regulatory authority phone: 218-998-8095 Certification / hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. Inspector name: Phil Stoll Business name: Stoll Inspections Inspector signature:_____ Certification number: 7526_______ License number: 2982_______ Phone number: 218-839-1849 Necessary or Locally Required Attachments □ System/As-built drawing ■'ak:;eu^ Soil boring logs □ Other information (list): ^ Forms per local ordinance wvw.pca.state.mn.us • 651-296-6300 • 800-657-3864 wq-wwists4-31 • 3/16/12 TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 1 of 3 , Property address; 30570 Lodge Loop, Dent MN 56528 Inspector initials/Date; PJS | 7/28/2015 (mm/dd/yyyy) 1. Impact on Public Health - Compliance component #1 of 5 Compliance criteria: System discharges sewage to the ground surface. System discharges sewage to drain □ Yes S No tijej^surface waters^ System causes sewage backup into □ Yes S No dwelling or establishment. Any “yes” answer above indicates the system is an imminent threat to public health and safety. Comments/Explanation: Verification method(s): ^ Searched for surface outlet ^ Searched for seeping in yard/backup in home D Excessive ponding in soil system/D-boxes r~l Homeowner testimony (See Comments/Explanation) □ “Black soil” above soil dispersal system D System requires “emergency" pumping □ Performed dye test D Unable to verify fSee Comments/Explanation) O Other methods not listed (See Comments/Explanation) □ Yes S No 2. Tank Integrity - Compliance component #2 of 5 Complianc^criteriaj__________ System consists of a seepage pit, cesspool, drywell, or leaching pit. Seepage pits meeting 7080.2550 may be compliant if allowed in local ordinance. Sewage tank(s) leak below their designed operating depth. If yes, which sewage tank(s) leaks: Any “yes” answer above indicates the system is failing to protect groundwater. Comments/Explanation: Verification method(s): 0 Probed tank(s) bottom S Examined construction records □ Examined Tank Integrity Form (Attach) □ Observed liquid level below operating depth □ Examined empty (pumped) tanks(s) E Probed outside tank(s) for “black soil” r~l Unable to verify (See Comments/Explanation) r~l Other methods not listed (See Comments/Explanation) □ Yes I3 No O^es ® No 3. Other Compliance Conditions - Compliance component #3 of 5 a. Maintenance hole covers are damaged, cracked, unsecured, or appear to be structurally unsound. □ Yes* * 0 No □ Unknown b. Other issues (electrical hazards, etc.) to immediately and adversely impact public health or safety. □ Yes* E No □ Unknown ‘System is an imminent threat to pubiic health and safety. Explain: c. System is non-protective of ground water for other conditions as determined by inspector. □ Yes* S No *System is failing to protect groundwater. Explain: wvw.pca.state.mn.us • 651-296-6300 • 800-657-3864 wq-wwists4-31 • 3/16/12 TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 2 of 3 Property address: 30570 Lodge Loop, Dent MN 56528 Inspector initials/Date: PJS | 7/28/2015 (mm/dd/yyyy) A, Soil Separation - Compliance component #4 of 5 Date of installation: 6/5/1985 (mm/dd/yyyy) Shoreland/Wellhead protsction/Food beverage lodging? Compliance cnteria:______________ For systems built prior to April 1, 1996, and not located in Shoreland or Wellhead Protection Area or not serving a food, beverage or lodging establishment: Drainfield has at least a twro-foot vertical separation distance from periodically saturated soil or bedrock. ^ Unknown Verification method(s): Soil observation does not expire. Previous soil observations by two independent parties are sufficient, unless site conditions have been altered or local requirements differ. ^ Conducted soil observation(s) (Attach boring logs) Q Two previous verifications (Attach boring logs) r~l Not applicable (Holding tank(s), no drainfield) □ Unable to verify (See Comments/Explanation) r~l Other /See Comments/Explanation) ^ Yes □ No □ Yes □ No 3/z^8“ Idnr VS Yes □ No Comments/Explanation:Non-performance systems built April 1, 1996, or later or for non-perfonnance systems located in Shoreland or Wellhead Protection Areas or serving a food, beverage, or lodging establishment: Drainfield has a three-foot vertical separation distance from periodically saturated soil or bedrock.* II Vl^ %|(jcvw\ ch □ Yes □ No“Experimental”, “Other", or “Performance” systems built under pre-2008 Rules; Type IV or V systems built under 2008 Rules (7080. 2350 or 7080.2400 (Advanced Inspector License required) Drainfield meets the designed vertical separation distance from periodically saturated soil or bedrock. Indicate depths or elevations 29"A. Bottom of distribution media >66"B. Periodically saturated soil/bedrock C. System separation____________>36" D. Required compliance separation* 36" *May be reduced up to 15 percent if allowed by Local Ordinance. Any “no” answer above indicates the system is failing to protect groundwater. 5. Operating Permit and Nitrogen BMP* — Compliance component #5 of 5 ^ Not applicable □ Yes 0 No If “yes”, A below is required □ Yes S No If “yes”, B below is required Is the system operated under an Operating Permit? Is the system required to employ a Nitrogen BMP? BMP = Best Management Practice(s) specified in the system design If the answer to both questions is “no”, this section does not need to be completed. Compliance criteria a. Operating Permit number: __________________ _____Have the Operating Permit requirements been met? _b. Js the required nitrogen BMP in place and properly functioning? Any “no” answer indicates Noncompliance. □ Yes □ No □ Yes □ No Upgrade Requirements (Minn. Stat §115.55) An imminent threat to public health and safety (ITPHS) must be upgraded, replaced, or its use discontinued within ten months of receipt of this notice or within a shorter period if required by local ordinance. If the system is failing to protect ground water, the system must be upgraded, replaced, or its use discontinued within the time required by local ordinance. If an existing system is not failing as defined in law, and has at least two feet of design soil separation, then the system need not be upgraded, repaired, replaced, or its use discontinued, notwithstanding any local ordinance that is more strict This provision does not apply to systems in shoreland areas, Wellhead Protection Areas, or those used in connection with food, beverage, and lodging establishments as defined in law. www.ptca.state.mn.us • 651-296-6300 • 800-657-3864 wq-wwists4-31 • 3/16/12 TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 3 of 3 Department of LAND AND RESOURCE MANAGEMENT OTTER TAIL COUNTY Government Serv)ces Center - 540 West Fir Fergus Falls, mn 56537 Ph: 218-998-8095 OTTER Ta». County's Website: www.co.otter-tail.mn.us receivedOTTER TRIl CO«BTt a<•»4IOT• otter Tail County Compliance Inspection Form Addendum RESOURCE This form is a required attachment to MPCA Compiiance Inspection Form for all Existing Subsurface Sewage Treatment Systems in Otter Tail County as of June 1, 2011. Property InformationParcel Number: S^OOOO^QOSTOQQ Township;Section; ^ Property Owner Name(s): Property Address; 'loSlO I pclaP Loop {^^n4- . MhJ S^S? ^ Reason for Inspection: ^ (mJs X 100 C^J^TNumber of Bedrooms; 0 □In Shoreland Area? Lake/River Name, Number, & Class Yes No S4<Jvr Lo^icz System Compliance Status: ^ Compliant Non-Compliant Does the soil treatment area have less than 3 feet of vertical separation? Is the septic tank located less than 50 feet from any well? Is the soil treatment area located less than 50 feet from any deep well? Is the soil treatment area located less than 100 feet from any shallow well? Does any part of the septic system fail to meet the minimum OHWL setback requirements for the public water classification? Yes Yes No No Yes No Yes No Yes No "Yes" indicates that the system is failing to protect ground water and is noncompliant. if "Yes", describe the condition noted: Required Attachments: System drawing to scale on next page. Completed MPCA Compliance Inspection I hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. Z <«-r.Name:Phil Stoll Certification Number:7526 Business License Name & Number: Signature: Stoll Inspections 2982 TIS'ISDate: Excel/Compliance Form for OTC 1/15/2014 Page 1 of 2 Otter Tail County Compliance Inspection Form Addendum (cont.) Parcel Number: 3^0000^0C)S'~7oC>O Date & Initial; _____________ System Drawing The system drawing must be to scale and include all septic/holding/lift tanks, drainfields, wells within 100 feet of system (indicate depth of wells), dwelling and non-dwelling structures, lot lines, road right-of-ways, easements, OHWLs, wetlands, and topographic features (i.e. bluffs). f Additional Comments;lA Excel/Compliance Form for OTC 1/15/2014 Page 2 of 2 ^ "CA‘:?!E0 N J . /C3 DDDDUry Si f Compliance Inspection FormMinnesota Pollution Control Agency 520 Lafayette Road North St. Paul, MN 55155-4194 Existing Subsurface Sewage Treatment Systems (SSTS) Doc Type: Compliance and Enforcement For local tracking purposes;Inspection results based on Minnesota Pollution Control Agency (MPCA) requirements and attached forms - additional local requirements may also apply. Submit completed form to Local Unit of Government (LUG) and system owner within 15 days System Status System status on date (mm/dd/yyyy): 7/28/2015 ^ Compliant - Certificate of Compliance (Valid for 3 years from report date, unless shorter time frame outlined in Local Ordinance.) O Noncompliant - Notice of Noncompliance (See Upgrade Requirements on page 3.) Reason(s) for noncompliance (check all applicable) □ Impact on Public Health (Compliance Component #1) - Imminent threat to public health and safety □ Other Compliance Conditions (Compliance Component #3) - Imminent threat to public health and safety □ Tank Integrity (Compliance Component #2) - Failing to protect groundwater □ Other Compliance Conditions (Compliance Component #3) - Failing to protect groundwater □ Soil Separation (Compliance Component #4) - Failing to pmtect groundwater □ Operating permit/monitoring plan requirements (Compliance Component #5) - Noncompliant Property Information Property address: 30570 Lodge Loop, Dent MN 56528 Property owner: John Fr^k_____________________ Parcel ID# or Sec/Twp/Range: 56000090057000 _____________ Reason for inspection: Permit _____________ Owner’s phone:___________ or Owner’s representative;_______________ Local regulatory authority: Ottertail County Representative phone; ________________ Regulatory authority phone: 218-998-8095 Brief system description; 1500 gal. Concrete septic tank to rock and trench drainfield. 1005 sq.ft._________________ Comments or recommendations: Certification I hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. Inspector name: Phil Stoll _ Business name: Stoll Inspections Inspector signature: Certification number: 7526_______ License number; 2982_______ Phone number: 218-839-1849 Necessary or Locally Required Attachments □ System/As-built drawing ANiNED;Soil boring logs □ Other information (list): S Forms per local ordinance wiw vww.pca.state.mn.us • 651-296-6300 • 800-657-3864 wq-wwists4-31 • 3116112 TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Poge 1 of 3 Property address: 30570 Lodge Loop, Dent MN 56528 Inspector initials/Date: PJS | 7/28/2015 (mm/dd/yyyy) 1. Impact on Public Health - Compliance component #1 of 5 Compliance criteria: ___ System discharges sewage to the ground surface. System discharges sewage to drain □ Yes ^ No _tile or surface waters.___ System causes sewage backup into □ Yes ^ No dwelling or establishment. Any “yes" answer above indicates the system is an imminent threat to public health and safety. Comments/Explanation: Verification method(s): E Searched for surface outlet S Searched for seeping in yard/backup in home □ Excessive ponding in soil system/D-boxes □ Homeowner testimony (See Comments/Explanation) □ “Black soil” above soil dispersal system n System requires “emergency” pumping □ Performed dye test □ Unable to verify (See Comments/Explanation) n Other methods not listed (See Comments/Explanation) □ Yes S No 2. Tank integrity - Compliance component #2 of 5 Compliance criteria: __ System consists of a seepage pit, cesspool, drywell, or leaching pit. Seepage pits meeting 7080.2550 may be compliant if allowed in local ordinance. Verification method(s): S Probed tank(s) bottom 0 Examined construction records □ Examined Tank Integrity Form (Attach) □ Observed liquid level below operating depth □ Examined empty (pumped) tanks(s) S Probed outside tank(s) for “black soil” □ Unable to verify (See Comments/Explanation) □ Other methods not listed (See Comments/Explanation) □ Yes S No Q Yes H NoSewage tank(s) leak below their designed operating depth. If yes, which sewage tank(s) leaks: Any “yes” answer above indicates the system is failing to protect groundwater. Comments/Explanation: 3. Other Compliance Conditions - Compliance component #3 of 5 a. Maintenance hole covers are damaged, cracked, unsecured, or appear to be structurally unsound. □ Yes* * H No □ Unknown b. Other issues (electrical hazards, etc.) to immediately and adversely impact public health or safety. □ Yes* I3 No □ Unknown *System is an imminent threat to public health and safety. Explain: c. System is non-protective of ground water for other conditions as determined by inspector. □ Yes* 0 No *System is failing to protect groundwater. Explain: www.pca.state.mn.u5 • 651-296-6300 • 800-657-3864 wq-wwists4-31 • 3/16/12 TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 2 of 3 Property address; 30570 Lodge Loop, Dent MN 56528 Inspector initials/Date: PJS | 7/28/2015 (mm/dd/yyyy) 4. Soil Separation - Compliance component #4 of 5 Date of installation: 11/14/2003 ___ (mm/dd/yyyy) Shoreland/Wellhead protection/Food beverage lodging? ^nyjliance criteria:___________ For systems built prior to April 1, 1996, and not located in Shoreland or Wellhead Protection Area or not serving a food, beverage or lodging establishment: Drainfield has at least a two-foot vertical separation distance from periodically saturated soil or bedrock. E Unknown Verification method(s): Soil observation does not expire. Previous soil obsen/ations by two independent parties are sufficient, unless site conditions have been altered or local requirements differ. E Conducted soil observation(s) (Attach boring logs) □ Two previous verifications (Attach boring logs) l~l Not applicable (Holding tank(s), no drainfield) □ Unable to verify (See Comments/Explanation) □ Other (See Comments/Explanation) SYes DNo □ Yes □ No IE]Yes DNoNon-performance systems built April 1, 1996, or later or for non-performance systems located in Shoreland or Wellhead Protection Areas or serving a food, beverage, or lodging establishment: Drainfield has a three-foot vertical separation distance from periodically saturated soil or bedrock.* Comments/Explanation: 2o" Cit^ 111 r^i 54^ ^•r'□ Yes □ No“Experimental", “Other”, or “Performance" systems built under pre-2008 Rules; Type IV or V systems built under 2008 Rules (7080. 2350 or 7080.2400 (Advanced Inspector License required) Drainfield meets the designed vertical separation distance from periodically saturated soil or bedrock. Indicate depths or elevations 38"A. Bottom of distribution media >74"B. Periodically saturated soil/bedrock >36"C. System separation D. Required compliance separation* 36" "May be reduced up to 15 percent if allowed by Local Ordinance. Any “no” answer above indicates the system is failing to protect groundwater. 5. Operating Permit and Nitrogen BMP* — Compliance component #5 of 5 ^ Not applicable □ Yes S No If “yes”, A below is required □ Yes ^ No If “yes”, B below is required Is the system operated under an Operating Permit? Is the system required to employ a Nitrogen BMP? BMP = Best Management Practice(s) specified in the system design If the answer to both questions is “no”, this section does not need to be completed. Compliance criteria a. Operating Permit number; Have^he Operating Permit requirements been met?__________ b. Is the required nitrogen BMP in place andjiroperly functioning? Any “no” answer indicates Noncompliance. □ Yes □ No □ Yes □ No Upgrade Requirements (Minn. Stat §115.55) An imminent threat to public health and safety (ITPHS) must be upgraded, replaced, or its use discontinued within ten months of receipt of this notice or within a shorter period if required by local ordinance. If the system is failing to protect ground water, the system must be upgraded, replaced, or its use discontinued within the time required by local ordinance. If an existing system is not failing as defined in law, and has at least two feet of design soil separation, then the system need not be upgraded, repaired, replaced, or its use discontinued, notwithstanding any local ordinance that is more strict This provision does not apply to systems in shoreland areas. Wellhead Protection Areas, or those used in connection with food, beverage, and lodging establishments as defined in law. www.pca.state.mn.us • 651-296-6300 • 800-657-3864 wq-wwists4-31 • 3/16/12 TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 3 of 3 APPLICATfON FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENTCENTER, 540 WEST FIR. FERGUS FALLS, MN 56537 218-998-8095 www.co.otter-tail.mn.us OTTCR THII PINK - Owner/ Contractor (after issue)YEjt-OW -L&R InspectorcovaTT-BiiiacfOTa Permit No. 0 3 IS 3^O BE PROCESSEDAPPLICATION MUST BE TWP NAMELAKE/RIVER CLASS SECTION TWP NO.RANGELAKE NUMBER LAKE/RIVER NAME /Jr y/i E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROADPARCEL NUMBER (S) OF PROPERTY BEING SERVICED SL ocx)e)9 60 ^9no 6 LEGAL DESCRIPTION 9./V 3/z. A/C^^^Y /Q'>^ yy?" Cf-v r /L/i Daytime Phone No.First Initial Mailing AddressLast Name L)pj^ /• Property Owner m rO y /V.O h'ooY ! ^ (Ta;.Contractor Lie.#'nurx I ;v ; r- ^ THtS SPACE FOR OFFICE USE ONLY ► This System will be ready for inspection on iL&R OfficialTime ReceivedDate Received NSTALLATION (circle one)TYPE OF SEWAGE TREATMENT SYSTEM DESIGN AS SHOWN ON DRAWINGOther Est.Residential (A) New (B) Replacement (C) Add on Collector (G) New (H) Replacement (I) Add on (D) New (E) Replacement (F) Add on So]^ ment(C0--LiftTank Treat»• t t u '6Effluent Distribution (j^^) Gravity ( ) Pressure Design Flow (Gallons/Day) (J) 0 (K) v 1 •^2,49» (L) 2,500 — 4,999 (M) 5,000 — 10,000 Area GIs GIs Ft./7sySize Setback To Nearest Well V / Ft-Ft.Ft.Type IIType I /OO / (27) Rapidly Permeable(20) Trench, Rock a/'-'Ft-Ft.^0 Ft.Setback To OHWL(21) Trench, Gravelless (28) Flood Plain t(22)>Trench, Chamber (29) Privies — Ft.Ft.Ft.tSetback To Bluff(30) Holding Tank (Contract Required) (23) Bed (24) Mound Ft.C- Ft./OO 7 '"t-Setback To Dwelling (25) At Grade Type III Setback To Non-Dwelling 5-0 y/j Ft.Ft.Ft.(31) Other/Problem Soils/<12" Soil(26) Greywater Type IV(34) Tank Only Setback To Nearest Lot Line /C)0^Ft./OC ' Ft.Ft.(32) Public Domain & Proprietary Technologies(35) Other Setback To Road Right-Of-WayDepth of Well /A?''Ft.Ft.7 Oo ^ Ft.Type V Total # Bedrooms (33) Performance Elevation Above Restrictive Layer - (• Ft.Ft. Ft.Garbage Disposal Y NAbatement Y / N PERCTEST DATA Highest RateDate of Test_ License #Designer Agreement: The undersigned hereby makes appiication 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 iine). //■ oo)■ ' :6>Permit Fee $Date: Signature of Propert^vmer/Agent for Owner 0 C'f - C ^Date:Rec. No.. a'/' Land St Resource Management Official Comments: ■r ^ g/Nffj -\v ipra M/y/k 1) K \(\\\riLud 1 Form No. BK — 04-2014-06 357,243 • Victor Lundeen Co..rers • Fergus Falls, Minnesota i\SEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTS STA (Soil Treatment Area) OUTHOUSE TRENCH REDUCTIONHOLDING SEPTIC TANK LIFT TANKCATEGORY inchesRock trenches withFT2CapacityGLS.GLS. %of sidewall forFTFTFTSetback from Nearest Well reduction / equivalent toSetback from Buried Water Suction Pipe FTFT STA CALCULATION (Soil Treatment Area) ____Ft. X _______ Setback from Buried Pipe Distributing Water Under Pressure FT FTFT FTSetback from OHWL (lake &/or river)FT FT Ft. FTFTSetback from Bluff FT FP FT MOUND / AT-GRADEFTFTSetback from Dwelling ROCK BEDFTSetback from Non-Dwelling FT FT FTFTSetback from Nearest Property Line FT Ft.Ft. X FT FTSetback from Right-of-Way FT Ft* FTElevation above Restrictive Layer FT FT SAND IN MOUNDINSTALLERS COMMENTS SEPTIC TAN K(s)Holding Tank / Lift Alarm □ YES □ NO # Tanks InstalledWeep HolesOld System Pumped & Destroyed □ YES □ NO Manuf.Lateral Pipe Size INNumber of Laterals # Model #Perforation Diameter Size INFt.Perforation Spacing Feet of Total Head FILTERS DYES □ NOGallons Per MinutePUMPS Inspector's Comments: Sketch: the above described sewage system installation was found to be compliant with the provisions of the Sanitation Code of Otter Tail County. As of Initial / L S R OfficialTimaDate Land & Resource Management Official Form No. BK — 04-2014-06 357,243 ■ Victor Lundeen Co., Printers • Fergus Falls. Minnesota f t Minnesota Pollution Control Agency I'-OSTP Design Summary Worksheet University OF Minnesota Property Owner/Client: Franks Lodge Cabins, Lodge, House 6 apt v05.13.14Project ID: Site Address: 30543 Lodge Loop Dent, MN 56528 Date: 9/26/15 1. DESIGN FLOW AND TANKS Note: The estimated design flow is considered a peak flow rate including a safety factor. For long term performance, the average daily flow is recommended to be < 60% of this value. Gallons, in 1710A. Design Flow:Gallons Per Day (GPD) B. Septic Tanks: Minimum Code Required Septic Tank Capacity:5130 1 Tanks or Compartments Recommended Septic Tank Capacity:6500 Gallons, in 3 Tanks or Compartments Effluent Screen:optional electricAlarm: C. Holding Tanks Only: Minimum Code Required Capacity:Gallons, in Tanks Designer Recommended Capacity:Gallons, in Tanks Type of High Level Alarm: 1000D. Pump Tank 1 Capacity (Code Minimum):Gallons Pump Tank 2 Capacity (Code Minimum):Gallons 1000Pump Tank 1 Capacity (Designer Rec):Gallons Pump Tank 2 Capacity (Designer Rec):Gallons 30.0 GPM Total Head 38.3 ftPump 1 GPM Total HeadPump 2 ft Supply Pipe Dia. 2.00 in 150.0 gal Supply Pipe Dia.Dose Volume:in Dose Volume:gal 2. SYSTEM TYPE (^Trench Obrip Otiolding Tank Oeed @Gravity Distribution * Selection Required O^tGrade OPressure Distribution-LevelOMound OPressure Distribution-Unlevel Oother 100.00Benchmark Elevation:ft Benchmark Location: System Type Type of Distribution Media: I brainfield Rock Qtegistered Treatment Media:El Type I □ Type II □ Type III □ Type IV □ TypeV quick-4 high capicity 3. SITE EVALUATION: 60Depth to Limiting Layer:A.5.0 ft 6.0inB.Measured Land Slope %:% Elevation of Limiting Layer:C.sandy loamD.Soil Texture: Loc. of Restricive Elevation:GPD/ft^0.78E.F.Soil Hyd. Loading Rate: [T^ft36G. Minimum Required Separation:in MPIH.Perc Rate: jinI. Code Maximum Depth of System:24 Comments: 4. DESIGN SUMMARY Trench Design Summary ft^Dispersal Area 1754 Sidewall Depth 12 Trench Width 3in ft Total Lineal Feet 588 ft Number of Trenches 6 Code Maximum Trench Depth 24.0 in 1.2Contour Loading Rate ft 36.0Designer's Max Trench Depth in Bed Design Summary ft^Absorption Area Depth of sidewall Code Maximum Bed Depthin in Bed Width Bed Lengthft Designer's Max Bed Depthft in 4- ■ Minnesota Pollution ' Control Agency OSTP Trench Design Worksheet University J OF Minnesota i ■'->7 f v05.13.14Project ID:1. SYSTEM SIZING: '^^gnerl^Ma^mum Depth:^ tT>< chtfA. Design Flow: B. Code Maximum Depth: C. Soil Loading Rate: D. Required Bottom Area: Design Flow (1.A) ^ Loading Rate (1.C) = .Initial Required Bottom Area 1710 |gPD-| 0^78 GPD/ft^ = 2192 ft^ □ Rock El Registered Product □ Pressure □ Gravity-Drop El Gravity-Other G. If distribution media is installed in contact with sandy or loamy sand or with a percolation rate of 0.1 to 5 mpi indicate distribution or treatment method: ;48 inchesinches i 0.78 GPD/ft^.......1.2Contour Loading Rate:gal/ft E. Select Dispersal Media: (selection required) F. Select Distribution Method: END CAPS 2; TRENCH CONFIGURATION: ROCK Initial required trench bottom area (ft^): (from 1.D) Sidewall Absorption (inches) Design trench bottom area A.Bottom Area Reduction Bottom Area Multiplier A.L X Cover5’ 6 to 11 1 Q.^ Dist rihution20%0.812 to 17 0.6618 to 23 34%^Sidewall 24 40%0.6 WidthB. Select Sidewall Height:ftinches ft^C. Design Bottom Area (2.A): ftD. Select Trench Width: E. Total Designed Trench Length: Bottom Area -r Trench Width = Total Required Trench Length ft^ -ftft = I. Calculate Minimum system length based on Contour Loading Rate: Design Flow t Contour Loading Rate = gal/ft ftgpd T !F. Select No. of Trenches:trenches ft (typically 5 - 12 ft from center to center)G. Select Trench Spacing : ;H. Calculate Lawn Area: Trench Length (2.E) X Trench Spacing (2.G) = square feet of lawn area ft X ft^ lawn areaft = J. Select Depth Required to Cover Distribution Pipe: ft (0.33 ft for pressure, 0.5 ft for gravity) K. Calculate Rock Volume: (Sidewall Height (2.B) + Depth to Cover Pipe (2.J)) X Bottom Area (2.C) = cubic feet ------------— ------------------- -------------------ft^ =---------------------- ! ft^ft +ft) X( Divide ft^ by 27 ft^/yd^ to calculate cubic yards: Ift' - 27 =yd' OSTP Design Summary Worksheet University OF MinnesotaMinnesota Pollution Control Agency Mound Design Summary ft^Absorption Bed Area Bed Length Bed Widthft Absorption Width Clean Sand Liftft Berm Width (0-1%)ft ft Upslope Berm Width ft Downslope Berm Width Endslope Berm Widthft ft Total System Length Total System Widthft ft Contour Loading Rate gal/ft At-Grade Design Summary Absorption Bed LengthAbsorption Bed Width System Heightftft ft gal/ft Upslope Berm WidthContour Loading Rate Downslope Berm Widthft ft Endslope Berm Width System Length System Widthftft ft Level Et Equal Pressure Distribution Summary No. of Perforated Laterals Perforation Spacing Perforation Diameterft in gal galLateral Diameter in Min. Delivered Volume Maximum Delivered Volume Non-Level and Unequal Pressure Distribution Summary Elevation Pipe Volume (gal/ft) Perforation SizePipe Length (ft)Pipe Size (in)(ft)Spacing (ft)(in)Spacing (in) Lateral 1 Minimum Delivered Volume Lateral 2 gal Lateral 3 Lateral 4 Maximum Delivered Volume galLateral 5 Lateral 6 5. Additional Info for Type IV/Pretreatment Design A. Calculate the orsanic loading 1. Organic Loading to Pretreatment Unit - Design Flow X Estimated BOD in mg/L in the effluent X 8.35 ^ 1,000,000 gpd X mg/L X 8.35^ 1,000,000 =lbs BOD/day 2. Type of Pretreatment Unit Being Installed: 3. Calculate Soil Treatment System Organic Loading: BOD concentration after pretreatment = Bottom Area = Ibs/day/ft^ Ibs/day/ft^ft^ =mg/L X 8.35 = 1,000,000 v Comments/Special Design Considerations: SIZING: 2 CABINS 14 PEOPLE @ 50 GPD= 700 GPD, 2BD HOUSE 300 GPD, 1BD APARTMENT 150 GPD, Lodge OPEN 16 HOURS OR LESS 28 SEATS @ 20 GPD = 560 GPD. 700 + 300 + 150-r 560 = 1710 GALLONS PER DAY. I hereby certify that I have completed this work in accordance with all applicable ordinances, rules and laws. Randy Anderson 09/26/15634 7(Designer)(Signature)(License #)(Date) }3. t'rENCH CONFIGURATION: REGISTERED PRODUCTS - CHAMBERS AND EZFLOW Initial required trench bottom area (ft^): (from 1.D) Sidewall Absorption (inches) Design trench bottom area A.Bottom Area Reduction Bottom Area Multiplier 6 to 11 1 2192 12 to 17 20%0.8 17542192 18 to 23 34%0.66 1447 24 40%0.6 1315 QUICK-4 HIGH CAPB. Registered Product: 12 1.0C. Select Sidewall Height:inches ft 1754 ft^D. Design Bottom Area (3.A): 3E. Registered Width:ft F. Minimum Designed Trench Length = Bottom Area (3.C) -r Trench Width (3.D) ft^ -1754 3.0 585 ftft = G. Enter the Registered Product Component Length:4 ft H. Number of Components = Minimum Total Length Required divided by Component Length (Round up) 585 4ft V ft =components I. Actual Total Trench Length = Number of Components X Component Length: ft =147 4.0 588 ftcomponents X J. Calculate Minimum length per trench based on Contour Loading Rate: Design Flow v CLR = 1710.0 gpd ^ 1^2 Igal/ft = 1425.0 Ift K. Select No. of Trenches:6 trenches L. Length per trench = Actual Trench Length t Number of Trenches. Recommended to not exceed 3. J. 588.0 gal/ft =98.06ftT ft M. Select Trench Spacing :4 ft (typically 5 -12 ft from center to center) N. Calculate Lawn Area: Trench Length X Trench Spacing = square feet of lawn area ft^ lawn area2339588ft X 4 ft = Comments: I OSTP Basic Pump Selection Design Worksheet University OF MinnesotaMinnesota Pollution Control Agency 1. PUMP CAPACITY Project ID: ®X5ravity QPressurePumping to Gravity or Pressure Distribution:Selection required 30.01. If pumping to gravity enter the gallon per minute of the pump:GPM (10 - 45 gpmj 2. If pumping to a pressurized distribution system:GPM 3. Enter pump description:Demand Dosing Soil Treatment Soil Irentnicnt systcrt* K point oI <tisr.tia«jc2. HEAD REQUIREMENTS 28A. Elevation Difference betv^een pump and point of discharge: ft nlci pipe voiioo • eroncoSIS w“o '■10 .......dr5B. Distribution Head Loss:fl ft (due toroedal equipment, etc.)C. Additional Head Loss: Table I. Friction Loss in Plastic Pipe per 100ftDistribution? .(’ns.*?Flow Rate (GPM)Gravity Distribution = Oft 1.51.25 21 Pressure Distribution based on Minimum Average Head Value on Pressure Distribution Worksheet: 1.3 0.3109.1 3.1 12.8 4.3 1.8 0.412 Distribution Head LossMinimum Average Head 17.0 5.7 2.4 0.614 5ft1ft 3.0 0.71621.8 7.36ft2ft189.1 3.8 0.9lOft5ft2011.1 4.6 1.1 25 16.8 6.9 1.7 23.5 9.7 2.4302.0D. 1. Supply Pipe Diameter:in 35 12.9 3.2 1802. Supply Pipe Length:ft 16.540 4.1 20.5 5.045 E. Friction Loss in Plastic Pipe per 100ft from Table I:50 6.1 7.3552.37 ft per 100ft of pipeFriction Loss =8.660 F. Determine Equivalent Pipe Length from pump discharge to soil dispersal area discharge . point. Estimate by adding 25% to supply pipe length for fitting loss. Supply Pipe Length (0.2) X 1.25 = Equivalent Pipe Length 10.065 70 11.4 13.075 85 16.4 225.0180X 1.25 ftft 20.195 G. Calculate Supply Friction Loss by multiplying Friction Loss Per 100ft (Line E) by the Equivalent Pipe Length (Line F) and divide by 100. Supply Friction Loss = 5.3225.02.37 ftft per 100ft ft 100X■r H. Total Head requirement is the sum of the Elevation Oifference (Line A), the Distribution Head Loss (Line B), Additional Head Loss (Line C), and the Supply Friction Loss (Line G ) 38.35.328.0 5.0 ftft =ft ft ft +++ 3. PUMP SELECTION A pump'Tnust be selected to deliver at least 30.0 0PM (Line 1 or Line 2) with at least “3'8.3...... feet of total head. Comments: WILL BE INSTALLING DUAL ALTERNATING PUMPS EACH WITH OWN LIFT LINE. CONTROL PANEL TO HAVE ALARM, EVENT COUNTER & MUST TURN ON 2ND PUMP IF ALARM EVENT HAPPENS. ) OSTP Pump Tank Design Worksheet University OF MinnesotaMinnesota Pollution Control Agency Project ID:DETERMINE TANK CAPACITY AND DIMENSIONS v05.13.14 1710A. Design Flow (Design Sum. 1A):1.GPD 10001000 GalGal C.Recommended pump tank capacity:B. Min. required pump tank capacity: Demand to GravityD. Pump tank description: MEASURED TANK CAPACITY (existing tanks): 2. A. Rectangle area = Length (L) X Width (W)Widthft'Xft ft B. Circle area = 3.14r' (3.14 X radius X radius) 3.14 X ,2 ft'ft Length C. Calculate Gallons Per Inch. Multiply the area from 1 .A or 1 .B, by 7.5 to determine the gallons per foot the tank holds and divide by 12 to calculate the gallons per inch. X 7.5 gal/ft' V 12 in/ftft'Gallons per inch D. Calculate Total Tank Volume Depth from bottom of inlet pipe to tank bottom: Total Tank Volume = Depth from bottom of inlet pipe (Line 4.A) X Callons/Inch (Line 2) 23.3 Gallons Per Inch = in GallonsXin A<ANUFACTURER'S SPECIFIED TANK CAPACITY (when available): Note: Design calculations are based on this specific tank. Substituting a different tank model will change the pump float or timer settings. Contact designer if changes are necessary. BROWNA. Tank AAanufacturer:3. 1000PTB. Tank Model: 1001 GallonsC. Capacity from manufacturer: 23.3 Gallons per inchD. Gallons per inch from manufacturer: 43.0 inchesE. Liquid depth of tank from manufacturer: DETERAAINE DOSING VOLUA4E 4. Calculate Volume to Cover Pump (The inlet of the pump must be at least 4-inches from the bottom of the pump tank a 2 inches of water covering the pump is recommended) (Pump and block height + 2 inches) X Gallons Per Inch (2C or 3E) in 2 inches) X 32623.3 Gallons12Gallons Per Inch( 5. Minimum Delivered Volume = 4 X Volume of Distribution Piping: - Line 17 of the Pressure Distribution or Line 11 of Non-level Gallons (minimum dose) 6. Calculate Maximum Pumpout Volume (25SS of Design Flow) GPD X 42817100.25 Gallons (maximum dose)Design Flow: 1507. Select a pumpout volume that meets both Minimum and Maximum: 8. Calculate Doses Per Day = Design Row t Delivered Volume gpd V Gallons Volume of Liquid in Pipegal =150 111710 Doses 9. Calculate Drainback: A. Diameter of Supply Pipe =Liquid Per Foot (Gallons) Pipe Diameter (inches) 2 inches 180 feetLength of Supply Pipe =B. 0.170 Gallons/ftC.Volume of Liquid Per Lineal Foot of Pipe = Drainback = Length of Supply Pipe X Volume of Liquid Per Lineal Foot of Pipe ft X OJ70 Igal/ft = 0.0451 D.0.0781.2530.6180 Gallons 1.5 0.110 10. Total Dosing Volume = Delivered Volume plus Drainback 0.1702 gal =181150gal +30.6 Gallons 0.3803 11. Minimum Alarm Volume = Depth of alarm (2 or 3 inches) X gallons per inch of tank in X 4 0.661gal/in =46.5223.3 Gallons OSTP Pump Tank Design Worksheetm University OF MinnesotaMinnesota Pollution Control Agency TIMER or DEAAAND FLOAT SETTINGS Select Timer or Demand Dosing: A. Timer Settings 12. Required Flow Rote: A. From Design (Line 12 of Pressure Distribution or Line 10 of Non-Level*): B. Or calculated: GPM = Change in Depth (in) x Gallons Per Inch / Time Interval in Minutes gal/in V Cyrimer ^Demand Dose GPM ‘Note: This value must be adjusted after GPM installatian based on pump calibration. in X min = GPM13. Flow Rate from Line 12.A or 12.B above. 14. Calculate TIMER ON setting: Total Dosins Volume/GPM gal F Minutes ONgpm = 15. Calculate TIMER OFF setting: Minutes Per Day (1440)/Doses Per Day - Minutes On 1440 min Minutes OFFdoses/day ■ 16. Pump Off Float • Measuring from bottom of tanic Distance to set Pump Off Float=Gallons to Cover Pump / Gallons Per Inch: gal T 17. Alarm Float - Measuring from bottom of tank: Distance to set Alarm Float = Tank Depth(4A) X 90% of Tank Depth in X0.90 = minT gal/in =Inches in B. DEMAND DOSE FLOAT SETTINGS 18. Calculate Float Separation Distance using Dosing Vo/ume. Total Dosing Volume /Gallons Per Inch 181 gal F 23.3 gal/in =7.8 Inches 19. Measuring from bottom of tank: A. Distance to set Pump Off Float = Pump block height 2 inches in =12 2 14in + B. Distance to set Pump On Float=Distance to Set Pump-Off Float + Float Separation Distance in + Inches 227.8 in =14 Inches C. Distance to set Alarm Float = Distance to set Pump On Float + Alarm Depth (2-3 inches) in +2.0 2422in =Inches FLOAT SETTINGS TIMED DOSINGDEMAND DOSING J-7.8 inInches for Dose:riL inAlarm DepthAlarm Depth 23.8 in PumpOn 21.8 in Pump Off 14.0 jp 46.54 Gal 181 Gal Pump Off in 326 Gal 1 University OF Minnesota OSTP Soil Observation Log Project ID;v05.13.14 Legal Description/ GPS:houseEtlodge&cabinsFranks LodgeClient/ Address: rn Outwash n Lacustrine Q Loess [UTill Q Alluvium n Bedrock lH Organic MatterSoil parent material(s): (Check all that apply) I I Summit [H Shoulder [2] Back/Side Slope Q Foot Slope D Toe Slope Slope shapeLandscape Position: (check one) Soil survey map units 1196Elawn Slope%6.0 Elevation:Vegetation 09/26/15Weather Conditions/Time of Day:Date #2 Observation Type:Observation #/Location:auger I Structure-IRockMatrix Color(s)Mottle Color(s)Redox Kind(s)Indicator(s)Depth (in)Texture Frag. %ConsistenceGradeShape FriableWeakPrismaticsandy loam <10 lOyr 2/20-6 FriableSingle grain :Weaksandy loam <20 10yr4/36-15 looseSingle grain Structureless15-48 sandy loam <30 lOyr 4/4 looseSingle grain Structurelesssand<30 lOyr 5/448-60 I Comments I hereby certify that I have completed this work in accordance with all applicable ordinances, rules and laws. ' (Desigher/lnspector)(Date)(Signature)(License #) Additional Soil Observation Logs Project ID: Legal Description/ GPS:house&lodge&cabinsClient/ Address:Franks Lodge I i Organic MatterI I Outwash Q Lacustrine Q Loess [J Till I ^Alluvium I I BedrockSoil parent material(s): (Check all that apply) I I Summit O Shoulder O Back/Side Slope ^1! Foot Slope □ Toe Slope Slope shapeLandscape Position: (check one) Soil survey map units 1196E 6.0 Elevation:Slope%Vegetation 09/26/15Weather Conditions/Time of Day:Date Observation Type:Observation #/Location:#3 auger Structure IIRockMottle Color(s)Redox Kind(s)Indicator(s)Matrix Color(s)Depth (in)Texture ConsistenceGradeFrag. %Shape FriableWeakGranularsandy loam <10 lOyr 2/20-5 FriableWeakSingle grainsandy loam <15 lOyr 4/35-20 looseSingle grain Structurelesssandy loam lOyr 4/4<3020-49 looseSingle grain StructurelesssandlOyr 4/449-65 <30 Comments Observation Type:Observation #/Location: StructureIRockRedox Kind(s)Indicator(s)Mottle Color(s)Matrix Color(s)Depth (in)Texture ConsistenceFrag. %Shape Grade Comments Subsoil Indicator(s) of Saturation: 51. Distinct gray or red redox features 52. Depleted matrix (value >/=4 and chroma </=2) 53. 5Y chroma </= 3 54. 7.5 YR or redder faint redox concentrations or redox depletii Consistence: Loose- Textures: c-clay sic-silty clay sc-sandy clay Intact specimen not available Friable- Slight force between fingers Moderate force between fingers Extremely Moderate force between hands or slight foot pressure Foot pressure Firm- cl-clay loam firm- Rieid-If yes to one of the above indicators then: Topsoil Indicator(s) of Saturation: T1. Wetland Vegetation T2. Depressional Landscape T3. Organic texture or organic modifiers T4. N 2.5/ 0 color T5. Redox features in topsoil T6. Hydraulic indicators sicl-silty clay loam scl-sandy clay loam si-silt sil-silt loam I-loam sl-sandy loam* Is-loamy sand* s-sand* Slope Shape: Slope shape is described in two directions: up and down slope (perpendicular to the contour), and across slope (along the horizontal contour); e.g. Linear, Convex or LV. *Sand Modifiers co-coarse m-medium f-fine vf-very fine Soil Structure Grade: Massive-No observable aggregates, or no orderly arrangement of natural lines of weakness Poorly formed, indistinct peds, barely observable in place Moderate- Well formed, distinct peds, moderately durable and evident, but not distinct in Durable peds that are quite evident in un-displaced soil, adhere weakly to one another, withstand displacement, and become separated when soil is disturbed No peds, sandy soil r.‘l Weak- ■ I A ' CL rStrong-r . I-niicl'Scnpe Posit^ioii:I Sunimii -------------------Loose- »: IS •*! rShould<?i- . : V} Back, side j Foot -SlopeSoil Structure Shape: Granular- The peds are approximately spherical or polyhedral and are commonly found in topsoil. These are the small, rounded peds that hang onto roots The peds are flat and plate like. They are oriented horizontally and are usually overlapping. Platy structure is commonly found in forested The peds are block-like or polyhedral, and are bounded by flat or slightly rounded surface that are casting of the faces of surrounding peds. Prismatic- Flat or slightly rounded vertical faces bound the individual peds. Peds are distinctly longer vertically, and faces are typically cast or molds of Single Grain The structure found in a sandy soil. The individual particles are not held together. Too Slope Platv- Blocky- Map Unit Description: Lida-Two Inlets complex, 15 to 30 percent slopes—Otter Tail County, Minnesota Otter Tail County, Minnesota 1196E—Lida-Two Inlets complex, 15 to 30 percent slopes Map Unit Setting National map unit symbol: gm72 Elevation: 1,000 to 1,800 feet Mean annual precipitation: 21 to 28 inches Mean annual air temperature: 36 to 45 degrees F Frost-free period: 90 to 140 days Farmland classification: Not prime farmland Map Unit Composition Lida and similar soils: 60 percent Two inlets and similar soils: 25 percent Minor components: 15 percent Estimates are based on observations, descriptions, and transects of the mapunit. Description of Lida Setting Landform: Hillslopes on outwash plains Landform position (two-dimensional): Summit, shoulder, backslope Down-slope shape: Convex Across-slope shape: Linear Parent material: Loamy mantle over sandy and gravelly outwash deposits Typical profile A - 0 to 3 inches: sandy loam E - 3 to 14 inches: loamy sand Bt - 14 to 20 inches: gravelly sandy loam SC - 20 to 27 inches: gravelly loamy sand C -27 to 60 inches: gravelly sand Properties and qualities Slope: 15 to 30 percent Depth to restrictive feature: More than 80 inches Natural drainage class: Well drained Capacity of the most limiting layer to transmit water (Ksat): High (2.00 to 6,00 in/hr) Depth to water table: More than 80 inches Frequency of flooding: None Frequency of ponding: None Calcium carbonate, maximum in profile: 15 percent Available water storage in profile: Low (about 4.2 inches) Interpretive groups Land capability classification (irrigated): None specified Land capability classification (nonirrigated): 6e Hydrologic Soil Group: A 9/22/2015 Page 1 of 3 Web Soil Survey National Cooperative Soil Survey t.iSDk Natural Resources Conservation Service Map Unit Description: Lida-Two Inlets complex, 15 to 30 percent slopes—Otter Tail County, Minnesota Other vegetative classification: Steep; Coarse Texture; Low AWC (G091XN018MN) Description of Two Inlets Setting Landform: Hilislopes on outwash plains Landform position (two-dimensional): Summit, shoulder, backslope Down-slope shape: Convex Across-slope shape: Convex Parent material: Sandy and gravelly outwash deposits Typical profile A - 0 to 3 inches: sandy loam E - 3 to 7 inches: loamy coarse sand Bt1,Bt2 - 7 to 21 inches: gravelly loamy coarse sand Bk,C - 21 to 60 inches: gravelly coarse sand Properties and qualities Slope: 15 to 30 percent Depth to restrictive feature: More than 80 inches Natural drainage class: Somewhat excessively drained Capacity of the most limiting layer to transmit water (Ksat): High (2.00 to 6.00 in/hr) Depth to water table: More than 80 inches Frequency of flooding: None Frequency of ponding: None Calcium carbonate, maximum in profile: 30 percent Available water storage in profile: Low (about 3.4 inches) Interpretive groups Land capability classification (irrigated): None specified Land capability classification (nonirrigated): 6s Hydrologic Soil Group: A ether vegetative classification: Steep; Coarse Texture; Low AWC (G091XN018MN) Minor Components Areas with surface stones Percent of map unit: 3 percent Bluffereek Percent of map unit: 3 percent Pinelake Percent of map unit: 3 percent Landform: Swales Almora Percent of map unit: 2 percent Areas with more or less slope Percent of map unit: 2 percent 9/22/2015 Page 2 of 3 Web Soil Survey National Cooperative Soil Survey ijPA Natural Resources Conservation Service 46'- 3r2S"N 1196E33 S3K S3in g3in S3 ■Hr' H im 46" 31' 22‘ N $ Map Sc^: 1:605 If printed on A landscape (11" x 8.5") sheet 3 MetersO'N 0 5 10 20 30 A °I Feet2550100150 Map projecdon: Web Mercator Corner coordinates: WGS84 Edge Bcs: IJTM Zone 15N WG584 9/28/2015 Page 1 of 3 Natural Resources Conservation Service Web Soil Survey National Cooperative Soil Survey Soil Map—Otter Tail County, Minnesota MAP INFORMATIONMAP LEGEND The soil surveys that comprise your AOI were mapped at 1:20,000.Area of Interest (AOI)Spoil AreamArea of Interest (AOI)6 stony Spot Warning: Soil Map may not be valid at this scale. Enlargement of maps beyond the scale of mapping can cause misunderstanding of the detail of mapping and accuracy of soil line placement. The maps do not show the small areas of contrasting soils that could have been shown at a more detailed scale. Soils Very Stony Spot Wet Spot Soil Map Unit Polygons Soil Map Unit Lines OtherA Soil Map Unit Points Special Line Features Special Point Features ^ Blowout Borrow Pit Please rely on the bar scale on each map sheet for map measurements. Source of Map: Natural Resources Conservation Service Web Soil Survey URL: http://websoilsurvey.nrcs.usda.gov Coordinate System: Web Mercator (EPSG:3857) Maps from the Web Soil Survey are based on the Web Mercator projection, which preserves direction and shape but distorts distance and area. A projection that preserves area, such as the Albers equal-area conic projection, should be used if more accurate calculations of distance or area are required. This product is generated from the USDA-NRCS certified data as of the version date(s) listed below. Soil Survey Area: Otter Tail County, Minnesota Survey Area Data: Version 10, Sep 16, 2014 Soil map units are labeled (as space allows) for map scales 1:50,000 or larger, Date(s) aerial images were photographed: Data not available. The orthophoto or other base map on which the soil lines were compiled and digitized probably differs from the background imagery displayed on these maps. As a result, some minor shifting of map unit boundaries may be evident. Water Features Streams and Canalsg3Transportation 1-1-4 RailsClay Spot Closed Depression0 Interstate Highways K Gravel Pit US Routes Gravelly Spot»%Major Roads Landfill Local Roads k Lava Flow Background 4k>Aerial PhotographyMarsh or swamp Mine or Quarry Miscellaneous Water o Perennial Water Rock Outcrop Saline Spot Sandy Spot Severely Eroded Spot Sinkhole Slide or Slip Sodic Spot0 9/28/2015 Page 2 of 3 LISDa Natural Resources Conservation Service Web Soil Survey National Cooperative Soil Survey f,« Soil Map—Otter Tail County, Minnesota V. Map Unit Legend otter Tail County, Minnesota (MN111) Percent of AOIAcres in AOIMap Unit NameMap Unit Symbol 7.7%0.1Lida-Two Iniets complex. 1 to 8 percent slopes 1196B 92.3%Lida-Two Inlets complex, 15 to 30 percent slopes 1,61196E 100.0%1.7Totals for Area of Interest 9/28/2015 Page 3 of 3 Web Soil Survey National Cooperative Soil Survey Natural Resources Conservation Service I r »r System design must be to scale and must include the proposed location of the sewage system, all existing/ proposed buildings, property lines, the ordinary high water level of the water body, bluff and all water wells within 150' of the sewage system. If there are any questions, see the University of Minnesota Site Evaluation worksheets. /__inch(es) equals feetScale:grid(s) equals feet, or &3VMPCA LICENSE #; LICENSE CATEGORY; f ADDRESS: J^r) DESIGNED BY: FIRM NAME:DATE: SIGNATURE: /^5 5^<«y3//cQ_y /jro<3P'J /AM // /}pp<3 /ooo . *I 1 \ ^ .1^?\\ \I' \ \ A A A t'' n AT—• i;. f'^rr-d. ■TiI /i 1 KI 1 L^' J I !^ /ope. I BK — 04-2014 — 029 . V'-;iin Lur.'t^i n ,u , Pf IK IS * r ( t I i,'". •R‘>_. AP,7(' SITE DATA WORKSHEET feirr-'' y^L/OTTER TflII received * ’f1.,LAND & RESOURCE MANAGEMENT GOVERNMENT SERVICES CENTER, 540 WEST FIR. FERGUS FALLS, MN ^1^70 J 20^8 218-998-8095 UNO ^ RESOURCE Sewage Treatment System Permit #_______ www.co.otter-tail.mn.usCQUaTT-aiOBCIOTi OWNER: 7LAST NAME FIRST TELEPHONE NUMBERMIDDLE ADDRESS: 3os^?5-e?rAy?n CITY ZIP CODE___STR./RT STATE 9 LAKE/RIVER NO. LEGAL DESCRIPTION: /o^ vAsr (ZTy LAKE NAME SEC.TWP RANGE TWP. NAME SOIL BORING LOG COLOR & MUNSELL NO. DEPTH (INCHES)STRUCTURETEXTURE BLOCKY PLATY PRISMATIC/6/»rmd-U<TL VniTin 9 J~ C? OOP PARCEL NUMBER E-9II Address or Directions From Nearest Public Road BLOCKY PLATY PRISMATIC WORE y/t-np^ A/rp/Z> ^f> e z kV" Y NUMBER OF BEDROOMS BLOCKY PLATY PRISMATIC <griMg/o^ /o^A Y/^GARBAGE DISPOSAL: YES WELL: CASING DEPTH^t) *~ft. SEWER LINE SEPARATIONi^O^ft BLUFF: YES BLOCKY PLATY/syAFLOODPLAIN: YES PRISMATIC .■<^o'ne?VEGETATION: AQUATIC BLOCKY PLATY PRISMATIC NONE SLOPE AT INSTALLATION SITE:% ~X^O^ tuyl- iAAuc/-(:J\ &Dv\ |^0‘‘ ** V^kJVTYPE OF OBSERVATION: Probe PARENT MATERIAL:Outwash Loess Bedrock Alluvium /3ORIGINAL SOIL:No Date of Soil Boring <0COMPACTED SOIL: Yes DEPTH OF BORING (To 7' or restrictive layer):____^ft.Date of Perc Test PERC TEST #1 PERC TEST #2- TWO TESTS ARE REQUIRED - WATER DROP TIME INTERVAL (MINUTES)WATER DEPTH PERC RATE TIME INTERVAt fMINIITFRt WATER DEPTFI WATER DROP PERC RATE START START TIME DROP PERC TIME DROP PERC INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME REFILL REFILL TIME DROP PERC TIME DROP PERC TIME INTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATE TIME INTERVAL(MINUTES) WATER DEPTH WA1 ER DROP PERC RATEREFILLREFILL PERCDROPPERCTIMEDROPTIME WATER DROP PERC RATEINTERVAL IMINUTESl WATER DEPTHWATER DEPTH WATER DROP PERC RATE TIMETIME INTERVAL IMINUTESlREFILL REFILL DROP PERCTIMEDROPPERCTIME WATER DROP WATER DROP PERC RATE TIME INTERVAL (MINUTES!WATER DEPTH PERC RATE TIME INTERVAL (MINUTES)WATER DEPTHREFILL REFILL PERC TIME DROP PERCTIMEDROP WATER DROP PERC RATEINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL(MINUTES! WATER DEPTH TIME REFILL REFILL DROP PERCTIMEDROPPERCTIME WATER DEPTH WATER DROP PERC RATEINTERVAL (MINUTES) REFILL WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES) TIME REFILL PERCIIMEDROPDROPTIME PERC RATEWATER DEPTH WATER DROPWATER DROP PERC RATE TIME INTERVAL (MINUTES)INTERVAL fMINtJTES)WATER DEPTH TIME REFILLREFILL TIME DROP PERCTIMEDROPPERC SEPTIC TANK MANUFACTURER: PROPOSED DESIGN: 2a PRESSURE DIST..HOLDING TANK.GRAVITY DISTMOUND.ATGRADE.BED.TRENCH. SPECIFY:.OUTHOUSE,OTHER.SEWER LINE. — SYSTEM DESIGN ON BACK — -rtrrtnr-r*" ~ .'•■ar rr: APPLICATIOW FOf^ PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENTGOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 218-998-8095 www.co.otter-tail.mn.us9jOTTCR Tflll WHITE - Office YELLOW - L & R Inspector PINK - Owner / Contractor (after issue)COU*TYaiiSCfOT« APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED Permit No. TWP NO.RANGE TWP NAMELAKE/RIVER CLASS SECTIONLAKE/RIVER NAMELAKE NUMBER /3^9 E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROADPARCEL NUMBER (S) OF PROPERTY BEING SERVICED S^L 000(^9 LEGAL DESCRIPTION Daytime Phone No,First Initial Mailing AddressLast Name ?OSV£f Zr^opProperty Owner Contractor Lie.# THIS SPACE FOR OFFICE USE ONLY A.M. , the year of P.M.>• This System will be ready for inspection on at. A.M. P.M. Time Received L & R OfficialDate Received TYPE OF NSTALLATION (circle one)SEWAGE TREATMENT SYSTEM DESIGN DATA AS SHOWN ON DRAWINGCollectorOther Est.Residential (A) New (B) Replacement (C) Add on (G) New (H) Replacement (I) Add on (DINfijai<teX'fieplacemenO* Add on Lift Soil Treatment AreaCJ__________ TankDesign Flow (Gallons/Day)Effluent Distribution Gravity ( ) Pressure (J) (K)GIsOOO(L) 2,506 — 4,999 (M) 5,000 — 10,000 Size Setback To Nearest WellType I Type II Ft.Ft.Ft./QO (20) Trench, Rock (27) Rapidly Permeable Ft.3 00''*Setback To OHWL(28) Flood Plain(21) Trench, Gravelless (22)^ench^ Ghamhi^(29) Privies ----- Ft.Ft.Ft.Setback To Bluff(23) Bed (30) Holding Tank (Contract Required)(24) Mound Ft.Setback To Dwelling (25) At Grade Type III Setback To Non-Dwelling £-0 Ft.-Ft.(26) Grey water (31) Other/Problem Soils/<12" Soil Type IV(34) Tank Only Setback To Nearest Lot Line /OOAFt ■>Ft./OO(32) Public Domain & Proprietary Technologies(35) Other Depth of Well .^73 ^Setback To Road Right-Of-Way /A?^Ft.Ft.Type V Total # Bedrooms (33) Performance Garbage Disposal Y Elevation Above Restrictive Layer Ft.Ft.3F Ft.Y / ^Abatement PERC TEST DATA 6.3 yDesigner Agreement: The undersigned hereby makes application for permit to install, alter, repair or extend Sewage Treatment System herein specified, agreeing to do ali such work in strict accor­ dance with Sanitation Code of Otter Taii 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. Date of Test Highest Rateense # 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 inciude the building sewer (sewer line). Permit Fee $Date: ^nature of Propert^^er/Agent tor Oi^n^ Land & Resource Manii^ment Official MlDate:Rec. No.. Cornmen^l^SflQ^C^^ ^Lo~»v3 /7 ^^ ^Date Stamp ^ VVi-yiilLU :^'C::iVED JAN 01 2016 L/Jvl.j RESOURCE /T 1#^L&R InitialForm No. BK — 04-2014-06 357.243 • Victor Lundean Co.. Printers • Fergus Falls. Minnesota N J y^nnanDD G nDDnun - f (^1 .A N., Or LJ \ 4 OSTP Design Summary Worksheet University OF MinnesotaMinnesota Pollution Control Agency V 05.13.14Project ID:Property Owner/Client: Franks Lodge Cabins, Lodge, House & apt Date: 9/26/15Site Address: 30543 Lodge Loop Dent, MN 56528 1. DESIGN FLOW AND TANKS Note: The estimated design flow is considered a peak flow rate including a safety factor. For long term performance, the average daily flow is recommended to be < 60% of this value. Gallons, in 1710 Gallons Per Day (GPD)A. Design Flow: B. Septic Tanks: 5130Minimum Code Required Septic Tank Capacity:1 Tanks or Compartments 6500 Gallons, in 3Recommended Septic Tank Capacity:Tanks or Compartments electricEffluent Screen: optional Alarm: C. Holding Tanks Only: Minimum Code Required Capacity:TanksGallons, in Designer Recommended Capacity:TanksGallons, in Type of High Level Alarm: Gallons1000Pump Tank 2 Capacity (Code Minimum):GallonsD. Pump Tank 1 Capacity (Code Minimum): Gallons1000Pump Tank 2 Capacity (Designer Rec):Pump Tank 1 Capacity (Designer Rec):Gallons GPM Total Head ft30.0 GPM Total Head 38.3 ft Pump 2Pump 1 Supply Pipe Dia.150.0 in Dose Volume:Supply Pipe Dia. 2.00 in galgalDose Volume: 2. SYSTEM TYPE ®Gravlty Distribution Ofressure Distribution-Level OPressure Distrlbutlon-Unlevel * Selection Required Benchmark Elevation: @Ttench (^Bed OMound O^t'Grade Oorip OHolding Tank Qoiher 100.00 ft Benchmark Location: System Type Type of Distribution Media: r~bralnfield Rock 0tegistered Treatment Media:□ TypeV0Typel [UTypell QTypetll QTypelV quick-4 high capicity 3. SITE EVALUATION: I 5.0 I ft 6.060Measured Land Slope %:%B.Depth to Limiting Layer:inA. sandy loamSoil Texture:Elevation of Limiting Layer:D.C. GPD/ft^0.78F. Soil Hyd. Loading Rate:Loc. of Restricive Elevation:E. [T^ft36 MPIG. Minimum Required Separation:in Perc Rate:H. JinI. Code AAaximum Depth of System:24 Comments: 4. DESIGN SUMMARY Trench Design Summary 1754 ft^3Trench WidthSidewall Depth 12Dispersal Area ftin 24.0Code Maximum Trench Depth588 ft Number of Trenches 6Total Lineal Feet in 36.01.2 Designer's Max Trench Depth inContour Loading Rate ft Bed Design Summary ft^Code Maximum Bed DepthDepth of sidewallAbsorption Area inin Designer's Max Bed DepthBed Width Bed Length inftft OSTP Design Summary Worksheet University OF MinnesotaMinnesota Pollution Control Agency Mound Design Summary ft^Bed WidthBed LengthAbsorption Bed Area ft Clean Sand Lift Berm Width (0-U)Absorption Width ftft ft Endslope Berm WidthUpslope Berm Width ft ftft Downslope Berm Width Total System WidthTotal System Length Contour Loading Rate gal/ftftft At-Grade Design Summary Absorption Bed Length System HeightAbsorption Bed Width ftftft gal/ft Upslope Berm Width System Length Downslope Berm Widthft ftContour Loading Rate System Width ftEndslope Berm Width ft ft Level & Equal Pressure Distribution Summary Perforation DiameterNo. of Perforated Laterals Perforation Spacing ft in galgalMaximum Delivered VolumeMin. Delivered VolumeLateral Diameter in Non-Level and Unequal Pressure Distribution Summary Perforation SizePipe Volume (gal/ft) Pipe LengthElevation Spacing (in)(ft)Spacing (ft)(ft)Pipe Size (in)(in) Lateral 1 Minimum Delivered Volume galLateral 2 Lateral 3 Lateral 4 AAaximum Delivered Volume galLateral 5 Lateral 6 Additional Info for Type IV/Pretreatment Design5. A. Calculate the organic loading 1. Organic Loading to Pretreatment Unit = Design Flow X Estimated BOD in mg/L in the effluent X 8.35 ^ 1,000,000 mg/LX 8.35 V 1,000,000 =gpd X lbs BOD/day 2. Type of Pretreatment Unit Being Installed; 3. Calculate Soil Treatment System Organic Loading: BOD concentration after pretreatment t Bottom Area = Ibs/day/ft^ ft^ =Ibs/day/ft^mg/L X 8.35 = 1,000,000 f Comments/Special Design Considerations: SIZING: 2 CABINS 14 PEOPLE ® 50 GPD= 700 GPD, 2BD HOUSE 300 GPD, 1BD APARTMENT 150 GPD. Lodge OPEN 16 HOURS OR LESS 28 SEATS ® 20 GPD = 560 GPD. 700 + 300 + 150 + 560 = 1710 GALLONS PER DAY. I hereby certify that I have completed this work in accordance vrith all applicable ordinances, rules and laws. 09/26/15634Randy Anderson (Date)(Designer)(Signature)(License #) OSTP Trench Design Worksheet University OF MinnesotaMinnesota Pollution Control Agency v05.13.14Project ID:1. SYSTEM SIZING: Designers Maximum Depth: inches gal/ft A. Design Flow-. 48 inchesB. Code Maximum Depth: GPD/ft^1.20.78 Contour Loading Rate:C. Soil Loading Rate: D. Required Bottom Area: Design Flow (1.A) ^ Loading Rate (1.C) = Initial Required Bottom Area GPD/ft^ =ft'21920.781710 GPD □ Rock El Registered Product □ P ressure □ G r av i ty - D ro p 0 Gravity-Other G. If distribution media is installed in contact with sandy or loamy sand or with a percolation rate of 0.1 to 5 mpi indicate distribution or treatment method: E. Select Dispersal Media: (selection required) F. Select Distribution Method: END CAPS 2. TRENCH CONFIGURATION: ROCK Initial required trench bottom area (ft'): (from 1.D) Design trench bottom area Sidewall Absorption (inches) A.Bottom Area Reduction Bottom Area Multiplier I Cover56 to 11 1 ^ Distributiono,..0.812 to 17 20% 34%0.6618 to 23 Sidewall 0.62440% ftB. Select Sidewall Height:inches Width ft'C. Design Bottom Area (2.A): ftD. Select Trench Width: E. Total Designed Trench Length: Bottom Area t Trench Width = Total Required Trench Length I ft' -ftft = I. Calculate Minimum system length based on Contour Loading Rate: Design Flow t Contour Loading Rate = gal/ft ftgpd ^ trenchesF. Select No. of Trenches: ft (typically 5 -12 ft from center to center)G. Select Trench Spacing : H. Calculate Lawn Area: Trench Length (2.E) X Trench Spacing (2.G) = square feet of lawn area ft X 2ft =ft lawn area J. Select Depth Required to Cover Distribution Pipe: ft (0.33 ft for pressure, 0.5 ft for gravity) K. Calculate Rock Volume: (Sidewall Height (2.B) + Depth to Cover Pipe (2.J)) X Bottom Area (2.C) = cubic feet ft' =ft'ft +ft) X( Divide ft' by 27 ft'/yd' to calculate cubic yards: ft' ^ 27 yd' 3. TRENCH CONFIGURATION: REGISTERED PRODUCTS - CHAMBERS AND EZFLOW Initial required trench bottom area (ft^): (from 1.D) Design trench bottom area Sidewall Absorption (inches) A.Bottom Area Reduction Bottom Area Multiplier 219216 to 11 0.820%175412 to 172192 0.6618 to 23 34%1447 40%0.6 131524 QUICK-4 HIGH CAPB. Registered Product: 12 1.0 ftinchesC. Select Sidewall Height:=: 1754D. Design Bottom Area (3.A): 3E. Registered Width:ft F. Minimum Designed Trench Length = Bottom Area (3.C) t Trench Width (3.D) 2 3.0 5851754ft =ftft" - 4 ftG. Enter the Registered Product Component Length: !!H. Number of Components = Minimum Total Length Required divided by Component Length (Round up) r('585 ftv 4 ft =components I- II. Actual Total Trench Length = Number of Components X Component Length: ft =5884.0147 ftcomponents X ! J. Calculate Minimum length per trench based on Contour Loading Rate: Design Flow -r CLR = gpd T I I1.2 gal/ft =1710.0 1425.0 ft 4 6 trenchesK. Select No. of Trenches:51IL. Length per trench = Actual Trench Length t Number of Trenches. Recommended to not exceed 3.J.t gal/ft 98.0588.0 6 ftft V i 5r-’4 ft (typically 5 - 12 ft from center to center)M. Select Trench Spacing :J f ■I'-;N. Calculate Lawn Area: Trench Length X Trench Spacing = square feet of lawn area ft^ lawn area23395884ft X ft =?-■- IComments:r s■j; I I .V }■ - I f ■i t OSTP Basic Pump Selection Design WorksheetMinnesota Pollution Control Agency University OF Minnesota Project ID:1. PUMP CAPACITY QPressure^GravityPumping to Gravity or Pressure Distribution:Selection required 30.01. If pumping to gravity enter the gallon per minute of the pump:GPM (10 ■ 45 spm) 2. If pumping to a pressurized distribution system:GPM Demand Dosing Soil Treatment3. Enter pump description: 5oii ireotitM-ni system & point ot <i s« hdftje2. HEAD REQUIREMENTS 28A. Elevation Difference between pump and point of discharge: ft niet pipe ElevationdiHerwceD5B. Distribution Head Loss:f] ft (due to «eda( equipment, etc.)C. Additional Head Loss: Table I.Friction Loss In Plastic Pipe per 100ft Flow Rate Pipe Diameter (inchesI (GPM) Distribution HeafyUjo^ Gravity Distribution = Oft 1.25 1.5 21 Pressure Distribution based on Minimum Average Head Value on Pressure Distribution Worksheet: 1.3 0.3109.1 3.1 4.3 1.8 0.41212.8 Distribution Head bossMinimum Average Head 17.0 5.7 2.4 0.6141ft5ft7.3 3.0 0.71621.82ft6ft 0,9189.1 3.85ft lOft 20 1.111.1 4.6 6.9 1.72516.8 9.7 2.43023.5D. 1. Supply Pipe Diameter:2.0 in 12.9 3.235 2. Supply Pipe Length:180 ft 16.540 4.1 5.04520.5 E. Friction Loss in Plastic Pipe per 100ft from Table I:6.150 7.355ft per 100ft of pipe2.37Friction Loss =8.660 F. Determine Equivalent Pipe Lensth from pump discharge to soil dispersal area discharge point. Estimate by adding 25% to supply pipe length for fitting toss. Supply Pipe Lensth (D.2) X 1.25 = Equivalent Pipe Length 10.065 70 11.4 13.075 85 16.4 225.0180X 1.25 ftft 20.195 G. Calculate Supply Friction Loss by multiplying Friction Loss Per 100ft (Line E) by the Equivalent Pipe Length (Line F) and divide by 100. Supply Friction Loss = 5.32.37 225.0 ftft per 100ft X ft 100T- H. Total Head requirement is the sum of the Elevation Difference (Line A), the Distribution Head Loss (Line B), Additional Head Loss (Line C), and the Supply Friction Loss (Line G ) 5.3 38.328.0 5.0 ftft =ft ft ft +++ 3. PUMP SELECTION A pump rhust be selected to deliver at least 30.0 38.3 feet of total head.GPM (Line 1 or Line 2) with at least Comments: WILL BE INSTALLING DUAL ALTERNATING PUMPS EACH WITH OWN LIFT LINE. CONTROL PANEL TO HAVE ALARM, EVENT COUNTER a MUST TURN ON 2ND PUMP IF AURM EVENT HAPPENS. ) OSTP Pump Tank Design Worksheet University OF MinnesotaMinnesota Pollution Control Agency Project 10:DETERMINE TANK CAPACITY AND DIMENSIONS v05.13.14 r 17101.A. Design Flow (Design Sum. 1A): B. Min. required pump tank capacity: GPD 1000 1000C.Recommended pump tank capacity:GalGal Demand to GravityD. Pump tank description: MEASURED TANK CAPACITY (existing tanks): 2. A. Rectangle area = Length (L) X Width (W)Widthft^Xft ft B. Circle area = 3.14r^ (3.14 X radius X radius) 3.14 X 2 ft^ft Length C. Calculate Gallons Per Inch. Multiply the area from 1.A or 1.B, by 7.5 to determine the gallons per foot the tank holds and divide by 12 to calculate the gallons per inch. ~| ft^ X 7.5 gal/ft^ t-12 in/ft Gallons per inch D. Calculate Total Tank Volume Depth from bottom of inlet pipe to tank bottom: Total Tank Volume = Depth from bottom of inlet pipe (Line 4.A) X Gallons/inch (Line 2) Gallons Per Inch = in 23.3X Gallonsin AtANUFACTURER'S SPECIFIED TANK CAPACITY (when available): Note: Design calculations are based on this specific tank. Substituting a different tank model will change the pump float or timer settings. Contact designer if changes are necessary. BROWN3.A. Tank Manufacturer: 1000PTB. Tank Model: 1001 GallonsC. Capacity from manufacturer: 23.3D. Gallons per inch from manufacturer:Gallons per inch 43.0E. Liquid depth of tank from manufacturer:inches DETERAAINE DOSING VOLUME 4. Calculate Volume to Cover Pump (The inlet of the pump must be at least 4-inches from the bottom of the pump tank & 2 inches of water covering the pump is recommended) (Pump and block height + 2 inches) X Gallons Per Inch (2C or 3E) in -t 2 inches) X 23.3 32612Gallons Per Inch Gallons( 5. Minimum Delivered Volume = 4 X Volume of Distribution Piping: - Line 17 of the Pressure Distribution or Line 11 of Non-level 6. Calculate Maximum Pumpout Volume (25% of Design Flow) Design Flow: Gallons (minimum dose) 1710 0.25 428GPD X Gallons (maximum dose) 1507. Select a pumpout volume that meets both Minimum and Maximum: 8. Calculate Doses Per Day = Design Flow t Delivered Volume gpd T Gallons Volume of Liquid in Pipegal =1501710 11 Doses 9. Calculate Drainback: A. Diameter of Supply Pipe =Liquid Per F«)t (Gallons) Pipe Diameter (inches) 2 inches 180 feetB.Length of Supply Pipe = 0.170 Gallons/ftC.Volume of Liquid Per Lineal Foot of Pipe = Drainback = Length of Supply Pipe X Volume of Liquid Per Lineal Foot of Pipe ft X 0J70 Igal/ft = 0.0451 D.1.25 0.07818030.6 Gallons 1.5 0.110 10. Total Dosing Volume = Delivered Volume plus Drainback 2 0.170 gal -t150 30.6 gal =181 Gallons 0.3803 11. Minimum Alarm Volume = Depth of alarm (2 or 3 inches) X gallons per inch of tank in X 0.661423.3 gal/in =46.52 Gallons •/ OSTP Pump Tank Design Worksheet University OF MinnesotaMinnesota Poltutiori Control Agency:\ TIMER or DEMAND FLOAT SETTINGS Select Timer or Demand Dosins: A. Timer Settings 12. Required F/ow Rote: A. From Design (Line 12 of Pressure Distribution or Line 10 of Non-Level*): B. Or caiculated: GPM = Change in Depth (in) x Gallons Per Inch / Time Intervai in Minutes gai/in T l®Demand DoseOtimer !.1. GPM ‘Note: This value must be adjusted after GPM installatian based on pump calibration. in X min = 13. -Fiow Rate from Line 12.A or 12.B above. 14. Calculate TIMER ON setting: Total Dosing Volume!0PM GPM gal F Minutes ONgpm = 15. Calculate TIMER OFF setting: Minutes Per Day (1440)/Doses Per Day - Minutes On 1440 min ■i Minutes OFFdoses/day - 15. Pump Off Float - Measuring from bottom of tank: Distance to set Pump Off Float=Gatlons to Cover Pump / Gallons Per Inch: minT ,1 ,1! gal/in =___________ gal F _______ 17. Alarm Float - Measuring from bottom of tank: Distance to set Alarm Float = Tank Depth(4A) X 90% of Tank Depth in X0.90 = Inches ir- (j. in } B. DEMAND DOSE FLOAT SETTINGS 18. Calculate Float Separation Distance using Dosing Volume. Total Dosing Volume /Gallons Per Inch gal F 19. Measuring from bottom of tank: A. Distance to set Pump Off Float = Pump block height + 2 inches in + B. Distance to set Pump On Float=Distance to Set Pump-Off Float * Float Separation Distance in + C. Distance to set Alarm Float = Distance to set Pump-On Float + Alarm Depth (2-3 inches) in + .5 ( gal/in =7.823.3181 Inches t 14122in =Inches <1 li !227.8 in =Inches14 24222.0 in =Inches i: FLOAT SETTINGS a TIMED DOSINGDEMAND DOSING 5 r 1 IInches for Dose;7.8 in ri-.? :!1 .finAlarm DepthAlarm Depth 23.8 in Pump On 21.8 in Pump Off 14.0 ■« 46.54 Gal Pump Off161 Gal in a326 Gal ? ■ 1 3 3 ;iI i . i!:> I i5 V.; •i’ University OF Minnesota OSTP Soil Observation Log Project ID:v05.13.14 Client/ Address:Franks Lodge Legal Description/ GPS:house&lodge&cabins QOutwash I i Lacustrine I I Loess I I Till I I Alluvium []] Bedrock n Organic MatterSoil parent material(s): (Check all that apply) □ Summit Q Shoulder 0 Back/Side Slope 0 Foot Slope 0 Toe Slope Slope shapeLandscape Position: (check one) lawn Soil survey map units 1196EVegetation Slope%6.0 Elevation: Weather Conditions/Time of Day:09/26/15Date Observation #/Location:#2 Observation Type:auger Structure-I IRockDepth (in)Texture Matrix Color(s)Mottle Color(s)Redox Kind(s)Indicator(s)Frag. %ConsistenceShapeGrade 0-6 sandy loam <10 lOyr 2/2 FriablePrismaticWeak 6-15 sandy loam <20 10yr4/3 FriableSingle grain Weak 15-48 sandy loam <30 lOyr 4/4 looseSingle grain Structureless 48-60 sand <30 lOyr 5/4 looseSingle grain Structureless Comments I hereby certify that I have completed this work in accordance with all applicable ordinances, rules and laws. /.3y^ (Desigher/Inspector)(Signature)(Date)(License #) «txit %' c«ft S« WA<->} T ATrv”;i„r4T r* I-! o <..»i .■>. fvi Additional Soil Observation Logs Project ID: house&lodge&cabinsClient/ Address:Franks Lodge Legal Description/ GPS: QOutwash n Lacustrine L] Loess EjTill I I Alluvium I I Bedrock I I Organic MatterSoil parent material(s): (Check all that apply) CH Summit O Shoulder O Back/Side Slope Q Foot Slope O Toe Slope Slope shapeLandscape Position: (check one) Soil survey map units 1196E Sloped 6.0 Elevation:Vegetation Weather Conditions/Time of Day:09/26/15Date Observation Type:Observation #/Location:#3 auger I Structure IRockIndicator(s)Depth (in)Matrix Color(s)Mottle Color(s)Redox Kind(s)Texture Frag. %ConsistenceShapeGrade FriableGranularWeak0-5 sandy loam <10 lOyr 2/2 Friable5-20 sandy loam lOyr 4/3 Single grain Weak<15 looseSingle grain Structureless20-49 sandy loam <30 lOyr 4/4 loosesandSingle grain Structureless49-65 <30 lOyr 4/4 Comments Observation #/Location: Observation Type: I Structure IRockDepth (in)Matrix Color(s)Mottle Color(s)Redox Kind(s)Indicator(s)Texture Frag. %ConsistenceShapeGrade Comments #■ Subsoil Indicator(s) of Saturation: 51. Distinct gray or red redox features 52. Depleted matrix (value >7=4 and chroma </=2) 53. 5Y chroma </= 3 54. 7.5 YR or redder faint redox concentrations or redox depleti( Consistence: Loose- Textures: c-clay sic-silty clay sc-sandy clay Intact specimen not available Friable- Slight force between fingers Moderate force between fingers Extremely Moderate force between hands or slight foot pressure Rigid- Foot pressure Firm- cl-clay loam firm- If yes to one of the above indicators then; Topsoil Indicator(s) of Saturation: T1. Wetland Vegetation T2. Depressional Landscape T3. Organic texture or organic modifiers T4. N 2.5/ 0 color T5. Redox features in topsoil T6. Hydraulic indicators sicl-silty clay loam scl-sandy clay loam si-silt sil-silt loam I-loam sl-sandy loam* Is-loamy sand* s-sand* Slope Shape: Slope shape is described in two directions; up and down slope (perpendicular to the contour), and across slope (along the horizontal contour); e.g. Linear, Convex or LV. *Sand Modifiers co-coarse m-medium f-fine vf-very fine Soil Structure Grade: Massive- -----------‘ U. K \ \\ No observable aggregates, or no orderly arrangement of natural lines of weakness Poorly formed, indistinct peds, barely observable in place Moderate- Well formed, distinct peds, moderately durable and evident, but not distinct in Durable peds that are quite evident in un-displaced soil, adhere weakly to one another, withstand displacement, and become separate^when soil is disturbed No peds, sandy soil VIWeak-rwV,1 pff lice :i'e .^\ ----c cvStrong- L.niittscnpe Posifioii: Suiimiii ---------------------- Loose- 4. ^ V »• S :> r.'®r-rSliouldej' \J Bstck/SicJe ' I Foot Slope ISoil Structure Shape: Granular- The peds are approximately spherical or polyhedral and are commonly found in topsoil. These are the small, rounded peds that hang onto roots The peds are flat and plate like. They are oriented horizontally and are usually overlapping. Platy structure is commonly found in forested The peds are block-like or polyhedral, and are bounded by flat or slightly rounded surface that are casting of the faces of surrounding peds. Prismatic- Flat or slightly rounded vertical faces bound the individual peds. Peds are distinctly longer vertically, and faces are typically cast or molds of Single Grain The structure found in a sandy soil. The individual particles are not held together. Toe Slope Platv- Blockv- Map Unit Description: Lida-Two Inlets complex, 15 to 30 percent slopes—Otter Tail County, Minnesota Otter Tail County, Minnesota 1196E—Lida-Two Inlets complex, 15 to 30 percent slopes v’ Map Unit Setting National map unit symbol: gm72 Elevation: 1,000 to 1,800 feet I Mean annual precipitation: 21 to 28 inches Mean annual air temperature: 36 to 45 degrees F Frost-free period: 90 to 140 days Farmland classification: Not prime farmland Map Unit Composition ^ Lida and similar soils: 60 percent Two inlets and similar soils: 25 percent Minor components: 15 percent Estimates are based on observations, descriptions, and transects of the mapunit. Description of Lida Setting Landform: Hillslopes on outwash plains Landform position (two-dimensional): Summit, shoulder, backslope Down-slope shape: Convex I Across-slope shape: Linear Parent material: Loamy mantle over sandy and gravelly outwash deposits Typical profile A - 0 to 3 inches: sandy loamj E - 3 to 14 inches: loamy sand Bt - 14 to 20 inches: gravelly sandy loam BC - 20 to 27 inches: gravelly loamy sand C - 27 to 60 inches: gravelly sand Properties and qualities Slope: 15 to 30 percent Depth to restrictive feature: More than 80 inches Natural drainage class: Well drained Capacity of the most limiting layerto transmit water (Ksat): High (2.00 to 6.00 in/hr) Depth to water table: More than 80 inches Frequency of flooding: None Frequency of ponding: None 1 Calcium carbonate, maximum ^in profile: 15 percent Available water storage in profile: Low (about 4.2 inches) Interpretive groups Land capability classification (irrigated): None specified Land capability classification (nonirrigated): 6e Flydrologic Soil Group: A ' 1 ’r Web Soil Survey National Cooperative Soil Survey l.iSOA Natural Resources Conservation Service 9/22/2015 Page 1 of 3 ■) ! Map Unit Description: Lida-Two Inlets complex, 15 to 30 percent slopes—Otter Tail County, Minnesota Other vegetative classification: Steep; Coarse Texture; Low AWC (G091XN018MN) Description of Two Inlets Setting Landform: Hillslopes on outwash plains Landform position (two-dimensional): Summit, shoulder, backslope Down-slope shape: Convex Across-slope shape: Convex Parent material: Sandy and gravelly outwash deposits Typical profile A - 0 to 3 inches: sandy loam E-3to7 inches: loamy coarse sand Bt1,Bt2 -7 to 21 inches: gravelly loamy coarse sand Bk,C - 21 to 60 irwhes: gravelly coarse sand Properties and qualities Slope: 15 to 30 percent Depth to restrictive feature: More than 80 inches Natural drainage class: Somewhat excessively drained Capacity of the most limiting layer to transmit water (Ksat): High (2.00 to 6.00 in/hr) Depth to water table: More than 80 inches Frequency of flooding: None. Frequency of ponding: None Calcium carbonate, maximum in profile: 30 percent Available water storage in profile: Low (about 3.4 inches) Interpretive groups Land capability classification (irrigated): None specified Land capability classification (nonirrigated): 6s Flydrologic Soil Group: A Other vegetative classification: Steep; Coarse Texture; Low AWC (G091XN018MN) ■■'i ) Minor Components Areas with surface stones Percent of map unit: 3 percent Bluffcreek Percent of map unit: 3 percent Pinelake Percent of map unit: 3 percent Landform: .Swales Almora Percent of map unit: 2 percent Areas with more or less slope Percent of map unit: 2 percent 9/22/2015 Page 2 of 3 Web Soil Survey National Cooperative Soil Survey ySDA Natural Resources Conservation Service a1 / c <JVoi>\qOA 46'=‘ 31' 2S" N 4B® 3r25*N 25 50 100 150 Map projection: Web Mefcator Comer coonjinatjes; WGS84 Edge tics: UTM ^ne 15N WGS&4 Natural Resources Web Soil Survey 9/28/2015 Conservation Service National Cooperative Soil Survey Page 1 of 3 Soil Map—Otter Tail County, Minnesota MAP INFORMATIONMAP LEGEND The soil surveys that comprise your AOI were mapped at 1:20,000.Area of Interest (AOI)Spoil AreamArea of Inlerest (AOI)Stony Spot Warning: Soil Map may not be valid at this scale. Enlargement of maps beyond the scale of mapping can cause misunderstanding of the detail of mapping and accuracy of soil line placement. The maps do not show the small areas of contrasting soils that could have been shown at a more detailed scale. Soils Very Stony Spot Wet Spot Soil Map Unit Polygons Soil Map Unit Lines OtherA Soil Map Unit Points Special Point Features ^ Blowout Borrow Pit .P,■ Special Line Features Water Features Please rely on the bar scale on each map sheet for map measurements. Streams and Canalsm Source of Map: Natural Resources Conservation Service Web Soil Survey URL: http://websoilsurvey.nrcs.usda.gov Coordinate System: Web Mercator (EPSG:3857) Maps from the Web Soil Survey are based on the Web Mercator projection, which preserves direction and shape but distorts distance and area. A projection that preserves area, such as the Albers equal-area conic projection, should be used if more accurate calculations of distance or area are required. This product is generated from the USDA-NRCS certified data as of the version date{s) listed below. Soil Survey Area: Otter Tail County, Minnesota Survey Area Data: Version 10, Sep 16, 2014 Soil map units are labeled (as space allows) for map scales 1:50,000 or larger. Date(s) aerial images were photographed: Data not available. The orthophoto or other base map on which the soil lines were compiled and digitized probably differs from the background imagery displayed on these maps. As a result, some minor shifting of map unit boundaries may be evident. Transportation RailsClay Spot Closed Depression0 Interstate Highways Gravel Pit US Routes Gravelly Spot Major Roads Landfill Local Roads k Lava Flow Background Marsh or swamp Aerial Photography Mine or Quarry Miscellaneous Water Perennial Water Rock OutcropV "f Saline Spot Sandy Spot Severely Eroded Spot<s- Sinkhole Slide or Slip Sodic Spot tiSPA Natural Resources Conservation Service Web Soil Survey National Cooperative Soil Survey 9/28/2015 Page 2 of 3 «t Soil Map—Otter Tail County, Minnesota Map Unit Legend otter Tail County, Minnesota (MN111) Acres in AOI Percent of AOIMap Unit Symbol Map Unit Name 7.7%Lida-Two Inlets complex, 1 to 8 percent slopes 0.11196B 92.3%Lida-Two Inlets complex, 15 to 30 percent slopes 1.61196E 100.0%Totals for Area of Interest 1.7 9/28/2015 Page 3 of 3 Web Soil Survey National Cooperative Soil Survey LSfM Natural Resources Conservation Service System design must be to scale and must include the proposed location of the sewage system, all existing/ proposed buildings, property lines, the ordinary high water level of the water body, bluff and all water wells within 150' of the sewage system. If there are any questions, see the University of Minnesota Site Evaluation worksheets. /__inch(es) equals feetfeet, orgrid(s) equalsScale: MPCA LICENSE #: LICENSE CATEGORY: fDESIGNED BY: FIRM NAME:DATE: ADDRESS:SIGNATURE: n: V S'\ \ A\e^yo' o'^ Q_'lf ^r//<e./t^’o <• ^ />epS A) ^ I /ooc, ^ P xt61 % V \ ^6°)oni i'l]fTvi ‘n 'V ^ SCANNED,v^ lops,^ BK — 04>2014 — 029 354.261 • V'?!of Lvindee'i Co. Pnniers • Fergus Falls. MN ■ i-80C-346-4870 SITE DATA WORKSHEET receivedLAND & RESOURCE MANAGEMENT GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN f 2{)1g 218-998-8095 OTTER Tflll LAND St RESOURCE Sewage Treatment System Permit #_______ www.co.otter-tail.mn.usCOViTT-HIIISIIOTa OWNER: LAST NAME7 FIRST MIDDLE TELEPHONE NUMBER ADDRESS: 305'^?^/7 ___STR./RT CITY STATE ZIP CODE S—LAKE/RIVER NO. LEGAL DESCRIPTION: 7c/ /o/ ^ d'zc Tie. d> LAKE NAME SEC.TWP RANGE TWP. NAME SOIL BORING LOG DEPTH (INCHES) COLOR £f MUNSELL NO.TEXTURE STRUCTURE BLOCKY PLATY PRISMATIC gOTOS BLOtKY PLATY PRISMATIC MOIT5 BLOCKY PLATY PRISMATIC tfrnNit BLOCKY PLATY PRISMATIC /■%Arr\b ' U0(!DS~C>oc>0 PARCEL NUMBER "^0^/73 yf>/) E-911 Address or Directions From Nearest Public Road y/HAp'^ b' NUMBER OF BEDROOMS /o^GARBAGE DISPOSAL: YES DEPTH^O *~ft. SEWER LINE SEPARATIONLS’O^ft.WELL: CASING FLOODPLAIN: YES BLUFF: YES ..<Ton£?VEGETATION: AQUATIC BLOCKY PLATY PRISMATIC NONE SLOPE AT INSTALLATION SITE:% <Ufl- tW-flcZ-cA &0^\ TYPE OF OBSERVATION: Probe PARENT MATERIAL: ^ ORIGINAL SOIL: \A.0V Outwash Loess Bedrock Alluvium No Date of Soil Boring ©COMPACTED SOIL: Yes DEPTH OF BORING (To 7' or restrictive layer):.ft.Date of Perc Test PERC TEST#1 PERC TEST #2- TWO TESTS ARE REQUIRED - INTERVAL IMINUTESlTIME WATER DEPTH WATER PROP PERC RATE TIME INTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATE START START TIME DROP PERC PERCTIMEDROP TIME INTERVAL IMINUTESl WATER DEPTH WATER DROP PERC RATE TIME INTERVALIMINUTESl WATER DEPTH WATER PROP PERC RATE REFILL REFILL TIME DROP PERC TIME DROP PERC INTERVAL (MINUTES) RB=ILL WATER DEPTH WATER DROPTIME PERC RATE TIME INTERVAL(MINUTES)WATER DEPTH WATER DROP PERC RATE REFILL TIME DROP PERC TIME DROP PERC TIME INTERVAL (MINUTES!WATER DROPWATER DEPTH PERC RATE TIME INTERVALIMINUTESl WATER DEPTH WATER DROP PERC RATE RFFllL REFILL TIME DROP PERC DROP PERCTIME TIME INTERVAL IMINUTESl WATER DROPWATER DEPTH PERC RATE TIME INTERVALIMINUTESl WATER DEPTH WATER DROP PERC -RATEREEILL REFILL TIME DROP PERC PERCTIMEDROP TIME INTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATE TIME INTERVAL(MINUTES!WATER DEPTH WATER DROP PERC RATEREFILL REFILL TIME DROP PERC TIME DROP PERC TIME INTERVAL(MINUTES! REFILL WATER DEPTH WATER DROP PERC RATE TIME INTERVAL IMINUTESl WATER DEPTH WATER DROP PERC RATEREFILL TIME DROP K.tC TIME DROP PERC INTERVAL IMINUTESl WATER DEPTH WATER DROP PERC RATETIME TIME INTERVAL (MINUTES) REFILL WATER DEPTH WATER DROP PERC RATEREFILL TIME DROP PERC TIME DROP PERC ■— UUl /SEPTIC TANK MANUFACTURER:zauu/d PROPOSED DESIGN: BED.ATGRADE.MOUND.TRENCH.HOLDING TANK.GRAVITY DIST,.PRESSURE DIST, Cztp CfivAOUTHOUSE.SEWER LINE OTHER. SPECIFY:. — SYSTEM DESIGN ON BACK — OTTER TAIL COUNTY LAND & RESOURCE MANAGEMENT PUBLIC WORKS DIVISION WWW.CO.OTTER-TAII. MN USqrrjERTtiii GOVERNMENT SERNflCES CENTER 540 WEST RRAN^NUE FERGUS FALLS. MN 56537 218-998-8095 FAX: 218-998-8112 10/17/2016 Frank's Lodge & Campground Lie 30570 Lodge Loop DentMN 56528 9227 RE: Primary Owner; Frank's Lodge & Campground Lie Sewage Treatment System Servicing Tax Parcel Number; 56000090057000 Described as:Sec 09 Twp Star Lake Township Sect-09 Twp-135 Range-041 9.89 AC N1/2 NW1/4, LOTS 4 & 5 EX STAR Lake: 56-385 Star As of 10/14/2016 the sewage treatment system (Sewage Treatment Installation Permit # 23828 servicing your property was determined to be in compliance with the provisions of the Sanitation Code of Otter Tail County for a 2450 gallons per day. Please be advised that this certification is only valid for five years from the date of this inspection 10/14/2021 If you have any questions regarding this matter, please contact our office. Sincerely Alexander Kvidt Inspector SCANe APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENT GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 218-998-8095 www.co.otter-tail.mn.us ' i OTTER TRIl PINK - Owner/ Contractor (after issue)WHITE - Office YELLOW -L&R InspectorcOKiTT-ainaiioTi APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED Permit No. RANGE TWP NAMELAKE/RIVER CLASS SECTION TWP NO.LAKE NUMBER LAKE/RIVER NAME 0 /^rE-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROADPARCEL NUMBER (S) OF PROPERTY BEING SERVICED Scoo Jo5~po LEGAL DESCmPTION ^ ^ //IrJ (fk /<’S <f y Daytime Phone No.Mailing AddressLast Name First Initiai 3CS~V3 AepProperty Owner /^CA t yv? r\ Sle> j '\<r X\4~>^ruj £cLCn4 Mm Contractor Lie.# THIS SPACE FOR OFFICE USE ONLY A.M. P.M.>• This System will be ready tor inspection on , the year of at. A.M. P.M. L&R OfficialTime ReceivedDate Received TYPE OF NSTALLATION fc/RCLE owe;SEWAGE TREATMENT SYSTEM DESIGN DATA AS SHOWN ON DRAWINGCollector (D) NewL----------^(EtPeplacerngutJ (F)Aaa on Other Est.Residential (A) New (B) Replacement (C) Add on (G) New (H) Replacement (I) Add on Soil Treatment Area LiftTankfpool /cco Design Flow (Gallons/Day) Effluent Distribution (Gravity ( ) Pressure (J)Cl — 2,49l!> 2,500 -^,999 (M) 5,000— 10,000 (K)GIs Ft.(L)Size Setback To Nearest Well Ft. Ft.Type II Ft.Type I /C6h/004-/eCT' (27) Rapidly Permeable(20) Trench, Rock Ft.Setback To OHWL c?0O4(21) Trench, Gravelless (22) (1rpn^. Chamber^ (28) Rood Plain (29) Privies Ft.Ft.-----Ft.Setback To Bluff(30) Holding Tank (Contract Required) (23) Bed /t>e *-y«=Ft.(24) Mound Ft.Ft.Setback To Dwelling /6 Jo(25) At Grade Type III Setback To Non-Dwelling Ft. Ft.Ft.(31) Other/Problem Soils/<12" Soil(26) Greywater 4^ Type IV(34) Tank Only Setback To Nearest Lot Line Ft./#e^Ft./o*/QO-(32) Public Domain & Proprietary Technologies(35) Other Setback To Road Right-Of-Way Ft.Depth of Well Ft. Ft.TypeV Total # BeUlUUiiis.^|J[j3) Performance Abatement Y /^*^*^* Garbage Disposal Y / N /<06-t Ft.Elevation Above Restrictive Layer Ft. Ft. PERC TEST DATA License # Date of Test Highest RateDesigner Agreement: The undersigned hereby makes application for permit to install, alter, repair or extend Sewage Treatment System herein specified, agreeing to do all such work in strict accor­ dance with Sanitation Code of Otter Tail County, Minnesota. Applicant agrees that the Site Data Worksheet submitted herewith and which is approved by a Land & Resource Management Official shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and approved for use. It shall be the responsibility of the applicant for the permit to notify Land & Resource Management that the installation is ready for inspection. Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Sanitation Code of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of the Sanitation Code. NOTE: I.This permit is valid for a period of six (6) months. 2.This permit does not include the building sewer (sewer line). '/\_____ t^fature of Property Ojjlrtm/Ager}t for OJteief AolL-o'i- /Date:Permit Fee $ 1Date:Rec. No..Land S Resource Manageri^t Official Id hrAKl.^ WjVi.a. a g-ctxy Date Stamp RECEIVED JAN 0 7 2015 LAND & RESOURCE Comments: 0L0D £)tSi^PU4 L&R InitialForm No. BK — 04-2014-06 357,243 • Victor Lundeen Co., Primers • Fergus Falls, Minnesola AApplication for permit to install sewage treatment system LAND & RESOURCE MANAGEMENT GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 218-998-8095 www.co.otter-tail.mn.usm4, ■S' fb-WK' OTTER TflII WHITE-Office YELLOW - L & R Inspector PINK - Owner / Contractor (after issue)covaTY-niiiiiOTi aAPPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED Permit No. TWP NO.RANGE TWP NAMESECTIONLAKE/RIVER CLASSLAKE/RIVER NAME -LAKE NUMBER c./ sr1 E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROADPARCEL NUMBER (S) OF PROPERTY BEING SERVICED :i ///o r^/ ^ r^tr y Jos 90f3 (rOQOG^ LEGAL DESCRIPTION ; % Daytime Phone No.Initial Mailing AddressLast Name First JQSyjProperty Owner f ,ryy o. . 2:rContractor Lie.# f -)91/F' VO j O' THIS SPACE FOR OFFICE USE ONLY idis , the year of> This System will be ready for inspection on \o\xs\\U? Date Received CX^. P.M. L & R OfficialTime Received NSTALLATION (circle one)TYPE OF SEWAGE TREATMENT SYSTEM DESIGN DATA AS SHOWN ON DRAWINGOther Est.CollectorResidential (A) New (B) Replacement (C) Add on (G) New (H) Replacement (I) Add on (D) New.(E| Replacement-'^' (F)Addori Soil Treatment Area LiftTank Effluent Distribution {,k1 Gravity ( ) Pressure Design Flow (Gallons/Day) (J) ,Q (K) ; 1.-2,.499.! (L) 2,—4,999 (M) 5,000 — 10,000 Ft.GIs GIs /.<, 32V-/ijO'-'^ S C) 0Size ’ Setback To Nearest Well Ft.Ft.Ft.Type IIType I /rV ^/O 0 4 (20) Trench, Rock (27) Rapidly Permeable F Ft.Ft.Ft.Setback To OHWL(28) Flood Plain(21) Trench, Gravelless >(22) Trench, .Chamber (29) Privies Ft.Ft.-- Ft.Setback To Bluff(30) Holding Tank (Contract Required) (23) Bed /r 0 ‘~(24) Mound Ft.^-1= 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(34) Tank Only Setback To Nearest Lot Line Ft.(. Ft.4- Ft./Oi(32) Public Domain & Proprietary Technologies(35) Other Setback To Road Right-Of-Way /(AO-f'- Ft.Depth of Well 4- Ft.Ft.Type V ZOO Total it Bedrooms (33) Performance J*Elevation Above Restrictive Layer Ft.Ft.Ft.Y / N;. ^Garbage Disposal Y / NAbatement PERCTEST DATA ) •L2</J'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 ot 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 thQ 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: 1. This permit is valid for a period of six (6) months. 2. This permit does not include the building sewer (sewer line). signature of Properly ^Irrier/Agent for Owner Permit Fee $Date:•? J0 r!Rec. No. 9. V /o/ ^Date;■aLand S Resource Management Official ■I J •;f\IComments: j 0 i Z L'j'T i -'i V' . , .0 --.V !±'!UA ■, •; Form No. BK — 04-2014-06 357.243 • Victor Lundoon Co., Printers • Fergus Fails, Mirwiesota nr * ^ SEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTS STA (Soil Treatment Ares) OUTHOUSE TRENCH REDUCTIONHOLDING SEPTIC TANK LIFT TANKCATEGORY TAC6 AulK iiijnciiut! wiiTi'_12,inches2CapacityldOC>GLS. 3.0 %of sidewall forFT FTFTSetback from Nearest Well 3’^^ ff2reduction / equivalent toSetback from Buried Water Suction Pipe FTFT STA CALCULATION (Soil Treatment Are Ft. X Setback from Buried Pipe Distributing Water Under Pressure 10^Mil FT FTFT /37vV/6o^Setback from OHWL (lake &/or river)FT FTFT Ft. FT FTSetback from Bluff FT Ft* 4-<6t V MOUND / AT-GRADEFTFTSetback from Dwelling FT f ^CK BEDmFTSetback from Non-Dwelling FT < 4^FTSetback from Nearest Property Line FT FT Ft. in’-lO*'16*'FT FTFTSetback from Right-of-Way Ft* FT FTElevation above Restrictive Layer FT SAND IN MOUNtT.INSTALLERS COMMENTS SEPTIC TAN K(s)Holding Tank / Lift Alarm ^YES # Tanks InstalledOld System Pumped & Destroyed MyES □ NO Weep Holes Manuf.Lateral Pipe Size IN Model itPerforation Spacing Perforation Diameter Size IN•t.' ^ Gallons Per Minute % 1 \ va-' i FILTERS DYES ^NOFeet of Total HeadPUMPS tiberVy LoInspector's Comments: Sketch: ^ JO iuV V "1 i ! ’ iocO ; il / il iruCi{ n n r n ii v^~ / /14■f: —1 =.-1 d above described sewage system installation1\qo As of was found to be compliant with the provisions of the Sanitation Code of Otter Tail County.Initial / L & H OfficialTimeDate Land & Resource Mariagement Offida! Form No. BK — 04-2014-06 357.243 * Victor Lundeen Co., Printers • Fergus Falls, Minnesota m SITE DATA WORKSHEET RECEIVED LAND & RESOURCE MANAGEMENTGOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS-'M^J S^;^315 218-998-8095 www.co.otter-tail.mn.us I LAND & F^ESOURCEOTTER TAIlCOIlTT'BlllilfOri Sewage Treatment System Permit # ^ 3 ^ ^ OWNER: y<g_ ' LAST NAME FIRST MIDDLE TELEPHONE NUMBER ADDRESS: ^ac9cp /jmp> Ehyj^ STR./RT '' ' XY\ VO CITY STATE ZIP CODE £23^ RANGELAKE/RIVER NO.LAKE NAME SEC.TWP TWP NAME LEGAL DESCRIPTION: *7- // </9^S' cV *5^'*' SOIL BORING LOG COLOR & MUNSELL NO. DEPTH (INCHES)TEXTURE STRUCTURE (£^tc /■^s /*>*'->'•<5^ocky> oooR PRISMATIC NONEPARCEL NUMBE yn JLaJpe.BLOCKY PLATYE-911 Address or Directions From Nearest Public Road i,'ZY PRISMATIC_^ON?y/p ^ /2f NUMBER OF BEDROOMS BLOCKY PLATY PRISMATIC WORE GARBAGE DISPOSAL: YES DEPTH-^^. SEWER LINE SEPARATION:^^ft. FLOODPLAIN: YES BLUFF: YES (1^ VEGETATION: AQUATIC (^RRESTRI^ SLOPE AT INSTALLATION SITE: ^ -g. WELL: CASING BLOCKY PLATY PRISMATIC ^6/fe:'>7Y\3A ■aiffligN V BLOCKY PLATY PRISMATIC none, , . QO''l 12‘^ %\ <^iO’ j^rin^TYPE OF OBSERVATION: Probe PARENT MATERIAL: Till Loess Bedrock Alluvium ORIGINAL SOIL: mC^No COMPACTED SOIL: Yes DEPTH OF BORING (To 7' or restrictive layer):. Date of Soil Boring Date of Perc Test PERC TEST #1 PERC TEST #2- TWO TESTS ARE REQUIRED - TIME INTERVAL fMINUTESI WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTESI WATER DEPTH WATER DROP PERC RATESTARTSTART TIME DROP PERC TIME DROP PERC TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE REFILL REFILL TIME DROP PERC DROPTIME PERC TIME INTERVAL (MINUTES) REFILL WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTESI WATER DEPTH WATER DROP PERC RATE refill DROPTIME PERC DROP PERCTIME TIME INTERVAL IMINUTESI WATER DEPTH WATER DROP PERC RATE TIME INTERVALIMINUTESI refill WATER DEPTH WATER DROP PERC RATEREFILL TIME DROP PERC DROP PERCTIME TIME INTERVAL (MINUTESI REFILL WATER DEPTH WATER DROP PERC RATE TIME INTERVAL IMINUTESI REFILL WATER DEPTH WATER DROP PERC RATE DROPTIME PERC TIME DROP PERC TIME INTERVAL IMINUTESI WATER DEPTH WATER DROP PERC RATE TIME INTERVAL(MINUTES) REFILL WATER DEPTH WATER DROP PERC RATEREFILL TIME DROP PERC TIME DROP PERC TIME INTERVAL (MINUTES) REFILL WATER DEPTH WATER DROP PERC RATE TIME INTERVAL IMINUTESI WATER DEPTH WATER DROP PERC RATEREFILL TIME DROP PERC TIME DROP PCRC TIME WATER DEPTH WATER DROPINTERVAL IMINUTESI REFILL PERC RATE TIME INTERVAL (MINUTESI WATER DEPTH WATER DROP PERC RATEREFILL TIME PERCDROP TIME DROP PERC SEPTIC TANK MANUFACTURER: PROPOSED DESIGN: X GRAVITY DIST. ^TRENCH BED.ATGRADE.MOUND.HOLDING TANK.PRESSURE DIST. SEWER LINE.OUTHOUSE.OTHER. SPECIFY:. — SYSTEM DESIGN ON BACK — System design must be to scale and must include the proposed location of the sewage system, all existing/ proposed buildings, property lines, the ordinary high water level of the water body, bluff and all water wells within 150' of the sewage system. If there are any questions, see the University of Minnesota Site Evaluation worksheets. JP C> feet/_inch(es) equalsfeet, orgrid(s) equalsScale; MPCA LICENSE #: DESIGNED BY:LICENSE CATEGORY: FIRM NAME:DATE: ADDRESS;SIGNATURE: A Ju/^! :V A; oi-ife-1'^') f .C/i ) Dt I2Z 4 /C. / - f^ Z' 9,/ft/Vi ^ po s S-er(J><^ 3M.251 • Victor Lundeen Co, Pftniers • Ferrjus Fans, MN • 1-80C-346-4870BK — 04-2014 — 029 N j4*£ s ^unnumynj □/ r- cC JbkIk- P'J ^ c?S 8'Vj 5:C rri«s>:dO o-> 0 /T7 if- as^ •t. f > c > ;//■o V’ A/■4 46® 31'27'N 46^ 3r2rN :37mOzimm s00 roC3 O CD < ^ < > E- pk^ 3l'2rN 46" 3l‘25*N 2Q1070 25 50 100 150 Map projection: Web Mercator Cx)rT)er coordinates-WGS84 Edge bcs: l/TM S>ne 15N WGS84 Natural Resources Web Soil Survey 9/28/2015 Conservation Service National Cooperative Soil Survey Page 1 of 3 OSTP Design Summary Worksheet University OF Minnesota •t Minnesota Pollution . Control Agency V 05.13.14Project ID;Property Owner/Client: Franks Lodge trailer house's Date: 9/26/15Site Address; 30570 Lodge Loop Dent, MN 56528 1. DESIGN FLOW AND TANKS Note: The estimated design flow is considered a peak flow rate including a safety factor. For long term performance, the average daily flow is recommended to be < 60% of this value. 2450 Gallons Per Day (GPD)A. Design Flow: B. Septic Tanks: Minimum Code Required Septic Tank Capacity:7350 Gallons, in 1 Tanks or Compartments Recommended Septic Tank Capacity:7500 Gallons, in 3 Tanks or Compartments Effluent Screen: optional electricAlarm: C. Holding Tanks Only: Minimum Code Required Capacity:Gallons, in Tanks Designer Recommended Capacity:Gallons, in Tanks Type of High Level Alarm: Gallons1000D. Pump Tank 1 Capacity (Code Minimum):Gallons Pump Tank 2 Capacity (Code Minimum); Gallons1000Pump Tank 2 Capacity (Designer Rec):Pump Tank 1 Capacity (Designer Rec);Gallons GPM Total Head30.0 GPM Total Head 50.3 Pump 2 ftftPump 1 Supply Pipe Dia.200.0Supply Pipe Dia. 2.00 in in Dose Volume:galDose Volume:gal 2. SYSTEM TYPE :^)Gravity Distribution OPressure Distribution-Level * Selection Required Benchmark Elevation: OPtbSSure Distribubon-Unlevel®Trench QBed Owound 0*t-Grade Octip OHoWing Tank Oothbr 100.00 ft Benchmark Location: System Type Type of Distribution Media: [~~brainfield Rock [^Registered Treatment Media:□ Type V0 Type I O Type II □ Type III O Type IV Quick -4 high cap 3. SITE EVALUATION: 0-2 %B. Measured Land Slope %;A.Depth to Limiting Layer: sandElevation of Limiting Layer:D.Soil Texture:C. GPD/ft^1.20Loc. of Restricive Elevation:F.Soil Hyd. Loading Rate:E. I 3.0 |ft36 MPIG. Minimum Required Separation: I. Code Maximum Depth of System: in Perc Rate;H. ^3J]in -Comments: 4. DESIGN SUMAAARY Trench Design Summary ft^3Dispersal Area 1633 Sidewall Depth 12 Trench Width ftin Total Lineal Feet 8 Code Maximum Trench Depth 36.0548 ft Number of Trenches in 36.01.2Contour Loading Rate ft Designer's AAax Trench Depth in Bed Design Summary ft^Code Ateximum Bed DepthAbsorption Area Depth of sidewall inin Bed Width Designer's Max Bed DepthBed Length ftft in OSTP Design Summary Worksheet University OF MinnesotaMinnesota Pollution , Control Agency Mound Design Summary ft^Bed WidthBed LengthAbsorption Bed Area ft Berm Width (0-1%)Clean Sand LiftAbsorption Width ftft ft Endslope Berm Width ftUpslope Berm Width ftft Downslope Berm Width Total System WidthTotal System Length Contour Loading Rate gal/ftftft At-Grade Design Summary System HeightAbsorption Bed LengthAbsorption Bed Width ftftft Downslope Berm Widthgal/ft Upslope Berm Width ftftContour Loading Rate System WidthEndslope Berm Width System Length ftftft Level & Equal Pressure Distribution Summary Perforation Spacing Perforation DiameterNo. of Perforated Laterals ft in galgalMaximum Delivered VolumeMin. Delivered VolumeLateral Diameter in Non-Level and Unequal Pressure Distribution Summary Pipe Length Perforation SizePipe Volume (gal/ft) Elevation Spacing (ft)Spacing (in)(ft)(ft)Pipe Size (in)(in) Lateral 1 Minimum Delivered Volume galLateral 2 Lateral 3 Lateral 4 Maximum Delivered Volume galLateral 5 Lateral 6 5. Additional Info for Type IV/Pretreatment Design A. Calculate the organic loading 1. Organic Loading to Pretreatment Unit = Design Flow X Estimated BOD in mg/L in the effluent X 8.35 t 1,(XX),000 mg/LX 8.35 V 1,000,000 =gpd X lbs BOD/day 2. Type of Pretreatment Unit Being Installed: 3. Calculate Soil Treatment System Organic Loading: BOD concentration after oretreatment v Bottom Area = Ibs/day/ft^ Ibs/day/ft^mg/L-X-&.135TT,obo,000 T ft^ = Comrn^Ats/Special Design Considerations: Dual alternating pumps: Control Panel must indued event counter, alarm, dual controls, if alarm sounds must turn on 2nd pum| I hereby certify that I have completed this work in accordance with all applicable ordinances, rules and laws. 09/26/15Randy Anderson 634 (License #)(Date)(Designer) .Signature) OSTP Trench Design Worksheet University OF MinnesotaMinnesota Pollution Control Agency V 05.13.14Project ID:1. SYSTEM SIZING: ^ 36>0 j inc 2450 GPDA. Design Flow:’r Designers Maximum Depth:inchesB. Code Maximum Depth: GPD/ft^1.20 1.Contour Loading Rate:gal/ftC. Soil Loading Rate: D. Required Bottom Area: Design Flow (1.A) - Loading Rate (1.C) = Initial Required Bottom Area 1.20 GPD/ft^ =ft^20422450GPD- □ Rock El Registered Product □ Pressure □ Gravity-Drop El Gravity-Other end caps E. Select Dispersal Media: (selection required) F. Select Distribution Method: G. If distribution media is installed in contact with sandy or loamy sand or with a percolation rate of 0.1 to 5 mpi indicate distribution or treatment method: 2. TRENCH CONFIGURATION: ROCK Initial required trench bottom area (ft^): (from 1.D) Sidewall Absorption (inches) Design trench bottom area A.Bottom Area Reduction Bottom Area Multiplier I Cover56 to 11 1 > Distributiono12 to 17 20%0.8 V(18 to 23 34%0.66 Sidewall 24 0.640% B. Select Sidewall Height:inches ft Width ft^C. Design Bottom Area (2.A): D. Select Trench Width:ft E. Total Designed Trench Length: Bottom Area -r Trench Width = Total Required Trench Length I ft' -ft =ft I. Calculate Minimum system length based on Contour Loading Rate: Design Flow t Contour Loading Rate = gal/ftgpd V ft F. Select No. of Trenches:trenches G. Select Trench Spacing :ft (typically 5 - 12 ft from center to center) H. Calculate Lawn Area: Trench Length (2.E) X Trench Spacing (2.G) = square feet of lawn area ft X ft' lawn areaft = J. Select Depth Required to Cover Distribution Pipe: ft (0.33 ft for pressure, 0.5 ft for gravity) K. Calculate Rock Volume: (Sidewall Height (2.B) + Depth to Cover Pipe (2.J)) X Bottom Area (2.C) = cubic feet ft) X 2 ft'ft +(ft" = Divide ft' by 27 ft'/yd' to calculate cubic yards: ft' ^ 27 yd' 3. TRENCH CONFIGURATION: REGISTERED PRODUCTS - CHAMBERS AND EZFLOW Initial required trench bottom area (ft^): (from 1.D) Design trench bottom area Sidewall Absorption (inches) A.Bottom Area Multiplier Bottom Area Reduction 20426 to 11 1 163312 to 17 20%0.82042 134818 to 23 34%0.66 24 0.6 1225. 40% f. Quick-4 High capB. . Registered Product: 12 1.0 ftinchesC.. Select Sidewall Height: ft^1633D. Design Bottom Area (3.A): E. Registered Width:3 ft i 1F. Minimum Designed Trench Length = Bottom Area (3.C) t Trench Width (3.D) ft^ -1633 3.0 544ft =ft ! G. Enter the Registered Product Component Length: H. Number of Components = Minimum Total Length Required divided by Component Length (Round up) 4 ft 1 I ...J:!ftv 137544 4 ft =componentsI' I. Actual Total Trench Length = Number of Components X Component Length: . 137 components X i4.0 ft =548 ft ■i J. Calculate Minimum length per trench based on Contour Loading Rate: Design Flow f CLR = gpd r '! gal/ft =2450.0 1.2 2041.7 ft K. Select No. of Trenches:8 trenches L. Length per trench = Actual Trench Length -f Number of Trenches. Recommended to not exceed 3.J. gal/ft548.0 8 68.5. ftft V ft (typically 5 - 12 ft from center to center)4M. Select Trench Spacing :1 N. Calculate Lawn Area: Trench Length X Trench Spacing = square feet of lawn area ft^ lawn area54821774ft =ft X !Comments: 10 mobile homes @ 225 gpd = 2250 gpd. 2 RV sites @ 100 gpd =200. 2250 + 200 = 2450 gpd.)? |: Sifi:' :iI l: ; l \■ii 4 OSTP Basic Pump Selection Design WorksheetW^~University OF MinnesotaMinnesota Pollution Control Agency Project ID:1. PUMP CAPACITY ®Gravity OPressure Selection requiredPumping to Gravity or Pressure Distribution; 30.0 GPM (10-45spm)1. If pumping to gravity enter the gallon per minute of the pump: 2. If pumping to a pressurized distribution system:GPM Demand Dosing Soil Treatment3. Enter pump description: Soil system& point oi d'SChnrqe2. HEAD REQUIREMENTS 40A. Elevation Difference between pump and point of discharge: ft nist EtevatNiR d«H B. Distribution Head Loss: C. Additional Head Loss:to Special equipment, etc.) Table I.Frictlon Loss In Plastic Pipe per 100ft Flow Rate .......Pipe Diameter jinches) (GPM) ^ Distribution Htym Loss --- Pressure Distribution based on Minimum Average Head Value on Pressure Distribution Worksheet: Gravity Distribution 1.25 1.5 21 1.3 0.39.1 3.110 12.8 4.3 1.8 0.412 Distribution Head LossMinimum Average Head 5.7 2.4 0.617.014 5ft1ft 3.0 0.721.8 7.316 6ft2ft 3.8 0.9189.1lOft5ft 1.12011.1 4.6 16.8 6.9 1.725 9.723.5302.0D. 1. Supply Pipe Diameter:in 12.9 3.235 2. Supply Pipe Length:180 ft 16.540 4.1 20.5 5.045 E. Friction Loss in Plastic Pipe per 100ft from Table I:6.150 7.3552.37 ft per 100ft of pipeFriction Loss =8.660 F. Determine Equivalent Pipe Length from pump discharge to soil dispersal area discharge point. Estimate by adding 25% to supply pipe length for fitting loss. Supply Pipe Lensth (D.2) X 1.25 = Equivalent Pipe Length 10.065 11.470 13.075 85 16.4 225.0180 ftX 1.25ft 20.195 G. Calculate Supply Friction Loss by multiplying Friction Loss Per 100ft (Line E) by the Equivalent Pipe Length (Line F) and divide by 100. Supply Friction Loss = 5.3225.0 ft2.37 ft 100ft per 100ft X H. Total Head requirement is the sum of the Elevation Difference (Line A), the Distribution Head Loss (Line B), Additional Head Loss (Line C), and the Supply Friction Loss (Line G ) 50.35.3 ft5.0 ft =40.0 ft +ftft + 3. PUMP SELECTION 50.330.0 feet of total head.A pump must be selected to deliver at least GPM (Line 1 or Line 2) with at least Comments; This system vdll have dual alternating pumps. In 1000 gal lift station. Alarm needs to sound if one pump fails to run, and other pump to kick in. ^3^ OSTP Pump Tank Design Worksheet University OF MinnesotaMinnesota Pollution Control Agency Project ID;DETERMINE TANK CAPACITY AND DIMENSIONS v05.13.14 24501.A. Design Flow (Design Sum. lA)GPD: 1000 1000B. Min. required pump tank capacity:Gal C.Recommended pump tank capacity:Gal Demand to GravityD. Pump tank description: MEASURED TANK CAPACITY (existing tanks): 2. A. Rectangle area = Length (L) X Width (W)Widthft^X ftft B. Circle area = 3.14r^ (3.14 X radius X radius) 3.14 X 2 ft^ft Length C. Calculate Gallons Per Inch. Multiply the area from 1.A or 1.B, by 7.5 to determine the gallons per foot the tank holds and divide by 12 to calculate the gallons per inch. X 7.5 gal/ft^ V 12 in/ftft^Gallons per inch D. Calculate Total Tank Volume Depth from bottom of inlet pipe to tank bottom: Total Tank Volume = Depth from bottom of inlet pipe (Line 4.A) X Gallons/Inch (Line 2) 23.3 Gallons Per Inch = in X Gallonsin MANUFACTURER'S SPECIFIED TANK CAPACITY (when available): Note: Design calculations are based on this specific tonk. Substituting a different tank model will change the pump float or timer settings. Contact designer if changes are necessary. Browm- WilbertA. Tank Manufacturer:3. 100PTB. Tank Model: 1001C. Capacity from manufacturer;Gallons 23.3D. Gallons per inch from manufacturer;Gallons per inch 43.0E. Liquid depth of tank from manufacturer:inches DETERMINE DOSING VOLUME 4. Calculate Volume to Cover Pump (The inlet of the pump must be at least 4-inches from the bottom of the pump tank 6t 2 inches of water covering the pump is recommended) (Pump and block height + 2 inches) X Gallons Per Inch (2C or 3E) in + 2 inches) X12 23.3 326Gallons Per Inch Gallons( 5. Minimum Delivered Volume = 4 X Volume of Distribution Piping: - Line 17 of the Pressure Distribution or Line 17 of Non-level 6. Calculate Maximum Pumpout Volume (25SS of Design Flow) Design Flow: Gallons (minimum dose) 2450 0.25 613GPD X Gallons (maximum dose) 2007. Select a pumpout volume that meets both Minimum and Maximum: 8. Calculate Doses Per Day - Design Flow t Delivered Volume 2450 gpd V Gallons Volume of Liquid in Pipegal =12200 Doses 9. Calculate Drainback: A. Diameter of Supply Pipe =Liquid Per Foot (Gallons) Pipe Diameter (inches) 2 inches 180Length of Supply Pipe =feetB. 0.170 Gallons/ftC.Volume of Liquid Per Lineal Foot of Pipe = Drainback = Length of Supply Pipe X Volume of Liquid Per Lineal Foot of Pipe ft X 0J70 Igal/ft = 0.0451 D.1.25 0.07818030.6 Gallons 1.5 0.110 10. Total Dosing Volume = Delivered Volume plus Drainback 2 0.170 200 gal +30.6 gal =231 Gallons 3 0.380 11. Minimum Alarm Volume = Depth of alarm (2 or 3 inches) X gallons per inch of tank in X 4 0.661223.3 gal/in =46.5 Gallons Minnesota Pollution Control Agency OSTP Pump Tank Design Worksheet University OF Minnesota t:-TIMER or DEMAND FLOAT SETTINGS ^ttemand DoseSelect Timer or Demand Dosing: A. Timer Settings 12. Required Flow Rate: A. From Design (Line 12 of Pressure Distribution or Line 10 of Non-Level*): B. Or calculated: GPM = Change in Depth (in) x Gallons Per Inch / Time Interval in Minutes Orimer GPM 'Note: This value must be adjusted after GPM installation based on pump calibration. gal/in iin X min = GPM13. Flow Rate from Line 12.A or 12.B above. 14. Calculate TIMER ON setting: Total Dosing Volume/GPM gal T Minutes ONgpm = 15. Calculate TIMER OFF setting: ’ Minutes Per Day (1440)/Doses Per Day ■ Minutes On 1440 min Minutes OFFdoses/day - 16. Pump Off Float - Measuring from bottom of tank: Distance to set Pump Off Float-Gallons to Cover Pump / Gallons Per Inch: gal -f 17. Alarm Float - Measuring from bottom of tank: Distance to set Alarm Float = Tank Depth(4A) X 90% of Tank Depth in X0.90 = minT gal/in =Inches in B. DEMAND DOSE FLOAT SETTINGS 18. Calculate Float Separation Distance using Dosing Volume. Total Dosing Volume /Gallons Per Inch gal T 19. Measuring from bottom of tank: A. Distance to set Pump Off Float = Pump + block height + 2 inches in = 9.9gal/in =Inches23123.3 142 Inchesin + B. Distance to set Purhp On Float-Distance to Set Pump-Off Float + Float Separation Distance in -r 12 249.9 in =Inches14 C. Distance to set Alarm Float = Distance to set Pump-On Float + Alarm Depth (2-3 inches) in -V 262.0 in =Inches24 FLOAT SETTINGS TIMED DOSINGDEMAND DOSING 1 Inches for Dose:9.9 in FL. inAlarm DepthAlarm Depth 25.9 in Pump On 23.9 in Pump Off 14.0 jp 46.54 Gal Pump Off231 Gal in.y A326 Gal c j Ii i{.- !l{ . 'I University OF Minnesota OSTP Soil Observation Log Project ID;v05.13.14 Client/ Address;Franks Lodge Legal Description/ GPS;trailer house's rjOutwash [j Lacustrine O Loess QtiII I I Alluvium C] Bedrock □ Organic MatterSoil parent material(s); (Check all that apply) PI Summit Q Shoulder CD Back/Side Slope Q Foot Slope C] Toe Slope Slope shapeLandscape Position; (check one) lawn Soil survey map units 267CVegetation Slope%0-2 Elevation; Weather Conditions/Time of Day:09/26/15Date Observation #/Location:#3 Observation Type:auger I Structure'Rock 1Depth (in)Texture Matrix Color(s)Mottle Color(s)Redox Kind(s)Indicator(s)Frag. %ConsistenceShapeGrade 0-6 sandy loam <10 10yr2/2 FriablePrismatic Moderate 6-18 sandy loam <10 lOyr 3/4 FriableSingle grain Moderate 18-40 sand <20 lOyr 4/4 looseSingle grain Structureless -i 40-72 SAND <20 10YR 5/4 looseSingle grain Structureless Comments 1 hereby certify that I have completed this work in accordance with all applicable ordinances, rules and laws. /(Designer/Inspector)(Signature)(Date)(License #) V’.NIVrKMl V t.J <"J ?r\ \ r r-S>i:iw/vo2i “T Rt“ ATfVl t^r'IT Rs'«10C*'i AM Additional Soil Observation Logs Project ID: Client/ Address:Franks Lodge Legal Description/ GPS:trailor house's I I Outwash I I Lacustrine I I Loess I I Till I I Alluvium O Bedrock n Organic MatterSoil parent material(s): (Check all that apply) Q Summit n Shoulder Q Back/Side Slope Q Foot Slope Q Toe Slope Slope shapeLandscape Position: (check one) Soil survey map units 267cVegetation Sloped Elevation: 09/26/05Weather Conditions/Time of Day:Date Observation #/Location:#3 Observation Type:AUGER Rock Structure-I IDepth (in)Texture Matrix Color(s)Mottle Color(s)Redox Kind(s)Indicator(s)Frag. %ConsistenceShapeGrade 0-5 LOAM Friable<10 10YR 2/2 ModeratePrismatic Friable5-20 SANDY LOAM <10 10YR 3/4 Single grain Moderate 20-36 SAND <20 10YR 4/4 LooseSingle grain Weak 36-48 SAND <30 10YR 4/4 LooseSingle grain Structureless 48-60 SAND <20 10YR 5/4 LooseSingle grain Structureless Comments Observation #/Location:Observation Type: Rock StructureI IDepth (in)Texture Matrix Color(s)Mottle Color(s)Redox Kind(s)Indicator(s)Frag. %Shape ConsistenceGrade 1I I! Comments Subsoil Indicator(s) of Saturation: 51. Distinct gray or red redox features 52. Depleted matrix (value >/=4 and chroma </=2) 53. 5Y chroma </= 3 54. 7.5 YR or redder faint redox concentrations or redox depletii Consistence: Loose- Textures: c-clay sic-silty clay sc-sandy clay cl-clay loam Intact specimen not available Friable- Slight force between fingers Moderate force between fingers Extremely Moderate force betvveen hands or slight foot pressure Rigid- Foot pressure Firm- firm- sicl-silty clay loam scl-sandy clay loam si-siIt sil-silt loam l-loam sl-sandy loam* Is-loamy sand* s-sand* If yes to one of the above indicators then: Topsoil Indicator(s) of Saturation: T1. Wetland Vegetation T2. Depressional Landscape T3. Organic texture or organic modifiers T4. N 2.5/ 0 color T5. Redox features in topsoil T6. Hydraulic indicators Slope Shape: Slope shape is described in two directions: up and down slope (perpendicular to the contour), and across slope (along the horizontal contour); e.g. Linear, Convex or LV. *Sand Modifiers co-coarse m-medium f-fine vf-very fine Soil Structure Grade: Massive- tlyj.u,. t No observable aggregates, or no orderly arrangement of natural lines of weakness Poorly formed, indistinct peds, barely observable in place Moderate- Well formed, distinct peds, moderately durable and evident, but not distinct in Durable peds that are quite evident in un-displaced soil, adhere weakly to one another, withstand displacement, and become separated when soil is disturbed No peds, sandy soil ^vcvt1\Weak-w Strong-cv Lrtnclscnpe PosiHcin:I Smiumt ..............—Loose- 1, *Slioiildei' Back/Side ] Foot Sl<^>e. ISoil Structure Shape:Toe !$lope Granular- The peds are approximately spherical or polyhedral and are commonly found in topsoil. These are the small, rounded peds that hang onto roots Platv-The peds are flat and plate like. They are oriented horizontally and are usually overlapping. Platy structure is commonly found in forested The peds are block-like or polyhedral, and are bounded by flat or slightly rounded surface that are casting of the faces of surrounding peds. Prismatic- Flat or slightly rounded vertical faces bound the individual peds. Peds are distinctly longer vertically, and faces are typically cast or molds of Single Grain The structure found in a sandy soil. The individual particles are not held together. Blockv- Map Unit Description. Snellman sandy loam, 8 to 15 percent slopes—Otter Tail County, Minnesota ^ ■ Otter Tail County, Minnesota 267C—Snellman sandy loam, 8 to 15 percent slopes 1 Map Unit Setting National map unit symbol: 2v0lk Elevation: 590 to 2,030 feet Mean annual precipitation: 24 to 33 inches Mean annual air temperature: 37 to 48 degrees F Frost-free period: 110 to 170 days Farmland classification: Farmland of statewide importance Map Unit Composition Snellman, rolling, and similar soils: 85 percent Minor components: 15 percent Estimates are based on observations, descriptions, and transects of the mapunit. Description of Snellman, Rolling Setting Landform: Moraines Landform position (two-dimensional): Summit, shoulder Landform position (three-dimensional): Side slope Down-slope shape: Linear Across-slope shape: Convex Parent material: Coarse-loamy till Typical profile A-Oto 2 inches: sandy loam E - 2 to 16 inches: loamy sand Bt - 16 to 31 inches: sandy clay loam C- 31 to 79 inches: sandy loam Properties and qualities Slope: 8 to 15 percent Depth to restrictive feature: More than 80 inches Natural drainage class: Well drained Capacity of the most limiting layer to transmit water (Ksat): Moderately high to high (0,60 to 2,00 in/hr) Depth to water table: More than 80 inches Frequency of flooding: None Frequency of ponding: None Calcium carbonate, maximum in profile: 15 percent Salinity, maximum in profile: Nonsaline to very slightly saline (0,0 to 2,0 mmhos/cm) Available water storage in profile: Moderate (about 7,5 inches) Interpretive groups Land capability classification (irrigated): None specified Land capability classification (nonirrigated): 3e Flydrologic Soil Group: B ) !: 1 fj! ;) lisjM Natural Resources Conservation Service Web Soii Survey Nationai Cooperative Soii Survey 9/28/2015 Page 1 of 3 r I Map Unit Description: Snellman sandy loam, 8 to 15 percent slopes—Otter Tail County, Minnesota Other vegetative classification: Sloping; Fine Texture (G057XN023MN) Minor Components i Wykeham Percent of map unit: 5 percent Landform: Moraines Landform position (two-dimensional): Backslope Landform position (three-dimensional): Side slope Down-slope shape: Convex Across-slope shape: Convex Other vegetative classification: Sloping Upland, Acid (G057XN006MN) Leaflake Percent of map unit: 3 percent Landform: Moraines Landform position (two-dimensional): Summit, shoulder Landform position (three-dimensional): Side slope Down-slope shape: Linear Across-slope shape: Convex Other vegetative classification: Sloping Upland, Neutral (G057XN002MN) :! i Egglake Percent of map unit: 3 percent Landform: Moraines Landform position (two-dimensional): Footslope Landform position (three-dimensional): Side slope Down-slope shape: Linear Across-slope shape: Concave Other vegetative classification: Level Swale, Neutral (G057XN001MN) ( *1 Cathro, ponded Percent of map unit: 2 percent Landform: Moraines Landform position (two-dimensional): Toeslope Landform position (three-dimensional): Side slope Down-slope shape: Concave Across-slope shape: Concave Other vegetative classification: Not Suited (G057XN024MN) Snellman, hilly Percent of map unit: 2 percent Landform: Moraines Landform position (two-dimensional): Summit, shoulder Landform position (three-dimensional): Side slope Down-slope shape: Linear Across-slope shape: Convex 1 !i| i r i 9/28/2015 Page 2 of 3 Web Soil Survey National Cooperative Soil Survey y.SOA Natural Resources Conservation Service ][ ■if V,'" -T Soil Map—Otter Tail County, Minnesota MAP INFORMATIONMAP LEGEND The soil surveys that comprise your AOI were mapped at 1:20,000.^ Spoil Area Stony Spot ^ Very Stony Spot ^ Wet Spot & Other Area of interest (AOI) Area of Interest (AOI)0 Warning: Soil Map may not be valid at this scale. Enlargement of maps beyond the scale of mapping can cause misunderstanding of the detail of mapping and accuracy of soil line placement. The maps do not show the small areas of contrasting soils that could have been shown at a more detailed scale. Soils Soil Map Unit Polygons Soil Map Unit Lines Soil Map Unit Points□Special Line Features Please rely on the bar scale on each map sheet for map measurements. Source of Map: Natural Resources Conservation Service Web Soil Survey URL: http://websoilsurvey.nrcs.usda.gov Coordinate System: Web Mercator (EPSG:3857) Maps from the Web Soil Survey are based on the Web Mercator projection, which preserves direction and shape but distorts distance and area. A projection that preserves area, such as the Albers equal-area conic projection, should be used if more accurate calculations of distance or area are required. This product is generated from the USDA-NRCS certified data as of the version date(s) listed below. Soil Survey Area: Otter Tail County, Minnesota Survey Area Data: Version 10, Sep 16, 2014 Soil map units are labeled (as space allows) for map scales 1:50,000 or larger, Date(s) aerial images v/ere photographed: Data not available. The orthophoto or other base map on which the soil lines were compiled and digitized probably differs from the background imagery displayed on these maps. As a result, some minor shifting of map unit boundaries may be evident. Special Point Features ^ Blowout Borrow Pit Water Features Streams and Canals Transportation RailsClay Spot Closed Depression0 Interstate Highways K Gravel Pit US Routes Gravelly SpotA Major Roads Landfill Local Roads k Lava Flow Backgrour^d Aerial PhotographyMarsh or swamp Mine or Quarry Miscellaneous Water Perennial Water Rock OutcropV •f Saline Spot :%Sandy Spot Severely Eroded Spot o Sinkhole Slide or Slip Sodic Spot -Web Soil Survey National Cooperative Soil Survey , 9/22/2015 Page 2 of 3 USrM Natural Resources Conservation Service -i - •-'l a 46® 31' IT N 46® 31‘27'N 46® 31'25*N 46° 31’ 25* M 0 25 50 100 150 Map projection: Wdi Mercator Corner Goordinates; WG584 Edge tics; UTM Zone 15N WGS84 Natural Resources Web Soil Survey 9/28/2015 Conservation Service National Cooperative Soil Survey Page 1 of 3 Department of LAND AND RESOURCE MANAGEMENTEchvedOTTER TAIL COUNTYGovernment services Center - 540 west fir JAn U 7 2(jiR FERGUS Falls, MN 56537 " Otter Tail County’s Website: www.co.otter-tail.mn.us ® ^t:^OURC£OTTCR Tim Otter Tail County Compliance Inspection Form Addendum This form is a required attachment to MPCA Compliance Inspection Form for all Existing Subsurface Sewage Treatment Systems in Otter Tail County as of June 1, 2011. Property Information Parcel Number: oooo a Township: _________Section: Property Owner Name(s): ______________ Property Address: e A-Reason for Inspection: Number of Bedrooms:h- □QIn Shoreland Area? Lake/River Name, Number, & Class Yes No System Compliance Status:^Compliant 7~h*\h-^ 6^1y iNon-Compliant Does the soil treatment area have less than 3 feet of vertical separation? Is the septic tank located less than 50 feet from any well? Is the soil treatment area located less than 50 feet from any deep well? Is the soil treatment area located less than 100 feet from any shallow well? Yes Yes Yes Yes No No No No "Yes" indicates that the system is failing to protect ground water and is noncompliant. If "Yes", describe the condition noted; Required Attachments: System drawing to scale on next page. Completed MPCA Compliance Inspection I hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. Certification Number: Business License Name & Number: M J ^ Compliance Inspection FormMinnesota Pollution Control Agency 520 Lafayette Road North St. Paul, MN 55155-4194 Existing Subsurface Sewage Treatment Systems (SSTS) Doc Type: Compliance and Enforcement For local tracking purposes:Inspection results based on Minnesota Pollution Control Agency (MPCA) requirements and attached forms - additional local requirements may also apply. Submit completed form to Local Unit of Government (LUG) and system owner within 15 days System Status System status on date (mm/dd/yyyy):9/26/2015 n Noncompliant- Notice of Noncompliance (See Upgrade Requirements on page 3.) Compliant - Certificate of Compliance (Valid for 3 years from report date, unless shorter time frame outlined in Local Ordinance.) Reason(s) for noncompliance (check all applicable) Q impact on Public Health (Compliance Component #1)- Imminent threat to public health and safety □ Other Compliance Conditions (Compliance Component #3) - Imminent threat to public health and safety □ Tank Integrity (Compliance Component #2) - Failing to protect groundwater □ Other Compliance Conditions (Compliance Component #3) - Failing to protect groundwater □ Soil Separation (Compliance Component #4) - Failing to protect groundwater Q Operating permit/monitoring plan requirements (Compliance Component #5) - Noncompliant Property Information Property address: Property owner: Franks Lodge Parcel ID# or Sec/Twp/Range: 56000090057000 Reason for inspection: building permit Owner’s phone: __________________ 30543 Lodge Loop Dent, MN 56528 or Representative phone: Regulatory authority phone: Owner's representative: 998-8095Local regulatory authority: Ottertail County Brief system description: collector system Comments or recommendations: Certification / hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. Inspector name: Randy Anderson Business name: Anderson On-Site Inspector signature: _____________ Certification number: 3044 License number: 634 Phone number: 218-849-3072 TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Pose 1 of 4 651-296-6300 • 800-657-3864www.pca.state.mn.us • wq-wwists4-31b • 6/4/14 Necessary or Lpcally Required Attachments K System/As-built drawing S Forms per local ordinance□ Soil boring logs □ other information (list): I 9/26/2015Inspector initials/Date:Property address: 30543 Lodge Loop Dent, MN 56528 (mm/dd/yyyy) 1. Impact on Public Health - Compliance component #1 of 5 Verification method(s): □ Searched for surface outlet □ Searched for seeping in yard/backup in home □ Excessive ponding in soil system/D-boxes □ Homeowner testimony (See Comments/Explanation) □ “Black soil” above soil dispersal system □ System requires “emergency” pumping □ Performed dye test □ Unable to verify (See Comments/Explanation) □ Other methods not listed (See Comments/Explanation) Compliance criteria: □ Yes ISlNoSystem discharges, sewage to the ground surface. _______■ □ Yes □ NoSystem discharges sewage to drain . tile or surface waters. □ Yes □ NoSystem causes sewage backup into dwelling or establishment. Any “yes ” answer above indicates the system is an imminent threat to public health and safety. ■ Comments/Explanation: 2.; Tank integrity - Compliance component #2 of 5 Compliance criteria:Verification method(s): □ Probed tank(s) bottom □ Examined construction records \ □ Examined Tank Integrity Form (Attach) □ Observed liquid level below operating depth □ Examined empty (pumped) tanks(s) □ Probed outside tank(s) for “black soil” □ Unable to verify (See Comments/Explanation) □ Other methods not listed (See Comments/Explanation) □ Yes □ NoSystem consists of a seepage pit, cesspool, drywell, or leaching pit. Seepage pits meeting 7080.2550 may be compliant if aliowed in iocal ordinance. □ Yes □ NoSewage tank(s) leak below their designed operating depth. . If yes, which sewage tank(s) leaks: Any “yes” answer above indicates the system is failing to protect groundwater. Comments/Explanation: camera 3. Other Compliance Conditions - Compliance component #3 of 5 ■: ia. Maintenance hole covers are damaged, cracked, unsecured; or appear to be structurally unsound. DYes* K No □ Unknown b. Other issues (e/ecfnca//?azands, etc.) to immediately and adversely impact public health or safety. DYes* ^ No □ Unknown *System is an imminent threat to public health and safety. Explain:i! c. System is non-protective of ground water for other conditions as determined by inspector. □ Yes* ^ No *System is failing to protect groundwater.'-r- TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 2 of 4 www.pca.state.rfin.us- • Wq-wwists4-31b • 6/4/14 651-296-6300 • 800-657-3864 i; Explain: Property address: 30543 Lodge Loop Dent, MN 56528 Inspector initials/Date:I 9/26/2015 (mm/dd/yyyy) A. Soil Separation - Compliance component #4 of 5 Date of installation:^ Unknown Verification method(s): Soil observation does not expire. Previous soil obsen/ations by two independent parties are sufficient, unless site conditions have been altered or local requirements differ. □ Conducted soil observation(s) (Attach boring logs) □ Two previous verifications (Attach boring logs) ^ Not applicable (Holding tank(s), no drainfleld) □ Unable to verify fSee Comments/Explanatlon) n Other (See Comments/Explanatlon) (mm/dd/yyyy) Shoreland/Wellhead protection/Food beverage lodging?□ Yes □ No Compliance criteria:____________ For systems built prior to April 1, 1996, and not located in Shoreland or Wellhead Protection Area or not sen/ing a food, beverage or lodging establishment: Drainfield has at least a two-foot vertical separation distance from periodically saturated soil or bedrock. □ Yes □ No □ Yes □ No Comments/Explanation: only checking tanks Non-performance systems built April 1, 1996, or later or for non-performance systems located in Shoreland or Wellhead Protection Areas or sen/ing a food, beverage, or lodging establishment: Drainfield has a three-foot vertical separation distance from periodically saturated soil or bedrock.* □ Yes □ No“Experimental’', “Other", or “Performance" systems built under pre-2008 Rules; Type IV or V systems built under 2008 Rules (7080. 2350 or 7080.2400 (Advanced Inspector License required) Drainfield meets the designed vertical separation distance from periodically saturated soil or bedrock. Indicate depths or elevations A. Bottom of distribution media B. Periodically saturated soil/bedrock C. System separation D. Required compliance separation* *May be reduced up to 15 percent if allowed by Local Ordinance.Any “no” answer above indicates the system is failing to protect groundwater. 5. Operating Permit and Nitrogen BMP* - Compliance component #5 of 5 Not applicable □ Yes □ No If “yes”, A below is required □ Yes □ No If “yes”, B below is required Is the system operated under an Operating Permit? Is the system required to employ a Nitrogen BMP? BMP = Best Management Practice(s) specified in the system design If the answer to both questions is “no”, this section does not need to be completed. Compliance criteria a. Operating Permit number;_____________________ Have the Operating Permit requirements been met? □ Yes □ No □ Yes □ Nob. Is the required nitrogen BMP in place and properly functioning? Any “no” answer indicates Noncompliance. Upgrade Requirements (Minn. Stat §115.55) An imminent threat to public health and safety (ITPHS) must be upgraded, replaced, or its use discontinued within ten months of receipt of this notice or within a shorter period if required by local ordinance. If the system is failing to protect 651-296-6300 • 800-657-3864 TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 3 of 4 www.pca.state.mn.us • wq-wwists4-31b • 6/4/14 ground water, the system must be upgraded, replaced, or its use discontinued within the time required by local ordinance. If an existing system ib not failing as defined in law, and has at least two feet of design soil separation, then the system need not be upgraded, repaired, replaced, or its use discontinued, notwithstanding any local ordinance that is more strict. This provision does not apply to systems in shoreland areas. Wellhead Protection Areas, or those used in connection with food, beverage, and lodging establishments as defined in law. TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 4 of 4 www.pca.state.mn.us • 651-296-6300 • 800-657-3864 wq-wwists4-31b • 6/4/14 & file memo & LAKE OR RIVER NAME & NO. PARCEL # ♦ ♦ * I * * I* * * * * * * * * * * * * ^ * i * * f t. * * * ^ *ate *7 |T<3| _______ L&R Official 6|(\ I^CCn Vction/Comments_^^______________ ...,. _____________ -Nl j gvYx HAJiua/- Qp>i>N|>UVUvac- IviyiLcnOiiyQ^ 7^ S<(( •ate L&R Official ction/Comments. )te L&R Official tion/Comments. 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.otter-tail.mn.us FILE MEMO FROM: BilIKalar DATE: June 9, 2009 Frank’s Lodge & Campground, Star Lake (56-385) Proposed Buckhom Campground, Non-Shoreland RE: From my review of the information received in May & June 2009, my calculations (June 1, 2009 and June 3, 2009), and the map received from the Otter Tail County GIS Department on June 4, 2009, I believe the following to be correct. 1. The aforementioned campgrounds are located on separate parcels. 2. Condition #1 (land area sufficient for 80 units) of Conditional Use Permit #6090 has been met. Since this is the case, previously requested Sewage System Permit for the proposed Buckhorn Campground may be issued. Department of LAIIIJk^D RESOURGE MANAGEMENT OTTER TAIL COUNTY Government Services Center - 54G West Fir FERGLE Fau_S, MN 56537 PH: 218-998-8095 Otter TAIL County’s Website: www:co.otter-tail.mn.us June 3, 2009 Frank's Lodge & Campground LLC 30570 Lodge Loop Dent, MN 56528-9227 Sewage Treatment System Servicing Tax Parcel Number 56000090057000 Described as N1/2 NW1/4, LOTS 4&5 EX Star Lake Beach..., Section 9 of Star Lake Township, Star Lake (56-385) As of 06/02/09, the sewage treatment system (Sewage Treatment Installation Permit #19665) servicing your property was deterrriined to be in compliance with the provisions of the Sanitation Code of Otter Taij County for ia Shower House. If you have any questions regarding this matter, please contact our office. RE: Sincerely, UUL^ Denise Gubrud Inspector i ) !! ; r *• «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.otter-tail.mn.us December 3, 2008 Barry Excavating Inc. 33545 County Highway 35 Dent, MN 56528 RE: Sewage Treatment System Permit (SP)#19665, Star Lake (56-385) Dear Barry Excavating Inc., Our records indicate that on May 30, 2008, SP#19665 was issued for the installation of a Sewage System on the John Frank/Frank's Lodge property at 30570 Lodge Loop. Our records also indicate that SP#19665 has expired and that the aforementioned installation has not occurred. If it is your intention to proceed with this installation, you must contact our office (218-998- 8095) on or before December 12, 2008 so that an extension of this permit can be arranged. Sincerely, Mavis Samuelson Permit Tech John Frank/Frank's Lodge 13980 Linda Vista Dr., Shasta Lake, CA 96089 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) APPLICATION MUST BE COMPLETE IN ORDER TO BE PROCESSED Permit No. RANGE TWP NAMESECTIONTWP NO.LAKE/RIVER CLASSLAKE/RIVER NAMELAKE NUMBER ixr E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROADPARCEL NUMBER (S) OF PROPERTY BEING SERVICED 9CO AJ. \^yr/s,, LEGAL DESCRIPTION Daytime Phone No.First Initial Mailing AddressLast Name ________ Property Owner ______________-_______ Contractor Lie.# THIS SPACE FOR OFFICE USE ONLY A.M. P.M.>• Ttiis System will be ready for inspection on , the year of at. A.M. P.M. L & R OfficialTime ReceivedDate Received SEWAGE TREATMENT SYSTEM DESIGN DATA - AS SHOWN ON DRAWINGTYPE OF INSTALLATION (CIRCLE ONE) TANK DRAINFIELD Cfoo Ft"dl^ Setback to nearest well Qtr/GoO GIs.Add-On/New System (20) Trench, Rock (21) Trench, Gravelless 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 OHWL (lake &/or river)Ft.Ft. 9/XArSetback to wetland Ft. Ft. Setback to dwelling Ft.Ft.Collector System (26) Trench, Rock (27) Trench, Gravelless (28) Trench, Chamber (29) Bed (30) Mound (31) At Grade /aSetback to non-dwelling Ft. Ft. Setback to nearest property line Ft.Ft./CO^Other (41) Tank, Holding (42) Outhouse (43) Sewer Line (44) Performance (45) Miscellaneous /m±_/QO'f— Ft.Setback to road right-of-way Ft. 3±lElevation above restrictive layer Ft.Ft. ALL DISTANCES ARE SHORTEST DISTANCE BETWEEN NEAREST POINTS.# Dl:DnoeMS^^sr^(^^l /oaOfiicA GARBAGE DISP. Y /C9 ABATEMENT Y DEPTH OF WATER WELL BSORPTION AREA FOR MOUNDS Ft^EFFLUENTDISTRIBUTION (S^Gravity ( ) Pressure HOLDING TANK MONITOR/ DISPOSAL CONTRACT ( )Yes ( ) No-L&R Can Not Process Designer Design^ 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 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: This permit is vaiid for a period of six (6) months. /3G*Date:Permit Fee $ Property Own^Ag^t foe. OwnerJnatui /yz 6^79Date:Rec. No.. Land & Resource Management Office Comments: I / Oau OForm No. BK — 0906-0 327,315 « Victor Lurtdesn Co.. Prirtters • Fergus Falls. Minnesota A / APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM- LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095) GOVERNNt^T SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 www.co.otter-tail.mn.usWHITE - Office YELLOW -L&R Inspector PINK - Owner / Contractor (after I / Permit No.APPLICATION MUST BE COMPLETE IN ORDER TO BE PROCESSED TWP NAMESECTIONTWP NO.RANGELAKE/RIVER CLASSLAKE NUMBER LAKE/RIVER NAME / £6-4/U9cx r E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLICfROADPARCEL NUMBER (S) OF PROPERTY BEING SERVICED / LEGAL DESCRIPTION Daytime Phon^Mailing AddressFirst InitialLast Name / 3 9tO Ur -_________tmtA.UP & V . - Property Owner Vtg- -t I tC _________ Contractor Lie.# 9^ ?o<:i THIS SPACE FOR OFFICE USE ONLY ■3-00 9 .. <S'00 ^> This System will be ready for inspection on , the year of (o y'-^ g>Time Received -----^ ’.M. Date Received & R Official SEWAGE TREATMENT SYSTEM DESIGN DATA - AS SHOWN ON DRAWINGTYPE OF INSTALLATION (CIRCLE ONE) TANK DRAINFIELD 900 Ft"Size^^^^ f^dy Setback to nearest well GIs.3lr/OoOAdd-On/New System (20) Trench, Rock (21) Trench, Gravelless 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.9cc>i- Setback to OFIWL (lake &/or river)Ft.Ft. 900^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 (31) At Grade Setback to non-dwelling Ft. Ft. Setback to nearest property line Ft.Ft./OO^Other (41) Tank, Holding (42) Outhouse (43) Sewer Line (44) Performance (45) Miscellaneous yrCG-h /aO-i- Ft.Setback to road right-of-way Ft. 2iiElevation above restrictive layer Ft.Ft. ALL DISTANCES ARE SHORTEST DISTANCE BETWEEN NEAREST POINTS.fr 6EQR00MS-^Wf>i /OOOj.)^DEPTH OF WATER WELL BSORPTION AREA FOR MOUNDS GARBAGE DISP. Y /Oik ABATEMENT Y Kn Ft^EFFLUENTDISTRIBUTION (x ) Gravity ( ) Pressure HOLDING TANK MONITOR/ DISPOSAL CONTRACT ( ) Yes ( ) No-L&R Can Not Process Designer Designer Lie. #____ PERCOLATION TEST DATA 9 '4^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 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: This permit is vaiid for a period of six (6) months. / /3g"°/i /ADate:4 Permit Fee $ signature Property Owrwf/Agent for Owner 4-' Date: y Land & Resource Management Office Rec. No.. Comments: — "—^/ U~r /C' c /94-- L u 4Form No. BK — 0906-003 327,315 • Victor Lundeen Co.. Printers * Fergus Felis, Minneso SEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTS Inspector must make all measurements HOLDING SEPTIC TANK DRAINFIELD OUTHOUSELIFT TANKCATEGORY XO^O GLS.Capacity 7 LfL^ FT2LGLS.FT2 \00'^ ftlOO'-h ftSetback from Nearest Well FT FT Setback from Buried Water Suction Pipe FT FT FT FT Setback from Buried Pipe Distributing Water Under Pressure 10 FT FT FT FT o?00''“ ft ftSetback from OHWL (lake &/or river)FT FT Setback from Setback from Wetland FT FT FT FT lOO'^ FTSetback from Dwelling FT FT FT ly N /Setback from Non-Dwelling FT FT FT FT I OO ^ FT^ FT[DOSetback from Nearest Property Line FT FT /OO'^ ftjpoSetback from Right-of-Way FT FT FT 3^Elevation above Restrictive Layer FT FT FT FT Holding Tank/Lift Alarm YES f'J ^Old System Pumped & Destroyed YES NO SEPTIC TANKfSf FILTER Sewer Line to Well Separation DRAINFIELD CALCULATION Actual Minimum# Tanks Installed □ YES ,FTX FTManuf. 77V10()/OOP yM .ft^FT FT20Model # lOUND CALCULATION MOUND /AT-GRADE. ROCK REDUCTION Inspector’s Comments:, -nuCR liiiiifthea with ' ^I ABSORBTION^REA inches */ of rock under pipe for reduction / equivalent to ft^ DF. .%X4 R2 SKETCH: /1\ o > vS5/t|s.) U'/ vi III'iVrvI "I ilL/ 2 fo jzLQ<:o n / r Initial / i & R Official - ^ /iF^'\Ppyv\ • Time the above described sewage system installation was found to be compliant with the provisions of the SanitationAs of MjMjq Code of Otter Tail County. ^ j’ Zand & Resource Management Officiali A f INDEX OF SHEETS SHEET No.DESCRIPTION 1EXISTING CONDITIONS 2GENERAL LAYOUT SOUTH ROAD PLAN AND PROFILE S4 NORTH ROAD PLAN AND PROFILE 7BOAT SLIP LAYOUT PROPOSED BATH HOUSE BUILDfrlG e I. lUS3 I (1affBwsDuCHARi'/iE I 300’O' GRAPHIC SCALEI, LEQEND APPROXttffATE PROPERTY BW CONTOUR LINE TIERBOUNOAfP 1000* SETBACK SHORELINE LOTUNE LOWLAND TREE LINE POWER POLE TELEPHONEP OVERHEAD PC BURIED TBH GRAVEL ROW TRAIL EXlSnNQOWt-t DOCK 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. Scale: ^.grid(s) equals feet, or inch(es) equals feet MPCA LICENSE #: LICENSE CATEGORY: DATE: DESIGNED BY: NAME: ADDRESS: — “To XFIRM SIGNATURE:( To S"WJUXc_ /N 4N I I a—D 3 % 6^ 'S D/^ uJAr^^ /Coo Per ^)cy -K. ^ftyO ^iCXp)Oi^ 0/^ l-ASf BK - 1003 - 029 315,904 • Victor Lundeen Co, Printers •. Fergus Falls. MN • 1-800-346-4870 T n r1TT i di11;!- H-f-I I.-L.r ■]”'1 i"I1IT..L SImEl DATAt WO R KSI^EETI.f ■ rri iJIl ']::a:r I! LAND iSl l^ESOURCE GOUN^ OFiOTTER TAIL GbVERN^ENt-SlR>i/teE§teENf^^^^^ 56537 www.cb.otter-tail mn u's ’ ' !(II..L... i...iiJ.Ii. -i it-!LT i■ !I•j....t-iri.i.i..IT OWMER: f biimiti:Sewage fTreatmehtiSystem Permit!#. ■■[ '-rti..hi-':' I -i '....f--4- ...I j ■I T ]['i m ! h l i..!s -i~-lJAST-NAME-^■i FIRST—. , , , ,■ ; i 4 ; i.i- h'- 1 1 -J—TELEPHONE-NUMBER—r -fi— |. . , I M , ^ i , . . . , I MIDDLE-—! !nf .. 1-.. I Ir I ■ , ' ' ADDRESS: | ! ' / ArJi. /A-l. Dr: V/.’ofe.' I:t57wd^7rt,i:j-ri.• i i ' -city^ -[ f IIf i- Al ii fi-'tiltrl ..j...I...^................I, A ; j. ...j, ..i....I I ■ i . L. l.i.j.\fwfO\ i I \rAnge\ \ Tf', ! ' '"dj::nSOIL{BORINd! lioG ! II [j_Ll!!f LAKE/RIVER NOJ^ iIegAl DESCRIPTIOM: pAr'cA^ni)i\1iber \ i 1 : | i - i EOAAddresAoriJirAtiofiAFromNearbsA ..^ ..Tt' ni'"i..........''T; 1..! ri'rr-t- f NUMBER GF BEDROOMS' i: .iiii:l. j iLi!::;:!:. :mxL GARBAGE piSROSAL:! [ YESwELLirtiAsiNb|pEti"H::^:^ L I■ lake-nAme, ■SEC:TWPANAME \ I 4d-?^IIIhF' :r t-i l-r!i.^ i..rl"i ;I I depth! (INCHES)- I ! I IpTEXjTURE.COLOR & i MUNSELL^NO. I . . STRUCTURED I Mi II i i . ■ i . tLg:M 4Mm X| UBLpckyX-i.--i i I PdATY M ‘ 1 I ' ! PRiSMATIC i !-4.T'"'J[ SH^-i W3-\tI i ;lIii, I , .,I: !i..L I ^....lOY^.:: fel'i: Iblogky! i i [- .Lj i I plIaty;! i_:i ; PRISMATIC I~tjnztffn^zrrM™r 1 md T'I1 ?-;T:r^i t L.!.J„ 1 } I BLGCKY L'j. J.I.piJaK' • iRRlSM^IC L i J J/HroKip I4- VA.t..h- SEWER LINE SEPARATIONi^^^ft. i '' : 1,... , , ------- <kT5>I JTiI -^-4 j_..(BLOGkYt: ' pbAT-Y— RRiSMATIC m/i. , |i[..T j i i..................................... FmpDPLA! Nt-r'Y E S-”i^'-rH'B LUFFiT-y E I . . . ! ' i \ jArTl~V-T~T)l- ■ I I i-ir i .yEGETATIGIN:" /^UATIG n^--j--p|-|.i.j.i ■ ±4'"t' T i ' rrSLOP&4T!-INSTALlLflJlbN!slTF i ’ ...4.4,4 T..L..[ I L ; [..4.4; j i ( ..,.._,.„il,.iH:rT !.:l.i..:rl.,.;..;;. h-u"..:|: i:..1.:...TK,.,i.„i....i..i.l, j.... >-JiYPE.OB.OBSER\ffli:iON:U-Prdbe.J.RitL<^rir^H-j-.i- :j' rJ W^^ENT MATERIALX|g butwasK ' Loess p Barack I i I ORIGINAL ISOIL:| j^g^ I No! - ' > -* ■' ^ r Ii m- : D ii I '1 t:t hf-ri ! BLOCKY1 LJ-!-%ItI.4,ppATY ■ iPRISMATIG, itNorijE M ■| I (1 !1'J M-I. I (I.i: i ' ;j Al(uyium j _j ji [ -r |Yes j|^I ■It j I compacted: SOIL ,....II , .!„! ;-:-yiTePThTS^P'^NG (ToX•;orrekrictivei^r)iit —"! —i ,.................!—i- 'I — ■ - • - t- - ■ ■! ; i '|- ! —r-" • !■ !—, TI , , „ . .d:rit4r'r|:,p|-4,,|d'''-p:r,,[,!4...r.“'': r I ^ TWO TESJS ARE'REQUIRED A\.drpd rPERC TEST-^2; i t-...| ...L ■ i PERC RATE i I I n f I i TIME i INTERVAL (MINUTESI WATER DEPTH I I WATER DROP i nmMftr P -rpER^-TEST f jl' ; i-fl.'i..tI •f1 TIME INTERVALMMINUTES) I WATER'DEPTH WATER DROP I 1 PERC RATE 1 H:.-i J- - J. f"T , r'Y'"p$FiMm.; ... •4 iTIME i ’ ! DROP i [ PERC. \LTIME! ‘i DROP t i PERC.i-.Li4.Spi'i I TIME \INTERVAL (MINUTES) 1 i WyER DEPTH f WATER DROP! I i PERC RATE! i TIME I INTERVAL (MINUTES)i WATER DEPTH!WATER DROP 1 I iPERC RATE IA^S:-'--4...iR^LL-----\--l [• !-rWill-4 -I II1: T-TIME!-- f DROP-i.....-r— PERC -j—4TIME t r DROP 1-.....I PERC....! ITIt-'!-4... MTIME J -INTERVAL (MINUTES)!' WATER-DEPTH 1 I. WATER DROP! 1 i PERC RATE i j l t l_ TIME t INTERVAL (MINUTES)I WATER DEPTHi r r^t -i 1 WATER DROP i ' I iPERC RATE I I- ^“j 4...! refill.......i ■■ it4-^C” i- "i- ;!. i.-l -E^l -I u ,1, .j._„.i-..,;.,.;...L.,1.. ,L..i ; kTIME t - h DROP ; - PERC -f V" TIME 4 -INTERVALMMINUTES)! F WATER DEPTH t-i -WATER DROP --PERCRATE4 .1-..-4 t ! TIME r-INTERVAL (MINUTES)4 WATER DEPTHf--I WATER DROP t j- ' - PERC RATE IItdLLJ _—L-;—L--;--.-.. : 1 i.t ^4 REFILL"';■I ;!'-MJ4X___ I ' I -j-' i ' ! = ■ ^ i iTIME I ' j DROP T ; PERC Iii4-J--irib4 ? > TIME! ‘i DROP r."T PERC T " 1TIME- r -INTERVAL(MINUTES)! I WATER DEPTH i -f JWATER DROPr- ^t 4 PERC RATE - I I t TIME-i- INTERVAL (MINUTES)t - WATER DEPTH!IWATERDROP i t r r-lPERC RATE-4- f .;....}. ..■ 'i' [4fill ; 4- -|I-=LLj:i I DROP I } PERC 1 I <TIME i ' I DROP i 1 PERC....................i'TTTIiI I TIME!4-1- ! TIME T INTERVALMMINUTES): I WATER'DEPTH I ^ WATER DROP T r PERC RATEI r t j TIME INTERVAL~(MINUTES) WATER DEPTHi ! WATER DROP ~ ! I f iPERC RATE '(I|-1.1 .1'“r'i-ri-yf-; I i...i.r r.L'ROTLL r [J1 ;■ ;■ ■■1 i DROP I I PERC t-1I -1-■r'""'r'T'T'V'ii iTIME I TIME DROP PERC t TIME ! INTERVALMMINUTES); WATER'DEPTH I WATER DROP! I PERC RATE: I i TIME INTERVAL (MINUTES)WATER DEPTHi I WATER DROP I I iPERC RATE I 1 ...j..[r^il!.- ^ - 41 ,.i..!.4 L i- j ...L, REFILL i ,1 ;i:I"L. ITIME -'t DROP.! 4 PERC ir-T'T—:t~ i aTIME j ‘ I. DROP I -l-PERCI !!•I TIME I INTERVALMMINUTES); 1 WATER DEPTH i WATER DROPl I, I ! PERC RATES : 1 1 TIME INTERVAL (MINUTES). WATER DEPTH-WATER DROP I IPERC RATE S Ljux!:.....^ i REFILL , .,11-: fL f 1.1-■=■ ■-4_L j I-- r PERC...-4 -F-DR0P4-I--PERC-I--•4TIME DROP 4TIME! L ! l-LGRWiTYJpjsT.' iPREsiuRF DISTliii.i : r-i- ' - I ' ■ i T : : 'I'l 4! |. .4.. f f..4 -•i.....: •*- j--'4 , " 1 -j i i- !' j-'l'- j...i 4"-....'f"|" [-■ i ~ 4RRbp6sEDlDEsiGNrr : 4..p-'Ti^T-r -T- i - r""TRENCH-.!^., r.[BEDTI LI i - ATGRADEv HOLDING TANK_ I SPECIFY:_____ MOUND,I di IX1 OUTHOUSEh ojRer■SEWER LINE.dT i "If ri' I i I i ; i fi i'd 1 ir r i i t \.I r r:l.i ■; i i' i d!'i" : d !'■ !; • i 1 i I I 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.ottertail.mn.us December 4, 2003 John M. Frank, Et Al Trustee 13980 Linda Vista Dr. Shasta Lake, CA 96089 RE;Sewage Treatment System Servicing Tax Parcel Number 56000090057000 & 56000090057001 Described as N1/2 NW1/4, Lots 4 & 5 (9.93 Ac) & N1/2 NW1/4, Lots 4 & 5 (91.26 Ac)..., Section 09 of Star Lake Township, Star Lake (56-385) As of November 21, 2003, the sewage treatment system (Sewage Treatment Installation Permit #16451) servicing your property was determined to be in compliance with the provisions of the Sanitation Code of Otter Tail County for 14 New Campsites. If you have any questions regarding this matter, please contact our office. Sincerely Wayne Roisum Inspector w APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM . LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095) 121 W. JUNIUS AVE. SUITE 130, FERGUS FALLS, MN 56537 www.co.otter-tail.mn.us WH/TE - Office YELLOW- L&R Inspector PINK - Owner / Contractor (after issue) APPLICATION MUST BE COMPLETE IN ORDER TO BE PROCESSED Permit No. TWPNO.RANGE TWP NAMESECTIONLAKE/RIVER NAME LAKE/RIVER CLASSLAKE NUMBER ^ I /..?5~ I »/ I 11 ADDRESS OR DfRECTIONS FROM NEAREST PUBLIC ROAD SOS'yO As PARCEL NUMBER (S) OF PROPERTY BEING SERVICED -Pop' E-91 LEGAL DESCRIPTION ^fTCL V Daytime Phone No.First Initial Mailing Address /Z. .^1 Last Name Property Owner /Contractor Lie.# THIS SPACE FOR OFFICE USE ONLY AM. .P.M.the year of> This System will be ready for inspection on .at. A.M. P.M. L&R OffictalTime ReceivedDate Received SEWAGE TREATMENT SYSTEM DESIGN DATA - AS SHOWN ON DRAWINGTYPE OF INSTALLATION (CIRCLE ONE) TANK DRAINFIELD Size GIs.Add-On/ 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 New System Trench, Rock Trench, Gravelless (22) Trench, Chamber (23) Bed (24) Mound (25) At Grade Setback to nearest well Ft. Setback to OHWL (lake &/or river)Ft. Ft.21 Setback to wetland Ft.Ft. Setback to dwelling /cS>Ft.-2o£ol lector System i2^Trench. Rock (27) Trench, Gravelless (28) Trench, Chamber (29) Bed (30) Mound (31) At Grade Setback to non-dwelling Ft.Ft./O Setback to nearest property line Ft. Ft.Other (41) Tank, Holding (42) Outhouse (43) Sewer Line (44) Performance (45) Miscellaneous Ft.Ft.Setback to road right-of-way 1Elevation above restrictive layer Ft.Ft. ALL DISTANCES ARE SHORTEST DISTANCE BETWEEN NEAREST POINTS. ABSORPTION AREA FOR MOUNDSDEPTH OF WATER WELL # BEDROOMS GARBAGE DISP. Y / N ABATEMENT Y / N .Ft^HOLDING TANK MONITOR/ DISPOSAL CONTRACT ( )Yes ( ) No-L&R Can Not Process EFFLUENT DISTRIBUTION (Gravity ( ) Pressure y 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. itior Owner 1^.Permit Fee $Date; Signature of Property Owner/Agent Office/6'7tPj-Date:Rec. No. Land & Resource Management RECEIVEDComments: OC-T 1 7 20Q3 LAND & RESOURCE Form No. BK — 0203-003 313,017 • Victor Lundoen Co.. Printer* • Fergu* Falls. Minnesota ~ *r • APPLICATION FOR PERMIT TO INSTALL SEWAGE TRE^ LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (21S^IW 121 W. JUNIUS AVE. SUITE 130, FERGUS FALLS, MN 5J5>53J- www.co.otter-tail.mn.us PM£NT SYSTEM WHITE -^Office YeLlOW - L&R Inspector PINK - Owner / Contractor (after issue) v\ M /APPLICATION MUST BE COMPLETE IN ORDER TO BE PROCESSED Permit No. SECTION TWP NO.RANGE TWP NAMELAKE/RIVER CLASS ■ LAKE/RIVER NAMELAKE NUMBER \ /ST \ y/ E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROADPARCEL NUMBER (S) OF PROPERTY BEI^ SERVICED ^ 0 S 70 /o ^r>a POkXj 6’HX) f 7 -1,0 °//:> k> b'ndciooo - ^JV2: /y cl ^(00^ - mV£ LEGAL DESCRIPTION byiDaytime Phone No.First Initial Mailing AddressLast Name ___________y /Z, 2Jol^to fVl. bhAl ’Jru^Jt'^ property Owner /Contractor Lie.# ZS2/> 'T 11 ^ /1" r - c 3''u-LI-O ■_________ TH/S SPACE FOR OFFICE USE ONLY /dT^ A.M. P.M., the year of>■ This System will be ready for inspection on jl -H- .at. Itcro&tJo A.M. P.M. L&R OfficialDate Received Time Received SEWAGE TREATMENT SYSTEM DESIGN DATA - AS SHOWN ON DRAWING^ TYPE OF INSTALLATIONI (CIRCLE ONE)TANK DRAINFIELD Ft'GIs.Size 9S'^c:>\ 5> ^ Add-On/New System Trench, Rock Trench, Gravelless (22) Trench, Chamber (23) Bed (24) jyiound (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.Setback to nearest well Ft. 251Setback to OHWL (lake &/or river)Ft. Ft. Setback to wetland Ft.Ft.5~o Setback to dwelling Ft. Ft.a a/C5>-Collector System<j2^jTrench, Rock (27) Trench, Gravelless (28) Trench, Chamber (29) Bed (30) Mound (31) At Grade Setback to non-dwelling Ft. Ft./O Setback to nearest property line Ft.Ft.Other (41) Tank, Holding (42) Outhouse (43) Sewer Line (44) Performance (45) Miscellaneous Setback to road right-of-way Ft.Ft. >Ft.Elevation above restrictive layer Ft. ALL DISTANCES ARE SHORTEST DISTANCE BETWEEN NEAREST POINTS.DEPTH OF WATER WELL # BEDROOMS GARBAGE DISP. Y / N ABATEMENT Y / N ABSORPTION AREA FOR MOUNDS Z)Ft^HOLDING TANK MONITOR/ DISPOSAL CONTRACT ( )Yes ( ) No-L&R Can Not Process EFFLUENT DISTRIBUTION (y) Gravity ( ) Pressure FTm fn Designer / /Designer Lie. # PERCOLATION TEST DATA Date of Test /O 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. (ftIS.Date:Permit Fee $ Signature of Property Owner/Agent for Owner //- OT-o 7 /sDate:Rec. No. Land & Resf^^t^eManagement Office d 4 NmJComments: c AForm No. BK — 0203-003 313.017 • Victor Lundeen Co., Printers • Fergus Falls, Minnesota SEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTS Inspector must make all measurements X^fTeld Oi^OUl>EHOLDING SEPTIC TANK DRLIFT TANKCATEGORY / PcrOf ft Capacity FT2GLS. FTFTt FTSetback from Nearest Well Setback from Buried Water Suction Pipe FTFT FTFT ^61 ftSetback from Buried Pipe Distributing Water Under Pressure ICii ft / D/ FT / t? FT pjJCfO^ ft f ftftSetback from OHWL (lake &/or river) ftftFTSetback from Setback from Wetland (T'd FTft.rot ^ ft FTSetback from Dwelling FT f- ft J FTSetback from Non-Dwelling FTFT ftSetback from Nearest Property Line FTFTSO f ftSetback from Right-of-Way FT FTElevation above Restrictive Layer FT FT Holding Tank/Lift Alarm NO YESOld System Pumped & Destroyed NO FILTERSEPTIC TANK DRAINHELD CALCULATIONSewer Line to Weil Separation 7f^~6MinimumActual Model ^ FTX□ YESManuf. Z. ^ t J y 7 ^ NO FT 20 MOUND CALCULATION MOUND /AT-GRADE ROCK REDUCTION Inspector’s Comments: ABSORBTION AREA inchesRock trenches with of rock under pipe for %Ft. X reduction / equivalent tc/ ^ V Stf(2 ft2 DF. SKETCH: 6. t>r/ 4- \ I \ 4^ if M!pfKJWO IW Initial/L & R OfficialDate jmo'>the above described sewage system installation was found to be compliant with the provisions of the SanitationAs of Code of Otter Tail County. /I ----trfnd Sl Resource Management Official RECEIVEDSITE DATA WORKSHEET m1*OCT 1 7 2003LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095) 121 W. JUNIUS AVE. SUITE 130, FERGUS FALLS, MN 56537 www.co.otter-tail.mn.us VLAtjQ S f^ESOURCE Sewage Treatment System Permit # OWNER: LAST NAME Z/ 2 K-1L TELEPHONE NUMBERMIDDLEFIRST ADDRESS: /)p CITY "lo T70 LccUjJi L(SOp STR/RT / 'STATE ZIP CODE TWP. NAMERANGETWPSEC.LAKE NAMELAKE/RIVER NO. SOIL BORING LOGLEGAL DESCRIPTION: COLOR & MUNSELL NO. DEPTH (INCHES)PtO.FLtH STRUCTURETEXTURE BLOCKY PLATY PRISMATIC NONE7PARCEL NUMBER ^70 LqcIq^ 7'^'ltl E-911 Address or Directions From Nearest Public Road Hood ^ jodf BLOCKY PLATY PRISMATIC NONE /BLOCKY PLATY PRISMATIC NONE NUMBER OF BEDROOMS C®GARBAGE DISPOSAL: YES WELL CASING DEPTH:BLOCKY PLATY PRISMATIC NONE L FLOODPLAIN: VES VEGETATION: AQUATIC BLOCKY PLATY PRISMATIC NONE %SLOPE AT INSTALLATION SITE: s>TYPE OF OBSERVATION: Probe Boring PARENT MATERIAL: Till ORIGINAL S0IL:^>»'^lg^ No Loess Bedrock Alluvium Date of Soil Boring. COMPACTED SOIL: Yes 7-LDEPTH OF BORING (To T or restrictive layer):.ft.Date of Perc Test PERC TEST #2PERC TEST #1 - TWO TESTS ARE REQUIRED - PERC RATEWATEf^EPTH WATER DROPINTERVAL (MINUTES)PERC RATE TIMEWAT^DEPTH WATER DROPINTERVAL (MINUTES)TIME ./;L Time drop perc TIME DROP PERC START/-4.Ta..MZJn... PERC RATEWATER DROPINTERVAL (MINUTES)WATER DEPTHTIMEWATER DROP PERC RATEWATER DEPTHINTERVAL (MINUTES)TIME i.REFILLREFIU ....lA__^e> - ...........J.Q.......PERCTIMEDROP PERC RATEWATER DEPTH WATER DROPINTERVAL (MINUTES)TIMEPERC RATEWATE^ DEPTH WATER DROPINTERVAL (MINUTES)TIME REFIUiL.:.REFIU ....Is3a PERCTIMEDROPPERCTIMEDROP PERC RATEWATER DROPINTERVAL (MINUTES)WATER DEPTHTIMEWATER DROP PERC RATEINTERVAL (MINUTES)WATER DEPTHTIME REFIUREFIU DROP PERCTIMEPERCTIMEDROP WATER DEPTH WATER DROP PERC RATEINTERVAL (MINUTESIPERC RATE TIMEWATER DROPINTERVAL (MINUTES)WATER DEPTHTIME REFIU ,REFILL PERCTIMEDROPTIMEDROPPERC«•PERC RATEINTERVAL ^MINUTES) ' REFIU ... WATER DEPTH WATER DROPWATER DROP PERC RATE TIMEINTERVAL (MINUTES) WATER DEPTHTIME REFIU PERCTIMEDROPTIMEDROPPERC PERC RATEWATER DEPTH WATER DROPTIMEINTERVAL (MINUTES)PERC RATEWATER DEPTH WATER DROPINTERVAL (MINUTES)TIME REFIUREFIU DROP PERCTIF«PERCTIMEDROP PERC RATEWATER DEPTH WATER DROPINTERVAL (MINUTES)TIMEWATER DROP PERC RATEINTERVAL (MINUTES)WATER DEPTHTIME REFIUREFIU PERCTIMEDROPPERCTIMEDROP PROPOSED DESIGN: PRESSURE DIST..GRAVITY DIST..HOLDING TANKATGRADE.MOUND.TRENCH.BED. SPECIFY:.OTHER.OUTHOUSE.SEWER LINE. — SYSTEM DESIGN ON BACK — f System design must be to scale and must include the proposed location of the sewage system, all existing/pr^osed 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. I lo.grid(s) equals jnch(es) equalsScale:feet, or feet SIGNATURE: _ DATE: MPCA LICENSE #: LICENSE CATEGORY: /) SUBMITTED BY: FIRM NAME:Tom1iBicfcho»Sivice 4S638 County Hwy 35 Verpas, MN 56587 S — ADDRESS: /s[■ \ /i I ; , 1 I '-II T t I‘ I A1 i\1 ;;4 I »;--i4 /i’1 t-t-T /7 H -\ r-(•i(I >Jr -I IT liL -4 : 5’ 1 1 \-H-i-r r if fI r ' 1 :V'■'T • r- X1i•H 't I- t/) VP4t4 4 * 1 ,n i :^-i [ P: 1: I i -TT li.i i ii BK - 0203 - 029 313,016 * Victor Lund««n Co.. Printors • Pergu* Pall*. MN • 1 •600-340'4870 -t ■ f --t' : ; - r :; CERTIFICATE OF COMPLIANCE SEWAGE SYSTEM Mt ft I 1 15th day nf JanuoAijThis certificate has been issued this to certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota.'1 ,1 The premises covered by this certificate are legally described as: Lake No.l^llAL Twp. Name. Stoh. Lake,9 Twp. 135 Range 41Sec. Wm FA.ank’-6 Lodge.G. L. 4 S 5 pt oi ME i Sllil i i; ;l John S. EnankOwner:Name. Vznt, Hinne^otaAddress. 5652SZip No. J 6790Permit No. SP_ ^Lee,^Shoreland Administrator,1 Signed by:.A Otter Tail County, Minnesota MKL-087 1-009 mm 159035 k««Mfa 4 CO. MiMTcaa. rcaouo nai. «ih : 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 4 mitB — Office Yellow — ^hspecfor Pink — Owner L190f~rcuJc Permit No.IfLEGAL A caJ k,/DESCRIPTION AND 2-STeir La. >fg-5G-^H£' STcxy-LOCATION TWP NameTWP RangeLake Classif.Sec.Lake NameLake No. IDENTIFICATION: Please Print All Information. Mailing Address — No. Street, City and State Zip No.Tel. No.InitialFirstLast Name ToOWNER Or cloSEWAGE SYSTEM INSTALLER IsName, This System will be ready for inspection on., 19. This space for office use only 19 .M Owner or Agent SignatureDate Rec'd Phone Cal) Rec'd ByTime Rec'd ) /qAqco&^ (\C)US^ ~NUMBER OF BEDROOMS;ESTIMATED COST; SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD /^OO Sq. FAGIs.Sq. Ft.Capacity D 3D//d<^Ft.Ft. Ft.Distance from nearest well 3Z)Ft.Ft. Ft.Distance from lake or stream ^ nFt.Ft.Ft.Distance from occupied building ZADistance from property line Ft.Ft. Ft.ZA 7 c5Ft. 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 fA By ^^..fj^19 ..KA,./..APERCOLATION TEST DATA; 7Z(tY\Sc5r—^ Date of First Test Rate / 6Date of Second Test 19 , Rate 1st Test Taken By /6 ^ O /cFirst 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^ob is ready for inspection.^ ^ S'-'i-Kp Signature/^Dated Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six (6) months. Shor^and Managem^n'K ~ Issued Date: Officeoo^0-Fee $Rec # Comments: Form No. MKL-032085 225239 — Vctor Lundeen Co.. Printers, Fergus FaDs. MN I% r-C.'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 — Ojfntt Yellow — mspector Pink — Owner Permit No.,I r„rci t..^c sLEGAL flDESCRIPTION4//rAND LOCATION TWP NameRangeSec.TWPLake Claasif.Lake NameLake No, IDENTIFICATION: Please Print All Information. Zip No.Tel. No.Mailing Address — No. Street, City and StateInitialFirstLast Name OWNER SEWAGE SYSTEM INSTALLER Name. .. .hThis System will be ready for inspection on. This space for office use only \y f-.oo Pt>one ( J9 .M Owner or Agent SignatureCall Rec'd ByDate Rec'd Time Rec'd ALa ANUMBER OF BEDROOMS:ESTIMATED COST; SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD GIs.Sq. Ft.Sq. Ft.Capacity Ft.Ft.Ft.Dists^ce from nearest well Distbi.ce from lake or stream Ft.Ft.Ft. Ft.Ft.Ft.Distance from occupied buildinq Ft.Ft.Distance from property line 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.......... ■ ..y By PERCOLATION TEST DATA:19Date of First Test Rate 1 Date of Second Test . 19 „ Rate 1ft Teit 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. Dated 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. Issued Date; Shorelend Menegement Office Fee $Rec # QF-PComments: Form No. MKL-032085 225239 — Vlclor Lundm Co.. PrMwi, Forgui fm, IM w T-wmr^ i I rJiA? fli^: s'.,- =»o ■ ^■.A'S'.>— ;;4S:vi:l''AA. A .A-lftCA-; 1€. ,SMU;: !'Tt4\iP^ : ■ . .i \/ ■ 'A'SV? ,<‘A--. ■ il.v i .1■* ..Aifv ^^sA V-A r- . .: •- •rsr-. INSPECTION RESULTS 'ApVi.: AInspector must make all measurements ■ :.y SEWAGE DISPOSAL SYSTEM STATISTICS SEPTIC TANK SEEPAGE PIT DRAIN FIELD VCATEGORYShould Be Should Be Should BeActual Actual Actual +-ijco0A /Jon l2kCapacityGIs.GIs.S F S F S F S F Distance from Nearest Well F F F F F F 4 iDistance from Lake or Stream SO F F F F F F tDistance from Occupied Building F F F F F F /Ot' F4-JADistance from Property Line FFFFF f3 3Distance from Bottom to Water Table F F F F F F «V\i, //-yyr*/Inspector’s Comments:^4-0^ DF C(aHc—(0— I "Sil;ii {KDate of Inspection^19 IVJO Al MTime of Inspection Signature of Inspector INTERPRETATION OF ABBREVIATIONS GIs = Gallons SF = Square Feet F = Linear Feet Job Title iOiT:)'- MKL • 032085 • Backer Agency ■-.isG ' ,v!!q > ! i 'bMi n< .:hi)oci, , «’V-i -TC' V'vn'f^i:1»r.j»||fT■'f 'i - ' b&t! '0i' \'Ai . I Jf 16 +-t'-‘ - ' i Scale: Each grid equals GRID PLOT PLAN SKETCHING FORMfeet/inches 19Dated;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. -C W NCl r ~ CO p -Sj i . 21598 7®MKL-0871-029 VICTOR LUNOCEN CO . RRINTCRS, FCRCU9 TAllS. yiMH.i ■ :e.215S02@ VICTOR LURDCEN CO.. PRINTCRB. FERGUS FALtS. PERCOLATION TEST DATAMKL -0871 -028 ILAND AND RESOURCE MANAGEMENTOtter Tail County -' Fergus Falls, Minnesota 56537 Mailing Address: V- /*Ph. No./,>wner: AW UlccTt NAME SEC. ' 3 Zip N6.StateMiddle.CitySt. &. No.FirstLast Name Legal Description; '' TWP NAMERANGEITWP.LAKE OR RIVER NO. 3> ^30 S TEST HOLE NO. 2TEST HOLE NO. 1 >3“3^inchesDepth to Bottom of Hole inches; Diameter of HoleDepth To Bottom of Hole,inches; Diameter of Hole inches Depth. Inches Soil Texture Soil TextureDepth. Inches Date 19_____>ate /^c/cPercolation, Test By____ Percolation Test By .••• (gy— i£:C01^----IV __________ FirmName.Firm Name. Ooicc LU Address.CC Address < CO Otter Tail County License No.Otter Tail County License No.,h-coUJMeasure­ ment, inches Percolation rate minutes per inch Drop in water level, inches Percolation rate minutes per inch I-Time Interval, minutes Measure­ ment inches Drop in water level, inches Time I ntervals minutes Remarks:Remarks:Time Timeo 33 •7.'/V 7 7 ':z,9 , I-A6n'.h^ 71.0- -J-32 7'^7 I I ^ zzs/o r'2-5 z/o ^ •'7 2^^ ' 3 __s /fr 117577/?9ri2-Cp /^9s:2- 9'fp ■•7.'cfq 1 ..x.'.'TX—r (ZO to_5:__2.1 Vz 'A Z3l $7 ...See Booklet, "How:,to Run a Percolation Test" by Agriculture Ext. Service,s Un.;Of;'Mf^.zoPercolation rate minutes per inchminutes per inch Percolation rate = V-, A, ------------- « o J \ 'T- V ! . ■*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 Y9II0W— im'^ctor Ptnfc' — Cord —Owner /- Pernilt pjo. LEGAL DESCRIPTION AND L^kc°^ P ^ TJsLOCATION Lake No. TWP NameLake Name Lake Classif.Sec.TWP Range IDENTIFICATION: Please Print All Information. Zip No.Tel. No.Last Name First Initial Mailling Address —No, Street, City and State rr^y7 r TTd n n ~S j- ^OWNER YY\o\Vz.o^Vv O /XV>vA-«-rSEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection on.., 19. This space for office use only 19 .M Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signature ~h VdNUMBER OF BEDROESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD ^ Sq. Ft.Capacity Sq. Ft. ^0 /100GOFt.Ft. Ft.Distance from nearest well Go £0Ft.Distance from lake or stream Ft.Ft. W-Ft.Distance from occupied building Ft. Ft. LO 10Distance from property line Ft.Ft.Ft. 3Ft.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 , 19 , Rate IlO...rDate of Second Tester 19 , Rate 1st Test Taken By /- ..Ill2 n - *7' / //a;?.l 3,0First Test -I- 2nd Test Rate2nd Test Taken By Agreement: 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. The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in Permission is hereby granted to the above named applicant to perform the work oescribed in the above statement. This permit is granted upon express 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. Issued Date: Shoreland Management Office Oia.ooFee $ hrcp^ /'g tpfns^ UrComments:. Form No. MKL-0771-003 [^VtfW »Am( LAKE MSNNESOTA ■ upK-*. ■ ~a: .■ •V pr ** *>' 'A.rT 'j •■ - T j :^r •I % INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS \.i SEEPAGE PIT DRAIN FIELDSEPTIC TANKCATEGORY Should beActualShould be Should be ActualActual Capacity SFSFGIs.GIs.S F SF \5075Distance from Nearest Well F F F F F F Distance from Lake or Stream F F F FF F 202010Distance from Occupied Building FF F F F F 10 1010Distance from Property Line F F FFFF 33Distance from Bottom to Water Table F FF F F F Inspector's Comments: O j>' i i - / ■Date of Inspection .19____ o .?- v\-- i-IVi'.i .e-r--’.r-v; ^Time of Inspection.'J.M >Signature of Inspector\INTERPRETATION OF ABBREVIATIONS Git “ Gallons SF ■ Square Feet ■ Linear Feet :• Job Title r :F ■ ;* .'’hi AgencyMKL-0771-003-Backer j- ';r t' • - z-..-■ s - . i• *•„ - r>':j • ^. -t kt- J: ' t t A Av ' ‘'•'*5 ..f mK. '1 % r ti'ti. »’ -V ■■ .. .eT ■■v;j-J■ f i ...s; 4 i. •-1'3 • '!>■V ;uA ... - — Vn.[v - * -ft.;- - r^'k ..>.1^-te -f .h 9". . iw ■■ •it,' -•’l*' -•. rii 1 Cj>^orc^ 0 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 YeHow -*■ trsp0Cfor Pink — Card — O^er oJ'/- k'Z'f ''C Permit No.. ^ 'S'i)f -hie S(/JLEGAL / DESCRIPTION AND uA I?LOCATION /Lake No.Lake Name Lake Ciatsif.Sec.TWP Range TWP Name IDENTIFICATION: Please Print All Information. Zip No.Tel. No.Mailling Address —No. Street, City and StateLast Name First Initial OWNER / SEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection on... 19. This space for office use only \19 .M Date Rec'd ^ Owner or Agent SignatureTime Rec'd Phone Call Rec'd By NUMBER OF BEDROOMS;f-ESTI MATED COST:-V. SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD ^-OGQGIs. / ' t Sq. Ft.Sq. Ft.Capacity CO , Ft./ ^ Ft.Ft.Distance from nearest well Ft.Ft.Ft.Distance from lake or stream Ft.Ft.Ft.Distance from occupied building 1CDistance from property line Ft.Ft.Ft. .3Ft.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 ,JV1 By kCPERCOLATION TEST DATA:Date of First Test 19 > Rate / >< / h/i2j.n.Date of Second Test 19 Rate / n 1st Test Taken By y 1 *7 ' • '> ^ I ..r- - // /'/First Test + 2nd Test 7 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. Dated. Signature Permit; Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE; Permit void if work is not commenced within six (6) months. CupVy1.■ ^21Issued Date; Shoreland Managenrtent Office /<scFee $ V -■7 . - Ik CoI<^:yfI-p/ ra e e/ f'lComryents:. « Form No. MK1^0771*003 ^ iV iSivtiw tAmi i*ki. minnisota ■ W ' tI 1 * » i \ • INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORYActualShould be Actual Should beActualShould be Capacity GIs.S FGIs.S F S F S F 50Distance from Nearest Well 75FF F F FF Distance from Lake or Stream F F F F FF 20 2010Distance from Occupied Building F F FF F F 10 1010Distance from Property Line F F F F F F 33Distance from Bottom to Water Table F F F F F F i looo^ /icrAr ^’''■1^ D.4 [io - ,oL ■ J^aA Inspector's Comments; /urzX’ AjuS. (Try /lyl^rpjJ^ ^ IQQ ^ ^ MjtA Jl^ ^2 _______________ ;1 /It ^'-lo .,9ATDate of Inspection 1:32>Time of Inspection, Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs ■ Gallons SF ■ Square Feet F - Linear Feet Job Title AgencyMKL-0771*003-Backer f p •/ INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORY Actual Should ba Actual Should ba Actual Should ba■r F krE±. mlm)Capacity • yGit.Gli.S F SF S F nt IO)-tDistance from Nearest Well 75 50FFF F 7 SODistance from Lake or Stream F f F F ' 20Z5 P/2010Distance from Occupied Building F F F F \!X FDistance from Property Line 10 \10 10/F F F F F 201■ / 3Distance from Bottom to Water Table /.3FFF F F Inspector's Comments: T~^/4 hcjf Oh frf , (p€e>triGi§ !< rih /i £LfCtLk N It 19.5CdimDate of Inspection. Ull£3-MTime of Inspection. StgnatJr* of liApactorINTERPRETATION OF ABBREVIATIONS Git ~ Gallont SF " Squara Faat F *■ LInaar Faat Job Title Agency MKL-0771-003-Backer \ \ . A.A ,S& ^ 1 (Dr-Qjt! If ^ S>-. //^_^>JjOC£^ -Jisi L b'T- I.. rJcOcf) £S.C; J_(/c//u cf D h-co S'O cf / ^0 ^u<ef-.c^ ^ -IT^-^^‘■v-^^y;3^lXsL^ _ ^Oc:> If^/Ao^ <^>!0)■g'^ 5, .Zs:;::-^ 1 / /■fj\ 3(6^^ f 1^ _____________r\ \ s:-x~^s PbX) 215502® VICTOR LUNOEtN CO^. PRINTCRO. PER6U9 FALLS. MINN.PERCOLATION TEST DATAMKL -0871 -028 LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, Minnesota 56537 Ph. No. Mailing Address:Owner: ^ Last Name Zip No.a. /sr & No.5:ivfiddle NAME City State ^TWP NAME First hLegal Description:Ul- TWP.RANGESEC.LAKE OR RIVER NO. TEST HOLE NO. 2TEST HOLE NO. 1 <r 2Jl2JlDepth to Bottom of Hole inches; Diameter of Hole JnchesDepth To Bottom of Hole,inches: Diameter of Hole inches Depth, Inches Soil Texture Depth, Inches Soil TextureDate Date Percolation Test By____ Percolation Test Bv ^:is2L 2Q 2rLUFirm Name. Firm Name,QC DOLUQC LU Address.QC Address < CO Otter Tail County License No..Otter Tail County License No..COLUMeasure­ ment,inches Time Intervals minutes Drop in water level, inches Percolation rate minutes per inch Percolation rate minutes per inch Time Interval, minutes Measure­ ment inches Drop in water level, inches Remarks:Remarks:Time Timeo H7 7 ' 4^ /Zf ^5 Z7ZI±r \‘y/H /o 1£1 Z2L lA yLtJa2^/o"Il2U-i /*2 I z z/o /oA H _____ //K-I *T i \ 1 ±An/ ±/ h n See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of *' Percolation rate = 2Per col ati o n, rat*minutes per inchminutes per inch r iSHORELAND MANAGEMENT - COUNTY OF^OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 - Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM W te — Office V low'^ Insp^torA Pli.^ — Owniiir ' W Card —^Ov^er - cSx S'^ ^CO'Xf S2SC-Z-Permit No. LEGAL Date DESCRIPTION AND Lake No. P ^ /3S~ >4?XigLOCATION Lake Classif.Sec.TWP Range TWP NameLake Name IDENTIFICATION: Please Print All Information. Zip No.Tel. No.Initial Mailling Address —No. Street, City and StateFirstLast Name OWNER SEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection on., 19. This space for office use only .19 .M Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signaiture '/NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD Sq. Ft.GIs.Sq.yft.Capacity O Ft.OFt.Ft.Distance from nearest well 1<0 <0 Ft.Ft.Distance from lake or stream Ft. Ft.Ft.Distance from occupied building Ft. (O /ODistance from property line Ft.Ft.Ft. i=LFt.Distance from bottom to Water Table Ft.Ft. AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on 19.....................M By ...... 19.... ;........ PERCOLATION TEST DATA: Date of First Test Rate Date of Second Test , Rate 1st Test TaWn By First Test + 2nd Test 2 Rate2nd Test Taken By The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work inAgreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn­ esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi­ cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. (Call or use attached mailer notice.) Dated. Signature Permit:Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six (6) months. Issued Date: Shoreland Management Office Fee $Surcharge $ B(TSS K /COComments:,7 Form No. MKL-0771-003 vicTon LuxeccM t CO . eaiHTEKt. rtutus fm-lo. hi«n.158906 r 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 4 ♦ W te -* Off^e V low —'Inspector ^ Owner , Card — O^ner A'Permit No.. LEGAL Dale./a ''-■t /DESCRIPTION ! AND LOCATION TWP NameLake Name Lake Classif.Sec.TWP RangeLake No. IDENTIFICATION: Please Print All Information. Tel. No.Zip No.Mailling Address —No. Street, City and StateFirstInitialLast Name OWNER SEWAGE SYSTEM INSTALLER Name This System will be ready for inspection , 19.on.4. This space for office use only 19 Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signa;ture NUMBER OF BEDROOMS;ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD GIs.Sq. Ft.Sq. Ft.Capacity Ft.Ft.Ft.Distance from nearest well Ft.Ft.Ft.Distance from lake or stream Ft.Ft.Distance from occupied building Ft. Distance from property line Ft.Ft.Ft. Ft.Ft.Distance from bottom to Water Table 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 ., 19 ......Rate .f. Date of Second Test 19 Rate 1st Test Taken By First Test -I- 2nd Test 2 Rate2nd Test Taken By The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work inAgreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn­ esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi­ cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. (Call or use attached mailer notice.) Dated. Signature Permit:Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. ^ NOTE: Permit void if work is not commenced within six (6) months. Issued Date: Shoreland Management Office Fee $O.Surcharge $< ' ' 'O . < ,Comments:. V ■r7'X -fForm No. MKL-0771-003 wicroa LuHPCCH a ee.. aeiMTiaa. pcasut r«^t.a. Miaa 158906 ♦.' «• *INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PIT DRAIN FIELDSEPTIC TANKCATEGORY Should beActualShould be Actual Should be Actual Capacity GIs.S F S FGIs.S F S F Distance from Nearest Well 5075FFFFF F Distance from Lake or Stream F F F F F F 20Distance from Occupied Building 10 20 FFF F F F Distance from Property Line 10 10 10F F F FF F 4 4Distance from Bottom to Water Table F F F F F F Inspector's Comments: Date of Inspection 19___ Time of Inspection,M Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs » Gallons SF ■ Square Feet F ■ Linear Feet Job Title • ;■Agency MKL-0771-003> Backer i ■ i 3 PERCOLATION TEST DATA SHORELAND MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Ph. No.Owner:Mailing Address: Last Name Middle St. & No.City Zip No.State Legal Description: LAKE OR RIVER NO.SEC.NAME TWP.RANGE TWP NAME TEST HOLE NO. 2TEST HOLE NO. 1 43 6 Depth to Bottom of Hole inches; Diameter of Hole.Depth To Bottom of Hole.inchesinches; Diameter of Hole inches Depth, Inches Depth, Inches SoihTexture TV'— Date.Date7^142.> Percolati } Test Bv_LLO /LUFirmName.QC FirmName.DaLU OC 1J LUAddress.QC Address </ toOtter Tail County License No..Otter Tail County License No..H LU Drop In Water Level. ItKhes Measurement, Inches Drop In Water Level. Inches I-Measurement, inchesTimeRemarksTime Remarks O J0>3~/o /y /5I-7-^/ 0^/d 'sx 3J £> IS-! IAAuj6J_s2L lLIMI/ ^!r. OH 4ll•i 73$n':t ?jr> 0^f llJ-n:i fu: !^yjk $367 jj ^ ‘ yiX-pU. • 183818. ® •/"MKL-0871-028 See Bookiet/'How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn, L /O’exit A , USiS )'2_C>o ol3 i i ! t ^ k. PERCOLATION TEST DATA SHORELAND MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Ph. No.Owner:Mailing Address: Last Name Middle St. & No.City State Zip No.Legal Description: LAKE OR RIVER NO.SEC.NAME TWP.RANGE TWP NAME TEST HOLE NO. 2TEST HOLE NO. 1 6.d 63 0 oDepth to Bottom of HoleDepth To Bottom of Hole.inches; Diameter of Hole.inches; Diameter of Hole Jnchesinches T?Depth, Inches Soil ^^exture Depth, Inches Texture Date 19____ Percolation /Test By___ Name rcolation St Bv .£‘j iS-U-c oLUFirm Name QC DoLLI oc LUAddress.QC Address < (/)Otter Tail County License No..Otter Tail County License No..Hifi liJMeasurement, Inches Drop In Water ■Levi, toches Drop In Water Level. Inches K Measurement, ____InchesTimeRemarksTime Remarks 3o//133 115y-IjIAlUltLk // ry 3 3 //;//f .Vv^ //sTJ' lA LAIS-LLAl //'/X4 iAl UAIP//-OT /9:o ^I-3IAAl /p ' rb/P ^ f ^■•ut rM.Lt. Nil u? •183818 ®MKL-0871-028 viCTtt LuMtCtH I M rmaTitt See Booklet/'How to Run a Percolation Test” by Agriculture Ext. Service, Un. of Minn. *t . • tD /OOC) V s/res /J^/OO cd(24(Di^ X I.Z3Tu •SOO s1