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Jones_20000990269000_Septic System Permits_
OTTER TAIL COUNTY LAND & RESOURCE MANAGEMENT PUBUC WORKS DIVISION WWW.CO OTTER-TAIL MN USprrcRTiiji GOVERNMENT SERVICES CENTER 540 WEST RR AVENUE FERGUS FALLS. MN 56537 218-998-8095 FAX; 218-998-8112 9/18/2017 SCANNEDJeffrey T & Ann R Jones 2034 100th Ave S Horace ND 58047 9709 RE: Sewage Treatment System Servicing Tax Parcel Number: 20000020008001 Described as:Sec 02 Twp Edna Township Sect-02 Twp-136 Range-040 3.84 AC PT GL 3 COM WESTERNMOST COR Lake: 56-328 Little Mcdonald As of 09/12/2017 the (type 3) sewage treatment system (Sewage Treatment Installation Permit # 24873 servicing your property was determined to be in compliance with the provisions of the Sanitation Code of Otter Tail County for a 4 bedroom home. Please be advised that this certification is only valid for five years from the date of this inspection 9/12/2022 If you have any questions regarding this matter, please contact our office. Sincerely, \ Eric Babolian Inspector 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-tall.mn.us OTTER Tflll WHITE - Office YELLOW -L&R Inspector PINK - Owner / Contractor (after issue)eoliTT-aiiaiiOTii APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED Permit No. LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER SECTION TWP NO.RANGE TWP NAME5^3 LiWe t/' =3 / HO < ed PARCEL NUMBER (S) OF PROPERTY I^ocacMooy^ool /'BEING SERVICED E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROADbn. ^ lIgAL DESCRIPTION ^ T r S.3H Ac GC3 torr\ vV'^st■■^x■^nooS^SCANNEDtar. . . Last Name First Initial Mailing Address Daytime Phone No. lOcD^ 5Property Owner i?r>eS HoraC'P, , A/T) rKaLUX^I in.Contractor ^ Lie.# j/*9 l?t'Cl-VU/'i l/€Hll1 THIS SPACE FOR OFFICE USE ONLY A.M. >■ This System will be ready for inspection on , the year of .P.M.at. A.M. P.M. Date Received Time Received L&R Official TYPE OF N STALL ATI ON (circle one)SEWAGE TREATMENT SYSTEM DESIGN DATA AS SHOWN ON DRAWINGResiden^l ^New i/ (B) Replacement Collector Other Est. (D) New (E) Replacement (F) Add on (G) New (H) Replacement (I) Add on Soil Treatment Area (C) Add on Tank LiftDesign Flow (Gallons/Day)Effluent Distribi^ion Cn ) Gravity ( ) Pressure 0 1 — 2,499 2,500 — 4,99 (M) 5,000— 10,000 GIs 5Vo^'Size Setback To Nearest Well U(' (/Type I Type II Ft. (20) Trench, Rock (27) Rapidly Permeable i3o'no' (yFt.Setback To OHWL(21) Trench, Gravelless ^(28) Flood Plain ^(22)"^nch, Chamber (23) Bed (29) Privies Ft. Ft.Ft.Setback To Bluff(30) Holding Tank (Contract Required)5b' j/'3d(24) Mound Ft.Setback To Dwelling (25) At Grade Type III 75';^/Setback To Non-Dwelling(26) Greywater (31) Other/Problem Soils/<12" Soil Ft. 4.Type IV(34) Tank Only Setback To Nearest Lot Line 05 V/Ft.130(32) Public Domain & ' Proprietary Technologies (35) Other Depth of Well 7)gjg_p't/Setback To Road Right-Of-Way Ft.^ypeV lO Total It Bedrooms >33) Performance__________________________ X Elevation Above Garbage Disposal Y / Restrictive Layer 3^Ft.Ft.Y /c^i/Abatement PERCTEST DATA Designer 6 l| I HCj 3TH~)License #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 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 valid for a period of six (6) months. 2.This permit does not include the building sewer (sewer line). Signature of Property Owner/Agent fo^>wner Land S Resource Management Official Date: R - <3i3 ~ 17 Permit Fee $ M \Zdil'Ml SgpbcJDate:Rec. No.. Sar^l Sd I_________________ Date StampComments: i^isra L&R InitialForm No. BK — 04-2014-06 357.243 • Victor Lundeen Co.. Printers • Fergus Falls. Minnesota r APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENT GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 cr Aiiurn 218-998-8095dvnRlfCU www.co.otter-tail.mn.us C|||2^ln OTTER Tflit WW/TE - Office YELLOW -L&R Inspector PINK - Owner/ Contractor (after issue)cooiTraiiftiJOTB '7.^APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED Permit No. LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS SECTION TWP NO.RANGE TWP NAME -A:i 1/l*i< no.MO C i L- ' >C\ ■)5 KI ;1/ PARCEL NUMBER (S) OF PROPERTY BEING SERVICED / /• 33'^V-. 'T.u\ Ls>.E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROAD ; o.Oi i;-■-( 3 Cjfv> W'iSi-t'* yv'c'M4r COf , , Last Name First Initial Mailing Address Daytime Phone No. Property Owner 5I ’I,1 :fyc.a\n^SKiM'n fi.-M .1/^ MA/ Contractor Lie.# ,ii 1 l-i. r-,, THIS SPACE FOR OFFICE USE ONLY a AM. > This System wilt be ready for inspection on , the year of at. 9hihi Date Received P.M. Time Received L&R Official TYPE OF NSTALLATION (CIRCLE ONE)SEWAGE TREATMENT SYSTEM DESIGN DATA AS SHOWN ON DRAWINGResidential (A) New (B) Replacement (C) Add on Collector Other Est. (D) New (E) Replacement (F) Add on (G) New (H) Replacement (I) Add on Soil Treatment Area Tank Lift Design Flow (Gallons/Day) (J) 0 TK) 1—2,499 (L) 2,500 — 4,99? (M) 5,000 — 10,000 Effluent Distribution ( ) Gravity ( ) Pressure GIs Ft-.6-'oSize ■r Setback To Nearest Well ■ ft/Type I Type II Ft. (20) Trench, Rock (27) Rapidly Permeable Setback To OHWL Ft.at(21) Trench, Gravelless (28) Flood Plain n'.: ' (22) Trench, Chamber y (23) Bed (29) Privies Ft.Ft.Ft.Setback To Bluff(30) Holding Tank (Contract Required)(24) Mound /30 fV •3;-Ft.Ft.Setback To Dwelling (25) At Grade Type III Setback To Non-Dwelling(26) Grey water (31) Other/Problem Soils/<12" Soil ^1/Ft. Type IV(34) Tank Only Setback To Nearest Lot Line It - Ft/ -30 i,' Ft.•U- Ft.'(32) Public Domain & Proprietary Technologies (35) Other Setback To Road Right-Of-WayDepth of Well «5^Fy'/Ft.Type V lu 1Total # Bedrooms (33) Performance / iElevation Above Restrictive Layer ^ Ft.Ft.Ft. 10Abatement Y / N Garbage Disposal Y / N 5 IyM 0, i. -PERC TEST DATA -VI- i 1 V 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. Designer License #Date of Test Highest Rate 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 conditiort t|jat 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 t‘^6ked at any time upon violation of the Sanitation Code. : | NOTE: I.Thls permit is valid for a period of six (6) months. 2.This permit does not include the building sewer (sewer line).; 175.°^- !0M?1 \ | Jil7 ) UDate: f Permit Fee $j!■ /Signature of Property Owner/Agent tor Owner A skill /cm jfrlAjItP i & Ree^rce Managem Date:Rec. No., Land & Re rce Management Official 5^-1Comments:r. ;r-.0.HA. Form No. BK — 04-2014-06 |iqy ■k]. 357.243 • Victor Lundeen Co., Printers • Fergus Fails. Minnesota 171,'?YSEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTS/ C r r •f STA (Soil Treatment Area) OUTHOUSE HOLDING SEPTIC TANK TRENCH REDUCTION d U ijr. —S neck trenches with LIFT TANKCATEGORY ^2- GLS.fe) GLS.12Capacity inchesFT2 ^2t\ fO(:?VrJ (O^^ oof sidewall for %Setback from Nearest Well /O Setback from Buried Water Suction Pipe reduction / equivalent to fPFTFTFT Setback from Buried Pipe Distributing Water Under Pressure STA CALCULATION/■ O-^ FT •/ FT FT (Soil Treatment Area) FT 3Setback from OHWL (lake &/or river)FTIZO Ft. X . Ft2 Ft. Setback from Bluff FT FT FT 3 3- FT Yo- ftSetback from Dwelling ZO FT MOUND / AT-GRADE ROCK BEDSetback from Non-Dwelling ftFT FTSetback from Nearest Property Line ^ ftFT53>/Ft. X Ft. 3c?-^ ftSetback from Right-of-Way FT FT FP 3Elevation above Restrictive Layer FT FT FT SAND IN MOUND( e( y pif 5 IINSTALLERS COMMENTS SEPTIC TANK(S)Holding Tank / Lift Alarm □ YES □ NO 2,# Tanks InstalledWeep Holes [Old System Pumped & Destroyed □ YES □ NO Manuf.Number of Laterals #Lateral Pipe Size IN Z^%Oc>j9 Model #Perforation Spacing Ft.Perforation Diameter Size IN Gallons Per Minute [Feet of Total Head [FILTERS GYES □ NOPUMPS "T 'lpe 3Inspector's Comments: '^jfneC^ ~f Sketch: 1 0^.' ^ 0 Si ' * , the ^bove described sewagd system instal was found to be compliant with the provisions of the Sanitation Code of Otter Tail Countv. ( —— ^jnln S.;/As of Time Initial / L & R Official Land & Resource Manage niwssiForm No. BK — 04-2014-06 357,243 • Victor Lund««n Co.. Printers • Fergus Fells, Minnesota PARCELSKETCH OF PROPERTY SEPTIC INSPECTIONAPPPlease sketch all structures and septic systems on the property; Include setbacks and wells within 100 feet of the property.^onYEAR S& - {J tt'c Mc^nalcl CsP ScaW I - H beds /Vo Gcubogc yes puv«|j) l^OO'/.ooLj +re*<b<S 5)0 WCC (g) HCC db IcujC 43^y % \ ll r-S'euvs-Z3 s 3• 1 ^3 TT •] 1,0001500 I0®\ .1 y*'' /! / // / y .y) 9' Land & Resource Management Otter Tail County Government Services Center, 540 W Fir Fergus Falls, MN 56537 OTTCR TflII 218-998-8095 www.co.otter-tail.mn.us FAX: 218-998-8112 SITE DATA WORKSHEET Property Information: Lake / River Name Lake / River Class Section Township Name Edna Lake / River Number GD56-328 Little McDonald 2 Parcel Number(s) Property’s E-911 Address 2000002008001 / 20000990266000 / 267000 / 268000 / 269000 / 270000 / 271000 / 272000 38395 Teal Ln. Property Owner Information: Name(s): Jeffrey & Ann Jones Mailing Address: 2034 100th Ave. S Designer Information: Name: Scott Ellingson MPCA License Number: 3947 Advanced DesignerFirm Name: Scott's Septic Services, LLC License Category: Mailing Address: 201 Meadow Circle Ashby, MN 56309 (218) 205-1667E-Mail Address: scottsseptic@outlook.com Phone Number: Sewage Treatment System Design information: Number of Bedrooms: S Garbage Disposal: Yes Well: Casing Depth: |98.00| Floodplain: Yes Vegetation: Sewer Line Separation: | Bluff: [^Terrestrial t/ Slope at Installation Site: |3.0 \%^ / . Type of Observation: | | Probe [2 P't ^ Boring^ Parent Material: [2^ EU Original Soil: |^|Yes I I No / Compacted Soil: Yes [2 No ^ Ft.□ Yes [7] No*/ Aquatic I I Bed rock [ [AlluviumOutwashLoess Jpt. I84.00 I \v\.^Depth of Boring (to 7’ or restrictive layer): [ Signature of LicensBd Designer /J 08/22/2017 Date LR: Online Permitting Forms 2016: Site Data Worksheet Filable 03-09-2016 University OF Minnesota OSTP Soil Observation Log Project ID:V 04.20.2016 Legal Description/ GPS:38395 Teal Ln.Jeffrey ft Ann JonesClient/ Address: r~l Organic Matterr~l Outwash Q Lacustrine Q Loess Q Till r~| Alluvium O BedrockSoil parent material(s): (Check all that apply) [~~| Summit Q Shoulder 0 Back/Side Slope 0 Foot Slope □ Toe Slope Slope shapeLandscape Position: (check one) Soil survey map units Sloped Elevation:3.0Vegetationgrass 08/21/17Morning CloudyWeather Conditions/Time of Day:Date Soil PitObservation Type:mObservation ///Location: I Structure-IRockIndicator(s)Mottle Color(s)Redox Kind(s)Matrix Color(s)Depth (in)Texture Frag. %Shape Grade Consistence FriableWeakGranular10YR 2/1Loamy Sand <35*0“-10" FriableBlockyWeak<35%10YR 4/610"-24"Sandy Loam Single grain LooseStructureless<35%10YR 5/6Sand24"-46” Single grain LooseStructureless<35%10YR 6/446"-84“ Comments I hereby certify that I have completed this work in accordance with all applicable ordinances, rules and laws. Scott Ellingson 3947 8/22/2017 (Date)(License #)(Designer/Inspector) UNivaastt-r tM> Mkhmot*OnsiteSewageTreatmentProgram Additional Soil Observation Logs Project ID: 38395 Teal Ln.Legal Description/ GPS:Jeffrey & Ann JonesClient/ Address: I I Organic MatterQ Outwash □ Lacustrine Q Loess [2] Till □ Alluvium Q BedrockSoil parent material(s): (Check all that apply) [~~1 Summit Q Shoulder [3 Back/Side Slope [3 Foot Slope □ Toe Slope Slope shapeLandscape Position: (check one) Soil survey map units Slope%3.0 Elevation:Vegetation grass 08/21/17Morning / Cloudy DateWeather Conditions/Time of Day: Observation Type:Auger#2Observation #/Location: I Structure'IRockRedox Kind(s)Indicator(s)Matrix Color(s)Mottle Color(s)Depth (in)Texture ConsistenceFrag. %GradeShape FriableGranularWeak10YR2/1Loamy Sand <35%0"-12" FriableBlockyWeak10YR 4/6<35%ir-2i"Sandy Loam LooseSingle grain Structureless10YR 5/4<35%Sand21 "-45" LooseSingle grain Structureless10YR 6/4<35%45"-84"Sand Comments Observation Type:#3 AugerObservation #/Location: I IStructure'Rock Redox Kind(s)Mottle Color(s)Indicator(s)Matrix Color(s)Depth (in)Texture ConsistenceFrag. %Shape Grade FriableGranularWeak10YR2/1Loamy Sand <35%o”-ir FriableBlockyWeak10YR 4/6<35%ir-20"Sandy Loam Structureless LooseSingle grain10YR 5/6<35%20"-50"Sand ^SanS^Structureless LooseSingle grain<35%10YR 6/450"-84” Comments OSTP Design Summary Worksheet University OF MinnesotaMinnesota Pollution Control Agency V 04.20.2016Property Owner/Client: Jeffrey 8t Ann Jones Project ID: Site Address; 38395 Teal In.Date: 8/22/17 1. DESIGN FLOW, STRENGTH OF WASTE, AND TANKS Number of Bedrooms (Residential): 4 " J) Nutrients:c 600 Gallons Per Day (GPD)A. Design Flow: Treatment Level:CType of Wastewater:Residential r~l Measured Flow:[H Esdmated Flow:Commercial (select method and provide data): B. Septic Tanks: Minimum Code Required Septic Tank Capacity (Dwellings): GPD GPD 1500 Gallons, in 1 Tanks or Compartments Minimum Septic Tank Capacity for Other Establishments = Design Flow X 3.0 if received by gravity or 4.0 if received by pressure GallonsGPD XWaste received by: _______ Recommended Septic Tank Capacity: Effluent Screen a /tlarm: □ Yes □ No □ OpOonal □ Screen Onty Effluent Screen Manufacturer/AAodel: Gallons, in Tanks or Compartments Minimum Capacity; Residential -400 gal/bedroom. Other Establishment = Design Row x 5.0, Minimum size 1000 gallons Type of High Level /Harm: C. Holding Tanks Only: Minimum Code Required Capacity:Gallons, in Tanks Designer Recommended Capacity:Gallons, in Tanks GallonsPump Tank 2 Capadty (Code Minimum):GallonsD. Pump Tank 1 Capacity (Code Minimum); GallonsPump Tank 2 Capacity (Designer Rec):GallonsPump Tank 1 Capacity (Designer Rec): GPM Total HeadGPM Total Head ftftPump 2Pump 1 Supply Pipe Dia.in Dose Volume:galSupply Pipe Dia.Dose Volume:galin 2. SYSTEM AND DISTRIBUTION TYPE Gravity DistributionTrenchSoil Treatment Area Type:Distribution Type; Benchmark Location:ftBenchmark Reference Elevation: [v] Registered Treatment Media;O Dtakifleld RockType I Type of Distribution Media:MPCA Type: Quick 4 HCCComments: 3. SITE EVALUATION: 7[T^ft (SandSoil Texture:G.Depth to Limiting Layer:inA. &GPD/ft*H. Soil Hyd. Loading Rate:B.Elevation of Limiting Layer: MPILoc. of Restricive Elevation:Perc Rate:I.C. [T^ft □ Yes (3 No36J. Soil with >35% Rock Fragments Present? If yes describe below; % rock and layer thickness, amount of soil credit and any additonal information for adressing the rock fragments in this design. inD. Minimum Required Separation; Jin48E. Code Maximum Depth of System; 3.0 %Measured Land Slope X;F. Comments: 4. DESIGN SUMA4ARY Trench Design Summary Trench Width 3ft^ftSidewall Depth 12 inDispersal Area 408 Code Maximum Trench Depth 48.0 inNumber of Trenches 4Total Lineal Feet 136 ft Designer's Max Trench Depth 44.0 inMin Trench Length 50 ft12.0 ftContour Loading Rate OSTP Design Summary Worksheet University OF MinnesotaMinnesota Pollutian Control Agency Bed Design Summary ft'Absorption Area Depth of sidewall Code Maximum Bed Depthin Bed Width Bed Length Designer's Max Bed Depthftft in Atound Design Summary ft'Absorption Bed Area Bed Length Bed Widthft ft Absorption Width Clean Sand Lift Berm Width (0-1%)ft 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 System Finished HeightAbsorption Bed Length ftft Downslope Berm Widthgal/ft Upslope Berm WidthContour Loading Rate ftft System WidthEndslope Berm Width System Length ft ftft Level & Equal Pressure Distribution Summary Perforation DiameterNo. of Perforated Laterals Perforation Spacing ft in galgalMaximum Delivered Volumein Min. Delivered VolumeLateral Diameter Non-Level and Unequal Pressure Distribution Summary Pipe Volume (gal/ft) Pipe Length Perforation SizeElevation Spacing (ft)Pipe Size (in)(ft)(in)Spacing (in)(ft) 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. Catculate the organic loading 1. Organic Loading to Pretreatment Unit = Design Flow X Estimated BOD in mg/L in the effluent X 8.35 -r 1,000,000 gpd X ______ 2. Type of Pretreatment Unit Being Installed; 3. Calculate Soil Treatment System Organic Loading: BOD concentration after pretreatment i Bottom Area = Ibs/day/ft' Ibs/day/ft' lbs BOD/daymg/L X 8.35^ 1,000,000 = ft' =mg/L X 8.35 = 1,000,000 t Comments/Special Design Considerations: I hereby certify that I have completed this work in accordance with all applicable ordinances, rules and laws. 08/22/173947Scott Ellingson (Date)(License #)(Designer) OSTP Trench Design Worksheet University OF MinnesotaMinnesota Pollution Control Agency 1. SYSTEM SIZING:V 04.20.2016Project ID: 600 GPDA. Design Flow: B. Code Maximum Depth:48 44.0Designers Maximum Depth:inches inches GPD/ft^1.20 12.0 gal/ftC. Soil Loading Rate:Contour Loading Rate: D. Required Bottom Area: Design Flow (1.A) h- Loading Rate (1.C) = Initial Required Bottom Area GPD- 1.20 GPD/ft^ =500 ft^600 □ Rock 0 Registered Product □ Pressure 0 Gravity-Drop □ 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 Atedia: (selection required) F. Select Distribution Method: OTC 25* Rule 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 Cover 6 to 11 1 DistributionQ20%0.812 to 17 34%18 to 23 0.66 Sidewall 40%0.624 ftB. Select Sidewall Height:inches =Width feC. Design Bottom Area (2.A): ftD. Select Trench Width: E. Total Designed Trench Length: Bottom Area i Trench Width = Total Required Trench Length Ift^ +ftft = F. Calculate Minimum system length based on Contour Loading Rate: Design Flow - Contour Loading Rate = gal/ft =ftgpd^ Designed Number of Trenches H. Length per trench = Actual Trench Length - Number of Trenches. Recommended to be equal or exceed 3.J. I ft - Minimium base on CLRG. Number of Trenches: ft— ft (typically 5 -12 ft from center to center)J. Select Trench Spacing : K. Calculate Lawn Area: Trench Length (2.E) X Trench Spacing (2.G) = square feet of lawn area I ft X ft^ lawn areaft = ft (0.33 ft for pressure, 0.5 ft for gravity)L. Select Depth Required to Cover Distribution Pipe: M. Calculate Rock Volume: (Sidewall Height (Z.B) + Depth to Cover Pipe (2.J)) X Bottom Area (2.C) = cubic feet t 27 = cubic yards + 27 yd^ft^ft^ =ft) Xft +( 3.. TRENCH 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 5(X)1 12 to 17 20%0.8 400500 18 to 23 34%0.66 330 24 40%3000.6 Quick 4 HCCB. Registered Product: 12 1.0 ftC. Select Sidewall Height:inches 408 ft^D. Design Bottom Area (3.A): 3 ftE. Registered Width: F. Minimum Designed Trench Length = Bottom Area (3.C) f- Trench Width 3.D) ft^ +136 ft4083.0 ft = 4 ftG. Enter the Registered Product Component Length: H. Number of Components = Minimum Total Length Required divided by Component Length (Round up) 341364ft =ftf components I. Actual Total Trench Length = Number of Components X Component Length: 34 components X 136 ft4.0 ft = J. Calculate Minimum length per trench based on Contour Loading Rate: Design Flow -a- CLR = 50.0 ft12.0 gal/ft =600.0 gpd^ Designers Number of Trenches43Minimium base on CLRK. Select No. of Trenches: L. Length per trench = Actual Trench Length t Number of Trenches. Recommended to be equal or exceed 3.J. 34^0 Ifttrenches =136.0 ft 4 4 ft (typically 5 -12 ft from center to center)5M. Select Trench Spacing : N. Calculate Lawn Area: Trench Length X Trench Spacing = square feet of lawn area 680 ft^ lawn area1365ft =ft X Comments: Land & Resource Management GSC, 540 W Fir, Fergus Falls, MN 56537 218-998-8095; Website: www.co.ottertail.mn.us9;niii.nii Subsurface Sewage Treatment System Management Plan Sewage Treatment System Permit Number: Property Information: Lake / River Class SectionLake I River Number Lake / River Name Township Name 56-328 Little McDonald GD 2 Edna Parcel Number(s) Property’s E-911 Address 38395 Teal Ln.20000020008001/ 20000990266000/267000/268000/269000/270000/271000/272000 Property Owner Jeffrey & Ann Jones 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). "n Check manhole cover (accessibility, security, or damage). I understand it is my responsibility to properly operate and maintain the sewage treatment system on this property in accordance with this Subsurface Sewage Treatment System Management Plan. 08/21/2017Property Owner: Signature^Date The following link will provide information from the University of Minnesota, regarding a Septic System Owner’s Guide; httD://www.extenslon.umn.edu/envirQnment/housina-lechnoloav/moisture-manaQement/seDtic-svstem-owner-quide/ LR: Online Pennitting Forms 2016: SSTS Management Plan Flllable 07-27-2016 ^LLOI 3curacy is not guaranteed. NOT to be construed or used as a legal description. tail ^w^wuiiiy, iviii II loooia lyrtght 2014 Otter ■&« Coonly, fcW Acctracy is NOT guararteed. For REFERENCE purposes only. THIS IS NOT A LEGAL DOCIACNT Tue Aug 222017 06:36.16 AM. =2 ooooo S.OOO 5“oo / ^0000^^0 ooo ^lilOOO SisQOOO gib^OOO ^noooo ^ 7;OOO ^iStOOO ' ■-. r -*i. ■7» ■ ■■ -.•- y * ■**■* a, ' / -c ■% Department of LAND AND RESOURCE MANAGEMENT OTTER TAIL COUNTY Government Serv»ces Center - 540 West Fir Fergus Falls, MN 56537 Ph: 218-998-5095 Otter Ta«_ County's Website: www.co.otter-tail.mn.us RECEIVED JUL 1 7 im LAND & RESOURCE OTTER TRIl o o • •• 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: - 11 ^ Property Owner Name(s): Terrtwcg t 1-4/ysoy> Property Address: Reason for Inspection: Number of Bedrooms: In Shoreland Area? Lake/River Name, Number, & Class Section: "Z, . MKJ I ( ~P ivf" R1 tvtiLjc. Yes No 0System 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 Yes No A No No Yes No AYes No "Yes" indicates that the system is failing to protect ground water and is noncompliant. If "Yes", describe the condition noted: Required Attachments: System drawing to scale on next page. Completed MPCA Compliance Inspection I hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. Pk.l SMIName: Certification Number: Business License Name & Number: Signature: SCNWEII 7-/ -/rDate: Excel/Compliance Form for OTC 1/15/2014 Page 1 of 2 Otter Tail County Compliance Inspection Form Addendum (cont.) Parcel Number: ZjOQODOZOCQ ( Date & Initial: ________P.S^System Drawing The system drawing must be to scale and include all septic/holding/lift tanks, dralnfields, 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). *2) Wi ! I n5 o Io 2jCCO V'a.L cr Puv--^*i:‘l (^COC •; I20 fe|So ‘vt5 = COrvipli'tvnCg-Additional Comments: Excel/Comptiance Form for OTC 1/15/2014 Page 2 of 2 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): 7/1/2014 ^ Compliant - Certificate of Compliance (Valid for 3 years from report date, unless shorter time frame outlined in Local Ordinance.) G 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 protect groundwater □ Operating permit/monitoring plan requirements (Compliance Component #5) - Noncompliant Property Information Property address: 38395 Teal Lane, Perham MN 56573 Property owner: Terrance and Elizabeth Larson______ Parcel ID# or Sec/Twp/Range: 20000020008001 _____________ Reason for inspection: Sale _____________ Owner’s phone: ___________ or Owner’s representative:_______________ Local regulatory authority: Ottertail County Representative phone: _____________________ Regulatory authority phone: 218-998-8095_____ 2000 gal concrete holding tank for campsites, 2-1000 gal concrete tanks to 996 sq. ft. drainfield for 4 Brief system description: cabins and 1000 gal concrete tank to rock and trench drainfield sized for 3 Br for dwelling. Comments or recommendations: Total bedrooms calculates out to 13 bd. 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 Mure 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 drawingSoil boring logs □ Other information (list): E Forms per local ordinance www.pca.state.mn.us • 651-296-6300 • 800-657-3864 wq-wwlsts4-31 • 3116112 TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 1 of 3 Inspector initials/Date: PJS | 7/1/2014Property address: 38395 Teal Lane, Perham MN 56573 (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 G Excessive ponding in soil system/D-boxes D Homeowner testimony (See Comments/Explanation) □ “Black soil” above soil dispersal system □ System requires “emergency” pumping □ Performed dye test G Unable to verify (See Comments/Explanation) G Other methods not listed (See Comments/Explanation) Compiiance criteria: G Yes G NoSystem discharges sewage to the ground surface.______________ G Yes S NoSystem discharges sewage to drain tile or surface waters. G Yes G NoSystem causes sewage backup into dwelling or establishment. 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 Verification method(s): S Probed tank(s) bottom ^ Examined construction records G Examined Tank Integrity Form (Attach) G Observed liquid level below operating depth G Examined empty (pumped) tanks(s) G Probed outside tank(s) for “black soil” G Unable to verify (See Comments/Explanation) G Other methods not listed (See Comments/Explanation) Compiiance criteria: G Yes S NoSystem consists of a seepage pit, cesspool, drywell, or leaching pit. Seepage pits meeting 7080.2550 may be compiiant if allowed in locai ordinance. G 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: Observed tanks with camera. 3. Other Compliance Conditions - Compliance component #3 of 5 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* ^ 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* ^ No *System is failing to protect groundwater. Explain: www.p)ca.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 | 7/1/2014Property address; 38395 Teal Lane, Perham MN 56573 (mm/dd/yyyy) 4, Soil Separation - Compliance component #4 of 5 □ UnknownDate of installation; 5/1/1996 (mm/dd/yyyy) Shoreland/Wellhead protection/Food beverage lodging? Compliance criteria:_____________ Verification method(s): Soil observation does not expire. Previous soil observations by two independent parties are sufficient, unless site conditions have been altered or local requirements differ. ^ Conducted soil observation(s) (Attach boring logs) □ Two previous verifications {Attach boring logs) □ Not applicable (Holding tank(s), no drainheld) D Unable to verify (See Comments/Explanation) D Other (See Comments/Explanation) S Yes □ No □ Yes □ NoFor systems built prior to ApriH, 1996, and not located in Shoreland or Wellhead Protection Area or not serving a food, beverage or lodging establishment: Drainfield has at least a two-foot vertical separation distance from periodically saturated soil or bedrock. S 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”, “Other", or “Performance" systems built underpre-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 26"A. Bottom of distribution media >62"B. Periodicaiiy saturated soil/bedrock >36"C. System separation 36"D. Required compiiance 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 □ 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? □ Yes □ No □ Yes □ Nob. Is the required nitrogen BMP in place and properly functioning? Any “no” answer indicates Noncompiiance. 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 iodging establishments as defined in iaw. 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 Z(0(p0Oo^.ooo'Scci'T<^-Yr&.vvoe. i,o\ r So n II mill n--------------------------------Hriill-------------Name;. ^ b4\c^>^■ ciM" 1 -n k 0^1 r43\al S«,!st<'^ 2cOC<yi^ .ZKf'^i'i- = tOOO(jiJ-J^ \ \ IC - 50"W) Of <>i'' Soil Borto^ (BR Locate each bonog oa ^ 7ta^ abovv. indicate oa &e of die ooliimn die so3. texaiie, struttuie, color, dep& of each different fioStyp^ evidence of motiJing, bedrock and standing'water. /Uso indicate if dbszoaniid^ is £UL TtjkJ.«jioJ BS.#SR#10 yr To/5So'lVzH'' Vfe Cc;«^s€ S<^o( ^^^J^HOFM&miNC.5&^S^aiffiWAIS&(ASISZBB!!flNS)lSMm}MEiJ,C0L0UB00K3{SLBS3S0C&0K Vp^c C0.<^) >nCemaaoisi WlielcewisfB bscoiijp3#ted<a bzingtiie above .-sjfstEm inwcontpSancegfauEd «nim wunpiiiace? met pAlscivngjiWFttiilia^.daa'« W.SI97*• / IMl mi A 1^V< W. m CJi CERTIFICATE OF APPROVAL SEWAGE SYSTEMft W 21 St 19 31FphriiaryThis certificate has been issued this day of to certify' that the sewage system installed as per sewage permit number indicated below has been approved for use W-3 f.. m.by Otter Tail County, Minnesota.UM ifMj The premises covered by this certificate are legally described as: Lake No. 56-328 Twp. 136 Range 40Sec. 1 Twp. Name Ednat. iMLazy Acres Resort Ryan's Beach Lots 5-10 & Wl/4 Lot 4 & M/B TrI 'h S L ' •s'-imT.azy Acrps TnvpstorsOwner: Name MAddress PO Box 95, Frazpp, MN Zip No. <>110-2 2Permit No. SP Services 4 Units (2 Bedrooms Each5^^^*^^ MKL-0987001 iJjJ2Slueu^ Land & Resource Management Official Oner Tail County. Minnesota mv\t miSTPW WzMTM 284.S0d • Victor tundeen Co.. Pfinlets • Fergus Falls. MN • 1-800-346-4870 APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM WHITE — Office Yellow — Inspector Pink — Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218)739-2271 - FERGUS FALLS, MN 56537 /E_s-<S^7^ ayf/i'SLEGAL7 Permit No. -S' cf-DESCRIPTION (^) Yes ( ) NoAbatement: c AAND LOCATION LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER SECTION TWP. NO.RANGE TWP NAME Alch>^l£^b Jl /3C, Vo PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBERd)^CP^ £>32. - 6)<S<£>S-OG/ AO'- J9-{ ■'a£>0 -Airu. tS>Jk72~<SGo') IDENTIFICATION: Please Print All Information Last Name First Initial Mailing Address — No. Street, City and State Zip Code Telephone No. fS-^0,2.'/ AcJ’2SProperty Owner 7-i^yi^2s4'ay's 2-^ip ^ A/ a,. Sewage System Installer Name ys9 A.M. This System will be ready for inspection on , 19.P.M.at This space for office use oniy ■KNUMBER OF BEDROOMS: A.M. 19 P.M..)YES (3<1N0GARBAGE DISPOSAL: (Dale Rec’d Time Rec'd Phone Call Rec’d By SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) ( X) Septic tank ( ) Lift station (Alarm required) (^) Drain field ( X) Trenches ( ) Bed ( ) Mound ( ) Outhouse ( ) Sewer line TANK DRAIN FIELD 9?t^ SqFt.;iocoCapacity GIs. Distance from nearest well 50 Ft.Ft. Distance from lake or stream Ft.Ft. Distance from building Ft.^ Ft. Distance from property line Ft.Ft. 3*Distance from bottom to Water Table Ft.Ft. EFFLUENT DISTRIBUTION ) Gravity ( ) Pressure All distances are shortest distance between nearest points PERCOLATION TEST DATA: WATER WELL DEPTH /y’s 7^9 Perc Tester.Date of Perc Test. <=^ Average Rate ;2.Rate of 1st Test Rate of 2nd Test Agreement; The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in strict accordance with Ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minnesota Department of Health. Applicant agrees that plot plan sketches and specifications submitted herewith and which are approved by Shoreland Management Officical shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibilty of the applicant for the permit to notify the County Shoreland Management that the job is 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 Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of any said ordinances. NOTE: Permit void if work is not commenced within six (6) months. DATE: Issued Date: Land & Resource Management Office35-Fee $.Rec # Comments: O 277.212 * ViclOf Lundeen Co . Printers • Fergus Falls. MinneoslaBK 0795-003 ■APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM♦ * WHITE — Office Yellow — Inspector Pink — Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218)739-2271 - FERGUS FALLS, MN 56537 ■ JLa~fs S'- ch ^ ^ ^4^ T <«/^ ^ a..RyrSLrt^SLEGAL Permit No. DESCRIPTION (^) Yes ( ) NoAbatement:AND LOCATION LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER SECTION RANGETWP. NO.TWP NAME , , ! , . . /CLASSSC.-SX9 <5 0 •a PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBEF\d)^o~ - 0003-oo/ T?-{02Li:, ~ OOP ~4iru OJiyp ^ oe>o') jok. IDENTIFICATION: Please Print All Information Last Name First Initial Mailing Address — No. Street, City and State Zip Code Telephone No. yii.-6r/7 AProperty Owner J- S-iaTS rt 2,j5^S'V4/ £jto f-tS Strx ^3/7 a. Sewage System Installer Name -H- ,3-37- !?-, 19 H(d► Ihis System will be ready for inspection on.at This space for office use only -KNUMBER OF BEDROOMS: 7-/7 i»96 A -g3 AftrTT^ Time Rec'd ^ Phone Call Rec’d By (\iNOGARBAGE DISPOSAL: ( ) YESDate Rec'd SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) ( X) Septic tank ( ) Lift Station (Alarm required) ( X) Drain field ( X) Trenches ( ) Bed ( ) Mound ( ) Outhouse ( ) Sewer line TANK DRAIN FIELD 9?^ SqFt.Capacity ;iooo GIs. ‘^o//dODistance from nearest well SO Ft. Distance from lake or stream %so Ft.Ft. Distance from building Ft.67 Ft. Distance from property line /z?Ft. Ft. Distance from bottom to Water Table Ft.Ft. EFFLUENT DISTRIBUTION {y) Gravity ( ) Pressure All distances are shortest distance between nearest points PERCOLATION TEST DATA: WATER WELL DEPTH /FS A7(^9 Perc Tester.Date of Perc Test.T7 -11-) F, yAverage 1;2.Rate of 1st Test Rate of 2nd Test Rate 1 Agreement: The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in strict accordance with Ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minnesota Department of Health. Applicant agrees that plot plan sketches and specifications submitted herewith and which are approved by Shoreland Management Officical shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibilty of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. 7 - J2 - 77^j2^ • ^ Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of any said ordinances. NOTE: Permit void if work is not commenced within six (6) months. DATE:. Signature Issued Date:ILand & Resource Management Office35-7_^J3797_^F^S£)'/Fee $.Rec # Comments: ,7 .Oi 277.212 • Victor Lundeen Co.. Prirtters • Fergus Falls. MinrteostaBK 0796-003 M ti.J lilt) J1>J * 0 INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS DRAIN FIELDHOLDING SEPTIC TANK LIFT TANKCATEGORY Actual Minimum L SFGLS.SFCapacityGLS.U/A^(WA ftSO FT70 FTDistance from Nearest Well FT FT Distance from Buried Water Suction Pipe FT FTFT50FT Distance from Buried Pipe Distributing Water Under Pressure fO^ FT+ FT FTFT10I 0 > Distance from Lake or River (OHWL)FT /oo-^ ftlooFT FT /S^Distance from Nearest Building (TO ft 10/20 FTFT FT FT 10(0'^FT FTFTDistance from Nearest Property Line IS^ ft /S+ ft FTDistance from Bottom to Water Table FT 3 YES NOHolding Tank/Lift Alarm ^ O'ES-7-NOOld System Pumped & Destroyed Sewer Line to Well Separation DRAINFIELD CALCULATIONINTERPRETATION OF ABBREVIATIONS GLS. = Gallons SF = Square Feet FT = Linear Feet 3S3- PTX ^Actual Minimum 77 FT FT20 SF / 77r\c^Inspector's Comments:i jn ^yrS3 t)0»vft 4rj 37 r y A-0 SKETCH: o a 'TTJ.s'fcI.W uo Ho 70 ys. I ■ € Hi ■SL(h___ ,1 Inspector's Signature Date of Inspection Time of Inspection i ' ' L-6^ uj ^x~c \ (j lj\ J^-4^ M^h^- X ^TKa^ ^:^\(X'w$^-cJ CWxj^ cKpU\AA-^^^-^<^ C ^^IaaX)oo( J^^cxcK^ (y\^ j:^a-<A. jv&4Lpri^^^y<&cicf<^ «5^ IJL JUJC-<L h^x. *"11^LO 1 *1'dc-co QjkJ^A, E ~TL^ . f ix^ GRID PLOT PLAN SKETCHING FORM — (Must Be To Scale) inchesScale: Each grid equais 19 ^ ^ ■Dated;I®, ff signature Please sketch your lot indicating setbacks frgm'f^d right-of-way, lake and sideyard for each building currently on lot and any proposed structures. ^ 20 U\\\ 5 ^©=*^N Ch-t V \ ’1 \ I 2^A-Ot/^ \ Kw C>^u^ >w t 4f ^ / 5 dc^USyO^I PERCOLATION TEST DATA LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, MN 56537 OWNER: 218-346-6917Lazy Acres Investers - Lazy Acres Resort TELEPHONE NUMBERMIDDLEFIRSTLAST NAME ADDRESS: 56544MNFrazeeRR 3 Box 237 ZIP CODESTATECITYSTR./RT. Edna401362Little McDonald328 TWP. NAMERANGETWP.SEC.LAKE NAMELAKE/RIVER NO. LEGAL DESCRIPTION: Ryan's Beach 1/2 lot #4 - lot #10 plus the back parcel 20-000-99-0271-000, 20-000-99-0272-000, 20-000-02-0008-000 20-000-99-0268-000, 20-000-99-0269-00020-000-99-0270-000, 20-000-99-0266-000. 20-000-99-0267-000, PARCEL NUMBER 4 cabins/8 bedroomsLM 92 N UMBER/BEDROOMSFIRE NUMBER ^ — TWO TESTS ARE REQUIRED If.SI HOLE NO. 2TEST HOLE NO. 1 IDepth To Bottom of Hole 2^^inchesinches; Diameter of Holeinches; Diameter of Hole.inchesDepth To Bottom of Hole ^ Depth. Inches I Soil Texture Dale^ ^Sa^enkamp ExcAVc^fing & p'^^oggenkamp Excavatina & Trenching nt. 3 Box 63 A Wadena, Miniii 1919DateSoil TextureDepth, Inches 7J_ Zf3 631-3389 -----5648'i Irenching — Ri. 3 Box 63 A 531. m AddressAt Otter Tail County License No. Otter Tail County License No.7>5-9 PERC TEST # 2PERC TEST # 1 TIME prratvsfcLfliflMin'm ST^RT WATBRDBrrpiWRCRATB reRC KATE^ATaVWflfWiOTRDBrrHinterval , ^ 4. ^ .•!(z TTMB" ^ pfcop PBRC TIMM' ^ PROP FHRC6.CT r:reRC RATSTIMEIWTBtVALOiflMUTBR^ RSPILL WAJ^PgFfH WAJBRpKORKRCRATHw/impuffTTT-lWTBRV*L<hfflfiniBR)TIME £LIL TIMB ^ DROP PHRCTO»4H • DROP AaAfc R^ILL -JMi WATER DEPTH WATER PROrINTERVAL AhnWlfTEft PERC RATEPERC RATE TIMEWATER PROPINTERVAL OnllMIfTBSl WTB^aBPTHTIME ...Atf..... - -7-5 „ St'3^(R^ILL ItMB" DROP PBRC JLW - /'HMk DROP PBRC R^ILL Zr?---SJ- TIME INTERVAL fMlWUTRg^ WATER DEPTH PERC RATHPERC RATEWATER DROPWAmPEPTINTERVAL IMINUTBSItime iX _/-X—----/-jZr—-LS 1.* ' - ' 'ItMIl DROP raB R^ILLRyiLL/,/A-' ^ TUlm ^ DROP PHRC /2d. TIME INTERVAL rygNITTB*^WATER DEPTH WATER PROPreHCRATE PBRC RATEWATER DROPWATER DEPTHINTERVAL fMlMtnESITll>g sd3d -/-/----- R^ILL / . '. ^ 'llMli DROP PERI'HMli PICCIP PERC ttRJlLL -A^T-1A'5' TIME INTERVAL IMTWtnERlPERORATE WATER DEPTH W>tfHRDROR PERC RATEWATER DROPINTERVAL fMTNt/TES>WATER DEPTHTIME ..fjCLiP.Id /f TO>C' ^ DROP PERC RyiLLREFILL jL+ ^ TlXm dr6!F PBRC 3d TIME INTERVAL <MPnfTETI PERC RATEreRC RATE WATER DEPTH WATER DRORWATER DROPINTERVAL IMPIUTBP WAI^JEPTWTIME .-LS.dl— -UC^__ 3d PROP PERC R^ILL1.R^ILL Li I. ( 'IIMM PR<ISt*^ PBRC /6I± TIME INTERVAL fMINlfTERI WATER DROPPERC RATE WATER DEPTH PERORATEWATER DROPINTERVAL IMTWlTTRft WATER DEPTHTIME Sl t.P./ ♦ / . / 'ITMB" ^ PltiSB PBRC R^ILL d Z-±R^ILL nim ^ DROP PBRC/—?-—..d-d... /XCOMMENTS/CALCVLA TIONS: 250,815 — Victor Lundeen Co.. Printers. Fergus Faiis. MinnesotaMKL - 0390 - 005 Little McDonald LakeLazy Acres Resort RR 3 Box 237 Frazee, MN 56544 218-346-6917 G LOG^ Is the area disturbed or compacted? Yes L B' cjp Is the area located within a floodplain?Yes What is the landscape position? Drainage?UnknownVegetation type?Wet Poor Recommendations TEST HOLE #2TEST HOLE #1 DEPTH (INCHES) TEXTURE MUNSELL COLOR* • STRUCTURESTRUCTURETEXTUREMUNSELL COLOR* DEPTH (INCHES) ( Blocky Platy Prismatic None sand Blocky Platy Prismatic None 7^^ // s 3/^Blocky Platy Prismatic None sand Blocky Platy Prismatic None // 2-3 : Blocky Platy Prismatic None sand Blocky Platy Prismatic None 3j(>ft Blocky Platy Prismatic None Blocky Platy Prismatic None sand I sand Blocky Platy Prismatic None sand Blocky Platy Prismatic None / tJ 7 01 sand Type of observation^^^orin^ Soil map unit;_____ Elevation of boring: Type of observation; boring pit probepit probe Soil map unit;. A'S-c-ql^Elevation of boring; Depth to standing waterDepth to standing water /t/€rv\JL Depth to mottling:Depth to mottling; tr Depth of system:Depth of system. ‘Please note: Soil horizons in the moisi condition that exhibit mottles that have chromas of 2 or less and a value of 4 or more according to the standard Munsell color notation, irxlicate that the horizon is or has been saturated. DESIGN CALCULATIONS lililMli Design Flow 4 GPD Pleasa draw cross section of trench conatniction 1ROCK (CUBIC YDS REQUIRED) TRENCH BOTTOM REQUIRED LFTYPE REQUIRED [‘T^^lsq. ft 33^ILFH Graveliess ^3 ] cubic yards 1n 6" rock under pipe ILF I[ 1 sq. ft ^S6 [ ] cubic yards] sq. ft ]LFIO 12" rock under pipe i [ ] cubic yards]LF] sq. ftIn 18" rock under pipe K. [ ] cubic yards1 sq. ft.ILFd 24" rock under pipe I iU> Comments: MOUhPPESIGN Pleaso draw cross section of mound oonstmction GPDDesign flow____ Land slope_____ Rock layer length Rock layer width Cubic yards of rock required Required absorption width _ Total mound width________ Total mound length_______ Downslope dike width____ Upslope dike width_______ % feet feet feet feet feet feet feet Number of perforated laterals Number of perforations Header pipe size Elevation difference between pump & point of discharge Total pipe length from pump to discharge point_______ Selected pump capacity Total head ! ( ______ GPM Feet of total head kf S»s»%. 'h'<■ id.■A ■!.V^rSiCTeti I'!i m.W1 CERTIFICATE OF APPROVAL SEWAGE SYSTEM HOLVING TANKS s* %&1 11&J PecgJTibpA3?^.tTTi/i' certificate has been issued this to certify that the sewage system installed as per sewage permit number indicated below has been approved for use by Otter Tail County, Minnesota. 1911day of mm* if Afm The premises covered by this certificate are legally described as: H56-3ZS Edna ■1 136 40Lake No.Sec.Twp.Range Twp. Name ml mm fe- 'i Lazy Acau Rz&ohJ: -.-■■a m ii[8 Camp.{,TJ:eJ>];■ ♦ Ri RobeAl VadnaLiOwner: Name n R#3 Box 237, F^aze^, MW5-;i Address St!56544miZip No. rM8704*6Permit No. SP 'PSigned by: m Land & Resource Management OfTicial Otter Tail County. MinnesotaMKL-0987001 1 ^1 Wi ■ij i?5 SR.*17^m 25.V617 Vidor Lundeen Co . Primers. I'ergus |-iills. Minnesofj 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 * mite • Office Yellow — Inspector Pink — Owner /hid * 70 3 /I^iaoL Po^y^-^ 0^ Sc^ VLj jgs - 3^ 1: iH*t m, bc**cU Permit No.LEGAL DESCRIPTION Parcel Number AND X I3C, w <CpeLOCATION Lake No.Lake Name Lake Classif. TWP NameSac.TWP Range IDENTIFICATION; Please Print All Information. Mailing Address — No, Street, City and StateFirst Zip No.Tel. No.Last Name Initial Coheir t 6,^77hcLCS JU.2 Aar^S RxSY)r^___________ OWNER P'r'n-L-e-^3^SVV SEWAGE SYSTEM INSTALLER f • * c1^ This System will be ready for inspection on., 19-WT7 P 1991 5 n^ScUfiCB This space for office use only 19 .M Date Rec'd Time Rec'd Phone Call Rec'd By NUMBER OF BEDROOMS:ESTIMATED COST: ~7aJd/< .5€PTfe-TAN^SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PIT >^RAIN FIELDzSq. FZGIs.Capacity /zFt.Ft.Ft.Distance from nearest well zFt.Distance from lake or stream Ft.Ft. //O Ft.Distance from occupied building Ft.Ft. 7/O Ft.Distance from property line Ft.Ft. 7Ft.Distance from bottom to Water Table Ft.Ft. Ah distances are shortest distance between nearest points PERCOLATION TEST DATA:Date of First Test Date of Second 19 , Rate 1st Test Taken By First Test + 2nd Test 2 :Rate Agreement: The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by 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 thg jtppii<-ant tho pnrmi* notify County Shoreland Management that the job is ready for inspection. l/ffiderstand that I have been granted a sewage system site permit in accordance witii^ the requirements of the Shoreiand Management Ordinance of Otter Tail County. I J understand I must contact my township in order to determine whether or not any addi-^,^ tlbnal permits are required by the township for my proposed project. ^“*****^ 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. 7 / Signature Permit: S-Z3-f/Issued Date:__ Fee $ Land S Resource Management Office Rec # Qy C/3 31 Form No MKL 082090 ^ c:..gL->.-yQ.o<-^^Y7 ^ ZXl.__^iSz2l3l Comments: 253,056 — Victor Lundeen Co., Printers, Fergus Falls. Minnesota f 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 T OffkM Yeltow Inspector Pink — OwnerI U) Ao-^s % <h/0. And *70 Aer^ 'hraa.-^ 3 ftiAcL 2.(N of SCAJ/tj - 3;?^ l; AU be U___&b j ^ !3Q do. ' M Soc. m Permit No.I'LEGAL ^20^70-^'9 -I DESCRIPTION ^ ^ ^ Parcel Number _______^Qp-i-ooto ■7o-t TC^- ^ ^AND LOCATION Lake No.Lake Name Lake Classif TWP TWP NameRange IDENTIFICATION: Please Print All Information. Mailing Address — No. Street, City and StateLast Name First Initial Tel. No.Zip No. v c^ ri r(f 3 Bme 237A3r)'t>et- t A 'lH /EttlieLS^OWNER AO/difl(>^d ■^rnr/>cA-*y 7 A c3>^sb3sA^ f'tf LSEWAGE SYSTEM INSTALLER /ClName. /AgAeri^i tHo>->J=_ il 4. S. fi. p.(p "v3This System will be ready for inspection on., 19 This space for office use only i 1i19,M Date Rac'd Time Rac'd » Phone Call Rac'd By 1 1NUMBER OF BEDROOMS:ESTIMATED COST: ' •&a^TI€--TAI4li' 1SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PIT DRAIN FIELD /Sq. FXGIs.Capacity So Ft.Ft.Ft.Distance from nearest well 73'^Ft.Distance from lake or stream ■ Ft.Ft. /oDistance from occupied building Ft.Ft.Ft. zDistance from property line Ft.Ft.Ft. 7Distance from bottom to Water Table Ft.Ft.Ft. AH distances are shortest distance between nearest points 7tyr-.. .iA-4 PERCOLATION TEST DATA:Date of First Test 19 RatP Date of Second 19 Rate 1st Taken By 7t ' f*+ 2nd Test..;-..First Test..r . s I2test, Takort^y Rate \ iThe 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 1 3 l^fhderstand that I have been granted a sewage system site permit In accordance with fhe requirements of the Shoreland Management Ordinance of Otter Tail County. I tmderstand I must contact my township in order to determine whether or not any addi- tidnaLpermits are required by the township for my proposed project. O-— Permit: 7 “^signature 'lZ % 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. ' I S-23-9/Issued Date: Land i Resource Management Office5J2-11Fee $ 73 Rec #j ^ ^ - ibOtO Af J ■ ^ • ■5Comments: I,1 J H,■C^XfZ- Form No MKL 082090 253,056 — Victor LunOden Co., Printers, Fergus Falls, Minnesota . ♦. 'i Jr-^ ■« ' .6 r.-. >« INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS li.T. WEPTICnANK SEEPAGE PIT DRAIN FIELDCATEGORYActualShould Be Actual Should Be Actual Should Be Capacity GIs.GIs.S F S F S F S F 50Distance from Nearest Well F F F F FF llX 50Distance from Lake or Stream F F,.F F F F 5“^yoDistance from Occupied Building F F F F F F ss IDDistance from Property Line F F F F F F Distance from Bottom to Water Table 3 3FFFFF.F AIns^ctor’s Comments: -------Ap<=>/^ I I •~<r''iYA-fi'OHj only N*^ I^^T>f//o/ Af -r1 4-I I j: 4 o uyv' Dat^of Inspection L19 rof Inspection P -■n Signature of InspectorIMTERPRETATION OF ABBREVIATIONS Gallons Square FeeC^^^ ' Linear Feet ^ L •Si ^ ^Job Tide i+'tWJ 32085 • Backor Agapcyr 1 y 1 nkVAJu^fi -4 t ru* I ii!:1 1 ; 1 i i II I :»• i- i I c:r:> \ \ I t Pump /a i ,v ^ t* /VA£'r^ ;!->1 ii IS' f i ':- i.4 ....I CERTIFICATE OF COMPLIANCE SEWAGE SYSTEMft /i 9th day of_koKAJiThis certificate has been issued this to certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota. The premises covered by this certificate are legally described as: 401361Lake No. 56-328 Sec. Twp.Range Twp. Name. 1i-2.08 AcA.e6 - ?t. SW 1/4 5.89 ActL^^ tn G.L. 3 Exce.pt ?tatted 04 Rt/on'4 Beoc^ Rocktey Wenzeli. m.Owner:Name. R#3 Box 246, ftiazee, Hinne&otaAddress. f-SA 56544Zip No. 6795Permit No. SP_ 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 Yeilow — inspector Pink ~ Owner px 6IX (/>/ Cl 3 S', “T?6,1 iRyf)y^'-s Permit No.,)LEGAL ^)C DESCRIPTION ( a^'sAND 56-I,GO o ^Orvi^LOCATION c>< TWP NameTWPRangeLake Classif.Sec.Lake NameLake No. IDENTIFICATION: Please Print All Information. Mailing Address — No. Street, City and State Zip No.Tel. No.InitialFirstLast Name 3 S<^ ;QULu ^h/'T.BLOWNER SEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection on... 19. This space for office use only .19 .M Owner or Agent SignatureDate Rec'd Phone Call Rec'd ByTime Rec'd 2,NUMBER OF BEDROOMS:ESTIMATED COST; SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD lS'r>GIs.Sq. Ft.Sq. Ft.Capacity Ft.Ft. Ft.Distance from nearest well Ft.Ft.Ft.Distance from lake or stream Ft.Ft.Ft.Distance from occupied building lO10Ft.Distance from property line 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 - ■3‘?2.1PERCOLATION TEST DATA:Date of First Test 19 . 19 Rate 5'^ ,1sir Test'^aken By I I (I r • Date of Second Test ., Rate 3.^7^7.....2.....First Test + 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 Shoreiand 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 Shoreiand Management that the-job is ready for inspection. T -4Dated.7^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. e.S'- IL - •^6Issued Date: Shoreiand Management Office20,0^SAILFee $Rec # Comments: iForm No. MKL-03208S 225239 — Victor LundNn Co., Prtotors. Fwgus Fils. IM SHORELAND MANAGEMENT — COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 • Fergus Falls, MN 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM White — Office Yellow — Inspector Pink — O^ner Gl 3 0e c h 0/7^^ft Permit No..yLEGAL pj. DESCRIPTION AND /7:Py,\'v>^)'1LOCATIONI i,‘. u (. Lake Clasilf. TWP NameLake No. Lake Name Sec.TWP Range IDENTIFICATION; Please Print All Information. Mailing Address — No. Street, City and State Zip No.Tel. No.First InitialLast Name f-OWNER ; SEWAGE SYSTEM INSTALLER Name,; ' /\fou7This System will be ready for Inspection on... 19. This space for office use only Dat4 Rac'd T Pfione Call Rac'd By .M Time Rec'd Owner or Agent Signature NUMBER OF BEDROOMS;ESTIMATED COST; SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD GIs.Capacity Sq. Ft.Sq. Ft. Ft.Ft.Ft.Distance from nearest well 7 Ft.Ft.Distance from lake or stream Ft. Ft.Distance from occupied building Ft.Ft. Distance from property line Ft.Ft.Ft. Ft.Distance from bottom to Water Table Ft.Ft. All distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on 19., Time M By PERCOLATION TEST DATA;Date of First Test . 19 , 19 Rate t-7Date of Second Test •7S., Rate 1st Test Taken By First Test + 2nd Test s 2nd Test Taken By Rate The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn- eMta 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. Agreement: 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. Permit: /S y \Issued Date: Shoreland Management Office Fee $Rec # Comments: iForm No. MKL-032085 225239 — Victor Lurtoecn Co.. Prtoton. forQus Fife. MN : ------------I-y /G-VO fa. iz ^4 ■ V Co -rvv *.'r S o.-\-=-i g v>.V(0*~ ka. V Covee • \■«. o T 0\^JL r^a. ^i-V~ - rvv t Kv N.O 0 Vn i • (j7. INSPECTION RESULTS Inspector must make all measurements DISPOSAL SYSTEM STATISTICS )~o CX‘Vf'€»CF'0 r/O DRAIN FIELDSEEPAGE PITSEPTIC TANK\CATEGORY Should BeShould Be ActualShould Be ActualActual 2 2S*C S FSTE rv bfcC ^ - vib'Capacity s Fs F S FGIs.GIs. T)lyiDistance from Nearest Well FFF. F FF )td'ISQDistance from Lake or Stream FFFFFF .f9UDistance from Occupied Building FFFFFF I F FDistance from Property Line F F FF/o 33Distance from Bottom to Water Table FF FFFF I »>e/^ 0»^^ S <4*0Inspector’s Comments: ^ Y 'PtVw-^ 'VsJW^^ o ri«i4 ^■X- PCt^c.e.o /I A ^ Oa C-Pf > CJL recye.'xoe’s ca \tiHg-i2-Q j_..w a La >g VNi'tV. AC^ WH\ I c^'V I VC po Z' 'Kt \sCo/£€ 0/\ \yj « S/ \% s -0 ots4- sI V-O \-o 2-H Cov»t 1 ? -IQ ^ to ' i»WiJ i . Date of Inspection / > OO MTime of Inspection Csfi. f €Jf! f m Signature of Inspector INTERPRETATION OF ABBREVIATIONS GIs = Gallons SF = Square Feet F = Linear Feet tfl''* ' ■' ( = , ..I'-.Vb 's^ 11' ,-:y . . ICi VtAaW Job me yKL - 032085 • Backar Agency t ^L, c* { • ^ I S',V\ 0 W5 Vd.S'. ■ Vv '4V5rJi.1-Z--t *V s . ?=»•>• \-U235^ki^ —(£.\J<L,r'« Cl ^<L.O.t 1^ -/--___Vj?\ __d nli iJj /-@j/m'. _v — cn 7— kUcf1 K N \y-V n" f- rr 7\ (1. MKL-0871 -028 215502® VICTOR LUNOEEN CO., PRINTERS, PERGUS FALLS,PERCOLATION TEST DATA LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, Minnesota 56537 3V4- c?/rPh. No. Mailing Address:Owner: C./T//7^a- g-, Zip No.StateFirst 'CitySt. & No.Last Name Middle J< f/}tLegal Description:iiAlf h(6 t-J TWP NAMESEC. TWP.RANGELAKE OR RIVER NO.NAME f /3 >ro6*yi^ .ro TEST HOLE NO. 2TEST HOLE NO. 1 ■6i3MDepth to Bottom of Hole inches; Diameter of HoleDepth To Bottom of Hole inchesinches;Diameter of Hole inches /A?A 'S'Depth, Inches Soil Texture Soil TextureDepth. InchesDate19 Date */ I7)^ n >'■'Percolation Test By____ Percolation Test By .£ tt. *1 g/*; Sn< r J/«y 7 f Q(r / /LUFirm Name.'7- t (^/c^ vy. QC F irm Name,Do111 /r QC TcA.UJ Address.CC Address < COOtter Tail County License No.Otter Tail County License No..H COLUIVleasure- ment, inches Time I ntervals minutes Drop in water level, inches Percolation rate minutes per inch Time I nterval, minutes Measure ment inches Drop In water level, inches Percolation rate minutes per Inch Remarks:Time Remarks:Timeo I—4,9 '■ HbAJ-Jn 7-^9.I2S.11 \ »oro; 2.1/h 1 f c/. 73.03,03? -?17L n.7 J±1/(I T y^- -y LX: Tt L I 0 : 6 o I /■z^3-T\n'SoZii\Ih.IL LM-1 i±Jr.■; I 2^/ "V 10 £70H7LAirlAtM-H4- rx ‘S4- HlA-HiXk ^aIaSa'.?T|—A¥A4.I All r See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of MN, Percolation rate =.minutes per inch minutes per inchPercolation rate =