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Jacob's Cove_37000290155001_Septic System Permits_
OTTER TAIL COUNTY LAND & RESOURCE MANAGEMENT PUBLIC WORKS DIVISION VWWV CO OTTER-TAIL MN US^nfRTflil GOVERNMENT SERVICES CENTER 540 WEST FIR AVENUE FERGUS FALLS, MN 56537 218-998-8095 FAX: 218-998-8112 8/29/2016 Robert W & Kimberly Jacobson 1981 58th AveS Fargo ND 58104 7216 RE: Primary Owner: Robert W & Kimberly Jacobson Sewage Treatment System Servicing Tax Parcel Number: 37000290154001 Sec 29 Sect-29 Twp-136 Range-042 PT LOT 3: BEG 198’ W & 445.8’ SLY OF NE COR S 40’ E 145.8’ N Described as:Twp Lida Township Lake: 56-747 Lida As of 08/29/2016 the new tanks and drainfields (Sewage Treatment Installation Permit # 24228 servicing your property was determined to be in compliance with the provisions of the Sanitation Code of Otter Tail County for a 11 bedroom home. Please be advised that this certification is only valid for five years from the date of this inspection 8/29/2021 If you have any questions regarding this matter, please contact our office. Sincerely, Alexander Kvidt Inspector /V 4< J1 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 OTTCR Tflll WHITE - Office YELLOW -L&R Inspector PINK - Owner/ Contractor (after issue)coiiaTT-BitiatiOTa APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED Permit No. LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS 6^0 o4x i.'da E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROAD 3^CX)b D 3 4 A/'Bs. LEGAL DESCRIPTION ^ Q()C ^ ^■^'i~ ^ £ o!^ S'u£ SECTION TWP NO.RANGE TWP NAME L(dQ PARCEL NUMBER (S) OF PROPERTY BEING SERVICED I u/ Last Name First Initial Mailing Address Daytime Phone No. TXt- //W7£ _______________/<7/n h tf,/ iQ - ^euw)fo's Ccy^ ~AJT) ____________________KrV\ ^ *7^/' Property Owner SYt- /A- HiJ __________ ✓lU,Contractor Lie.# THIS SPACE FOR OFFICE USE ONLY A.M. ► This System will be ready for inspection on , the year of P.M.at. A.M. P.M. Date Received Time Received L&R Official NSTALLATION (circle one)TYPE OF SEWAGE TREATMENT SYSTEM DESIGN DATA AS SHOWN ON DRAWINGResidentialCollectorOther Est. (A} blew —((B) Roplacemortt^ 1^ lo) Aoa on New (E) Repiacement (F) Add on (GXJto;pH) Repiacement ( Aoa on Soil Treatment Area Tank LiftDesign Flow (Gallons/Day) (C) 2.0UU ^^^^999 (M) 5,000 — 10,000 Effluent Distribution ( ) Gravity (>TPressure Size Setback To Nearest Well SsrType I Type II Ft.Ft. ^^0)TeiitJM, Rook"3 (27) Rapidly Permeable 2 00 Ft-XOO Ft-XJO %Setback To OHWL(21) Trench, Gravelless (28) Rood Plain (22) Trench, Chamber (29) Privies Ft.Ft. Ft.Setback To Bluffj(23)Se«Hj (30) Holding Tank (Contract Required)(24) Mound 9b 5TFt.Ft.Ft.Setback To Dwelling Type III -V (31) Other/Problem Soils/<12“Soifc7 (25) At Grade t Setback To Non-Dwelling im iSX Ft.(26) Greywater isofyFt. Type IV(34) Tank Only Setback To Nearest Lot Line LL Ft.Ft.//(32) Public Domain & Proprietary Technologies(35) Other Depth of Well Setback To RoadRight-Of-Way /r 3oFt.Ft.Etr^Type V Total # Bedrooms ! I v Abatement 7^/' N 7 /(33) Performance Elevation Above Restrictive Layer Ft.Ft.nicpncal V /Gar^gsjj >nc9*-9.PERC TEST DATA Designer Agreement: The undersigned hereby makes application for permit to install, alter, repair oo^idpr^d S^age 4‘r^attnent ^stem herein specified, agreeing to do all such work in strict accor dance with Sanitation Code of Otter Tail County, Minnesota. Applicant agrees that the Sib^^m^Wprl^eet 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 sysreMherae^ypieilniilwUile 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 isreSdy 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. License #Date of Test Highest Rate NOTE: 1. This permit is valid for a period of six (^ months. 2. This iit does not include the building sewer (sewer line). 'ZdK»-'V7 Date;Permit Fee $ “F j^j^orf^ure^Y^operty^wtier/^SentTor Owner T / Land & Resource Management Official Date:Rec. No.. "^c^L^§ ir OTf. ^3^000 O /S^^OOX ^ Aj€eJ To Hemcdpe r^/<4l O ^ He/i<r.e i,\j/Hr li^ltOT M(l 357,243 • Victor Lufideen Co., Printers • Fergus Falls, Minnesota L&R IflitiBl Dale Stamp Form No. BK — 04-2014-06 :3?▲APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM e tLAND & RESOURCE MANAGEMENT GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 ,1 218-998-8095 ^{?U!l(/> www.co.otter-tail.mn.us ^ I i 1 OTTER Tflil WHITE - Office YELLOW -L&R Inspector PINK - Owner / Contractor (after issue)couKTr-aiiiiiiioTii I APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED Permit No. LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS SECTION TWPNO.RANGE TWP NAME ,/ ■ 7'o/3^/i 1j‘ (■;ij 1y PARCEL NUMBER (S) OF PROPERTY BEING SERVICED E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROAD 4t— )•o \/3 V - ?ot SS^Qr i- / 0 ()0 9- '1 o /si ^ t/-' ■>LEGAL DESCRIPTION I'\£lL y /■' A.I i /f FirstLast Name Initial Mailing Address Daytime Phone No.-r/Property Owner / y\ jy A,< /C-..1 C o -)-e' - il‘ • ^r ,■v^//. IS VJK //iContractor Lie.# <.i■ \.!I /! "fo<y'. (/.( ..L |o-S>THIS SPACE FOR OFFICE USE ONLY ► This System will be ready for inspection on V______wL®-* ________, the year o ' Date Revived ' ' TimeFteceived '----- ’.M. L&R Official NSTALLATION (circle one)TYPE OF SEWAGE TREATMENT SYSTEM DESIGN DATA AS SHOWN ON DRAWINGResidential (A) New (B) Replacement ♦ (C) Add on Collector Other Est. (G)New ___ <■(1-1) Replacemeriy (T) Add on' ' (D) New (E) Replacement (F) Add on Soil Treatment Area Tank LiftDesign Flow (Gallons/Day) (J) 0 (K) 1 — 2,499 (L) 2,'500 — 4,999 (M) 5,000— 10,000 Effluent Distribution ( ) Gravity ( Pressure , ^Is / ' \ 'L Ft.Size L'- Setback To Nearest WellType I Type II ' r Ft.Ft. Ft. (20) Trench, Rbck (27) Rapidly Permeable Ft.Ft.FtSetback To OHWL(21) Trench, Gravelless (28) Flood Plain c (22) Trench, Chamber (29) Privies ____Ft.■------Ft.------Ft.Setback To Bluff(23) Bed (30) Flolding Tank (Contract Required)(24) Mound 7 r: Ft.■ Ft.Ft.Setback To Dwelling u-' Type III(25) At Grade Setback To Non-Dwelling(26) Greywater (31) Other/Problem Soils/<12" SpxLy Ft.Ft. Ft. Type IV(34) Tank Only Setback To Nearest Lot Line /■'. Px.Ft.Ft.(;(32) Public Domain & Proprietary Technologies(35) Other /•> Setback To Road Right-Of-WayDepth of Well Ft.Ft.Ft.Type V / Total # Bedrooms (33) Performance Elevation Above Restrictive Layer Ft.Ft..fL--Garbage Disposal Y / NAbatement Y / N 7PERCTEST DATA IDesigner Agreement: The undersigned hereby makes application for permit to install, alter, repair or extend Sewage Treatment System herein specified, agreeing to do all such work in strict accor dance with Sanitation Code of Otter Tail County, Minnesota. Applicant agrees that the Site Data Worksheet submitted herewith and which is approved by a Land & Resource Management Official shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and approved for use. It shall be the responsibility i of the applicant tor the permit to notify Land & Resource Management that the installation is ready for inspection. Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Sanitation Code of Otter Tail County, Minnesota. This permit may be revoked at any time ) upon violation of the Sanitation Code. NOTE: I.This permit Is valid for a period of six (6) months. 2.This permit does not Include the building sewer (sewer line). License #Date of Test Highest Rate \1 5 i Permit Fee $ / /Date: Signature of Property Owner/Agent for Owner \ . J/ ,•jDate:Rec. No..(Land & Resource Management Official “3TVp K r ^ j), 7 ;■>: i(': ;JO / j r: ^•/OComments:iy ii- 7 . . :/ D-f 7 ] ■;l ■ , fYv • J iM f'/CIjr i'j/uYV.V<' ' ■ jy -h ~ -1; [4iiwi«iForm No. BK — 04-2014-06 357,243 ■ Victor Lundeen Co., Printers • Fergus Falls, Minnesota A SEWAGE TREATMENT SYSTEM PERMIT^ INSPECTION RESULTS LIFT TANK STA (Soil Treatment Area) OUTHOUSE HOLDING SEPTIC TANK TRENCH REDUCTION CATEGORY /msgls.Capacity Rock trenches with inchesFT2lots Uo'*'of sidewall for %Setback from Nearest Well FT FT FT Setback from Burled Water Suction Pipe reduction / equivalent toFT FT FT Setback from Buried Pipe Distributing Water Under Pressure STA CALCULATION (Soil Treatment Area) .FT Zo^-2^0 FT FT it'>rSetback from OHWL (lake &/or river)■7^'®FT FT 2,06 FT Setback from Bluff FT FT FT Setback from Dwelling StT FT FT MOUND / AT-GRADE ROCK BEDSetback from Non-Dwelling FT FT FT J★-Setback from Nearest Property Line FT FTn Ft. X Ft. ■rir3tdSetback from Rjght-of-Way zoFT FT FT Ft* 3^Elevation above Restrictive Layer FT FT FT SAND IN MOUND FtINSTALLERS COMMENTS Holding Tank / Lift Alarm [)(yES □ NO SEPTIC TANK(S) # Tanks Installed *3 Manuf.^ Old System Pumped & Destroy^d^ J^I^S Weep Holes 5 --------—--------/ --------- Lateral Pipe Size j □ NO Number of Laterals #IN1_Model # j 1Perforation Spacing Ft.Perforation Diameter Size IN Gallons Per Minute FILTERS □ YES □ NOPUMPSFeet of Total Head ^Z<r//r.S?" fr^ ‘ 1^y€A.— tJjliriInspector's Comments: Sketch: «'*■----—IT4- \-1 ;« o o o ! U'C i•f 8Q {0^ 0Iyt) I 04si;1560 e»***>*-3 lMt.y P IWO«b 4I f r;/■ I V 'D fk; t i I ’ Date Time ^ pqt, 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 Official IJ Land & Resoume Management Official Form No. BK — 04-2014-06 law Bkl 3S7.243 • Victor Lundeen Co.. Printara • Pargua Falla, Minnasota ' • 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. Scale:grid(s) equals feet, or inch(es) equals feet ____ LICENSE CATEGORY: MPCA LICENSE #: DESIGNED BY: FIRM NAME: ^ ADDRESS: ____________/ DATE: SIGNATURE;^^^ 2,000 A, ooo 2.0O0 ],ooO Sef'^'C P/eSS(//^ 5,//5' os' X -gs'6 Uf 407C-BK — 04-2014 — 029 Prrnt-ri'j • ’-erijj,. i-,,! j MN • SITE DATA WORKSHEET LAND & RESOURCE MANAGEMENT GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 218-998-8095 www.co.otter-tail.mn.us «/ OTTER TflilCOVATT-BIlIRflOTI Sewage Treatment System Permit #OWNER: 'f' TELEPHONE NUMBERLAST NAME FIRST MIDDLE ADDRESS: 4 / 7 ZIP CODESTATE___STR./RT Cl JJ4 _Q^2zz TWP NAMERANGELAKE NAME SEC. TWP.LAKE/RIVER NO. LEGAL DESCRIPTION:SOIL BORING LOG DEPTH (INCHES) fT Sc/i> -^7“ y4- 31 ooo ^90/ 5'S'k>o/^ 3l000‘^^O/s'^i 3 _____________ PARCEL NUMBER 4/^^^ pk('0^ E-9H Address or Directions From Nearest Public Road ‘fo o COLOR & MUNSELL NO,STRUCTURETEXTURE BLOCKY PLATY PRISMATIC NONE BLOCKY PLATY PRISMATIC __NONE__c/uLLNUMBER OF BEDROOMS BLOCKY PLATY PRISMATIC NONE 17GARBAGE DISPOSAL: YES WELL: CASING DEPTH Ko Uu SEWER LINE SEPARATION ft BLOCKY PLATY PRISMATIC NONE FLOODPLAIN: YES NO BLUFF: YES VEGETATION: AQUATIC ^^RESTRI^ SLOPE AT INSTALLATION SITE: D - ^ %BLOCKY PLATY PRISMATIC NONE(3TYPE OF OBSERVATION: Probe Boring PARENT MATERIAL: Till Loess Bedrock Alluvium No COMPACTED SOIL: Yes ORIGINAL SOIL:Date of Soil Boring 77/ DEPTH OF BORING (To 7' or restrictive layer):.ft.Date of Perc Test PERC TEST #2PERC TEST #1 - TWO TESTS ARE REQUIRED - r PERC RATEINTERVAL(MINUTES)^AJtR.OEPIH______WATLR LIRP.P._WATLR CRQiL PERC RATE TIME!.ILSi_WATER DEPTHlU STARTSTART DROP PERCTIMEDROPPERCTIME PERC RATEWATER DEPTH WATER DROPWATEFt DROP PERL RATE TIME INTERVALIMINUTESITIMEINTERVAL (MINUTES)WATER DEPTH REFILLREFILL \DROP PERCTIMEPERCTIME D INTERVAL (hUNUTESl REFILL WATER DROP PERC RATEWATER DEPTHWATER DROP iC RATE TIME INTERVAL (MINUTES)TIME WATER DEPTH REFILL -----=PERCTIMEDROPDROP PERC RATETIMEINTERVAL(MINUTES) REFILL WAT£R DEPTH WATER DROPPERC RATETIMEINTERVAL (MINUTES!WAT&R DEPTHREFILL PERCDROPPERCTIMETIME DROP PERC RATEWATER DROPVILR DROP.PERC RATE M IlMjJiii. W&DTIMEINTERVAL (MINUTES) REFILL WATER DEPTH REFILL WATER DROP DROP PERCTIMEDROPPERCTIMEWAIgffpEPTHPERC RATEWATER DEPTH ;R DROPPERC RATE TIME INTERVAL(MINIINTERVAL (MINUTES!REFJREFILL PERCTIMEDROPDROPPERCI'NTERVAl/LwtfNUTESl /I^EFILL PERC RATEWATER DEPTH WATER DROPPEHc RATE ______TIME INTERVAL(MINUTES! REFILl. .TIME.WATER DEPTH WATER DROP V t_ DROP PERCTIMETIMEDROPPERC WATER DEPTH PERC RATEWATER DROPWATER DROP PERC RATE TIME INTERVAL IMINUTESIINTERVAL (MINUTESI RFFILL WATER DEPTHTIME refill DROP PERCTIMEDROPPERC.TIME 8/^rVL‘^y’ WtfhpfZr- SEPTIC TANK MANUFACTURER: PROPOSED DESIGN: PRESSURE DIST.,HOLDING TANK GRAVITY DIST.,ATGRADE.MOUNDTRENCH,BED. OTHER. SPECIFY:.OUTHOUSE.SEWER LINE. — SYSTEM DESIGN ON BACK — r- ”TTTi. I .-I-;; ! .t r .. ;■"I 1i ;System design must bp^ to scale and must! include the proposed locationj of the sewage system, all J iebdsting/p^pposed ipuildings; property lines, the ordipary| high| wpter( leyel[ o^ tbe ^ater iDody,] wetlariids, j ■ - —bluff-aWd-all-WaterWells-within+150^pf4he~sewage-{systetTl;4lf4here-iareahyJquestiohSviseekhe|Uniyers|ty- i of Minnesota Site-Evaluation worksheets. , i ' ' ‘ I , j i j ' ’ i ±±::n:tj±1:':T , i 1 .^.^.^ ^ji LI lT-::r- T" l-tI I 1 i s f"!Igrid(s) equals inch(es)i equals _Lii__feet / 7^Ifeet, orScale:( :ftT MPCA LICENSE #: j I r r I j' "* " j , 1 LICENSE CATEGORY; i.i. DESIGNED BY:-h-i-rf J.!I !,I !I(FIRMNAME:- ! I I I M M I 1 !ii •I..>I4-4-i4-DATE:1 i1U.1-44 4rmrn'.,,ADDRESS:; i . 1 1 J.I-ir7" 1 i■i' SIGNATURE:!I I..j.[J It “TTRlIiI I- L f,.L "I i i.i......-I-r—; .f..I..I..iT i.....I t:I 47“T 3L Tj i i ] I-1. L,i : -■ ■1_I■■I-I-•f -a'/^ r:M:''i -r>i lliD. 4^ f J.....1.i I.L_.I-•■!......f-f-i !- - -I B tIIi i 'U[T I IIitill ' ^1!\)(!r L.u gi lB : .lil; ' ' ' ' —4 ?T im i;i-i 1[ m f-I " C.^-^ 1 I i t-..j...'II 1;C^a—!-Iti14IIV 4" ]r—i—r I1 -I -tILL--------4. '-4 'i ^1;}54'.■■M-I l-I ..j..J I -i|4-Iir" -M :■ i-IWW4P■ I - it , ,L irr--I--! f 1fI -Irii 1-Ml1 1 -!r1 I-i 114-4 A'\1 I1 4-IT'I\ yi: LISI4-1 i I I4!i I 1 .L.,.L..(_1 LLli1 4-rr I II J 11“1!i !I 4r L }••r ■r••!—r~r—•■7'1 I..,t.---L..T,rI 1;I Ii r ■■■••“T—r—1 tILIrIII-/S*-4 I1f”,I ]il-'i'-t , r irt.lTi: '1 1 ■■44L-:^i , . IJ a) I I i -4a 41-1 11^1r-Htlh-■ 1I ElI-I l-L'I JJ _0U I 1tr7!■Q 1^It h ;11jIt-11j<r/ i?'F ;o.4 Q3 ,\«® L.i4I-'h i41"! I 7\ I-J I 0®l I li«IIiIf "1I[I f14!I'~T't'0 I 1-[r 1Tr -f-1 I QiL 1 I , --I ri I I L1...L o1..r.ITI-i-I WII-t--|!■ u::!-J LlliI..4....j...V-t--[I-t-!-44iTffiHt O; I -Kt-b u®^’ o I (!I i [,._..L,...,-0{iIa.,..-4-t T\~r—r-T7-i\I!1 S-_I 0 jX!44!.,L i-f■4......I....i i41 I-I-fTfT•■1 ....i-•]--4..f I L I .4-7^1 •!•/iI..i,.!■ J[-I..4.....L f-'r ‘ i I1!I44 ..11 •!...i -4....L- 4-i-ft.f-j-i-f-I.i!f •!■ t- +t' TTI 1 I •h 41!11!f _,l4..4 •r•|..i-i..|-f-•-t~- i •••• I l-Ui ;1 ..I t ;. .1 IQflp'^id Li. P,in.e,s : M.............’.......... : '.......-‘r-rr-V-~f 4 .., ;..i' r ; "I..I..'.. i . 0 — 029 I r ' 3V5.964 Sic.Sr4.iL«n ^ ;........ ; - [ ■; [TBK - 1003 !i I XL ![1J. ! ;:i i I i i.fcp-r'i i-tII [ LANDiSl RESOURCE MANAGEMENTS GpUNW^ TT^IL GOVERIvjMENT SERVlGBStGENTEfC 540 WEstmiC FER^ 56537! Ui——i—I !—<—=—1-4- I ! I I i ■ i i—j- ■ ! I" I 1 1 I I i I : I I I , i , i;!-;-44-i.......................................................................:■■■'.1-44-1-...4-1.j-j-H-J—.................................................. 1i-i iI1, _____i I •-1 •• -.f-U4-I 4-'M'~r T''i" Ti4- -H IU ii I —r—r"7..[..\...I...[■ System Permit)#1 ?1I2 OWNEBTI-L-LLU-L I i TreatmentSewageI 1 :n.:]:Ti44:-i-i::i: min ^ ..........: r^t-1-t..).!...iH.-ft-rhriI 4 u TELEPHONE-NUMBER-^Lk'st-NAME~-^ W-^ADDRESSl -144ti-yrmrrrriniu.i.i ■■first\MiDDLEA1 }■ n44 4l4tt4..414:7iI-!! -L ..L 1 ' i , t i-: ' i f 1 : CITY 1.l„' -LI ■~r '1 I i i■I.....i - ^1 i --'fIrrsTRi/RT ------------------- ---------------------j... I—INSTATE I ZIP CODE 'h 1 rXT+TT~r TT Ti I IiAkE/RIVER NO.\ -> - ; LAKEfNAiME.I- ..............I.“..-4_j—uu-j...tSAL-DESCB JFfroKht l|~......-tit-fl. l-sfd i ' \NAMEtWPlrAnge>-TWP.■7 •j..f-!!f ’ 4I;SblLiBORi|Mq[ LOGLEi- r' :.... iDEPTHh (INCHES) I i i . COLOR & [- MUNSELL NO. 4 TEXTUREit4Ii! ! I ! I■ s-L BLOCKY- PliATY- '1 -J-T 1 4--1 (44 -T_lT;-PRISMATIC-..-NOI^E..I..PARCEENUMBER „J..I I 1.1,..j...■j'i4.BLOCKYl I :pdAr4 J. FIRISMATIG ~rNbNE± 1 1 .4..4rrr-)!I -r44^ i Ah dreg's 4 Oirection's~From~'0^arest Pub^ Aphd -nM— ^jlfl - |„4 ltl|z Z| —4_|-4......„4 -,j I I NUMBER-OF-BEDROQMSbizJzirnm - 4 -;h-4 4.[ i [BLoekY-!Li 4■tr.f 4 -1-PLATY14!I 4------GARB/|iGE|-DISF|OSAL:f4-YES ' ' i 1. .1 . t~| - - 1 i i—L WELL: CASINGTDEPTH I i 144 INO t fl PRISMATIC NONE 1n:I ;r 4SEWERlUNE SyARATIOIsi: 4 1 !fft.BLOCKY -LpijATY^-j— PRISMATIC...noi^e.I- -^FLOOpPpyiNi-^YES-KNoH----j'BLbFF-rrYES-j-fNQ-i-; i 'VEGETATION:! AOuAtlC TEFIRESTRIAL [‘ I IrIIII i I I I i T iiII ! ;I ...r II1BLOCKYl plAtyLSLO^^/pflNSTALliATlbN SITE: 7L , l | " ^ ' 4 J ! ' ' ’ 1 1 : plYRE-OFlOBSERVATION:-.L.Rrobe.t-Mi4-4r-]-: ' 1- :mv; l4-h'm %4L..:1 Tti.-PRISMATIC I I I I I, NONE II I I.1.i.._4pitUi_Boringi™UJ ^ ^ ^ ^ ^ ^ ^ .I.ri-j—j—S-i t 4 ! 1 F^RENT Ml'VrERlkLri..rTiirrOutw^li Ld^i tBebrocLi Alluvium:|44::[:Lnipiirte^^^^^^ ... •ORIGINAL-IsOIL:^ Vfes-, iNo- - pr ^ M I 1 ’ '“"i ' ’IT-t^l ni-f-j I , , ) ' 1 -- -j mJ 1 eOMPAe;rED;-SOIL: f-|Yesr No ' 'r1.i.[.: II 1 I r j tp-L+..h I 14 1.pt-T r T I!I-4rTI ...r rDateof Soil .Boring t 1I i t iirlTtItl'i44 Li!"I; DEPTHIOFIBORING (Tolpjof -festrictive layer):! '; 'IperG test #1 i Xiu:of Perc Test T TTTF!Date 1 ( t~\I .tI ri'fWT«T^2 hi i n|- -i- Iri/VO ITfSre A/fF|/?jEQL///7£pII I WATER DEPTH ! TIME INTERVALMMINUTES)! ■WATER DROP!PERC RATEi t TIME i INTERVAL (MINUTES I I I r WATER DEPTHl WATER DROP I I ! I iPERC RATE I I I:□! “I j—j—f-y -, -jiSTART. i.....!....4 f J 14!L.START..L..LI ] , I i-i i-i -i ! ' r- DROP I I II -L_L_'—1=' '■ -iTIME ! ‘ LdROP L-.i PERC I rr"I.I..!..1 1 ^ I h4ILI- rrTTTrL J PERC I..1.I I I TIME!,L□TIME I INTERVAL* (MINUTES) I WATER DEPTH I WATER DROP I PERC RATE r TIME t J__I I__I INTERVAL (MINUTES)WATER DEPTH I WATER DROP i J__i iPERC RATE I I 1Ii—jREFlLL-h.-l--l 1 |—r-REF(U.1JI •r -!—- - t.....r-j:::;::.;...L!J : [4-4-t fI-tfT4}.-.„| mi— DR0P4-4- PERC -J- iTIME 4 •'drop -m- PERC it f f 4-4-4-4—L -4-4-TlME-i- WATER DEPTH’ TIME •INTERVAU, (MINUTES)WATER DROPi S PERC RATE TIME I INTERVAL (MINUTES)t, WATER DEPTH!(WATER DROP 1- I ! i PERC RATE \f I■j—RffILL—I ....•4—4.r-^I I—j"" RFFll 1 I-)J-iJ.i—^ 1='! L ( -fTIME f—4-DROP-i- tPERC....|- i!dd±"i...f..t h-i—F—J—f- ■ "4'fT-yv r-yi- f ■ i :.-I-WATERDEPTH4---i-TlME-fr -INTERVAL»(MINUTES)(r-WATER-DROPf—4 -mt.....PERC RATE4- -4-4—(- 4-TIME-j- INTERVAL (MINUTES)- -i-WATER•DEPTHI-- -1-WATER DROP f 4—>- PERC RATE- 4 ]“'[ ■|■■"('4REFILiI-t 'f -1.+•t mmr f ..j,. I1 I M 2 I 1 I =' i : t" ITIMEI ~V DROP r t PERC f~"'1 DROP ^ PERC I I-...I I T i i IT • I "• iT1TIME r mWATER DEPTH i-nTIME -f -(NTERVAL*(MINUTES)t t- WATER DROPt—I t r--f -PERC RATE )- i 1...1 -t TIME-t-INTERVAL (MINUTES)--i-WATER DEPTH!—- f WATER DROP iPERC-RATE L 1 "Ml " ;v‘;1dR^iLL-i;1-^-1.F 14 :rTT'iTYT y-... ■■■■■■■■■■„. I (TIME ; ' I -=rJ__I1DROP I PERC I TIME! i DROP I PERC ! TIME r INTERVAU(MINUTES)i r WATER DEPTH f WATER DROP I f T PERC RATE I rT- r r TIME INTERVAL (MINUTES)r WATER DEPTH!I WATER DROP I T 4 IPERC RATE I a I 'ID f r r-n! I ;-t!1'..i 4 X:r i;-r- I I I liJ-.i. .l.-i 1 ■ ,L _ I _■ = -J - -I.. .. [ ■ L aTlME I I DROP i I PERC I J M,1 I I 1 ■!" ) TIME ’l DROP I ”1 PERCt i I i I I I J__I j IJ_!I I I TIME I INTERVAU (MINUTES) I i WATER DEPTH I WATER DROP I 1 I I I PERC RATE lilt I TIME !INTERVAL (MINUTES)WATER DEPTHl WATER DROP i IPERC RATE 1 I UJ -LQ 1.4 UREFia...[...J4 ..■---ji.-.v-.4.-...L. i :— hh-h-hlx- r T Fixixi.I.;........ i i TIME! j DROP I [("iT..iTIME DROP- I. PERC 1. ! ,f PERC WATER DEPTH 1i TIME I INTERVAU (MINUTES) 1 WATER DROP I i I I PERC RATE I I )i TIME I INTERVAL (MINUTES)I WATER DROP II WATER DEPTHl !! IPERC RATE I UXj 4-J-JREFILL4-.i._.|i 4 —t—f-REFILL -I..I.l-XU-'r )y M- I -4 -I—j.. 4-- 4— ^ -..............MC"..r DR0P4-4-PERC-l _4TIME4-L[-DR0P •■- ) 4-------■4. PERC — -- 4. 4 TlMEi •4--t-I'L _ J -Lt-('f ttTTTPROPOSED, pESIGM^r|m~hT~j~rn"~j itRENCHLMl :BEcXl 1 jMi .ATGRADEi ...[..;. .4-;--!- -i -f-.|-1.........................!..L..j-..r-..p--^....... ....- j vSEWER LINE 4 I i I QUTHOUSEf 4 [ I [.OTHErI-..Lh t- -H -i..I.....i -j 'SPECIFY:!-H - -i-Lr ....Lr-fr+-.-) -[- j- 1 - T- '-f-r i | h'l..... ij^SYSTEM OES/GAI.diU BACk — “■^rLrm-T--T—I..r -.........; y I ' j ■ |.|.j.y.,.|-.j. ...y-j-:.■■■“rr 4m“T'i.r I : ' ri r T4.t t"i i ; r v i^r^irTi 1 1 iri...i.1.n..:.T"T'r T-i-i....ttiT) i‘ I rr i_L.— |i,L — ...|.........|... -r^l_____—__.. — .....j-.- jy^NpMliltHoi^iNG^ -f14. PRESSURE DIST. .i.IfX. j]I■■h(■T 4-1I II i.4-.n:I t I f/auj 'fo Minnesota Pollution Control Agency OSTP Design Summary Worksheet University OF Minnesota V 07.14.15Property Owner/Client: Robert 6t Kim Jacobson Project ID: Site Address: 41424 Dawn Trail Pelican Rapids, MN / Lida Lake Date: 8/16/16 1. DESiGN FLOW AND TANKS Note: The estimated design flow is considered a peak f(ow rate including a safety factor. For long term performance, the average daily flow is recommended to be < 60% of this value. Gallons, in A. Design Flow: .825 Gallons Per Day (GPD) B. Septic Tanks: Minimum Code R^uired Septic Tank Capacity: Recommended Septic Tank Capacity: 6600 4 Tanks or Compartments 7000 Gallons, in 4 Tanks or Compartments Effluent Screen:Alarm:no yes C. Holding Tanks Only: Minimum Code Required Capacity:Gallons, in Tanks Designer Recommended Capacity:Gallons, in Tanks i Type of High Level Alarm: •'"I D. Pump Tank 1 Capacity (Code Minimum): Pump Tank 1 Capacity (Designer Rec): Pump 1 650 GallonsGallonsPump Tank 2 Capacity (Code Minimum):■:T' Pump Tank 2 Capacity (Designer Rec): GPM Total Head 650 GallonsGallons GPM Total Head59.0 19.4 ft Pump 2 ft Supply Pipe Dia. 1.50 in gal'Supply Pipe Dia.286.0Dose Volume:gal in Dose Volume:r SYSTEM TYPE2. O Gravity Distribution ® Pressure Distribution-Level O Pressure Distribution-UnlevelOTrenchO Mound O At-Grade i'OOriP O Holding Tank Q Other * Selection Required Benchmark Elevation:ft Benchmark Location: System Type Type of Distribution Media: [vjDrainfield Rock □Registered Treatment Media:0Typel OTypell GTypelll GTypelV OTypeV f 3. SITE EVALUATION: 52Depth to Limiting Layer: Elevation of Limiting Layer: Loc. of Restricive Elevation: A. in B. Measured Land Slope *:0.0 % Sandy LoamSoil Texture:C. D. 0.78 GPD/ft^Soil Hyd. Loading Rate:F.E. 1 3.0 1ft :r-36G. Minimum Required Separation:in MPIH.Perc Rate: I. Code Maximum Depth of System:16 in Comments: 4. DESIGN SUMAAARY Trench Design Summary ft'Dispersal Area Total Lineal Feet Sidewall Depth Trench Widthin ft Number of Trenches Code Maximum Trench Depth rftin Contour Loading Rate ft Designer's Max Trench Depth in Bed Design Summary 1058 ft^Absorption Area Depth of sidewall Code AAaximum Bed Depth 16.0 in9.0 in Bed Width Bed Length 70.5 ft15 Designer's Max Bed Depthft in > OSTP Design Summary Worksheet University OF MinnesotaMinnesota Pollution Control Agency Mound Design Summary Absorption Bed Area ft^Bed Length Bed Width ftft Absorption Width Berm Width (0-1*)Clean Sand Liftft ft ft Upslope Berm Width Endslope Berm Widthft Downslope Berm Width ft ft Total System Length Total System Width Contour Loading Rate gal/ftftft At-Grade Design Summary Absorption Bed Width Absorption Bed Length System Heightftft ft gal/ft Upslope Berm Width Downslope Berm WidthContour Loading Rate ft ft Endslope Berm Width System Length System Widthft ft Level B Equal Pressure Distribution Summary No. of Perforated Laterals Perforation Spacing8 3 Perforation Diameter 1/8ft in 1.50 gal 206 galMin. Delivered VolumeLateral Diameter in 285 Maximum Delivered Volume Non-Level and Unequal Pressure Distribution Summary Elevation Pipe Volume (gal/ft) Pipe Length Perforation Size (ft)Pipe Size (in)(ft)(in)Spacing (ft)Spacing (in) Lateral 1 Minimum Delivered Volume Lateral 2 gal Lateral 3 Lateral 4 Maximum Delivered Volume Lateral 5 gal Lateral 6 S. 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 i 1,000,000 gpd X mg/L X8.35-1,000,000 =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^ ft^ =Ibs/day/ft^mg/L X 8.35 T 1,000,000 = Comments/Special Design Considerations: I hereby certify that I have completed this workJn aci ince with all applicable ordinances, rules and lavn. (License 6)(Designer)^Signature)(Date) OSTP Pressure Distribution Design Worksheet University OF Minnesota Minnesota Pollution Control Agency Project ID:V 07.14.15 7ft/J?1. Media Bed Width: 2. Minimum Number of Laterals ip^ system/zone = Rounded up numl^r of [(Atedia Bed Width - 4) -r 3] + 1.I---------^ I—^^ ^ ( '25 - 4) +1 = ^ la^als opply to at-grades 3. Designer Selected Number of Laterals: Cannot be less than line 2 (accept in at-qrades) 4. Select Perforation Spacins: laterals ft £■3.0 —-Siesaaa*£-m 5. Select Perforation Diameter Size:1/8 in ^ •€>< fotk / 6. Length of Laterals = AAedia Bed Length - 2 Fe‘et. -zO ft Perforation can not be closer then 1 foot from edge. ■j Determine the Number of Perforation Spaces. Divide the Length of Laterals by the Perforation Spacing and round dov/n to the nearest whole number. M ft 2ft ^-9 Number of Perforation Spaces 3 ft Spaces■r “ Number of Perforations per Lateral is equal to 1.0 plus the Number of Perforation Spaces. Check table 8. below to verify the number of perforations per lateral guarantees less than a 10% discharge variation. The value is double with a center manifold.2.3 2J± Perforations Per Lateral =-ift-Spaces + 1 =Perfs. Per Lateral Maximum Mumber of ^oratiom Per LUerai to Guvaftee < tOU Osdwfe Vwiatxm ^■■4 tncb Perforacons 7/32 Inch P«fofati<ws Diameter {bKhes)Pi|5e Diametef ({nchesiPerforatiofi %sac*ngPerforatkm Spaa^ (Feet) (Feet)m i 3 312im a 2 11 ii»21 34to131* m 2ns1216 28 54 10 14 20 32 64 3 3 9 301419 60812255216 3'16 Inch Perforwtom 1/8 Inch Perfofattorn Pipe Wimeter (Inchej)Pipe D»amet^ (Inches)f^or^n facing (FeetlPerforatiofl Spacx^ (Fert)tvi 2 31m 3r*i1B 2 12 11 26 46 17 21 33 14927444 215 2‘4171224 40 80 20 30 1356941 l573312223716752029 12164 9. Total Number of Perforations equals the Number of Perforations per Lateral multiplied by the Number of Perforated Laterals. KS-'A3’ -8-Perf. Per Lat. X Number of Perf. Lat. =Total Number of Perf. 10. Select Type 0/Moni/o/d Connection (End or Center): □End 0 Center 11. Select Lateral Diameter (See Table):1.50 in « OSTP Pressure Distribution University OF MinnesotaDesign WorksheetMinnesota Pollution Control Agency 12. Calculate the Square Feet per Perforation. Recommended value is 4-11 ft ^ per perforation. Does not apply to At-Crades a. Bed Area = Bed Width (ft) X ^^Length (ft)I 0'2-^d 2075-' ft^^5- IT ft ■83-X ft b. Square Foot per Perforation = Bed Area divided by the Total Number of Perforations. I I S" ft^ft^/perforations'2075 perforations =9.3 lO 13. Select Minimum Average Head:%82.0 ft 14. Select Perforation Discharge (GPM) based on Table:0.26 GPM per Perforation 15. Determine required Flow Rate by multiplying the Total Number of Perfs. by the Perforation Discharge. I'r _________ GPMPerfs X 0.26 GPM per Perforation =.-59- 16. Volume of Liquid Per Foot of Distribution Piping (Table tl):0.110 Gallons/ft 17. Volume of Distribution Piping =Table II Volume of Liquid in Pipe = [Number of Perforated Laterals X Length of Laterals X (Volume of Liquid Per Foot of Distribution Piping]!S'I Pipe Gallons i Diameter (inches) Liquid Per Foot (Gallons) —6 ft X 0.110X gal/ft -?t:3 18. Minimum Delivered Volume = Volume of Distribution Piping X4 1 0.045 1.25 0.0787155gals X 4 = X V -2»5r1 Gallons 1.5 0.110 37* Y 2 0.170 3 0.380 4 0.661 Comments/Special Design Considerations: uy 70 OSTP Bed Design WorksheetwfViinnesota Pollution Control Agency University OF Minnesota 1. SYSTEM SIZING:f Project ID:V 07.14.15 A. Design Flow (Design Sum.lA):825 GPD 1 inches y/" Designers AAaximum Depth: GPD/ft^ D. Required Bottom Area: Design Flow (1.A) Loading Rate (1.C) = Initial Required Bottom Area ft' >/• B. Code Maximum Depth*: C. Soil Loading Rate: 16 inches 0.78 GPD/ft^=825 GPD- 0.78 1058 .L- E. Select Distribution Method: @ Pressure □ Gravity _______' 0Rock □ Registered G. If distribution media is installed in contact with sandy or loamy sand or with a percolation rate of 0.1 to 5 rripi- indicate distribution or treatment method: I •’ F. Select Dispersal Type:.r I ( i BED CONFIGURATION: (for sites with less than 6% slope)2.;. t A. Select size Multiplier: B. Req'd Bottom Area = Bottom Area (1.D) X Size Multiplier = 1.0 1.0 = pressurized or 1.5 = gravity !■ ft'x1057.7 ft'1.0 ft =1058 <;I i C. Designed Bottom Area:825 ft Optional upsizins of bed areaI 4-D. Select Bed Width: E. Calculate Bed Length: Designed Bottom Area = Bed Width = Bed Length 15 ft ft'-1058 15.0 70.5ft =ft .. • •- *'r ■ 3. material CALCULATION: ROCK I. 'A. If drainfield rock is being used, select sidewall absorption 9.0 inches = B. Media Volume: (Media Depth + depth to cover pipe) X Designed Bottom Area = ft^ ft) X 1057.7 ]ft' =[ 793 C. Calculate Volume in cubic yards: Media volume in cubic feet - 27 = cubic yards 793 Ift' - 27 = 0.75 ft '( ( 0.8 ft +ft' i yd'29 4. AAATERIAL CALCULATION: REGISTERED PRODUCTS - CHAMBERS AND EZFLOWI A; Registered Product: B. Component Length:ft I C. Component Width:ft D. Component depth (louver or depth of sidewall loading) D. Number of Components per Row = Bed Length divided by Component Length (Round up) in ft -ft =components E. Actual Bed Length = Number of Components X Component Length: components X F; Number of Rows = Bed Width divided by Component Width ft = ft =ft I ft -rows Adjust width so this is an whole number. : V 1 G. Total Number of Components = Number of Components per Row X Number of Rows r i X components OSTP Basic Pump Selection Design University OF MinnesotaWorksheetMinnesota Pollution Control Agency 1. PUAtP CAPACITY Project ID: Pumping to Gravity or Pressure Distribution:O Gravity ©Pressure Selection required 1. If pumping to gravity enter the gallon per minute of the pump:30.0 GPM (10 - 45 spin) 2. If pumping to a pressurized distribution system:GPM 3. Enter pump description:Demand Dosing Soil Treatment Soil Srejimt'iis sji-stcfR & of flKfKvfJt*2. HEAD REQUIREMENTS A. Elevation Difference between pump and point of discharge: 6 ft *tterencenB. Distribution Head Loss:5 ft C. Additional Head Loss:ft (due to special equipment, etc. I Table I.FrIction Loss in Pjastic Pipe per 100ft Pipe (JnchesjOistribut-ion Head Loss Flow Rate I GPM)Gravity Distribution = Oft 1 1.25 1.5 2 Pressure Distribution based on AAinimum Average Head Value on Pressure Distribution Worksheet:II 12.8 10 3.1 1.3 0.3 12 4.3 1.8 0.4■ Minimurn Average Head Oistribution Head L-Oss 14 17.0 5.7 2.4 0.61ft5ft16 I 21.8 7.3 3.0 0.72ft6ft189.1 3.8 0.95ftlOft2011.1 4.6 1.1 25 16.8 6.9 1.7 D. 1. Supply Pipe Diameter:30 23.5 9.71.5 2.4in 35 12.9 3.2:• 2. Supply Pipe Length:20 ft 40 16.5 4.1 !45 20.5 5.0E. Friction Loss in Plastic Pipe per 100ft from Table I:50 6.1 55 7.3ft per 100ft of pipeFriction Loss =33.60 60 8.6 F. Determine Equivalent Pipe Length from pump discharge to soil dispersal area discharge point. Estimate by adding 2556 to supply pipe length for fitting loss. Supply Pipe Length (D.2) X 1.25 = Equivalent Pipe Length 65 10.0 70 11.4 75 13.0 85 16.420ft25.0X 1.25 ft 95 20.1 G. Calculate Supply Friction Loss by multiplying Friction Loss Per 100ft (Line E) by the Equivalent Pipe Length (Line F) and divide by 100. Supply Friction Loss = 33.60 ft per 100ft 25.0X ft 8.4100 ft 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 ) 6.0 ft 5.0 ft 8.4ft +19.4ft -ft+■f 3. PUMP SELECTION GPM (Line 1 or Line 2) with at least 19.4 / feet of total head.A pump must be selected to deliver at least Comments: OSTP Pump Tank Design Worksheet University OF MinnesotaMinnesota Pollution Control Agency DETERMINE TANK CAPACITY AND DIMENSIONS Project ID:V 07.14.15 8251.A. Design Flow (Design Sum. 1A):GPD 650 650C.Recommended pump tank capacity:B. Min. required pump tank capacity:Gal Gal Demand to PressureD. Pump tank description: MEASURED TANK CAPACITY (existing tanks): 2. A. Rectangle area = Length (L) X Width (W)WidthXft'ft ft B. Circle area = 3. Mr' (3.14 X radius X radius) 23.14 X 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' V 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 Callons/Inch (Line 2) 15.1 Gallons Per Inch = in Xin Gallons 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. 3.sbiA. Tank Manufacturer: 650B. Tank Model: C. Capacity from manufacturer;650 Gallons D. Gallons per inch from manufacturer:15.1 Gallons per inch E. Liquid depth of tank from manufacturer:43.0 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) X16 15.1 272(Gallons Per Inch Gallons 5. Minimum Delivered Volume = 4 X Volume of Distribution Piping: - Line 17 of the Pressure Distribution or Line 11 of Non-ievel 6. Calculate Maximum Pumpout Volume (25% of Design Row) Design Row; J) Gallons (minimum dose) 825 GPD X 0.25 206 Gallons (maximum dose) 7. Select a pumpout volume that meets both Minimum and Maximum: 8. Calculate Doses Per Day = Design Row -f Delivered Volume gpd ^ 286 Gallons Volume of Liquid in Pipegal =825 286 2 Doses 9. Calculate Drainback:Pipe Diameter (inches) Liquid Per Foot (Gallons) 1.5A.Diameter of Supply Pipe =inches 20B.Length of Supply Pipe =feet 0.110C.Volume of Liquid Per Lineal Foot of Pipe = Drainback = Length of Supply Pipe X Volume of Liquid Per Lineal Foot of Pipeft X oTIio |gal/ft = Gallons/ft 0.0451 D.0.0781.25202.2 Gallons 0.1101.5 10. Total Dosing Volume = Delivered Volume plus Drainback gal = 2 0.170 gal -r286 2.2 288 Gallons 11. Minimum Alarm Volume = Depth of alarm (2 or 3 inches) X gallons per inch of tank 0.3803 0.66142in X 15.1 gal/in =30.2 Gallons OSTP Pump Tank Design Worksheet University OF MinnesotaMinnesota Pollution Control Agency TIMER or DEAAAND FLOAT SETTINGS Select Timer or Demand Dosing: A. Timer Settings 12. Required Flow Rote: @ Demand Dose A. From Design (Line 12 of Pressure, Line 10 of Non-Level or Line 6 of Pump*): B. Or calculated: GPM = Change in Depth (in) x Gallons Per Inch / Time Interval in Minutes 1 in X GPM 'Atofe: This value must be adjusted after GPM instollotion based on pump calibration. gal/in 4 min = 11. Row Rate from Line 12.A or 12.B above. Calculate TIMER ON setting: Total Dosing Volume/CPM GPM gal T Minutes ONgpm = 15. Calculate TIMER OFF setting; Minutes Per Day (1440)/Doses Per Day - Minutes On 1440 min doses/day - 16. Pump Off Roat - Measuring from bottom of tank: Distance to set Pump Off Float=Gallons to Cover Pump / Gallons Per inch: ___________ gal ^ ___________ 17. Alarm Roat - Measuring from bottom of tank: Distance to set Alarm Float = Tank Depth(4A) X 90% of Tank Depth in X0.90 = Minutes OFFminT gal/in =Inches in B. DEA4AND DOSE FLOAT SETTINGS 18. Calculate Float Separation Distance using Dasing Volume. Total Dosing Volume /Gallons Per inch gal 4 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 + 288 15.1 gal/in =19.1 Inches 16 2 in =18 Inches 18 19.1 in =37 Inches C. Distance to set Alarm Float = Distance ta set Pump-On Float + Alarm Depth (2-3 inches) 37 in +2.0 in =39 Inches FLOAT SETTINGS DEA4AND DOSING TIMED DOSING 3 Inches for Dose:19.1 in IT Alarm Depth 39.1 in Pump On 37.1 in Pump Off 18.0 jj, inAlarm Depth 30.24 Gal 288 Gal Pump Off in A A272 Gal University OF Minnesota OSTP Soil Observation Log Project ID:V 07,14.15 Client/ Address:Jacobson 41424 Dawn Trail Legal Description/ GPS: PI Outwash Q Lacustrine [] Loess Q Till [~l Alluvium r~l Organic MatterI I BedrockSoil parent material(s): (Check all that apply) PI Summit E] Shoulder Q Back/Side Slope Q SloF>e D Toe Slope Slope shapeLandscape Position: (check one) Soil survey map unitsVegetation Sloped Elevation:0-2 Weather Conditions/Time of Day:cloudy 08/04/16Date Observation ^/Location:Observation Type:Soil Pit I Structure-IRockDepth (in)Texture Matrix Color(s)Mottle Color(s)Redox Kind(s)Indicator(s)Frag. %ConsistenceShapeGrade Sandy Loam0-12 <35%10YR4/3 Blocky 10YR4/$12-52 <35%Sandy Loam Blocky Concentrations, depletions52+SI Comments zZI hereby certify that I have completed this work in aotiordance With alU^plicable ordinances, rules and laws. ^Signature)(Designer/Inspector)(License #)(Date) OwsiTii SlK'WACC. T«t ATJV1Y.NT Ph o<.a m Additional Soil Observation Logs Project ID: Client/ Address:Jacobson 41424 Dawn Trail Legal Description/ GPS: □ Outwash Q Lacustrine Q Loess Q Till r~l Alluvium r~l Bedrock O Organic MatterSoil parent materlal(s): (Check all that apply) Landscape Position: (check one)n Summit Q Shoulder Q Back/Side Slope Q Foot Slope □ Toe siopeSlope Shape Soil survey map unitsVegetation Slope%Elevation: Weather Conditions/Time of Day:Date Observation ^/Location:Observation Type: Rock Structure'I IDepth (In)Texture AAatrIx Color(s)Mottle Color(s)Redox K1nd(s)Indlcator(s)Frag. %Shape Grade Consistence Sandy Loam0-11 <35%10YR4/4 Blocky Sandy Loam11-53 <35%10YR4/6 Blocky Concentrations, depletions53+6/8 SI Comments ^ "Z- Observation #/Locat1on;Observation Type: Rock I Structure IDepth (In)Texture AAatrix Color(s)Mottle Color(s)Redox K1nd(s)Indicator(s)Frag. %Shape ConsistenceGrade 0-12 Sandy Loam <35%10YR 4/3 Blocky Sand12-52 <35%10YR 4/4 Blocky 52+ Comments Land & Resource Management GSC, S40 W Fir, Fergus Falls, MN 56537 218-998-8095; Website: www.co.ottertail.mn.usOTTCR TAIl Subsurface Sewage Treatment System Management Plan Sewage Treatment System Permit Number: Property Owner: Parcel Number; 3 V (^r06 (3 / ( Lake Name / Number; A id} CX Section: ______Township Name: E-911 Address: Ti/la/( Pe(,'Cc^ 36 This management plan will identify the operation and maintenance activities necessary to ensure long-term performance of your septic system. Some of these activities must be performed by you, the homeowner. Other tasks must be performed by a licensed septic service provider. Homeowner's Management Tasks - Should Be Checked Every 6 months: Leaks - Check (look, listen) for leaks in toilets and dripping faucets. Repair leaks promptly. Surfacing sewage - Regularly check for wet or spongy soil around your soil treatment area. Effluent filter (if applicable) - Inspect and clean twice a year or more. Pump Tank Alarms - Alarm signals when there is a problem. Contact a service provider any time an alarm signals. Holding Tank Alarms - Can be either an electronic or a manual float, when activated, service (pumping) is required. Event counter or water meter (if applicable) - Record your water use. Vegetative Cover-Establish and maintain a vegetative cover over the sewage system. Professional's (Licensed Septic Service Provider) Management Tasks - Should Be Checked Every 24 Months (2 Years); □ Check to make sure tank is not leaking. □ Check and clean the in-tank effluent filter. □ Check the sludge/scum layer levels in all septic tanks. □ Recommend if tank should be pumped. □ Check inlet and outlet baffles. □ Check the drainfield effluent levels in the rock layer. □ Check the pump and alarm system functions. □ Check wiring for corrosion and function. □ Provide homeowner with list of results and any action to be taken. □ Check inspection pipe caps (replace as necessary). □ Check manhole cover (accessibility, security, or damage). I understand it is my responsibility peTprop^ly operate and maintain the sewage treatment system on this property in accordance with this Management Plan. Property Owner;D, Signature Received by Land & Resource Management:Date: The following link will provide information from the University of Minnesota, regarding a Septic System Owner's Guide: http://www.extension.umn.edu/environment/housine-technologv/moisture-management/septic-svstem-owner-guide/ LR: SSTS Management Plan 07-23-2014 OTTER TAIL COUNTY LAND & RESOURCE MANAGEMENT PUBLIC WORKS DIVISION WVW CO OTTER-TAIl MN LJSQTTiRTflIl GOVERNMENT SERVICES CENTER 540 WEST FIR AVENUE FERGUS FALLS, MN 56537 218-998-8095 FAX: 218-998-8112 01/19/2016 SEWAGE SYSTEM ABATEMENT NOTICE Robert W & Kimberly Jacobson 1981 58th Ave S Fargo ND 58104 7216 CURRENT PROPERTY OWNER: Parcel Number:37000290154001 Section:29 Town/City:Lida Township Lake Name:Lida Property Address:41424 DAWN TRL You are hereby notified that the sewage system which you maintain on the above identified parcel is not constructed and/or located in accordance with minimum standards of the Sanitation Code of Otter Tail County. Please be advised that you must correct this situation by 02/22/2016. You should contact this office in order to determine what corrections and permits are required prior to complying with this notification. Alex Kvidt Inspector (^CvV\-Cc/ ^ Cl up Vx, U.S. Postal Service n CERTIFIED MAIL , RECEIPT (Domestic Mail Only; No Insurance Coverage Provided)irHI For delivery information visit our website at www.usps.comru JO 3-$PostageruLn Certified Fee□Postmark Hers□ Return Receipt Fee I—I (Endorsement Required) Restricted Delivery Fee (Endorsement Required)□m ^ Total Postage & Fees□ ........ cifyrsietsrzrpir^-' ........................................ Serrt Tocr□o PS Form 3800, 2Jii6 See Reverse for Instructions OTTER TAIL COUNTY LAND & RESOURCE MANAGEMENT PUBLIC WORKS DIVISION WWWCO OTTER-TAIL.MN USOTTCR Tflil GOVERNMENT SERVICES CENTER 540 WEST RR AVENUE FERGUS FALLS, MN 56537 218-998-8095 FAX 218-993-8112 08/20/2014 Robert W & Kimberly Jacobson 1981 58th Ave S Fargo ND 58104 7216 RE: Primary Owner Robert W & Kimberly Jacobson Result of Onsite Sewage System Inspection, Non-Compliant 37000290154001 37000290154002 37000290155001 Lake No 56-747 Class GD Parcel(s) Lake Name Lida Dear Robert W & Kimberly Jacobson; As part of Otter Tail County’s ongoing Sewage System Inspection Program, our Office inspected your sewer system located at 23163 STATE HWY 108 on 8/19/2014 and agreed with Schueller’s Septic Solutions. At that time, we found your sewage system to be non-compliant for the following reason(s): Failed compliance inspection Please contact our Office by 09/22/2014, at 218-998-8095, so that this matter can hopefully be resolved. |2' 3A 3 ■■ 2 (e ^Sincerely, hcuJC, Scott Ellingson Inspector is aY///7 o.u '— ■ d-Compliance Inspection Formt Minnesota 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 RECEIVED AUG 1 h 201^ System Status LAND & RESOtfICE System status on date (mm/dd/yyyy): 8/5/2014 ^ Noncompliant- Notice of Noncompliance (See Upgrade Requirements on page 3.) Q 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 S Soil Separation (Compliance Component #4) - Failing to pmtect groundwater n Operating permit/monitoring plan requirements (Compliance Component #5) - Noncompliant Property Information Property address: NONE __ Property owner: Wells Fargo Bank NA Parcel ID# or Sec/Twp/Range: 37000290154003 _____________Reason for inspection: _______ ________ Owner’s phone: ___________ or Owner’s representative: Tom Verhelst - Keller WHIjarns Realty Local regulatory authority: Ottertail Co Land and Resource Dept Brief system description: S^buildings (16 bedrooms), Ejector lift tank to septic tanks, drainfield bed Comments or recommendations: 4 dwellings on the lakeside drain into an ejector lift tank and are lifted across Hwy 108 to a large septic tank (2500 gal??). Two dwellings off the lake across Hwy 108 gravity feed to the large tank. The large tank is followed by a 1500 gallon tank. The effluent then drains into a drainfield bed. Because of the high water table in this area a new drainfield must be designed or convert septic tanks to holdiing tanks. Representative phone: 218-998-4344 Regulatory authority phone: 218-998-8095 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: Bill Schueller Business name: Schuej|ef5:^eptic Solutions ^ Inspector signature: ^ Certification number: C3332 License number: L2945 Phone number: 218-770-9119 Necessary or Locally Required Attachments S System/As-built drawing0 Soil boring logs □ Other information (list): S Forms per local ordinance vrww.pea.state.mn.us • 651-296-6300 • 800-657-3864 wq-wwists4-31b • 6/4/14 TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 1 of 3 Property address: NONE Inspector initials/Date: BJS 1-8/5/2014 (mm/dd/yyyy) ■ -J1. Impact on Public Health - Compliance component #1 of 5 Verification method(s): K Searched for surface outlet S Searched for seeping in yard/backup'in home’ □ Excessive ponding in soil system/D-boxes □ Homeowner testimony fSee Comments/Explanation) □ “Black soil” above soil dispersal system □ System requires “emergency” pumjDing □ Performed dye test D Unable to verify (See Comments/Explanation) . □ Other methods not listed (See Comments/Explanation) Compliance criteria: D Yes ^ NoSystem discharges sewage to the ground surface.______________■ '.'i □ 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 r Verification method(s): ^ Probed tank(s) bottom □ Examined construction records □ Examined Tank Integrity Form f/Affacft; □ Observed liquid level below operatirig depth □ Examined empty (pumped) tanks(s) ^ Probed outside tank(s) for “black soil” D Unable to verify (See Cbmmenfs/Exp/anaf/on) D Other methods not listed (See Comments/Explanation) Compliance criteria: □ Yes M NoSystem consists of a seepage pit, cesspool, drywell, or leaching pit. Seepage pits meeting 7080.2550 may be compiiant if allowed 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: 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 fe/ecfnca//?azarc/s, efc.) to immediately and adversely impact public health or safety. DYes* 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. S Yes* □ No *System is failing to protect groundwater. Explain: Less than 3 feet of separation in soils from bottom of drainfield to saturated soil. 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 2 of 3 www.pca.state.mn.us • wq-wwists4-31b • 6/4/14 Inspector initials/Date: BJS | 8/5/2014Property address: NONE (mm/dd/yyyy) 4. Soil Separation - Compliance component #4 of 5 ^ 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. ^ Conducted soil observation(s) (Attach boring logs) D Two previous verifications {Attach boring logs) O Not applicable (Holding tank(s), no drainfield) D Unable to verify fSee Comments/Explanation) D 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. _____i □ Yes S No Comments/Explanation: Soil Boring: 0-40 Loamy Sand 10yr3/2 40-48 Sand 10yr 4/2 48 Sand 10yr4/3 Saturated Non-performance systems built April 1, 1996, or later or for non-perfonnance systems Ideated 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.* : r Indicate depths or elevations□ Yes □ No“Experimental'', “Other", or “Perfomnance" 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. \ 32A. Bottom of distribution media I- 48B. Periodically saturated soil/bedrock 16C. System separation: 36D. 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. V D Yes n 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 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. 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 3 of 3 www.pca.state.mn.us • wq-wwists4-31b • 6/4/14 Department of LAND AND RESOURCE MANAGEMENT OTTER TAIL COUNTY Government Services Center - 540 West Fir Fergus Faei-s, MN 56537 PH: 218-998-6095 Otter Taie County’s website: www.co.otter-taii..mn.us OTTERTflll 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: 37000290154003 Township: jjda___________ Property Owner Name(s): weiis Fargo Bank na Property Address: No 911 address Reason for Inspection: Transfer of ownership Number of Bedrooms: 2 29Section: □Yes[^In Shoreland Area? Lake/River Name, Number, & Class No Lida 56-747 GO System Compliance Status:__Compliant ^ Non-Compliant X 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 X NoYes Yes X No Yes X 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: Bill Schueller Certification Number: C3332 Business License Name & Number:Schu^U^'s-Septic Solutions L2945 Date:8/5/2014 Page 1 of 2Excel/Compliance Form for OTC 4/30/2014 otter Tail County Compliance Inspection Form Addendum (cont.) Parcel Number; ^3 Date & Initial: _____________8/5/2014 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). C^SJaJ 6ePVL »bcep / S._ Additional Comments; Page 2 of 2Excel/Compliance Form for OTC 04/30/2014 OTC Parcel Map Output Page 1 of 1 Otter Tail County Parcel Viewer Map http://www.ottertailcounty.net/servlet/com.esri.esrimap.Esrimap?ServiceName=parcelscoun... 2/8/2006 Print Key Output Page 1 01/19/06 12:07:495722SS1 V5R3M0 040528 OTTER Display Device User ....QPADEV0045MRONNING RCB310M1 RECAP Collection System R 37000290154003Calc thru: 1/19/2006 MP#:Total: EMV 107,100Dist: 3701 TIE Dist: Plat :Sect Inquiry - ♦STATUSES General Summar EXIST *NOTES y (A) EXISTR2007 Mod? Taxpayer TRACY S ROBERTS 20836 135TH ST WHITING lA 51063-8774 130382 Deeded acres .40LMV107,100 Twnshp Range Lot 136PT LOT 3, BEG 40' S OF SW COR SL A, E 218' TO LAKE, SLY 45', NON-HSTD - SEASONAL RES REC BlockAlternate29042Subd:Escrow 9400000WELLS FARGO REAL EST TAX SERV Prop Address 23162 STATE HWY 108 PELICAN RAPIDS MNOriginal 56572- Ad j /ChgT Unpaid BalPaymentsNet Tax Special Asmt Tot before P&I Penalty Interest Fees* *TotalsF2=Tier F14=Legal F16=Notes F17=APINs F19=OtherNames F24=MoreKeys A=GS B=ASM C=DQ E=TR F=SP H=THST I=PRASC J=COJ P=PA R=ADJ U=CAMA Y=CMP \ •N Inquiry - General Summary (A) ♦NOTES EXIST:' : RCB310M1 RECAP Collection System ^ E 370002901540022015 Mod? _ Calc thru: T■8/20/2014 MP#: 135774ROBERT W & KIMBERLY JACOBSON 1981 58TH AVE S FARGO ND 58104-7216 S. ♦COMMTaxpayer Total: EMV TMV Deeded acres500 500 .17Dist: 3701 TIF Dist: Plat:Sect Twnshp Range136PT GL 3 COM Wl/4 COR SEC 29 E 1934.47', S 23 DEG W 359.15' NON-HSTD - COMM SEAS REC RES Lot Block29042AlternateSubd: ♦MOREEscrow Prop Address Adj/ChgOriginalT Payments Unpaid Bal _ Net Tax _ Special Asmt Tot before P&I :: _ Penalty_ Interest . _ Fees♦ *TotalsF2=Tier F14=Legal F16=Notes F17=APINs F19=0therNames F24=MoreKeys A=GS B=ASM C=DQ E=TR F=SP H=THST I=PRASC J=C0J P=PA R=ADJ U=CAMA Y=CMP !■ Deeded acres Inquiry - General Summary (A) ♦NOTES EXIST , RCB310M1 RECAP Collection System E 37000290155001 _________2015 Mod? _ Calc thru: 8/20/2014 MP#: R 37000290154001 135774 *C0MM E TMV.. TaxpayerROBERT W & KIMBERLY JACOBSON 1981 58TH AVE S FARGO ND 58104-7216 Total:EMV 227,400 Dist: 3701 TIF Dist: Plat: Sect Twnshp Range 042 SELY 90.8' OF SUB LOT A OF GOVT. LOT 3 *SEE DOC 1003221 NON-HSTD - COMM SEAS REC RES 227,400 BlockLot 29 136Alternate Subd: ♦MOREEscrow Prop Address Adj/Chg Unpaid-Bal- j _ Net Tax ; _ Special Asmt . Tot before P&I ' ^ Penalty . _ Interest _ Fees Original Payments * *Totals ■ •<'. F2=Tier F14=Legal F16=Notes F17=APINs F19=0therNames F24=MoreKeys A=GS B=ASM C=DQ E=TR F=SP H=THST I=PRASC J=C0J P=PA R=ADJ U=CAMA Y=CMP »;■ :v i-' Inquiry - General Summary (A) ♦NOTES EXIST RCB310M1 RECAP Collection System ................ s 370002901540012015 Mod? _ Calc thru: 8/20/2014 MP#: R 37000290154001 135774 *C0MMROBERT W & KIMBERLY JACOBSON 1981 58TH AVE S FARGO ND 58104-7216 E Taxpayer Total:EMV TMV Deeded acres 130,700 Dist: 3701 TIF Dist: Plat:Sect 130,700 Twnshp Range 136PT LOT 3: BEG 198' W & 445.8' SLY OF NE COR S 40' E 145.8' N NON-HSTD - SEASONAL RES REC Lot BlockAlternate29042 Subd:♦MOREEscrow ♦MOREProp Address23163 STATE HWY 108 PELICAN RAPIDS MN 56572- Ad j /ChgTOriginal Unpaid BalPayments_ Net Tax _ Special Asmt Tot before P&I _ Penalty _ Interest _ Fees * *Totals F2=Tier F14=Legal F16=Notes F17=APINs F19=0therNames F24=MoreKeys A=GS B=ASM C=DQ E=TR F=SP H=THST I=PRASC J=C0J P=PA R=ADJ U=CAMA Y=CMP Section of Hotels, Resorts and Restaurants 717 Delaware S.E., Minneapolis, Minn. 55440 * N.> PUBLIC HEALTH and SAFETY INSPECTION RECORD P.O. /^jS^y/7^ LICENSEE ^ ADDRESS ATf/o BUSINESS NAME 2XLDATE OWNERCO. ADDRESS P.O. NO. OF EMPLOYEES Lie. NO. POSTED , CABINS ^NO. OF: BEDS____, SLEEPING ROOM^____, UNITS <S>Mobile Home Park and/or Recreational Camping Area Sites,TYPE OF BUSINESS ORDERS WRITTEN BELOW MUST BE COMPLIED WITH BY DATE INDICATED y/A) yfj ___________________________ ' /Tje^r^y- .5^,..jM_A^.syU£. i/yo’ /7^' y/ ^y. ' Ay} y Ayy'py,**j ■7'^Av ’ a'’ u A—yr ^ • * — " - ■ "“'B""/ /4 ^ jyAxx Arjycj/ AAyjAA j^jjA A uA> yyyA;^4.y y^/ /'yzLc yAAfi (J 4/ r?// —— -’ » ................................ < y/dZ y'^^yyy'J y42zyir Va-" » ______A^AAyiy AAy}/A. c. i y* T a.A2.^ A / iL TTk WELL - SEWER DIAGRAM COMPLIANCE PREVIOUS ORDERS YES NO COiLDISTRICT OFFICES ■ 1. Bemidji (755-3820) 2. Mankato (389-6025) 3. Rochester (285-0178) 4. Duluth (723-4643) 5. Marshall (537-6110) 6. Mpls. (296-5335) 7. Fergus FaUs (736-6922) 8. St. Cloud (255-4216) COPIES ■ Cfintr^ Office, Licensee. District Office ~ Z 1 /Received hy ^ . /A^Anyy^ ^Wetrll^Se^leUd/pimV^cto^^ m & 't rj^.. -^ ■ ■■■^'H 4^Tgkt*Sli> [vv f/ - %MS mWrCERTIFICATE OF COMPLIANCE SEWAGE SYSTEMPmM 9th 79 76JuneT/ifs certificate has been issued this day of.Pi fo certify compliance with regulations of Shoreland Management Ordinance. Otter Tail County, Minnesota. Sm m'M( pi m hitfi The premises covered by this certificate are legally described as: Lake No ^6-7U? Ser 29Is 136 Range LidaTwp. Hill's Resort Parcel in G.L. 3 29 A & B in Pla t Book Twp. Name. i5> rm m mt,laIpGeorge DingmanOwner: Name m Route #3 Address Pelican Rapids, Minnesota mm 56572Zip No. 1236 m-1 Permit No. SP_ISigned ^ —< K. Lee, Shoreland Administrator Otter Tail County, Minnesota MKL-087 1-009 ®159035 *‘eto» Lu«9tt>i ( eo. ^iiiTf«s, ftfcvt r»i.L», Kiim SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 - Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM White ■- Office Yeliow — Inspector Pink — Owner \ Card — Owr\er' M/U c^9 /Q Ci S ■— VI Date ,, ^ Permit No.,LEGAL C3t2> . 3 DESCRIPTION t r>AND Cr^<riC -7V> TWP LOCATION Lake Classif.Lake No. Lake Name Sec.Range TWP Name IDENTIFICATION: Please Print All Information. Initial Mailling Address —No. Street, City and StateFirst Zip No..Last Name Tel. No. ir *Y Y U 3~J./O; nn mn -/j)n urtf^ rAhf^ OWNER 3 iT »*'r5 Aw /Vn ^aA. 1 SEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection on.19. This space for office use only .M19 Phone Call Rec'd ByDate Rec'd Time Rec'd Owner or Agent Signa^ture NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT GIs.Sq./Ft.Sq. Ft.Capacity Ft.Ft.Ft.Distance from nearest well '5~r~) .L- y- Ft-Ft.Ft.Distance from lake or stream /(T) Ft.Ft.-QnDistance from occupied building Ft. 7Distance from property line Ft.Ft.Ft./ n Z yFt.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 ..........JVI By , 19....Z^.„, Rate.±Z/.u. PERCOLATION TEST DATA:Date of First Test Rate Date of Second Test,31st Test Taken By L.k.-y ^z.....First Test -I- 2nd Test 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.) V c2.0Dated. 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. 9/^ JyfZ QIssued Date: Shoreland Management Office Fee $___ Surcharge $_i(o bc’Cracrn S ______/vsro A cl____3c>no /Oo ' QfVa. i r\Comments: ^ ■/i'A /r>P) ijct fpfUn f\C L hyy-nrif=>.hi S4•?S>v vicTca WBSCIH • ee.. piiartM. rc«*us ratbi. .158906Form No. MKL-0771-003 SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 - Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM White — pffice Yello Pink Cdrrd -* dwrxer • —•Inspector — Owner .* fj,)k 'f-C' SPermit No.. /QuXlAtLEGAL Orl . 3 i Ao K V 'y/Date DESCRIPTION / - ^ c? S-29 / nAND I _7-LOCATION ~c , Lake No.Lake Name Lake Classif.Sec.TWP Range TWP Name IDENTIFICATION: Please Print All Information. Mailling Address —No. Street, City and StateFirstInitial Zip No.Tel. No.Last Name JTTY -• —1 r 1-^ ^ //On 0"' f Co y/'- r ;OWNER a.T7 ic/r m ' O-' /or /SEWAGE SYSTEM INSTALLER <r>Name, r .. 7^- AThis System will be ready for inspection on. This space for office use only /M.19 Date Rec'd Time Rec'd Phone CaM Rec'd By Owner or int Signature ■QNUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD Sq., Ft.GIs.Sq. Ft.Capacity / /_Ft.Ft. Ft.Distance from nearest well 'SO— /^-r') ^ Ft.Ft.Ft.Distance from lake or stream / /O Ft.Ft.Distance from occupied building Ft. / Distance from property line Ft./ o Ft.Ft./ /A/Ft.Ft.Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS:'s Inspection was made on 19 , Time JVI By ■yS/APERCOLATION TEST DATA:Date of First Test , 19...., , 19.... /> Rate Date of Second Test t..., Rate 1st Test Taken By /n 4.-77 VFirst 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 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. o / ^ Permit: /-V- A , , Cj "■ r Shorelar^ i Issued Date: Office Fee $_S Surcharge $___1 (/cZ-n > r\^ \Comments:. CjTyysr^r'j! g/ /. :v i r..’r( j-rLhi ^).A.h.'y-T)'' .f e r-: - \> Form No. MKL-0771-003 VICTDI kUMBCCa » e«.. PMIHTCM. rCMUl FALL*. MHia.lSS906 ? ■f-W « ' r*;v .> ■>INSPECTION RESULTS • -‘rl rInspector must make all measurements '• SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORYActualShould be Actual Should be Actual Should be Capacity GIs.GIs.S F S F S F S F Distance from Nearest Well 75F 50FFFF F Distance from Lake or Stream F F F F F F Distance from Occupied Building 10 2020FF F F F F Distance from Property Line 10 10 10FFF F F F Distance from Bottom to Water Table 4 4FFFF F F Inspector's Comments: TVs' ■- ' ■ - Ii. Date of Inspection 19___r Time of Inspection,M Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF = Square Feet “ Linear Feet Job TitleF 1 Agency MKL-0771-003-Backer , i -• •.-‘rT»9r V ■'% .•V .'r - ?! V .. fi-i - i iV' . .-■ ■V :■ ...>1 '■>'.. • :i.’ ••N ■•il > i V / ' ■' \l I('I m^'fi-' ^££»£^v£ 4^r L/DA i f.'f i; a—-*/^ ;V‘;;- p fC r\ 1/\ V i>. .• 1' I :•: f' . ^ ., '•• >"Si^^ '1; '^-M^-4. .ij V ■ u 1 1f 4 Lt I ✓o/^ L 1 /Od'C^- 'f- / / : GRID PLOT PLAN SKETCHING FORM.feet/inches.Scale: Each grid equals .19.Application for Building Permit Dated_____ Application for Sewage System Permit Dated Building Permit Number_________________ Applicant agrees that this plot plan is a part of application (s)'Adicated above. 19 1 I Sewa^System Permit Number. 19Dated Signal dicate all present builditias l|r additions with dotted j; A Vide yard setback and relr' On this form moke a drawing of your lot, \f with solid lines and ell proposed buildingp lines. Also Indicate in feet; lake setback yard setback. i I It 4.: . —r 4- i seiyiA " /OkI p/7' SUJly /so ^ /^o.s' 7^5;: / rtir4-•r-t- +■TT ir -f-rt ii J4 . .4-t r+T-4t r-H 4-1 - ------------------------i- f - ~ 15 3104 (ip vimi u)«tci 1I’•• h t _U- 1 •TMKL-0871-029 t pR liit' 9»k■ t »RtMnRR. I. +4-4 +4-.r PERCOLATION TEST DATA SHORELAND MANAGEMENT OTTER TAIL COUMTY Fergus Falls, Minnesota 56537 Trice $ 1.00 per pad.o I Ph. No.Ov;rier:Mailing Address:);/)/ 6^//i/W Last Name ^ First A i- d <z IT h A ? // RAp. 'd \ A), a'/)/ City ' StaleMiddleSt. & No.Zip No.) L. / v/Legal Descriptio'-;L-^T)Tioi(<, LAKE OR RIVER NO.NAME SEC.TWP.RANGE TWP NAME TEST HOLE NO. 2TEST HOLE NO. 1 aL^-Depth To of Hole Depth to Bottom of HoleInches;Inches; Diameter of HoleDiameter of Hole jnehesinches Date ^ / / ^ip7/Depth, ,Soil Texture Depth, Inches Soil Texture 19 7 ADate /..Sjj-'ri?) ..ZT>/n Percolation —I Test By. /z / k+ -f Percolation Test By____■LU^1 1Q LUFirmName.OCI F irm Name.{DOLU ---------------------------------------------------------------- cc M a,.- Z.-..Address.Address <5.< CO Otter Tail County License No.Otter Tail County License No^HCOUJMeasurement, Inches Depth In Water Level, Inches K Measurement, Inches Depth In Water Level, Inches Remarks Time Remarks i 7, Z; I I T ll 7:0C /Z‘7 /T:/gy<r 3T5iz'h'Tm Z'P'k/y /%7‘jg /3’ jyji / .T 'i Vu'7:ro 7IZ!~SlLlLL/ %keS / /1/.r7"^l /z) Z 5 Zea Ml7.'T8 ■7155. - I’'rr5 3Jk!Z ^ Va 12iMiL LTLUJZ J5'! 7'Mi ^ ‘J Z 3yizjoZ2J/a\Z 7.'5fo 9:o?r ZIZ ti?5 HVq LZTZ /%L/£5105e Sr.j-5 nis.} /£iz zy? i ' /5 9 ZLJyJZ^JX3Je^o MKL-0871 -028 See Booklet, "How to Run e Percolation Test" by Agriculture f.vr. Service, Un. of Minn. TO BE CO'n:>LETED BY PERCOLATION TESTER 1 hereby attest that I am familiar with the minimum standards required bv the OTTER TAIL COUNTY SHORELAND ^lANAOEMENT ORDINANCE regarding sewage systems and that the land elevation where soil absorption portion of sewage system will be installed in not less than six (6) feet above the high water level of the lake, stream or flowage involved. Legal Description; r fOwners Name ( Lake Name Please return when completed to Land and Resource Management Office, Court House, Fergus Falls, Minnesota percolation test results. 56537.Attach a copy of the r !IKL-05 74-045