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Home My WebLink AboutXanadu Island_25000290185000_Septic System Permits_Page 1 of 1 OTTER TAIL COUNTY Land & Resource Management 7/5^^ /Phone (218) 998-8095 ^ ' Sewage Treatment System Permit PERMIT NUMBER 25351PERMIT TYPE Camp Elbow Lake LiePROPERTY OWNER LAKE INFORMATION Elbow DNR ID(S)306 LOCATION Parcel(s): 25000290185000 Township Name: Everts Township Property Address(es): 35484 235TH ST Section/Township/Range: Sect-29 Twp-133 Range-040 Legal; 3,90 AC PT GL 3 COM NE COR GL 3 SI864' SWLY ON CURVE 97.7' S WORK AUTHORIZED Install 500 gallon lift tank with 250 sqft drainfield. Existing septic tank is compliant. Kyle Westergard 07/10/2018 07:57 AM 9bdc4c7e5947da9776a12dfa2a83552c 253abbb3a0247d24d8e85ec7a076d2dd 07/10/201907/10/2018 ISSUE DATE DATE EXPIRESLand and Resource Management Official/Date NOTP: ot more than 6 feet above grade on the laintained there until completion of such work, nit maybe revoked and the owner/contractor This System will be ready for inspection on the year of at 'ater drainage which may occur, within 10 days of the completion unless a.m. has been inspected or approved, ady for inspection (218) 998-8095. Date Received Time Received L & R Official 7/10/2018https://onegov.co.ottertail.mn.us/admst/viewcard.php?card=2&app=3088 7/9/2018 Land & Resource Permit ApplicationsV Land & ResburGe Management Government Services Center 540 Fir Avenue West Fergus Falls MN 56537 OTTER fflil Phone: 218-998-8095OO IIH T T? 5 I 0 0 tro T ? Sewage Treatment System Permit Permit#____ Applicant Information Applicant Information:Name; Scott M Ellingson Phone: I (218 >205 Email Address: -1667 sc0ttsseptlcpermit@9mail.com Mailing Address: 201 Meadow Circle j 201 Meadow Circle Ashby MN 56309 Agent/DesignerI am the: Is this Sewer Permit Application for a Collector System? Work Performed By Work to be performed by:Contractor Contractor's Contact Information Contractor Information:Name: Don Schmidt Company or Business Name: Don Schmidt Excavating Contractor License Number: 2173 Additional Phone:Phone: (218 ) 282 - 0815 () Email: djschmidt@arvig.net Address: 35207 235th St. BattJeJLake MN 5W15 Property Owner's Contact Information ;Property Owner Contact Information: Name: Camp Elbow Lake LLC Phone: I Ij (303 )868 -4304 | Email Address: nrelnan@mac.com Mailing Address: 3548£235th SL Battle Lake MN 56515 9117 y Property Information Property Please search by one of the following: Parcel #, name, or Physical Address. Click the blue. "Select" to select Selected: Legal Description Primary Name/AddressProperty AddressProper^ Attributes Primary Address Line 1 CityLegal Description NameCityLegal Description Legal DescriptionParcel #Property Address CAMP ELBOW LAKE BATTLE LAKEPT GL 3 COM NE COR GL 3 S 1864' SWLYON CURVE 97.7' S 35484 235TH ST3.90 AC35484 235TH ST BATTLE LAKE 25000290185000 LLC DevelopedIs the property Developed or Undeveloped? Is the property located in the Shoreland or Non- Shoreland area? ) J 1/3https://onegov.co.ottertail.mn.us/view.php?id=3088&viewOnly=1&p= Land & Resource Permit Applications7/9/2018 Shoreland Information Associated Lakes :Selected: DNR ID Lake Class LR CDLake Name 306 NE 56-306Elbow Bluff:^9 Project Information Other Establishment - New 1 to 2,499 Gallons Per Day Type of Installation: Design Flow: TypeJ PressurePressure System Type: Efiuent Distirbution: System Components BedType I Components: Depth of Well:Deep Feet 2Number of Bedrooms: YesAbatement: Garbage Disposal: Ejector: Number of Tanks:I Number of Lifts:1 Number of Soil Treatment Areas: 1 Septic/Holdinq Tank(s) Total Capacity of Septic/Holding Tank(s): 0 Gallons 0 Feet 0 Feet Setback to Nearest Well: Setback to Ordinary High Water Level: Setback to Bluff:0 Feet 0 FeetSetback to Dwelling: Setback to Non-Dwelling:0 Feet 0 FeetSetback to Nearest Lot Line: Setback to Road Right-of-Way: 0 Feet Lift Tank(s) 500 GallonsTotal Capacity of Lift Tank(s): 200+ FeetSetback to Nearest Well: y FeetSetback to Ordinary High Water Level: NA FeetSetback to Bluff: 12 FeetSetback to Dwelling : Setback to Non-Dwelling:NA Feet 100+ FeetSetback to Nearest Lot Line: Setback to Road Right-of-Way:100+ Feet Soil Treatment Area(s) 250 Square FeetTotal size of Treatment Area: 200+ FeetSetback to Nearest Well: 75 FeetSetback to Ordinary High Water Level: NA FeetSetback to Bluff: 32 Feet NA Feet Setback to Dwelling: Setback to Non-Dwelling: ^00+ Feet Setback to Road Right-of-Way: 100+; Feet Elevation above Restrictive Layer: 3+ Feet Setback to Nearest Lot Line: Documentation ! File 1: ^ Compiete_Design_PB.pdfAttach Supporting Documentation:I1 Applicant Approval Ellingson, Scott M 07/05/2018 I understand that checking this box constitutes a legal signature This system will use the existing septic tank passed by compliance inspection adding new lift and new pressure bed. Applicant Signature: Date Signed: Please check to approve: Comments: Terms 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 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 pad 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, https://onegov.co.ottertail.mn.us/view.php?id=3088&viewOnly=1&p=2/3 Note 7/9/2018 _Land & Resource Permit Applications Once a permit is approved it is valid for a period of twelve (12) months from the date of approval unless otherwise indicated on peimit. A sewer permit does not include the building sewer (sewer line). Invoice 07/05/2018 Charge Cost TotalQuantity Grand Total $0.00Total (Unpaid)rApprovals Approval Signature #1 Received and Assigned Brittany A. Walters - 07/06/2018 8:06 AM 2020b5ffad4d087dfl05c0c6989a87bl 7c9cb0lcc42ee465bf7f24b3f3db590b #2 Application Review #3 Application Approval ; ■4 'i 3/3. .1https://onegov.co.ottertail.mn.us/view.php?id=3088&viewOnly-1&p- University OF Minnesota OSTP Soil Observation Log V 04.20.2016Project ID: . tLegal Description/ GPS;35484 235th St.Camp Elbow Lake LLCClient/ Address: n Organic MatterI I Loess Q Till I I Alluvium I I BedrockI I Outwash Q LacustrineSoil parent material(s): (Check all that apply) I I Summit n Shoulder 0 Back/Side Slope 0 Foot Slope 0 Toe Slope Slope shapeLandscape Position: (check one) Elevation:Soil survey map units Slope%3.0Vegetationgrass 05/04/18Morning / Sunny DateWeather Conditions/Time of Day: Observation Type:Auger#1Observation #/Location: Structure-I IRockRedox Kind(s)Indicator(s)Matrix Color(s)Mottle Color(s)Depth (in)Texture Frag. %ConsistenceGradeShape FriableBlockyWeak10YR 2/1<35%0”-6"Sandy Loam Sandy Clay Loam FirmModerateBlocky7. SYR 4/66"-20"<35% LooseSingle grain Structureless10YR 5/6Sand10YR 5/4<35%20"-60" LooseSingle grain Structureless10YR 6/4 10YR 6/6Sand60”-75"<35% Depletions SI10YR7/110YR 6/4Silt Loam <35%75"+ Comments 75" I hereby certify that-l have completed this work in accordance with all applicable ordinances, rules and laws. . Scott Ellingson , ■■i .. ■ 5/13/20183947 (Si^ature) //(Date)(License #)(Designer/Inspector) UrovKaitrv op Moo<ii.w>tAOnsite- ScwAOC T REATMENTProgramAdditional Soil Observation Logs Project ID: 35484 235th St.Client/ Address;Camp Elbow Lake LLC Legal Description/ GPS: I I Organic MatterI I Outwash Q] Lacustrine []3 Loess 0 Tiil I I Alluvium I I BedrockSoil parent material(s): (Check all that apply) I I Summit 0 Shoulder 0 Back/Side Slope 0 Foot SlopeLandscape Position: (check one)0 Toe Slope Slope shape Soil survey map units 3.0 Elevation:Slope%Vegetation grass 05/13/18Morning / SunnyWeather Conditions/Time of Day:Date Observation ^/Location:Observation Type;Auger#2 Structure-IIRockDepth (in)Matrix Color(s)Mottle Color(s)Redox Kind(s)Indicator(s)Texture ConsistenceFrag. %GradeShape FriableWeakBlockySandy Loam0"-6"<35%10YR 2/1 Sandy Clay Loam FirmModerateBlocky6"-18"7.5YR 4/6<35% LooseSingle grain StructurelessSand18"-58"<35%10YR 5/4 10YR 5/6 LooseStructurelessSandSingle grain58"-75"<35%10YR 6/4 10YR 6/6 Silt Loam 10YR 7/1 Depletions SI75' +<35%10YR 6/4 Comments Observation Type:Observation #/Location:#3 Auger Structure-IIRockRedox Kind(s)Indicator(s)Depth (in)Matrix Color(s)Mottle Color(s)Texture Frag. %ConsistenceGradeShape FriableWeakBlocky0"-8"Sandy Loam <35%10YR 2/2 Sandy Clay Loam FirmModerateBlocky8"-19"<35%7.5YR 4/6 LooseStructurelessSingle grain19". 59-Sand 10YR 5/6<35%10YR 5/4 LooseStructurelessSingle grain59"-75"Sand <35%10YR 6/4 10YR 6/6 Silt Loam 10YR 7/1 Depletions SI75"+<35%10YR 6/4 Comments 75" Consistence: Loose- Subsoil Indicator(s) of Saturation: 51. Distinct gray or red redox features 52. Depleted matrix (value >/=4 and chroma </=2) 53. 5Y chroma </= 3 54. 7.5 YR or redder faint redox concentrations or redox depletio Textures: c-clay sic-silty clay sc-sandy clay Intact specimen not available Slight force betv/een fingers Moderate force betv/een fingers Friable- Firm- Extremelv Moderate force between hands or slight firm-cl-clay loam foot pressure Foot pressureIf yes to one of the above indicators then: Topsoil Indicator(s) of Saturation: T1. Wetland Vegetation T2. Depressional Landscape T3. Organic texture or organic modifiers T4. N 2.5/ 0 color T5. Redox features in topsoil T6. Hydraulic indicators Rigid-sicl-silty clay loam scl-sandy clay loam si-silt sil-silt loam I-loam sl-sandy loam* Is-loamy sand* s-sand* Slope Shape: Slope shape is described in two directions: up and down slope (perpendicular to the contour), and across slope (along the horizontal contour); e.g. Linear, Convex or LV. *Sand Modifiers co-coarse m-medium f-fine vf-very fine tvSoil Structure Grade: Massive-No observable aggregates, or no orderly arrangement of natural lines of weakness Poorly formed, indistinct peds, barely observable in placeWeak-vv Moderate- soil Durable peds that are quite evident in un-displaced soil, adhere weakly to one another, withstand displacement, and become separated when soil is disturbed No peds, sandy soil Strong- L.an<lscnpe Position: I SyumuitLoose- V • C<4sfi,v#>r: C **1 jt;.„ ■ Shoulder | __u,Foot Slope I Gack/Side Soil Structure Shape: Granular- when soil is turned over. Platv- Blockv- Blocky structure is commonly found in the lower topsoil and subsoil. Prismatic- adjoining peds. Prismatic structure is commonly found in the lower subsoil. Single Grain-The structure found in a sandy soil. The individual particles are not held together. Toe'Slo^ just below the leaf litter or shallow topsoil. OSTP Design Summary Worksheet University OF MinnesotaMinnesota Pollution Control Agency V 04.20.2016Project ID:Property Owner/Cllent: Camp Elboe Lake LLC 5/13/18Date:Site Address: 35484 235th St. 1. DESIGN FLOW, STRENGTH OF WASTE, AND TANKS 300 Number of Bedrooms (Residential):Gallons Per Day (GPD)A. Design Flow:2 Treatment Level:CType of Wastewater:Residential Nutrients: I I Measured Flow;f~1 Estimated Flow:GPDCommercial (select method and provide data): B. Septic Tanks: Minimum Code Required Septic Tank Capacity (Dwellings): GPD existing 1000 Gallons, in Tanks or Compartments Minimum Septic Tank Capacity for Other Establishments = Design Flow X 3.0 if received by gravity or 4.0 if received by pressure GallonsGPDXWaste received by: Recommended Septic Tank Capacity: Effluent Screen & Alarm: D xes 0 No □ Optional 0 Screen Only Effluent Screen Manufacturer/Model: Gallons, in Tanks or Compartments C. Holding Tanks Only: Minimum Code Required Capacity: Minimum Capacity: Residential =400 gal/bedroom, Other Establishment = Design Flow x 5.0, Minimum size 1000 gallons Gallons, in Tanks Type of High Level Alarm: Designer Recommended Capacity:TanksGallons, in Gallons500GallonsPump Tank 2 Capacity (Code Minimum):D. Pump Tank 1 Capacity (Code Minimum): Gallons500Pump Tank 2 Capacity (Designer Rec):Pump Tank 1 Capacity (Designer Rec):Gallons 18.0 GPM Total Head GPM Total Head15.4 Pump 2 ftftPump 1 Supply Pipe Dia.Supply Pipe Dia. 2.00 in 50.0 in Dose Volume:Dose Volume:gal gal 2. SYSTEM AND DISTRIBUTION TYPE Pressure Distribution-LevelBedSoil Treatment Area Type:Distribution Type: ft Benchmark Location:Benchmark Reference Elevation: 0 Dralnfield Rock I I Registered Treatment Media;Type IMPCA Type:Type of Distribution Media: Comments: 3. SITE EVALUATION: [^ft75 SandG.Soil Texture:Depth to Limiting Layer:inA. GPD/ft^1.20H. Soil Hyd. Loading Rate:Elevation of Limiting Layer:B. Loc. of Restricive Elevation:MPII.Perc Rate:C. f~1 Yes (2] No36D. Minimum Required Separation: E, Code Maximum Depth of System: in J. Soil with >35% Rock Fragments Present? If yes describe below: % rock and layer thickness, amount of soil credit and any additonal information for adressing the rock fragments in this design. ]ln39 3.0Measured Land Slope %:%F. Comments: 4. DESIGN SUAMXARY Trench Design Summary ft^Dispersal Area Sidewall Depth Trench Widthin ft Number of Trenches Code Maximum Trench DepthTotal Lineal Feet ft in Min Trench LengthContour Loading Rate ft ft Designer's Max Trench Depth in OSTP Design Summary Worksheet University OF MinnesotaMinnesota Pollution Control Agency Bed Design Summary ft^Absorption Area 250 Depth of sidewall 0.8 Code Maximum Bed Depthin Bed Width 10 Bed Length 25.0 ftft Designer's Max Bed Depth 24.0 in Mound Design Summary ft^Absorption Bed Area Bed Length Bed Widthft ft Absorption Width Clean Sand Lift Berm Width (0-1%)ft ft ft Upslope Berm Width Endslope Berm Widthft Downslope Berm Width ft ft Total System Length Total System Width ft Contour Loading Rateft gal/ft At-Grade Design Summary Absorption Bed Width Absorption Bed Length System Finished Heightft ftft gal/ft Upslope Berm Width Downslope Berm Widthft ftContour Loading Rate System Length System WidthEndslope Berm Width ft ftft Level B Equal Pressure Distribution Summary No. of Perforated Laterals Perforation Spacing Perforation Diameter3 3 ft 1/4 in 2.00 galgalMin. Delivered Volume Maximum Delivered Volume 75Lateral Diameter 47in Non-Level and Unequal Pressure Distribution Summary Perforation SizePipe Volume (gal/ft)Pipe LengthElevation Spacing (ft)(ft)Spacing (in)(ft)Pipe Size (in)(in) Lateral 1 Minimum Delivered Volume galLateral 2 Lateral 3 Maximum Delivered VolumeLateral 4 galLateral 5 Lateral 6 5. Additional Info for Type IV/Pretreatment Design A. Calculate the organic loading 1. Organic Loading to Pretreatment Unit = Design Flow X Estimated BOD in mg/L in the effluent X 8.35 ^ 1,000,000 mg/LX8.35 ^ 1,000,000 =lbs BOD/daygpd X 2. Type of Pretreatment Unit Being Installed: 3. Calculate Soil Treatment System Organic Loading: BOD concentration after pretreatment i Bottom Area = Ibs/day/ft^ ft' =Ibs/day/ft^mg/L X 8.35 4 1,000,000 ^ Comments/Special Design Considerations: I hereby certify that i have completed this work in accordance with all applicable ordinances, rules and laws. 05/13/183947Scott Ellingson (Date)(License #)(Designer) OSTP Bed Design Worksheet University OF Minnesota I ^Minnesota Pollution Control Agency V 04.20.2016Project ID:1. SYSTEM SIZING: 300 GPDA. Design Flow (Design Sum.1A): 24Designers Maximum Depth:inches39inches GPD/fF D. Required Bottom Area: Design Flow (1.A) + Loading Rate (1.C) = Initial Required Bottom Area GPD/ft^= B. Code Maximum Depth*: 1.20C. Soil Loading Rate: ft^1.20 250300GPD-f E. Select Distribution Method: B Pressure □ Gravity 0Rock □ Registered G. If distribution media is installed in contact with sandy or loamy sand or with a percolation rate of 0.1 to 5 mpi indicate distribution or treatment method: F. Select Dispersal Type: Pressure distribution 2. BED CONFIGURATION: (for sites with less than 6% slope) 1.0 = pressurized or 1.5 = gravity1.0A. Select size Multiplier: B. Req'd Bottom Area = Bottom Area (1 .D) X Size Multiplier = 250.0 ft^ X TO Ift =ft^250 ft Optional upsizing of bed areaC. Designed Bottom Area: 10 ftD. Select Bed Width: E. Calculate Bed Length: Designed Bottom Area t Bed Width = Bed Length ft^ -10.0250 ft =25.0 ft 3. AAATERIAL CALCULATION: ROCK A. If drainfield rock is being used, select sidewall absorption 0.75 ft B. Media Volume: (Media Depth + depth to cover pipe) X Designed Bottom Area = ft^ 250.0 Ift^ =1 im ft^0.330.75 ft +ft)X{ C. Calculate Volume in cubic yards: Media volume in cubic feet -r 27 = cubic yards 270 Ift^ = 27 =yd’10 4. AAATERIAL CALCUUTION: REGISTERED PRODUCTS - CHAMBERS AND EZFLOW A. Registered Product: B. Component Length:ft C. Component Width:ft D. Component depth (louver or depth of sidewall loading) E. Number of Components per Row = Bed Length divided by Component Length (Round up) in ft =ft =components F. Actual Bed Length = Number of Components X Component Length: components X G. Number of Rows = Bed Width divided by Component Width ft = ft =ft ft T rows Adjust width so this is an whole number. H. Total Number of Components = Number of Components per Row X Number of Rows X components OSTP Pressure Distribution Design Worksheet University OF Minnesota Minnesota Pollution Control Agency Project ID:V 04.20.2016 101. Media Bed Width:ft 2. Minimum Number of Laterals in system/zone = Rounded up number of [(Media Bed Width - 4) -f 3] 1. Does not apply to at-srades10- 4 ) T 3] n- 1 =3[(laterals 33. Designer Selected Number of Laterals: Cannot be less than line 2 (accept in at-<zrades) 4. Select Perforation Spacing: laterals Nun 3.0 ft 'A* a|ai»r»1/45. Select Perforation Diameter Size: 6. Length of Laterals = Media Bed Length - 2 Feet. in ~~~T 01 rork tiring; ’/«* 23 ft Perforation can not be closer then 1 foot from edge. Determine the Number of Perforation Spaces. Divide the Length of Laterals by the Perforation Spacing and round down to the nearest whole number. 25 2ft 7. 3 7 Spaces Number of Perforations per Lateral is equal to 1.0 plus the Number of Perforation Spaces. Check table 8. below to verify the number of perforations per lateral guarantees less than a 10% discharge variation. The value is double with a center manifold. 23 ft ftNumber of Perforation Spaces =T 8Perforations Per Lateral =7 Spaces + 1 =Perfs. Per Lateral Kaximum Number of fWoratiom Per to Guvantee <1(R( Dbdtarge Vanatfam 7/32 Inch PerfmatiomV4 Inch Perforations Pipe Diameter (Inches)Pipe Diamets' (Inches)Perforation ^>acingPerforation Spacing (Feet)(Feet)2 33tVimmih211 16 21 34 6821123060101318 2142«321420 6412285410816 30 6039141935212 258 16 1/8 Inch Perforations3/16 Inch Perfwaticms Pipe Diameter (Inches)Pipe Diameta- (Inches)Perforation SpadngPerforation Spacing (Feet)(Feet)2 33m21114\yk \Vl1 33 74 149872 21 44182646212 2V4214 69 1358020301724404112 33 29 12837 75 20 38 64221216 9. Total Number of Perforations equals the Number of Perforations per Lateral multiplied by the Number of Perforated Laterals. 24 Total Number of Perf.3 Number of Perf. Lat. =8 Perf. Per Lat. X 10. Select Type 0/Atani/o/d Connection (End or Center): [7] End □ Center 2.0011. Select Lateral Diameter (See Table):in OSTP Pressure Distribution Design Worksheet r >,1. University OF MinnesotaMinnesota Pollution Control Agency 12. Calculate the Square Feet per Perforation. Recommended value is 4-11 ft ^ per perforation. Does not apply to At-Crades a. Bed Area = Bed Width (ft) X Bed Length (ft) ft^2502510ftftX b. Square Foot per Perforation = Bed Area divided by the Total Number of Perforations. ft^/perforationsft^10.4perforations =24250T 1.0 ft13. Select Minimum Average Head: 0.74 GPM per Perforation14. Select Perforation Discharge (GPM) based on Table: 15.Determine required Flow Rate by multiplying the Total Number of Perfs. by the Perforation Discharge. 180.74 GPM per Perforation =GPM24Perfs X 0.170 Gallons/ft16. Volume of Liquid Per Foot of Distribution Piping (Table II): 17. Volume of Distribution Piping = = [Number of Perforated Laterals X Length of Laterals X (Volume of Liquid Per Foot of Distribution Piping] Table II Volume bflliquidin Pipe I «Pe Gallons i Wameter i (inches) Liquid Per Foot (Gallons) 0.170 11.723gal/ft3ft XX 18. Minimum Delivered Volume = Volume of Distribution Piping X4 0.0451 0.0781.25 gals X 4 =46.911.7 Gallons 0.1101.5 0.1702 0.3803 0.6614 Comments/Special Design Considerations: 1 OSTP Basic Pump Selection Design Worksheet University OF MinnesotaMinnesota Pollution Control Agency 1. PUMP CAPACITY Project ID:V 04.20.2016 Pumping to Gravity or Pressure Distribution;Pressure 1. If pumping to gravity enter the gallon per minute of the pump:GPM (10 ■ 45 gpm) 2. If pumping to a pressurized distribution system:18.0 GPM Demand Dosing Soil Treatment3. Enter pump description: Soinrvatmcnt $y»te>n| & poiiii of discharge2. HEAD REQUIREMENTS A. Elevation Difference betv/een pump and point of discharge; 9 ft niet pipe Eievirtlon' differenceB. Distribution Head Loss:5 ft C. Additional Head Loss:ft (due to special equipment, etc.) Table I.Friction Loss in Plastic Pipe per 100ft Distribution Head Loss Pipe Diameter (inches)Flow Rate (GPM)Gravity Distribution = Oft 1.25 1.5 21 Pressure Distribution based on Minimum Average Head Value on Pressure Distribution Worksheet: 9.1 1.3 0.3103.1 1.81212.8 4.3 0.4 Distribution Head LossMinimum Average Head 17.0 5.7 2.4 0.614 1ft 5ft 21.8 7.3 3.0 0.716 2ft 6ft 3.8189.1 0.95ftlOft204.6 1.111.1 25 16.8 6.9 1.7 30 9.7 2.423.52.0D. 1. Supply Pipe Diameter;in 12.935 3.2 2. Supply Pipe Length:125 ft 16.540 4.1 20.5 5.045 E. Friction Loss in Plastic Pipe per 100ft from Table I:50 6.1 55 7.3 ft per 100ft of pipe0.92Friction Loss =8.660 F. Determine Equivalent Pipe Length from pump discharge to soil dispersal area discharge point. Estimate by adding 25% to supply pipe length for fitting loss. Supply Pipe Length (D.2) X 1.25 = Equivalent Pipe Length 10.065 70 11.4 75 13.0 85 16.4156.3125 ftftX 1.25 20.195 G. Calculate Supply Friction Loss by multiplying Friction Loss Per 100ft (Line E) by the Equivalent Pipe Length (Line F) and divide by 100. Supply Friction Loss = 156.3 1.4 ft1000.92 ftft per 100ft X H. Total Head requirement is the sum of the Elevation Difference (Line A), the Distribution Head Loss (Line B), Additional Head Loss (Line C), and the Supply Friction Loss (Line G ) 15.4 ft1.4 ft =5.0 ft ft +9.0 ft ++ 3. PUMP SELECTION 15.418.0 feet of total head.GPM (Line 1 or Line 2) with at leastA pump must be selected to deliver at least Comments: #OSTP Pump Tank Design Worksheet (Demand Dose)University OF MinnesotaMinnesota Pollution Control Agency V 04.20.2016Project ID:DETERMINE TANK CAPACITY AND DIMENSIONS 300A. Design Flow (Desisn Sum. 1 A) :1.GPD 500 Gal500GalC.Recommended pump tank capacity:B. Min. required pump tank capacity: IM-540InfiltratorB. Tank Model:A. Tank Manufacturer:2. Note: Design calculations are based on this specific tank. Substituting a different tank model will change the pump float or timer settings. Contact designer if changes are necessary. 552 GallonsC. Capacity from manufacturer: 12.0 Gallons per inchD. Gallons per inch from manufacturer: 44.0E. Liquid depth of tank from manufacturer:inches DETERMINE DOSING VOLUME 3 Calculate Volume to Cover Pump (The inlet of the pump must be at least 4-inches from the bottom of the pump tank ft 2 inches of water covering the pump is recommended) (Pump and block height + 2 inches) X Cations Per inch (2C or 3E) in 2 inches) X 4 Minimum Delivered Volume = 4 X Volume of Distribution Piping: - Line 17 of the Pressure Distribution or Line 11 of Non-level 5 Calculate Maximum Pumpout Volume (25% of Design Flow) Design Flow: 21612.0 Gallons16Gallons Per Inch( 47 Gallons (minimum dose) X 0.25 75 Gallons (maximum dose)300 GPD 6 Select a pumpout volume that meets both Minimum and Maximum: 7 Calculate Doses Per Day = Design Flow F Delivered Volume 50 Gallons Volume of Liquid in 'l^pe- .. gpd F gal =300 50 6 Doses MflMi4 Per Foot (Gallons^ Pipe Diameter (inches) 8 Calculate Drainback: 2 inchesDiameter of Supply Pipe =A. 0.0451125feetB.Length of Supply Pipe = 0.0781.250.170 Gallons/ftVolume of Liquid Per Lineal Foot of Pipe = Drainback = Length of Supply Pipe X Volume of Liquid Per Lineal Foot of Pipe C.1.5 0.110 D.2 0.170 ft X gal/ft =21.31250.170 Gallons 3 0.380 9. Total Dosing Volume = Delivered Volume plus Drainback 0.6614 gal =50 gal +21.3 71 Gallons 10. Minimum Alarm Volume = Depth of alarm (2 or 3 inches) X gallons per inch of tank in X gal/in =24.0212.0 Gallons DEA6AND DOSE FLOAT SETTINGS 11. Calculate Float Separation Distance using Dosing Volume . Total Dosing Volume /Cations Per Inch gal F 12.0 5.971gal/in =Inches ] 12. Measuring from bottom of tank: A. Distance to set Pump Off Float = Pump * block height + 2 inches in + Inches for Dose: 5.9 in 182in =16 Inches 25.9 inAlarm Depth Pump On Pump Off B. Distance to set Pump On Float=Distance to Set Pump-Off Float * Float Separation Distance in + 23.9 in 24.0 Gal 5.9 2418in =Inches 18.0 in 71 Gal C. Distance to set Alarm Float = Distance to set Pump-On Float + Alarm Depth (2*3 inches) in + 216 Gat in =24 2.0 26 Inches rtcott’s Weptic services, LID Scott Ellingson 201 Meadow Circle, Ashby, MN 56309 218-205-1667 scottsseptic@outlook.com Subsurface Sewage Treatment System Management Plan Sewage Treatment System Permit Number: Property Information: Lake / River Number 56-306 Lake / River Name Elbow Lake Lake / River Class Section Township Name EvertsNE29 Parcel Number(s) Property’s E-911 Address 35484 235th St.25000290185000 Property Owner: Camp Elbow Lake LLC This management plan will identify the operation and maintenance activities necessary to ensure long-term performance of your septic system. Some of these activities must be performed by you, the homeowner. Other tasks must be performed by a licensed septic service provider. Homeowner’s Management Tasks - Should Be Checked Every 6 months: Leaks - Check (look, listen) for leaks in toilets and dripping faucets. Repair leaks promptly. Surfacing sewage - Regularly check for wet or spongy soil around your soil treatment area. Effluent filter (if applicable) - Inspect and clean twice a year or more. Pump Tank Alarms - Alarm signals when there is a problem. Contact a service provider any time an alarm signals. Holding Tank Alarms - Can be either an electronic or a manual float, when activated, service (pumping) is required. Event counter or water meter (if applicable) - Record your water use. Vegetative Cover - Establish and maintain a vegetative cover over the sewage system. Professional’s (Licensed Septic Service Provider) Management Tasks - Should Be Checked Every 24 Months (2 Years); □ Check to make sure tank is not leaking. n Check to make sure tank is not leaking. C] Check and ciean 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. [~1 Check the pump and alarm system functions. Q Check wiring for corrosion and function. r~l Provide homeowner with list of resuits and any action to be taken. r~| Check inspection pipe caps (replace as necessary). r~l Check manhole cover (accessibility, security, or damage). I understand it is my responsibility to properly operate and maintain the sewage treatment system on this property in accordance with this Subsurface Sewage Treatment System Management Plan. 05/13/2018Property Owner: DateSignature The following link will provide information from the University of Minnesota, regarding a Septic System Owner’s Guide: htto://www.extenslon.umn.edu/environment/housinq-technoloQv/moisture-manaQement/septic-svstem-owner-quide/ cott'sl?3ptiC 'er'Vicgs, lie y PARCEL n ^5b0oJ?9O IgS <9t?o YEAR _______________ SCALE (•' - HO'Scott Ellingson 201 Meadow Circle, Ashby, MN 56309 218-205-1667 SKETCH OF PROPERTY ^ bec>5 500 r/gvv7 'oui \d X ^5 gi" 3' Wol« Vif- IS -^f'^ |5.i| -j5"4-o W'^ f t p« -I can's >Tpnc 0i-viCf:S, i„U-i PARCEL # P50q>J?9Q IgS OOP YEAR _______________ SCALE O' Scott Ellingson 201 Meadow Circle, Ashby, MN 56309 218-205-1667 SKETCH OF PROPERTY 300 NS'*^ \ 'TV^3Su.«^ 'O-ID Sl^ 7,jr -5 'o4joI ? :iS<3 -7 loyr ^/y L'-n4. ^3’ 'V IS 1S‘+ ., H \ t>P\^i/' 7S f t T71a4— I i ' I Land & Resource Management Otter Tail County Government Services Center, 540 W Fir Fergus Falls, MN 56537 OTTER mil 218-998-8095 www.co.otter-tail.mn.us FAX: 218-998-8112 009aTfaiaaii0Ta SITE DATA WORKSHEET Property Information: Lake / River Number Lake / River Name Lake / River Class Section Township Name Everts56-306 Elbow Lake NE 29 Property’s E-911 AddressParcel Number(s) 35484 235th St.25000290185000 Property Owner Information: Name(s): Camp Elbow Lake LLC Mailing Address: 35484 235th St. Battle Lake, MN 56515-9117 Designer Information: Name: Scott Ellingson MPCA License Number: 3947 Advanced DesignerFirm Name: Scott's Septic Services, LLC License Category: Mailing Address: 201 Meadow Circle Ashby, MN 56309 (218) 205-1667E-Mail Address: scottsseptic@outlook.com Phone Number: Sewage Treatment System Design Information: Number of Bedrooms: [2__ Garbage Disposal: Yes Well: Casing Depth: |88.od~| Ft. Sewer Line Separation: [ Floodplain: [71 No ]fl I I Yes [7] No[7] No Bluff:Yes [TjTerrestrialVegetation: Aquatic Slope at Installation Site: |3.0 |%__ Type of Observation: Probe [j^Pit >/ Boring 71 Till [^ Outwash I [Bedrock | lAlluviumParent Material: Original Soil: [7 Yes | | No Compacted Soil: | | Yes \^\No Loess Ft. 175.00 I In.Depth of Boring (to 7’ or restrictive layer): 05/13/2018 Signature ofJTicensed Designer LR: Online Permitting Forms 2016: Site Data Worksheet Fillable 03-09-2016 Date SEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTS TRENCH REDUCTIONSTA (Se/ntttmtntAm) OUTHOUSE HOLDING SEPTIC TANK LIFT TANK:ategory InchesRock trenches withDapadtyGLS.GLS. ^ FT %of sMewan forFTSetback from Nearest Well IPreduction / equivalent toSetback from Burled Vater Suction Pipe FT FT STA CALCULATION (SolITtBalitmtAm) R. X Setback from Buried Pipe )istributlng Water Under Pressure ^ FT^ FTMFT FT 1^FTSetback from OHWL (lake &/or river)FT R. ^■^0 Ft*Setback from Bluff FTFTFT I S' FT ftSetback from Dwelling MOUND / AT-GRADEFT ROCK BEDSetbadc from Non-Dwelling FT FT FT ft IbOSetback from Nearest Property Line FT Ft. ^ FT ftSetback from Right-of-Way FT IOi>Ft* •levation above Restrictive Layer 3 r ftFTFT SAND IN MpUNC'"'^ NSTALLERS COMMENTS SEPTIC TANK(s)folding Tank / Lift Alarm □ YES □ NO □ YES jlf^ONO \# Tanks Installed)ld System Pumped & Destroyed Weep Holes Marajf.lumber of Laterals #Lateral Pipe Size IN Model#•erforatlon Spacing Ft.Perforation Diameter Size IN Gallons Per Minute I i ^ 1 Feet of Total Head | |RLTERS OYES □ NO»UMPS T.rrUU/' (b/0 Iipector's Comments: SoX^ OA <4ra-Lc>\>^^ CejL -ta=^+5ujLec)etch: f^Ahnl was found to oe , the above described sewage system installation compliant with the provisions of the SanitationVmpCode of Otter Tail County. n Land 4 H>»ouie» M»nmgtn»nt OtHeU w No. BK — 04-2014-06 987.343 • Vieter Lundeen Co., Prtntoro • Porout Polio, Mlnnooolo &3 t' CERTIFICATE OF APPROVAL SEWAGE SYSTEM a 9miFebruary jg 9721stThis certificate has been issued this to certify that the sewage system installed as per sewage permit number indicated below has been approved for use day of --sX i-*by Otter Tail County, Minnesota.M1^-■!% I The premises covered by this certificate are legally described as:»uMLake No. 56-306 Sec. 29 Twp. 133 Range 40 Twp. Name Ever ts , J wl 25-000-29-0185-000 Sublot 1 of Lot 3 iJ■M Bryan LonskiOwner: NametJ ¥ aR#2 Box 51, Battle Lake, MNAddre.ss 5651 5Zip No. Permit No. SP 11279(A) .^(r) Land & Resource Management OfTtcial 'i'Signed by:(A- Lodge & 2 Cabins) (B- 1 Cabin) ' MKI.098700I 'Oucr Tail County. Minnesota 4 264.909 • Vidor Lundeen Co.. Priniers • Fergus Falls. MN • 1 •800-348-4870 LAND & RESOURCE MANAGEMENT Otter Tail County Courthouse Fergus Falls, MN 56537 218-739-2271 Ext. 225 October 10, 1996 Bryan Lonski R#2 Box 51 Battle Lake, MN 56515 RE: Sewage System Permit #11279, Elbow Lake (56-306) Dear Mr. Lonski: Our office has been informed that in order for a septic system to be installed at a substandard setback, approval from the Board of Adjustment is required. Therefore, this is to inform you that in order to install your septic system at a setback of less than 150' from the lake, you will need to apply for and receive a variance. Variance Applications filed by October 17, 1996 will be considered at the November meeting. I have included an Application and Application Checklist for your use. Since this is the case. Sewage System Permit #11279 is currently on hold. If you have any questions regarding this matter, please contact our office. Sincerely, /aJL k^cuy 9..^‘a (n^/V/^ Bill Kalar Administrator mgb APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM WHITE — Office Yellow — Inspector Pink — Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 - FERGUS FALLS, MN 56537 LEGAL Permit No. sXuAUtj / 3DESCRIPTION Abatement: ( ) Yes NoAND LOCATION LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER SECTION TWP. NO.RANGE TWP NAME 5(r>-^OG iilA-e-cO /35 4^ PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER IDENTIFICATION: Please Print All Information Laa Name___________________ Fir Initial Mailing Address — No. Street, City and Slate____________________ ,5/ :5&5/6> Zip Code Telephone No. OynJProperty Owner 5^557Sewage System Installer Name ~n A.M. This System will be ready for inspection on , 19-P.M.at This space for office use only 9NUMBER OF BEDROOMS: A.M. 19 P.M GARBAGE DISPOSAL: (^) YES ( ) NODate Rec'd Time Rec'd Phone Call Rec'd By SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) (^) Septic tank ( ) Lift Station (Alarm required) (^) Drain field (^) Trenches ( ) Bed ( ) Mound ( ) Outhouse ( ) Sewer line TANK DRAIN FIELD 3<pon ll^t ^ 1=1CapacityGIs. ^o//on6nDistance from nearest well Ft. Ft. Distance from lake or stream !bn160Ft.Ft. iQDistance from building Ft.Ft. lODistance from property line Ft.la Ft. 3Distance from bottom to Water Table Ft.Ft. EFFLUENT DISTRIBUTION ()^) Gravity ( ) Pressure All distances are shortest distance between nearest points PERCOLATION TEST DATA: WATER WELL DEPTH (7^', Date of Perc Test. =3-0Rate of 1st Test Rate of 2nd Test Average 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 Officical shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibilty of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. J7^ t ^4^Uj^DATE:. Signature Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit iWgranted upon express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of any said ordinances. NOTE: Permit void if work is not commenced within six (6) months. Issued Date: oo Land & Resource Management Office35Fee $.Rec if. Comments: 277.212 • Victor Lundeen Co.. Printers • Fergus Falls. MinneostaBK 0795-003 APPLICATION FOR PERMI. . OINS7 WAGE TREATMENT SYSTEM ^ '*■ JA/HITE -s. Office Yellow — lilspector Pink — Owner LAND & RESOURC ^NAGEMENT OTTER TAIL COUNTV COURT HOUSE Phone:(218)739-2271 - FERGUS FALLS, MN 56537 }0'A PermirfJ5:-----7 ('?Q ^VLEGAL DESCRIPTION Abatement: ( ) Yes ( ) No^^<sco7~ ) oP 3AND LOCATION LAKE NUMBER LAKE/RIVER CLASS f\i €. SECTIONLAKE/RIVER NAME TWP. NO.RANGE TWP NAME rz ifeSC- 3-czo CL'G>c:>Wo PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER <■ - O ( COCO IDENTIFICATION: Please Print All Information First Mailing Address — No. Street, City and StateLast Name Initial Zip Code Teiephone No. s /<r: n s !<'ryI Cl y-v. .Property Owner GcWU LK rn tj ■J- Sewage System Installer ^___^CvName < V i^3od-------------------------------------------------------------------~ This System will be ready for inspection on 96. 19.P.M.at This space for office use only NUMBER OF BEDROOMS: Phone Call Rec'd By S6ilo/c - (c? in GARBAGE DISPOSAL: ( ) YES ( /) NOTime Rec’dDate Rec'd SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) ( Septic tank ( ) Lift Station (Alarm required) ( ) Drain field (v^v-)'Trenches ( ) Bed ( ) Mound ( ) Outhouse ( • ) Sewer line TANK StDOCapacity GIs.qFt. /goDistance from nearest well Ft. Ft. Distance from lake or stream Ft. Ft. lODistance from building Ft. Ft.20 (ODistance from property line Ft.Ft. 3Distance from bottom to Water Table Ft.Ft. EFFLUENT DISTRIBUTION ( ,- ) Gravity ( ) Pressure All distances are shortest distance between nearest points PERCOLATION TEST DATA: WATER WELL DEPTH I 0 -‘iir't Y '^ /Perc Tester.Date of Perc Test,T 3. /Rate of 1 st Test Rate of 2nd Test Average Rate 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 Health. Applicant agrees that plot plan sketches and specifications submitted herewith and which are approved by Shoreland Management Officical shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibilty of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. 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 condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of any said ordinances. NOTE: Permit void if work is not commenced within six (6) months. /Issued Date:Vv~~»Land & Resource Management Office ■ (.0Fee $.Rec #, Z-Pvill jUr'.> i i VIComments:< o CT^JhI Y ^ ^ 277.212 • Victor Lundeen Co.. Printers • Fergus Falls. MinneostaBK 0795-003 llvf(/^INSt Inspector mt 'I \ SEWAGE DISPOv - SYSTEM STATISTICS DN RESULTS ke all measurements A n- \K» HOLDING SEPTIC TANK DRAIN FIELDLIFT TANKCATEGORY Actual Minimum ~hOOO GLS.yn/oooCapacity GLS. SF lie?‘fO ftDistance from Nearest Well FT FT FT Distance from Buried Water Suction Pipe FT FT FTFT50 Distance from Buried Pipe Distributing Water Under Pressure loi FT FT FTFT10 // O FTDistance from Lake or River (OHWL)FT FTFT CLO FTDistance from Nearest Building 10/20 FTFTFT ^ FTDistance from Nearest Property Line fO FT FTFT10 f- ftDistance from Bottom to Water Table FT FT FT3 ;sHolding Tank/Lift Alarm NO YES NOOld System Pumped & Destroyed Sevi^ Line to Well Separation DRAINFIELD CALCULATIONINTERPRETATiON OF ABBREVIATIONS GLS. = Gallons SF = Square Feet FT = Linear Feet Actual Minimum ^ 7 / FTX ^ //ft 20 FT SF Inspector’s Comments:■ Ir SKETCH: f 0 ’•y) J Inspector's Signature pection ^Date of Ins Time of Inspection System design must be to scale and must include the proposed location of the sewage system, all existirig/proposed buildings, property lines, the ordinary high water level of the water body and all water wells within 150' of the sewage system. GRID PLOT PLAN feet SKETCHING FORMIjnch(es) equals.grid(s) equals feet, orScale: fhn ^ ' ' f. SIGNATURE: DATE: MPCA LICENSE #:~ * TLICENSE CATEGORY: TyMufe-l 2T SUBMITTED BY:7 FIRM NAME: ADDRESS: _ /V i % : ^ —is------------z ^ ., /•T:-/ 4 7/■a 17/ /■ //i-97^/ ;//' //// X/ Cl p3 p tI I! U, J! \\\-u §3'^ \ \\\A \V. -\\ \\ •jJ V3n j201.183'• ViclOf Lundeen Co.. Printers • Fergus Falls, MN • .1-800-346-4870BK— 0496— 029 SITE DATA>■»- LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, MN 56537 OWIMER: A on 5'X TELEPHONE NUMBERFIRSTMIDDLELAST NAME ADDRESS: ^<Sr/P^f^/1 ^ ^ €/ ZIP CODECITYSTATESTR./RT 3oCf LAKE/RIVER NO. J3J SEC.RANGE TWP. NAMETWPLAKE NAME LEGAL DESCRIPTIOM:SOIL BORING LOG COLOR & MUNSELL NO. DEPTH (INCHES)STRUCTURETEXTURE BLOCKY PLATY PRISMATIC NONE ybcO 10 ^7/ / Qt-ef o ^-lO PARCEL NUMBER BLOCKY PLATY PRISMATIC NONE Scr/n(i + Cfyaue.!FIRE NUMBER id -30 7NUMBER OF BEDROOMS GARBAGE DISPOSAL: (Y^ NO BLOCKY PLATY PRISMATIC NONE S<7hi 'I 3o~&}SOfWELL CASING DEPTH:ft.BLOCKY PLATY PRISMATIC NONE FLOODPLAIN: YES VEGETATION: AQUATIC ^TERRESTRIAL BLOCKY PLATY PRISMATIC NONE %SLOPE AT INSTALLATION SITE: \TYPE OF OBSERVATION: Probe Pit PARENT MATERIAL: Till Outwash Loess Bedrock Alluvium No COMMENTS: ORIGINAL SOIL: COMPACTED SOIL: Yes 01 ..DEPTH OF BORING:. PERC TEST #2PERC TEST #1 - TWO TESTS ARE REQUIRED - PERC RATEINTERVAL IMINUTES)WATER DEPTH WATER DROPINTERVAL (MINUTES) START WATER DEPTH WATER DROP PERC RATE TIMETIME 'WHE START I /!-Q-H-PERCTIMEPERCTIMEDROPDROP PERC RATEINTERVAL (MINUTES)WATER DEPTH WATER DROPINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIMETIME I.=4_/REFILLREFILL ,yla/H'ji--uH'.DROP PERCTIMEPERCTIMEDROP WATER DROP PERC RATETIMEINTERVAL (MINUTES)WATER DEPTHINTERVAL (MINUTES)WATER DEPTH WQ-lw WATER DROP PERC RATETIME qriL..s^l REFILL/d ^ Eh. ^ - TIME DROP PERC REFILL DROP PERCTIME PERC RATEWATER DROPINTERVAL (MINUTESI WATER DEPTHINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIMETIME REFILLREFILL DROP PERCTIMETIMEDROPPERC WATER DROP PERC RATEWATER DEPTHINTERVAL (MINUTESI WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES) REFILL TIME REFILL -----------r-------^ =DROP PERCTIMETIMEDROPPERC WATER DEPTH WATER DROP PERC RATETIMETIMEINTERVAL (MINUTES)INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE REFILLREFIU ----=;PERCTIMEDROPTIMEPERCDROP WATER DROP PERC RATEINTERVAL (MINUTES)WATER DEPTHTIMEINTERVAL (MINUTESI WATER DEPTH WATER DROP-PERC RATE TIME REFILLREFILL PERCTIMEDROPTIMEDROPPERC WATER DROP PERC RATEINTERVAL IMINUTESI REFILL WATER DEPTHTIMEINTERVAL (MINUTESI WATER DEPTH WATER DROP PERC RATE TIME REFia PERCTIMEDROPTIMEDROPPERC PROPOSED DESIGN: PRESSURE DIST..BED.ATGRADE.MOUND.HOLDING TANK. ITY DIST.TRENCH SEWER LINE.OUTHOUSE.OTHER.SPECIFY:______________ — SYSTEM DESIGN ON BACK — MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring Sealing No. Minnesota Unique No. or W-series No. (Leave blank il not known) H 107734WELL Oa?>BORING LOCATION WELL AND BORING SEALING RECORDCounty NaiTjp <0 //er> '/-a i f Minnesota Statutes, Chapter 1031 Township Name Township No.Range No.Section No.Fraction (sm. Ig.) Date Sealed Date Weil or Boring Constructed E /^'2l7*.; I 1ilOtA ^ • / /- /iT- ‘=7/' Numerical Street Address or Fire Number and City of Well or Boring Location S ft.Depth Before Sealing Original Depth Show exact location of well or boring In section grid with 'X'. Sketch map of well or boring location, showing property lines, roads, and buildings. AQUIF^S) rn^InQle Aquifer Q Multiaquifer STATIC WATER LEVELQ^Simate^ ^3*_«• \ □ MeasuredWELL/BpR Supply Well D Monit. Well Q Env. Bore Hole □ Other____ INGN i -p.. p_.I ! I !G above land surface CASING TYPE(S)T EW □H^teeTTT....t"Q Plastic □ Tile □ Other a mile CASING Diam^er1rt-y-t-t-f't'i Depth Set in oversize hole?Annualar space initially grouted^,^ Yes Q No r^J^ffl<r^wn^ tn~ 4^^ «.4K □ Yesin. from7 mile Q No Q Unknown□ Yes□ Yes □ Noin. from ft.PROPE OWNER’S NAME y ,$ K !------------- Property owner's mailing address if different than weil location address indicated above. to □ No □ Unknown□ Yes□ Yes □ Noin. from ft.to /?-;? 3c/- S/ A. 7//, ^.l^. SCREEN/OPEN HOLE //. ^ to cjSifSiS ft. Open Hole from ft.Screen from to< / OBSTRUCTION/DEBRIS/FILL QUoCstrurton □ Debris □ Fill □ No Obstruction Type of Obstruction/Debris/RII WELL OWNER’S NAME aa^reM i^t^prent thjtnWell owner's m property owner's address indicated above. □ NoObstruction/Debris/RII removed? PUMP Type [fl»'rtemoved □ Not Present □ OtherHARDNESS OF FORMATIONGEOLOGICAL MATERIAL COLOR FROM TO METHOD USUETHOOUS^ 0*^0 Annular Space Exits □ Annular space grouted with tremie pipe Q Casing Perforation/Removal TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND BORE HOLE:If not known, indicate estimated formation log from nearby well or boring. -r At c. □ Perforated Q Removedin. from ft.to D Perforated D Removedin. from ft.to Type of perforator □ Other GROUTING MATERIAL(S) nr C\^ to ~ ft.Grouting Material from yards bags from to ft.yards bags from ft.yards bags from ft yards bags REMARKS, SOURCE OF DATA, DIFRCULT1ES IN SEAUNG UNSEALED WELLS AND BORINGS Other unsealed well or boring on property? O Yes UCENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed In accordance with Minnesota Rules. Chapter 4725. The information contained in this report is true to the best of my knowledge. O'.// E License or Registration f7o.Contractor Busi,Name Authorized^pr^wtatiw Sifiaturo Oete Name of Person Sealing Weil or BoringyIMPORTANT-RLE WITH PROPERTY PAPERS-WELL OWNER COPY H 107734 Department of LAND & RESOURCE MANAGEMENT COUNTY OF OTTER TAIL Phone; (218) '739-2271 Court House FERGUS FALLS. MINNESOTA 56537 n-s-’iC> 1^0 aS f I/22^iukz*Sk2^.RE: Inspecdoa on Sewage System Permit #. This is to inform you thar an inspection was made on the above mentioned Permit. At that time we could not complete the inspection and certify the sewage system for the following reason(s): ___There was not a visual alarm on the lift station. ___ There was not an alarm oh the holding tank . ___There was not a dwelling onsite. ___The non-conforming sewage system had not been destroyed. 2__There was not a well onsite. ___The Installer had not completed the air test. ___Our office has not received a letter from the Twp. allowing the sewage system to be from the road right-of-way. ___Our office has not received a letter from the neighbor allowing the sewage system to be less than 10 feet ( feet) from the lotline. ^ Our office has not received Well Abandonment Certfficadon. feet Please contaa oifr office for a reinspecdon of your sewage system when the problem is corrected. Certification of the sewage system can not occur until this matter is resolved. 2^ Inspector 4 APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM WHITE — Office Yellow — Inspector Pink — Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218)739-2271 - FERGUS FALLS, MN 56537 )/Z7? (B JPermit No.LEGAL DESCRIPTION Abatement; ( ) Yes { ) NoI of C-o-r 3AND LOCATION LAKE/RIVER CLASS SECTIONLAKE NUMBER LAKE/RIVER NAME TWP. NO.RANGE TWP NAME ^7 (33 WoNe FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER(S) -zS'-or^o ~ a (S'S'- cooo IDENTIFICATION: Please Print All Information Mailing Address — No. Street, City and StateFirstInitial Zip Code Telephone No.Last Name P>oy^ r /U ryci .sic'lo nProperty Owner S'CWS^ 'rm tj •4-6.Sewage System Installer Name y V A.M. This System will be ready for inspection on . 19-P.M.at This space for office use oniy XNUMBER OF BEDROOMS: A.M. GARBAGE DISPOSAL: ( ) YES ( y/) NO19P.M Date Rec'd Time Rec'd Phone Call Rec’d By SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) ( Septic tank ( ) Lift station (Alarm required) ( ) Drain field (v„x'fiVenches ( ) Bed ( ) Mound ( ) ^thouse .-''iTSewer line TANK DRAIN FIELD -ys-oCapacity GIs.Sq Ft. Distance from nearest well Ft.Ft. -9^Distance from lake or stream Ft. Ft. laDistance from building Ft.Ft.20 !0Distance from property line Ft.Ft. -3(Distance from bottom to Water Table Ft.Ft. EFFLI^T DISTRIBUTION ( »-xfGravity ( ) Pressure All distances are shortest distance between nearest points PERCOLATION TEST DATA: WATER WELL DEPTH 0Uy r-Perc Tester.Y\Date of Perc Test. 2Rate of 1st Test Rate of 2nd Test Average 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 Officical shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibilty of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. /CP'-/-^C Signature ^ / / f/ / J ‘ Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of any said ordinances. NOTE: Permit void if work is not commenced within six (6) months. DATE: Issued Date: Larfd & Resource Mamgement Office Fee $.__________________ Rec #BiU WftL-p)>2- ^ Comments: 277.212 * Victor Lundaen Co. Printers • Fergus Falls. MinneostaBK 0796-003 I APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM 5;, WHITE — Office Yellow — Inspector Pink — Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218)739-2271 - FERGUS FALLS, MN 56537 )0 MLEGALPermit No. DESCRIPTION Abatement: ( ) Yes (^X^) NoA 6 L 5AND [LOCATION I LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS SECTION[RANGETWP. NO.TWP NAME ,/■ i.>ilL /1 ’L. i PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER i ' 1^6'-CXJO IDENTIFICATION: Please Print All Information Last Name First Mailing Address — No. Street, City and State k''tS ______■ SarUi Al-n Initial Zip Code Telephone No. oi ■Property Owner 37 t. .4^0Sewage System Installer Name TT' ^ ^ at This System will be ready for inspection on., 19- This space for office use only NUMBER OF BEDROOMS: GARBAGE DISPOSAL: () ^ES ( ) NODate Rec’d Time Rec’d Phone Call Rac'd By SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) (‘^) Septic tank ( ) Lift station (Alarm required) (y^) Drain field ( Trenches ( ) Bed ( ) Mound ( ) Outhouse ( ) Sewer line TANK FIELD Capacity GIs.•Sq Ft.Z:5o L. 60Distance from nearest well Ft.Ft. Distance from lake or stream ' Ft.i6L2 Ft. Distance from building Ft.t Ft. / /i Distance from property line Ft. Ft.A Distance from bottom to Water Table Ft.Ft. EFFLUENT DISTRIBUTION ( V ) Gravity ( ) Pressure All distances are shortest distance between nearest points PERCOLATION TEST DATA: WATER WELL DEPTH / v /•■ j '7 .1/2 Perc Tester.Date of Perc Test, Rate of 1st Test Rate of 2nd Test Average 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 Officical shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibilty of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. 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 condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of any said ordinances. NOTE: Permit void if work is not commenced within six (6) months.I ' Issued Date: Land & Resource Management Office Fee $.Rec #.'■-J o Comments: / - 277,212 • Victor Lundeen Co.. Printers • Fergus Falls, MinneosteBK 0796-003 ■T i INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS 4 > i DRAIN FIELDHOLDING SEPTIC TANK LIFT TANKCATEGORY Actual Minimum ~7SO gls.Capacity SF SFGLS. 0 i/Oo FTFT FTDistance from Nearest Well FT Distance from Buried Water Suction Pipe FT FTFTFT504 Distance from Buried Pipe Distributing Water Under Pressure !cA >0"i 10FTFTFT FT \50 5^Distance from Lake or River (OHWL)FT FT FTFT (>0 10/20 FTFTDistance from Nearest Building FT FT 4/O FT FT FTFT 10Distance from Nearest Property Line i«rFT FT 3// ^ ftDistance from Bottom to Water Table FT £ YES NOHolding Tank/Lift Alarm V YES NOOld System Pumped & Destroyed A DRAINFIELD CALCULATIONSewer Line to Well SeparationINTERPRETATiON OF ABBREVIATiONS GLS. = Gallons SF = Square Feet FT = Linear Feet 3Actual Minimum;•FTFTXi/a FT 20 FT SFi' I '/ RgyInspector’s Comments:'i i SKETCH! - J l\I po 9^{O J ao] ^3 s 50* p f ' * V Inspector's Signature Date of Inspection Time of Inspection 1 System,.design must be to scale and must include the proposed location of the sewage system, all exisfing/proposed buildings, property lines, the ordinary high water level of the water body and all water wells within 150' of the sewage system. GRID PLOT PLAN So feet SKETCHING FORMzinch(es) equals.grid(s) equals feet, orScale: SIGNATURE: DATE: Sc,D > 7 V MPCA LICENSE #: LICENSE CATEGORY: TL SUBMITTED BY: Y ADDRESS: ^ ^2 7 ■jf- FIRM NAME: ’ *1 C*' 1 'Cl v> ; V,> 9 L»'t| \ •«dN ^>5 ___n< I 13 / /I \. j:- \\ \ \h \ 1>1/ 'C-<Falls. MN • 1 •800-346-4870281.183 • Victor Lundoert Co.. Primers • FergusBK- 0496- 029 j r SITE DATA o LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, MN 56537 QWMER: aw- (fFIRST ^ J(7n ,57^/* TELEPHONE NUMBERMIDDLELAST NAME ADDRESS: Aa/^r S'CS/S ZIP CODESTATECITYSTR./RT /I ho ^id133 TWP NAMESEC.TWP.RANGELAKE NAMELAKE/RIVER NO. LEGAL DESCRIPTIOM:SOIL BORING LOG COLOR & MUNSELL NO. DEPTH (INCHES)STRUCTURETEXTURE ~T^fi 3c I! £u ^cn>j BLOCKY PLATY PRISMATIC NONE /O0-^ I PARCEL NUMBER OofI< Cir«5^ / & v/3 BLOCKY PLATY PRISMATIC NONE /\00y^/FIRE NUMBER ANUMBER OF BEDROOMS S/Cz BLOCKY PLATY PRISMATIC NONE GARBAGE DISPOSAL: YES Of ft.WELL CASING DEPTH:BLOCKY PLATY PRISMATIC NONE &FLOODPLAIN: YES BEfjRisT^ VEGETATION: AQUATIC BLOCKY PLATY PRISMATIC NONE I %SLOPE AT INSTALLATION SITE: TYPE OF OBSERVATION: Probe Pit PARENT MATERIAL: Till Outwash ORIGINAL SOIL: No Loess Bedrock Alluvium COMMENTS:. (S>COMPACTED SOIL: Yes if0^ft.DEPTH OF BORING:. PERC TEST #2PERC TEST #1 - TWO TESTS ARE REQUIRED - PERC RATEWATER DROPINTERVAL (MtNUTESi WATER DEPTHPERC RATE TIMEWATER DROPINTERVAL (MINUTES)WATER DEPTHTIME ..^3z__52^ TIME DROP PERC STARTSTART '^E ‘ DROP ~ PERC RATEWATER DEPTH WATER DROPINTERVAL (MINUTES)PERC RATE TIMEWATER DEPTH WATER DROPTIMEINTERVAL (MINUTESI 0S:/s 3^./VREFILLREFILL ZOJnUj...4 TIME PROF PERC /litc::::TIME DROP PERC RATEWATER DROPINTERVAL (MINUTES!WATER DEPTHPERC RATEWATER DROP TIMEWATER. DEPTH -TAf— INTERVAL (MINUTES)TIME 6 (e .iky.REFILL,REFILL TIME DROP PERC WATER DROP PERC RATEINTERVAL (MINUTES!WATER DEPTHPERC RATEWATER DROP TIMEWATER DEPTHTIMEINTERVAL (MINUTES)REFILLREFia TIME DROP PERCTIMEDROPPERC PERC RATEWATER DROPWATER DEPTHINTERVAL IMINUTES)WATER DROP PERC RATE TIMEWATER DEPTHTIMEINTERVAL (MINUTES!REFiaREFia PERCTIMEDROPPERCTIME DROP WATER DROP PERC RATEWATER DEPTHINTERVAL (MINUTES!PERC RATE TIMETIMEWATER DEPTH WATER DROPINTERVAL IMINUTES)REFILLREFILL DME DROP PERCDROPPERCTIME WATER DROP PERC RATEINTERVAL (MINUTES) WATER DEPTHPERC RATE TIMEWATER DROP-INTERVAL IMINUTESI WATER DEPTHTIME REFILLREFILL TIME PERCDROPPERCDROPTIME WATER DEPTH WATER DROP PERC RATEINTERVAL (MINUTES)PERC RATE TIMEWATER DEPTH WATER DROPTIMEINTERVAL (MINUTES!REFILLREFia TIME PERCDROPPERCDROPTIME PROPOSED DESIGN: PRESSURE DIST.GRAVITY DIST..HOLDING TANKATGRADE.MOUND.TRENCH BED. OUTHOUSE.OTHER.SPECIFY:.SEWER LINE. — SYSTEM DESIGN ON BACK —