HomeMy WebLinkAboutSilver Sage Guest Ranch_36000060044000_Conditional Use Permits_10-12-2022Date Received / Date Stamp
LYHN R LARSOH
OTTER TAIL COUNTY
RECORDER/REGISTRAR OF TITLES
FERGUS FALLS, MN
RECORDED ON
li/08/2022 10:00 AM
FEE: 46.00
PAGES 9
RECEIVED
SEP 2( 2022
-AND & RESOUBCt':C
%
THE ABOVE SP^E IS RESERVED FOR THE COUNTY RECORDER
L&R Initial"L
17C.L L TrTCTTTErTcjrnTl F
APPLICATION FOR CONDITIONAL USE PERMIT
COUNTY OF OTTER TAIL
GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537
(218) 998-8095
Otter Tail County’s Website: www.co.ottertail.mn.us
5oD -Application Fee _
Receipt Number
Reviewed / Accepted By; Date T
DAYTIME PHONE
/5 3Sr/ f J'li-kf/o/!. M
Jn/p/i /On/).
LAKE NUMBER/^___LAKE NAME Uv\A/LL\A g/\
^ RANGE 3? TOWNSHIP NAME f~ 1^/76//ij' Qn3]
PROPERTY OWNER
MAILING ADDRESS
E-MAIL ADDRESS
HeLAKE CLASS
u TOWNSHIPSECTION
E-911
ADDRESS
PARCELNUMBER 3G-cr)D or^ oo^i{Doa 13330
LEGAL DESCRIPTION
Please Check The Appropriate Requests
Cowwvyg VAwt^Land Use: Land Use Requested (From Table 1)
I I Shoreland Alteration; Total Cubic Yards Requested______
I I Excavation In a Bluff or BIZ: Total Cubic Yards Requested
SPECIFY YOUR REQUEST. PLEASE BE BRIEF AS THIS WILL BE USED FOR PUBLIC NOTIFICATION.
camps)+o camffmaJ-
5" (Inktci
t ^ iiyxiXo ~T'lV^
Conditional Use Permit Application / Page 2
Property Owner:,
I Understand That Approval Of This Request Applies Only To The Use Of The Land.
I Also Understand That Other Permits May Be Required; It Is My Responsibility To Contact Land & Resource
Management Regarding This Matter.
22
NATURE OF PROPERTY OWNER / AGENT FOR OWNER DATE
APPLICANT MUST BE PRESENT AT THE HEARING
(Applicant Will Receive Notification As To The Date/Time Of Hearing)
OFFICE USE ONLY
Date Of Planning Commission Hearing !'2^ %0Z/Z^Time
Planning Commission Recommendation
Motion; A motion by Trites seconded by Wass to approve the request to add an additional 23
campsites to the campground located at Silver Sage Guest Ranch. 8 Units in tier one and 15
units in tier two. Voting: All Members in favor.
Chairmlan/Otter Tail County Planning Commission
County Board Action
Approved As Recommended
_____Other
Denied As Recommended
lOlzsjzO^
Date OT Final Actionail dounty Board of Commissioners
CONDITIONAL USE PERMIT - f) I ^
L & R Official/Date
Permit(s) required from Land & Resource Management
Yes (Contact Land & Resource Management)No
Copy of Application Mailed to Applicant, Co. Assessor and MN DNR
Official/Date
CUP App 09-29-2021 Letter Sized
LAND & RESOURCE
OTTER TAIL Government Services Center
540 West Fir Avenue
Fergus Falis, MN 56537COUNTY - MINNESOTA
CONDITIONAL USE PERMIT
NO. 2022-013
STATE OF MINNESOTA
COUNTY OF OTTER TAIL
In the matter of:
A request for a Conditional Use Permit submitted by Michael & Joan Otto, Silver Sage Guest
Ranch, to add an additional 23 campsites to the campground “Silver Sage Guest Ranch”. 8
Units in Tier One and 2 Units in Tier Two. The Otter Tail County Shoreland Management
Ordinance requires a Conditional Use Permit to expand a Commercial PUD in the Shoreland District
of Otter Tail County.
The above-entitled matter was heard before the Otter Tail County Planning Commission on the 12th
day of October 2022 and granted by the Otter Tail County Board of Commissioners on the 25th day
of October 2022, on the request for a Conditional Use Permit pursuant to the Otter Tail County
Shoreland Management Ordinance for the following property:
15380 41O**^ Ave, Clitherall MN 56524PROPERTY ADDRRESS:
36000060044000PARCEL NUMBER:
Unnamed Lake (56-147)LAKE NAME/NUMBER:
South Quarter Corner, Section 6 of Leaf Mountain TownshipLEGAL DESCRIPTION:
(^) ottertailcountymn.usOTTER TAIL COUNTY IS AN EQUAL OPPORTUNITY EMPLOYER218-998-8095
LIVE YOUR best life HERE.
2
IT IS ORDERED that Conditional Permit No. 2022-013 be granted for a Commercial PUD to expand
the existing campground and add 23 campsites (8 units in tier one and 15 units in tier two).
STATE OF MINNESOTA )
) ss. LAND AND RESOURCE MANAGEMENT
COUNTY OF OTTER TAIL)
I, Chris LeClair, Director of the Otter Tail County Land and Resource Management department, do
hereby affirm that I have compared the foregoing document and Order granting this Conditional Use
Permit with the original Planning Commission minutes thereof preserved in my office and the Otter
Tail County Board of Commissioners action on the permit and have found the same to be a correct
and true transcript of the permit thereof.
This permit shall be issued in accordance with and subject to the conditions of the plans, maps,
designs, and all other documents referenced in the provisions of the permit between Otter Tail County
and the applicant(s).
1^day of 2022Dated this
Chris LeClair, Director
Otter Tail County Land and Resource Management
Drafted by:
Otter Tail County Land and Resource Management
540 W. Fir Avenue
Fergus Falls, MN 56537
1182269
No delinquent taxes and transfer entered;
Certificate of Real Estate Value
( ) filed ( X ) not required.
oo5 Cert, of Real Estate Value No. _____
CAROL SCHMALTZ
OTTER TAIL COUNTY RECORDER
FERGUS FALLS, MN
RECORDED ON
10/25/2016 3:26 PM
-|_acUcr_2^FEE: 46.00
PAGES 5
WELL CERTIFICATE REC'D: N
(Year)
Wayne Stein, County Auditor/Treasurer
by__---------------------------------------------
3WXX>0{»OD4^000 Deputy
X
(Top 3 Indios reseved for recordiiig data)
QUIT CLAM DEED
lndh»ldual(s) to Joint Tenants
Minnesota Unffiomi Conveyancfeig Blanks
■ _______ FofmlO.3,3 (2013)
eCRV number WA
DEED TAX DUE S1.6S DATE:!
iFOR VALUABLE CONSIDERATION, Michael R. Otto andJoan M. Otto, married to each other
OSBti iGnaaficTi !CGrantor^,i
hmwhy mnMpya anri qiiHniaiinB In Craig M. Otto and Nichote L. Otto, married to each other
tfasMl eTaadifinnta^
(^Grantee*), as joht
tenants, real wooerty In Otter Tall County, Minnesota, lagaily descrtbed as Idiom;
See attached Exhibit ‘A*
5feCCl»(oC}OH-H Ooo
3<sQcCOCoCC>H IcjCsO
OiSrCO a>SOOQ
I hereby certify that the
taxes for the year.^ciu_
for the lands described
within are paid.
County Treasurer
THIS DEED CONVEYS ALL AFTER-ACQUIRED TITLE OF THE GRANTORS.
The total consideration for this transfer b $500.00 or less.
Check here all or pan of ihedesalbed real pmper^ Is Re0aered(Toirens}O
together wflh a9 heredtamoits and appurtenances belonging thsfeto.
Oedtanpficahfeixw;
"m The Seler certifies that ttieSeSer does not know of any wesson
' Ihe described real property.
□ A wall dbctosuracertiflcateacconyanles this document a has
□ I am femiar with the property dascrfoed in this instnanent and
I certify that the status and number of weBs on the descrSrsd
real property have not chan^ since the last pravlousiy filed
wsA disdosure certHcalB.
Grantor
^aruMToto '
Page^til^
3tter Tail County, Minnesota 1182269 1 of 5
Page2o(2 iiifcwiesote Unifam (knveyaticing Blanlts Fonn 1(13.3
SlaleofMhne80ta.CounNof _________
This Instrument was actoKW(ledoad before me on /Q-lS^lla
manrled to emh other
. bv Michael R. Otto and Joan M. (3tto.
(teeBiiBBB««twSi(aMarfBBtri<itaMDtf
(Stamp)
IsigpmctfiMmuS^
T1ll8(llndRank):__
MyoomimBaionexpbn:
JUUEM. OLSON
I Notary PuMo-Mbmesota
M|r Camntatan fiyfeM Jsn 31, aoeo
TAX STATEMENTS FOR THE REAL PROPERTY DESCRIBED IN THIS
INSTRUMENT SHOULD BE SENT TO: IhsBilegilimeawliesllMUattustassMeactOatBBl
THSINSTRUNENT WAS ORAFTB) BY: pnsetiamailtitusl
Alexandria Title Co.
1804 S. Broadway, Ste. 140
Aiaxendrla, MN 56308
15-46 QO
Craig M. Otto & Nichole L. Otto
^*1/1
[
\
Dtter Tail County, Minnesota 1182269 2 of 5
5.00 Acre Parcel
That part of the East Half of the Southeast Quarter (E14 SE%) of Section 6, Township
131 North, Range 39 West, Otter Tail County, Minnesota, described as follows:
Commencing at the south quarter corner of said Section 6;
thence North 00 degrees 27 minutes 11 seconds West, assumed bearing along
the north-south quarter line of said Section 6, a distance of 1719.17 feet;
thence South 80 degrees 30 minutes 02 seconds East 263.66 feet;
thence northeasterly, along a tangential curve concave to the northwest, radius
266.00 feet, central angle 57 degrees 09 minutes 12 seconds, 265.34 feet;
thence North 42 degrees 20 minutes 46 seconds East, along tangent, 154.41
feet;
thence northeasterly, along a tangential curve concave to the southeast, radius
200.00 feet, central angle 63 degrees 50 minutes 18 seconds, 222.84 feet;
thence South 73 degrees 48 minutes 56 seconds East, along tangent, 42.91 feet;
thence easterly, along a tangential curve concave to the north, radius 566.00
feet, central angle 16 degrees 28 minutes 28 seconds, 162.74 feet;
thence North 89 degrees 42 minutes 36 seconds East, along tangent, 24.83 feet;
thence southeasterly, along a tangential curve concave to the southwest, radius
440.00 feet, central angle 52 degrees 21 minutes 32 seconds, 402.09 feet;
thence South 37 degrees 55 minutes 52 seconds East, along tangent, 58.75 feet;
thence southeasterly, along a tangential curve concave to the northeast, radius
265.00 feet, central angle 53 degrees 52 minutes 15 seconds, 249.16 feet;
thence North 88 degrees 11 minutes 53 seconds East, along tangent, 72.73 feet;
thence North 76 degrees 10 minutes 51 seconds East 54.08 feet;
thence Nprth 73 degrees 13 minutes 34 seconds East 89.92 feet;
thence southeasterly, along a tangential curve concave to the southwest, radius
195.00 feet, central angle 69 degrees 37 minutes 46 seconds, 236.98 feet;
Page 1 of 3 - #8549-desc
Dtter Tail County, Minnesota 1182269 3 of 5
thence South 37 degrees 08 minutes 40 seconds East, along tangent, 159.69
feet;
thence South 54 degrees 01 minutes 18 seconds East 191.40 feet to the point of
beginning of the land to be described;
thence South 00 degrees 00 minutes 00 seconds East 495.68 feet;
thence North 57 degrees 55 minutes 29 seconds West 339.27 feet;
thence North 00 degrees 00 minutes 00 seconds West 667.48 feet
thence North 90 degrees 00 minutes 00 seconds East, 287.48 feet to a
line bearing North 00 degrees 00 minutes 00 seconds West from the point
of beginning;
thence South 00 degrees 00 minutes 00 seconds East 351.96 feet to the
point of beginning.
The tract contains 5.00 acres more or less together with and subject to a 33.00 foot
easement for access and utility purposes over that part of the Southeast Quarter of
Section 6, Township 131 North, Range 39 West, Otter Tail County, Minnesota, the
centerline of said easement is described as follows:
Commencing at the south quarter corner of said Section 6;
thence North 00 degrees 27 minutes 11 seconds West, assumed bearing along
the north-south quarter line of said Section 6, a distance of 1719.17 feet to the
point of beginning of the centerline to be described;
thence South 80 degrees 30 minutes 02 seconds East 263.66 feet;
thence northeasterly, along a tangential curve concave to the northwest,
radius 266.00 feet, central angle 57 degrees 09 minutes 12 seconds,
265.34 feet;
thence North 42 degrees 20 minutes 46 seconds East, along tangent,
154.41 feet;
thence northeasterly, along a tangential curve concave to the southeast,
radius 200.00 feet, central angle 63 degrees 50 minutes 18 seconds,
222.84 feet;
thence South 73 degrees 48 minutes 56 seconds East, along tangent,
42.91 feet;
Page 2 of 3 - #8549-desc
)tter Tail County, Minnesota 1182269 4 of 5
thence easterly, along a tangential curve concave to the north, radius
566.00 feet, central angle 16 degrees 28 minutes 28 seconds, 162.74 feet;
thence North 89 degrees 42 minutes 36 seconds East, along tangent,
24.83 feet;
thence southeasterly, along a tangential curve concave to the southwest,
radius 440.00 feet, central angle 52 degrees 21 minutes 32 seconds,
402.09 feet;
thence South 37 degrees 55 minutes 52 seconds East, along tangent,
58.75 feet;
thence southeasterly, along a tangential curve concave to the northeast,
radius 265.00 feet, central angle 53 degrees 52 minutes 15 seconds,
249.16 feet;
thence North 88 degrees 11 minutes 53 seconds East, along tangent,
72.73 feet;
thence North 76 degrees 10 minutes 51 seconds East 54.08 feet;
thence North 73 degrees 13 minutes 34 seconds East 89.92 feet;
thence southeasterly, along a tangential curve concave to the southwest,
radius 195.00 feet, central angle 69 degrees 37 minutes 46 seconds,
236.98 feet;
thence South 37 degrees 08 minutes 40 seconds East, along tangent,
159.69 feet;
thence South 54 degrees 01 minutes 18 seconds East 191.40 feet and
there terminating.
The sidelines of said easement are to be prolonged or shortened to terminate on
aforesaid north-south quarter line of Section 6, and on a line bearing North 00 degrees
00 minutes 00 seconds West and South 00 degrees 00 minutes 00 seconds East from
the point of termination.
Page 3 of 3 - #8549-desc
)tter Tail County, Minnesota 1182269 5 of 5
Amy Busko
Amy Busko
Monday, November 7, 2022 10:54 AM
Jack Lelwica
Conditional Use Permit
SPRTLR0222110710220.pdf; Permit Application Process Handout 08-27-2021.docx
From:
Sent:
To:
Subject:
Attachments:
Good morning -
Attached is your Conditional Use Permit for your Residential PUD. Please be aware that you will now need a structure
permit for the Structures (Except Structures over 1000 feet from Otter Tail Lake) and any septic systems that will be
installed that are not part of the Otter Tail Water Management District.
Our permit application is online. Here is the link, https://oneROv.co.ottertail.mn.us/
If you have not created an account on the OneGov website you will need to do so and follow the directions. I have also
attached a help sheet for you to use if needed.
If you have any questions, please feel free to contact me.
Thank you and have a great day.
From: PRTLR02@CO.OTTERTAIL.MN.US <PRTLR02@CO.OTTERTAIL.MN.US>
Sent: Monday, November 7, 2022 10:22 AM
To: Amy Busko <ABusko@co.ottertail.mn.us>
Subject: Scan from OTC Land & Resource
1
Board of Commissioners’ Meeting Minutes
October 25, 2022
NOW, THEREFOR BE IT FURTHER RESOLVED, that the Otter Tail County Board of Commissioners hereby
authorizes the per parcel service fee to be increased from fourteen and 00/100 dollars ($14.00) to sixteen and
00/100 dollars ($16.00) per point per year, effective January 1, 2023.
The motion for the adoption of the foregoing resolution was introduced by Commissioner Rogness, duly
seconded by Commissioner Mortenson and, after discussion thereof and upon vote being taken thereon,
passed unanimously.
Adopted at Fergus Falls, MN this 25th day of October 2022.
OTTER TAIL COUNTY BOARD OF COMMISSIONERS Dated: Hgmm& 8, 2022
Attest:By:
Nicole^Harisen, ClerkWBetty Murphy, Board of Commissioners Chair
RECESS & ^iC6NVENE
At 8:54 a.m.. Chair Murphy declared the meeting of the Otter Tail Cpuhty Board of Commislifriers recessed
for a short break. The Board of Commissioners meeting was^ reconvened at 9:01 a.m.
\ : -
SION RECOMMENDATIONS
Motion by Mortenson, second by Rogness^;Snd**TOtion carried with'Johnson abstaining to approve the
Preliminary Plat "Jana Subdivision”, owned by Brett and danice Stein; consisting of 3 Single Family Non-
Riparian Lots, 1 Block, with conditions that existing buildings be legally located, and the septic system areas
be staked and fenced off. The proposal is located;at 486;IT.AIdeLDr , F?elican Rapids, MN, Sections 22 &23,
Scambler Township; Tamarac Lake (56-931), RD.
PLANNING CO
WkMotion by Johnson, second by Mortenson and motion carried, with Bucholz opposed, to approve the
Preliminary Plat “Brown Lake Addition”, owned by Joel Dotzenrod and Sharon Dotzenrod, consisting of 6 Non-
Riparian Lots and 1 Riparian Lot, 2 Blocks, with the condition that the septic system areas be staked and
fenced off. The proposal is located near 34801 County Highway 1, Battle Lake, MN, Section 32 of Amor
Township; Brown lake (56-315), NE.
Motion by Rogness, second by Mortenson and unanimously carried to approve a 15 unit Planned Unit
Development (PUD), owned by Jack and Ashley Lelwica, consisting of 3 units over 1,000 feet from Otter Tail
Lake and 12 units within 1,000 feet from Otter Tail Lake. 8 of the units will be for single family use and 2 duplex
units (each duplex has 2 units for a total of 4 units). Also included in the proposal is 20 boat-slips and 1 boat-
slip for transient use for a total of 21 boat-slips.
Motion by Mortenson, second by Rogness and unanimously carried to approve the addition of 23 campsites
to campground “Silver Sage Guest Ranch”, owned by Michael and Joan Otto, consisting of 8 units in tier one
and 15 units in tier two. The proposal is located at 15380 410th Avenue, Clitherall, MN, Section 6 of Leaf
Mountain Township; Unnamed Lake (56-147), NE.
Motion by Mortenson, second by Johnson and unanimously carried to approve the amended Preliminary Plat
of “Hull Creek Addition”, owned by Studio 78 Investments, Wes and Heidi Hull and Paul & Mary Olinger,
consisting of 5 Residential Non-Riparian Lots attached to 5 Non-Residential Riparian Lots 2 Blocks with a
decrease in lot size on Lots 1, 3, 4, and 5, Block 2 with no change in buildable area. The proposal is located
Page 3 of 16 OTTER TAIL
COUNTY ■ MINNESOTA
otter Tail County, Planning Commission
October 12, 2022; Page 3
Michael & Joan Otto - Silver Sage Guest Ranch - Approved:
Requesting 23 campsites to campground “Silver Sage Guest Ranch”. 8 units in tier one and
15 units in tier two. The proposal is located at 15380 410*^ Ave, Clitherall MN, Section 6 of
Leaf Mountain Township; Unnamed Lake (56-147) NE.
Brad Nyberg (Nyberg Surveying), Michael & Joan Otto (Property Owners) represented the
Commercial PUD.
The audience was polled with no one speaking for or against the application as presented.
Motion: A motion by Trites seconded by Wass to approve the request to add an additional
23 campsites to the campground located at Silver Sage Guest Ranch. 8 Units in tier one
and 15 units in tier two. Voting: All Members in favor.
Studio 78 Investments, Wes & Heidi Hull and Paul & Mary Olinqer “Hull Creek
Addition” - Approved as Presented with the Modification to Lot Sizes:
A Preliminary Plat “Hull Creek Addition”, consisting of 5 Residential Non-Riparian Lots
attached to 5 Non-Residential Riparian Lots 2 Blocks. The proposal is located at 22552 Co.
Hwy 5, Henning MN, Sections 33 & 34, Girard Township; West Battle Lake (56-239), GD.
Jack Rosenthal (Boundary Pro) represented the Residential PUD.
Motion: A motion by Frazier seconded by Fischer to accept the amended “Hull Creek
Addition” Preliminary Plat dated October 8, 2022, as presented which will allow a decrease
in lot size on Lots 1, 3, 4, & 5 BIk 2 of Hull Creek Addition with no change in buildable area.
Voting: All Members in favor.
Adjourn: At 7:33 P.M., Chairman Boyer adjourned the Meeting. The next Meeting is
scheduled for 6:30 P.M. on November 9, 2022.
Respectfully submitted,
Sheila Dahl
Recording Secretary
LAND & RESOURCE MANAGEMENT
OTTER TAIL Government Services Center
540 West Fir Avenue
Fergus Falls, MN 56537COUNTY - MINNESOTA
OTTER TAIL COUNTY PLANNING COMMISSION
NOTICE OF PUBLIC HEARING
APPLICANT: Michael & Joan Otto
15381 410'^^ Ave
Clitherall MN 56524
HEARING DATE/LOCATION:October 12, 2022, at 6:30 P.M.**
Commissioner's Room
Government Services Center
500 West Fir Ave
Fergus Falls, MN 56537
CONDITIONAL USE PERMIT APPLICATION REQUEST (as stated by the Applicant on the
Application): Requesting 23 campsites to campground “Silver Sage Guest Ranch”. 8 units in
tier one and 15 units in tier two.
LAKE NAME/NUMBER/CLASS: Unnamed Lake (56-147), Natural Environment (NE)
E-911 ADDRESS: 15380 410‘^ Ave., Clitherall MN 56524
LEGAL DESCRIPTION: That Pt of El/2 SE1/4, Section 6 of Leaf Mountain Township
** Weather Conditions may change the Hearing date and time. If bad weather occurs, please listen to the local Fergus Falls
Radio Stations or contact the Land & Resource Management Office, by 4:30 p.m., for possible rescheduling of the Hearing.
The applicant and/or applicant's agent must be present at the public hearing or participate virtually to present the
application. A link to the virtual meeting will be provided on the Land & Resource website seven days prior to the
public hearing.
Public comments regarding this application expressed by mail or emailed to land@co.ottertail.mn.us must be
received by 12:00PM the day before the public hearing date. Members of the public wishing to observe and/or make
comments at the public hearing may be present at the public hearing or participate virtually.
Individuals with questions or requiring special accommodations should contact the Land & Resource
Management Office, 218-998-8095, prior to the hearing.
September 28, 2022Rod Boyer
Mailing DateChairman Planning Commission
; ■
m MINNESOTA POLLUTION
CONTROL AGENCY Trwch Design Worksheet
ELWOOD SEPTICprofessiomals
1. SYSTEMSiZiNG:Project ID:r ■V 04.01.2021
2436 |gPD
46 {inches Designers AAaxvmmi Oepth:[ 48.0
1.20 GPD/ft^ G)ntour Loading Rate:
A. Design Flow:
jnKhesB. Cocte AAaxiimim Depth:
C. Soil Loading Rate:
O. Required Bottom Area: Desi^ Flow -f Soil Loading Rate
12 gal/ft
2436 GPDf 1.20 GPD/ft^ =
E. Select Dispersal Media: [
2030 ft^
] [Rock
If Registered Media
I Gravity - Drop Box IF. Select Distribution Method:Notes:
G. Is distribution media installed in contact with sand or loamy sand or with a percolation rate of 0.1 to 5 mpi?
If yes. Indicate distributian or trealmenl method:Serial di^ribution in 15% sections
2. TRENCH CONFIGURATION
Initial required
trench bottom area
(ft^): (from 1.D)
Sidewall
Absorption
(inches)
Design
trench
bottom area
A.Bottom Area
Reduction
Bottom Area
Multiplier /-'CO'.ei
.^Disnibiition0......0%6 to 11 1 2030
12 to 17 20%0.8 16242030 > sidewall18 to 23 34%0.66 1340
24 40%0.6 1218
svidthinches = |12B. Select Sidewall Height:
C Design Bottom Area:
D. Select Trench/Registered Width:
E. Total Designed Trench Length: Bottom Area -r Trench Width
1649 jft^ -f} 3.0 ] ft = I 550 |ft
F. Calculate Minimum length of each trench based on Contour Loading Rate: Design Row « CLR =
2436 Igpd^l 12.0 |gal/ft = | 203.0 [ft
G. Rapidly Permiabie S(A Design Considerations: ISerial distribution in 15% sections
1.0 ft Check registered product
informttim for specific
application deteals tend design
1649
3 ft
1
15% Trench Distribution = Required Bottom Area X i15%.
1649 jft^ X 15%
Length Trench^ at 15 %: Trench area ? Trench Width
247.35 Ift^ J 3 Ift = 1 82.45 Ift
I 247.35 ft^
JBased on 15% sectionsH. Number of Trenches: 3
Designed Number of Trenches:
I. Equal Length per Trench = Actual Trench Length f Number of Trenches
550 (ft 5.0
Based on CLR minimum length 7
5
I 109.9 ft
J. Select Trench Spacing :
K. Calculate Lawn Area: Trench Lei^th X Trench Spacing
550 jft xj 7
7 ft (typically 5 -12 ft from center to center)
ft^ lawn twea3848ft =
4. ROCK MATERIALS Project ID:
A. Select Depth Required to Cover Distribution Pipe:
B. Caladate Rock Votione: (SidewMl Hei^t + Depth to Cover Pipe XBottomArea == cubic feet ? 27 = ad»c yards
(| 1.00 |ft t| 0.50 Ift) x| 1649 jft^ 2474 ~{fe 27} 92 jyd^
0.5 ft (0.33 ft for pressure, 0.5 ft for gravity)
5. REGISTERED PRODUCTS MATERIALS
A. Registered Product:AAodel:
B. Total Length to be Installed:
C. Total Designed for Install - Total Trench Required (must be a positive number)
{Total ft - 549.7 jft required =
Check registered product
informaUon for specific
application details and
designF
6. DiitKnsion Summary
One 4' Inspection
pipe per trench
36 Trench V\hdth (in)
Minimum 12 inch
cover
550 12 Sidewall Height (in)
Total Feet
48.0 {Max Depth (in)- Design
5 48 AAax Depth (in) - CodeS-;
rZ~.
umber of Trenchs
36 Required Separation (in)
Distribution Media Rock
Cormnents:
m MINNESOTA POILUTION
CONTROL ACENCY Basic Pump Selection Itesign Worteheet
EL.WOOD SEPTICPROFESSIOMALS
1. PUMPCAPACrTY Project ID:V 04.01.2021
Pumping to Gravity or Pressme Distnbutiixn:Gravity
A. If pumping to gravity enter the gallon per minute of the pump:
B. If pumping to a pressiBlzed distribution system:
I C. Enter pump description;
15.0 GPM (10-45 spmj
GPM
Demand Dosing
soil VrJimertt system & point n< tfiscUliQP2. HEADREQUIREMEKTS
15A. Elevation Difference
between pump and point of discharge:
ft
Hpvjtinn
...KB. Distribution Head Loss:5 ft
C. Additional Head Loss:ft (ibetospeclatequipinent.etc.)
Table I.Friction Loss in Plastic Pipe per 100ft
Distribution Head Loss Pipe Diameter (inches)Flow Rate
(GPM)Gravity Distribution = Oft 1.251 1.5 2
Pressure Distribution based on Minimum Average Head
Value on Pressure Distribution Worksheet:
10 9.1 3.1 1.3 0.3
12 4.312.8 1.8 0.4
tVlinimum Average Head Ptstribution Head Loss 17.0 5.714 2.4 0.6
1ft 5ft 21.8 7.316 3.0 0.72ft 6ft 18 9.1 3.8 0.95ftlOft2011.1 4.6 1.1
25 16.8 6.9 1.7
30 23.52.0 9.7D. 1. Supply Pipe Diameter:2.4in
35 12.9 3.2
2. Supply Pipe Length:300 ft 40 16.5 4.1
45 20.5 5.0E. Frktian Loss bi Plastic Pipe per 100ft from Tdile I:50 6.1
55 7.30.66 ft per 100ft of pipeFriction Loss =60 8.6
F. Determine Eiguivnlent Pipe Length from pieiqi discharge to soil dispersal area
discharge point. Estimate by adding 25% to supply pipe length for fittii^ toss.
Supply Pipe Length X 1.25 = Equivalent Pipe Length
65 10.0
70 11.4
75 13.0
85 16.4300375.0 ftftX 1.25 95 20.1
G. CalctAate Supply Fiictian Loss by mit^ying Friction Loss Per 101^ by the Equivaleia Kpe Length and divide by 100.
Supply Friction Loss =
0.66 ft per 100ft 375.0 ft 2.5X100 ft-i-
\H. Total Head requirement is the sum of the Elevation Difference * Di^rdaition Head Loss, + Additianal Head Loss + Siqiply FricticBi itv^
5.015.0 ft 2.5 22.5ftft =ft +ft+•f
3. PUMPSELECnON
15.0 22.5A pump must be selected to deliva- at least GPM with at least feet of total head.
Comments:
!
MINNESOTA POLLUTION CONTROL AGENCY Pump Tank Design Worksheet (Demand Dose)
ELWOOO SEPTICPWOFESSICJIVALS
DETCIUUKE TANK CAPACITY AfO MMEMSIONS Project ID:V 04.01.2021
1400 Oos^1. A. Design Flow (DesipiSiBn.1At:CPO C. Tank Use:
B. Min. required pump tank capacity:1500 Gal D. Recommended pump tank capacity:1500 Gal
[Brown Precast2. A. Tank Manutacturer;1SOOB. TaAModel:
Note: Design calculations are based on this specific tank.
Substituting a rSffereat tank, model will duntge the pump
float or doer settiags.Oatactdes^ter if changes are
necessary.
1539C. Capacity from manufacturer:Gallons
jGaUms per indi
inches
34.5D. Gallons per inch from nenddsSmtsz
43.5E. Liquid depth of tank from manufacturer:
DETBUeS DOSBCG VOLUME
3 Calculate Volume to Cover Pump (The inlet of the pump must be at least 4-inchQ from the bottom of the pump tank & 2 inches of water coverins the pump is
recommended)
(Planp and block height * Z inches) X Coffons Per bi^
in + 2 inches) X
4 Minimum Delivered Volume = 4 X Volume of Distribution Piping:
-Item IBaflhenessureDistrflaitianarltem llofHmrlevet
5 Calculate Maximum Pumpout Volume (25X of Design Flow)
Design Flow:
34.516 621(Gallons Per Inch Gallons
linches/ibBeGaUotB (MEuCbbuu dose)
1400 GPD X 0.25 350 10.2Gallons (Maximum dose)inches/dose
6 Select a pungxrut volume that meets both/hnimian and Maximum:
7 Calculate Oases Per Day = Design Flow * Delivered Volume
gpdv
im Gallofis
Volume of Liquid in
Pipegat =1001400 14.00 Doses
Pipe Liquid
Per Foot
(Gallons)
8 Calculate Drainback:
Diameter2A.Diameter of Supply Pipe =inches
(inches)
Length of Supply Pipe =300B.feet 1 0.045
1.25 0.0780.170C.Volume of liquid lineal foot Pipe =
DrmrdxKk = Length of SuppiyPipe X Volume of liquid Per lineal FdM of Pipeft X 0470 Igal/ft =
GaUons/ft
0.1101.50.
2 0.17030051.0 Gallons
3 0.3809. Tofof Dodng Volume = DeUvered Volwne plus Ortnnback
gat +
10. Mmimisn Alarm Volume = Depth of alarm (2 or 3 inches) X gallons per inch of tank
in X
4 0.66110051.0 gat =151 Gallons
jgat/in =iGallons3 34.5 103.4
DEMAND DOSE FLOAT SETTINGS
11. Calculate Float Separation Distance using Dosing Volume.
Total Dosing Volume /Gallons Per Inch
gal ^
17. Measuring from bottom of tank:
A. Distance to set Pump Off Float = Pump * block hei^it * 2 inches
in + 2 in =
B. Distance to set Pianp On Float=Oisbmce to Set Pump-Off Float * Float Separation Distance
34.5151 gaUin =4.4 Inches 1
rL.Inches for Dose: 4.4 in
1816 Inches inAlarm Depth
Pump On
Pump Off
25.4
22.4 in 103.4 Gal
18 in +4.4 in =22 Inches 18.0 in 151 Gal
AC. Distance to set Aiann Float =!hstance to set Pump-On Float + Alarm Depth (1-3 incites)
in +
621 Gal
3.022 in =25 Inches :
Field EvBlnation Date! I 8/26/22
I Map scale:NA
Ifest Needed spressure
200'+. 2" SCH40 pipe
Sleeve 2" pump tine with 4” SCH40 pipe across tank
excavation to protect from settling
Flow from RVs
f CO c
Flow from RVs
Tflok;
. 2500 gallon tank Tanki
• 2 2500 gaUon tanks
• Poty Loc 625 filter
2 - 40' long 12" rock trenches
N
• ^ -O' v'' -■'
9Tank &. Hft^
- 1500 gallon llA tank
. Dual alternating pun^
2 pumps with alarm 15 gpm w/22.S t(h
5 65' long 12" rock trenches3.50' long 12" rock trenches
N..
/oV r
*a,
.w,N. ■■"v.-'-N.•<S.
:v.
I r^ . 'ilf • -
r
^ •'* *I i.a. MM a, wmm * mm • ■■;:;o^Syatem Notes:« «Ml'T
Sentlc Tank:
- 3 2500 gallon tank - code minimum (total tanking)
- Effluent Filter
- Tank may be relocated as needed, maintain all setbacks
- All maintenance hole risers must extend above final grade & insulated to R value of 10
Ppmp lanta• 1500 gallon • code minimum
• Dual Altemattog watertight power post with alarm & event counter
- Pump with alarm -15 gpm at 22.5 tfe (est.)
• Demand'dose floats settings
- High water alarms required for pump & effluent filter
- Install pump disconnect 24" fixtm finished grade
- Tank may be relocated as needed, maintain all setbacks
- All maintenance hole risers must extend above final grade & insulated to R value of 10
Treatment Area:
- 1649 sq. ft. with 12" of rock under the pipe
- 550 lineal ft. of 12" rock under pipe
- No trench to exceed 82' long
- 5 drop box trenches with 4" inspection pipe at both ends, brought to finish grade
- Half cap in drop boxes for serial distribution
- 4 - trenches 40' long
- T trench center to center trench spacing
- Install trench on contour
OB#S
•!I.
O' ~County
BoringO
>t«rAurwjerti'i**
Omflgd litRtamanH
The pfopoted aewtige treatment lystesi bu been designed in accordance with MN Rulea Cb. 7080
and local codes. Tbe soil treatmeat area must be protected from dlsturtmnce and cisnpaction before
and after construction. Non.sewBge waste (drain tile, water softener disdiarge, etcO shall not be
discharge Into this system. No warrant is made that this system will continue to ftweda) indeftnltdy.
System must be properly maintained. For Instructla on proper septic system qwrallon &
maintenance, go to http://septic.umn.ethi, the University of Minnesota Extension Agency, or local
regulating agency.
Elwood Septic Pn>feaslonals,LLC MPCA License #2820
Elwpod Septic Professionals, LLC
Project Name: Silver Sage Guest Ranch
Address; 15380410th Ave, Clitberall
A
PL-625 Effluent Filter ■f
m
PL-625 Test Results:
Testing on the performance of the Polylok PL-625 Effluent Filter took
place at a 140,000 square foot facility located at 3 Fairfield Blvd.
Wallingford, CT. The facility tested, is a light manufacturing and sales
facility with two cafeterias and over 70 employee’s.
Testing was performed over a six month period which began in
November 2009 and ran through April 2010. The test sample was
taken at Test Tank #1, (1 of 2 Test Septic Tanks.) Testing was started
when all effluent was diverted thru a valve to the Test Tank #1.
Because of the amount of employees at this facility this test tank
was loaded at approximately 10 times the capacity of a standard
residential 4 bedroom home.
Results of testing are as follows:
Biochemical Oxygen Demand (BOD):
Before: 697.2
After: 313.3
Total Suspended Solids (TSS):
Before: 1610.
After: 120.
PL-625 Features:
• Rated for 10,000 GPD (gallons per day).
• 625 linear feet of 1/32” filtration.
• Accepts 4” and 6” SCHD 40 pipe.
• Built in gas deflector.
• Automatic shut-off ball when filter is removed.
• Alarm accessibility.
• Accepts PVC extension handle.I
C-m;
; r!'• I rJ'T' ;Soil Observation Log EUWODD SERTICP>RaFESSlONALSProject ID:
Silver Sage Guest Ranch
Soil parent material(s): (Check all that apply) 0 Outwash □ Lacustrine □ Loess □ Till
Location / Address:Client:15381 410th Ave, Clltherall MN 56524
□ Alluvium □ Bedrock □ Organic Matter
Elevation-relative toBack / SideLandscape Position: (select one)Linear, LinearSlope %: 8.5 Slope shape 94.5___________benchmark:
Limiting Layer Elevation: 87.50Wooded Site Soil survey map units:721E, Corliss Loamy SandVegetation:
Weather Conditions/Time of Day:08/26/22Date
Observation #/Location;Observation Type:#1 Auger
Structure'RockDepth (in)Texture Matrix Color(s)Mottle Color(s)Redox Kind(s)Indicator(s)Frag. %Shape ConsistenceGrade
10YR 2/1 None
Blocky Weak0 - 6 Loamy Sand <35%Friable
10YR 3/4 None
6-24 Loamy Sand <35%Single grain Loose
10YR 4/6 None
24 - 36 Coarse Sand <35%Single grain Loose
7.5YR 4/4 NoneMed Sand36-48 <35%Single grain Loose
10YR 5/4 None
Med Sand Single grain48-84 <35%Loose
Comments
I hereby certfy that I have completed this work in accordance with all aoDllcable ordinances, rules and laws.
Scott Elwood 2820 8/26/2022
(Designer / Inspector)(Signature)(License #)(Date)
Soil Observation Log EUWOOD SERTICRRQRGSSONiAuSProject ID:
Silver Sage Guest Ranch
Soil parent material(s): (Check all that apply) 0 Outwash □ Lacustrine □ Loess □ Till
Location / Address:15381 410th Ave, Clitherall MN 56524Client:
□ Alluvium □ Bedrock □ Organic Matter
tlevatlon-reiative toBack / Side Linear, LinearLandscape Position: (select one)Slope %: 8.5 Slope shape 96.4___________benchmark:
Limiting Layer Elevation: 89.40Wooded Site Soil survey map units:721E, Corliss Loamy SandVegetation:
Weather Conditions/Time of Day:08/26/22Date
Observation ^/Location:#2 Observation Type:Auger
Structure'RockDepth (in)Texture Matrix Color(s)Mottle Color(s)Redox Kind(s)Indicator(s)Frag. %Shape Grade Consistence
10YR2/2 None
0-8 Loamy Sand <35%Blocky Weak Friable
10YR4/3 None
8 -16 Loamy Sand <35%Single grain Loose
10YR 5/4 None
Coarse Sand <35%16-31 Single grain Loose
7.5YR 6/4 None
31-72 Med Sand <35%Single grain Loose
10YR7/3 None
Med Sand72-84 <35%Single grain Loose
Scott Elwood
(Designer/Inspector)
Comments
I hereby certify that I have completed this work in accordance with all applicable ordinances^ rules and laws.
2820 8/26/2022
¥(Signature)(License #)(Date)
L» I' IK'.; 11 ••• ■'l;r mo Soil Observation Log EL.WOOO SEPTICpROF=essiorsiAusProject ID:Pi’O:
mammammmma*
Silver Sage Guest Ranch
Soil parent material(s): (Check all that apply) □ Outwash □ Lacustrine □ Loess □ "nil □ Alluvium □ Bedrock
15381 410th Ave, Clltherall MN 56524Location / Address:Client:
□ Organic Matter
Elevation-relative toBack / SideLandscape Position: (select one)Sloped: 8.5 Linear, LinearSlope shape 89.1benchmark:
Limiting Layer Elevation: 82.10Wooded Site Soil survey map units:721E, Corliss Loamy SandVegetation:
Weather Conditions/Time of Day:08/26/22Date
Observation ^/Location:ff2 Observation Type:
I Structure'RockDepth (in)Texture Matrix Color(s)Mottle Color(s)Redox Kind(s)Indicator(s)Frag. %ConsistenceShapeGrade
10YR 2/2 None
0-8 Loamy Sand <35%Blocky Weak Friable
10YR 4/3 None
8-18 Loamy Sand <35%Single grain Loose
10YR 5/4 None
18-42 Coarse Sand <35%Single grain Loose
7.5YR 6/4 None
Med Sand42-84 <35%Single grain Loose
Comments
I hereby certify that I have completed this work in accordance with all aoDlicable ordinances, rules and laws.
Scott Elwood 2820 8/26/2022
(Designer/Inspector)(Signature)(License #)JDa^
0:'is‘'; i' Se-.v'A'.--!!Soil Observation LogNs.EUWOOD SEPTICF=>F=tOFESSlOMALSProject ID:
15381 410th Ave, Clttherall MN 56524Silver Sage Guest Ranch
ISoll parent material(s): (Check all that apply) □ Outwash □ Lacustrine □ Loess □ Till
Location / Address:Client:
□ Alluvium □ Bedrock □ Organic Matter
Elevation-relative to
benchmark:
Limiting Layer Elevation: 87.00
Back / Side Linear, LinearLandscape Position: (select one)Slope %: 8.5 Slope shape 94.0
Wooded Site Soil survey map units:721E, Corliss Loamy SandVegetation:
Weather Conditions/Time of Day:08/26/22Date
Observation ^/Location:#4 Observation Type:Auger
StructureRockDepth (in)Texture Matrix Color(s)Mottle Color(s)Redox Kind(s)Indicator(s)Frag. %Shape Grade Consistence
10YR2/2 None0-8 Loamy Sand <35%Blocky Weak Friable
10YR 4/3 None8 -18 Loamy Sand <35%Single grain Loose
10YR 5/4 None
Coarse Sand18-42 <35%Single grain Loose
7.5YR 6/4 None
42-84 Med Sand <35%Single grain Loose
I hereby certify that I have completed this work in accordance with all applicable ordinances^ rules and laws.
Scott Elwood
(Designer/Inspector)
Comments
(Signature)'
2820 8/26/2022
(Date)(License #)
<•» IMH
Bl'v,'Ao;:
viY V„SM
Soil Observation Log11^Project ID:V 04.01.2021
Silver Sage Guest Ranch
Soil parent materlal(s): (Check all that apply) E] outwash □ Lacustrine □ Loess □ Till
Client:Location / Address:15381 410th Ave, Clitherall MN 56524
□ Alluvium □ Bedrock □ Organic Matter
Elevation-relative toBack/Side Slope Slope d: 8.5Landscape Position; (select one)Linear, LinearSlope shape 88.1benchmark:
Limiting Layer Elevation: 81,10WoodedSoil survey map units:Vegetation:721E, Corliss Loamy Sand
Weather Conditions/Time of Day:08/26/22Date
Observation #/Location:Observation Type:#5 Auger
Structure-RockDepth (in)Texture Matrix Color(s) Mottle Color(s)Redox Kind(s)Indicator(s)Frag. %ConsistenceShapeGrade
10YR 2/2 None
0-12 Loamy Sand <35%FriableBlockyWeak
10YR 4/3 None12-22 Loamy Sand <35%Single grain Loose
10YR 5/4 None
22 - 38 Coarse Sand <35%Single grain Loose
7.5YR 6/4 None
38-84 Med Sand <35%Single grain Loose
Comments
I hereby certify that I have completed this work In accordance with all applicable ordinances, rules and laws.
(Designer/Inspector)(Signature)(License it)(Date)
University
OF Minnesota OSTP Soil Observation Log t
Client/ Address;Legal Description/ GPS:
n Alluvium □ Bedrock □ Organic Matter□ Outwash □ Lacustrine □ Loess □ TillSoil parent material(s); (Check all that apply)
Landscape Position; (check one) Q Summit □ Shoulder □ Back/Side Slope □ Foot Slope □ Toe Slope Slope shape
Soil survey map units Sloped Elevation:Vegetation
Weather Conditions/Time of Day: |Date
□ Auger □ Probe □ pitObservation #/Location:Observation Type:
I Structure IRockDepth (in)Texture Matrix Color(s)Mottle Color(s)Redox Kind(s)Indicator(s)Frag. %ConsistenceShapeGrade
Granulir
Flaw
RofVy
PrUmaiic
Single Crain Massive
Loote
Friable
Firm
Exli einely FirmRigid
Concentrations
Depletions
Gleyed
Concentrations
Depletions
Gleyed
Weal<
Wofiorfltp
Strong
Loosi?
;:•
Granular
riaiy
B.oc«y
Priimaiic
Sliiyic Ciflln /lUssive
Loose
Friable
nrn>
Extremely Firm
Weak
Moderate
Strong
Loose
:
I
!T Loose
Friable
Firm
Extremely Firm Rigid
Crsnulor
rtatv
Hlocky
Pntmaiic
Sinfilo GfainMassive
Concentrations
Depletions
Gleyed
Weak
Moderate
Strong
Loose
;
Loose
Friable
Grenuta'
P.atv
BiocVy
Prisma Uc
Singla Grain M.asslvc
Concentrations
Depletions
Gleyed
Weak
Moderate
Strung
Loose
;
FirmI
Extremely Firm Rigid:V
’Cranula:
Piflty
blacky
Prlsnalk
Single Grain /Aassive
Loose
Friable
Firm
Extremely Firm Rigid
' Concentrations WedK
Moderate
Strong
Loose
Depletions
Gleyed
i
;;Loose
Friable
Firm
ExLicniely Firm Rigid
Graiular
Plmy
Blecky
Prisnatic
Single Grain /Aauivc
Concentrations
Depletions
Gleyed
V/eak
Moderate
Strong
loose!
Comments
I hereby certify that I have completed this work in accordance with all applicable ordinances, rules and laws,
(County inspector)(Signature)(Certification 4)(Date)
te*ssffsai:Ba$iig§fsgi
n-ii */» '
S’-ii-lO ^ <D
o o “• ro fU> NJ 5117330 ■<S* 37Jl*»V51174335ir4?0 5ii7!:io 507560 5I175BD■!
-I 2ir
?»
Minnesota Department of Health
Well Management Section
P.O. Box 64975, St. Paul, Minnesota 55164-0975
651/20M600 or 800/383-9808
Certification of Buried Sewer Construction and Testing
This form must be completed and submitted to the Minnesota Department of Health (MDPI) for installation of a
buried sewer located 20 to 50 feet fix)m a wat0--si^ply well, or the installation of a wato'-supply well located 20 to 50
feet from a buried sewer. NOTE: A 50-foot minimum separation must be maintained between a water-supply well
and a buried collector or municipal sewer, an unapproved sewer, or a buried sewer serving a facility handling
infectious or pathological waste.
Owner of Property Where Sewer is Located (please print)
Silver Sage Cnest Ranch
Street Address, City, ZIP for Property Where Sewer is Located
15380 410th Ave, Clitherall MN 56524
Section No.FractionTownship No.Range No.County Name
639Steams County 131
Peison(s) Present to Witness TestingDate of Testing (nnn/dd/yyyy)
Well Information
or, if unavailableProvide Minnesota Well and Bming Number(s)
provide the following information for each well located within 50 feet of the buried sewer.
Well CcmtiactofWell Well Year of
ConstnictioD
Well Address
(if dififeroit from above)Well NoTDescrqition Depth Diameter Company Name
Variance Information
Was a variance issued by the MDT for this sewer or well installation?
If yes, please provide the variance tracking number; TN__________
□ Yes □ No
Sewer Materials
ABS (ASTM F628)
PVC (ASTM F789)
□ ABS (ASTM D2751)
□ PVC (ASTM D3430)
[] Cast Iron_________
□□ ABS (ASTM D2661)
□ PVC (ASTM D2665)
□ PVC (ASTM D2665)□
Test Methods (check one)
SlAir Test (5 psi constant pressure for 15 minutes).
□Manometer Test (1 -inch water column).
□Hydrostatic Test (for Plastic pipe only)
The portion of the buried sewer tested is described as follows (please specify each segment of sewer pipe which was
tested
Please draw a diagram of the sewer system on back and note the locations of any wells and the portions of
the sewer system that were pressure tested.
Buried Sewer Testing Diagram
Please draw a site diagram of the sewer syst^ and all buried sewer pipes, including those buried breath buildings
(serving floor drain[s], bathroom[s], laundry room, etc.). Please note the portions of the buried sewer pipes that were
pressure tested, the location of flie well(s), and major landmarks on flie property.
, certify that the buried sewer(s) described above is/are
constnuded of the indicated, approved sewer material meeting the requirements of the Mirmesota Plumbing Code,
Minnesota Rules, part 4715.0530, and has/have been successfully tested in accordance with Minnesota Rules, part
4715.2820, by the indicated method._________________________________________________________
In accordance with Minnesota Statutes, section 144.992, p^ons submitting false information to the Mirmesota
Department of Health are subject to administrative penalties of up to $10,000.
I, (name)
Name Title
Street Address
State ZIP Code
License/Ceitification Number Signature Date
HE-01488-03 origs/sewer test form.doc 2/09R
i
Minnesota Department of Health
Well Management Section
P.O. Box 64975, St Paul, Minnesota 55164-0975
651/201-4600 or 800/383-9808
Certification of Buried Sewer Construction and Testing
This form must be completed and submitted to the Minnesota Department of Health (MDH) for installation of a
buried sewm* located 20 to 50 feet from a water-siqiply well, or the installation of a watm'-si^ly well located 20 to 50
feet fiom a buried sewer. NOTE: A 50-foot minimum separation must be maintained between a water-supply well
and a buried collector or municipal sewer, an unapproved sewer, or a buried sewer serving a facility handling
infectious or pathological waste.
Owner of Property Where Sewer is Located (please print)
SByarSageGnestlRaBdi
Street Address, City, ZIP for Property Where Sewer is Located
1S380 410th Ave, ClhheraU MN 56524
County Name Township No.Section No.Range No.Fraction
Steams County 131 39 6
Dale of Testing (mm/dd/yyyy)Peison(s) Presort to Witness Testing
Weil Infonnation
Provide Minnesota WeU and Boring Number(s)
provide the following information for each well located within 50 feet of the buried sewer.
or, if unavailable
Well Contractor
Company Name
WellWell Year of
Ccmstraction
Well Addi^
(if dififagrt from above)WeU No./Descttytion Depth Diameter
Variance Information
Was a variance issued by the MDT for this sewer or well installation?
If yes, please provide the variance tracking number; TN__________
□ Yes □ No
Sewer Materials
□ ABS(ASTMD2661)
□ PVC (ASTM D2665)
□ PVC (ASTM D2665)
□ ABS(ASTMD2751)
□ PVC (ASTM D3430)
[] Cast Iron_________
ABS (ASTM F628)
PVC (ASTM F789)□□
Test Methods (check one)
SI Air Test (5 psi constant pressure for 15 minutes).
□Manometer Test (1-inch water column).
□Hydrostatic Test (for Plastic pipe only)
The portion of the buried sewer tested is described as follows (please specify each segment of sewer pipe which was
tested
Please draw a diagram of the sewer system on back and note the locations of any wells and the portions of
the sewer system that were pressure tested.
i
Buried Sewer Testing Diagram
Please draw a site diagram of the sewer system and all buried sewer pipes, including diose buried beneath buildings
(serving floor drain[s], bathroom[s], laimdiy room, etc.)- Please note the portions of the buried sewer pipes that were
pressure tested, the location of the well(s), and major landmarks on the property.
, certify that the buried sewer(s) described above is/are
constructed of die indicated, approved sewer material meeting the requirements of the Mirmesota Plumbing Code,
Minnesota Rules, part 4715.0530, and has/have been successfully tested in accordance with Minnesota Rules, part
4715.2820, by the indicated method.________________________________________________________
In accordance with Mirmesota Statutes, section 144.992, persons submitting false information to the Mirmesota
Department of Health are subject to administrative penalties of up to $10,000.
I, (name)
Name Title
Street Address
City State ZIP Code
License/Ceitification Number Signature Date
HE-01488-03 ori^sewer test fonn.doc 2/09R
Detroit LakesBloomington
2200 West 94th Street
BloCHiiiogtbn, MN SS431
952-456-8470
Ribbing
1111 7thAve.E.22796 County Highway 6
Detroit Lakes, hW 56501 Hibbing, MN 55746
218-440-2043Environmental Laboratories, Inc.
wwwjmbel.com
218-846-1465
■-iSeptember 12,2022
Laboratory Report
Elwood Septic Pro LLC
Scott Elwood
2511CoRd82NW
Alexandria, MN 56308
RE: Elwood Septic
Work Order :D036590
Enclosed are the results of analyses for samples received by die laboratory on 09/01/2022 21 :S0. If you have any
questions concerning this report, please feel fiee to reach out to customer service at 888-200-5770 or the contacts
listed below:
MeLisa.Woods@nnbel.com
Kristin.Hanson@rmbel.com
Rachel JDanielson@nnbeLcom
Kathleen.Mitchell@rmbel.com
Robeit.Borash@rmbel.com
(218) 849-8747
(218)440-2043
(218)846-1465
(785) 493-1633
(218)849-6420
MeLisa Woods
Kristin Hanson
Rachel Danielson
Kathleen Mitchell
Robert Borash
Project Manager
Project Manager
Project Manager
Quality Assurance Director
President | CEO
Report approved by:
MeLisa Woods
Project Manager
The results in this report apply only to the samples analyzed in accordance with the chain of custody document. This aaafytical report must be reproduced in its entirety.
Date of Riqiott: 9/12/2022Work Order: D036590
Blootnineton
2200 West 94th Street
BlotMmngtoD, MN SS431
952-456-8470
Detroit Lakes Hibbing
22796 County Highway 6
Detroit L^es, MN 56501
218-846-1465
nil 7thAve. E.
Hibbing, MN 55746
218-440-2043Enviromiiental Laboratories, inc.
wwwTmbel.com
Report To: Elwood Septic Pro LLC
Scott Elwood
2511CoRd82NW
Alexandria, MN, S6308
Laboratory Results
September 12,21122
BID To: Elwood Septic Pro LLC
Scott Elwood
2511 Co Rd 82 MW
Alexandria, MN, 56308
Elwood Septic
D036590-01
Water
Sample Description: Silver Sage Tank InletProject:
Lab Code:
Matrix:
DateOlme Sampled: 09/01/2022 12:44
Date/Time Received: 09/01/2022 21:50
CoDection Method:
Sanqtled by:
Sanqile Rece^ Information:
Scott Elwood
See chain of custody.
Result Units Sample DF Preparatlan
Method
Prepared Analysis
Method
Analyzed Analyte Facility
Qualifiers
Analyte
RL
naadegl numahtry Parametera
Biodienilcal Oxygen
Demand (BOD)
Garbonaceons
Biochemical Oxygen
Reddne - nonfilterable
(TSS)
60.0 09/02/22 14:38mg/L160 HACK 10360
Revl2-20II
DL
132 mg/L 60.0 09/02/22 15:46^HACH 10360
„v 12-2011
DL
09/06/22 17:18mg/L 10.0 USGSD76S-85 DL36.0
Qualifiers and Definitions
DefinitionItem
Repoftiiig Limit (Conccted for dflntian foctnr when applicable doe to sample preparatioo variation.)
Dilution Factor
Indicates test perfonned by RMB Envinmmental Laboratories - Detroit Lakes.
RL
DF
DL
The results in this report apply only to the samples analyzed in accordance with the chain of custody document. This analytical report must be rqmduced in its entirety.
Date of Report: 9/12/2022Work Order D036590
Internet^ RM® EnviroEmemtal Laboratories, Inc.Detroit Lakes
22796 County Highway 6
Detroit Lakes, MN 56501
(218) 846-1465
Page □of □ ,Grand Rapids
1851 East Highway 169
Room 105 Wilson Hall, ICC
Grand Rapids. MN 55744
(216) 322-2304
rmbel@rmbel.info
www.rmbel.info
Electronic version available at http://www.rmbel.lnfo/lab/chains-of-custody/CHAIN OF CUSTODY RECORD
Client;Phone#: , -v-s-7 Fax#;Q "EQUIS" EDD Lab Format - MPCA Data Submittal
D036590Project Name:Project Task Code;PO/WO #:Analysis Requested
Samplers; (print first & last name)Samplers: (signature)
i£?/Lc/o c U
Report to:Bill to;
Sample Comments:
(Equipment Type,
Filtration, AIS,
Preservation)
EndStart
Depth#of
'SSttles
Sample
Type
Depth
Sample Method (m)Lab Code Station ID/Sample Description (m)MatrixDate Time
tZ-W'-i 4-p3C:
’-To3 i
■V
(initials) In the event that samples are received by the lab at a temperature greater than 6 ° C, I hereby authorize RMB Environmental Laboratories to process the samples as received.
before processing samples.(Initials) In the event that samples are received by the lab at a temperature greater than 6 “ C, please contact client at phone #
Relinquished by; (signature)SHIPPING TO LAB
□ Speedee
□ UPS
□ USPS
□ FedEx
n Hand Delivery
BILLINGRelinquished by Lab: (signature)Date Time Date Time
Shlpplns:
Received by Lab:,(signature) /V Received by Lab: (signature)Date Time TimeDate
MileBse:
N—'
Q DOES meet proper sample storage and transportation guidelines
Q Does NOT meet proper sample storage and transportation guidelines
Explain: ___________________-
QRcvdonice []] Rcvd at room temp RcvdTemp:.
Q Samples,received same day as collection
Comments:-______
PTl DOES meet proper sample storage and transportation guidelines
Q Does NOT meet proper sample storage and transportation guidelines
Explain:
Q. Rcvd on ice Q Rcvd at room temp Rcvd Temp: C
[^.Samples received same day as collection
Comments;______________
Flald staff:
INTERLAB SHIPPING
Q Speedee
□ UPS
n USPS
(j3 FedEx
n Hand Delivery
Equipment:"C
LTG;LTG:Other;
Chlorine: No Yes 'DIAj;
PLANNING COMMISSION NOTIFICATION WORKSHEET
Michael & Joan OttoApplicant:
Unnamed Lake 147 October 12, 2022Meeting Date:Lake:
V4 Mile (1320’) Conditional Use App __X V2 Mile (2640’) Preliminary Plat
*Township / County Roads: Shorty (GtS) will get map, listing, labels (she has an
advanced mapping system), unless it is adjacent to the parcel(s) that rUn the length of
the road project. Be sure to list the road name(s) and the parcel number(s) involved
with the project on this sheet for Sherry.
11 Envelopes
8 Extra
7 PC
Beverly Hanson, Clerk
Everts Township______
3 Extra Extra12589 Co Hwy 5
Clitherall MN 56524
30 Notices
Nyberg Surveying
509 22"** Ave E
Suite 101
Alexandria MN 56308
PC:Worksheet Notification 10/2015
LAND AND RESOURCE MANAGEMENT
OTTER TAIL COUNTY, GOVERNMENT SERVICES CENTER, FERGUS FALLS, MN 56537
STATE OF MINNESOTA )
) ss
COUNTY OF OTTER TAIL )
I, Marsha Bowman, duly appointed and Acting Secretary of the Otter Tail County
Planning Commission for Otter Tail County, Minnesota, do hereby certify that on
2022, the attached Notice of Hearing and was dulySept28thday of
served upon the following:
the.
CourthouseCounty Sheriff
County Highway Engineer
Otter Tail COLA, 4302 13*^ Ave S Ste. 4-333, Fargo, ND 58103
MPCA, 714 Lake Ave., Suite 220, Detroit Lakes, MN 56501
DNR, Julie Aadland, Div. Eco & Water Resources, 1509 1st Ave N, Fergus Falls, MN 56537
Shawn Donais, DNR, Trails & Waterways
Jim Wolters, DNR, Div. of Fisheries
Mike Oehler, DNR, Div. of Wildlife
5ame
Envelope
Planning Commission Members
(The above receive al[ Notices)
Lake Improvement District (if project is located on their lake, mail Notices to the Lake Improvement District)
Big McDonald: Big McDonald Lake Improvement Dist., PO Box 81. Dent, MN 56528
—Devils (Near Perham):
—Eaglei---------------------
—Lkta: -----------------------
Devils Lake Imp. Dist., PO Box 431 Perham, MN 56573
Eagle Lake Imp. Dist-T-Kelly Hepper, 38079 South Eagle Lake Rd., Battle Lake MN 56515
Lida Lakes Imp. Dist., David Hilber, 41026 Backroad TrI., Pelican Rapids MN 56515
■Lt McDonald, Kerbs & PauLLMKP Lakes Imp. Dist., PO Box 133, Perham, MN 56573
Pine Lakes Imp. Dist., PO Box 405, Perham, MN 56573Little Pine & Big Pine:
Pelican, Fish, Bass & Lt. Pelican: Pelican Lake Group Lake Imp. Dist., PO Box 336, Pelican Rapids, MN 56572
South Turtle Lake:—South Turtie Lake Imp. Dist., PO Box 168, Underwood, MN 56586
City Clerk (if located within 2 miles of a city)
MNDOT Dist. Office, 1000 Hwy 10 W, Detroit Lakes, MN 56501(if locatecfofta State or Fed Hwy)
Adjacent County Zoning Administrator (If the County is-in the “Buffer)—check their website for name/address
Becker County Auditor-(notify in addition to their Zoning Administrator)—check their website for name/address
Do not notify individuals within a City Lirrtit
Township Clerk, Lake Association, surveyor (if appropriate),
and those listed on the attached sheet...,
by placing a true and correct copy thereof in a sealed envelope, postage prepaid, and by depositing them in the U.S. Mail at
Fergus Falls, MN, properly addressed to each of the above named at the addresses shown above.
Secretary Amy Busko
If parcel owner is "USA”, mail to Fish & Wildlife Service, 18965 Co. Hwy 82, Fergus Falls, MN 56537
If parcel owner is “DNR”, ignore as they are receiving a notice as stated above
If parcel owner is “St of MN. 375 Centennial Bldg Spec Asst to Atty General St. Paul, MN ", mail to
DNR Lands & Minerals 2115 Birchmont Beach Rd NE Bemidji, MN 56601
l:\PC\Affidavit Orig 2018
*
Buffer Parcels
Addr 2 Citv St ZiDParcel No
36000050036000 Carl Haagenson & G Wagnild
Addr 1Name 2Name 1
Blaine MN 55434 2553829 96th Ave NE
Clitherall MN 56524 957536000050038000 Michael R & Joan M Otto 15381 410th Ave
Clitherall MN 56524 930241762 Carlson Rd36000050039000 Steven J & Nancy A Koep
Clitherall MN 56524 957536000060041000 Michael R & Joan M Otto 15381 410th Ave
Clitherall MN 56524 957515531 410th Ave36000060041001 Thomas P Lien
Clitherall MN 56524 957536000060042000 Michael R & Joan M Otto 15381 410th Ave
Clitherall MN 56524 957536000060044000 Michael R & Joan M Otto 15381 410th Ave
Clitherall MN 56524 957536000060044001 Craig M & Nichole L Otto 15376 410th Ave
Battle Lake MN 56515 953939801 160th St36000060045000 Wayne A & Mary L Nelson Tst
Clitherall MN 56524 957515725 410th Ave36000060045004 James & Myrna Vanwatermulen
Battle Lake MN 56515 958038540 Eagle Lake Rd N36000060045005 Douglas P & Laura C F Norberg
Elbow Lake MN 56531 940736000060045006 Timothy D & Susan K Wiese 27211 230th Ave
Clitherall MN 56524 956642327 County Highway 3836000070047002 Ralph B & lone E Hanson Tstees
Lake Elmo MN 55042 960736000070049000 John G & Julie A Heintz 1335 Manning Ave N
Lake Elmo MN 55042 960736000080055000 John G & Julie A Heintz 1335 Manning Ave N
Page 1 of 1Tuesday. Seotember 27. 2022
Buffer Mail
City, State, ZipAddress iName Address 2
Carl Haagenson & G Wagnild 829 96th Ave NE Blaine MN 55434 2553
John G & Julie A Heintz Lake Elmo MN 55042 96071335 Manning Ave N
Steven J & Nancy A Koep Clitherall MN 56524 930241762 Carlson Rd
Thomas P Lien 15531410th Ave Clitherall MN 56524 9575
Douglas P & Laura C F Norberg 38540 Eagle Lake Rd N Battle Lake MN 56515 9580
Craig M & Nichole L Otto 15376 410th Ave Clitherall MN 56524 9575
Michael R & Joan M Otto 15381 410th Ave Clitherall MN 56524 9575
Ralph B & lone E Hanson Tstees Clitherall MN 56524 956642327 County Highway 38
James & Myrna Vanwatermulen 15725 410th Ave Clitherall MN 56524 9575
Wayne A & Mary L Nelson Tst 39801160th St Battle Lake MN 56515 9539
Timothy D & Susan K Wiese 27211 230th Ave Elbow Lake MN 56531 9407
Tuesday, September 27, 2022 Page 1 of 1