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Swan Lake Club_13000190112000 _ 22630_Septic System Permits_
https://onegov.co.ottertail.mn.us/admst/viewcard.php?card=2&ap... OTTER TAIL COUNTY Land & Resource Management Phone (218) 998-8095 % PERMIT TYPE Sewage Treatment System Permits PERMIT NUMBER 25851 PROPERTY OWNER Swan Lake Club Inc LAKE INFORMATION Swan DNR ID(S)781 LOCATION Parcel(s): 13000190112000 Township Name: Dane Prairie Township Property Address(es): 18313 INTERLAKEN LN Section/Township/Range: Sect-19 Twp-132 Range-042 Legal; 29.64 AC PT G.L. 3 (REC BK 203 PG 486)EX TRS i. WORK AUTHORIZED Add 577 square feet of trench drainfield to existing, compliant system Denise Gubrud 05/29/2019 08:48 AM 2c3ed58b1 d2efd64f783f930bc0bd26c 79746361 fa89c79c094a858bbc6e0c45 05/29/202005/29/2019 ISSUE DATE DATE EXPIRESLand and Resource Management Official/Date NOTE: • This permit must be placed in a conspicuous place not more than 6 feet above grade on the premises on which work is to be done, and must be maintained there until completion of such work. • If the terms of this permit are violated, the entire permit may be revoked and the owner/contractor may be subject to legal prosecution. • Property Owner is legally responsible for all surface water drainage which may occur. • No part of the Septic System shall be covered until it has been inspected or approved. • Notify Land & Resource Management when job is ready for inspection, requests for inspection must be called in no later than 4pm the day prior to inspection. (218) 998-8095. This System wiJi be ready for inspection on , the year of II at (i^V^nexy^ a.m., p.m. Time ReceivedDate Received L & R Official 5/29/2019, 8:49 AM1 of 1 https://onegov.co.ottertail.mn.us/view.php?id=6152&viewOnly= 1 ...Land & Resource Permit Applications f?Land & Resource Management Government Services Center 540 Fir Avenue West Feigus Falls MN 56537 OTTCR Tflil Phone: 218-998-8095 Sewage Treatment System Permit Application Sewage Treatment System Permits Permit # 25851, App. # 841, UID # 6152 Valid: 05/29/2019 - 05/29/2020 Applicant Information Applicant Information:Name: Bill Schueller , Phone; '^(218 ) 770 - 9119 : Email Address: ! billschueiler@gmai|.com Mailing Address; 23725 240th.^ Fergus Falls MN 56537 Agent/DesignerI am the: Is this Sewer Permit Application No for a Collector System? Work Performed By Wori< to be performed by: Contractor's Contact Information fContractor Information:Name: ■ Cory Budke ; Company orBusnessName: ; Septics Plus / Budke Exca\ating ’ Contractor License Number L3069 Phone: (218 ) 731 - 3282 : Email; ; budkeexcavating@Yahoo.com j Address: I i 32873 WtoR^ng SEririsioog j : • I Ertiard MN 56534 Property Owner*s Contact Information Property Owner Contact Information: . Name: i Swan Lake Club, Inc / Richard Baker I Phone: i (612 ) 877 - 1934. ; Email Address rich@rcbaker.com Mailing Address i; 22630 N Swan Lake ,; Fergus Falls MN 56537 5/29/2019, 8:49 AM1 of 3 Land & Resource Permit Applications https://onegov.co.ottertail.mn.us/view.php?id=6152&viewOnly=l... Property Information Project Location:Property Attributes Property Address Legal Description Primary Name/Address CityParcel #Property Address City Legal Description Legal Description Legal Description Name Primary Address Line 1 FERGUS FALLS 29.64 AC PTG.L. 3 (REC BK 203 PG 486) EXTRS SWAN LAKE CLUB 22343 SWAN LAKE RD FERGU FALLS 13000190112000 18313 INTERLAKEN LN N INC Is the property De\«loped or Undeveloped? Developed ShorelandIs the property located in the Shoreland or Non- Shoreland area? Shoreland Information Associated Lakes : DNR ID Lake Class LR CDLake Name Swan 781 RD 56-781 NoBluff: Project Information Residential - Add-OnType of Installation: 1 to 2,499 Gallons Per Day TypeJ Gravity Design Flow: System Type: Efluent Distirbution: System Components Type I Components:Trench - Chamber +50 FeetDepth of Well: 5Number of Bedrooms: Abatement;No Garbage Disposal:No Ejector Yes Number of Tanks:2 Number of Lifts:0 Number of Soil Treatment Areas: 1 Septic/Holding Tank(s) Total Capacity, of Septic/Holding 2500 Gallons Tank(s): Setback to Nearest Well:65 Feet Setback to Ordinary High Water +75 Feet Level: Setback to Bluff:NA Feel Setback to Dwelling: Setback to Non-Dwelling: 13 Feet 85 Feet Setback to Nearest Lot Line:+ 10 Feet Setback to Road Righl-of-Way: HO Feet Soil Treatment Area(s) Total size of Treatment Area:585 Square Feet 150+ FeetSetback to Nearest Well: Setback to Ordinary High Water 200+ Feet Level: NA FeetSetback to Bluff; 125 FeetSetback to Dwelling: 35 Feet + 10 Feet Setback to Non-Dwelling; Setback to Nearest Lot Line: Setback to Road Righl-of-Way: +10 Feet ^ FeetElevation above Restricti\e Layer Documentation Attach Supporting Documentation:• File 1: ; File 2: ^ 22630_N__Swan_Lake_Rd..-_BakGL_-_drawing._otc._05222019.pdf 22630_N_Swan_Lake_Rd_-Baker_-Jrenches_add_on_05102019.xlsx 5/29/2019, 8:49 AM2 of 3 https://onegov.co.ottertaiI.nin.us/view.php?id=6152&viewOnly=l..., Land & Resource Permit Applications Applicant Approval Applicant Signature:Btjl Schueller 05/28/2019Date Signed: Please check to approve;Ij^derstand that chec^king this box constitutes a legal signature Attention;Denise Terms Agreement Tbe undersigned hereby makes application for permit to Install, alter, repair or extend Sewage Treatment System herein specified, agreeing to do all such wor1( in strict accordance with Sanitation Code of Otter Tail County, Minnesota. Applicant agrees that the Attached Documentation 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 co\«red 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 fbr inspection. Note Once a permit is approved it is valid for a period of twelve (12) months from the date of approval unless otherwise indicated on pemiit. Inspections need to be called in by 4pm the day prior. A sewer permit does not include the building sewer (sewer line). Invoice #4743 (05/29/20191 Cost Quantity TotalCharge $350.00$350.00 X 1Sewage System Permit - Licensed instaiier & Privies added 05/29/2019 8:24 AM includes County Soil Verification Grand Total $350.00Total $350.00Payment 05/29/2019 $0.00Due Approvals SignatureApproval Sheila Dahl - 05/29/2019 8:20 AM af69ce99a9fafb2eb30742f95c83cll0 9271dl7be9ceef74d4a0ef7f0930Sf45 #1 Received and Assigned Denise Gubrud - 05/29/2019 8:24 AM7e32al3f8589119abccdf394f3eadc7f fl22fcc8cedd3744b62fd2136d0f56el #2 Application Review Denise Gubmd - 05/29/2019 8:48 AM 2c3ed58bld2efd64f783f930bc0bd26c 79746361fa89c79c094a858bbc6e0c45 #3 Application Approval Public Notes Text: File(s): Internal Notes Text: File(s): 5/29/2019, 8:49 AM3 of 3 -JuMA/ a/- Ji^/^A/'^4 /^64&0 4/A/ mAACLL © SM 4ir^c ~7AfA//f ^AUr/z/C^ A<h& Ai -y^x/A ==r sA rrr:^ sAtmr/m 0IW/ d0/^Ayr/ A0mA/dA /iAA Ta> ty/sr/A/^ -tp M/0/^ S/AreM 7^ S'S^ - yb / "“1!SS!sg2£ *<"“«Fergus Falls,‘^sw37ons ^ Land & Resource Management GSC, 540 W Fir, Fergus Falls, MN 56537 ^fTSR.y.RH 218-998-8095; Website: aaMM,.{{L<ittea3iLmn.ns Subsurface Sewage Treatment System Management Plan Sewage Treatment System Permit Number: Property Owner; ^ ___________________ Parcel Number; /300O/90_________ Lake Name / Number; ^Uf/iA/ " /^/ Township Name; E-911 Address; 2Jlf30 // .^/MAA/ AA> This management plan will identify the operation and maintenance activities necessary to ensure long-term performance of your septic system. Some of these activities must be performed by you, the homeowner. Other tasks must be performed by a licensed septic service provider. Homeowner's Management Tasks - Should Be Checked Every 6 months: Leoks - Check (look, listen) for leaks in toilets and dripping faucets. Repair leaks promptly. Surfacing sewage - Regularly check for wet or spongy soil around your soil treatment area. Effluent filter (if applicable) - Inspect and clean twice a year or more. Pump Tank Alarms - Alarm signals when there is a problem. Contact a service provider any time an alarm signals. Holding Tank Alarms - Can be either an electronic or a manual float, when activated, service (pumping) is required, Event counter or water meter (if applicable) - Record your water use. Section; Professional's (Licensed Septic Service Provider) Management Tasks - Should Be Checked Every 24 Months (2 Years): □ Check to make sure tank is not leaking. □ Check and clean the in-tank effluent filter. □ Check the sludge/scum layer levels in all septic tanks. □ Recommend if tank should be pumped. □ Check inlet and outlet baffles. □ Check the drainfield effluent levels in the rock layer. □ Check the pump and alarm system functions. □ Check wiring for corrosion and function. □ Provide homeowner with list of results and any action to be taken. □ Check inspection pipe caps (replace as necessary). □ Check manhole cover (accessibility, security, or damage). I understand it is my responsibility to properly operate and maintain the sewage treatment system on this property in accordance with this Management Plan. Property Owner:Date; Signature Received by Land & Resource Management:Date; signature The foilowing link will provide information from the University of Minnesota, regarding a Septic System Owner's Guide: http://www.extension.umn.edu/environment/housin^-technoloBv/moisture-management/septic-sv.stem-owner-guide/ LR: SSTS Management Plan 06-20-2014 (3000 I ‘fo_ ^ •SU)<Ov 55o-''7j^/ vCM.01.20lrProject 10: Owarrc ScwAcr TnL*TM6WT PnOCRAS?-Soil Observation Log locatfon / Address: // ShQX,^ LLfi-JClient:V □ Outwash Oucustrine □Loess DTi# OAlluvnjm O Bedrock □ Organic MatterSoil parent reaterial(s): (Check all that apply) □ Surrer* S Shoulder 3'^aWSde Slope OFootaope GToeStopeLandscape Position: (check one)Slope shape * 5iCudK ! T Weather Condiltons/Titne of Day: | Soil survey map units:Vegetation:Slope %: ^Elevation;i Date Observation ^/Location; 5 /v t,V J Observation Type: Sfnicture- <^«lrva.y^ Rock I IDepth (in)Texture Matrix Color(s)Mottle Colof(s)Redox Kind(s)lndicator{s)Frag. %ConsistenceShapeGrade I M I- i 1 iq-isl i I cfjH t iiIiiI !i-i I ;!ii !i 1 ;!; ;■ ] f^ill SchiAelUr :•rv> -^4^ry \f^\^ roc- f hereby certify that 1 have completed this work in accordance with at) applirable ordinances, rules and tews,‘bg-tu^L, G S^AriLj "X^^g^y _____ O- (Oesigner/lnspector) Comments n \ i iignature)(Date)(License #) (h»U Onsite. ' 'SCWAOE. -TueAriviEN'T Procram ^rnfisswiis^^''°"Design Summary Page 1. PROJECT INFORAAATION V 04.02.2019 Richard Baker Swan Lake Club 22630Property Owner/Client:Project ID: 22630 N Swan Lake Rd, Fergus Falls, MN 56537 05/10/19Site Address:Date: Email Address: rich@rcbaker.com Rich Baker Jr.612-877-1934Phone: 2. DESIGN FLOW a WASTE STRENGTH Attach data / estimate basis for Other Establishments 450 ResidentialDesign Flow:GPD Anticipated Waste Type: BOD:mg/L TSS:mg/L Oil a Grease:mg/L CTreatment Level:Select Treatment Level C for residential septic tank effluent 3. HOLDING TANK SIZING Minimum Capacity: Residential =400 gal/bedroom, Other Establishment = Design Flow x 5.0, Minimum size 1000 gallons Code Minimum Holding Tank Capacity: Recommended Holding Tank Capacity: Type of High Level Alarm: Gallons Tanks or Compartments Tanks or Compartments (Set @ 75% tank capacity) in Gallons in Comments: 4. SEPTIC TANK SIZING A. Residential dwellings: Number of Bedrooms (Residential): Code Minimum Septic Tank Capacity: Recommended Septic Tank Capacity: Effluent Screen 8t Alarm (Y/N): 5 2250 2Gallons Tanks or Compartments Tanks or Compartments in 32500Gallonsin No Model/Type: B. Other Establishments: [Days Hyd. Retention Time Tanks or Compartments Tanks or Compartments GPDxWaste received by: GallonsCode Minimum Septic Tank Capacity: Recommended Septic Tank Capacity: Effluent Screen 6t Alarm (Y/N): In Gallons In Model/Type: PUMP TANK SIZING5. GalGalPump Tank 2 Capacity (Minimum):Pump Tank 1 Capacity (Minimum): Pump Tank 1 Capacity (Recommended): ]gPM Total Head Supply Pipe Dia. I lin Dose Vol: GalGal : Pump Tank 2 Capacity (Recommended): ]gPM Total Head Dose Vol: ftftPump 2 gal i Supply Pipe Dia. I ~| Pump 1 Gal Onsite. ' Sewage Design Summary PageProgram 6. SYSTEM AND DISTRIBUTION TYPE Project ID: 22630 TrenchSoil Treatment Type: Elevation Benchmark: Gravity DistributionDistribution Type: Benchmark Location:100 Propane tank cylinderft Type I Registered Product:Distribution Media:MPCA System Type: Type lll/IV Details:High Capacity Chambers 7, SITE EVALUATION SUMAAARY: Describe Limiting Condition: Depth of Observation Layers with >35% Rock Fragments? (yes/no)[~N^ If yes, describe below: % rock and layer thickness, amount of soil credit and any additional information for addressing the rock fragments in this design. Note: DepthDepth Elevation 14.00 ft84inchesftLimiting Condition: Minimum Req'd Separation: 7.0 Critical for system compliance36inchesft3.0 Elevation 17.00Code Max System Depth: 48 inches 4.0 ft ft Sandy LoamSoil Texture: GPD/ft^0.78 Percolation Rate:MPISoil Hyd. Loading Rate: Contour Loading Rate: Measured Land Slope: Comments: Note: 18.0 %Note: 8. SOIL TREATMENT AREA DESIGN SUMAAARY Trench: ft^ Sidewall Depth Trench Width 3 ft12468inDispersal Area 48.03Code Max. Trench Depth ft Designed Trench Depth in156No. of TrenchesTotal Lineal Feet ft iSfVALUE!inee commen'Min. LengthContour Loading Rate ft Bed: ft^ Sidewall Depth Bed Length Maximum Bed Depth Designed Bed Depth ininDispersal Area inftBed Width ft Mound: ft^ftBed WidthBed Length ftDispersal Area Absorption Width Upslope Berm Width Total System Length ftBerm Width (0-1%) Endslope Berm Width Contour Loading Rate ftftClean Sand Lift ftft Downslope Berm System Width ft gal/ftftft Project ID: 22630 iJvivbi&m or.VbtHiierrAOnsite, Sewacc TreatmentProgram MINNESOTA POLLUTION CONTROL AGENCYvmDesign Summary Page At-Grade: ftBed Width ft ft Finished Height Downslope Berm System Width Bed Length gal/ft Upslope Berm ft System Length ftftContour Loading Rate Endslope Berm ftft Level & Equal Pressure Distribution No. of Laterals Lateral Diameter ft Perforation Diameter inPerforation Spacing galin Min Dose Volume gal Max Dose Volume Non-Level and Unequa Pressure Distribution Pipe Volume (gal/ft) Pipe Perf Size Spacing SpacingElevationPipe Size (ft)Length (ft)(in) (in)(ft)(in)Minimum Dose VolumeLateral 1 Lateral 2 Lateral 3 Lateral 4 Lateral 5 Lateral 6 gal Maximum Dose Volume gal 9. Additional Info for At-Risk, HSW or Type IV Design A. Starting BOD Concentration = Design Flow X Starting BOD (mg/L) X 8.35 t 1,000,000 |gpd X B. Target BOD Concentration = Design Flow X Target BOD (mg/L) X 8.35 t 1,000,000 mg/L X 8.35 T 1,000,001 = Lbs. BOD To Be Removed: mg/L X 8.35 T 1,000,001 =lbs. BOD/day lbs. BOD/daygpd X ‘Must Meet or Exceed Target ‘Required for Levels A 6t B PreTreatment Technology: Disinfection Technology: C. Organic Loading to Soil Treatment Area:, Ibs./day/ft^ft^gpd X 8.35 T 1,000,000 Tmg/LX 10. Comments/Special Design Considerations: This design is for the addition of a tank and drainfield square footage to bring the system in compliance for a 5 bedroom dwelling. The system is currently sized for only 2 bedrooms. I hereby certify that I have completed this work in accordance with all applicable ordinances, rules and laws. 5/10/2019L2945Bill SchuellerBill Schueller (Date)(License #)(Signature)(Designer) tAiiumirwVi»! ■■ •{Onsite Sewage :::TREAJMEtjr PnoGriAM Soil Observation Log Project ID: 22630 V 04.02.2019 Location / Address:Swan Lake ClubRichard Baker 22630 N Swan Lake Rd, Fergus Falls, MN 56537Client: □ Outwash □ Lacustrine □ Loess [3 Till □ Alluvium □ Bedrock □ Organic MatterSoil parent material(s): (Check all that apply) □ Shoulder □ Back/Side Slope □ Foot Slope□ Summit □ Toe SlopeLandscape Position: (check one)Slope shape Wooded Soil survey map units:Slope %:Vegetation:18.0 Elevation: Weather Conditions/Time of Day:04/29/19Date Observation #/Location:Approximately first trench location Observation Type: Auger I Structure-IRockMottle Color(s)Texture Matrix Color(s)Redox Kind(s)Depth (in)Indicator(s)Frag. %ConsistenceShapeGrade 10YR 2/1 Sandy Loam <35%0-9 Blocky Weak Friable 10YR 5/6Fine Sandy Loam9-84 <35%Blocky FriableModerate Comments I hereby certify that I have completed this work in accordance with alt applicable ordinances, rules and laws. Bill SchuellerBill Schueller L2945 4/29/2019 (Signature)(Designer/Inspector)(Date)(License #) CNivriuiT^MiKNnviTA Onsite: SiEWAce XwCATMENT RrooramAdditional Soil Observation Logs Project ID: 22630 Client:Richard Baker Swan Lake Club Location / Address: 22630 N Swan Lake Rd, Fergus Falls, MN 56537 □ Outwash □ Lacustrine □ Loess □ Till □ Alluvium □ Bedrock □ Organic MatterSoil parent material(s): (Check all that apply) □ Toe SlopeLandscape Position: (check one) □ Summit □ shoulder □ Back/Side Slope □ Foot Slope Slope shape Soil survey map units:Wooded Slope %:Elevation:Vegetation: Weather Conditions/Time of Day:04/29/19Date: Observation #/Location:Approximate location of 4th trench Observation Type:Auger I Structure-Rock IMatrix Color(s)Mottle Color(s)Redox Kind(s)Indicator(s)Depth (in)Texture ConsistenceFrag. %Shape Grade 10YR 2/1 Blocky Weak0-13 Sandy Loam <35%Friable 10YR 5/6Fine Sandy Loam Blocky<35%Moderate Friable13-72 Comments This boring is down slope by last trench. Hit rock at 72". Last trench should be no deeper than 36". OnSITCi SeVMG£ TRI-ATWeNT Program Field Evaluation Worksheet mi MINNESOTA POLLUTION CONTROL AGENCY V 04.02.2019. 1. Project Information Property Owner/Client:Richard Baker Swan Lake Club Project ID:22630 22630 N Swan Lake Rd, Fergus Falls, MN 56537 Date Completed:4/29/2019Site Address: 2. Utility and Structure Information Utility Locations Identified □ Gopher state One Call # Locate and Verify (see Site Evaluation map) □ Existing Buildings □ improvements □ Any Private Utilities: □ Setbacks□ Easements 3. Site Information Wooded Back/ Side SlopeVegetation type(s):Landscape position: 12 northSlope shape: Linear, LinearPercent slope:Slope direction:% Describe the flooding or run-on potential of site: Describe the need for Type III or Type IV system: Note: Elevations and Benchmarks identified on map? (Y/N):Yes If yes, describe: StakedYesProposed soil treatment area protected? (Y/N):If yes, describe: 4. General Soils Information Filled, Compacted, Disturbed areas (Y/N):No If yes, describe: YesSoil observations were conducted in the proposed system location (Y/N): YesA soil observation in the most limiting area of the proposed system (Y/N): 3 YesSoil observation logs attached (Y/N):Number of soil observations: NoPercolation tests performed 6t attached (Y/N): 5. Phase I. Reporting Information Depth Elevation fine sandy loam8414Periodically saturated soil: Standing water: Bedrock: Benchmark: ft Soil Texture: Percolation Rate: ft Soil Hyd Loading Rate: in min/inch gpd/ft^ ftin 0.6in 100 ft Top of propane tank cylinderBenchmarck Location: Differences between soil survey and field evaluation: Site evaluation issues / comments: Anticipated construction issues: Preliminary Evaluation Worksheet Onsnc ' StWAOEXRiKATf.lKNT Program MINNESOTA POLLUTION CONTROL AGENCYrm 1. Contact Information V 04.02.2019 Property Owner/Client: Richard Baker Swan Lake Club Date Completed:4/29/2019 22630 N Swan Lake Rd, Fergus Falls, MN 56537 22630Project ID:Site Address: Email: rich@rcbaker.com Rich Baker Jr.Phone: 612-877-1934 Mailing Address: 3770 Woodland Cove Parkway, Minnetrista, MN 55331 Legal Description: 132 042Parcel ID: 13000190112000 19 RNG:TWP:SEC: 2. Flow and General System Information A. Client-Provided Information Project Type: □ New Construction Project Use: □ Residential □ Other Establishment: □ Replacement El Expansion □ Repair 5 Dwelling Sq.ft.:Unfinished Sq. Ft.:Residential use: ft Bedrooms; ft Children:ft Teenagers:# Adults: In-home business (Y/N): No If yes, describe: □ Garbage Disposal/Grinder Water-using devices: 0 Sewage pump in basement (check all that apply) □ Large Bathtub >40 gallons □ Clothes Washing Machine □ Hot Tub* □ Sump Pump* □ Self-Cleaning Humidifier* □ Other: □ Dishwasher El Water Softener* □ Iron Filter* □ High Eff. Furnace* * Clear water source - should not go into system Additional current or future uses: Anticipated non-domestic waste: The above is complete & accurate: Client sisnature ft date B. Designer-determined flow Information Attach additional information as necessary. Residential450Anticipated Waste Type:Design Flow:GPD mg/LOil a Greasemg/LBOD:mg/L TSS Confining Layer STAWell Depth Casing Depth (ft.)Setback Source(ft.)Description Mn. ID## Deep Well1 owner 2 3 4 Additional Well Information: I'k frti tm m Preliminary Evaluation Worksheet Onsiti!« * SCWACCThb&tmhnt Progra?/!nm MINNESOTA POLLUTION CONTROL AGENCY Site within 200' of noncommunity transient well (Y/N) Site within a drinking water supply management area (Y/N) Site in a Well Head Protection inner wellhead management zone (Y/N) Buried water supply pipes within 50 ft of proposed system (Y/N) No Yes, source: No Yes, source: No Yes, source: B. Site located in a shoreland district/area?Yes SwanYes, name: Elevation of ordinary high water level:ft Source: Lake- RecreationalClassification:75 75Tank Setback:ft. STA Setbk:ft. C. Site located in a floodplain?No Yes, Type(s): Floodplain designation/elevation (10 Year):ft Source: Floodplain designation/elevation (100 Year): D. Property Line Id / Source: 0 Owner □ Survey 0 County GIS □ Plat Map □ other: E. ID distance of relevant setbacks on map: 0 Water □ Easements 0 Well(s) 0 Building(s) 0 Property Lines 0 OHWL □ Other: ft Source: 4. Preliminary Soil Profile Information From Web Soil Survey (attach map ft description) Slope Range:%Map Units: List landforms: Landform position(s): Parent materials: inDepth to Bedrock/Restrictive Feature:Depth to Watertable:in Septic Tank Absorption Field- At-grade: Map Unit Ratings Septic Tank Absorption Field- Mound: Septic Tank Absorption Field- Trench: 5. Local Government Unit Information Name of LGU: Ottertail County Land and Resource Dept 218-998-8095LGU Contact: LGU-specific setbacks: LGU-specific design requirements: LGU-specific installation requirements: Notes: OnsiteSewa<se Treatment Program MINNESOTA POLLUTION CONTROL AGENCYnriTTrench Design Worksheet Project ID: 22630 V 04.02.20191. SYSTEM SIZING: 450A. Design Flow:GPD Designers Maximum Depth: See comments inches48B. Code Maximum Depth:inches GPD/ft^0.78 Contour Loading Rate:gal/ftC. Soil Loading Rate: D. Required Bottom Area: Design Flow (1.A) Loading Rate (1.C) = Initial Required Bottom Area 450 I GPD-I oTtS I GPD/ft^ =ft^577 □ Rock El Registered Product □ Pressure □ Gravity-Drop Box □ Gravity-Other chamber to chamber G. If distribution media is installed in contact with sand or loamy sand or with a percolation rate of 0.1 to 5 mpi indicate distribution or treatment method: E. Select Dispersal Media: (selection required) F. Select Distribution Method: 2. TRENCH CONFIGURATION: ROCK Initial required trench bottom area (ft^): (from 1.D) Sidewall Absorption (inches) Design trench bottom area A.Bottom Area Reduction Bottom Area Multiplier X a Cover 6 to 11 1 a__Distribution 12 to 17 20*0.8 18 to 23 34*0.66 Sidewall 40*0.624 inches ftB. Select Sidewall Height:=Width ft^C. Design Bottom Area (2.A): D. Select Trench Width:ft E. Total Designed Trench Length: Bottom Area t Trench Width = Total Required Trench Length Ift^ft =ft F. Calculate Minimum length of each trench based on Contour Loading Rate: Design Flow t CLR = gpdv gal/ft ft Designed Number of Trenches H. Length per trench = Actual Trench Length t Number of Trenches (recommended to be equal or exceed 2F) I ft T Mini mi urn base on CLRG. Number of Trenches: ft ft (typically 5 - 12 ft from center to center)J. Select Trench Spacing : K. Calculate Lawn Area: Trench Length (2.E) X Trench Spacing (2.G) = square feet of lawn area ft X ft^ lawn areaft = ft (0.33 ft for pressure, 0.5 ft for gravity)L. Select Depth Required to Cover Distribution Pipe: M. Calculate Rock Volume: (Sidewall Height (2.B) + Depth to Cover Pipe (2.J)) X Bottom Area (2.C) = cubic feet + 27 = cubic yards ft' =yd'ft'ft +ft) X + 27( 3. TRENCH CONFIGURATION: REGISTERED PRODUCTS - CHAMBERS AND EZFLOW Initial required trench bottom area (ft^): (from 1.D) Sidewall Absorption (inches) Design trench bottom area •A.Bottom Area Reduction Bottom Area Multiplier 6 to 11 1 577 12 to 17 20%0.8 462577 18 to 23 34%0.66 381 24 40%0.6 346 B. Registered Product: C. Select Sidewall Height: High Capacity Chambers Check registered product information for specific applicationdetails and design 12 1.0inches ft— 468 ft^D. Design Bottom Area (3.A): 3 ftE. Registered Width: F. Minimum Designed Trench Length = Bottom Area (3.C) f Trench Width (3.D) ft^468 3.0 156ft =ft 4G, Enter the Registered Product Component Length:ft H. Number of Components = Minimum Total Length Required divided by Component Length (Round up) 391564ftTft =components I. Actual Total Trench Length = Number of Components X Component Length: ft = r39 components X 4.0 156 ft J. Calculate Minimum length per trench based on Contour Loading Rate: Design Flow f CLR = gpdv gal/ft450.0 #VALUE! ft #VALUE!3 Designers Number of TrenchesK. Select No. of Trenches:Minimium based on CLR L. Length per trench = Actual Trench Length t Number of Trenches. Recommended to be equal or exceed 3.J. trenches =52.0 ft156.0 3ftv 7 ft (typically 5 - 12 ft from center to center) N. Calculate Lawn Area: Trench Length X Trench Spacing = square feet of lawn area M. Select Trench Spacing : ft^ lawn area10921567ft X ft = Comments: Maximum depth of 48" on first trench. Trenches 2 and 3 should be shallower as slope allows. L SEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTS STA (SowneOmentArea) OUTHOUSE TRENCH REDUCTIONHOLDING SEPTIC TANK LIFT TANKCATEGORY 12$T7GLS.Rock trenches with inchesCapacityFT^ ^20'10^.S FT of sidewall forFT _ %FTSetback from Nearest Well snreduction/equivalent to fpSetback from Buried Water Suction Pipe FT FT FT Setback from Buried Pipe Distributing Water Under Pressure STA CALCULATION (Soil Tteatmenl Area) Ft. X \0^FT FT FT j 'L‘7^ ft My 3fLSetback from OHWL (lake &/or river)FT FT Ft. Setback from Bluff FT FT FT Ft* W-S /OC)^ FTSetback from Dwelling FT FT MOUND/AT-GRADE &"7 ROCK BEDSetback from Non-Dwelling FT FT FT 7Setback from Nearest Property Line FT FT FT Ft. /Setback from Right-of-Way FT FT FT Ft* 3Elevation above Restrictive Layer FT FT FT SAND IN MOUND FtINSTALLERS COMMENTS SEPTIC TANK(s)Hdij^rigJ^k / Lift Alarrrt,gA‘ES------g-NO' 1# Tanks InstalledWeep Holes I IQlg^^Sitem^P0mpetL&-Destroved gVES J NO Manuf.iteral Pjoe Siza—i'Number of Laterals #IN Model #: Perforati^Spacing Perforation Diameter SizeFt.IN pfNOPUM(4'Gallons Per-Miniit^ J Feet of Total Head [FILTERS OYES T Inspector's Comments: LalOL Sketch: L ) n lODS 1 -Z3S'^6 h - ' II 1Z6U ll y ■ the above described sewage system installation was found to be compliant with-the provisions of the Sanitation Code of Otter Tail County. ) As 0iInittal/LiRCmdal ! Land & Resource Management OfUdal Form No. BK — 04-2014-08 tL 357^43 • Victor Lundoen Co., PrlntorBT^efQus FoIIb, Minnesota ^ (ttU^ M JaW/ '€i^- 3 33/3/3/#-■ ?jr<f5-/Mt-y^utCL & jA/eu/zf/^ S<^< /Ak/ A:^o 4r/«i £f 'fi’7///^ A JzASZ>^ lk¥Ay^ i/Iiijm/i^ I ,{/3^^) /. ( . 3/40' /3M(J^/ / / Jlp3t\ JPfCfjMr/A/^^I Z! S^' '* ■Vau/ 3^ dZ/TirW^/J I I I V -■'-")k\\}I! imr///a 7^f 75? S Sz^i I I4d/" = 70/ C il^ cijjz *“p " 2?7Mli^g Fergus Falla, MN 56637\ly^ 13000 I fo /f^doo Ss- Project ID; ! kivtartfiyorOnsitc Sewace TRfcATMEfiT PrtocriAM Soil Observation Log •5uio>v V 04.01.201T 2 ckMd' 6>a^y^65*(0 <^UJ£trvClient:Location / Address:V □ Outwash □ Lacustrine □ Loess □ Till □ Alluvium □ Bedrock □ Organic MatterSoil parent material(s): (Check all that apply) B Shoulder ©MCk/Side Slope□ Summit O Foot Slope □ Toe SlopeLandscape Position: (check one)Slope shape 6al.sK ! 'f r-tc^Soil survey map units:Vegetation:Slope %: ^Elevation: Weather Conditions/Time of Day: ^ |DateZ2. Observation Type: Structure Observation ^/Location: IRock IDepth (in)Matrix Color(s)Mottle Color(s)Texture Redox Kind(s)Indicator(s)Frag. %ConsistenceShapeGrade 1^ yr T'j y-0"^<3^ft.b L'cp {'b^S b l-K ^I ll ■S ckut ryo ^ kil-^ ro!>^ I hereby certify that I have completed this work in accordance with all appli^ble ordinances, rules and laws.^ tytuSvu G fr^ru.J____ ________ O Comments (Designer/Inspector)[Signature)(License #)(Date) /j CERTIFICATE OF APPROVAL SEWAGE SYSTEM SI This Certificate has been issued this 17th of November,1999 , to certify that the sewage system installed as per Sewage Treatment System Permit Nijmber 13230 has been approved for use by Otter Tail County, Minnesota. g. The property served by this Sewage System is legally described as: UNPLATTED'0-PT G.L. 3 (REC BK 203 PG 486) EX TRS%Parcel Number{s); 13000190112000 Section: 19 Township: 132 Range: 042 Township Name: DANE PRAIRIE TWP Is Lake/River Number: 56-781 Lake/River Name: SWAN Current Property Owner: SWAN LAKE CLUB INC (*)m Number of Bedrooms: 2 * This system services Richard Baker Residence Land & Resource 204.709 • Victor Lunaecn Co. Printers • Fergus Falls. MN • 1 •800-346-4870 APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM 1* LAND & RESOURCE MANAGEMENTOTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 - EERGUS FALLS, MN 56537 WHITE — Office YELLOW — L & R Inspector PINK — Owner / Contractor pr s 5'c^ LEGAL Permit No. DESCRIPTION cIck^ ))NoAbatement: ( ) YesAND<vLOCATION LAKE NUMBER LAKE/RIVER CLASS SECTION TWP NO RANGE TWP NAMELAKE/RIVER NAME 5ujA.rO J32./eo /‘f FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER(S) / J Qoo /f a//:2^ QOQ IDENTIFICATION: Please Print All Information Mailing Address — No. Street, City and State Zip Code Telephone No.Last Name First Initial Lj ■ /T ZProperty Owner / 6-^/J7 ASewage System Installer Name state Lie. # A.M. >■ This System will be ready for inspection on.PM.the year of .at. This space for office use only NUMBER OF BEDROOMS: AM. PM.GARBAGE DISPOSAL; ( ) YES (^)NO Date Rec’d Year of Time Rec’d Phone Call Rec’d By TYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) ( Septic tank ( ) Lift station (Alarm Required) Drainfield (Trenches ( ) Bed ( )Mound * ( ) Outhouse ( ) Sewer line SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTS DRAINFIELDTANK Ft^GIs.Capacity S~^Ft. Ft.Distance from nearest well 7jT-Ft.Distance from lake, wetland or river (OHWL)Ft. /c^Ft.Ft.Distance from dwelling /O Ft.Ft.Distance from non-dwelling /'O Ft.Distance from property line Ft./o EFFLUENT DISTRIBUTION Gravity ) Pressure Ft. Ft.Distance from bottom to Water Table All distances are shortest distance between nearest points( PERCOLATION TEST DATA:WATER WELL DEPTH /pOfZr^ 70Z- * ABSORBTION AREA FOR MOUNDS Date of Perc TestDesigner Lie. # .ft2 2, /L±Rate of 1 St Test Rate of 2nd Test Highest Rate Agreement: The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in strict accordance with Ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minnesota Department of Health, Applicant agrees that plot plan sketches and specifications submitted herewith and which are approved by Shoreland 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 accepted. It shall be the respon sibility of the applicant for the permit to notify the County Shoreland f^nagement tffA the job isT^dy for inspection. 7, DATE: 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 con dition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of any said ordinances. NOTE: Permit void if work is not commenced within six (6) months. Issued Date: Land & Resou^g^lSarlS^ment Office — t>Fee S.Rec if Comments: 298.110 • Victor Lundeen Co Printers ♦ Fergus Falls. MinnesotaBK 1099-003 APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM it LAND & RESOURCE MANAGEMENTOTTER TAIL COUNTY COURT HOUSE Phone; (218) 739-2271 - FERGUS FALLS, MN 56537 WHITE — Office YELLOW — L&R Inspector PINK — Owner / Contractor pT (?4 7 Permit No.LEGAL DESCRIPTION ) Yes (y. ) NoAbatement: {AND LOCATION V SECTION TWP NO.RANGE TWP NAMELAKE NUMBER LAKE/RIVER NAME LAKE/RIVERCLASS a-^U2.r?o PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER .7 Vcf}J Ooo /f ^//-^ OOP IDENTIFICATION: Please Print All Information Zip Code Telephone NoMailing Address — No Street, City and Stateist Name First Initial P ^ j_________________ , SUf'T^/Kt, J j zProperty Owner /^c/eGuJ / (y^/ T/ ^Sewage System Installer Name /oo/- State Lie. # ../7>• This System will be ready for inspection on.=.M., the year of This space for office use only NUMBER OF BEDROOMS:llInlM Ph^r^ Cail^ec'd By GARBAGE DISPOSAL: ( ) YES ( T<) NODate Rac'd Year of Time Rec'd TYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) ( Septic tank ( ) Lift station (Alarm Required) Drainfield ( ) Trenches ( ) Bed ( ) Mound * ( ) Outhouse ( ) Sewer line SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTS DRAINFIELDTANK Ft"Gis.Capacity 7r^ 5"^Distance from nearest well Ft.Ft. Distance from lake, wetland or river (OHWL)Ft.Ft. Ft.Ft.Distance from dwelling 2 Ft.Ft.Distance from non-dwelling Ft.Ft.Distance from property line /c^ EFFLUENT DISTRIBUTION (^^>4 Gravity ) Pressure J?Ft.Ft.Distance from bottom to Water Table All distances are shortest distance between nearest points( PERCOLATION TEST DATA:WATER WELL DEPTH /QO&' 70^----- * ABSORBTION AREA FOR MOUNDS Date of Perc TestDesigner Lie. # ft2 2< /2. /LTl Highest RateRate of 1 St Test Rate of 2nd Test Agreement: The undersigned hereby makes application for permit to instail or extend Sewage Disposai System herein specified, agreeing to do all such work in strict accordance with Ordinances of the County of Otter Taii, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minnesota Department of Heaith. Applicant agrees that plot plan sketches and specifications submitted herewith and which are approved by Shoreiand management Official shall become a part of the permit. Applicant further agrees that no part of the system shaii be covered until it has been inspected and accepted. It shall be the respon sibility of the applicant for the permit to notify the County Shoreiand Management that the job is ready for inspection. DATE: //7_______________ 7 ,/ Signature ^ ^f Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express con dition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of any said ordinances. NOTE: Permit void if work is not commenced within six (6) months. Issued Date: Land & Resource Management Office Fee $Rec # Comments: 298.110 • Victor Lundeen Co Printers • Fergus Falls. MinnesotaBK 1099003 e-■WSi • ^ '^69* INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS DRAINFIELDHOLDING SEPTIC TANK LIFT TANKCATEGORY MinimumActual Capacity A '-^/gais.FT 2FT 2GLS. Distance from Nearest Well FTFTFT Distance from Buried Water Suction Pipe ft FTFT50FT Distance from Buried Pipe Distributing Water Under Pressure /O /« f-FT FT FT 10 FT Distance from(Cakg]^etland or River (OHWL)/5"or- FT/i"‘> ^ ft FTFT Distance from Dtwelling //10/20 FTFTFTFT Distance from Non-Dwelling /oft FTFTFT Distance form Nearest Property Line FT FT 10 FTFT Distance from Bottom to Water Table / Restrictive Layer FTFT3FTFT Holding Tank/Lift Alarm NOf^/A/SB)Old System Pumped & Destroyed NO DRAINFIELD CALCULATIONSewer Line to Well SeparationINTERPRETATION OF ABBREVIATIONS Actual Minimum ^ pt/GLS. = Gallons FT^ = Square Feet FT = Linear Feet FTX 5''^'“ FT ft"FT20 MOUND CALCULATION' t/ROCK REDUCTION Inspector’s Comments: ^pcr.ppTir.M APg^ inchesRock trenches with Ft. X %of rock under pipe for ,ft2 DF.reduction / equival SKETCH: § tors NamePrint In Inspector’s Signature Date / Time of Inspectioi I ^ J System design must be to scale and must include the proposed location of the sewage system, all^ existing/proposed buildings, property lines, the ordinary high water level of the water body, wetlands and all water wells within 150' of the sewage system. GRID PLOT PLAN feet SKETCHING FORMfeet, or/Scale:grid(s) equals inch(es) equals /,SUBMITTED BY: S^LX FIRM NAME: ADDRESS: P^/ SIGNATURE: -3o-~ 99DATE: LICENSE CATEGORY: / ^ ^ MPCA LICENSE #: i n ja d i JOiNO \ - V ! L ! 296.213 • Victor Lundeen Co. Pfintefs ■ Ftrgus F*lls. MN » 1-0OO-346-487OBK - 0496 — 029 SITE DATA LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, MN 56537 OWMER: R/Ct kic/t TELEPHONE NUMBERFIRSTMIDDLELAST NAME ADDRESS: ftojk meus CITY STATE ZIP CODE SEC.RANGE TWP. NAMELAKE/RIVER NO.LAKE NAME TWP. LEGAL DESCRIPTION:SOIL BORING LOG — Date COLOR & MUNSELL NO. DEPTH (INCHES)STRUCTURETEXTURE BLOCKY PLATY PRISMATIC r-TsfONE~~3 BLOCKY PLATY PRISMATIC /3 /T-o//-z_3// PARCEL NUMBER /o Cfe CL^tfFIRE NUMBER ANUMBER OF BEDROOMS iOCfe.BLOCKY PLATY3^J GARBAGE DISPOSAL: YES PRISM^LLCL i^"KiONE7c?WELL CASING DEPTH:ft.BLOCKY PLATY PRISMATIC NONE FLOODPLAIN: YES -^terrestrial]^VEGETATION: AQUATIC BLOCKY PLATY PRISMATIC NONE JSLOPE AT INSTALLATION SITE: Pit <*'65rinq DTYPE OF OBSERVATION: Probe PARENT MATERIAL: ORIGINAL SOILf’^^V^ No Outwash Loess Bedrock Alluvium COMMENTS:. COMPACTED SOIL: Yes ft.DEPTH OF BORING:. PERC TEST #2PERC TEST # 1 - TWO TESTS ARE REQUIRED - PERC RATETIMEINTERVAL (MINUTES)WATER DEPTH WATER DROPINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATETIME 3-/STARTs /$-STA^^/O TIME DROP PERCPERCTIMEDROP WATER DEPTH WATER DROP PERC RATEPERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROPTIMEINTERVAL (MINUTES) gkivr 33-Wjs FSO 9.../T/o-Zc.PERCTIMEDROPDROPPERCTIME WATER DEPTH WATER DROP PERC RATEPERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROPINTERVAL (MINUTES)TIME Clio REFIIX,^2.g-TIME DROP PERCDROPPERCTIME PERC RATEWATER DEPTH WATER DROPPERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROPINTERVAL (MINUTES)TIME “7F 9^—*?•' 6a ..7—-TIME DROP PERCTIMEDROPPERC WATER DROP PERC RATEPERC RATE TIME INTERVAL (MINUTES)WATER DEPTHWATER DEPTH WATER DROPTIMEINTERVAL (MINUTES) ..S'.?__K.REFILL /r.^.7 TIME DROP PERCTIMEDROPPERC PERC RATEWATER DEPTH WATER DROPWATER DROP PERC RATE TIME INTERVAL (MINUTES)INTERVAL (MINUTES)WATER DEPTHTIME REFILLREFILL TIME DROP PERCPERCTIMEDROP PERC RATEWATER DEPTH WATER DROPWATER DROP PERC RATE TIME INTERVAL (MINUTES!WATER DEPTHTIMEINTERVAL (MINUTES)REFILLREFILL TIME DROP PERCTIMEDROPPERC WATER DROP PERC RATEPERC RATE TIME INTERVAL (MINUTES)WATER DEPTHWATER DEPTH WATER DROPTIMEINTERVAL (MINUTES)REFILLREFILL TIME DROP PERCDROPPERCTIMEillicit('9PROPOSED DESIGN: X GRAVITY DIST. X PRESSURE DIST..HOLDING TANKATGRADE.MOUND.TRENCH.BED. OUTHOUSE.OTHER. SPECIFY:.SEWER LINE. — SYSTEM DESIGN ON BACK — PJ EXCAVATING RR#1 BOX 151A ERHARD, MN 56534 SUBJECT GARBAGE DISPOSAL NAME ADDRESS LO. ______ CITY & ZIP ^'79?/^. LAKE OR RIVER RANGE 9g? SECTION TWP /-^=^ Zk^ TANK SIZE DRAINFIELD SIZE ^3J ________ SET UP FOR GARBAGE DISPOSAL X NOT SET UP FOR GARBAGE DISPOSAL OWNERS SIGNATURE INSTALLER SIGNATURE PERCOLATION TEST DATA ■ ■- Price $ 1. 00 per pad.I SHORELAIMD MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Owner:Mailing Address:ij a.ILuLast Name First Middle Zip No.Legal Description; fTWP NAME iiZ LAKE OR RIVER NO.SEC.NAME TWP.RANGE TEST HOLE NO. 2TEST HOLE NO. 1 41377L Depth to Bottom of HoleDepth To Bottom of Hole inches; Diameter of Hole Jnchesinches;Diameter of Hole inches .... ____ Depth, Inches Soil Texture Depth, Inches Soil Texture Date a^ni_*/%Percolation Test Bv____ Percolation Test By____dC6^ -y ^LUFirmName.QC FirmName.D oLU GC /d 7^joyd LUAddress.QC Address < C/)Otter Tail County License No.Otter Tail County License No^HC/DLUMeasurement, Inches____Depth in Water Level, Inches I-Measurement, Inches Depth in Water Level. Inches Time Remarks Time Remarks o S::?a 7' .^rgt- sU3X/I A4-^ 9- .7?*r\£L4 L *5 a ./uy7:^J2^9^ ^4 SL ^pju MKL-0871-028 ’83-818 See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn.I Review battie iake. Minnesota/ r « 1 <7 I.' V'SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 — Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM Whffe — Office Yel/ow — inspector Pink — Owner Cord — Owner Tr?. Xn/ Gi *-2 SU/Atj lAH£ CiLue Permit No., LEGAL DESCRIPTION AND i- 130 Va QFhrj£ PfiAlfilEaoLOCATION TWP NameLake Classif.TWP RangeLake Name Sec.Lake No. IDENTIFICATION: Please Print All Information. Zip No.Tel. No.Mailling Address —No. Street, City and StateFirst InitialLast Name Pi<^KOWNER £4£r?FeecjAS Falls SEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection on.. 19. This space for office use only ,19 ,M Owner or Agent SignatureDate Rec'd Time Rec'd Phone Call Rec'd By g r ^00 = 2000^NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD Qi.Goo GIs.Sq./Ft.Sq.Capacity Ft.Ft.Ft.Distance from nearest well IS Ft.Ft.Ft.Distance from lake or stream M Ft.Ft.Ft.Distance from occupied building 10 Ft.Distance from property line 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 .M By PERCOLATION TEST DATA:Date of First Test , 19 Rate Dat-3 of Second Test 19 , Rate 1st Test Taken By First Test -I- 2nd Test 2 Rate2nd Test Taken By The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work inAgreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi cial shall become a part of. the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job js.ready for inspection. (Call or use attached mailer notice.) 7 -Dated Signature Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if.work is not commenced within six (6) months. Permit: /3.7 - //'S’S Issued Date: Shoreland Management Office \0.OOFee $ Comments:. {^{VIEW BA1TLE LAKE. VdNNESOIAForm No, MKL 0771*003 «i ■S ■i INSPECTION RESULTS' ■V4: Vi.Inspector must make all measurements ?^ V ■v 'T SEWAGE DISPOSAL SYSTEM STATISTICS SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORYActualShould be Actual Should be Actual Should be Capacity GIs.GIs.S F SF S FS F Distance from Nearest Well 75 50FFFFF F Distance from Lake or Stream F F F F F F Distance from Occupied Building 10 20 20FFFFF F Distance from Property Line 1010 10FFFFF F Distance from Bottom to Water Table 33FFFFF F Inspector's Comments: : J - ‘ ! A Date of Inspection 19___ Time of Inspection..M signature of InspectorINTERPRETATION OF ABBREVIATIONS Git “ Gallons SF “ Square Feet F “ Linear Feet Job Title AgencyMK1^0771-003-Backet j '■ > ^.\ : \V.. .v%--A .vi'- .' -I'O'n- 'aiK t" $ r SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 - Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM WhlW-Offic* Yeflow — Inspector Pink — OwriBf Card —0«vn«f Permit No. LEGAL DESCRIPTION AND LOCATION TWP NameSec.TWP RangeLake Classif.Lake NameLake No. IDENTIFICATION; Please Print All Information. Tel. No.Zip No.Mailling Address —No. Street, City and StateInitialFirstLast Name OWNER SEWAGE SYSTEM INSTALLER Name. >n - II-This System will be ready for inspection on.., 19. This space for office use only Z-Ofi.. 'SK't-I^LT- U Owner or Agent SignaturePhone Call Rec'd ByDate Rec'd Time Rec'd NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PIT DRAIN FIELDSEPTIC TANK SO^/QO Sq. Ft.GIs.Sq. Ft.Capacity % Ft.Ft.Ft.Distance from nearest well 75“Ft.Ft.Ft.Distance from lake or stream Ft.Ft.Ft.Distance from occupied building loFt.Ft.Ft.Distance from property line Ft.Ft.Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS: . .............. Time. .....&Z.-1..Z..... M By19Inspection was made on 9fi..Rate. 19....?^.^., Rate Date of First Test 19PERCOLATION TEST DATA: C~^ol U.Date of Second Test 1st Test Taken By \1 1....s:.u?..(V + 2nd TestFirst Test 2 Rate 2nd Test Taken By The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work inAgreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. (Call or use attached mailer notice.) Dated Signature Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon expressPermit: condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six (61 months. Issued Date: Shoreland Management Office Fee $ Form No. MKL-0771-003 } X, INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SFEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORY Should beActual Actual Should be Actual Should be 0P6bCapacity GIs.GIs.S F S F S FS F Distance from Nearest Well 505FFF F F SIDistance from Lake or Stream F F F,F F F Distance from Occupied Building 10 20 20FFF F icfDistance from Property Line 10 10 10FFFFF F Distance from Bottom to Water Table 33FFFFF F Inspector's Comments; Oa. ^ ***J2^ ^ T 7- /J?■19. F3Date of Inspection 1/^M/ :.1Time of Inspection. ^/C\\v Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs « Gallons SF “ Square Feet F “ Linear Feet Job Title AgencyM KL-0771-003-Backer i r \ 7 \ 3 a FORM 780 - REV. 1/54