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Home My WebLink AboutSwan Lake Club_13000190112000 _ 22820_Septic System Permits_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 08/27/2015 Swan Lake Club Inc Attn Richard C Baker 22630 Swan Lake Rd N Fergus Falls MN 56537 8235 RE: Primary Owner: Swan Lake Club Inc Sewage Treatment System Servicing Tax Parcel Number: 13000190112000 Described as:Sec 19 Twp Dane Prairie Twp Sect-19 Twp-132 Range-042 29.64 AC PT G.L. 3 (REC BK 203 PG 486) Lake: 56-781 Swan As of 08/25/2015 the sewage treatment system (Sewage Treatment Installation Permit # 23592 servicing the Judy Stringer property at 22820 N Swan Lake TrI) was determined to be in compliance with the provisions of the Sanitation Code of Otter Tail County for a 3 bedroom home. If you have any questions regarding this matter, please contact our office. Sincerely, Kyle Westen Inspector ^ Cc Judy Stringer APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENT GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 218-998-8095 www.co.otter-tail.mn.us OTTER Tim PINK - Owner/ Contractor (after issue)WHITE - Office YELLOW -L&R InspectorCOftTT-aiRaCIOTII Permit No. 2—APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED RANGETWP NAMELAKE/RIVER NAME LAKE/RIVER CLASS SECTION TWP NO.LAKE NUMBER /9 E-911 ADDRESS ORI OR D*R/ip.ixa'T/. /UmA> ECTIONS FROM NEAREST PUBLIC ROADPARCEL NUMBER (S) OF PROPERTY BEING SERVICED /^ooo/90//;<i7>c>< LEG/DESCRIPTION 9 ^<7/^ First Initial Mailing Address Daytime Phone No.Last Name a/.Property Owner / TiMiO'OniS ACL7X4 ^//3-t:Contractor Lie.#ma/ THIS SPACE FOR OFFICE USE ONLY A.M. >• This System will be ready for inspection on , the year of P.M..at A.M. P.M. Date Received Time Received L&R Official TYPE OF NSTALLATION (circle one)SEWAGE TREATMENT SYSTEM DESIGN DATA AS SHOWN ON DRAWINGOther Est.Residential Collector (G) New (H) Replacement (I) Add on New / Replacement!/ (C) Add on (D) New (E) Replacement (F) Add on Soil Treatment Area Tank Lift Design Flow (Gallons/Day) (A °1 — 2,499 i/ (Q 2,500 — 4,999 (M) 5,000— 10,000 Efflu^t Distrib^ion (N/) Gravity Ft.( ) Pressure \Size /Setback To Nearest WellType I Type II ery Ft. (27) Rapidly Permeable(20) Trench, Rock Ft.Setback To OHWL(21) Trench, Gravelless (28) Flood Plain (22) Trench, Chamber (29) Privies Ft.Ft. Ft.Setback To Bluff(30) Holding Tank (Contract Required) (23) Bed (24) Mound Ft.AO^\/Setback To Dwelling (25) At Grade Type III Setback To Non-Dwelling Ft.(26) Greywater (31) Other/Problem Soils/<12” Soil ^S^Tank Only Type IV Setback To Nearest Lot Line /£> Fy Ft.(32) Public Domain & Proprietary Technologies(35) Other /Depth of Well —Setback To Road Right-Of-Way y /d^y Ft.Type V Total It Bedrooms _ w ' (33) Pedormance Garbage Disposal Y / ^ /Elevation Above Restrictive Layer ------- Ft.Ft. Ft.Abatement Y / PWTCTEST DATA Date of Test Highest RateDesigner Agreement: The undersigned hereby makes application for permit to install, alter, repair or extend Sewage Treatment System herein specified, agreeing to do all such work in strict accor dance with Sanitation Code of Otter Tail County, Minnesota. Applicant agrees that the Site Data Worksheet submitted herewith and which is approved by a Land & Resource Management Official shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and approved for use. It shall be the responsibility of the applicant for the permit to notify Land & Resource Management that the installation is ready for inspection. License # Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit Is granted upon express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Sanitation Code of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of the Sanitation Code. NOTE: I.Thls permit is valid for a period of six (6) months. 2.This permit does not include the building sewer (sewer line). Permit Fee $ I 7 S''Date: Signature of P^perty for uw^r Land & Resource Managemdit Official ly Rec. No..Date: Date StampComments: L&R InitialForm No. BK — 04-2014-06 Itqy wtL 357,243 ■ Victor Lundeen Co., Printers • Fergus Falls, Minnesota APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENT GOVERNMENT SERVICES CENTER, 540 WEST FIR. FERGUS FALLS, MN 56537 218-998-8095 www.co.otter-tail.mn.us -t OTTER TAII WHITE-Office YELLOW - L & R Inspector PINK - Owner / Contractor (after issue)coviTY-aitaiioTii Permit No.APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED TWP NAMETWP NO.RANGELAKE/RIVER NAME LAKE/RIVER CLASS SECTION^LAKE NUMBER //9 E-911 ADDRESS OR pjRECTIONS FROM NEAREST PUBLIC ROADPARCEL NUMBER (S) OF PROPERTY BEING SERVICED - ; ono / ^ onp legal description / 5 L y 77<^r/< / 1.9 XC /V 0^3 Daytime Phone No.First Initial Mailing AddressLast Name UXXProperty Owner //-,777/33^ At a/ S (^^•S %-'19\ 1 : 1\ l u-c n? '/ L%;2f\ r, XiyXContractor Lie.# y 9jrYl/S.I THiS SPACE FOR OFFICE USE ONLY , the year of► This System will be ready for inspection on A.M. P.M. L & R OfficialDate Received Time Received TYPE OF NSTALLATION (circle one)SEWAGE TREATMENT SYSTEM DESIGN DATA AS SHOWN ON DRAWINGCollectorOther Est.Residential (A) New (B) Replacement / (C) Add on (G) New (H) Replacement (I) Add on (D) New (E) Replacement (F) Add on Soil Treatment Area LiftTank Design Flow (Gallons/Day) (J) 0 (K) 1 — 2,499 : ' (L) 2,500 — 4,9&9 (M) 5,000 — 10,000 Effluent Distrib^ion ( V) Gravity { ) Pressure Ft.GIsSize //Setback To Nearest Well i f- Ft yrX \9 ar p"'Ft.Type I Type II <« (27) Rapidly Permeable(20) Trench, Rock , Ft.Setback To OHWL(28) Flood Plain(21) Trench, Gravelless (22) Trench, Chamber (29) Privies Ft.Ft. Ft.Setback To Bluff(30) Holding Tank (Contract Required) (23) Bed (24) Mound Ft.. . Ft,. FtSetback To Dwelling ir(25) At Grade Type III 7Setback To Non-Dwelling Ft.Ft./'.y(31) Other/Problem Soils/<12“ Soil(26) Greywater /3 Type IV(34) Tank Only \/Setback To Nearest Lot Line /.-vFt.Ft.//■^ Ft..(32) Public Domain & Proprietary Technologies(35) Other /.. Setback To Road Right-Of-WayDepth of Well Ft.Ft./3 ^Type V • r-\ Total If Bedrooms (33) Performance Elevation Above Restrictive Layer Ft.Ft.Ft.yGarbage Disposal Y / NY / N j-Abatement PERC TEST DATA Highest RateDate of TestLicense #Designer Agreement: The undersigned hereby makes application for permit to install, alter, repair or extend Sewage Treatment System herein specified, agreeing to do all such work in strict accor dance with Sanitation Code of Otter Tail County, Minnesota. Applicant agrees that the Site Data Worksheet submitted herewith and which is approved by a Land & Resource Management Official shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and approved for use. It shall be the responsibility of the applicant for the permit to notify Land & Resource Management that the installation is ready for inspection. Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Sanitation Code of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of the Sanitation Code. NOTE: I.This permit Is valid for a period of six (6) months. 2.This permit does not Include the building sewer (sewer line). -Date: 99^ \ \ j Permit Fee $ ^ I ~7 S - 7~)- 1 Signature of Property Owner/Agent for Owter :l^lz/jlT » Rec. No..Date: Land & Resource Management Official [Ml) /■i i]iiT',''Comments: i t; .SCANNED)•} Form No. BK — 04-2014-06 357.243 • Victor Lundoen Co.. Printer* • Fergus Falls, Minnesota SEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTS STA (Soil Treatment Area) OUTHOUSE TRENCH REDUCTIONHOLDING SEPTIC TANK LIFT TANKCATEGORY lU So GLS.inchesRock trenches withCapacityFT2GLS. 1/5-of sidewall for %FTFT FTSetback from Nearest Well reduction / equivalent toSetback from Buried Water Suction Pipe FTFT STA CALCULATION (Soil Treatment Area) ____Ft. X _______ Setback from Buried Pipe Distributing Water Under Pressure FT FTI 0 FT 10 OSetback from OHWL (lake &/or river)FTFTFT Ft. FT FTSetback from Bluff FT FP Setback from Dwelling FT FT FT MOUND / AT-GRADElo ^ ROCK BEDSetback from Non-Dwelling FT FTFT Setback from Nearest Property Line FT FTFT Ft.Ft. X FTSetback from Right-of-Way lo'*'FT FT FP 0 FTElevation above Restrictive Layer FTFT SAND IN MOUNDINSTALLERS COMMENTS SEPTIC TAN K(s)gUc~CrtcYES □ NOHolding Tank / Lift Alarm # Tanks InstalledWeep HolesOld System Pumped & Destroyed □ YES □ NO rZ/uy AManuf.Lateral Pipe Size INNumber of Laterals # ')OSModel #Perforation Diameter Size INFt.Perforation Spacing □ YESFeet of Total Head FILTERSGallons Per MinutePUMPS CVQj-f •7YrS 7^YInspector's Comments: Sketch: As of , the above described sewage system installation was found to be compliant with the provisions of the Sanitation Code of Otter Tail County.Initial / L & Ft OfficialTimeDate / Land & Rg^iil^Management OWcial Form No. BK — 04-2014-06 Itov mkL 357,243 • Victor Lundeen Co.. Printers • Fergus Falls, Minnesota 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. /inch(es) equals feetgrid(s) equals feet, orScale: MPCA LICENSE #: L LICENSE CATEGORY: DATE: ^ 2^//^______________ DESIGNED BY: SjUL. FIRM NAME: ADDRESS: Schueller's Septic Solutions 2S725 240th Avenue Fergus Falls, MN 56537 SIGNATURE; !Ji^AaI LMC /\/o C/>r L/a/€S - ^^^ALJJ0^A /^oo O a SCANNED 354.251 • Victor LuncJeen Co , Punters • Fergus Palls. MN • 1 800-346-487CBK — 04-2014 — 029 SITE DATA WORKSHEET e VLAND & RESOURCE MANAGEMENT GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 218-998-8095 www.co.otter-tail.mn.usOTTER Tflileo«*TT-aia»iiQTa L/U^£ ZTk/^V Sewage Treatment System Permit #OWNER: LAST NAME FIRST TELEPHONE NUMBERMIDDLE ADDRESS: M Ma/ CITY /9 ^ /JT. s'CrSy? ZIP CODE___STR./RT STATE SEC.LAKE/RIVER NO.LAKE NAME TWP RANGE TWP. NAME LEGAL DESCRIPTION:SOIL^ORING LOG DEPTH (INCHES) /^0OD/<7/)U3^7?O^fl ^ COLOR a MUNSELL NO.TEXTURE STRUCTURE BLOCKY PLATY PRISMATIC NONE /e/^L4d9 'TAa/K / PARCEL NUMBER Cr/n^ 4^BLOCKY PLATY PRISMATIC NONE E-91! Address or Directions From Nearest Public Road 3NUMBER OF BEDROOMS BLOCKY PLATY PRISMATIC NONE GARBAGE DISPOSAL: YES WELL: CASING DEPTH <-Sj?ft^SEWER LINE SEPARATION:ft. FLOODPLAIN: YES ^LUFF: YES^<SS>BLOCKY PLATY PRISMATIC NONE(^^RRESf^i^ VEGETATION: AOUATIC 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 7' or restrictive layer):.ft.Date of Perc Test PERC TEST #1 PERC TEST #2- TWO TESTS ARE REQUIRED - INTERVAL fMirJfcU'ESIINTERVAL (MINUT WATER DEPTH WATER DROP PERC RATE TIMETIME WATER DEPTH WATER DROP PERC RATESTART START ^ME DROP PERC PERCTIMEDROP INTERVAL fMINUTESI WATER DROP PERC RATE TIMETIMEWATER DraTH INTERVAL(MINUTES)WATERLDEPTH WATER DROP PERC RATEREFILLREFILL TIME DROP PERC RATE PERC DROP PERCTIME TIME INTERVAL (MINUTES) REFILL WATER DEPTH WATER DROP TIME INTERVALIMINUTESI REFILL WATER DIPTH WATER DROP PERC RATE TIME DROP PERC PERCTIMEDROP WATER DROP TIMETIMEINTERVAL (MINUTES) REFILL WATER DEPTI PERC RATE INTERVAL (MINUTES)ER DEPTH WATER DROP PERC RATE REFILL TIME DROP PERC PERCTIMEDROP INTERVAL (MINUTES! WATEf^EPTH WATER DROP TIMETIMEPERC RATE INTERVAL(MINUTES! REFILL WATER DEPTH WATER DROP PERC RATEREFILL TIME DROP PERC TIME DROP PERC TIME INTERVAL (MINUTES) REFILL ^TER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)/ATER DEPTH WATER DROP PERC RATEREFILL TIME DROP PERC TIME DROP PERC TIME INTERVAL (MINUTES)WATPB DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES) REFILL WATER [^PTH PERC RATEWATER DROPREFILL TIME DROP PERC TIME DROP PERC WATER DROP TIMETIMEINTERVAL (MINUTES)WATER PEPT L PERC RATE INTERVAL (MINUTES) REFILL WATER DIPTH WATER DROP PERC RATEREFILL TIME DROP PERC TIME DROP PERC 7SEPTIC TANK MANUFACTURER: PROPOSED DESIGN: TRENCH BED.ATGRADE.MOUND.HOLDING TANK.GRAVITY DIST. ^ Tv Ay PRESSURE DIST.,v/SEWER LINE.OUTHOUSE.OTHER. SPECIFY:. — SYSTEM DESIGIU ON BACK — Land & Resource Management GSC, 540 W Fir, Fergus Falls, MN 56537 OTTIR THIl 218-998-8095; Website: www.rn.ottertail.mn.us Subsurface Sewage Treatment System Management Plan Sewage Treatment System Permit Number: Judy Stringer__________________________________Property Owner: Parcel Number: 1300019011200(|Lake Name / Number: Swan 781 Chautauqua 780 Section: 19 Township Name: Dane Prairie______ E-911 Address: 22820 N Swan Lake Trail. Fergus Falls. MN This management plan will identify the operation and maintenance activities necessary to ensure long-term performance of your septic system. Some of these activities must be performed by you, the homeowner. Other tasks must be performed by a licensed septic service provider. Homeowner's Management Tasks - Should Be Checked Every 6 months: Leaks - Check (look, listen) for leaks in toilets and dripping faucets. Repair leaks promptly. Surfacing sewage - Regularly check for wet or spongy soil around your soil treatment area. Effluent filter (if applicable) - Inspect and clean twice a year or more. Pump Tank Alarms - Alarm signals when there is a problem. Contact a service provider any time an alarm signals. Holding Tank Alarms - Can be either an electronic or a manual float, when activated, service (pumping) is required. Event counter or water meter (if applicable) - Record your water use. Professional's (Licensed Septic Service Provider) Management Tasks - Shouid Be Checked Every 24 Months (2 Years): □ Check to make sure tank is not leaking. □ Check and clean the in-tank effluent filter. □ Check the sludge/scum layer levels in all septic tanks. □ Recommend if tank should be pumped. □ Check inlet and outlet baffles. □ Check the drainfield effluent levels in the rock layer. □ Check the pump and alarm system functions. □ Check wiring for corrosion and function. □ Provide homeowner with list of results and any action to be taken. □ Check inspection pipe caps (replace as necessary), n Check manhole cover (accessibility, security, or damage). SCANNED I understand it is my responsibility to properly operate and maintain the sewage treatment system on this property in accordance with this Management Plan. C/ ^ Signature 8/17/15Date:Property Owner: ^/;2///rReceived by Land & Resource Management:Date: Signature The following link will provide information from the University of Minnesota, regarding a Septic System Owner's Guide: http://www.extension.umn.edu/envirnnment/housing-technology/moisture-management/septic-system-owner-guide/ LR; SSTS Management Plan 06-20-2014 I 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 For local tracking purposes:Inspection results based on Minnesota Pollution Control Agency (MPCA) requirements and attached forms - additional local requirements may also apply. Submit completed form to Local Unit of Government (LUG) and system owner within 15 days System Status System status on date (mm/dd/yyyy): 8/6/2015 ^ Noncompliant - Notice of Noncompliance (See Upgrade Requirements on page 3.) □ Compliant - Certificate of Compliance (Valid for 3 years from report date, unless shorter time frame outlined in Local Ordinance.) Reason(s) for noncompliance (check all applicable) D Impact on Public Health (Compliance Component #1) - Imminent threat to public health and safety □ Other Compliance Conditions (Compliance Component #3) - Imminent threat to public health and safety E Tank Integrity (Compliance Component tt2) - Failing to protect groundwater □ Other Compliance Conditions (Compliance Component ft3) - Failing to protect groundwater □ Soil Separation (Compliance Component tf4) - Failing to protect groundwater □ Operating permit/monitoring plan requirements (Compliance Component #5) - Noncompliant Property Information Parcel ID# or Sec/Twp/Range: 13000190112000________ Reason for inspection: Sale of property ^ Owner’s phone. 218-770-0412_______ Property address: 22820 N Swan Lake Trail, Fergus Falls, MN 56537 Property owner: Judy Stringer or Owner’s representative:_______________________________________ Local regulatory authority: Ottertail Co Land and Resource Dept Brief system description: Septic tank, lift tank, drainfield gravity bed Comments or recommendations: The tanks are leakingin groundwater. The drainfield bed passes inspection. Representative phone:_______________ Regulatory authority phone: 218-998-8095 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. Inspector name: Bill Schueller________ Business name: Schuejief^ Septic S^Jji Inspector signature: Certification number: C3332 License number: L2945 Phone number: 218-770-9119 Necessary or Locally Required Attachments E System/As-built drawingE Soil boring iogs □ Other information (list): H Forms per local ordinana TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 1 of 3 www.pca.state.mn.us • 651-296-6300 • 800-657-3864 wq-wwists4-31 • 3/16/12 Property address: 22820 N Swan Lake Trail, Fergus Falls, MN 56537 Inspector initials/Date: BJS | 8/6/2015 (mm/dd/yyyy) 1. Impact on Public Health - Compliance component #1 of 5 Compliance criteria:Verification method(s): S Searched for, surface outlet S Searched for seeping in yard/backup in home D Excessive ponding in soil system/D-boxes Kl Homeowner testimony (See Comments/Explanation) □ “Black soil” above soil dispersal system D System requires “emergency” pumping □ Performed dye test Q Unable to verify (See Comments/Explanation) n Other methods not listed (See Comments/Explanation) □ Yes S NoSystem discharges sewage to the ground surface.______________ System discharges sewage to drain tile or surface waters. D Yes S No □ Yes S NoSystem causes sewage backup into dwelling or establishment. Any “yes” answer above indicates the system is an imminent threat to public health and safety. Comments/Explanation: 2. Tank Integrity - Compliance component #2 of 5 Compliance criteria:Verification method(s): S Probed tank(s) bottom □ Examined construction records □ Examined Tank Integrity Form (Attach). □ Observed liquid level below operating depth S Examined empty (pumped) tanks(s) □ Probed outside tank(s) for “black soil” O Unable to verify (See Comments/Explanation) □ Other methods not listed (See Cdmments/Explanation) System consists of a seepage pit, cesspool, drywell, or leaching pit. Seepage pits meeting 7080.2550 may be compiiant if aliowed in iocal ordinance. □ Yes S No S Yes □ NoSewage tank(s) leak below their designed operating depth. If yes, which sewage tank(s) leaks:.i; Any “yes” answer above indicates the system is failing to protect groundwater. Comments/Explanation: Both the septic tank and the lift tank leak groundwater into the tanks. 3. Other Compliance Conditions - Compliance component #3 of 5 a. Maintenance hole covers are damaged, cracked, unsecured, or appear to be structurally unsound. DYes* S No □ Unknown b. Other issues (e/ecfr/ca/hazards, etc.) to immediately and adversely impact public health or safety. □ Yes* S No □ Unknown " *System is an imminent threat to public health and safety. Explain: 1- c. System is non-protective of ground water for other conditions as determined by inspector. □ Yes* H No *System is failing to protect groundwater. Explain: TTY 651 -282-5332 or 800-657-3864 • Available in alternative formats Page 2 of 3 www.pca.state.mn.us • 651-296-6300 • 800-657-3864 wq-wwists4-31 • 3/16/12 Property address: 22820 N Swan Lake Trail, Fergus Falls, MN 56537 Inspector initials/Date: BJS | 8/6/2015 (mm/dd/yyyy) A, Soil Separation - Compliance component #4 of 5 S UnknownDate of installation:Verification method(s): Soil observation does not expire. Previous soil observations by two independent parties are sufficient, unless site conditions have been altered or local requirements differ. S Conducted soil observation(s) (Attach boring logs) □ Two previous verifications (Attach boring logs) □ Not applicable //-/o/d/ng tank(s), no drainfield) □ Unable to verify (See Comments/Explanation) □ Other (See Comments/Explanation) (mm/dd/yyyy) Shoreland/Wellhead protection/Food beverage M Yes □ Nolodging? ^ ^ Compliance criteria: □ Yes □ NoFor systems built prior to April 1, 1996, and not located in Shoreland or Wellhead Protection Area or not serving a food, beverage or lodging establishment: Drainfield has at least a two-foot vertical separation distance from periodically saturated soil or bedrock. .-r □ Yes □ NoNon-performance systems built April 1, 1996, or later or for non-performance systems located In Shoreland or Wellhead Protection Areas or serving a food, beverage, or lodging establishment: Drainfield has a three-foot vertical separation distance from periodically saturated soil or bedrock.* Comments/Explanation: Soil Pit: 0-32 Sandy Loam 10yr 2/1 32-72 Coarse Sand/gravel lOyr 4/4 Some red 7.5yr 4/6 in the gravel ' □ Yes □ No“Experimental”, “Other”, or “Performance” systems built under pre-2008 Rules; Type IV or V systems built under 2008 Rules (7080. 2350 or 7080.2400 (Advanced Inspector License required) Drainfield meets the designed vertical separation distance from periodically saturated soil or bedrock. Indicate depths or elevations 30A. Bottom of distribution media 72B. Periodically saturated soil/bedrock 42,iC. System separation D. Required compliance separation* | 36 _______ *May be reduced up to 15 percent if allowed by Local Ordinance. Any “no” answer above indicates the system is failing to protect groundwater. 5. Operating Permit and Nitrogen BMP* - Compliance component #5 of 5 ^ Not applicable □ Yes □ No If “yes”, A below is required □ Yes □ No If “yes”, B below is required Is the system operated under an Operating Permit? Is the system required to employ a Nitrogen BMP? BMP = Best Management Practice(s) specified in the system design \ If the answer to both questions is “no”, this section does not need to be completed. Compliance criteria a. Operating Permit number: _____________________ Have the Operating Permit requirements been met? □ Yes □ No □ Yes □ Nob. Is the, required nitrogen BMP in place and properly functioning? Any “no” answer indicates Noncompliance. Upgrade Requirements (Minn. Stat. § 115.55) An imminent threat to public health and safety (ITPHS) rnust be upgraded, replaced, or its use discontinued within ten months of receipt of this notice or within a shorter period if required by local ordinance. If the system is failing to protect ground water, the system must be upgraded, replaced, or its use discontinued within the time required by local ordinance. If an existing system is not failing as defined in law, and has at least two feet of design soil separation, then the system need not be upgraded, repaired, replaced, or its use discontinued, notwithstanding any local ordinance that is more strict. This provision does not apply to systems in shoreland areas, Wellhead Protection Areas, or those used in connection with food, beverage, and lodging establishments as defined in law. TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 3 of 3 800-657-3864www.pca.state.mn.us • 651-296-6300 wq-wwists4-31 • 3116112 .r. Department of LAND AND RESOURCE M ANAGEMENT OTTER TAIL COUNTY GOVERNMENT SERVICES CENTER - 540 WEST FiR Fergus Falls, MN 56537 PH; 218-998-BOS5 OTTER TAIL COUNTY’S WEESITE: WWW.CO.OTTER-TAIL.MN.USOTTER Timoo*BTf<aiaaiiof* Otter Tail County Compliance Inspection Form Addendum This form is a required attachment to MPCA Compliance Inspection Form for all Existing Subsurface Sewage Treatment Systems in Otter Tail County as of June 1, 2011. Property Information Parcel Number: 13000190112000 Township: Dane Prairie Property Owner Name(s): Judy stringer Property Address: 22820 N Swan Lake Trail, Fergus Falls, MN 56537 Reason for Inspection: sale of property Number of Bedrooms: 3 Section: Swan Lake Club, Inc Yes[T~| Lake/River Name, Number, & Class Chautauqua 56-780 NE □In Shoreland Area?No Swan 56-781 RD System Compliance Status:__Compliant ^ Non-Compliant Does the soil treatment area have less than 3 feet of vertical separation? Is the septic tank located less than 50 feet from any well? Is the soil treatment area located less than 50 feet from any deep well? Is the soil treatment area located less than 100 feet from any shallow well? X NoYes Yes Yes Yes X No NoX X No "Yes" indicates that the system is failing to protect ground water and is noncompliant. If "Yes", describe the condition noted: Tanks leak groundwater in Required Attachments: System drawing to scale on next page. Completed MPCA Compliance Inspection I hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. Name: biii Schueller Certification Number: Business License Name & Number: schug] Signature:^_j^^ C3332 Septic Solutions LLC L2945 Date:8/6/2015 Page 1 of 2Excel/Compliance Form for OTC 4/30/2014 Otter Tail County Compliance Inspection Form Addendum (cont.) Parcel Number: Date & Initial: s/e/is bjs 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). Drawing provided with new design for replacing existing septic tank and lift tank. Additional Comments: Excel/Compliance Form for OTC 04/30/2014 Page 2 of 2 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 o- white — Office Yellow — Inspector Pink — Owner Cord — Owner SooAN CA/te C(o L tr m (J-.C3 Permit No. LEGAL DESCRIPTION AND H [3^ \>i\Ne5£~7^/ SiOANLOCATION Lake Classif.TWP NameTWPRangeSec.Lake No.Lake Name IDENTIFICATION; Please Print All Information. Tel. No.Mailiing Address —No. Street, City and State Zip No.InitialFirstLast Name 5 By STW Tf r^oS.OWNER Fa//s ' P<l2<rSEWAGE SYSTEM INSTALLER Name This System will be ready for inspection on., 19. This space for office use only .M,19 Owner or Agent SignaturePhone Call Rec'd ByDate Rec'd Time Rec'd 3NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD 15X11)00 Sq. Ft.GIs.Sq. Ft.Capacity 100/SO50 Ft.Ft.Ft.Distance from nearest well 75 75 Ft.Ft. Ft.Distance from lake or stream 10 Ft.Ft. Ft.Distance from occupied building 10 10 Ft.Ft. Ft.Distance from property line 3 Ft.Ft.Ft.Distance from bottom to Water Table All distances are shortest distance between nearest points RECORD OF TESTS: 19 , Time M ByInspection was made on SO (S't, -gj-PERCOLATION TEST DATA:Date of First Test , 19 , Rate 1st Test Taken By ................... 19...&.^, 12..V . •iX'i I DADate of Second Test , Rate / + 2nd TestFirst 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 jdbjis ready for inspectioryfCall o^use attached mailer notice.) Dated Signature Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express ces of Otter Tail County Minnesota. Permit; condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordi 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:Shoreli 'Management Office 10Fee $ Comments:. [^fVIEW ftATUE LAKE, V.INNESOIAForm No. MKL-0771-003 M«*f i .- -t-.-.-t.'^— --W.' ■f i. INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORY Should beActual Actual Should be Actual Should be Capacity GIs.GIs.S F SF SFS F 50Distance from Nearest Well 75FFF F F F Distance from Lake or Stream F F FF F F Distance from Occupied Building 10 20 20FFFFF F Distance from Property Line 10 10 10FFF F F F Distance from Bottom to Water Table 33FFF F F F Inspector's Comments: Date of Inspection 19. Time of Inspection.M t f Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs » Gallons SF “ Square Feet F " Linear Feet a I , » Job Title AgencyMKL-0771-003-Backer e 4 >!1ir. 'i 'f- ■ J-- ■ *■ ' :\; /■: '! ■' > . -,-1 1 y ■' I (\i 0 X? ^ac<A.v>^(j_ o V'iQ.e*■ >T o ^1<L_^CL oV« yVNSHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 - Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM 4 Office y«//ow — Inspector Pink — Owner Ccrd —Owner ^\aYT- b*-/ AtsV.-/ Sa’AN LA/a? Civ i tr .M G-,C3 Permit No., LEGAL DESCRIPTION AND LOCATION TWP NameTWPRangeSec.Lake Cla&sif.Lake NameLake No. IDENTIFICATION: Please Print All Information. Zip No.Tel. No.Mailling Address —No. Street, City and StateInitialFirstLast Name OWNER ! SEWAGE SYSTEM INSTALLER Name. 7' /3This System will be ready for inspection on., 19 fTi/TioThis space for office use only iw T- ,.g-J r-Si jg. Owner or Agent SignaturePhone Call Rec'd ByDate Rec'd Time Rec'd NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD Sq. Ft.GIs.Sq. Ft.Capacity Ft.Ft. Ft. Distance from nearest well Ft. Ft.Ft.Distance from lake or stream Ft.Ft. Ft.Distance from occupied building Ft.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: 19 , Time ,JVI ByInspection was made on b , RateDate of First Test , 19 .r: . 19.2.- PERCOLATION TEST DATA: RateDate of Second Test 1st Test Taken By + 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. i-' Issued Date: Shoreland Management Office Fee $ Comments:r..C -------------. .. ---------—dFC.HPrrfi K-li-m Q>ld t)F HilllBp. /fhts /!J fr [Review iatile lake. v.:nnesotaForm No. MKL-0771-003 ■ •i INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORY Actual Should be Actual Should be Actual Should be /7 fcO S F/ax>1000Capacity 'SFGIs.GIs.S F S F/\/7/^0 7S0 FDistance from Nearest Well 50FFFF F V ^F __20 7Sim //Distance from Lake or Stream F F F F /Distance from Occupied Building 10 20FF F F ■u \10'^.IDDistance from Property Line 10 1 10FFFF F 3Distance from Bottom to Water Table 3FFFF F 'r. +Inspector's Comments; ‘ +■ J2J7' JhSrJiM. ^<L<^y'y\yyy-c/'^CKrJt^ Jlp- C3fC go.’1 CnOs ^T3 7-/3 19.^^Date of Inspection. IC\OC J1_MTime of Inspection 6/C Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs “ Gallons SF ■ Square Feet F ■ Linear Feet Job Title AgencyMKL-0771-003-Backer 2 -I ^.00 /3C 1+ WAS syVo-v*- oi-toN Y\ (7^PERCOLATION TEST DATA Price $1.00 per pad. SHORELAIMD MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Ph. No.Owner:5^Mailing Address: Pahs rr\ City State c00f2./A^T CLS_ Last Name Middle St. & No.Zip No.Legal Description: LAKE OR RIVER NO.NAME SEC.TWP.RANGE TWP NAME 5 Roam in (5"£J y TEST HOLE NO. 2TEST HOLE N 4U:iSDepth To Bottom of Hole,Depth to Bottom of Holeinches; Diameter of Hole inches; Diameter of Hole.inches Jnches flMA IQ £„_S'Depth, inches Soil Texture a,-7SL ^ 'k'Depth. Inches Soil TextureDate.Date6AAC/^ PllS>X,Cz 2. ercolation Test By___ Percolation Test By____L9 A Ln> /Q UiFirm Name,q:Firm Name.15 omGC LUAddress.GC Address < COOtter Tail County License No.Otter Tail County License No„HCOUJMeasurement, Inches nnpsh in Water Level, Inches H-Measurement, I nchyes in Water Level. Inches Time Remarks Time Remarks o j)MdhJ g: Voo1- ^yu8!11.9: fO 9 IQ', to Q3 UuJjLASmsslO ‘ ^^5 ^ a m' 40 ft < (O h ' 40 j!L& Am.£M.iny-i. pAl. 11', .^s 7/: iTS ALKj2i b 1: lO 1^ 1 9q£kL m _______tr/'nE5om1 MKL-0871-028 See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un, of Minn. r r .•i *. \ { fbti\|J0