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Sunrise Resort_14000250201000_Septic System Permits_
r OTTER TAIL COUNTY LAND & RESOURCE MANAGEMENT PUBLIC WORKS DIVISION VVvWV CO OTTER-TAIL MN USOTTCR Tflll GOVERNMENT SERVICES CENTER 540 WEST RR AVENUE FERGUS FALLS, MN 56537 218-998-8095 FAX: 218-998-8112 06/09/2014 Brenda R Samson Po Box 51 Cavalier ND 58220 0051 RE: Primary Owner: Brenda R Samson Sewage Treatment System Servicing Tax Parcel Number: 14000250201000 Described as:Sec 25 Twp Dead Lake Township Sect-25 Twp-135 Range-040 10.93 AC GLS 7 & 8 N OF ROAD EXCEPT W Lake: 56-383 Dead As of 06/05/2014 the septic tank replacement (Sewage Treatment Installation Permit # 22806 servicing your property was determined to be in compliance with the provisions of the Sanitation Code of Otter Tail County for a 10 bedrooms. If you have any questions regarding this matter, please contact our office. Sincerely, Scott Ellingsdn Inspector SCANNED APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENT GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 218-998-8095 www.co.otter-tail.mn.useOTTCR TAII WHITE - Office YELLOW - L & R Inspector PINK - Owner / Contractor (after issue)COftTT-MliAIIOTi Asi'dou>APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED Permit No. TWPNO.RANGE TWP NAMELAKE/RIVER CLASS SECTIONLAKE NUMBER LAKE/RIVER NAME /3T~ ^0 E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROADPARCEL NUMBER (S) OF PROPERTY BEING SERVICED 955" J|0( fccj LEGAL DESCRIPTION f0‘ aJ Daytime Phone No.Initial Mailing AddressLast Name First /toProperty Owner (^Ixua^ Contractor Lie.# THIS SPACE FOR OFFICE USE ONLY A.M. , the year of P.M.>• This System will be ready for inspection on at. A.M. P.M. L & R OfficialTime ReceivedDate Received SEWAGE TREATMENT SYSTEM DESIGN DATA AS SHOWN ON DRAWING NSTALLATION (circle one)TYPE OF Other Est. (E) New (D) Replacement (5 Replacement CollectorResidential (C) New(A) New Soil Treatment Area ^0) riByfaLyiiiyiii LiftTank Design Flow (Gallons/Day) 1 — 2,499 (H) 2,500 — 4,999 (I) 5,000— 10,000 Effluent Distribution (Gravity GIs GIs() Pressure Size /Cp^ Ft.Setback To Nearest Well Ft.Type II Ft.Type I /0<^ (27) Rapidly Permeable(20) Trench, Rock ^iQQ^Ft.Ft.Ft.//OSetback To OHWL(21) Trench, Gravelless (28) Flood Plain (22) Trench, Chamber (29) Privies Ft. Ft.Ft.3^^Setback To Bluff(30) Holding Tank (Contract Required) (23) Bed (24) Mound 5.1 Ft.Ft.Setback To Dwelling (25) At Grade Type III Setback To Non-Dwelling podV-Ft.Ft. Ft.(31) Other/Problem Soils/<12" Soil(26) Greywater /<54- fS^TanteiOnly Type IV Setback To Nearest Lot Line Ft./Cokr- F*-(32) Public Domain & Proprietary Technologies(35) Other Depth of Wel,^^/o.A*Setback To Road Right-Of-Way JoT^Ft.Ft.Ft.Type V Total # Bedrooms iO (33) Performance Elevation Above Restrictive Layer Ft.Ft.Ft.- (5 —Garbage Disposal Y /Abatement Y / N PERC TEST DATA ^ -prxi Highest RateLicense #Date of TestDesigner Agreemefll: The undersigrua hereby makes application for permit to Install, alter, repair or extend Sewage Treatment System herein specified, agreeing to do aii such work in strict accor dance with Sanitation Code of Otter Tail County, Minnesota. Appiicant 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 shaii be covered untii it has been inspected and approved for use. it shail be the responsibiiity of the appiicant for the permit to notify Land & Resource Management that the instaiiation is ready for inspection. Permit: Permission is hereby granted to the above named appiicant 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, empioyees and workmen shall conform in ail respects to the Sanitation Code of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of the Sanitation Code. NOTE: I.This permit is valid for a period of six (6) months. 2.This permit does not include the building sewer (sewer line). /^?/ Permit Fee $Date: ^^^^ignature of Property fwnef/Agent forO^ner Rec. No..Date; Land & Resource Management Official JXioJi tUtli i;y. i>T<l-tallFff Date StampComments: JUh (!. ■7 Irisov 1^1 354.250 • Vidor Lundeen Co., Printers • Fergus Palis, Minnesota L&R InitialForm No. BK — 04-2014-06 APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENT GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 218-998-8095 www.co.otter-tail.mn.useOTTER TflII WHITE - Office YELLOW -L&R Inspector PINK - Owner/ Contractor (after issue)COiiTY BIilillOTi 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 I PARCEL NUMBER (S) OF PROPERTY BEING SERVICED E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROAD 3-S9V'? . l/<^jl/cco ^ go< (Soo LEGAL DESCRIPTION /O' Last Name First Initial Mailing Address Daytime Phone No. PO_Property Owner Contractor Lie.# THIS SPACE FOR OFFICE USE ONLY c(?0 >■ This System will be ready for inspection on , the year of at.P.M. Time Received ^------^ \j-<^; \\4- Date Received | ’.M. L&R Official zTYPE OF NSTALLATION (circle one)SEWAGE TREATMENT SYSTEM DESIGN DATA AS SHOWN ON DRAWING Soil Treatment Area Residential (A) New ^B)-flep(acemerrt Other Est. (E) New (D) Replacement ^ Replacement Collector (C) New Tank Lift Design Flow (Gallons/Day) (^) 1 — 2,499 (H) 2,500 — 4,999 (I) 5,000— 10,000 Effluent Distribution (>t) Gravity ( ) Pressure f GIs GIs-fiXiSize Setback To Nearest Well Ft.Type I Type II Ft./o-%(20) Trench, Rock (27) Rapidly Permeable Ft.Ft.5oo ^Setback To OHWL /.'6(21) Trench, Gravelless (28) Flood Plain '! O (22) Trench, Chamber (29) Privies Ft. Ft. Ft.Setback To Bluff ,".>o(23) Bed (30) Holding Tank (Contract Required)(24) Mound Ft.I Ft.Ft.Setback To Dwelling "1 (25) At Grade Type III Setback To Non-Dwelling(26) Greywater (31) Other/Problem Soils/<12" Soil Ft./ /) t- Ft.Ft./'O Type IV(34), Tank Only Setback To Nearest Lot Line Ft.Ft./OCif-Ft.’Ook-(32) Public Domain & Proprietary Technologies (35) Other Depth of WelL^ : 'Setback To Road Right-Of-Way joc:>^Ft.Ft.Ft.Type V S?5 Total It Bedrooms iQ (33) Performance Elevation Above Restrictive Layer f Ft.Ft.Ft.- C5Garbage Disposal Y /Abatement Y / N PERC TEST DATA Designer_/[ __________License # Agreemeaf: The undersigng^tiereby 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 Cod4 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. 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 condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Sanitation Code of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of the Sanitation Code. NOTE; I.This permit is valid for a period of six (6) months. 2.This permit does not include the building sewer (sewer line). ■:'y Date:Permit Fee $ ^^ignature of Property O^fiSif^ent tor ^fffier y.'Date: ^>.7 Rec. No.. Land S Resource Management Official i i* [q 1 \y£iComments:iul 1 Ti SCANNED ! j 1 1#^Form No. BK — 04-2014-06 354,250 * Victor Lundaen Co., Printers • Fergus Fells, Minnesota SEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTS Inspector must make all measurements SOIL TREATMENT AREA HOLDING dEPTICTANK;) gls. OUTHOUSELIFT TANKCATEGORY Capacity FT2 FT2GLS. t V Setback from Nearest Well FT FT FT FTfco Setback from Buried Water Suction Pipe Sc>^FT FT FT FT IfcV Setback from Buried Pipe Distributing Water Under Pressure -t'FT >o^FT FT FTOIO'37Setback from OHWL (lake &/or river)FT FT FT FT Setback from Bluff FT FT FT FT l5^/~/5'y- FTSetback from Dwelling FT FT FT I o'Setback from Non-Dwelling FT FT FT FT ftSetback from Nearest Property Line FT FT FT zSetback from Right-of-Way FTFT FT FT/oo^ Elevation above Restrictive Layer FT FT FT Holding Tank/Lift Alarm NO Old System Pumped & Destroyed YES NO SEPTIC TANK(s) # Tanks Installed MOUND / AT-GRADEFILTER SOIL TREATMENT AREA CALCULATION ,TRENCH REDUCTION ROCK BEDA Rock trenches with inches □ YES D"no ■j. Manuf.of sidewall for________ reduction / equivalgnt1e=. Soil Treatment Area. ,%Ft.Ft. X Ft. X Ft. ft= Model # t^-l'ooo lP//-Iq'2S Ft*Ft* Inspector's Comments:94 IhuLdt 0^ -ipp c/t B(J^^ Sketch: i > > \a^i 'V LAk£ wTimeInitial/Li R OfficialDate As ____ Code of Otter Tail County. the above described sewage system installation was found to be compliant with the provisions of the Sanitation Land & RedtJQrce Mat itOfficiai i#BS?aForm No. BK — 04-2014-06 354.250 • Victor LundOBn Co.. Printorc • Fergus Falls, MIrmasola . System design must be to scale and must include the proposed location of the sewage system, all existing/ proposed buildings, property lines, the ordinary high water level of the water body, bluff and all water wells within 150' of the sewage system. If there are any questions, see the University of Minnesota Site Evaluation worksheets. Scale:/inch(es) equals _^5^feetgrid(s) equals feet, or MPCA LICENSE #: <3l fttyril rDESIGNED BY: LICENSE CATEGORY: FIRM NAME:DATE: ADDRESS: SIGNATURE: o4i \ \ .0^ c-jj \j ky A" Kiro / / ^ ifp SCMBK — 04-2014 — 029 ,1 Co. P'lnters • Pergus Falls. MN • 1-800-346 4870 SITE DATA WORKSHEET LAND & RESOURCE MANAGEMENT GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 218-998-8095 www.co.otter-tail.mn.usOTTER TflIICOaiTT-BIftlllOTI Sewage Treatment System Permit #OWNER: 6^r>]p.s LAST NAME F/RST TELEPHONE NUMBERMIDDLE ADDRESS: ThAnx'sa /f/h ___STR./RT CITY STATE ZIP CODE ^ - ?^j LAKE/RIVER NO.LAKE NAME SEC.TWP RANGE TWP NAME LEGAL DESCRIPTION:SOIL BORING LOG COLOR & MUNSELL NO. DEPTH (INCHES) E-911 Address or Directions From Nearest Public Road TEXTURE STRUCTURE BLOCKY PLATY PRISMATIC NONEPARCEL NUMBER BLOCKY PLATY PRISMATIC NONE (NUMBER OF BEDROOMS BLOCKY PLATY PRISMATIC NONE GARBAGE DISPOSAL: YES P DEPTH5(y]fet*^SEWER LINE SEPARATION:WELL: CASING .ft.BLOCKY PLATY PRISMATIC NONE (n^FLOODPLAIN: YES BLUFF: YES VEGETATION: ^^6lWIG> TERRESTRIAL BLOCKY PLATY PRISMATIC NONE SLOPE AT INSTALLATION SITE:% TYPE OF OBSERVATION: Probe Pit Boring PARENT MATERIAL: Till Outwash Loess Bedrock Alluvium ORIGINAL SOIL:Yes No Date of Soil Boring COMPACTED SOIL: Yes No DEPTH OF BORING (To T or restrictive layer):__ PERC TEST#1 ft.Date of Perc Test PERC TEST #2- TWO TESTS ARE REQUIRED - TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL(MINUTES)WATER DEPTH PERC RATEWATER DROPSTARTSTART TIME DROP PERC DROPTIME PERC TIME INTERVAL fMINUTESI WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEREFILLREFILL TIME DROP PERC DROPTIME PERC INTERVAI (MINUTES^TIME WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATEREFILLREFILL TIME DROP PERC TIME DROP PERC TIME INTERVAL iMINUTESI WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES! REFILL WATER DEPTH WATER DROP PERC RATEREFILL TIME DROP PERC DROPTIME PERC WATER DROPTIMEINTERVAL (MINUTES) REFILL WATER DEPTH ■IIMEPERC RATE INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEREFILL WATER DEPTH TIME DROP PERC DROPTIME PERC TIME INTERVAL (MINUTES] WATFR DROPWATER DEPTH PERC RATE JML INTERVAL (MINUTESt REFILL PERC RATEREFILL f ; TIME PPOP PERC RATE PERC TIME DROP PERC WATER DROP 'TIME INTERVAL (MINUTES) REFILL WATFR DROPWATER DEPTH TIME INTERVAL(MINUTES) REFILL WATE PERC RATE TIME DROP PERC DROP PERC INTERVAL (MINUTES)WATER DEPTH WATFR DROPT1M£PERC RATE TIME INTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATEREFILLREFILL -r--------- =TIME DROP PERC DROPTIME PERC SEPTIC TANK MANUFACTURER: PROPOSED DESIGN: TRENCH BED.ATGRADE MOUND.HOLDING TANK GRAVITY DIST..PRESSURE DIST.. SEWER LINE OUTHOUSE OTHER.SPECIFY:. —' SYSTEM DESIGN ON BACK — 1 V U,J\01 1 1 OF Minnesota Septic System Management Plan for Below Grade Systems The goal of a septic system is to protect human health and the environment by properly treating wastewater before returning it to the environment. Your septic system is designed to kill harmful organisms and remove pollutants before the water is recycled back into our lakes, streams and groundwater. This management plan will identify the operation and maintenance activities necessary to ensure long-term performance of your septic system. Some of these activities must be performed by you, the homeowner. Other tasks must be performed by a licensed septic maintainer or service provider. However, it is YOUR responsibility to make sure all tasks get accomplished in a timely manner. The University of Minnesota’s Septic System Owner’s Guide contains additional tips and recommendations designed to extend the effective life of your system and save you money over time. Proper septic system design, installation, operation and maintenance means safe and clean water! Brenda SampsonProperty Owner 14000250201000Property Address 35299 Co. Hwy. 14 Property ID 218-205-7025Laremie Barry PhoneSystem Designer System Installer Barry Excavating Inc.Phone 218-495-2686 Lakes Sewer Service Phone 218-495-3473Service Provider/Maintainer Ottertail County 218-998-8095PhonePermitting Authority Permit#Date Inspected Keep this Management Plan with your Septic System Owner’s Guide. The Septic System Owner’s Guide includes a folder to hold maintenance records including pumping, inspection and evaluation reports. Ask your septic professional to also: • Attach permit information, designer drawings and as-builts of your system, if they are available. • Keep copies of all pumping records and other maintenance and repair invoices with this document. • Review this document with your maintenance professional at each visit; discuss any changes in product use, activities, or water-use appliances. For a copy of the Septic System Owner’s Guide, call 1-800-876-8636 or go to http://shop.extension.umn.edu/ http://septic.umn.edu SCANNEDVersion 6/10/2010 University OF Minnesota Septic System Management Plan for Below Grade Systems Your Septic System -Cleanout Ground st^ace Soil treatment trench Distribution media Septic System Specifics I I System is subject to operating permit* I I System uses UV disinfection unit* Type of advanced treatment unit_______ * Additional Management Plan required System Type:(^IQII {Based on MN Rules Chapter 7080.2200 - 2400) Well ConstructionDwelling Type TIT shallowWell depth (ft):Number of bedrooms: System capacity/ design flow (gpd): Anticipated average daily flow (gpd): Comments Business?!jWhat type? 2499 0 Cased well Casing depth: Other (specify): Distance from septic (ft): Is the well on the design drawing? ^ Y 1000 169 N Septic Tank 625Pump Tank {if one) Effluent Pump make/model. Pump capacity___ One tank Tank volume:gallons gallons zollerDoes tank have two compartments'ij jfj |n gallons1600^ Two tanks Tank volume: □ Tank is constructed of GPM 70concrete Feet of head In yard TDH none □ Alarm location□ Effluent Screen type: Soil Treatment Area (STA) y/ Gravity distribution ||total lineal feetTrenches:Pressure distributionNumber of trenches:feet each ST A size (width x length): ft x ft Location of additional STA: ____ at Inspection ports [ j Clean^^ SCANN "D Additional STA not available University OF Minnesota Septic System Management Plan for Below Grade Systems Homeowner Management Tasks These operation and maintenance activities are your responsibility. Use the chart on page 6 to track your activities. Identify the service intervals recommended by your system designer and your local government. The tank assessment for your system will be the shortest interval of these three intervals. Your pumper/maintainer will determine if your tank needs to be pumped. 36System Designer. check every__ Local Government: check every__ State Requirement: check every 36 months months months My tank needs to be checked monthsevery Seasonally or several times per year • Leaks. Check (listen, look) for leaks in toilets and dripping faucets. Repair leaks promptly. • Surfacing sewage. Regularly check for wet or spongy soil around your soil treatment area. If surfaced sewage or strong odors are not corrected by pumping the tank or fixing broken caps and leaks, call your service professional. Untreated sewage may make humans and animals sick. • Alarms. Alarms signal when there is a problem; contact your maintainer any time the alarm signals. • Lint fdter. If you have a lint filter, check for lint buildup and clean when necessary. Consider adding one after washing machine. • Effluent screen. If you do not have one, consider having one installed the next time the tank is cleaned. Annually • Water usage rate. A water meter can be used to monitor your average daily water use. Compare your water usage rate to the design flow of your system (listed on the next page). Contact your septic professional if your average daily flow over the course of a month exceeds 70% of the design flow for your system. • Caps. Make sure that all caps and lids are intact and in place. Inspect for damaged caps at least every fall. Fix or replace damaged caps before winter to help prevent freezing issues. • Water conditioning devices. See Page 5 for a list of devices. When possible, program the recharge frequency based on water demand (gallons) rather than time (days). Recharging too frequently may negatively impact your septic system. • Review your water usage rate. Review the Water Use Appliance chart on Page 5. Discuss any major changes with your pumper/maintainer. During each visit by a pumper/maintainer • Ask if your pumper/maintainer is licensed in Minnesota. • Make sure that your pumper/maintainer services the tank through the manhole. (NOT though a 4” or 6” diameter inspection port.) • Ask your pumper/maintainer to accomplish the tasks listed on the Professional Tasks on Page 4. SCANNED University OF Minnesota Septic System Management Plan for Below Grade Systems Professional Management Tasks These are the operation and maintenance activities that a pumper/maintainer performs to help ensure long-term performance of your system. Professionals should refer to the 0/M Manual for detailed checklists for tanks, pumps, alarms and other components. Call 800-322-8642for more details. • Written record provided to homeowner after each visit. Plumbing/Source of Wastewater • Review the Water Use Appliance Chart on Page 5 with homeowner. Discuss any changes in water use and the impact those changes may have on the septic system. • Review water usage rates (if available) with homeowner. Septic Tank/Pump Tanks • Manhole lid. A riser is recommended if the lid is not accessible from the ground surface. Insulate the riser cover for frost protection. • Liquid level. Check to make sure the tank is not leaking. The liquid level should be level with the bottom of the outlet pipe. (If the water level is below the bottom of the outlet pipe, the tank may not be watertight. If the water level is higher than the bottom of the outlet pipe of the tank, the effluent screen may need cleaning, or there may be ponding in the drainfield.) • Inspection pipes. Replace damaged caps. • Baffles. Check to make sure they are in place and attached, and that inlet/outlet baffles are clear of buildup or obstructions. • Effluent screen. Check to make sure it is in place; clean per manufacturer recommendation. Recommend retrofitted installation if one is not present. • Alarm. Verily that the alarm works. • Scum and sludge. Measure scum and sludge in each compartment of each septic and pump tank, pump if needed. Pump Pump and controls. Check to make sure the pump and controls are operating correctly. Pump vault. Check to make sure it is in place; clean per manufacturer recommendations. Alarm. Verify that the alarm works. Drainback. Check to make sure it is operating properly. Event counter or run time. Check to see if there is an event counter or run time log for the pump. If there is one, calculate the water usage rate and compare to the anticipated average daily flow listed on Page 2. Soil Treatment Area • Inspection pipes. Check to make sure they are properly capped. Replace caps that are damaged. • Surfacing of effluent. Check for surfaced effluent or other signs of problems. • Gravity trenches and beds. Check the number of gravity trenches with ponded effluent. Identify the percentage of the system in use. Determine if action is needed. • Pressure trenches and beds - Lateral flushing. Check lateral distribution; if cleanouts exist, flush and clean as needed. ^SCANmAll other components - inspect as listed here: ■ ■ University OF Minnesota Septic System Management Plan for Below Grade Systems Water-Use Appliances and Equipment in the Home Impacts on SystemAppliance Management Tips • Uses additional water. • Adds solids to the tank. • Finely-ground solids may not settle. Unsettled solids can exit the tank and enter the soil treatment area. Use of a garbage disposal is not recommended. Minimize garbage disposal use. Compost instead. To prevent solids from exiting the tank, have your tank pumped more frequently. Add an effluent screen to your tank. Garbage disposal • Washing several loads on one day uses a lot of water and may overload your system. • Overloading your system may prevent solids from settling out in the tank. Unsettled solids can exit the tank and enter the soil treatment area. Choose a front-loader or water-saving top-loader, these units use less water than older models. Limit the addition of extra solids to your tank by using liquid or easily biodegradable detergents. Install a lint filter after the washer and an effluent screen to your tank Wash only full loads. Limit use of bleach-based detergents. Think even - spread your laundry loads throughout the week. Washing machine • The rapid speed of water entering the tank may reduce performance. Install an effluent screen in the septic tank to prevent the release of excessive solids to the soil treatment area. Be sure that you have adequate tank capacity. 2"“* floor laundry Use gel detergents. Powdered detergents may add solids to the tank. Use detergents that are low or no-phosphorus. Wash only full loads. Scrape your dishes anyways to keep undigested solids out of your septic system. • Powdered and/or high-phosphorus detergents can negatively impact the performance of your tank and soil treatment area. • New models promote “no scraping”. They have a garbage disposal inside. Dishwasher Expand septic tank capacity by a factor of 1.5. Include pump monitoring in your maintenance schedule to ensure that it is working properly. Add an effluent screen. • Finely-ground solids may not settle. Unsettled solids can exit the tank and enter the soil treatment area. Grinder pump (in home) • Large volume of water may overload your system. • Heavy use of bath oils and soaps can impact biological activity in your tank and soil treatment area. Avoid using other water-use appliances at the same time. For example, don’t wash clothes and take a bath at the same time. Use oils, soaps, and cleaners in the bath or shower sparingly. Large bathtub (whirlpool) Management TipsClean Water Uses Impacts on System Re-route water into a sump pump or directly out of the house. Do not route furnace recharge to your septic system. • Drip may result in frozen pipes during cold weather. High-efficiency fiimace These sources produce water that is not sewage and should not go into your septic system. Reroute water from these sources to another outlet, such as a dry well, draintile or old drainfield. When replacing, consider using a demand-based recharge vs. a time-based recharge. Check valves to ensure proper operation; have unit serviced per manufacturer directions • Salt in recharge water may affect system performance. • Recharge water may hydraulically overload the system. Water softener Iron filter Reverse osmosis • Water from these sources will likely overload the system.Surface drainage Footing drains ^SCANNED University OF Minnesota Septic System Management Plan for Below Grade Systems Maintenance Log Track maintenance activities here for easy reference. See list of management tasks on pages Sand 4. Activity Date accomplished Check frequently: Leaks: check for plumbing leaks Soil treatment area check for surfacing Lint filter: check, clean if needed Effluent screen: if owner-maintained Check annually: Water usage rate (monitor frequency Caps: inspect, replace if needed Water use appliances - review use Other: Notes: Mitigation/corrective action plan: "As the owner of this SSTS, I understand it is my responsibility to properly operate and maintain the sewage treatment system on this property, utilizing the Management Plan. If requirements in this Management Plan are not met, I will promptly notify the permitting authority and take necessary corrective actions. If I have a new system, I agree to adequately protect the reserve area for future use as a soil treatment system." DateProperty Owner Signature: 3^)Management Plan Prepared By: Permitting Authority: ' Certification # ©2010 Regents of the University of Minnesota. All rights reserved. The University of Minnesota is an equal opportunity educator and employer. This material is available in alternative formats upon request Contact the Water Resources Center, 612-624-9282. The Onsite Sewage Treatment Program is delivered by the University of Minnesota Extension Service and the Universjbi|^f Minnesota Water Resources Center. ^SCANNED C Department of LAND AND RESOURCE MANAGEMENT OTTER TAIL COUNTY Government Services center - 540 West Fir Fergus Falls, MN 56537 PH: 218-998-8095 OTTER Tail County’s Website: www.co.otter-tail.mn.us 08/15/2013 United Community Bank Po Box 128 DentMN 56528 0128 RE: Primary Owner United Community Bank Result of Onsite Sewage System Inspection, Non-Compliant Parcel(s) 14000250201000 Lake Name Dead Lake No 56-383 Class NE Dear United Community Bank: As part of Otter Tail County’s ongoing Sewage System Inspection Program, our Office inspected your sewer system located at 35299 CO HWY 14 on 08/14/2013 At that time, we found your sewage system to be non-compliant for the following reason(s): Failed compliance inspection Unsealed tank Please contact our Office by 09/16/2013, at 218-998-8095, so that this matter can hopefully be resolved. Sincerely, Scott Ellingson Inspector SCANNED CHRONOLOGY REGARDING THE SEWAGE SYSTEM INSPECTION PROGRAM Primary Owner United Community Bank Alternate Owner NELakeDead56-383 Parcel No 14000250201000 35299 CO HWY 14CIS Address Date of Compliant Letter Date of Non-Compliant Letter Date Initial Response (owner) Date Sewer Permit Issued Date Abatement Notice Date Violation Issued Date to County Attorney Date Resolved No Further Action Comments: ,'k'A Chronology Sewage System Inspection Program 1-2012 Department of LAND AND RESOURCE MANAGEMENT OTTER TAIL COUNTY Government Services Center - 540 West Fir FERGUS Falls, MN 56537 PH: 21S-998-8095 Otter Tail County's Website: www.co.otter-tail.mn.us 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 May 1,2011, Property Information Parcel Number: 9'OJ _________ Property Owner Name(s): __________ Property Address: CU Reason for Inspection: Number of Bedrooms: ? In Shoreland Area? Lake/River Name, Number, & Class (if applicable); Inspection Results Does the soil treatment area have less than 3 feet of vertical separation? Is the septic tank located less than 50 feet from any welt? Is the soil treatment area located less than 50 feet from any deep well? Is the soil treatment area located less than 100 feet from any shallow well? Yes Does any part of the septic system fail to meet the minimum OHWL setback requirements for the public water classification? No .^PJ Yes Yes Yes "Yes" indicates that the system is failing to protect ground water and is noncompliant. If "Yes" ^ io£_ ■ '^tfi I le condition noted: IpRvvcC .lYv Required Attachments: System drawing to scale on next page. Completed MPCA Compliance Inspection form, Pages 1 through 8, revision dated 4/24/09 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. System Compliance Status: Compliant (Circle one)J4qrf-Complianr~> Name: Certification Number; Business License Name & Number: Signature:gjehDate: Page 1 of 2Excel/Compliance Form for OTC 2/23/2011 Otter Tail County Compliance Inspection Form Addendum (cont.) Property Information Parcel Number: _____________________Property Owner Name(s): //v/atv _________ Property Address:' ck, ^ ^ ^S'7^ System Drawing The system drawing must be to scale and include all septic/holding/lift tanks, drainfields, wells within 100 feet of system (Indicate depth of wells), dwelling and non-dwelling structures, lot lines, road right-of-ways, easements, OHWLs, wetlands, and topographic features (i.e. bluffs). Additional Comments:lUlJ iv Lc ^Ce'y^ lrfuu<{/K 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 maintenan^/or future water usage. Name; •-Pl^ / Sidil Certification Number: Business License Name & Number: Signature: Page 2 of 2Excel/Compliance Form for OTC 2/23/2011 Minnesota Pollution Control Agency 520 Lafayette Road North St Paul, MN 55155-4194 Compliance Inspection Form Existing Subsurface Sewage Treatment Systems (SSTS) Doc Type: Compliance and Enforcement Instructions on page 6 Summary Form (Completed form must be submitted to the local unit of government within 15 days.) Parcel number: _ „ _ _ _ System status: □ Compliant ^ Noncompliant (based on all compliance requirements) For Local Tracking Purposes: Property Information Property owner name(s): HiHary Barry________________ Property address: 35299 Cty Hwy 14, Richville, MN 56576 Property owner address (if different): County Ottertail Date system constructed: Property owner phone: Permitting authority: Ottertail^ounty Reason for inspection:__ System Description Brief system description: 25WDjahajik to Hfl tank to drainfield Local permit number: ___ _ Is the system: In Shoreland area? An U S. Environmental Protection Agency (EPA) Class V Injection Weil? O Yes S No Number of bedrooms: Design flow rate: ^ Yes n No □ Yes ^ NoIn Wellhead Protection Area? System serving a Minnesota Department of Heath (MDH) licensed facility?O Yes ^ No Compliance Status (Based on state requirements - additional local requirements may also apply.) Based on the information gathered and reported on attached forms, the compliance status of this system is (check one): □ Certificate of Compliance - valid until (3 years from date of report): S Notice of Noncompliance - For Noncompliant systems: The reason for noncompliance is: Probed tank ajd found no concrete bottom. (Cesspool)____________________ _ This noncompliant system is classified as (check one below): □ Imminent threat to public health & safety |3 Failing to protect ground water □ Not in compliance with operating permit Certification / hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. Name: Phil Stoll__________________ ____ Business license name and number: _Stoll Inspections Name of local uniL^governrafej^;. / Signature _______ Certification number: L2982 or Date: 8/8/13 Required Attachments 13 Hydraulic Performance 3 Soil Boring Logs □ System drawing/As-built drawing □ Any local requirements that are different from what is required on this form O other information (list): _ _______^ _ _ _ _ _ ________________ _ _____________ Upgrade Requirements (derived from 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 ofdmpnce If the system is failing to protect ground water, the system must be upgraded, replaced, or its use discontinued within the time required'Wfpcal existing system is not failing as defined in law. and has at least two feet of design soil separation, then the systemreplaced, or its use discontinued, notwithstanding any local ordinance that is more strict. This provision does not apply to^y^ms in shoreland areas. Wellhead Protection Areas, or those used in connection with food, beverage, and lodging establishments as defined In law. 3 Tank Integrity 3 Soil Separation □ Operating Permit Form (if applicable) TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 1 of 8 651-296-6300 • 800-657-3864www.pca.state.mn.us • wq-wwists4-31 • 4/24/09 System status: D Compliant ^ Noncompliant (as determined by this form) Parcel number: Hydraulic Performance and Other Compliance - Compliance Inspection Form for Existing SSTS Compliance Issue #1 of 4 Date of observation: ^/8/13 This form expires upon next inspection or in three years, whichever occurs first: Reason for observation: Sale Verification Method*: (Optional) (Check the appropriate box) ^ Searched for surface outlet O Performed hydraulic test S Searched for seeping in yard □ Checked for backup in home □ Excessive ponding in soil system/D-boxes □ Homeowner testimony □ Examined for surging in tank □ "Black soil" above soil dispersal system □ System requires “emergency" pumping □ Performed dye test O Other:________________ Compliance questions/criteria: (Required) (Check the appropriate box) ________ Does the system discharge sewage to the □ Yes ^ No ground surface? _________ ____ Does the system discharge sewage to drain O Yes S No tile or surface waters? □ Yes ^ NoDoes the system cause sewage backup jrito dwelling or establishment? _ Do other situations exist that have the potential to immediately and adversely impact or threaten public health or safety (electrical, unsafe covers, etc.)? Any “yes" answer indicates that the system is an imminent threat to public health and safety. □ Yes S No S Yes □ NoDoes the system pose a threat to ground water for any conditions deemed non- jrotectiye asjtetermined by the inspector?_ “Yes" indicates that the system is faiiing to protect ground water. If “yes", describe the condition noted: No Bottom in holding tank. Cesspool * No standard protocol exists. This list is not exhaustive, in sequential order, nor does it indicate which combinations are necessary to make this determination. Certification This form is to be completed and attached to the Summary Form of the Minnesota Pollution Control Agency's (MPCA) Compliance Inspection Form for Existing Subsurface Sewage Treatment Systems. Observations, interpretations, and conclusions must be completed by an inspector. Completed form must be submitted to the local unit of government within 15 days. Property owner name(s): f^llary^arry______________ Property address: 35299 Cty Hwy 14, RichvilLe, MN 56576 Property owner's address (If different): County: Ottertail Property owner phone: / hereby certify that I personally made the observations, interpretations, and conclusions reported on this form and that they are correct. Certification number: L2982Name: Phil Stoll Business license name and number: Stoll Inspections or Name of local un>overn Date: 8/8/13Signature: SCANNED TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Poge 2 of 8 651-296-6300 • 800-657-3864wwv/.pea. state, mn. us wq-wwists4-31 • 4124109 System status: □ Compliant ^ Noncompliant (as determined by this form) Parcel number; Tank Integrity and Safety Compliance - Compliance Inspection Form for Existing SSTS Compliance Issue #2 of 4 Date of observation: 8/8/13_ This form expires on (three years): Reason for observation: Sale Compliance questions/criteria: (Required) JCheck the appropriate box)________________ Does the system consist of a seepage pit*, ' ^ Yes □ No cesspool, drywelljDr leaching pit? _ Do any sewage tank(s) leak below their ^signe^d qperatirig depth? If yes, identify which sewage tank leaks. Any “yes” answer indicates that the system is faiiing to protect ground water. Verification Method**: (Optional) (Check the appropriate box) S Probed tank bottom n Observed low liquid level O Examined construction records □ Examined empty (pumped) tank □ Probed outside tank for “black soil" Q Pressure/vacuum check □ Other: ____ S Yes □ No Needs new tank installed * Seepage pits meeting 7080.2550 may be compliant if allowed in ordinance by local permitting authority. ** No standard protocol exists This list is not exhaustive, in sequential order, nor does it indicate which combinations are necessary to make this determination. Safety Check n Yes* ^ No 13 Yes □ No* S No □ Yes* S No 1. Are maintenance hole covers damaged, cracked, or appeared to be structurally unsound? 2. Were maintenance hole covers replaced in a secured manner (e g., screws replaced)? 3. Was secondary access restraint present (safety pan, second cover, or safety netting) - highly recommended. O Yes 4. Are other safety/health issue present? Explain: *System is an imminent threat to pubiic heaith and safety. Certification This form is to be completed and attached to the Summary Form of the Minnesota Pollution Control Agency’s (MPCA) Compliance Inspection Form for Existing Subsurface Sewage Treatment Systems. Observations, interpretations, and conclusions must be completed by an inspector, maintainer, or service provider Completed form must be submitted to the local unit of government within 15 days. Property owner name(s): H[llary^riy Property address: 35299 Cty Hwy 14, Richville, MN 56576 Property owner's address (if different): County: _Otte^il Property owner phone: / hereby certify that I personally made the observations, interpretations, and conclusions reported on this form and that they are correct. Certification number: L29IName: Phil Stoll SGANNEIh “Business license name and number: Stoll Inspections Name of local unit/67/ovarnm' Date. 8/8/13Signature. TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 3 of 8 651-296-6300 • 800-657-3864v/ww. pea. state, mn. us wq-wwists4-31 • 4/24/09 System status: S Compliant □ Noncompliant fas determined by this form) Parcel number: Soil Separation Compliance and Other Compliance - Compliance Inspection Form for Existing SSTS Compliance Issue #3 of 4 Date of observation: 8/8/13 This information on this form does not expire. Reason for observation: Sale Verification Method**: (Optional) (Check the appropriate box) E Conducted soil observation(s) (attach boring logs) □ Two previous verifications (attach boring logs) □ Other: _____ Compliance questions/criteria: (Required) (Check the appropriate box) __ For systems built prior to April 1, 1996, and not located in Shoreland or Wellhead Protection Area or not serving a food, beverage or lodging establishment: Does the system have at least a two-foot vertical separation distance from periodically saturated soil or bedrock? ____ For 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: Does the system have a three-foot vertical separation distance from periodically saturated soil or bedrock?* □_Yes □ No Soil observation does not expire. Previous observations by two independent parties are sufficient, unless site conditions have been altered. ^ Yes □ No For reduced separation distance systems (i.e., “performance" systems under old 7080.0179 or Type IV or V system under new 7080. 2350 or 7080.2400): Does the system meet the designed vertical separation distance from periodically saturated soil or bedrock?* * May be reduced by up to 15 percent if allowed in local ordinance ** No standard protocol exists. This list is not exhaustive, in sequential order, nor does it indicate which combinations are necessary to make this determination.□jfes □ No Any “no” answer indicates that the system is failing to protect ground water. Certification This form is to be completed and attached to the Summary Form of the Minnesota Pollution Control Agency’s (MPCA) Compliance Inspection Form for Existing Subsurface Sewage Treatment Systems. Observations, interpretations, and conclusions must be completed by an inspector or designer. Completed form must be submitted to the local unit of government within 15 days. Property owner name(s): Hillary Barry Property address: 35299_Cty l^y 14, Richville, MN 56576 Property owner's address (if different): County. Ottert^Property owner phone: I hereby certify that I personally made the observations, interpretations, and conclusions reported on this form and that they are correct. Certification number: L2982Name: Phi[Stoll_ ________________ Business license name and number: Stoll Inspections Name of local unit of or^vernmaCii' ^___________ Signature: _____________ or CANNEDDate: TTY 651 -282-5332 or 800-657-3864 • Available in alternative formats Poge 4 of S800-657-3864651-296-6300www.pca.state.mn.us • wq-wwists4-31 • 4/24/09 cl, /y ,Site Sketch: . Suunrru.Be Cods ;Name; 75' r' 1-^ j i.#E] K*v^ QjU^I Soil Boring (SR ff)i Locate each boring onriie map above, iridicots ot. the ri^ of the cahmm 4c soil struetura, color, dqrth of each dlSterent soil type, evidence of motfling, bedrock and standing -water.tooure,Also indicate if the material is rill- BR#SR# % i'6>d RECORD DEPTH OFMOITLINO. SSABOmK® WATER (AS I}3IERMIHED^JS2^GmMIa4mCOIX»BOO^ CR®»0CK0N ABOVELINES . .. |"2V^lV\ ' I S cXj b ^ ('-^pL-C^JGr>\c^p\I cV^vl^_-XComnieDb: __hi^iXi Ti-h-i 'i lA^ataesd5 to be completed ta Mag the ihove system mm compflance if &und iud.in conpliaiicd? SCALEDmet pnlsir.(imsL<t*'''^'«t‘ep3-^'* SflV91 It!l I! ■U4- ^SUhJd\SC il ;! ^Oi^SlTi^ UhTH NlLLr^/Z'lKhi€lI :i ir C>UTfiO<^S£ hfnS K)QT US>^0 P- V Uni STuci<- c>K> u<^ fi<s.H>r-JST 7^ c Oao/Z■rt ti r !'i t Sms U(Lt- /='/i-C /V p)T A?k//9 t3£>n/lO___ — P^iLOj^c,__Ul JpeiL STZ^/^GtC ni^ UP The sTefT i ^ He pLSp sms _ i-f p ILL 10/2/_ j4__po,cir>^ pcTTs Jl-f-c Pi?PTYiP(^TTJ LJux. f3^ pLr^cea yv _1 T^UP H>rr) T2> CJ^eciC UJiTH Th^ 0££r, . 6)e pe^Cfp Ceictc IM Loc^r^u It'__PpfTJIt ^ T^yns ii| 44 lit He sms TH^ OuTH^ytse uuiu. 6££o^S _ "7//^/ IH 'THC Ppepj^ Time iSe se/9L€o __ fiuo T^nr / T u>tci^ ,joi£>/Zt1 (3 s Usss i.!i;H■! ! ii il ii! TT ^3/ t ! LAND & RESOURGE MANAGEMENT OTTER TAIL COUNTY GOURTHOUSE 121 West Junius Ave. FERGUS FALLS, MN 56537 218-739-2271t.4#er 00/ li:Uri tb rsti7> ;+ c VS,< U January 13, 1998 ;l('ri/s o^^ -1$ e . A.BARRYS SUNRISE RESORT Hilary & Marilyn Barry PO Box 66 Richville, MN 56576-0066 o-i-'- Sewage System Abatement, Dead Lake (56-383).RE:t,/-Vt Dear Mr. & Ms. Barry, According to our records your Sewage System Abatement has not been resolved. Please contact me before January 30, 1998 in regards to this matter. Sincerely, APat Eckert Inspector ) -CO~-<3- t 'A CC^ ^RE/mls I’/A (ojOil ?Unt - PeCSw-1 < i'f t - C/t-U < fAlk -h? ;iJ0O k ^ <^}i. SEWAGE SYSTEM ABATEMENT NOTICE LAND & RESOURCE MANAGEMENT COUNTY OF OTTER TAIL COURTHOUSE, FERGUS FALLS, MN 56537 (218) 739-2271 Lake Number: (56-244.1) Lake Name: ALICE,DEAD HILARY D & MARILYN J BARRY PO BOX 66 RICHVILLE, MN 56576 You are hereby notified that the sewage system which you maintain on the following described property: UNPLATTED GLS 7 & 8 N OF ROAD EXCEPT W 500' Sec: 25 Twp: 135 Range: 040 DEAD LAKE TOWNSHIP Parcel Number: 14000250201000 Lake Assoc/Fire #: DL41 is not constructed and/or located in accordance with minimum standards of the Shoreland Management Ordinance of Otter Tail County. Please be advised that you must correct this situation within 30 days. You should contact this office in order to determine what corrections and permits are required prior to complying with this notification. Land & Resource Management Official - Dated 7/28/97 FIELD NOTES i Ini t?DATELAKE NO.: 56- 244LAKE NAME: ALICE DEAD 383 Parcel No.: 14000250201000 FIRE NO.:LEGAL DESCRIPTION 3> CUnJo ^ 25 135 40 GLS 7 & 8 N OF ROAD EXCEPT W 500' 3 r ‘ i-*— OWlfERS NAME AND ADDRESS: BARRY, HILARY D BARRY, MARILYN J PO BOX 98 4aJijeJi, -P<frr'L/^S’ 56151LAKE WILSON, MN / /^// J s4o uj lA-f hdeXSJ^ 3 Comments: ly uy SEPARATION DISTANCES(IN FEET) OUTHOUSEABSORPTION AREATANKSEWER LINE 7WELL OHWL LOT LINE DWELLING NON DWELLING r3GROUND ELEVATION @ REASON(S) FOR ABATEMENT: i) e>./^ c i so a) £>. y L3"a.O C/ SKETCH ON BACK... Inspector's Signature(s) P ofi d- ; 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 \A' ;te — Office V low — Inspector Pii.. — Owner\ Card — Owner ' Permit No___LEGAL Date f. TDESCRIPTION AND LOCATION 15^'- 3^40 4.. TWP NameLake No.Lake Name Lake Classif.Sec.TWP Range IDENTIFICATION: Please Print All Information. Mailling Address —No. Street, City and State Zip No.Tel. No.InitialLast Name First /?/OWNER SEWAGE SYSTEM INSTALLER Name This System will be ready for inspection , 19.on. This space for office use only .19 .M Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signature cy/PA7S NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PIT /SEPTIC TANK DRAIN FIELD )GIs.30K7S~ Sq. Ft.. Ft.Capacity /f/ Distance from nearest well Ft.Ft.Ft. 140 4 00Ft.Ft.Distance from lake or stream Ft. /n Ft.Ft.Distance from occupied building Ft. /(O /ODistance from property line Ft.Ft.Ft. 7 4Ft/Ft.Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on , 19 , Time M By PERCOLATION TEST DATA:Date of First Test , 19 , Rate Date of Second Test 19 , Rate 1st Test Taken By First Test -I- 2nd Test 2 Rate2nd Test Taken By Agreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. (Caillor use attached mailer notice.) The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in Dated 7 Signature (7is hereby granted to the above narned 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:Permission Issued Date: Shoreland Management Officeod/isc:Fee $Surcharge $ — A/'/rComments:. Form No. MKL-0771-003 vicroa LuaBCEN 4 CO.. Paiat(BO. rCKCuS r^cL*. aiaa 158906 f / 5 f ^ X ■2- <: £? >/ ^.y '7 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 WMe - Office V low — Inspector Pji.. — Owner Card — Owner Permit No., ^-'6- 1LEGAL Date DESCRIPTION AND LOCATION ■r' TWP NameLake Classif.Sec.TWPLake No. Lake Name Range IDENTIFICATION: Please Print All Information. Zip No.Tel. No.Initial Mailling Address —No. Street, City and StateLast Name First OWNER SEWAGE SYSTEM INSTALLER Name. £/£2This System will be ready for inspection on., i92e: This space for office use only IQ-00 A ^ Date Rec'd Owner or Agent SignatureTime Rec'd Pho^e OqTi Rec'd By NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD GIs.Sq. Ft.Sq. Ft.Capacity Ft.Ft.Ft.Distance from nearest well Ft.Ft.Ft.Distance from lake or stream Ft. Ft.Distance from occupied building Ft. Distance from property line Ft.Ft.Ft. Ft.Ft. Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on 19 , Time ,JVI By PERCOLATION TEST DATA:Date of First Test 19 , Rate Date of Second Test 19 , Rate 1st Test Taken By 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 Shoreland Management Offi cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. (Call or use attached mailer notice.) Dated Signature Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE; Permit void if work is not commenced within six (6) months. Issued Date: Shoreland Management Office /<P <ZFee $Surcharge $ Comments:. Form No. MKL-0771-003 158906 VICTOII UiaOeCM 4 CO.. PtlMTCBt. rt4«W4 r«4L». HINN INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PIT DRAIN FIELDSEPTIC TANKCATEGORY Should be Should be Actual Should beActual Actual Capacity S FGIs.GIs.S FS F S F :)ooA'fDistance from Nearest Well 75FF F FF Distance from Lake or Stream F F F FF F 20Distance from Occupied Building 10 20 FFFFF 10 10 10Distance from Property Line F F FFF 6Z F4 4Distance from Bottom to Water Table F FF F F 3o^ ^Q frh^s yInspector's Comments: pj? <nsp/>.>sror2. -G Oci 19_^s 12Date of Inspection Time of Inspection,M ' /,-fi Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs - Gallons SF “ Square Feet F ■ Linear Feet Job Title . « Agency MKL-0771*003-Backer PERCOLATION TEST DATA SHORELAND MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Ph. No.Owner:Mailing Address: Last Name First Middle St. & No.Zip No.City State Legal Description: SEC.LAKE OR RIVER NO.NAME TWP.RANGE TWP NAME TEST HOLE NO. 2TEST HOLE NO. 1 Depth to Bottom of Hole inches; Diameter of Hole.jnchesDepth To Bottom of Hole Inches; Diameter of Hole inches //Depth, Inches Soil Texture zz.Depth, Inches Soil TextureDate.19 19Date Percolation Test By____ Percolation Test Bv .Q LUFirm Name.Firm Name.CC DoLU (T LUAddress.GC Address < CO Otter Tail County License No..Otter Tail County License No..H CO UJMeasurement, Inches Drop in Water -Levol. lT>ches Drop in Water Level. Indies Measurement, InchesTimeRemarksTime Remarks o 11.%rZl / 111/O/S'Jf: /c c ^9*’j,1^%7'Jz/: 3 c S- ISa■ex/S.5z/: so .Z - MKL-0871-0281^3818 ®viCTfl* Luaetta 1 CO rtMul rM.i.8.See Book!et,"How to Rune Percolation Test" by Agriculture Ext. Service, Un. of Minn.