Post on 09-Jul-2018
Electronic design form instructions (13-1)
Pre-design forms (13-2) Preliminary evaluation (13-2) Field evaluation (13-4) Soil boring log (13-5) Site evaluation map (13-7) Percolation test worksheet (13-8) Class V injection well inventory form (13-9) Homeowner survey (13-11) Design Flow and soil (13-13)
System design forms (13-15) Trench and bed (13-15) Mound (13-17) At-grade (13-21) Pressure distribution – level (13-24) Pressure distribution – non level (13-26) Pump selection (13-30) Pump tank, dosing and float and timer setting (13-32) Single-pass and recirculating sand filter (13-35) Existing dwellings flow determination (13-39) New development flow determination (13-40) Measured flow for other establishments (13-41) Estimated flow for other establishments (13-42) Final permitting flow (13-43) LISTS design flow and system summary (13-44) Loading rates and absorption ratios for effluent treatment Level C using detailed soil descriptions (13-47) Loading rates and absorption ratios for effluent treatment Levels A and B using detailed soil descriptions (13-49)
Inspection forms (13-51) Existing (13-51) New construction (13-59)
Installation forms (13-63) As-built (13-63) MDH Pressure Testing Form (13-65) Abandonment form (13-67)
Maintenance (13-69) Land application (13-69) Management plans (13-79) Septic Tank Pumping Frequency Guidelines (13-95) Service provider forms – (see CIDWT O&M Manual or OSTP Website: http://septic.umn.edu/formsandsheets/bytype/index.htm#maintenance)
Equations and Constants (13-96)
SECTION 13: Forms and ReferenceAll forms are available electronically on the University of Minnesota OSTP website at: http://septic.umn.edu/formsandsheets
The bold forms are interactive on our web page.
Section 13: Forms and Reference n 13-1
09/09
1. Preliminary Evaluation 8. Mound 15. Flow Estimate for Existing Dwellings2. Field Evaluation 9. At-Grade 16. Flow Estimate for New Subdivision3. Boring Log 10. Pressure Distribution 17. Measured Flow-Other Establishment4. Site Evaluation Map 11. Non-Level Pressure Distribution 18. Estimated Flow-Other Establishment5. Percolation Test 12. Pump Selection 19. Final Flow Total6. Flow & Soil 13. Pump Tank 20. Flow & System Summary7. Trench & Bed 14. Single-Pass & Recirculating Filter 21. Supporting Information
There are two ways you can utilize this workbook:
Instructions for 2009 OSTPSSTS Design Forms
Yellow cells are user input cells, that is, these are the cells where you as the designer must manually enter the value that the worksheet is requesting.
G ll ll th t ill fill i t ti ll t l i t th ll ll
2. You can print blank copies of the worksheets and fill them out by hand.
1. Your security level must be medium or low (not the default of high). This can be changed under Tools, Macro, Security. In Office 2007, click the Microsoft Office Button, then click the Excel Options. Select the Trust Center, Settings, and then click Macro Settings to enable.
The 2009 Design forms included in this file are intended to meet the new 2008 Chapter 7080 Rules. Due to the many changes there will be updates over the next months and year. Please check back to the website frequently and download the most current version. There are 20 worksheets and additional supporting information in the 2009 SSTS Design Form Workbook, they are:
In each worksheet, you will notice each cell is colored either green (or grey depending on your system settings) or yellow.
These worksheets were created in Microsoft Excel. You must have a software program that can open .xls documents to use these forms. If you do not have Microsoft Excel, you can download a similar program named OpenOffice online: http://www.openoffice.org/
1. You can use the Excel worksheet on a computer and fill in the values on a computer & print out the results or email them. Using this function you must be sure to enable macros if asked this by Excel, or
SECURITY LEVEL & MACROS
This file contains macros which are imbedded formulas to do some of the calculations. In order for these to work:
2. If prompted enable the macros.
INPUTS
The worksheets should display and print at 100%. This makes the worksheets readable and able to be filled in by hand. The worksheets can be printed in either color or black and white. You may need to set your computer/printer to grayscale option or you may wish to change the colored portions of the worksheets. Each sheet that is part of your design must be printed separately as there is not a way to print them all at one time.
CHECK BOXES
Green cells are cells that will fill in automatically as you enter values into the yellow cells.
CREDITS
Developed by the University of Minnesota: Sara Christopherson, Dave Gustafson and Dan Wheeler; Tim Haeg, Watab Inc.; Chris LeClair, Washington County; and the Minnesota Pollution Control Agency. Thanks to the many that provided comments and feedback during thedevelopment process.
Some of the yellow cells have a drop-down menu function. A small arrow pointing downwards will appear in the lower right corner of the cells with a drop-down menu. You MUST choose one of the values in the drop-down menu. To erase the value, simply highlight the cell and press the Delete key on your keyboard.
PRINTING
NOTE: Most of the cells in this workbook have a great deal of complex formatting and formulas in the background. If you alter the formulas, the workbook will not function properly. It would be a good idea to copy this workbook and always work with the the copy, so the original canbe utilized for back-up purposes only.
SAVING
Each time a design is done the file should be saved with a unique file name. Keep an original version of the workbook with no data entered. To have a version which can not be altered you can create at PDF. Creating a PDF requires the full version of Adobe Acrobat which is softwareyou may not have. The other option is to go to "Tools"..."Protection"..."Protect Worksheet" and save the file for that particular job which it what the overall plan for how to do this.
DROP DOWN MENUS
Many of the worksheets have check boxes that one may check on the computer. If these are not working, you are most likely is in "design mode" in excel. To fix this, from the menu, select View, Toolbars, and then select "Control Toolbox". Now a new toolbar will appear in your menu bar. There is a button that looks like a ruler and a speed square. Click it to get out of design mode. Now the check boxes should work.
09/0909/09
13-2 n Section 13: Forms and Reference
09/09
Address
Parcel I.D. Township # Range # W Section
Date Township name Latitude/Longitude
Evaluation for system type Parcel dimensions
Client-Provided Information
Adults Children Teenagers
\
Other (specify )
* Clear water source
Designer-determined Flow Information
A. Estimated Design Flow (gallons per day)
Description:
OSTP Preliminary Evaluation Form
Client Phone Number:
1. Contact InformationProperty Owner/Client:
Unfinished space (ft2)
2. Flow Information
No. of bedrooms* (if applicable)
Type(s) of use (all that apply )
No. of residents in home
Existing flow measurements
Water-using devices (check all that apply)
Any additional current or future uses on this parcel (specify )
Any non-sewage discharges to system (specify )
Water use concerns (check all that apply)
Anticipated waste strength
3. Preliminary Site Information
B(1) W l ll( ) i hi 100 f f b i
Sewage ejector or grinder pump in home
I acknowledge the above is complete and accurate (Client(s) signature and date)
New Construction Existing Dwelling
Residential Commercial Other Use (Specify)
Yes (If Yes, attach readings) No
Garbage Disposal
Dishwasher
Large Bathtub/Jacuzzi
Laundry/Large Tub on 2nd Floor
Water Softener*
Sump Pump*
High Efficiency Furnace*
Hot Tub*
Iron Filter*
Faucet/Toilet
In-Home Business
Multiple Loads of Laundry/Day
No Lint Screen Use of Anti-Bacterial Soap
Long-Term Prescription Meds
Frequent Entertaining of Out-of-Town Guests
Yes No
Domestic High Strength
Yes No
Daycare
Depth of well(s) ft ft Source
Source
List landforms
inches inches
inches inchesMaximum bedrock depth:
Minimum bedrock depth: Minimum bedrock depth:
Maximum bedrock depth:
Parent materials -check all that apply
H. Soil Survey Information (from web soil survey ) Map Units on Parcel
Slope Range
Landscape Position (check all that apply )
Site located in a shoreland district/area
F. Determine property lines (see Site Evaluation map )
E. Floodplain designation and flood elevation
Source
Source
D. Elevation of ordinary high water level (OWHL) - MN DNR (if adjacent to parcel )
B(4). Location of all existing and proposed buildings and improvements on lot (see Site Evaluation map )
C. Location of all easements on lot (see Site Evaluation map )
Source
Well(s) were located
G. Distance of setbacks
B(1). Water supply well(s) within 100 ft of absorption area
Well casing depth(s)
B(2). Site within 200 ft of noncommunity transient supply well
B(3). Site within a drinking water supply management area
B(5). Buried water supply pipes within 50 ft of proposed system
Map Unit Ratings
Septic Tank Absoprtion Field - Trench (MN)
Septic Tank Absorption Field - At-grade (MN)
Septic Tank Absorption Field - Mound (MN)
New Construction Existing Dwelling
Residential Commercial Other Use (Specify)
Yes (If Yes, attach readings) No
Garbage Disposal
Dishwasher
Large Bathtub/Jacuzzi
Laundry/Large Tub on 2nd Floor
Water Softener*
Sump Pump*
High Efficiency Furnace*
Hot Tub*
Iron Filter*
Faucet/Toilet
In-Home Business
Multiple Loads of Laundry/Day
No Lint Screen Use of Anti-Bacterial Soap
Long-Term Prescription Meds
Frequent Entertaining of Out-of-Town Guests
Yes No
Domestic High Strength
Yes No
Direct Observation County Well Index Maps Personal Communication
Yes No
Yes No
Yes No
Yes No
Survey Plat Map Other
Map
Property Lines OHWL Easements Water Supply Pipes Well(s)
Other Buildings
Daycare
Till Outwash Loess Bedrock Alluvium
Colluvium Lacustrine Organic Cut/FillSummit
Depression
Shoulder ToeslopeFootslopeBackslope
ManmadeTerraceStream Plain
Section 13: Forms and Reference n 13-3
09/09
OSTP Preliminary Evaluation Form
Map Unit
Consistence
Map Unit
Consistence
Map Unit
Consistence
Map Unit
Consistence
Structure(s) Other (flooding, ponding, etc.)
4. Preliminary Soil Profile Information (from web soil survey - map unit description & official series descriptions )
Depth Texture(s)
Horizon 2
Horizon 4
Horizon 3
Horizon 1
Horizon 2
Other (flooding, ponding, etc.)Depth Texture(s) Structure(s)
Horizon 5
Horizon 1
Horizon 4
Depth
Horizon 3
Horizon 5
Texture(s) Structure(s) Other (flooding, ponding, etc.)
Horizon 4
Horizon 1
Horizon 3
Horizon 2
Structure(s) Other (flooding, ponding, etc.)
Horizon 5
Depth Texture(s)
Horizon 1
Horizon 2
Horizon 4
Horizon 3
Horizon 5
LGU Contact
I hereby certify that I have completed this work in accordance with all applicable ordinances, rules and laws.
(License #) (Date)
5. Local Government Unit Information
Name of LGU
(Designer) (Signature)
LGU-specific installation requirements
LGU-specific setbacks
LGU-specific design requirements
13-4 n Section 13: Forms and Reference
09/09
Date
Client's Approval (initial)
Proposed soil treatment area adequately protected
4. General Soils Information
Utility Locations Identified
2. Utility and Structure Information
Property Lines
OSTP Field Evaluation Form
Client Phone Number:
1. Contact Information
Address
Weather Conditions
Property Owner/Client
Slope DirectionPercent Slope
Locate and Verify (see Site Evaluation map )
3. Site Information
Discuss the flooding or run-on potential of site
Slope Shape
Vegetation type(s)
Evidence of cut, fill, compacted or disturbed areas
Landscape Position
Identify benchmarks and elevations (Site Evalulation Map )
Original soils
Gopher State One Call # Any Private Utilities
Determined and Approved By Client
Determined But Not Approved
Approximate
Property Lines Surveyed
Existing Buildings Improvements Easements Setbacks
Yes No
Yes No
Yes No
Locate Areas on Site Evaluation Map
I hereby certify that I have completed this work in accordance with all applicable ordinances, rules and laws.
(License #) (Date)
Type of observation *Soil pit required if determining loading rate without perc test
Number of soil observations
Original soils
Soil observations were conducted in the proposed system location
A soil observation was made within the most limiting area of the proposed system
Soil boring log forms completed and attached
Percolation tests performed, forms completed and attached
Depth to standing water inches Anticipated construction issues
5. Phase I. Reporting Information
Flood elevation feet
Depth to bedrock inches
Contour loading rate gpd/ft
Loading rate gpd/ft2
Maximum depth of system inches
Depth to periodically saturated soil inches
Site evaluation issues / comments
(Designer) (Signature)
Elevation at system bottom feet Differences between soil survey and field evaluation
Percolation rate min/inch
Gopher State One Call # Any Private Utilities
Determined and Approved By Client
Determined But Not Approved
Approximate
Property Lines Surveyed
Existing Buildings Improvements Easements Setbacks
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Locate Areas on Site Evaluation Map
Soil Probe Soil Boring Soil Pit*
Section 13: Forms and Reference n 13-5
09/09
Ons
ite
Sew
age
Trea
tmen
t Pro
gram
Soi
l Bor
ing
Log
Cl
ient
/ A
ddre
ss:
Le
gal D
escr
ipti
on/G
PS:
Dat
e:
So
il Pa
rent M
ater
ial(s
):
Till
Out
was
h La
cust
rine
A
lluvi
um
Loes
s
Org
anic M
atte
r Be
droc
k
(cir
cle
all t
hat a
pply
)
La
ndsc
ape
Posi
tion
: Sum
mit
Shou
lder
Back
/Sid
e Sl
ope
Foot S
lope
To
e Sl
ope
Sl
ope
Shap
e:
(cir
cle
one)
V
eget
atio
n:
So
il Su
rvey
Map
Uni
t(s)
:
Sl
ope
(%):
W
eath
er c
ondi
tion
s/Ti
me
of D
ay:
Elev
atio
n:
D
epth (i
n)
Te
xtur
e
Coar
se
Frag %
M
atri
x Co
lor(
s)
M
ottl
e Co
lor(
s)
Re
dox
Kind
(s)
Satu
rate
d So
il In
dica
tor(
s)
(see
bac
k)
St
ruct
ure
Shap
e
St
ruct
ure
Gra
de
Cons
iste
nce
Co
ncen
trations
Dep
letio
ns
Gleyed
Granu
lar
Platy
Blocky
Prismatic
Single Grain
Massive
Weak
Mod
erate
Strong
Loose
Loose
Friable
Firm
Extrem
ely Firm
Rigid
Co
ncen
trations
Dep
letio
ns
Gleyed
Granu
lar
Platy
Blocky
Prismatic
Single Grain
Massive
Weak
Mod
erate
Strong
Loose
Loose
Friable
Firm
Extrem
ely Firm
Rigid
Co
ncen
trations
Dep
letio
ns
Gleyed
Granu
lar
Platy
Blocky
Prismatic
Single Grain
Massive
Weak
Mod
erate
Strong
Loose
Loose
Friable
Firm
Extrem
ely Firm
Rigid
Co
ncen
trations
Dep
letio
ns
Gleyed
Granu
lar
Platy
Blocky
Prismatic
Single Grain
Massive
Weak
Mod
erate
Strong
Loose
Loose
Friable
Firm
Extrem
ely Firm
Rigid
Co
ncen
trations
Dep
letio
ns
Gleyed
Granu
lar
Platy
Blocky
Prismatic
Single Grain
Massive
Weak
Mod
erate
Strong
Loose
Loose
Friable
Firm
Extrem
ely Firm
Rigid
Co
ncen
trations
Dep
letio
ns
Gleyed
Granu
lar
Platy
Blocky
Prismatic
Single Grain
Massive
Weak
Mod
erate
Strong
Loose
Loose
Friable
Firm
Extrem
ely Firm
Rigid
Com
men
ts:
Cert
ified
Sta
tem
ent: I
here
by c
erti
fy t
hat I h
ave
com
plet
ed t
his
wor
k in a
ccor
danc
e w
ith
all a
pplic
able o
rdin
ance
s, r
ules a
nd la
ws.
____
____
____
____
____
____
____
____
____
____
____
__
(Des
igne
r)
____
____
____
____
____
____
____
____
____
___
(Sig
natu
re)
____
____
____
__
(Li
cens
e #)
____
____
___
(Dat
e)
13-6 n Section 13: Forms and Reference
09/09
Textures:
Soil Structure G
rade: Weak ‐poorly form
ed, indistinct peds, barely observable in place Moderate ‐W
ell formed, distinct peds,
moderately durable and evident, but not
distinct in undisturbed soil Strong ‐durable peds that are quite evident in un‐displaced soil, adhere w
eakly to one another, w
ithstand displacement, and becom
e separated w
hen soil is disturbed Loose ‐no peds, sandy soil Landscape Position: 9.09
Soil Structure Shape: Granular ‐the peds are approxim
ately spherical or polyhedral and are com
monly found in
topsoil. These are the small, rounded
peds that hang onto roots when soil is turned
over. Platy‐the peds are flat and plate like. They are oriented horizontally and are usually overlapping. Platy structure is com
monly found
in forested areas just below the leaf litter or
shallow topsoil.
Blocky‐the peds are block‐like or polyhedral, and are bounded by flat or slightly rounded surface that are casting of the faces of surrounding peds. Blocky structure is com
monly
found in the lower topsoil and subsoil.
Prismatic‐ flat or slightly rounded vertical faces
bound the individual peds. Peds are distinctly longer vertically, and faces are typically cast or m
olds of adjoining peds. Prism
atic structure is commonly found in the
lower subsoil.
Single Grain‐the structure found in a sandy soil.
The individual particles are not held together. Massive‐no observable aggregates, or no
orderly arrangement of natural lines of
weakness
Consistence: Loose ‐intact specim
en not available Friable ‐slight force betw
een fingers Firm
‐moderate force betw
een fingers Extrem
ely firm‐m
oderate force between hands
or slight foot pressure Rigid ‐foot pressure
Subsoil Indicator(s) of Saturation: S1. D
epleted matrix (value ≥4 and
chroma ≤2)
S2. Distinct gray or red redox features
S3. 5Y chroma ≤ 3
S4. 7.5 YR or redder faint redox concentrations or redox depletions
If yes to one of the above indicators then: Topsoil Indicator(s) of Saturation: T1. W
etland vegetation T2. D
epressional landscape T3. O
rganic texture or organic modifiers
T4. N 2.5/ 0 color
T5. Redox features in topsoil T6. H
ydric soil Slope Shape ‐ Slope shape is described in tw
o directions: up‐and‐dow
n slope (perpendicular to the contour), and across slope (along the horizontal contour); e.g., Linear, Convex or LV.
c-clay sic-silty clay sc-sandy clay cl-clay loamsicl-silty clay loam
scl-sandy clay loam
si-siltsil-silt loam
* Sand M
odifiers l-loam
co-coarse
sl-sandy loam*
m-m
edium
ls-loamy sand*
f-fine s-sand*
vf-very fine
Summ
it
Foot Slope
Toe Slope
Back/Side
Shoulder
Section 13: Forms and Reference n 13-7
09/09
OSTP Site Evaluation Map
Contact Information
Address:
Property Owner/Client:
List any construction issues:
Mapping Checklist
Map scale: indicate north show slope % direction
Locate Easements Setbacks
Elevations
I hereby certify that I have completed this work in accordance with all applicable ordinances, rules and laws.
(Date)(Designer) (Signature) (License #)
Lot Dimensions/Property Lines
Dwellings and other improvements
Existing or proposed system(s)
Replacement area
Unsuitable area(s)Public water supply wells
Pumping access
Inner wellhead zone
Phone
Electric
Gas
Building
All water wells within 100 feet
Pressure PipeWater Suction PiStreams, Lakes, RiversFloodway and Fringe
Borings
Benchmark
Perc Tests
Horizontal & Vertical Reference Points
13-8 n Section 13: Forms and Reference
09/09
Diameter in
* Not required in sandy soils
Soak* endtime:
hrs of soak
Test hole: #1 Location:
Date reading taken: Elevation:
Depth**: inches
Soil texture description:
Address:
OSTP Percolation Data Sheet1. Contact Information
Method to maintain 12 in of water during soak
2. General Percolation Information
Date prepared and/or soaked:
Property Owner/Client:
Is pre-soak requiried*?
** 12 inches for mounds & at-grades, depth of absorption area for trenches &
Soil Texture
Starting time:
3. Percolation Test Data
Soak* start time:
Method of scratching sidewall:
Depth (in)
Reading End Time Start Reading End Reading Perc rate % Difference Pass1 NA NA2 NA NA3
mpi
mpi
(License #) (Date)
Additional percolation test data may be included on attached pages
I hereby certify that I have completed this work in accordance with all applicable ordinances, rules and laws.
(Designer) (Signature)
Chosen Percolation Rate for Test Hole #1
Design Percolation Rate (maximum of all tests) =
depth of absorption area for trenches & beds
Start Time
Section 13: Forms and Reference n 13-9
09/09
Type
or
prin
t al
l inf
orm
atio
n. S
ee r
ever
se f
or in
stru
ctio
ns.
OM
B N
o. 2
040-
0042
A
ppro
val E
xpire
s 4/
30/0
7
(Thi
s in
form
atio
n is
col
lect
ed u
nder
the
aut
hori
ty o
f th
e S
afe
Dri
nkin
g W
ater
Act
)
UN
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STA
TES
ENVI
RO
NM
ENTA
L PR
OTE
CTI
ON
AG
ENC
Y
INVE
NTO
RY
OF
INJE
CTI
ON
WEL
LS
Del
etio
n
PAPE
RW
OR
K R
EDU
CTI
ON
AC
T N
OTI
CE
OFF
ICE
OF
GR
OU
ND
WAT
ER A
ND
DR
INKI
NG
WAT
ER
1. D
ATE
PREP
ARED
2.
FAC
ILIT
Y ID
NUM
BER
(Yea
r, M
onth
, Day
)
The
publ
ic re
port
ing
burd
en fo
r thi
s co
llect
ion
of in
form
atio
n is
est
imat
ed a
t abo
ut 0
.5 h
our p
er re
spon
se, i
nclu
ding
tim
e fo
r rev
iew
ing
inst
ruct
ions
, sea
rchi
ng e
xist
ing
data
sou
rces
, gat
herin
g an
d m
aint
aini
ng th
e da
ta n
eede
d, a
nd c
ompl
etin
g an
d re
view
ing
the
colle
ctio
n of
info
rmat
ion.
su
gges
tions
for r
educ
ing
this
bur
den,
to C
hief
, Inf
orm
atio
n Po
licy
Bra
nch,
213
6, U
.S. E
nviro
nmen
tal P
rote
ctio
n A
genc
y, 4
01 M
Stre
et,
SW, W
ashi
ngto
n, D
C
3. T
RANS
ACTI
ON
TYPE
(P
leas
e m
ark
one
of t
he f
ollo
win
g)
Ent
ry C
hang
e
Firs
t Ti
me
Ent
ry
Rep
lace
men
t
4. F
ACIL
ITY
NAM
E AN
D LO
CATI
ON
A. N
AME
(last
, fir
st, a
nd m
iddl
e in
itial
)C
. LA
TITU
DE
TOW
NS
HIP
RA
NG
ES
EC
T.
DEG
MIN
SEC
E. T
OW
NSH
IP/R
AN
GE
1/4
SEC
T
.
DEG
MIN
SEC
D. L
ON
GIT
UD
EB
. STR
EET
AD
DR
ESS/
RO
UTE
NU
MB
ER
F. C
ITY/
TOW
N
G. S
TATE
H
. ZIP
CO
DE
I.
NU
ME
RIC
C
OU
NTY
CO
DE
J. IN
DIA
N L
AN
D
(mar
k "x
")
Yes
No
5. L
EGAL
CO
NTAC
T:
A. T
YPE
(mar
k "x
")
Ow
ner
Ope
rato
r
C. P
HO
NE
(a
rea
code
an
d nu
mbe
r)
B. N
AM
E (la
st, f
irst
, and
mid
dle
initi
al
D. O
RG
AN
IZA
TIO
N
E. S
TREE
T/P.
O. B
OX
F. C
ITY/
TOW
N
G. S
TATE
H
. ZIP
CO
DE
I. O
WN
ER
SH
IP (m
ark
"x")
PRIV
ATE
STAT
E
PU
BLI
C
FED
ERA
L
SPEC
IFY
OTH
ER
6. W
ELL
INFO
RMAT
ION:
A
. CLA
SS
AN
DTY
PE
C. T
OTA
L N
UM
BER
OF
WE
LLS
B. N
UM
BE
R O
F W
ELL
S
D. W
ELL
OPE
RA
TIO
N S
TATU
S
CO
MM
NO
N-C
OM
MU
CAC
TAPA
AN
CO
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13-10 n Section 13: Forms and Reference
09/09
INSTRUCTIONS AND DEFINITIONS
SECTION 1. DATE PREPARED: Enter date in order of year, month, and day.
SECTION 2. FACILITY ID NUMBER: In the first two spaces, insert the appropriate U.S. Postal Service State Code. In the third space, insert one of the following one letter alphabetic identifiers:
D - DUNS Number, G - GSA Number, or S - State Facility Number.
In the remaining spaces, insert the appropriate nine digit DUNS, GSA, or State Facility Number. For example, A Federal facility (GSA -123456789) located in Virginia would be entered as : VAG123456789.
SECTION 3. TRANSACTION TYPE: Place an “x” in the applicable box. See below for further instructions.
Deletion. Fill in the Facility ID Number. First Time Entry. Fill in all the appropriate information. Entry Change. Fill in the Facility ID Number and the information that has changed. Replacement.
SECTION 4. FACILITY NAME AND LOCATION: A. Name. Fill in the facility’s official or legal name. B. Street Address. Self Explanatory. C. Latitude. Enter the facility’s latitude (all latitudes assume
North Except for American Samoa). D. Longitude. Enter the facility’s longitude (all longitudes assume
West except Guam). E. Township/Range. Fill in the complete township and range.
The first 3 spaces are numerical and the fourth is a letter (N,S,E,W) specifying a compass direction. A township is North or South of the baseline, and a range is East or West of the principal meridian (e.g., 132N, 343W).
F. City/Town. Self Explanatory. G. State. Insert the U.S. Postal Service State abbreviation. H. Zip Code. Insert the five digit zip code plus any extension.
SECTION 4. FACILITY NAME & LOCATION (CONT’D.): I. Numeric County Code. Insert the numeric county code from
the Federal Information Processing Standards Publication (FIPS Pub 6-1) June 15, 1970, U.S. Department of Commerce, National Bureau of Standards. For Alaska, use the Census Division Code developed by the U.S. Census Bureau.
J. Indian Land. Mark an “x” in the appropriate box (Yes or No) to indicate if the facility is located on Indian land.
SECTION 5. LEGAL CONTACT: A. Type. Mark an “x” in the appropriate box to indicate the type
of legal contact (Owner or Operator). For wells operated by lease, the operator is the legal contact.
B. Name. Self Explanatory. C. Phone. Self Explanatory. D. Organization. If the legal contact is an individual, give the
name of the business organization to expedite mail distribution. E. Street/P.O. Box. Self Explanatory. F. City/Town. Self Explanatory. G. State. Insert the U.S. Postal Service State abbreviation. H. Zip Code. Insert the five digit zip code plus any extension. I. Ownership. Place an “x” in the appropriate box to indicate
ownership status.
SECTION 6. WELL INFORMATION: A. Class and Type. Fill in the Class and Type of injection wells
located at the listed facility. Use the most pertinent code (specified below) to accurately describe each type of injection well. For example, 2R for a Class II Enhanced Recovery Well, or 3M for a Class III Solution Mining Well, etc.
B. Number of Commercial and Non-Commercial Wells. Enter the total number of commercial and non-commercial wells for each Class/Type, as applicable.
C. Total Number of Wells. Enter the total number of injection wells for each specified Class/Type.
D. Well Operation Status. Enter the number of wells for each Class/Type under each operation status (see key on other side).
INJECTION WELL CLASS AND TYPE CODES
CLASS I Industrial, Municipal, and Radioactive Waste Disposal Wells used to inject waste below the lowermost Underground Source of Drinking Water (USDW).
TYPE 1I Non-Hazardous Industrial Disposal Well. 1M Non-Hazardous Municipal Disposal Well. 1H Hazardous Waste Disposal Well injecting below the
lowermost USDW. 1R Radioactive Waste Disposal Well. 1X Other Class I Wells.
CLASS II Oil and Gas Production and Storage Related Injection Wells.
TYPE 2A Annular Disposal Well. 2D Produced Fluid Disposal Well. 2H Hydrocarbon Storage Well. 2R Enhanced Recovery Well. 2X Other Class II Wells.
CLASS III Special Process Injection Wells.
TYPE 3G In Situ Gassification Well 3M Solution Mining Well.
CLASS III (CONT’D.)
TYPE 3S Sulfur Mining Well by Frasch Process. 3T Geothermal Well. 3U Uranium Mining Well. 3X Other Class III Wells.
CLASS IV Wells that inject hazardous waste into/above USDWs.
TYPE 4H Hazardous Facility Injection Well. 4R Remediation Well at RCRA or CERCLA site.
CLASS V Any Underground Injection Well not included in Classes I through IV.
TYPE 5A Industrial Well. 5B Beneficial Use Well. 5C Fluid Return Well. 5D Sewage Treatment Effluent Well. 5E Cesspools (non-domestic). 5F Septic Systems. 5G Experimental Technology Well. 5H Drainage Well. 5I Mine Backfill Well. 5J Waste Discharge Well.
EPA Form 7520-16 (Revised 8-01)
Section 13: Forms and Reference n 13-11
09/09
Homeowner Survey –Onsite Septic System
Updated 8/5/2009 Page 1 of 2
These questions help septic system professionals determine the best level of care for your septic system. The questionscan also help troubleshoot problems, address needed upgrades or changes, or other issues.
Name____________________________________________________________ Phone Number____________________
Address____________________________________________________________________________________________
County/Township Permit No._________________
Information about the home and residents:1. The house/cabin is used full time, year round seasonal or part time
2. Number of people living in the home: adults children age 0 – 11 children age 12 & up
3. Current number of bedrooms number of bedrooms in original design
number of bathrooms: full three fourths half
4. Do you have an in home business? If yes – what is it?
Information about the Septic System: italicized answers best protect your system.
5. Number of septic tanks or chambers in tanks: capacity of tanks in gallons unknown
6. Date of last pumping or evaluation: How many tanks pumped unknown
7. Are there risers on the septic tank maintenance holes? yes no unknown
8. Are the risers insulated for freezing protection, and well secured for safety? yes no unknown
9. Is there an effluent screen on the outlet baffle of the tank? yes no unknown
10. If an effluent screen is present, do you maintain it? the pumper checks it yes _____unknown
11. Do you know how old your septic system is? no yes, installed in
12. Are you aware of any problems or repairs? Describe:
13. Has the system ever frozen? Yes, specify where no unknown
14. Do you use septic tank or system additives? no yes, we have added
15. Have you noticed any odors? Where?
16. We have: in ground soil treatment area above ground other
17. We mow the grass over the drainfield regularly yes no
18. We keep all vehicles, snowmobiles, dirt bikes, 4 wheelers, other items off our drain field area yes no
19. Pumps: yes, our system has pumps no unknown Gallons/dose ______ Doses/day
20. Alarms: alarms are present for pumps and/or effluent screen. Alarms do not work
unknown we do not have any alarms.
21. Well: yes no Well casing depth feet Distance from drainfield feet
22. Is this your first home with a septic system?
Are you familiar with the “dos and don’ts” of a septic system?
Do you have a copy of the Septic System Owner’s Guide from the University of Minnesota?
13-12 n Section 13: Forms and Reference
09/09
Homeowner Survey –Onsite Septic System
Updated 8/5/2009 Page 2 of 2
Household product and use information: italicized answers best protect your system.
23. Garbage Disposal: (circle) no yes, and use it often rarely never
24. Dishwasher: no yes loads per week
we use gel or powdered detergents. we read labels for phosphorus content.
Does it discharges to the septic system? _____yes no
25. Clothes Washer: no _____yes, _____and wash loads/week. We wash more than 1 load/day.
We have: an older agitator top loading washer suds saver washer front loading washer
We use liquid or powdered laundry detergents. Lint screen on the washer? Yes no
Amount of laundry bleach used in one week: Type?
Does it discharge to the septic system? yes no
26. Water Softener: no yes, and it discharges to the septic system yes no
27. Other water treatment filter: what: it discharges to the septic system yes no
28. Whirlpool bathtub: no yes, and it discharges to the septic system yes no
29. Sump Pump: no yes, and it discharges to the septic system yes no
30. Floor, roof or other drains: no yes, and it discharges to the septic system yes no
31. Skin care products: bath and shaving oils, creams, moisturizers: yes, we use these, times/week: ______
32. Anti bacterial soaps, cleansers: yes, we use these no, we do not use anti bacterials.
33. Cleaning products: indicate those used: Every flush toilet cleaners after shower door cleansers
drain cleaners bleach based kitchen and bathroom cleansers.
List other commonly used cleaning products:
34. Toilet Paper: number of rolls used per week
35. Prescription Drugs used long term: no yes,
type of medicine
type of medicine
36. We dispose of un needed prescription drugs by
37. Please attach system sketch if available. Include: footing drains, surface drainage and system replacement area
What questions do you have?
© 2009, Regents of the University of Minnesota. All rights reserved. For additional copies or for Americans with Disabilities Act accommodation,
please call(800) 322 8642. University of Minnesota is an equal opportunity educator and employer.
Section 13: Forms and Reference n 13-13
09/09
1.
A. Estimated Design Flow (GPD): gpd
or Measured Flow (GPD) : flow times safety factor
= gpd
Design Flow: Gallons Per Day (GPD)
B. Septic Tank capacity: Gallons
Number of Septic Tanks or Compartments : Effluent Screen & Alarm ?
* Flows for Classification IV dwellings are 60 percent of the values as determined for Classification I, II or III systems.
2. SITE EVALUATION:
A. Depth to Limiting Layer : inches ft
System Type
AVERAGE DESIGN FLOW:
Note: The estimated design flow is considered a peak flow rate including a safety factor. For long term performance, the average daily flow is recommended to be < 60% of this value.
gpd X
OSTP Design Flow and Soil Worksheet
f l d l
Type I Type II Type III Type IV Type V
B. 0
C. 0
D. Landscape Position :
E. Estimated Percent Land Slope : %
F. Calculated Slope = ÷ 0.0
Runor Rise
x 100 =
Trenches Bed At-Grade Mound
Gravity Distribution Pressure Distribution-Level Pressure Distribution-Unlevel
Type of Soil Treatment and Dispersal Area
Type of Distribution
Type I Type II Type III Type IV Type V
13-14 n Section 13: Forms and Reference
09/09
OSTP Design Flow and Soil Worksheet
3. SOIL LOADING RATES: Use either A. or B. below
A. B.
4. ORGANIC LOADING (if pretreatment is being used)
Grade
Texture Group
Structure
Design Loading Rate: GPD/ft2
Select Soil Loading Rate:
C.
Organic Loading = Design Flow X Estimated BOD in mg/L in the effluent X 8.35 ÷ 1,000,000
Select Soil Loading Rate:
DETAILED SOIL DESCRIPTIONS (SOIL PIT REQUIRED)
Consistence
Texture
7080 Table IX
Slowest measured percolation rate:
*Rapidly permeable soils: see 7080.2260
lbs BOD/day
I hereby certify that I have completed this work in accordance with all applicable ordinances, rules and laws.
(Signature)(Designer)
gpd X
(Date)(License #)
mg/L X 8.35 ÷ 1,000,000 =
Section 13: Forms and Reference n 13-15
09/09
1. SYSTEM SIZING:
A. Design Flow : GPD B. Maximum Depth : inches
C. Soil Loading Rate: GPD/ft2 C(i). Recommended CLR: gal/ft
D. Required Bottom Area: Design Flow (1.A) ÷ Loading Rate (1.C) = Initial Required Bottom Area
GPD ÷ GPD/ft2 = ft2
E. Select Dispersal Media :
F. Select Distribution Method :
G. Select Dispersal Type :
2. TRENCH CONFIGURATION: (Rock or equivalent media)
A.
6 to 11
Bottom Area Multiplier
1
0.66
OSTP Trench & Bed Design Worksheet
0.8
Design trench
bottom area
12 to 17
34%
Bottom Area Reduction
0%
18 to 23
Initial required trench bottom area
(ft2): (from 1.D)
20%
Sidewall Absorption
(inches)
RockOther Approved Media (Describe):
Pressure (required for rapidly permeable soils)
Gravity-Drop BoxGravity-Other (Describe):
Trench - Rock or equivalent (section 2 below)
Bed (section 4 below)
Trench - Registered Products (section 3 below)
B. Select Sidewall Height : inches = ft
C. Design Bottom Area (2.A): ft2
D. Select Trench Width : inches = ft
E. Total Designed Trench Length: Bottom Area (2.C) ÷ Trench Width (2.D) = Total Required Trench Length
ft2 ÷ ft = ft
F. Select Trench Spacing : ft (typically 5 - 12 ft from center to center)
G. Calculate Lawn Area: Trench Length (2.E) X Trench Spacing (2.F) = ft2 lawn area
ft X ft = ft2 lawn area
H. Calculate Minimum length based on Contour Loading Rate: Design Flow(1A) ÷ CLR (1Ci) =
gpd ÷ ft
I. If using rock or similar substitute media, select Depth Required to Cover Distribution Pipe :
ft (0.33 for pressure, 0.5 for gravity)
J. Calculate Media Volume : (Sidewall Height (2.B) + Depth to Cover Pipe (2.H)) X Bottom Area (2.C) = cubic ft.
( ft + ft ) X ft2 = ft3
Divide ft3 by 27 ft3/yd3 to calculate cubic yards:
ft3 ÷ 27 = yd3
0.66
0.6
gal/ft =
34%18 to 23
24 40%
RockOther Approved Media (Describe):
Pressure (required for rapidly permeable soils)
Gravity-Drop BoxGravity-Other (Describe):
Trench - Rock or equivalent (section 2 below)
Bed (section 4 below)
Trench - Registered Products (section 3 below)
13-16 n Section 13: Forms and Reference
09/09
3. TRENCH CONFIGURATION: (Registered Products)
A. Registered Product: (from MPCA list)
B. Product Absorption Area: ft2 / linear ft
(from MPCA Registered Product List)
C. Req'd Bottom Area (1.D): ft2
D. Total Required Trench Length: Bottom Area (4.C) ÷ Sizing Value (4.B) = Total Required Trench Length
ft2 ÷ ft2 / lin. ft = ft
E. Select Trench Spacing : ft (typically 5 - 12 ft from center to center)
F. Calculate Lawn Area: Trench Length (3.D) X Trench Spacing (3.E) = ft2 lawn area
ft X ft = ft2 lawn area
4. BED CONFIGURATION: (for sites with less than 6% slope)
A. Select size Multiplier :
B, Req'd Bottom Area (1.D): ft2
Designed Bottom Area : ft2
C. Select Bed Width : ft
D. Calculate Bed Length: Designed Bottom Area (4.B) ÷ Bed Width (4.C) = Bed Length
ft2 ÷ ft = ft
E. Select Sidewall Absorption : inches below the pipe = ft
F. Calculate Media Volume : (Media Depth (4.E) + depth to cover pipe) X Designed Bottom Area (4.B) = ft3
( ft ft) X ft2 = ft3
Maximum width = 25 ft. (pressurized) Maximum width = 12 ft. (gravity)
1.0 = pressurized 1.5 = gravity (not allowed in rapidly permeable soils)
+( ft ft) X ft = ft
Calculate Volume in cubic yards : Media volume in cubic feet (4.F) ÷ 27 = cubic yards
yd3
5. ORGANIC LOADING: (Optional)
A. Organic Loading = Design Flow X Estimated BOD in mg/L in the effluent X 8.35 ÷ 1,000,000 (See Table III)
gpd X mg/L X 8.35 ÷ 1,000,000 = lbs BOD/day
B. Calculate System Organic Loading: lbs. BOD/day (5.A) ÷ Bottom Area (2.C) , (3.C) or (4.A) = lbs/day/ft2
ft2 = lbs/day/ft2
I hereby certify that I have completed this work in accordance with all applicable ordinances, rules and laws.
(Date)(Designer) (Signature) (License #)
ft3 ÷ 27 =
lbs/day ÷
+
Section 13: Forms and Reference n 13-17
09/09
1. SYSTEM SIZING:
A. Design Flow (Flow & Soil - 1.A) : GPD
B. Soil Loading Rate (Flow & Soil-3.C): GPD/ft2
C. Depth to Limiting Condition: ft
D. Percent Land Slope: %
E. Design Media Loading Rate: GPD/ft2
F. Mound Absorption Ratio (1.E÷1.B):
G. Design Contour Loading Rate: GPD/ft
(From Table I - same as Linear Loading Rate)
2. DISPERSAL MEDIA SIZING
A. Calculate Required Dispersal Bed Area: Design Flow (1.A) ÷ Design Media Loading Rate (1.E) = ft2
GPD ÷ GPD/ft2 = ft2
ft2
B. Calculate Dispersal Bed Width: Contour Loading Rate (1.G) ÷ Design Media Loading Rate (1.E) = Bed Width
ft ÷ ft
C. Calculate Dispersal Bed Length: Dispersal Bed Area (2.A) ÷ Bed Width (2.B) = Bed Length
OSTP Mound Design Worksheet
*Systems with these values are not Type I systems.Contour Loading Rate is a recommended value.
gpd/ft2 =
If a larger dispersal media area is desired, enter size:
ft2 ÷ ft = ft
D. Select Dispersal Media :
3. ABSORPTION AREA SIZING
Note: Mound setbacks are measured from the Absorption Area.
A. Calculate Absorption Width: Bed Width (2.B) X Mound Absorption Ratio (1.F) = Absorption Width
ft X = ft
B. For slopes from 0 to 1%, the Absorption Width is measured from the bed equally in both directions.
Calculate Absorption Width Beyond the Bed : Absorption Width (3.A) - Bed Width (2.B) ÷ 2 = Width beyond Bed
( ft - ft) ÷ = ft
C. For slopes >1%, the Absorption Width is measured downhill from the upslope edge of the Bed .
Calculate Downslope Absorption Width : Absorption Width (3.A) - Bed Width (2.B) = ft
ft - ft = ft
Comments:Slope, CLR Choice, Material issues
Rock
Other Approved Media (Describe):
13-18 n Section 13: Forms and Reference
09/09
4. MOUND SIZING
A. Calculate Clean Sand Lift: 3 feet minus Depth to Limiting Condition (1.C) = Clean Sand Lift (1 ft minimum)
3.0 ft - ft = ft
B. Calculate Upslope Height: Clean Sand Lift (4.A) + media depth (1 ft.) + cover (1 ft.) = Upslope Heightft + ft + ft = ft
(figure D-34)
D. Calculate Upslope Berm Width : Multiplier (4.C) X Upslope Mound Height (4.B) = Upslope Berm Width
ft X ft = ft
E. Calculate Drop in Elevation Under Bed: Bed Width (2.B) X Land Slope (1.D) ÷ 100 = Drop (ft)
ft X ft
F. Calculate Downslope Mound Height: Upslope Height (4.B) + Drop in Elevation (4.E) = Downslope Height
ft + ft = ft
(figure D-34)
H. Calculate Downslope Berm Width: Multiplier (4.G) X Downslope Height (4.F) = Downslope Berm Width
x ft = ft
I. Calculate Minimum Berm to Cover Absorption Area: Downslope Absorption Width (3.B or 3.C) + 4 ft. = ft
ft + ft = ft
% ÷ 100 =
C. Select Upslope Berm Multiplier(based on land slope):
G. Select Downslope Berm Multiplier(based on land slope):
J. Design Downslope Berm = greater of 4H and 4I: ft
K. Select Endslope Berm Multiplier : (usually 3.0 or 4.0)
L. Calculate Endslope Berm (4.K) X Downslope Mound Height (4.F) = Endslope Berm Width
ft X ft = ft
M. Calculate Mound Width: Upslope Berm Width (4.D) + Bed Width (2.B) + Downslope Berm Width (4.J) = ft
ft + ft + ft = ft
N. Calculate Mound Length: Endslope Berm Width (4.L) + Bed Length (2.C) + Endslope Berm Width (4.L) = ft
ft + ft + ft = ft
5. ORGANIC LOADING: (Optional)
A. Organic Loading = Design Flow X Estimated BOD in mg/L in the effluent X 8.35 ÷ 1,000,000
gpd X mg/L X 8.35 ÷ 1,000,000 = lbs BOD/day
B. Calculate System Organic Loading: lbs. BOD (5.A) ÷ Bed Area (2.A) = lbs/day/ft2
ft2 = lbs/day/ft2
C. Recommended Organic Loading Rate: lbs/day/ft2
lbs/day ÷
Section 13: Forms and Reference n 13-19
09/09
6. MOUND DIMENSIONS`
Comments:Divert surface water away from mound.
13-20 n Section 13: Forms and Reference
09/09
7. APPROXIMATE MOUND MATERIAL CALCULATIONS:
A. Calculate Bed (rock) Volume : Bed Length (2.C) X Bed Width (2.B) X Depth = Volume (ft3)
ft X ft X 1.0 = ft3
Divide ft3 by 27 ft3/yd3 to calculate cubic yards:
ft3 ÷ 27 = yd3
Add 20% for constructability: yd3 X 1.2 = yd3
B. Calculate Clean Sand Volume:
Upslope Volume : ((Upslope Mound Height - 1 ) x 3 x Bed Length ) ÷ 2 = cubic feet
(( ft - 1) X ft X ) ÷ 2 = ft3
Downslope Volume : ((Downslope Height - 1) x Downslope Absorption Width x Media Length ) ÷ 2 = cubic feet
(( ft - 1) X ft X ) ÷ 2 = ft3
Endslope Volume : (Downslope Mound Height - 1) x 3 x Media Width = cubic feet
( ft - 1 ) X ft X ft = ft3
Volume Under Rockbed : Average Sand Depth x Media Width x Media Length = cubic feet
ft X ft X ft = ft3
Total Clean Sand Volume : Upslope Volume + Downslope Volume + Endslope Volume + Volume Under Media
ft3 + ft3 + ft3 + ft3 = ft3
Divide ft3 by 27 ft3/yd3 to calculate cubic yards: ft3 ÷ 27 = yd3
Add 20% for constructability: yd3 X 1.2 = yd3
C. Calculate Sandy Berm Volume:
Total Berm Volume (approx) : ((Avg. Mound Height - .5 ft topsoil) x Mound Width x Mound Length) ÷ 2 = cu. ft.
( - )ft X ft X ) ÷ 2 = ft3
Total Mound Volume - Clean Sand volume -Rock Volume = cubic feet
ft3 - ft3 - ft3 = ft3
Divide ft3 by 27 ft3/yd3 to calculate cubic yards: ft3 ÷ 27 = yd3
Add 20% for constructability: yd3 x 1.2 = yd3
D. Calculate Topsoil Material Volume: Total Mound Width X Total Mound Length X .5 ft
ft X ft X 0.5 ft = ft3
Divide ft3 by 27 ft3/yd3 to calculate cubic yards: ft3 ÷ 27 = yd3
Add 20% for constructability: yd3 x 1.2 = yd3
I hereby certify that I have completed this work in accordance with all applicable ordinances, rules and laws.
(Date)
(Designer) (Signature) (License #)
0.5
Section 13: Forms and Reference n 13-21
09/09
1. DISPERSAL MEDIA SIZING:
A. Design Flow (Flow & Soil 1.A) GPD
B. Soil Loading Rate (Flow & Soil 3.C) GPD/ft2
C. Land Slope %
D. Contour Loading Rate GPD/ft(From Table I - Same as Linear Loading Rate)
E. Absorption Bed Width = Contour Loading Rate (1.D) ÷ Soil Loading Rate (1.B)(round up to nearest whole number) Cannot exceed 15 feet
ft
F. Absorption Bed Length = Design Flow (1.A) ÷ Contour Loading Rate (1.D)
ft
G. Required Absorption Bed Area = Design Flow (1.A) ÷ Soil Loading Rate (1.B)
gpd ÷ ft2
2. BERM SIZING:
A. Determine System Height = media height + 12" cover, divide by 12 inches per foot to convert to feet
ft
B. Upslope Mulitiplier based on percent slope (see Table II)
GPD/ft =
GPD/ft =
inches ÷ 12 inches/ft =
GPD ÷
GPD/ft2 ÷
GPD/ft2 =
OSTP At-GradeDesign Worksheet
C. Upslope Width = Upslope Multiplier (2.B) X System Height (2.A)
X ft = ft
D. Downslope Mulitiplier based on percent slope (see Table II)
E. 4 to 1 Downslope Berm Width = Downslope Multiplier (2.D) X System Height (2.A)
X ft = ft
F. Minimum Downslope Berm to cover media by 5 ft = Absorption Bed Width (1.E) + 5 ft
ft
G. Design Downslope Berm: Use the greater of the 4 to 1 berm (2.E) and the Minimum Downslope berm (2.F)
ft
H. Endslope Mulitiplier (usually 4.0)
I. Endslope Width = Endslope Multiplier (2.H) X System Height (2.A)
X ft = ft
J. System Width = The sum of the Upslope Width (2.C) + Downslope Width (2.G) (Minimum of 6 feet)
ft + ft = ft
K. System Length = Sum of the Endslope Width (2.I) + Absorption Bed Length (1.F) + Endslope Width (2.I)
ft + ft + ft = ft
ft + 5 ft =
13-22 n Section 13: Forms and Reference
09/09
3. AT-GRADE DIMENSIONS:
Section 13: Forms and Reference n 13-23
09/09
4. APPROXIMATE VOLUME CALCULATIONS:
A. Rock Area = (Absorption Bed Length (1.F) + additional rock upslope of lateral) X Absorption Bed Width (1.E)
( ft + ft) X ft = ft2
B. Rock Volume in Cubic Feet = Rock Area (4.A) by Depth of Media (Rock) (1 foot) and divide by 2.
ft3
C. Rock Volume in Cubic Yards = Volume in Cubic Feet (4.B) divided by 27
ft3 ÷ 27 = yd3
D. Loamy or Sandy Loam Cover Material Volume: Volume in Cubic Feet = System Width (2.J) X System Length (2.K) X 1.5 ÷ 2, minus rock volume (4.B)
( ft X ft X 1.5 ÷ 2) - = ft3
E. Loamy or Sandy Loam Cover Volume in Cubic Yards = Volume in Cubic Feet (4.D) divided by 27
ft3 ÷ 27 = yd3
F. Add 20% for constructability: yd3 x 1.2 = yd3
G. Topsoil Volume in Cubic Feet = System width (2.J) X System Length (2.K) x 0.5
X X 0.5 = ft3
H. Topsoil Volume in Cubic Yards = Volume in Cubic Feet (4.G) divided by 27
ft3 ÷ 27 = yd3
I. Add 20% for constructability: yd3 x 1.2 = yd3
5. Organic Loading: (optional)
A O i L di D i Fl (1 A) X E ti t d BOD i /L i th ffl t X 8 35 1 000 000 (T bl III)
ft2 X 1 ft ÷ 2 =
A. Organic Loading = Design Flow (1.A) X Estimated BOD in mg/L in the effluent X 8.35 ÷ 1,000,000 (Table III)
gpd X mg/L X 8.35 ÷ 1,000,000 = lbs BOD/day
B. Calculate System Organic Loading: lbs. BOD (5.A) ÷ Absorption Bed Area (1.G) = lbs/day/ft2
ft2 = lbs/day/ft2
5. Comments:
I hereby certify that I have completed this work in accordance with all applicable ordinances, rules and laws.
(Date)
lbs/day ÷
(Signature)(Designer) (License #)
13-24 n Section 13: Forms and Reference
09/09
1. Select Number of Perforated Laterals in system/zone :
(2 feet is minimum and 3 feet is maximum spacing)
2. Select Perforation Spacing : ft
3. Select Perforation Diameter Size inch 0
4. Length of Laterals = Media Bed Length - distance from edge
ft - ft = ft
5.
Number of Perforation Spaces = ft ÷ ft = Spaces
6. Number of Perforations per Lateral is equal to 1.0 plus the Number of Perforation Spaces (Line 5).
Perforations Per Lateral = + 1 = Perfs. Per Lateral
7. Total Number of Perforations equals the Number of Perforations per Lateral (Line 6) multiplied by the Number of Perforated Laterals (Line 1).
Spaces
Check Table I to verifty the number of perforations per lateral guarantees less than a 10% discharge variation. The value is double if the a center manifold is used.
OSTP Pressure Distribution Design Worksheet
Determine the Number of Perforation Spaces . Divide the Length of Laterals (Line 4) by the Perforation Spacing (Line 2) and round down to the nearest whole number.
(1 or 2 feet depending on manifold location as perfs can not be closer then 1 foot from edge)
Perf. Per Lateral X Number of Perf. Laterals = Total Number of Perf.
8. Calculate the Square Feet per Perforation. Recommended value is 4-10 ft 2 per perforation. Does not apply to At-GradesBed Area = Bed Width (ft) X Bed Length (ft)
ft X ft = ft2
Square Foot per Perforation = Bed Area divided by the Total Number of Perforations (Line 7).
ft2 ÷ = ft2/perforations
9. Select Minimum Average Head : ft
10. Select Perforation Discharge (GPM) based on Table III: GPM per Perforation
11.
Perforations X GPM per Perforation = GPM
12. Select Type of Manifold Connection (End or Center):
Determine required Flow Rate by multiplying the Total Number of Perforations (Line 7) by the Perforation Discharge (Line 10).
perforations
End Center
Section 13: Forms and Reference n 13-25
09/09
OSTP Pressure Distribution Design Worksheet
14. Select Lateral Diameter based on Table I: in
15. Volume of Liquid Per Foot of Distribution Piping : Gallons/ft
16. Volume of Distribution Piping =
X ft X gal/ft = Gallons
17. Minimum Dose = Volume of Distribution Piping (Line 17) X 5
Gallonsgals X 5 =
= [Number of Perforated Laterals (Line 1) X Length of Laterals (Line 4) X (Volume of Liquid Per Foot of Distribution Piping (Line 15)]
Gallons
(License #)
I hereby certify that I have completed this work in accordance with all applicable ordinances, rules and laws.
(Date)(Designer) (Signature)
gals X 5
13-26 n Section 13: Forms and Reference
09/09
1. Enter soil treatment area (STA) length in order of the Highest Elevation to the Lowest Elevation:
Lateral 1 Pipe Elevation ft ft Highest
Lateral 2 Pipe Elevation ft Length of STA ft
Lateral 3 Pipe Elevation ft Length of STA ft
Lateral 4 Pipe Elevation ft Length of STA ft
Lateral 5 Pipe Elevation ft Length of STA ft Lowest
2. Calculate Change in Elevation over the laterals
= Highest Elevation (Lateral 1) - Lowest Elevation (Last Lateral above) ft - ft = ft
3. Select Minimum Average Head : ft
Use 1.0 ft for dwellings using 1/4 inch or 3/16 inch holes.
Use 2.0 ft for dwellings using 1/8 inch holes; or, for MSTS or other establishments using 1/4 inch or 3/16 inch holes.
4. Calculate the Total Head = Minimum Average Head (Line 3) + Change in Elevation (Line 2)
ft + ft = ft
5. Calculate Pressure Head for Each Lateral
A Highest trench elevation (Pipe Elevation 1): Pressure Head equals Minimum Average Head (Line 3)
This worksheet cannot be used for a Minimum Average Head of 5.0 feet. Design must be modified or valving must be used to equalize flow.
OSTP Non-Level Pressure Distribution Design Worksheet
Length of STA from manifold
A. Highest trench elevation (Pipe Elevation 1): Pressure Head equals Minimum Average Head (Line 3)
B. All other trenches: Pressure Head equals Minimum Average Head (Line 3) plus the Change in Elevation from Lateral 1.
Lat 1 ft + [ ft - ft] = ft
Lat 2 ft + [ ft - ft] = ft
Lat 3 ft + [ ft - ft] = ft
Lat 4 ft + [ ft - ft] = ft
Lat 5 ft + [ ft - ft] = ft
Elevation of Lateral 1
Minimum Average Head Pressure HeadElevation of Lateral
Section 13: Forms and Reference n 13-27
09/09
OSTP Non-Level Pressure Distribution Design Worksheet
6. Determine the Flow Rate per Hole
c=0.60; d=perforation diameter; h=pressure head
or Calculate Perforation Discharge (Q) in GPM:
Lat 1 Pressure Head = GPM FALSE HighestFALSE
Lat 2 Pressure Head = GPM FALSEFALSE
Lat 3 Pressure Head = GPM FALSEFALSE
Lat 4 Pressure Head = GPM FALSEFALSE
Lat 5 Pressure Head = GPM FALSE Lowest
7. Calculate Flow in Gallons Per Minute for Lateral 1
A. Select Perforation Spacing : feet
B. Length of Lateral = Length of STA (Line 1) - distance from edge (1 or 2 feet)
- ft = ft
C.
ft Perforation Diameter
ft Perforation Diameter
ft Perforation Diameter
ft Perforation Diameter
Select a Perforation Diameter and the corresponding gallons per minute from Table I, interpolating as needed.
Number of Perforation Spaces = Divide the Length of Lateral 1 (7.B) by the Perforation Spacing (Line 10) and round down to the nearest whole number. Check Table II to ensure the maximum number of perforations is not exceeded.
ft Perforation Diameter
hcdQ 265.19
ft/ ft = Spaces
D. Select Type of Manifold Connection (End or Center):
E. Number of Perforations =Number of Perforation Spaces (Line 11) + 1.
F. Flow Rate for Lateral 1 = Number of Perforations X Flow Rate Per Hole for Lateral 1
X = GPM for Lateral 1
8.
Gallons Per Length = Flow Rate for Lateral 1 divided by Length of Lateral 1
÷ = GPM/Foot
Spaces +1 =
Calculate the Gallons Per Minute Per Foot for Lateral 1. This value will then be used to make sure that the gallons per minute per foot is equivalent in each lateral
End Center
13-28 n Section 13: Forms and Reference
09/09
OSTP Non-Level Pressure Distribution Design Worksheet
9. Balance flows for other lateral lengths, spacing, and size.
If you end up with large perforation spacing (3' is max) lower the initial spacing for Lateral 1 (Line 7.A) or the perforation size (Line 6)
Lateral 2 GPM = Length of Lateral X Gallons Per Minute Per Foot (Line 8)
ft X GPM
Number of Perforations = GPM/Flow Rate for Lateral 2 (Line 6.2)
÷ = Perforations Select Type of Manifold Connection (End or Center):
Spacing = (Length of Lateral)/(Number of Perforations -1)
( = ft
Lateral 3 GPM = Length of Lateral X Gallons Per Minute Per Foot (Line 8)
ft X GPM
Number of Perforations = GPM/Flow Rate for Lateral 2 (Line 6.3)
÷ = Perforations Select Type of Manifold Connection (End or Center):
Spacing = (Length of Lateral)/(Number of Perforations -1)
( = ft
L t l 4 GPM L th f L t l X G ll P Mi t P F t (Li 8)
Perforations-1)) ÷ (
) ÷ (
Check Table to ensure the maximum number of perforations is not exceeded.
GPM/Ft=
Perforations-1)
Check Table to ensure the maximum number of perforations is not exceeded.
GPM/ft=
End Center
End Center
Lateral 4 GPM = Length of Lateral X Gallons Per Minute Per Foot (Line 8)
ft X GPM
Number of Perforations = GPM/Flow Rate for Lateral 2 (Line 6.4)
÷ = Perforations Select Type of Manifold Connection (End or Center):
Spacing = (Length of Lateral)/(Number of Perforations -1)
( = ft
Lateral 5 GPM = Length of Lateral X Gallons Per Minute Per Foot (Line 8)
ft X GPM
Number of Perforations = GPM/Flow Rate for Lateral 2 (Line 6.5)
÷ = Perforations Select Type of Manifold Connection (End or Center):
Spacing = (Length of Lateral)/(Number of Perforations -1)
( = ft
) ÷ (
GPM/Ft=
Check Table to ensure the maximum number of perforations is not exceeded.
Perforations-1)
Check Table to ensure the maximum number of perforations is not exceeded.
GPM/Ft=
Perforations-1)
) ÷ (
End Center
End Center
Section 13: Forms and Reference n 13-29
09/09
OSTP Non-Level Pressure Distribution Design Worksheet
10. Calculate Total GPM for system - the total GPM need from the pump.
Lateral 1 Flow = GPM
Lateral 2 Flow = GPM
Lateral 3 Flow = GPM
Lateral 4 Flow = GPM
Lateral 5 Flow = GPM
Total Flow GPM
11. Summary
Highest
Lowest
Total Volume to Fill Pipe (gal)
Perforation Size (in)
Lateral 5
Lateral 4
Lateral 3
Lateral 2
Pipe Volume (gal/ft)
Lateral 1
Pipe Size (in)
Enter the minimum pipe size that allows for even distribution and the volume of liquid in the pipe from the table.
Spacing (ft)Pipe Length (ft)
Min. Delieved Dose Volume = Five X the Total Volume of Piping =
(Date)(License #)
I hereby certify that I have completed this work in accordance with all applicable ordinances, rules and laws.
(Designer) (Signature)
Total Volume of Distribution Piping =
13-30 n Section 13: Forms and Reference
09/09
A. 0
1. If pumping to gravity enter the gallon per minute of the pump: GPM
2. If pumping to pressure, is the pump for the treatment system or the collection system:
0
3. If pumping to a pressurized treatment system, what part or type of system:
4. If pumping to a pressurized distribution system: GPM(Line 11 of Pressure Distribution or Line 10 of Non-Level or enter if Collection System)
3. ft
4. ft
5.
NOTE : IF system is an individual subsurface sewage treatment system, complete steps 4 - 9. If system is a Collection System, skip steps 4, 5, 7 and 8 and go to Step 10.
between pump and point of discharge:
1. PUMP CAPACITY
Distribution Head Loss:
Elevation Difference
Additional Head Loss:
OSTP Pump Selection Design Worksheet
2. HEAD REQUIREMENTS
ft (due to special equipment, etc.)
Pumping to Gravity or Pressure Distribution:
Soil Treatment Media Filter Other
Collection System
Gravity Pressure
Treatment System
6. A. Supply Pipe Diameter: in
B. Supply Pipe Length: ft
7.
Friction Loss =
8.
ft X 1.25 = ft
9.
ft per 100ft X ft ÷ 100 = ft
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 (5.B) X 1.25 = Equivalent Pipe Length
Supply Friction Loss =
Calculate Supply Friction Loss by multiplying Friction Loss Per 100ft (Line 6) by the Equivalent Pipe Length (Line 7) and divide by 100.
Based on Friction Loss in Plastic Pipe per 100ft from Table I:
ft per 100ft of pipe
Soil Treatment Media Filter Other
Collection System
Gravity Pressure
Treatment System
Section 13: Forms and Reference n 13-31
09/09
OSTP Pump Selection Design Worksheet
10. Equivalent length of pipe fittings.
Quantity X Equivalent Length Factor = Equivalent Length
X =
X =
X =
X =
X =
X =
X =
X =
X =
X =
X =
A. Sum of Equivalent Length due to pipe fittings: ft
Valve 11
NOTE: System installer should contact system designer if the number of fittings varies from the design to the actual installation.
Gate Valve
Section 10 is for Collection Systems ONLY and does NOT need to be completed for individual subsurface sewage treatment systems.
QuantityFitting Type
45 Deg Elbow
90 Deg Elbow
Tee - Flow Thru
Equivalent Length (ft)
Equivalent Length Factor
Butterfly Valve
Globe Valve
Angle Valve
Tee - Branch Flow
Swing Check Valve
Valve 10
NOTE: Equivalent length values for PVC pipe fittings are based on calculations using the Hazen-Williams Equation. See Advanced Designs for SSTS for equation. Other pipe material may require different equivalent length factors. Verify other equivalent length factors with pipe material manufacturer.
B. Total Pipe Length = Supply Pipe Length (5.B) + Equivalent Pipe Length (9.A.)
ft + ft = ft
C. Hazen-Williams friction loss due to pipe fittings and supply pipe (hf): Q in gpm L in feet D in inches C = 130
X ( X Total Pipe Length (10.B)
in4.87 ) X ( gpm ÷ 130)1.85 X ft = ft
11.
ft + ft + ft + ft = ft
Total Head requirement is the sum of the Elevation Difference (Line 3), the Distribution Head Loss (Line 4), Additional Head Loss (Line 5), and either Supply Friction Loss (Line 9 ), or Friction Loss from the Supply Pipe and Pipe Fittings for collection systems (Line 10.C)
Hazen-Williams Equation for h
Pipe Diameter4.87 )
(10.5 ÷
I hereby certify that I have completed this work in accordance with all applicable ordinances, rules and laws.
GPM (Line 1 or Line 2) with at least feet of total head.
(10.5 ÷ Flow Rate ÷ Constant)1.85
3. PUMP SELECTION
(Date)
NOTE: Friction Loss from the Supply Pipe and Pipe Fittings (Line 9.C) need ONLY be used if system is a collection system.
(Designer) (Signature) (License #)
NOTE: Supply Friction Loss (Line 8) need ONLY be used if NOT a collection system.
A pump must be selected to deliver at least
LCQD
h f *)(*5.10 85.187.4
13-32 n Section 13: Forms and Reference
09/09
DETERMINE AREA AND/OR GALLONS PER INCH
1. A. Rectangle area = Length (L) X Width (W)
ft X ft = ft2
B. Circle area = 3.14r2 (3.14 X radius X radius)
3.14 X 2 ft = ft2
C. Get area from manufacturer ft2
D. Get gallons per inch from manfufacture Gallons per inch
2. Calculate Gallons Per Inch :
(Area X 7.48 gallons/ft3)/(12 in/ft) =
ft2 X = Gallons per inch
3. Enter the Pump Tank Capacity (minimum provided in the table below): Gallons
4. Calculate Total Tank Volume
A. Depth from bottom of inlet pipe to tank bottom : in
TANK CAPACITY
7.48 gal/ft3 ÷
There are 7.48 gallons per cubic foot. Therefore, multiply the area from 1.A, 1.B, or 1.C by 7.48 to determine the gallons per foot the tank holds. Then divide that number by 12 to calculate the gallons per inch.
12 in/ft
OSTP Pump Tank Sizing, Dosing and Float and Timer Setting Design Worksheet
Width
Length
Radius
B. Total Tank Volume = Depth from bottom of inlet pipe (Line 4.A) X Gallons/Inch (Line 2)
in X Gallons Per Inch = Gallons
5.
(Pump and block height + 2 inches) X Gallons Per Inch (1D or 2)
( in + 2 inches) X Gallons Per Inch = Gallons
Calculate Volume to Cover Pump (The inlet of the pump must be at least 4-inches from the bottom of the pump tank & 2 inches of water covering the pump is recommended)
Width
Length
Radius
Section 13: Forms and Reference n 13-33
09/09
OSTP Pump Tank Sizing, Dosing and Float and Timer Setting Design Worksheet
7. Gallons
- Line 17 of the Pressure Distribution or Line 11 of Non-level
8. Calculate Maximum Pumpout Volume (25% of Design Flow)
Design Flow: GPD X = Gallons
9. Gallons
10. Calculate Doses Per Day = Design Flow ÷ Dosing Volume
gpd ÷ gal = Doses
11. Calculate Drainback:
A. Diameter of Supply Pipe = inches
B. Length of Supply Pipe = feet
C. Volume of Liquid Per Lineal Foot of Pipe = Gallons/ft
D. Drainback = Length of Supply Pipe X Volume of Liquid Per Lineal Foot of Pipe
ft X gal/ft = Gallons
12. Total Dosing Volume = Dosing Volume (Line 9) plus Drainback (Line 11.D)
gal + gal = Gallons
13 Mi i Al V l D th f l (2 3 i h ) X ll i h f t k (Li 1 2)
0.25
DOSING VOLUME
Minimum Pumpout Volume - 5 X Volume of Distribution Piping:
Select a pumpout volume that meets both items above (Line 7 & 8):
13. Minimum Alarm Volume = Depth of alarm (2 or 3 inches) X gallons per inch of tank (Line 1 or 2)
in X gal/in = Gallons
TIMER or DEMAND FLOAT SETTINGS
Select Timer or Demand Dosing: 0
A. Timer Settings
14. Required Flow Rate :
A. From Design (Line 11 of Pressure Distribution or Line 10 of Non-Level*): GPM
B. Or calculated: GPM = Change in Depth (in) x Gallons Per Inch (Line 1 or 2) / Time Interval in Minutes
in X gal/in ÷ min = GPM
15. Choose a Flow Rate from Line 14.A or 14.B above. GPM
16. Calculate TIMER ON setting:
Total Dosing Volume (Line 12)/GPM(Line 15)
gal ÷ gpm = Minutes ON
17. Calculate TIMER OFF setting:
Minutes Per Day (1440)/Doses Per Day (Line 10) - Minutes On (Line 16)
÷ doses/day - min = Minutes OFF
17. Pump Off Float - Measuring from bottom of tank:
Distance to set Pump Off Float=Gallons to Cover Pump (Line 5) / Gallons Per Inch (Line 1 or 2):
gal ÷ gal/in = Inches
18. Alarm Float - Measuring from bottom of tank:
Distance to set Alarm Float = Tank Depth(4A) - Alarm Depth (Line 13)
in - in = in
*Note: This value must be adjusted after field
measurement & calculation.
1440 min
Timer Demand Dose
13-34 n Section 13: Forms and Reference
09/09
OSTP Pump Tank Sizing, Dosing and Float and Timer Setting Design Worksheet
B. DEMAND DOSE FLOAT SETTINGS
18. Calculate Float Separation Distance using Dosing Volume .
Total Dosing Volume (Line 12)/Gallons Per Inch (Line 2)
gal ÷ gal/in = Inches
19. Measuring from bottom of tank:
A. Distance to set Pump Off Float = Pump Height + Block Height (Line 5) + Alarm Depth (Line 13)
in + in = Inches
in + in = Inches
C. Distance to set Alarm Float = Distance to set Pump-On Float (19.B) + Alarm Depth (2-3 inches)
in + in = Inches
in Alarm Depth in
Pump On in
Pump Off in Pump Off in
Distance to set Pump On Float=Distance to Set Pump-Off Float (Line 19.A) + Float Separation Distance (Line 18)
TIMED DOSINGDEMAND DOSING
B.
Alarm Depth
FLOAT SETTINGS
I hereby certify that I have completed this work in accordance with all applicable ordinances, rules and laws.
(Signature)(Designer) (License #) (Date)
Section 13: Forms and Reference n 13-35
09/09
A. GENERAL SPECIFICATIONS
1. Design flow - from Flow & Soil or LISTS Flow worksheet:
2. Type of filter (check ):
B. MINIMUM RECIRCULATION/DOSING TANK CAPACITY (if applicable)
A minimum of 24 hours (1 day) of hydraulic retention time is required, but can be greater.
Minimum capacity is equal to the Design Flow (1) multiplied by 1.
gpd X day(s) = Gallons
C. FILTER DIMENSIONS
1. Select hydraulic loading rate: ft2/gpd
Maximum hydraulic loading rate for single-pass is 1.0ft 2 /gpd and 0.2 ft 2 /gpd for recirculating.
2. Filter area based on hydraulic loading rate = flow rate (A1) x loading rate (C1):
gpd X ft2/gpd = ft2
3. Verifty organic loading rate is accectable
OSTP Single-Pass & Recirculating Sand Filter
Worksheet
Single-Pass Recirculating
a.
gpd X lbs BOD
b. Divide lbs of BOD by square feet of filter (C2).
lbs BOD ÷ ft2 = lbs BOD/ft2
c.
lbs BOD ÷ 0.005 = ft2
d.
4. Select width of filter: ft
5. Length of filter = filter area (C3d) divided by filter width (C3) =
ft2 ÷ ft = ft
Number of Zones:
1 zone minimum for single family dwelling, minimum of two zones for anything else.
Organic loading rate must be less then 0.005 lbs BOD/ft2. Divide lbs of BOD (Line 3a) by 0.005 lbs/ft 2
Required filter area is the larger of line C2 and 3c:
mg/l X 0.00000834 =
Take design flow (A1) multipled by estimated BOD5 multipled by conversion factor (0.00000834).
Single-Pass Recirculating
13-36 n Section 13: Forms and Reference
09/09
OSTP Single-Pass & Recirculating Sand Filter
WorksheetD. DRAINAGE SYSTEM
1. Type(s) of Drainage Media:
2. (a) Total Depth of Drainage Media: ft
(b) Depth of Pea Gravel: in. ÷ 12 = ft
c) Depth of Drainfield Rock: in. ÷ 12 = ft
3.
ft2 X ft = ft3
Divide cubic feet by 27 ft3/yd3 to get cubic yards:
ft3 ÷ 27 = yd3
To protect the liner, 6 in. of 3/8- media must be installed under the liner and 2 in. of pea gravel on top of the liner. Drainfield rock must surround the collection pipe. The upper 2 in. must be pea gravel to limit migration of treatment media into drai
Pea Gravel Volume: Multiply filter area (C2) by drainage depth (2b):
Minimum depth is 1 foot with bottom sloped 1% to drainage pipe unless pump is part of filter drainage.
y
4.
ft2 X ft = ft3
Divide cubic feet by 27 ft3/yd3 to get cubic yards (for sand and gravel only):
ft3 ÷ 27 = yd3
5. Number of Drainage Pipes:
6. Number of Inspection Ports: One inspection port per zone is minimum.
Drainfield Rock Volume: Multiply filter area (C2) by drainage depth (2c):
One drainage pipe per zone or twenty feet is minimum, more are recommended to facilitate system recovery.
Section 13: Forms and Reference n 13-37
09/09
OSTP Single-Pass & Recirculating Sand Filter
WorksheetE. TREATMENT MEDIA
1. Type (sand, gravel, etc):
2. Depth of Treatment Media: ft 2 feet is required
3. Treatment Media Volume: Multiply filter area(C2) by treatment depth (E2):
ft2 X ft = ft3
Divide cubic feet by 27 ft3/yd3 to get cubic yards
ft3 ÷ 27 = yd3
F. DISTRIBUTION MEDIA
1. Type of Distribution Media:
If other, please specify:
2. Depth of Distribution Media: ft
Minimum depth is 0 67 feet (8 inches = 6 inches below the
3.
ft2 X ft = ft3
Divide cubic feet by 27 ft3/yd3 to get cubic yards
ft3 ÷ 27 = yd3
G. COVER MATERIAL (if applicable)
Is the system covered with geotextile & soil (check box) ?
ft
Single-pass sand filters may be covered with soil while recirculating sand filter must have distribution media to the surface. If soil cover installed, maximum depth of 12 inches of loamy or sandy material with upper six inches of topsoil borrow is required alongwith appropriate vegetation.
Minimum depth is 0.67 feet (8 inches = 6 inches below the lateral and 2 inches above).
If using rock or gravel, media volume: Multiply filter area (C2) by distribution depth (F2):
Yes-Depth:No
13-38 n Section 13: Forms and Reference
09/09
OSTP Single-Pass & Recirculating Sand Filter
WorksheetH. LINER
1.
ft + ft + ft +
ft = ft
2.
ft + ( ft x 2) + 2 = ft
3.
ft + ( ft x 2) + 2 = ft
4. Liner size/area is then determined by multiplying the width(H2) and length (H3):
ft2 X ft = ft2
Total system height is sum of depth of drainage(D2), treatment(E2), distribution(F2) & cover(G):
Length of liner equals the design length (C5) plus two times the total system height (H1) of the filter plus two additional feet for constructability:
Width of liner is equal to the design width (C4) plus the two times the total system height (H1) plus two additional feet for constructability:
Assumes verticle walls. If sloped additional liner will be
needed.
I hereby certify that I have completed this work in accordance with all applicable ordinances, rules and laws.
(License #) (Date)(Designer) (Signature)
Section 13: Forms and Reference n 13-39
09/09
Dwelling#
# of Bedrooms (minimum = 2)
DwellingClassification(see Table IV)
7080.1860Design Flow (gpd)
(See Table 1)
Reduction Factor- 0.45
(if applicable*)
LISTS Flow perDwelling (gpd)
123456789101112131415161718
OSTP Flow Estimation:
Existing Dwellings
192021222324252627282930
* Use 1.0 for the flow from the ten hightest flow dwellings and 0.45 for remaining dwellings
Total Dwelling Flow Estimate
13-40 n Section 13: Forms and Reference
09/09
OSTP Flow Estimation:
New Developments
Dwelling # # of Bedrooms (minimum = 2)Average Daily Flow
(# of bedrooms x 110 gallons)
12345678910111213141516171819202021222324252627282930
Total Dwelling Flow
Section 13: Forms and Reference n 13-41
09/09
Day (1-30)
Meter Reading*
(gal)% Capacity (if exists) GPD
Day (31-60)
Meter Reading*
(gal)% Capacity (if exists) GPD
Day (61-90)
Meter Reading*
(gal)% Capacity (if exists) GPD
1 NA 31 612 32 623 33 634 34 645 35 656 36 667 37 678 38 689 39 6910 40 7011 41 7112 42 7213 43 7314 44 7415 45 7516 46 7617 47 7718 48 7819 49 7920 50 8021 51 8122 52 8223 53 8324 54 84
OSTP Measured Flow:Other Establishments
24 54 8425 55 8526 56 8627 57 8728 58 8829 59 8930 60 90
Minimum Flow gpd
Peak Flow gpd
Full capacity flow from 7 busiest consectutive days (if available): gpd
Average Flow of Days in Operation (without capacity information) gpdDo not include days with no flow
Flow Calculations
* Daily flow data collected during peak season of usuage. Meter calibrated monthly. Data could also be gathered from event counter or running time clock and converted to gallons.
13-42 n Section 13: Forms and Reference
09/09
Establishment 7081 Specified Type of Establishment Unit # of Units
Design Flow per Unit (See
Table I)Total Avg Daily
Flow
1
2
3
4
5
0
Establishment NON 7081 Specified Type of Establishment Unit # of UnitsDesign Flow
per Unit Total Avg Daily
Flow
6
7
8
9
10
0
OSTP Flow Estimation:Other Establishments
Total Flow Non-7081 Establishments (gpd)
Total Flow 7081 Establishments (gpd)
0Total Flow 7081 and Non 7081 Establishments (gpd)
Section 13: Forms and Reference n 13-43
09/09
1. Flow from Dwellings Flow from Dwellings gpd
2. Flow from Other Establishments
Permitting Flow from Other Establishments
gpd
a) Total Length of CollectionPipe:
feet
b) Diameter of Pipe (Minimum of 2 in):
inches
c) Flow from I& I in Collection System:
gpd
gpd
OSTP Final Permitting FlowWorksheet
Design flow must include 200 gallons of infiltration and inflow
per inch of collection pipe diameter per mile per day with a minimum pipe diameter of two
inches. Flow values can be further increased if the system employs
treatment devices that will infiltrate precipitation.
4. Final Permitting Flow
From either existing and new development worksheet
From either Measured or Estimated-OE worksheet
Sum of 1, 2 and 3c.
3. Flow from Collection System
13-44 n Section 13: Forms and Reference
09/09
Permitting Flow (from Final Flow worksheet): GPD
A.
See Assessment and Waste Strength Table
B. If Yes, Estimated or Measured Values
i. BOD5 mg/l
ii. TSS mg/l
iii. FOG mg/l
Facility with potential elevated levels of BOD5, TSS or FOG?
If concentrations of BOD, TSS, and O&G are expected to be higher than 175 mg/1, 65 mg/1, or 25 mg/1 respectively, an estimated or measured
average concentration must be determined.
3. GREASE TRAP
Grease trap required for facilities with high levels of O&G. A minimum of 24 hours (1 day) of hydraulic retention time is required, but can be up 4 days or more.The outlet baffle must extended to 50 - 70% of liquid depth.
OSTP LISTS Design Flow and System Summary Worksheet
1. PERMITTING FLOW
2. ORGANIC LOADING
Yes No
Estimated Measured
A. Design Flow - Grease Trap (kitchen waste only): GPD
Use 70% of permited flow to size the grease trap if using estimated design flows are being used.
B. Minimum capacity is equal to the Design Flow for Grease Traps (3A) multiplied by 1.
X day(s) = Gallons
A. Individual septic tanks at each dwelling (7080.1930 minimum)*:
Septic Tank capacity: Gallons
Number of Septic Tanks/Compartments:
(1/8 or 1/16 inch)
4. SEPTIC TANKS
* When septic tanks are installed at each dwelling
an effluent screen and alarm must either be
located at each dwelling or a the common treatment area. Effluent Screen Minimum Size Slots**
Yes No
Estimated Measured
Section 13: Forms and Reference n 13-45
09/09
OSTP LISTS Design Flow and System Summary Worksheet
B. Gravity collection to common septic tanks:
Minimum capacity is the design flow (1) multiplied by 3 days.
X 3 days = Gallons
Number of Septic Tanks/ Compartments :
(1/8 or 1/16 inch)
C. Pressure collection to common septic tanks:
Minimum septic tank capacity is the design flow multiplied by 4 days.
X 4 days = Gallons
Number of Septic Tanks/Compartments :
(1/8 or 1/16 inch)
D. Septic tank liquid capacity prior to other treatment devices:
** 1/16 inch screen slots must be used when
downstream distribution components utulize 1/8 inch diameter orifices.Effluent Screen Minimum Size Slots**
Effluent Screen Minimum Size Slots**
Capacity set by manufacturer's requirements, accepted engineering principles, or as identified in the product
Gallons
Number of Septic Tanks/Compartments :
A. Depth to Limiting Layer : inches feet
B. Landscape Position :
C. Soil Texture Group Number :
D. Percent Land Slope : %
5. SITE EVALUATION OVERVIEW:
Effluent Screen & Alarm ?
registration recommended standards and criteria.
Yes No
13-46 n Section 13: Forms and Reference
09/09
OSTP LISTS Design Flow and System Summary Worksheet
A. B.
mpi
C. GPD/ft2
DETAILED SOIL DESCRIPTIONS (SOIL PIT REQUIRED)
6. SOIL LOADING RATES: Select method A. or B. below
Design Loading Rate:
Grade
Consistence
*Rapidly permeable soils: see 7080.2260
Slowest measured percolation rate:
Select Soil Loading Rate:
Texture Group
Select Soil Loading Rate:
7080 Table IX
Texture
Structure
A. Type of Collection System
B.
C. Type of System:
D. Registered Product/pretreatment unit:
E. Distribution Method :
I hereby certify that I have completed this work in accordance with all applicable ordinances, rules & laws.
(License #) (Date)(Signature)(Designer)
Note: Pressure distribution must be used for soil treatment systems with flows greater than 2,500 gallons per day.
Kind of Soil Treatment and Dispersal Area :
7. SYSTEM OVERVIEW
Gravity Pressure
Yes-Type:No
Type I Type II Type III Type IV Type V
Section 13: Forms and Reference n 13-47
09/09
MoundTexture Soil
Table IX
Loading Rates for Determining Bottom Absorption Area for Trenches and Seepage Beds for Effluent Treatment LevelC and Absorption Ratios for Determining Mound Absorption Areas using Detailed Soil Descriptions
StructureType Grade
Loose - 1.0Weakly Cemented Friable - 2.0Cemented-Firm - -Loose 1.20 1.0Weakly Cemented Friable 0.60 2.0C t d Fi
MoundAbsorption
Structureless1
TextureTextureGroup
SoilLoading
Medium Sand* 2 Single Grain Structureless
Consistence
Coarse Sand*
Structure
Single Grain
Cemented-Firm - -Loose 0.60 2.0Weakly Cemented Friable 0.24 5.0Cemented-Firm - -Loose 1.20 1.0Weakly Cemented Friable 0.60 2.0Cemented-Firm - -
Coarse and Medium Loamy Sand*
4 Single Grain Structureless
Fine Sand 3 Single Grain Structureless
Loose 0.60 2.0Weakly Cemented Friable 0.24 5.0Cemented-Firm - -Very Friable, Friable 0.45 2.6Firm 0.24 5.0Very Friable, Friable 0.78 1.3Firm 0.45 2.6
Weak
Moderate or Strong
Fine and Very Fine Loamy Sand
5 Single Grain Structureless
Prismatic,Blocky,
GranularFirm 0.45 2.6Very Friable, Friable 0.45 2.6Firm 0.24 5.0Very Friable, Friable 0.45 2.6Firm - -Very Friable, Friable 0.24 5.0Firm - -Very Friable Friable 0 24 5 0
Strong
PlatyWeak
Moderate or Strong
Coarse and Medium Sandy Loam
6
StructurelessMassive
Very Friable, Friable 0.24 5.0Firm 0.24 5.0Very Friable, Friable 0.60 2.0fim 0.24 5.0Very Friable, Friable 0.24 5.0Firm - -Very Friable, Friable - -Firm
Fine and Very Fine Sandy Loam
7
Prismatic,Blocky,
Granular
Weak
Moderate or Strong
Moderate or St
PlatyWeak
Firm - -Very Friable, Friable 0.24 5.0Firm - -
Strong
Massive Structureless
13-48 n Section 13: Forms and Reference
09/09
Very Friable, Friable 0.45 2.6Firm 0.24 5.0Very Friable, Friable 0.60 2.0Fi 0 24 5 0
Loading Rates for Determining Bottom Absorption Area for Trenches and Seepage Beds for Effluent Treatment LevelC and Absorption Ratios for Determining Mound Absorption Areas using Detailed Soil Descriptions
Table IX (cont.)
Prismatic,Blocky,
Granular
Weak
Moderate or St Firm 0.24 5.0
Very Friable, Friable 0.24 5.0Firm - -Very Friable, Friable - -Firm - -Very Friable, Friable 0.24 5.0Firm - -
Loam 8
GranularStrong
PlatyWeak
Moderate or Strong
Massive Structureless
Very Friable, Friable 0.45 2.6Firm 0.24 5.0Very Friable, Friable 0.50 2.4Firm 0.24 5.0Very Friable, Friable 0.24 5.0Firm - -Very Friable, Friable - -
Silt Loam 9
Prismatic,Blocky,
Granular
Weak
Moderate or Strong
PlatyWeak
Moderate or y ,Firm - -Very Friable, Friable 0.24 5.0Firm - -Very Friable, Friable 0.24 5.0Firm - -Very Friable, Friable 0.45 2.6Firm 0.24 5.0
Massive Structureless
Moderate or Strong
Prismatic,Blocky,
Granular
Weak
Moderate or Strong Firm 0.24 5.0
Very Friable, Friable - -Firm - -Very Friable, Friable - -Firm - -Very Friable, Friable - -Firm - -Very Friable Friable
WeakClay Loam, Silty Clay
Loam, Sandy Clay Loam10
Strong
Platy
Massive Structureless
Moderate or Strong
Very Friable, Friable - -Firm - -Very Friable, Friable 0.24 5.0Firm - -Very Friable, Friable - -Firm - -Very Friable, Friable - -Fi
Clay, Silty Clay, Sandy Clay
11
Prismatic,Blocky,
Granular
Weak
Moderate or Strong
PlatyWeak
Moderate or Firm - -Very Friable, Friable - -Firm - -Massive Structureless
Strong
Section 13: Forms and Reference n 13-49
09/09
Table XII
Loading Rates for Determining Bottom Absorption Area for Trenches and Seepage Beds for Effluent Treatment Levels A & B & Absorption Ratios for Determining Mound Absorption Areas using Detailed Soil Descriptions
Type GradeLoose - 1.0Weakly Cemented Friable - 2.0Cemented-Firm - -Loose 1.60 1.0W kl C t d F i bl 0 78 2 0
MoundAbsorption
Structureless1
TextureTextureGroup
SoilLoading
M di S d* 2 Si l G i S l
Levels A & B & Absorption Ratios for Determining Mound Absorption Areas using Detailed Soil Descriptions
Consistence
Coarse Sand*
Structure
Single Grain
Weakly Cemented Friable 0.78 2.0Cemented-Firm - -Loose 1.00 2.0Weakly Cemented Friable 0.12 2.0Cemented-Firm - -Loose 1.60 1.0Weakly Cemented Friable 0.78 2.0
Coarse and Medium Loamy Sand*
4 Single Grain Structureless
Fine Sand 3
Medium Sand* 2 Single Grain Structureless
Single Grain Structureless
yCemented-Firm - -Loose 1.00 2.0Weakly Cemented Friable 0.45 5.0Cemented-Firm - -Very Friable, Friable 0.60 2.6Firm 0.45 5.0Very Friable, Friable 1.00 1.3
Loamy Sand*g
Weak
Moderate or
Fine and Very Fine Loamy Sand
5 Single Grain Structureless
Prismatic,Blocky,
G lVery Friable, Friable 1.00 1.3Firm 0.60 2.6Very Friable, Friable 0.60 2.6Firm 0.45 5.0Very Friable, Friable 0.60 2.6Firm - -Very Friable, Friable 0.45 5.0Firm - -
Moderate or Strong
PlatyWeak
Moderate or Strong
Coarse and Medium Sandy Loam
6
StructurelessMassive
Granular
Firm - -Very Friable, Friable 0.45 5.0Firm 0.45 5.0Very Friable, Friable 0.78 2.0fim 0.45 5.0Very Friable, Friable 0.45 5.0Firm 0.00 -V F i bl F i bl 0 24
Fine and Very Fine Sandy Loam
7
Prismatic,Blocky,
Granular
Weak
Moderate or Strong
dPlaty
Weak
Very Friable, Friable 0.24 -Firm - -Very Friable, Friable 0.45 5.0Firm - -
Moderate or Strong
Massive Structureless
Platy
13-50 n Section 13: Forms and Reference
09/09
Very Friable, Friable 0.60 2.6Firm 0.45 5.0V F i bl F i bl 0 78 2 0
Loading Rates for Determining Bottom Absorption Area for Trenches and Seepage Beds for Effluent Treatment Levels A & B & Absorption Ratios for Determining Mound Absorption Areas using Detailed Soil Descriptions
Table XII (cont.)
Prismatic,Blocky,
Weak
Very Friable, Friable 0.78 2.0Firm 0.45 5.0Very Friable, Friable 0.45 5.0Firm - -Very Friable, Friable 0.24 -Firm - -Very Friable, Friable 0.45 5.0
Loam 8
Blocky,Granular
Moderate or Strong
PlatyWeak
Moderate or Strong
Massive Structurelessy
Firm - -Very Friable, Friable 0.60 2.6Firm 0.45 5.0Very Friable, Friable 0.78 2.4Firm 0.45 5.0Very Friable, Friable 0.45 5.0Firm - -Silt Loam 9
Prismatic,Blocky,
Granular
Weak
Moderate or Strong
Pl tWeak
Massive Structureless
FirmVery Friable, Friable - -Firm - -Very Friable, Friable 0.30 5.0Firm - -Very Friable, Friable 0.30 5.0Firm - -Very Friable Friable 0 60 2 6
Platy
Massive Structureless
Moderate or Strong
Prismatic,Blocky,
Weak
Moderate or Very Friable, Friable 0.60 2.6Firm 0.30 5.0Very Friable, Friable - -Firm - -Very Friable, Friable - -Firm - -Very Friable, Friable - -Firm
WeakClay Loam, Silty Clay
Loam, Sandy Clay Loam
10
Granular Moderate or Strong
Platy
Massive Structureless
Moderate or Strong
Firm - -Very Friable, Friable - -Firm - -Very Friable, Friable 0.30 5.0Firm - -Very Friable, Friable - -Firm - -
Massive Structureless
Clay, Silty Clay, Sandy Clay
11
Prismatic,Blocky,
Granular
Weak
Moderate or Strong
PlatyWeak
Very Friable, Friable - -Firm - -Very Friable, Friable - -Firm - -Massive Structureless
PlatyModerate or
Strong
Section 13: Forms and Reference n 13-51
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Compliance Inspection FormExisting Subsurface Sewage Treatment Systems (SSTS)
Doc Type: Compliance and Enforcement
Instructions on page 6
Summary Form (Completed form must be submitted to the local unit of government within 15 days.)
Parcel number:
System status: Compliant Noncompliant For Local Tracking Purposes:
(based on all compliance requirements)
Property Information Property owner name(s): Property owner phone: Property address: Property owner address (if different): County: Permitting authority: Date system constructed: Reason for inspection:
System Description Brief system description: Local permit number: Number of bedrooms: Design flow rate:
Is the system: In Shoreland area? Yes No An U.S. Environmental Protection Agency (EPA) Class V Injection Well? Yes No
In Wellhead Protection Area? Yes No System serving a Minnesota Department of Heath (MDH) licensed facility? Yes No
Compliance Status (Based on state requirements – additional local requirements may also apply.)Based on the information gathered and reported on attached forms, the compliance status of this system is (check one):
Certificate of Compliance – valid until (3 years from date of report): Notice of Noncompliance - For Noncompliant systems:
The reason for noncompliance is: This noncompliant system is classified as (check one below):
Imminent threat to public health & safety Failing to protect ground water Not in compliance with operating permit
CertificationI 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: Certification number: Business license name and number: orName of local unit of government:
Signature: Date:
Required Attachments Hydraulic Performance Tank Integrity Operating Permit Form (if applicable) Soil Boring Logs Soil Separation System drawing/As-built drawing Any local requirements that are different from what is required on this form Other information (list):
Upgrade Requirements (derived from Minn. Stat. § 115.55) An imminent threat to public health and safety (ITPHS) must be upgraded, replaced, or its use discontinued within ten months of receipt of this notice or within a shorter period if required by local 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.
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Parcel number: System status: Compliant Noncompliant (as determined by this form)
Hydraulic Performance and Other Compliance – Compliance Inspection Form for Existing SSTS
Compliance Issue #1 of 4 Date of observation: Reason for observation:
This form expires upon next inspection or in three years, whichever occurs first:
Compliance questions/criteria: (Required) (Check the appropriate box)
Does the system discharge sewage to the ground surface?
Yes No
Does the system discharge sewage to drain tile or surface waters?
Yes No
Does the system cause sewage backup into dwelling or establishment?
Yes No
Do other situations exist that have the potential to immediately and adversely impact or threaten public health or safety (electrical, unsafe covers, etc.)?
Yes No
Any “yes” answer indicates that the system is an imminent threat to public health and safety.
Does the system pose a threat to ground water for any conditions deemed non-protective as determined by the inspector?
Yes No
“Yes” indicates that the system is failing to protect ground water. If “yes”, describe the condition noted:
Verification Method*: (Optional)(Check the appropriate box)
Searched for surface outlet
Performed hydraulic test
Searched for seeping in yard
Checked for backup in home
Excessive ponding in soil system/D-boxes
Homeowner testimony
Examined for surging in tank
“Black soil” above soil dispersal system
System requires “emergency” pumping
Performed dye test
Other:
* No standard protocol exists. This list is not exhaustive, in sequential order, nor does it indicate which combinations are necessary to make this determination.
CertificationThis form is to be completed and attached to the Summary Form of the Minnesota Pollution Control Agency’s (MPCA) Compliance Inspection Form for Existing Subsurface Sewage Treatment Systems. Observations, interpretations, and conclusions must be completed by an inspector. Completed form must be submitted to the local unit of government within 15 days.
Property owner name(s):
Property address:
Property owner’s address (if different):
County: Property owner phone:
I hereby certify that I personally made the observations, interpretations, and conclusions reported on this form and that they arecorrect.
Name: Certification number:
Business license name and number: or
Name of local unit of government:
Signature: Date:
Section 13: Forms and Reference n 13-53
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Parcel number: System status: Compliant Noncompliant (as determined by this form)
Tank Integrity and Safety Compliance – Compliance Inspection Form for Existing SSTS
Compliance Issue #2 of 4 Date of observation: Reason for observation:
This form expires on (three years):
Compliance questions/criteria: (Required) (Check the appropriate box)
Does the system consist of a seepage pit*, cesspool, drywell, or leaching pit?
Yes No
Do any sewage tank(s) leak below their designed operating depth?
Yes No
If yes, identify which sewage tank leaks. Any “yes” answer indicates that the system is failing to protect ground water.
* Seepage pits meeting 7080.2550 may be compliant if allowed in ordinance by local permitting authority.
Verification Method**: (Optional)(Check the appropriate box)
Probed tank bottom
Observed low liquid level
Examined construction records
Examined empty (pumped) tank
Probed outside tank for “black soil”
Pressure/vacuum check
Other:
** No standard protocol exists. This list is not exhaustive, in sequential order, nor does it indicate which combinations are necessary to make this determination.
Safety Check 1. Are maintenance hole covers damaged, cracked, or appeared to be structurally unsound? Yes* No
2. Were maintenance hole covers replaced in a secured manner (e.g., screws replaced)? Yes No*
3. Was secondary access restraint present (safety pan, second cover, or safety netting) – highly recommended. Yes No
4. Are other safety/health issue present? Yes* No
Explain:
*System is an imminent threat to public health and safety.
CertificationThis form is to be completed and attached to the Summary Form of the Minnesota Pollution Control Agency’s (MPCA) Compliance Inspection Form for Existing Subsurface Sewage Treatment Systems. Observations, interpretations, and conclusions must be completed by an inspector, maintainer, or service provider. Completed form must be submitted to the local unit of government within15 days.
Property owner name(s):
Property address:
Property owner’s address (if different):
County: Property owner phone:
I hereby certify that I personally made the observations, interpretations, and conclusions reported on this form and that they arecorrect.
Name: Certification number:
Business license name and number: or
Name of local unit of government:
Signature: Date:
13-54 n Section 13: Forms and Reference
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Parcel number: System status: Compliant Noncompliant (as determined by this form)
Soil Separation Compliance and Other Compliance – Compliance Inspection Form for Existing SSTS
Compliance Issue #3 of 4 Date of observation: Reason for observation: This information on this form does not expire.
Compliance questions/criteria: (Required) (Check the appropriate box)
For systems built prior to April 1, 1996, and not located in Shoreland or Wellhead Protection Area or not serving a food, beverage or lodging establishment:
Does the system have at least a two-foot vertical separation distance from periodically saturated soil or bedrock? Yes No
For non-performance systems built April 1, 1996, or later or for non-performance systems located in Shoreland or Wellhead Protection Areas or serving a food, beverage or lodging establishment:
Does the system have a three-foot vertical separation distance from periodically saturated soil or bedrock?* Yes No
For reduced separation distance systems (i.e., “performance” systems under old 7080.0179 or Type IV or V system under new 7080. 2350 or 7080.2400):
Does the system meet the designed vertical separation distance from periodically saturated soil or bedrock?* Yes No Any “no” answer indicates that the system is failing to protect ground water.
Verification Method**: (Optional)(Check the appropriate box)
Conducted soil observation(s) (attach boring logs)
Two previous verifications (attach boring logs)
Other:
Soil observation does not expire. Previous observations by two independent parties are sufficient, unless site conditions have been altered.
* May be reduced by up to 15 percent if allowed in local ordinance.
** No standard protocol exists. This list is not exhaustive, in sequential order, nor does it indicate which combinations are necessary to make this determination.
CertificationThis form is to be completed and attached to the Summary Form of the Minnesota Pollution Control Agency’s (MPCA) Compliance Inspection Form for Existing Subsurface Sewage Treatment Systems. Observations, interpretations, and conclusions must be completed by an inspector or designer. Completed form must be submitted to the local unit of government within 15 days.
Property owner name(s):
Property address:
Property owner’s address (if different):
County: Property owner phone:
I hereby certify that I personally made the observations, interpretations, and conclusions reported on this form and that they arecorrect.
Name: Certification number:
Business license name and number: or
Name of local unit of government:
Signature: Date:
Section 13: Forms and Reference n 13-55
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Parcel number: System status: Compliant Noncompliant (as determined by this form)
Operating Permit Compliance and Nitrogen BMP Compliance – Compliance Inspection Form for Existing SSTS
Compliance Issue #4 of 4
Applicability: Is the system operated under an Operating Permit? Yes No If “yes”, then complete item A, below
Is the system required to employ a nitrogen BMP? Yes No If “yes”, then complete item B, below
If the answer to both questions is “no”, then this form does not need to be completed.
Compliance questions/criteria: (Required) (Check the appropriate box)
A. For systems with operating permits:
Has all the required monitoring and maintenance taken place and does the monitoring indicate compliance with the permit thresholds?
Yes No
B. For a system that has a required nitrogen reducing BMP and does not have an operating permit:
Is the nitrogen BMP in-place and appears to be properly operating? Yes No
Any “no” answers indicates noncompliance
Date of observation: Reason for observation:
Operating permit number:
This form expires upon next inspection or in three years, whichever occurs first:
CertificationThis form is to be completed and attached to the Summary Form of the Minnesota Pollution Control Agency’s (MPCA) Compliance Inspection Form for Existing Subsurface Sewage Treatment Systems. Observations, interpretations and conclusions must be completed by an advanced inspector, service provider, or maintainer (maintainer for holding tanks only). Completed form must besubmitted to the local unit of government within 15 days.
Property owner name(s):
Property address:
Property owner’s address (if different):
County: Property owner phone:
I hereby certify that I personally made the observations, interpretations and conclusions reported on this form and that they arecorrect.
Name: Certification number:
Business license name and number: or
Name of local unit of government:
Signature: Date:
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Instructions – Compliance Inspection Form for Existing SSTS
The Minnesota Pollution Control Agency’s (MPCA) compliance inspection form must be completed for all compliance inspections of existing Subsurface Sewage Treatment Systems (SSTS) (Minn. Stat. § 115.55 subdivision 5a (i)). A compliance inspection is an inspection for the purpose of issuing a certificate of compliance or notice of noncompliance (Minn. R. ch. 7080.1100, subpart 18).Additional local forms may also be required in local ordinance; if this is the case, attach the appropriate local form(s) as well.
The inspection form is divided into five separate pages, each dealing with a separate compliance issue. The pages include: Summary Form, Hydraulic Performance and Other Compliance Form, Tank Integrity and Safety Form, Soil Separation and Other Compliance Form, and Operating Permit and Nitrogen BMP Compliance Form. The following table indicates which sheets need to be completed for which type of systems:
System Classification
Summary Form
Hydraulic Performance
and Other Compliance
Form
TankIntegrity and Safety Form
SoilSeparation and Other
Compliance Form
Operating Permit and Nitrogen
BMPCompliance
Form Type I and old Standard Systems x x x x
Type II and old “Alternative” Systems
x x x x
Type III and old “Other” Systems x x x x
Type IV x x x x x Type V and old “Performance” Systems
x x x x x
ISTS or MSTS with nitrogen BMP x x x x x
MSTS with advanced nitrogen reduction x x x x x
ISTS = Individual Sewage Treatment Systems MSTS = Mid-Sized Subsurface Sewage Treatment Systems
The purpose of multiple forms is to accommodate the different times the system may be assessed and the various individuals thatmay do the assessment. The goal of these forms is to document a continual state of compliance for the system.
The final determination of compliance is determined on the Summary Sheet. This compliance status is based on the supporting compliance forms. Each supporting form has an expiration date (except the Soil Separation form), and, if not expired, will be used to support the Summary Sheet.
1. Summary Form Purpose and Intent This is the form that is completed once all the supporting information is gathered and the supporting forms are completed. Thisform acts as the official “Notice of Noncompliance” or “Certificate of Compliance”. The supporting forms must be attached to the summary form.
Line by Line Instructions (for non self-evident queries)
System Status (top line) - The “Compliant” or “Noncompliant” Section is based on all the required forms for that system.
Property Owner Section - The “Date System Construction” query must be determined from records or owner testimony. If neither of these two sources are available, then a reasonable estimate should be made. The method used to determine the date (records, estimate, testimony, etc… could be provided near the date blank).
System Description Section - The “Local Permit Number”, “Number of Bedrooms” and “EPA Class V Injection Well” queries are optional. An U.S. Environmental Protection Agency (EPA) Class V injection well is any system which serves more than one dwelling, or receives non-domestic waste, or a system which serves an Other Establishment which serves more than 20 persons per day.
The “Design Flow Rate” must be determined or estimated to determine if an advanced inspector is required to conduct the compliance inspection for that system.
Wellhead Protection Areas can be found at: http://mdh-agua.health.state.mn.us/swa/pdwmain.cfm.
Section 13: Forms and Reference n 13-57
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Compliance Status Section - The compliance status required to be recorded on this form is based on state rule and state statute requirements. The compliance status is based on the supporting compliance forms. If local compliance requirements differ, that can be noted on a separate document, but the state form still needs to be completed based on state criteria.
Certification Section - The final determination of compliance must be done by an inspector (or advanced inspector for a Type IV, Type V, or system with a design flow of greater than 2,500 gallons per day).
Required Attachments Section - The number of supporting compliance forms must be noted to ensure that the supporting information is complete.
If you are filling the form out on your computer, click the “Print Preview” button at this point – this will trigger the automaticfilling of system identification and Inspector information on subsequent pages.
2. Hydraulic Performance and Other Compliance Form (Compliance Issue #1) Purpose and Intent This form denotes compliance for surfacing of sewage or if an inspector is determining that the system is failing to protect ground water other than a leaking sewage tank (septic, pump, cesspool, seepage pit, etc…)
Line by Line Instructions (for non self-evident queries)
System Status (top line) - The “Compliant” or “Noncompliant” Section is based only on the criteria evaluated on this form, not based on criteria on other forms.
Compliance Questions/Criteria Section - The question in the lowest left-hand box which states: “Does the system pose a threat to ground water for any condition deemed to be non-protective as determined by the inspector?” is meant to allow the inspector to make a determination outside of the obvious non-protective systems (separation distance, leaky sewage tanks, etc…). These systems could include such things as a system covered by an impermeable surface.
3. Tank Integrity and Safety Compliance Form (Compliance Issue #2) Purpose and Intent This form denotes compliance for watertight tanks. Water tightness only refers to water tightness below the tank’s designed operating depth. Non-water tightness above the designed operating depth (i.e., water leaking into the tank) may be harmful for system operation, but is likely not a direct threat to environmental protection.
Line by Line Instructions (for non self-evident queries)
System Status (top line) - The “Compliant” or “Noncompliant” Section is based only on the criteria evaluated on this form, not based on criteria on other forms.
4. Soil Separation Compliance and Other Compliance Form (Compliance Issue #3) Purpose and Intent This form denotes compliance for the required vertical separation distance to the periodically saturated soil or bedrock. Line by Line Instructions (for non self-evident queries)
System Status (top line) - The “Compliant” or “Noncompliant” Section is based only on the criteria evaluated on this form, not based on criteria on other forms.
Compliance Questions/Criteria Section - The 15 percent reduction in separation distance is further explained by the following table:
System Type Example Required
Separation Distance
Required Separation
Distance with 15% Reduction
For systems built prior to April 1, 1996, and not located in Shoreland or Wellhead Protection Area or not serving a Food, Beverage or Lodging Establishment
Septic tank with trench system, built in 1980 not near a lake or stream 24 inches
24 inches (15% rule does not
apply)
For non-performance systems built April 1, 1996, or later or for non-performance systems located in Shoreland or Wellhead
Protection Areas or Serving a Food, Beverage or Lodging Establishment
Septic tank with a trench system, built in 1980 within a Minnesota Department of
Natural Resources (DNR) Shoreland Area, Or Septic tank with trench system, built in
2001, not in a DNR Shoreland Area
36 inches 31 inches
For reduced separation distance systems (i.e., “performance” systems under old
7080.0179 or Type IV or V system under new 7080. 2350 or 7080.2400)
Septic tank with advanced treatment to a trench system
12, 24 or 36 inches
10, 21, or 31 inches
13-58 n Section 13: Forms and Reference
09/09
www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats wq-wwists4-31 • 4/24/09 Page 8 of 8
Verification Method Section - The vertical separation distance must be determined. This determination can be made by the following:
A. A new soil boring (which does not need to be verified by another for an existing system compliance inspection). B. Previous borings by two independent certified individuals (one can be the original borings by the designer). C. For more complex or difficult site conditions, please refer to MPCA’s fact sheet on determining vertical
separation distance for existing systems.
The soil boring(s) must be attached to this form.
5. Operating Permit Compliance and Nitrogen BMP Compliance Form (Compliance Issue #4) Purpose and Intent This form denotes compliance for proper system operation as determined by compliance with the system’s operating permit, or for systems which employ a best management practice for nitrogen, whether that practice is currently in-place and property operating. These two conditions will only apply to a few systems which are required to have these measures, which began between the years 2008 and 2011.
Line by Line Instructions (for non self-evident queries)
System Status (top line) - The “Compliant” or “Noncompliant” Section is based only on the criteria evaluated on this form, not based on criteria on other forms.
Compliance Questions/Criteria Section - The assessment of the nitrogen best management practice (BMP) can be a simple visual evaluation if the BMP is still present and whether it appears to be properly functioning at the time of inspection.
Section 13: Forms and Reference n 13-59
09/09
Inspected by # Date
Owner Phone
Address
As-builts
Second site
Certi ed statement Lic. #
System DesignCerti ed statement Lic. #
# Bedrooms Flow gpd
Garbage disposal: Yes No Sump pump: Yes No
Clean water sources
Site Preparati on Same as design? Yes No
Setbacks: Well ft . Water lines ft . Buildings ft .
Surface water ft . Property line ft .
Traffi c Patt erns:
Pressure-tested? Yes No
MaterialsClean sand
Washed rock
Proper cover
Acceptable topsoil
Appropriate pipe specs
AcceptableUnacceptable
AcceptableUnacceptable
AcceptableUnacceptable
New System Inspecti on Report
13-60 n Section 13: Forms and Reference
09/09
Soil informati on Depth to limiti ng conditi on in. Maximum depth of system in.
System elevati on Bench mark
SSF sqft /gpd LLR gpd/ ft
System width ________ ft System length______ ft
System square footage ___________ sqft Absorpti on area _________ sqft
Site drainage: Yes No Swale: Yes No
Building SewerBedding Yes No
Piping Yes No
Slope Yes No
Insulati on Yes No
Clean out Yes No
TankWarning label Yes No
Acceptable Base Yes No
Sealed Penetrati ons Yes No
Manhole grade Yes No
Inspecti on pipes Yes No
Baffl es Yes No
Effl uent screen Yes No
Alarm Yes No
Effl uent screen: Yes No
Tank capacity gal
Compartments? Yes No #
Lift stati on/GrinderTank size gallons % of daily ow %
Timed Dose: Yes No Demand dose: Yes No Piggyback? Yes No
Pump sizing: gpm tdh Alarm : Yes No
Assembly locati on: Wiring Check:
Water ti ght:
�Acceptable�Unacceptable
�Acceptable�Unacceptable
�Acceptable�Unacceptable
�Acceptable�Unacceptable
Section 13: Forms and Reference n 13-61
09/09
Pretreatment DeviceDistributi on pressure: Yes No
Pump sizing gpm tdh
Media _______________ Depth________ ft
Drainage type � pump � gravity
Operati ng Pemit:
Sampling locati on and equipment Yes No
Effl uent quality Yes No
Frequency Yes No
Miti gati ve plan Yes No
Responsible parti es Yes No
Soil Treatment Area
Below GradeExcavati on
Plasti c limit Yes No Compacti on concerns Yes No
Smearing Yes No
Level Yes No
Distributi on �Serial (�drop boxes) �Parallel �Pressure
Drainback: Yes No Lateral locati ons: Unlevel distributi on Yes No
Perforati on size: Number: Perfs / Laterals
Distributi on media �Rock �Gravelless pipe �Chamber system
�Other*
Above GradeScari cati on: Yes No Compacti on concerns: Yes No
Level: Yes No Drainback: Yes No
Lateral locati ons
Perforati on size: _______ Number: ______Perfs / ______ Laterals
Distributi on �Timed �Pressure
Distributi on media: �Rock �Other*__________
�Acceptable�Unacceptable
�Acceptable�Unacceptable
�Acceptable�Unacceptable
13-62 n Section 13: Forms and Reference
09/09
© Regents of the University of Minnesota. All rights reserved.The University of Minnesota is committ ed to the policy that all persons shall have equal access to its programs, faciliti es, and employment without regard to race, color, creed, religion, nati onal origin, sex, age, marital status, disability, public assistance status, veteran status, or sexual orientati on.This publicati on/material is available in alternati ve formats upon request. Please contact OSTP at (800) 322-8642. Updated 09/09.
Site Sketch:
Section 13: Forms and Reference n 13-63
09/09
Owner:___________________________________Parcel Number: _________________
Street/City/Zip Code:_________________________________________________________________________
Lot: ___________ Secti on: ___________ Township: ____________ N Range: ____________ W
Installati on Date:_______________ Installer:_____________________ License Number: __________
Is the system in Shoreland, serving a MDH facility or in a Wellhead Protecti on area? YES NO
Number of Bedrooms/ Flow Rate:_________________# / gpd Septi c Tanks, No & Size:______________#/gal
Pump Tank Size:_____________gal Tank Manufacturer: ____________________________
Pump Size: _________ hp _______ gpm _______ft of TDH Floats properly set? YES NO
Soil Treatment Area:TYPE I TYPE II TYPE III TYPE IV TYPE V TRENCH BED MOUND AT-GRADE WARRANTIED OTHER:______________
Design Variances:____________________________________________________________________________ Site Drawing:
Limiti ng Layer/Depth:________”
Depth from Surface:_________ ”
Rock or Slat depth:__________ ”
Diameter of Gravelless:_______”
Trench Width:______________ft
Bott om Square Feet Area:____ft 2
Rockbed Size:_____________________
Adsorpti on width:__________________
Sand depth:_______________________ (under mound)
Describe: __________________
__________________________
__________________________
__________________________
__________________________
North Items to be Identi ed:1. Septi c, holding and pump
tanks, piping, and soil system con gurati on. Label bed or trench width and length or rockbed size, absorpti on width and nal dimensions. Indicate alarm locati on.
2. Show all setbacks from tank and soil system
a. Property boundries b. Buildings c. Wells d. Water bodies e. Road right-of-way3. Improvements - present and
future.4. Benchmark locati on and
distance of tank and soil system from benchmark
5. Replacement site6. Abandoned system
Reverse Side
OSTP As-Built Form
13-64 n Section 13: Forms and Reference
09/09
Other Informati on:
List any further system descripti ons:
List any material testi ng results (jar test, sieve analysis, etc):
List conditi ons during constructi on:
List who is responsible for establishing vegetati ve cover:
© 2009, Regents of the University of Minnesota. All rights reserved. For additi onal copies or for Americans with Disabiliti es Act accommodati ons, please call (800) 322-8642. University of Minnesota is an equal opportunity educator and employer. Updated 09/09.
I herby certi fy that I have completed this work in accordance with applicable ordinances, rules, and laws.
________________________________________(Installer) ________________(license #) ___________(Date)
Section 13: Forms and Reference n 13-65
09/09
Minnesota Department of Health Well Management Section
P.O. Box 64975, St. Paul, Minnesota 55164-0975 651/201-4600 or 800/383-9808
Certification of Buried Sewer Construction and Testing
This form must be completed and submitted to the Minnesota Department of Health (MDH) for installation of a buried sewer located 20 to 50 feet from a water-supply well, or the installation of a water-supply well located 20 to 50 feet from a buried sewer. NOTE: A 50-foot minimum separation must be maintained between a water-supply well and a buried collector or municipal sewer, an unapproved sewer, or a buried sewer serving a facility handling infectious or pathological waste.
Owner of Property Where Sewer is Located (please print)
Street Address, City, ZIP for Property Where Sewer is Located
County Name Township No. Range No. Section No. Fraction
¼ ¼ ¼
Date of Testing (mm/dd/yyyy) Person(s) Present to Witness Testing
Well Information
Provide Minnesota Well and Boring Number(s) ________________________________ or, if unavailable, provide the following information for each well located within 50 feet of the buried sewer.
Well No./Description Well
Depth Well
Diameter Year of
Construction Well Contractor Company Name
Well Address (if different from above)
Variance Information
Was a variance issued by the MDH for this sewer or well installation? Yes No If yes, please provide the variance tracking number: TN _____________.
Sewer Materials
ABS (ASTM D2661) ABS (ASTM D2751) ABS (ASTM F628) PVC (ASTM D2665) PVC (ASTM D3034) PVC (ASTM F789) PVC (ASTM F891) Cast Iron _______________
Test Methods (check one) Air Test (5 psi constant pressure for 15 minutes). Manometer Test (1-inch water column). Hydrostatic Test (for plastic pipe only).
The portion of the buried sewer system tested is described as follows (please specify each segment of sewer pipe which was tested).
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Please draw a diagram of the sewer system on back and note the locations of any wells and the portions of
the sewer system that were pressure tested.
13-66 n Section 13: Forms and Reference
09/09
Buried Sewer Testing Diagram
Please draw a site diagram of the sewer system and all buried sewer pipes, including those buried beneath buildings (serving floor drain[s], bathroom[s], laundry room, etc.). Please note the portions of the buried sewer pipes that were pressure tested, the location of the well(s), and major landmarks on the property.
I, (name) ______________________________________, certify that the buried sewer(s) described above is/are constructed of the indicated, approved sewer material meeting the requirements of the Minnesota Plumbing Code, Minnesota Rules, part 4715.0530, and has/have been successfully tested in accordance with Minnesota Rules, part 4715.2820, by the indicated method.
In accordance with Minnesota Statutes, section 144.992, persons submitting false information to the Minnesota Department of Health are subject to administrative penalties of up to $10,000.
Name Title
Firm
Street Address
City State ZIP Code
License/Certification Number Signature Date
HE-01488-03 origs/sewer test form.doc 2/09R
Section 13: Forms and Reference n 13-67
09/09
www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats wq-wwists4-03 • 11/21/08 Page 1 of 2
SSTS AbandonmentReporting Form
Subsurface Sewage Treatment Systems (SSTS) Program)
InstructionsThis form is offered to meet the abandonment requirements of Minn. R. 7080.2500 and Disclosure Requirements of Minn. Stat. § 115.55, subd. 6. Future water supply well placement can also be affected by an abandoned SSTS. The use of this form is not mandatory; however the information on this form must be submitted to the local government unit (LGU)within 90 days after the abandonment. This form may be completed by a certified SSTS practitioner or by an individual who has direct knowledge of how the system was abandoned.
Property Information
Date of abandonment: Reason for abandonment:
Property owner name(s):
Property owner’s address:
City: State: Zip:
Site address (if different):
City: State: Zip:
Compliance Information
1. All solids and liquids removed from all tanks? Yes No Disposal Site:
2. All electrical devices and devices containing mercury removed? Yes No Disposal Site:
3. All underground sewage tanks crushed and filled with soil or rock material? Yes No orRemoved and disposed off site? Yes No
Disposal Site:
4. Contaminated materials* removed and disposed off site? Yes No Disposal Site:
5. All underground cavities** crushed and filled with soil or rock material? Yes No or:Removed and disposed off site? Yes No
Disposal Site:
6. Future discharge to system permanently denied? Yes No Method(s) used:
*Contaminated materials = Distribution media, soil or sand within three feet of the system bottom, distribution pipes, geotextilefabric/rosin paper/straw, tanks, contaminated soil around leaking tanks, any soil that received sewage from a surface failure (7080.2500 subp.3).
**Underground cavities = Cesspools, leaching pits, drywells, seepage pits, vault privies, pit privies, pump chambers (7080.2500 subp. 1). Does not include chamber media, drop boxes, or distribution boxes.
13-68 n Section 13: Forms and Reference
09/09
www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats wq-wwists4-03 • 11/21/08 Page 2 of 2
MapInclude location of building sewer, septic tank(s), soil dispersal system, cesspools, seepage pits, and other pits. Also include a permanent reference point(s) and dimensions.
Certification
I hereby certify the system was abandoned in accordance with Minn. R. 7080.2500 and any local requirements.
Name (please print): Title:
Address:
City: State: Zip:
Phone: License # if applicable):
Date: Signature:
↑ North
Section 13: Forms and Reference n 13-69
09/09
Septic Tank Maintenance Reporting FormGeneral Information
This form is offered to meet the reporting requirements of Minn. R. 7080.2450 subp. 2 and 7083.0770 subp. 2. The use of this form is not mandatory; however, the information on this form must be submitted to the homeowner within 30 days after the maintenance work is performed, and to the local government unit as required.
A copy of this information must be maintained by the Subsurface Septic Tank System (SSTS) business for a period of five (5) years from the maintenance date.
For systems installed under ordinances developed before February 4, 2008 (old 7080.0130), the maintenance hole covers:
1. Must be covered by a minimum of 12 inches of soil or be adequately secured.
2. Are not required to be brought up to ground surface. Covers can remain deep once the septic tank has been
pumped.
3. Are recommended, but not required, to be brought slightly above the ground surface.
if brought up to ground surface, the cover must be secured in accordance with the new rule (See Part B)
4. Currently at ground surface are recommended, but not required, to be secured in accordance with the new rule (Part B), or at a minimum, secured to the satisfaction of the SSTS licensee and local government unit if local regulations exist
For systems designed under ordinances adopted after February 4, 2008, the maintenance hole covers:
1. Must be brought to ground surface or slightly above
2. Must be re-secured in accordance with the new requirements
a) cover must be locked, bolted or screwed or must be 95 pounds in weight
b) cover cannot be susceptible to being slid or flipped
c) cover must have a warning label
www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats wq-wwists4-38 • 8/25/08 Page 1 of 2
13-70 n Section 13: Forms and Reference
09/09
Septic Tank Maintenance Reporting Form
Date of maintenance: Reason for maintenance: Property address: City: State: Zip:
Property owner’s name:
Property-owner’s address if different:
City: State: ZIP: Phone: Fax:
1. Access used to remove septage: Maintenance hole Other (Go to #3 below)
2. If maintenance hole was used, were all covers securely replaced? Yes No please explain
Explanation:
3. If owner refuses to allow a Subsurface Sewage Treatment System (SSTS) to be pumped through the maintenance hole, have them complete and sign the following statement.
I, (owner’s name), refuse to allow the removal of the solids and liquids through the maintenance hole. I understand that removal of solids and liquids through other access points is not considered maintenance.
Owner’s signature: Date:
4. Is the tank designed as a leaky tank? example: seepage pit, cesspool, drywell, leaching pit Tank #1: Yes No Verification method used? Tank #2: Yes No Verification method used?
5. Is there evidence of tank leakage from a septic, holding, pretreatment or pump tank below the operating depth or evidence of damaged, cracked or structurally unsound maintenance hole covers?
Tank Leaking out Leaking in Cover damage Septic/holding Tank #1 Yes No Yes No Yes No Septic/holding Tank #2 Yes No Yes No Yes No Pretreatment Tank Yes No Yes No Yes No Pump Tank Yes No Yes No Yes No
6. How many gallons of septage were removed?
Tank #1: Tank #2: Pretreatment Tank: Pump Tank:
7. Is there any sensory (smell and/or sight) evidence of non-domestic wastes?
Yes Please explain: No Disposal site Wastewater treatment plant Land application Other please explain
Explanation:
Other information: List any troubleshooting, minor repairs conducted, tank safety* concerns or other concerns:
8. Certification: I hereby certify as a State of Minnesota-certified SSTS Maintainer that I personally conducted the work and made the observations, or directly supervised others in the performance of this job.
Maintainer’s name and address:
Maintainer’s license #: Maintainer’s phone:
Maintainer’s signature: Date:
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Section 13: Forms and Reference n 13-71
09/09
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13-72 n Section 13: Forms and Reference
09/09
OSTP Septage Application Worksheetfor Nitrogen ‐ 08/09/2009
Cropping Year: September 1, to August 31,
EXAMPLE Site Information
Site Code Jones 1 Yield Goal 135 bu/ac Site Code Yield Goal
Crop Corn Acres 20 Crop Acres
Soil OM med. Soil OM
Last year's Crop Soybeans Last year's Crop
Recommended crop N rate 80 Recommended crop N rate
N Credits 20 N Credits
Step 1: Maximum Allowable Nitrogen Application Rate (MANA) Step 1: Maximum Allowable Nitrogen Application Rate (MANA)
Recommended crop N rate 80 lb/acre Recommended crop N rate lb/acre
N credits 20 lb/acre N credits lb/acre
MANA 60 lb/acre MANA lb/acre
Step 2: Maximum Septage Application Rate (MSAR) Step 2: Maximum Septage Application Rate (MSAR)
MANA Rate 60 lb/acre MANA Rate lb/acre
0.0026 0.0026 conversion 0.0026 0.0026 conversion
MSAR 23,077 gal/acre/year MSAR gal/acre/year
Step 3: Maximum Quantity of Septage for this Site Step 3: Maximum Quantity of Septage for this Site
MSAR 23,077 MSAR
Useable Site Acres 20 Useable Site Acres
Maximum Quantity of Septage 461,538 gal/site/year Maximum Quantity of Septage gal/site/year
Notes:N credit is the amount of nitrogen supplied by fertilizer, manure, or other wastes applied on the site.
Recommended rates of nitrogen are from Table 7 in the MPCA guidelines or from "Fertilizer Recommendations for Agronomic Crops in Minnesota"Minnesota Extension Service Bulletin BU-6240-E.
X X
OSTP Septage Application Worksheetfor Nitrogen ‐ 08/09/2009
Cropping Year: September 1, to August 31,
EXAMPLE Site Information
Site Code Jones 1 Yield Goal 135 bu/ac Site Code Yield Goal
Crop Corn Acres 20 Crop Acres
Soil OM med. Soil OM
Last year's Crop Soybeans Last year's Crop
Recommended crop N rate 80 Recommended crop N rate
N Credits 20 N Credits
Step 1: Maximum Allowable Nitrogen Application Rate (MANA) Step 1: Maximum Allowable Nitrogen Application Rate (MANA)
Recommended crop N rate 80 lb/acre Recommended crop N rate lb/acre
N credits 20 lb/acre N credits lb/acre
MANA 60 lb/acre MANA lb/acre
Step 2: Maximum Septage Application Rate (MSAR) Step 2: Maximum Septage Application Rate (MSAR)
MANA Rate 60 lb/acre MANA Rate lb/acre
0.0026 0.0026 conversion 0.0026 0.0026 conversion
MSAR 23,077 gal/acre/year MSAR gal/acre/year
Step 3: Maximum Quantity of Septage for this Site Step 3: Maximum Quantity of Septage for this Site
MSAR 23,077 MSAR
Useable Site Acres 20 Useable Site Acres
Maximum Quantity of Septage 461,538 gal/site/year Maximum Quantity of Septage gal/site/year
Notes:N credit is the amount of nitrogen supplied by fertilizer, manure, or other wastes applied on the site.
Recommended rates of nitrogen are from Table 7 in the MPCA guidelines or from "Fertilizer Recommendations for Agronomic Crops in Minnesota"Minnesota Extension Service Bulletin BU-6240-E.
X X
Section 13: Forms and Reference n 13-73
09/09
Site S
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____
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: St
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Cr
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M
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:
M
axim
um R
ate
of S
epta
ge A
llow
ed (g
allo
ns/a
cre/
year
):
M
axim
um G
allo
ns o
f Sep
tage A
llow
ed (g
allo
ns/s
ite/
year
):
A
ttac
h a
copy
of a
soi
l sur
vey
map
or
anot
her
map
con
tain
ing
the
sam
e in
form
atio
n w
ith
the
site b
ound
arie
s an
d un
suit
able a
reas o
f the
fiel
d id
enti
fied.
D
escr
ibe
how p
atho
gen
requ
irem
ents w
ere
met a
t the
sit
e:
Des
crib
e ho
w v
ecto
r at
trac
tion
red
ucti
on r
equi
rem
ents w
ere
met a
t the
sit
e:
OST
P Se
ptag
e A
pplic
atio
n W
orks
heet
for
Nit
roge
n ‐ 0
8/09
/200
9
Cro
ppin
g Ye
ar: S
epte
mbe
r 1,
toA
ugus
t 31,
EXA
MPL
ESi
te In
form
atio
n
Site
Cod
eJo
nes
1Y
ield
Goa
l13
5 bu
/ac
Site
Cod
eY
ield
Goa
l
Cro
pC
orn
Acr
es20
Cro
pA
cres
Soi
l OM
med
.S
oil O
M
Last
yea
r's C
rop
Soy
bean
sLa
st y
ear's
Cro
p
Rec
omm
ende
d cr
op N
rate
80R
ecom
men
ded
crop
N ra
te
N C
redi
ts20
N C
redi
ts
Step
1:
Max
imum
Allo
wab
le N
itrog
en A
pplic
atio
n R
ate
(MA
NA
)St
ep 1
: M
axim
um A
llow
able
Nitr
ogen
App
licat
ion
Rat
e (M
AN
A)
Rec
omm
ende
d cr
op N
rate
80lb
/acr
eR
ecom
men
ded
crop
N ra
telb
/acr
e
N c
redi
ts20
lb/a
cre
N c
redi
tslb
/acr
e
MA
NA
60lb
/acr
eM
AN
Alb
/acr
e
Step
2:
Max
imum
Sep
tage
App
licat
ion
Rat
e (M
SAR
)St
ep 2
: M
axim
um S
epta
ge A
pplic
atio
n R
ate
(MSA
R)
MA
NA
Rat
e60
lb/a
cre
MA
NA
Rat
elb
/acr
e
0.00
260.
0026
conv
ersi
on0.
0026
0.00
26
conv
ersi
on
MSA
R23
,077
gal/a
cre/
year
MSA
Rga
l/acr
e/ye
ar
Step
3:
Max
imum
Qua
ntity
of S
epta
ge fo
r thi
s Si
teSt
ep 3
: M
axim
um Q
uant
ity o
f Sep
tage
for t
his
Site
MS
AR
23,0
77
M
SA
R
Use
able
Site
Acr
es20
Use
able
Site
Acr
es
Max
imum
Qua
ntity
of S
epta
ge46
1,53
8
gal/s
ite/y
ear
Max
imum
Qua
ntity
of S
epta
gega
l/site
/yea
r
Not
es:
N c
redi
t is
the
amou
nt o
f nitr
ogen
sup
plie
d by
fert
ilize
r, m
anur
e, o
r oth
er w
aste
s ap
plie
d on
the
site
.
Rec
omm
ende
d ra
tes
of n
itrog
en a
re fr
om T
able
7 in
the
MPC
A g
uide
lines
or f
rom
"Fe
rtili
zer R
ecom
men
datio
ns fo
r Agr
onom
ic C
rops
in M
inne
sota
"M
inne
sota
Ext
ensi
on S
ervi
ce B
ulle
tin B
U-6
240-
E.
XX
13-74 n Section 13: Forms and Reference
09/09
Site Specific Record
Date of A
pplication Load #(s)
Gallons A
pplied A
creage Used
Rate A
pplied G
allons/Acre
Running Total of
Gallons A
pplied per Site
“I certify, under penalty of law, that the inform
ation that will be used to determ
ine compliance w
ith the pathogen requirements [check one or both of
the following] 503.32(c)(1)[crop restrictions] or 503.32(c)(2) [pH
adjustment to 12.0 for 30 m
inutes and crop restrictions] and the vector attraction reduction requirem
ent in [check one or more of the follow
ing] 503.33(b)(9) [injected], 503.33(b)10) [incorporated within 6 hours], or 503.33(b)(12) [pH
adjustm
ent to 12.0 for 30 minutes] w
as prepared under my direction and supervision in accordance w
ith the system designed to ensure that qualified
personnel properly gather and evaluate the information. I am
aware that there are significant penalties for false certification including the possibility
of fine and imprisonm
ent.”
Signature:
Printed Nam
e:
Title:
OSTP Septage A
pplication Worksheet
for Nitrogen ‐ 08/09/2009
Cropping Year: Septem
ber 1, to
August 31,
EXAM
PLESite Inform
ation
Site C
odeJones 1
Yield G
oal135 bu/ac
Site C
odeY
ield Goal
Crop
Corn
Acres
20C
ropA
cres
Soil O
Mm
ed.S
oil OM
Last year's Crop
Soybeans
Last year's Crop
Recom
mended crop N
rate80
Recom
mended crop N
rate
N C
redits20
N C
redits
Step 1: Maxim
um A
llowable N
itrogen Application R
ate (MA
NA
)Step 1: M
aximum
Allow
able Nitrogen A
pplication Rate (M
AN
A)
Recom
mended crop N
rate80
lb/acreR
ecomm
ended crop N rate
lb/acre
N credits
20lb/acre
N credits
lb/acre
MA
NA
60lb/acre
MA
NA
lb/acre
Step 2: Maxim
um Septage A
pplication Rate (M
SAR
)Step 2: M
aximum
Septage Application R
ate (MSA
R)
MA
NA
Rate
60lb/acre
MA
NA
Rate
lb/acre
0.00260.0026
conversion
0.00260.0026
conversion
MSA
R23,077
gal/acre/year
MSA
Rgal/acre/year
Step 3: Maxim
um Q
uantity of Septage for this SiteStep 3: M
aximum
Quantity of Septage for this Site
MS
AR
23,077
MS
AR
Useable S
ite Acres
20
Useable S
ite Acres
Maxim
um Q
uantity of Septage
461,538
gal/site/yearM
aximum
Quantity of S
eptagegal/site/year
Notes:
N credit is the am
ount of nitrogen supplied by fertilizer, manure, or other w
astes applied on the site.
Recom
mended rates of nitrogen are from
Table 7 in the MPC
A guidelines or from
"Fertilizer Recom
mendations for A
gronomic C
rops in Minnesota"
Minnesota Extension Service B
ulletin BU
-6240-E.
XX
Section 13: Forms and Reference n 13-75
09/09
Dai
ly H
aulin
g Re
cord
Dat
e:
D
rive
r N
ame:
Lo
ad #
So
urce
(s) o
r In
voic
e #
(s)
Se
ptag
e G
allo
ns
Oth
er
Gal
lons
(nam
e)
To
tal
Gal
lons
A
pplic
atio
n M
etho
d1
Te
mpe
ratu
re
of S
epta
ge2
Ti
me
/ In
itia
l pH
(aft
er li
me
adde
d) 2
Ti
me
/ Fi
nal p
H
(aft
er 3
0 m
in.) 2
Des
tina
tion
(s
ite
code
or
POTW
nam
e)
1 App
licat
ion
met
hods a
re I=
inje
ctio
n, S
A=s
urfa
ce a
pplie
d, S
A6=
surf
ace
appl
ied
and
inco
rpor
ated
with
in 6 h
ours
. 2 O
nly
requ
ired
whe
n lim
e st
abili
zatio
n us
ed to
mee
t pat
hoge
n or v
ecto
r at
trac
tion
redu
ctio
n re
quir
emen
ts.
OST
P Se
ptag
e A
pplic
atio
n W
orks
heet
for
Nit
roge
n ‐ 0
8/09
/200
9
Cro
ppin
g Ye
ar: S
epte
mbe
r 1,
toA
ugus
t 31,
EXA
MPL
ESi
te In
form
atio
n
Site
Cod
eJo
nes
1Y
ield
Goa
l13
5 bu
/ac
Site
Cod
eY
ield
Goa
l
Cro
pC
orn
Acr
es20
Cro
pA
cres
Soi
l OM
med
.S
oil O
M
Last
yea
r's C
rop
Soy
bean
sLa
st y
ear's
Cro
p
Rec
omm
ende
d cr
op N
rate
80R
ecom
men
ded
crop
N ra
te
N C
redi
ts20
N C
redi
ts
Step
1:
Max
imum
Allo
wab
le N
itrog
en A
pplic
atio
n R
ate
(MA
NA
)St
ep 1
: M
axim
um A
llow
able
Nitr
ogen
App
licat
ion
Rat
e (M
AN
A)
Rec
omm
ende
d cr
op N
rate
80lb
/acr
eR
ecom
men
ded
crop
N ra
telb
/acr
e
N c
redi
ts20
lb/a
cre
N c
redi
tslb
/acr
e
MA
NA
60lb
/acr
eM
AN
Alb
/acr
e
Step
2:
Max
imum
Sep
tage
App
licat
ion
Rat
e (M
SAR
)St
ep 2
: M
axim
um S
epta
ge A
pplic
atio
n R
ate
(MSA
R)
MA
NA
Rat
e60
lb/a
cre
MA
NA
Rat
elb
/acr
e
0.00
260.
0026
conv
ersi
on0.
0026
0.00
26
conv
ersi
on
MSA
R23
,077
gal/a
cre/
year
MSA
Rga
l/acr
e/ye
ar
Step
3:
Max
imum
Qua
ntity
of S
epta
ge fo
r thi
s Si
teSt
ep 3
: M
axim
um Q
uant
ity o
f Sep
tage
for t
his
Site
MS
AR
23,0
77
M
SA
R
Use
able
Site
Acr
es20
Use
able
Site
Acr
es
Max
imum
Qua
ntity
of S
epta
ge46
1,53
8
gal/s
ite/y
ear
Max
imum
Qua
ntity
of S
epta
gega
l/site
/yea
r
Not
es:
N c
redi
t is
the
amou
nt o
f nitr
ogen
sup
plie
d by
fert
ilize
r, m
anur
e, o
r oth
er w
aste
s ap
plie
d on
the
site
.
Rec
omm
ende
d ra
tes
of n
itrog
en a
re fr
om T
able
7 in
the
MPC
A g
uide
lines
or f
rom
"Fe
rtili
zer R
ecom
men
datio
ns fo
r Agr
onom
ic C
rops
in M
inne
sota
"M
inne
sota
Ext
ensi
on S
ervi
ce B
ulle
tin B
U-6
240-
E.
XX
13-76 n Section 13: Forms and Reference
09/09
Property Address: ______________________
______________________
______________________
I have chosen to have my system serviced in a manner not meeting the
requirements of Minnesota Rules, Chapter 7080.2450 subp. 3 B
If no maintenance hole exists on a sewage tank, the owner or the owner’s agent shall install maintenance
holes in accordance with Minnesota Rules Chapter 7080.1970, to allow for maintenance to take place through
the maintenance hole. If the owner or owner’s agent refuses to allow removal through a maintenance hole,
the licensed Maintainer must, per Minnesota Rules Chapter 7083.0770 Subp. 2 C, obtain a signed statement
from the owner or owner’s agent that the owner or agent was informed of correct removal procedures and
the reason for refusal.
The reason for this choice is listed below.
I understand that this is my choice and accept responsibility if the system has
problems and also understand that this is substandard as recommended in the
Minnesota Rules Chapters 7080 ‐ 7083.
Stated Reason:
___________________________________________________________________
___________________________________________________________________
Owner or Agent’s Name: _______________________________________________
Signature: ___________________________________________________________
Your Logo Here
We at _____________________________________________
do not recommend the pumping of the tank through the
inspection pipe and cannot be responsible for the quality of
cleaning or inspection of the tank when service is provided
through the inspection pipe. We hope in the future to maintain
your business and stand at the ready to meet your onsite
sewage treatment needs.
Section 13: Forms and Reference n 13-77
09/09
Receipt for Septic Tank Cleaning Tasks performed: Locate Tank Open manhole depth:________ Check:
Tank level Scum depth ____% Capacity Sludge depth ____% Capacity Baffle integrity
Filter: Yes/No Type_________ Tank integrity Manhole/Riser integrity Remove contents Inspection pipes
Close/secure manhole Manhole location and depth
Clean up Locate treatment area System overview Tank Volume: __________gal
Your system has been properly maintained and should be visited again in ______ months/years. This will assure the proper operation and treatment of the wastewater at your site. If you have any questions please feel free to contact us at _______________.
Total amount collected: ____________________________ Additional work necessary: ________________________ Where was the septage disposed? __________________ Company: _____________________ Lic. # _____________
YourLogoHere
Acceptable/Problem _____________________________ Acceptable/Problem _____________________________ Acceptable/Problem _____________________________
Inlet: Acceptable/Problem________________
Outlet: Acceptable/Problem_______________
Acceptable/Problem _____________________________ Acceptable/Problem _____________________________ Acceptable/Problem _____________________________
Acceptable/Problem _____________________________
Acceptable/Problem _____________________________
13-78 n Section 13: Forms and Reference
09/09
Septic System Best Management Practices
Septic systems protect human health and the environment by safely recycling wastewater and returning it to the natural environment. It is your job as the homeowner to be sure this happens effectively and safely. As with your car, regular maintenance and attention is needed to keep it operating efficiently in a cost effective manner.
Septic TankFunctions:��Separates into three layers: scum (stuff that floats),
sludge (stuff that sinks), and the liquid. ��The solids and scum are held until removed by the
maintainer. Anaerobic bacteria work to break down wastes, prepare the liquid for the drainfield.
��The liquid is delivered to the soil treatment area to complete the treatment process.
�� If solids are not removed, they can end up in the soil treatment area, causing (often irreparable) damage.
��Factors that increase frequency of pumping: use of garbage disposal, water treatment unit that discharges into the septic system, in-home daycare or other reason a large number of people are present most of the time, laundry on the 2nd floor, excessive use of water and strong cleaning products.
Best management practices: ��Tanks need to be evaluated every two to three years
and pumped if necessary. Some counties require pumping on a specified basis. New homes—pump within 3—12 months of occupancy the first time.
��Never allow a tank to be cleaned through the inspection pipe. This is not allowed by code, and it does not allow a good cleaning to occur. Scum can plug the baffle, baffles can be knocked off. Tanks should only be cleaned through the manhole or maintenance hole.
��Be sure baffles, effluent screen, pumps and other components are inspected when the tank is pumped.
�� Install risers on the manhole covers to allow easier access. Insulate the cover and secure tightly.
��An effluent screen will prevent most solids from reaching the soil treatment area. Install and clean according to manufacturer recommendations.
��Never use additives. The cleaners are harmful to your system. They do not replace good management practices. Starters and feeders are not effective.
��Warning: NEVER go into a septic tank—there are dangerous gases and no oxygen!
��Do not ignore alarms—troubleshoot the problem.
http://septic.umn.edu
For more information: Order the Septic System Owner’s Guide. Call 800-876-8636 or go to http://shop.extension.umn.edu. Onsite Sewage Treatment Program web site: http://septic.umn.edu. University of Minnesota Extension http://www.extension.umn.edu.
Written by Valerie Prax, Regional Extension Educator, 6/07 ©2008 Regents of the University of Minnesota. All rights Reserved. The University of Minnesota is an equal opportunity educator and employer. This material can be
made available in alternative formats for people with disabilities. Call the Water Resources Center, 612-624-9282.
Septage—the solids from the tank are usually land-applied. Lime is added in the truck to destroy pathogens and help control odors. Septic pumpers must follow strict guidelines to protect public safety and water quality. Septage disposal is managed by the MN Pollution Control Agency (MPCA) and the Environmental Protection Agency (EPA).
Soil Treatment Area: Trench or Mound Functions:��Soil organisms destroy pathogens (bacteria, viruses). ��Remove phosphorus, reduce nitrogen content. ��Recycle clean water into the soil and ground water.
Water and nutrients enter the ground water, evaporate through plants, and are used by plants.
Best management practices:��Maintain vegetative cover (turf grass, native grasses,
flowers). Mow, but do not fertilize, burn or over-water. ��Keep all vehicles, bikes, snowmobiles, etc. off. ��Do not plant trees or shrubs near drainfield. �� Inspect for cracked, missing inspection pipe covers. ��Follow practices to prevent freezing, including
mulching the entire system if needed.
Household Best Management PracticesManage water use:�� Repair all leaking faucets, toilets, fixtures. �� Change to low flow toilets, shower heads. �� Replace appliances with low water use models. �� Spread water uses evenly throughout the day and week.. �� Re-route clean water sources: water softener, treatment
unit recharge water, high efficiency furnace drip, sump pumps to separate drainage area.
Watch what goes down the drain:��The toilet is not a garbage can—nothing should be
flushed except human waste and toilet paper. ��Excess medications—return to pharmacy or land-fill. ��Limit or eliminate drain cleaner use. ��Do not use automatic toilet cleaners, disposable brushes. ��Do not use every-use or automatic shower cleaners. ��No hazardous waste, paints, solvents, chemicals. Use
disposable paint brushes. ��Eliminate or limit use of garbage disposal. ��No chlorine treated water such as from hot tubs.
Manage product use:��Minimize use of anti-bacterial soaps, cleansers. ��Detergents: measure accurately, use as little as possible. ��Limit use of bleach-based cleansers.
Septic System Best Management Practices
Septic systems protect human health and the environment by safely recycling wastewater and returning it to the natural environment. It is your job as the homeowner to be sure this happens effectively and safely. As with your car, regular maintenance and attention is needed to keep it operating efficiently in a cost effective manner.
Septic TankFunctions:��Separates into three layers: scum (stuff that floats),
sludge (stuff that sinks), and the liquid. ��The solids and scum are held until removed by the
maintainer. Anaerobic bacteria work to break down wastes, prepare the liquid for the drainfield.
��The liquid is delivered to the soil treatment area to complete the treatment process.
�� If solids are not removed, they can end up in the soil treatment area, causing (often irreparable) damage.
��Factors that increase frequency of pumping: use of garbage disposal, water treatment unit that discharges into the septic system, in-home daycare or other reason a large number of people are present most of the time, laundry on the 2nd floor, excessive use of water and strong cleaning products.
Best management practices: ��Tanks need to be evaluated every two to three years
and pumped if necessary. Some counties require pumping on a specified basis. New homes—pump within 3—12 months of occupancy the first time.
��Never allow a tank to be cleaned through the inspection pipe. This is not allowed by code, and it does not allow a good cleaning to occur. Scum can plug the baffle, baffles can be knocked off. Tanks should only be cleaned through the manhole or maintenance hole.
��Be sure baffles, effluent screen, pumps and other components are inspected when the tank is pumped.
�� Install risers on the manhole covers to allow easier access. Insulate the cover and secure tightly.
��An effluent screen will prevent most solids from reaching the soil treatment area. Install and clean according to manufacturer recommendations.
��Never use additives. The cleaners are harmful to your system. They do not replace good management practices. Starters and feeders are not effective.
��Warning: NEVER go into a septic tank—there are dangerous gases and no oxygen!
��Do not ignore alarms—troubleshoot the problem.
http://septic.umn.edu
For more information: Order the Septic System Owner’s Guide. Call 800-876-8636 or go to http://shop.extension.umn.edu. Onsite Sewage Treatment Program web site: http://septic.umn.edu. University of Minnesota Extension http://www.extension.umn.edu.
Written by Valerie Prax, Regional Extension Educator, 6/07 ©2008 Regents of the University of Minnesota. All rights Reserved. The University of Minnesota is an equal opportunity educator and employer. This material can be
made available in alternative formats for people with disabilities. Call the Water Resources Center, 612-624-9282.
Septage—the solids from the tank are usually land-applied. Lime is added in the truck to destroy pathogens and help control odors. Septic pumpers must follow strict guidelines to protect public safety and water quality. Septage disposal is managed by the MN Pollution Control Agency (MPCA) and the Environmental Protection Agency (EPA).
Soil Treatment Area: Trench or Mound Functions:��Soil organisms destroy pathogens (bacteria, viruses). ��Remove phosphorus, reduce nitrogen content. ��Recycle clean water into the soil and ground water.
Water and nutrients enter the ground water, evaporate through plants, and are used by plants.
Best management practices:��Maintain vegetative cover (turf grass, native grasses,
flowers). Mow, but do not fertilize, burn or over-water. ��Keep all vehicles, bikes, snowmobiles, etc. off. ��Do not plant trees or shrubs near drainfield. �� Inspect for cracked, missing inspection pipe covers. ��Follow practices to prevent freezing, including
mulching the entire system if needed.
Household Best Management PracticesManage water use:�� Repair all leaking faucets, toilets, fixtures. �� Change to low flow toilets, shower heads. �� Replace appliances with low water use models. �� Spread water uses evenly throughout the day and week.. �� Re-route clean water sources: water softener, treatment
unit recharge water, high efficiency furnace drip, sump pumps to separate drainage area.
Watch what goes down the drain:��The toilet is not a garbage can—nothing should be
flushed except human waste and toilet paper. ��Excess medications—return to pharmacy or land-fill. ��Limit or eliminate drain cleaner use. ��Do not use automatic toilet cleaners, disposable brushes. ��Do not use every-use or automatic shower cleaners. ��No hazardous waste, paints, solvents, chemicals. Use
disposable paint brushes. ��Eliminate or limit use of garbage disposal. ��No chlorine treated water such as from hot tubs.
Manage product use:��Minimize use of anti-bacterial soaps, cleansers. ��Detergents: measure accurately, use as little as possible. ��Limit use of bleach-based cleansers.
Section 13: Forms and Reference n 13-79
09/09 - 1 -
Septic System Management Plan for Below Grade Systems
The goal of a septic system is to protect human health and the environment by properly treating wastewater before returning it to the environment. Your septic system is designed to kill harmful organisms and remove pollutants before the water is recycled back into our lakes, streams and groundwater.
This management plan will identify the operation and maintenance activities necessary to ensure long-term performance of your septic system. Some of these activities must be performed by you, the homeowner. Other tasks must be performed by a licensed septic maintainer or service provider. However, it is YOUR responsibility to make sure all tasks get accomplished in a timely manner.
The University of Minnesota’s Septic System Owner’s Guide contains additional tips and recommendations designed to extend the effective life of your system and save you money over time.
Proper septic system design, installation, operation and maintenance means safe and clean water!
Property Owner
Property Address Property ID
System Designer License #
System Installer License #
Service Provider/Maintainer Phone
Permitting Authority Phone
Permit # Date Inspected
Keep this Management Plan with your Septic System Owner’s Guide. The Septic System Owner’s Guide includes a folder to hold maintenance records including pumping, inspection and evaluation reports. Ask your septic professional to also:
Attach permit information, designer drawings and as-builts of your system, if they are available. Keep copies of all pumping records and other maintenance and repair invoices with this document. Review this document with your maintenance professional at each visit; discuss any changes in product
use, activities, or water-use appliances.
For a copy of the Septic System Owner’s Guide, call 1-800-876-8636 or go to http://shop.extension.umn.edu/
http://septic.umn.edu
13-80 n Section 13: Forms and Reference
09/09
Septic System Management Planfor Below Grade Systems
- 2 -
Your Septic System
Septic System Specifics
System Type: I II III IV* V*
(Based on MN Rules Chapter 7080.2200 – 2400)
System is subject to operating permit* System uses UV disinfection unit* Type of advanced treatment unit ______________ *Additional Management Plan required
Dwelling Type Well Construction Number of bedrooms: ______________________
System capacity/ design flow (gpd): __________
Anticipated average daily flow (gpd): __________
Comments________________________________
In-home business? ___ What type? ____________
Well depth (ft): __________________________
Cased well Casing depth: ___________
Other (specify): ___________________
Distance from septic (ft):____________________
Is the well on the design drawing? Y N
Septic Tank One tank Tank volume: _________ gallons
Does tank have two compartments? Y N
Two tanks Tank volume: _________ gallons
Tank is constructed of _________
Effluent Screen type: __________________
Pump Tank (if one) _________ gallons
Effluent Pump type: _________________
TDH _____ Feet of head
Pump capacity ______ GPM
Alarm _____ visual _____ audible
Soil Treatment Area Trenches: ___________ total lineal feet
Number of trenches: _____ at _______ feet each
Drainbed size (length x width): ____ ft x ____ ft
Gravity distribution Pressuredistribution
Inspection ports Cleanouts
Section 13: Forms and Reference n 13-81
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- 3 -
Homeowner Management Tasks
These operation and maintenance activities are your responsibility. Use the chart on page 6 to track your activities.
Identify the service intervals recommended by your system designer and your local government. The tank assessment for your system will be the shortest interval of these three intervals. Your pumper/maintainer will determine if your tank needs to be pumped.
System Designer: check every ________ months My tank needs to be checked every _____ months
Local Government: check every ________ months State Requirement: check every 36 months
Seasonally or several times per year
Leaks. Check (listen, look) for leaks in toilets and dripping faucets. Repair leaks promptly. Surfacing sewage. Regularly check for wet or spongy soil around your soil treatment area. If
surfaced sewage or strong odors are not corrected by pumping the tank or fixing broken caps and leaks, call your service professional. Untreated sewage may make humans and animals sick.
Alarms. Alarms signal when there is a problem; contact your maintainer any time the alarm signals.
Lint filter. If you have a lint filter, check for lint buildup and clean when necessary. Consider adding one after washing machine.
Effluent screen. If you do not have one, consider having one installed the next time the tank is cleaned.
Annually
Water usage rate. A water meter can be used to monitor your average daily water use. Compare your water usage rate to the design flow of your system (listed on the next page). Contact your septic professional if your average daily flow over the course of a month exceeds 70% of the design flow for your system.
Caps. Make sure that all caps and lids are intact and in place. Inspect for damaged caps at least every fall. Fix or replace damaged caps before winter to help prevent freezing issues.
Water conditioning devices. See Page 5 for a list of devices. When possible, program the recharge frequency based on water demand (gallons) rather than time (days). Recharging too frequently may negatively impact your septic system.
Review your water usage rate. Review the Water Use Appliance chart on Page 5. Discuss any major changes with your pumper/maintainer.
During each visit by a pumper/maintainer
Ask if your pumper/maintainer is licensed in Minnesota. Make sure that your pumper/maintainer services the tank through the manhole. (NOT though a 4”
or 6” diameter inspection port.) Ask your pumper/maintainer to accomplish the tasks listed on the Professional Tasks on Page 4.
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Professional Management Tasks These are the operation and maintenance activities that a pumper/maintainer performs to help ensure long-term performance of your system. Professionals should refer to the O/M Manual for detailed checklists for tanks, pumps, alarms and other components. Call 800-322-8642 for more details.
Written record provided to homeowner after each visit.
Plumbing/Source of Wastewater Review the Water Use Appliance Chart on Page 5 with homeowner. Discuss any changes in
water use and the impact those changes may have on the septic system. Review water usage rates (if available) with homeowner.
Septic Tank/Pump Tanks Manhole lid. A riser is recommended if the lid is not accessible from the ground surface. Insulate
the riser cover for frost protection. Liquid level. Check to make sure the tank is not leaking. The liquid level should be level with the
bottom of the outlet pipe. (If the water level is below the bottom of the outlet pipe, the tank may not be watertight. If the water level is higher than the bottom of the outlet pipe of the tank, the effluent screen may need cleaning, or there may be ponding in the drainfield.)
Inspection pipes. Replace damaged caps. Baffles. Check to make sure they are in place and attached, and that inlet/outlet baffles are clear
of buildup or obstructions. Effluent screen. Check to make sure it is in place; clean per manufacturer recommendation.
Recommend retrofitted installation if one is not present. Alarm. Verify that the alarm works. Scum and sludge. Measure scum and sludge in each compartment of each septic and pump tank,
pump if needed.
Pump Pump and controls. Check to make sure the pump and controls are operating correctly. Pump vault. Check to make sure it is in place; clean per manufacturer recommendations. Alarm. Verify that the alarm works. Drainback. Check to make sure it is operating properly. Event counter or run time. Check to see if there is an event counter or run time log for the pump.
If there is one, calculate the water usage rate and compare to the anticipated average daily flow listed on Page 2.
Soil Treatment Area Inspection pipes. Check to make sure they are properly capped. Replace caps that are damaged. Surfacing of effluent. Check for surfaced effluent or other signs of problems. Gravity trenches and beds. Check the number of gravity trenches with ponded effluent. Identify
the percentage of the system in use. Determine if action is needed. Pressure trenches and beds - Lateral flushing. Check lateral distribution; if cleanouts exist, flush
and clean as needed.
All other components – inspect as listed here:
Section 13: Forms and Reference n 13-83
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Septic System Management Planfor Below Grade Systems
- 5 -
Water-Use Appliances and Equipment in the Home
Appliance Impacts on System Management Tips
Garbage disposal
Uses additional water. Adds solids to the tank. Finely-ground solids may not settle.
Unsettled solids can exit the tank and enter the soil treatment area.
Use of a garbage disposal is not recommended. Minimize garbage disposal use. Compost instead. To prevent solids from exiting the tank, have your
tank pumped more frequently. Add an effluent screen to your tank.
Washing machine
Washing several loads on one day uses a lot of water and may overload your system.
Overloading your system may prevent solids from settling out in the tank. Unsettled solids can exit the tank and enter the soil treatment area.
Choose a front-loader or water-saving top-loader, these units use less water than older models.
Limit the addition of extra solids to your tank by using liquid or easily biodegradable detergents.
Install a lint filter after the washer and an effluent screen to your tank
Wash only full loads. Limit use of bleach-based detergents. Think even – spread your laundry loads throughout
the week.
2nd floor laundry The rapid speed of water entering
the tank may reduce performance. Install an effluent screen in the septic tank to prevent
the release of excessive solids to the soil treatment area.
Be sure that you have adequate tank capacity.
Dishwasher
Powdered and/or high-phosphorus detergents can negatively impact the performance of your tank and soil treatment area.
New models promote “no scraping”. They have a garbage disposal inside.
Use gel detergents. Powdered detergents may add solids to the tank.
Use detergents that are low or no-phosphorus. Wash only full loads. Scrape your dishes anyways to keep undigested
solids out of your septic system.
Grinder pump (in home)
Finely-ground solids may not settle. Unsettled solids can exit the tank and enter the soil treatment area.
Expand septic tank capacity by a factor of 1.5. Include pump monitoring in your maintenance
schedule to ensure that it is working properly. Add an effluent screen.
Large bathtub (whirlpool)
Large volume of water may overload your system.
Heavy use of bath oils and soaps can impact biological activity in your tank and soil treatment area.
Avoid using other water-use appliances at the same time. For example, don’t wash clothes and take a bath at the same time.
Use oils, soaps, and cleaners in the bath or shower sparingly.
Clean Water Uses Impacts on System Management Tips
High-efficiency furnace
Drip may result in frozen pipes during cold weather.
Re-route water into a sump pump or directly out of the house. Do not route furnace recharge to your septic system.
Water softener Iron filter Reverse osmosis
Salt in recharge water may affect system performance.
Recharge water may hydraulically overload the system.
These sources produce water that is not sewage and should not go into your septic system.
Reroute water from these sources to another outlet, such as a dry well, draintile or old drainfield.
When replacing, consider using a demand-based recharge vs. a time-based recharge.
Check valves to ensure proper operation; have unit serviced per manufacturer directions
Surface drainage Footing drains
Water from these sources will likely overload the system.
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Maintenance Log
Track maintenance activities here for easy reference. See list of management tasks on pages 3and 4.
Activity Date accomplished
Check frequently:
Leaks: check for plumbing leaks
Soil treatment area check for surfacing
Lint filter: check, clean if needed
Effluent screen: if owner-maintained
Check annually:
Water usage rate (monitor frequency____)
Caps: inspect, replace if needed
Water use appliances – review use
Other:
Notes: ________________________________________________________________________ ______________________________________________________________________________Mitigation/corrective action plan: __________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
“As the owner of this SSTS, I understand it is my responsibility to properly operate and maintain the sewage treatment system on this property, utilizing the Management Plan. If requirements in this Management Plan are not met, I will promptly notify the permitting authority and take necessary corrective actions. If I have a new system, I agree to adequately protect the reserve area for future use as a soil treatment system.”
Property Owner Signature: Date
Management Plan Prepared By: Certification #
Permitting Authority:
©2009 Regents of the University of Minnesota. All rights reserved. The University of Minnesota is an equal opportunity educator and employer. This material is available in alternative formats upon request. Contact the Water Resources Center, 612-624-9282. The Onsite Sewage Treatment Program is delivered by the University of Minnesota Extension Service and the University of Minnesota Water Resources Center.
Section 13: Forms and Reference n 13-85
09/09
- 1 -
Septic System Management Planfor Above Grade Systems
The goal of a septic system is to protect human health and the environment by properly treating wastewater before returning it to the environment. Your septic system is designed to kill harmful organisms and remove pollutants before the water is recycled back into our lakes, streams and groundwater.
This management plan will identify the operation and maintenance activities necessary to ensure long-term performance of your septic system. Some of these activities must be performed by you, the homeowner. Other tasks must be performed by a licensed septic maintainer or service provider. However, it is YOUR responsibility to make sure all tasks get accomplished in a timely manner.
The University of Minnesota’s Septic System Owner’s Guide contains additional tips and recommendations designed to extend the effective life of your system and save you money over time.
Proper septic system design, installation, operation and maintenance means safe and clean water!
Property Owner
Property Address Property ID
System Designer License #
System Installer License #
Service Provider/Maintainer Phone
Permitting Authority Phone
Permit # Date Inspected
Keep this Management Plan with your Septic System Owner’s Guide. The Septic System Owner’s Guideincludes a folder designed to hold maintenance records including pumping, inspection and evaluation reports. Ask your septic professional to also:
Attach permit information, designer drawings and as-builts of your system, if they are available. Keep copies of all pumping records and other maintenance and repair invoices with this document. Review this document with your maintenance professional at each visit; discuss any changes in product
use, activities or water-use appliances.
For a copy of the Septic System Owner’s Guide, call 1-800-876-8636 or go to http://shop.extension.umn.edu/
http://septic.umn.edu
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Your Septic System
Septic System Specifics
System Type: I II III IV* V*
(Based on MN Rules Chapter 7080.2200 – 2400)
System is subject to operating permit* System uses UV disinfection unit* Type of advanced treatment unit ______________ *Additional Management Plan required
Dwelling Type Well Construction Number of bedrooms: ______________________
System capacity/ design flow (gpd): __________
Anticipated average daily flow (gpd): __________
Comments________________________________
In-home business? ___ What type? ____________
Well depth (ft): __________________________
Cased well Casing depth: ___________
Other (specify): ___________________
Distance from septic (ft):____________________
Is the well on the design drawing? Y N
Septic Tank One tank Tank volume: _________ gallons
Does tank have two compartments? Y N
Two tanks Tank volume: _________ gallons
Tank is constructed of _________
Effluent Screen type: __________________
Pump Tank (if one) _________ gallons
Effluent Pump type: _________________
TDH _____ Feet of head
Pump capacity ______ GPM
Alarm _____ visual _____ audible
Soil Treatment Area
Mound/At-Grade area (length x width): ___ ft x ___ ft
Rock bed size (length x width): ___ ft x ___ ft
Cleanouts or Inspection Ports
Surface Water Diversions
Section 13: Forms and Reference n 13-87
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- 3 -
Homeowner Management Tasks These operation and maintenance activities are your responsibility. Use the chart on page 6 to track your activities.
Identify the service intervals recommended by your system designer and your local government. The tank assessment for your system will be the shortest interval of these three intervals. Your pumper/maintainer will determine if your tank needs to be pumped.
System Designer: check every ________ months My tank needs to be checked every _____ months
Local Government: check every ________ months State Requirement: check every 36 months
Seasonally or several times per year
Leaks. Check (listen, look) for leaks in toilets and dripping faucets. Repair leaks promptly. Surfacing sewage. Regularly check for wet or spongy soil around your soil treatment area. If
surfaced sewage or strong odors are not corrected by pumping the tank or fixing broken caps, call your service professional. Untreated sewage may make humans and animals sick.
Alarms. Alarms signal when there is a problem; contact your maintainer any time the alarm signals.
Lint filter. If you have a lint filter, check for lint buildup and clean when necessary. Consider adding one after washing machine.
Effluent screen. If you do not have one, consider having one added the next time the tank is cleaned.
Annually
Water usage rate. A water meter can be used to monitor your average daily water use. Compare your water usage rate to the design flow of your system (listed on the next page). Contact your septic professional if your average daily flow over the course of a month exceeds 70% of the design flow for your system.
Caps. Make sure that all caps and lids are intact and in place. Inspect for damaged caps at least every fall. Fix or replace damaged caps before winter to help prevent freezing issues.
Water conditioning devices. See Page 5 for a list of devices. When possible, program the recharge frequency based on water demand (gallons) rather than time (days). Recharging too frequently may negatively impact your septic system.
Review your water usage rate. Review the Water Use Appliance chart on Page 5. Discuss any major changes with your pumper/maintainer.
During each visit by a pumper/maintainer Ask if your pumper/maintainer is licensed in Minnesota. Make sure that your pumper/maintainer services the tank through the manhole. (NOT though a 4”
or 6” diameter inspection port.) Ask your pumper/maintainer to accomplish the tasks listed on the Professional Tasks on Page 4.
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Professional Management TasksThese are the operation and maintenance activities that a pumper/maintainer performs to help ensure long-term performance of your system. Professionals should refer to the O/M Manual for detailed checklists for tanks, pumps, alarms and other components. Call 800-322-8642 for more details.
Written record provided to homeowner after each visit.
Plumbing/Source of Wastewater Review the Water Use Appliance Chart on Page 5 with homeowner. Discuss any changes in
water use and the impact those changes may have on the septic system. Review water usage rates (if available) with homeowner.
Septic Tank/Pump Tanks Manhole lid. A riser is recommended if the lid is not accessible from the ground surface. Insulate
the riser cover for frost protection. Liquid level. Check to make sure the tank is not leaking. The liquid level should be level with the
bottom of the outlet pipe. (If the water level is below the bottom of the outlet pipe, the tank may not be watertight. If the water level is higher than the bottom of the outlet pipe of the tank, the effluent screen may need cleaning, or there may be ponding in the drainfield.)
Inspection pipes. Replace damaged caps. Baffles. Check to make sure they are in place and attached, and that inlet/outlet baffles are clear
of buildup or obstructions. Effluent screen. Check to make sure it is in place; clean per manufacturer recommendation.
Recommend retrofitted installation if one is not present. Alarm. Verify that the alarm works. Scum and sludge. Measure scum and sludge in each compartment of each septic and pump tank,
pump if needed.
Pump Pump and controls. Check to make sure the pump and controls are operating correctly. Pump vault. Check to make sure it is in place; clean per manufacturer recommendations. Alarm. Verify that the alarm works. Drainback. Check to make sure it is operating properly. Event counter or run time. Check to see if there is an event counter or run time log for the pump.
If there is one, calculate the water usage rate and compare to the anticipated average daily flow listed on Page 2.
Soil Treatment Area Inspection pipes. Check to make sure they are properly capped. Replace caps that are damaged. Surfacing of effluent. Check for surfaced effluent or other signs of problems. Lateral flushing. Check lateral distribution; if cleanouts exist, flush and clean as needed. Ponding. Check for ponding. Excessive ponding in at-grade and mound beds indicates
problems.
All other components – inspect as listed here:
Section 13: Forms and Reference n 13-89
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- 5 -
Water-Use Appliances and Equipment in the Home
Appliance Impacts on System Management Tips
Garbage disposal
Uses additional water. Adds solids to the tank. Finely-ground solids may not settle.
Unsettled solids can exit the tank and enter the soil treatment area.
Use of a garbage disposal is not recommended. Minimize garbage disposal use. Compost instead. To prevent solids from exiting the tank, have your
tank pumped more frequently. Add an effluent screen to your tank.
Washing machine
Washing several loads on one day uses a lot of water and may overload your system.
Overloading your system may prevent solids from settling out in the tank. Unsettled solids can exit the tank and enter the soil treatment area.
Choose a front-loader or water-saving top-loader, these units use less water than older models.
Limit the addition of extra solids to your tank by using a liquid or easily biodegradable detergents.
Install a ling filter after the washer and an effluent screen on your tank.
Wash only full loads. Limit use of bleach-based detergents. Think even – spread your laundry loads
throughout the week.
2nd floor laundry The rapid speed of water entering
the tank may reduce performance. Install an effluent screen in the septic tank to
prevent the release of excessive solids to the soil treatment area.
Be sure that you have adequate tank capacity.
Dishwasher
Powdered and/or high-phosphorus detergents can negatively impact the performance of your tank and soil treatment area.
New models promote “no scraping”. They have a garbage disposal inside.
Use gel detergents. Powdered detergents may add solids to the tank.
Use detergents that are low or no-phosphorus. Wash only full loads. Scrape your dishes anyways to keep undigested
solids out of your septic system.
Grinder pump (in home)
Finely-ground solids may not settle. Unsettled solids can exit the tank and enter the soil treatment area.
Expand septic tank capacity by a factor of 1.5. Include pump monitoring in your maintenance
schedule to ensure that it is working properly. Add an effluent screen.
Large bathtub (whirlpool)
Large volume of water may overload your system.
Heavy use of bath oils and soaps can impact biological activity in your tank and soil treatment area.
Avoid using other water-use appliances at the same time. For example, don’t wash clothes and take a bath at the same time.
Use oils, soaps, and cleaners in the bath or shower sparingly.
Clean Water Uses Impacts on System Management Tips
High-efficiency furnace
Drip may result in frozen pipes during cold weather.
Re-route water into a sump pump or directly out of the house. Do not route furnace recharge to your septic system.
Water softener Iron filter Reverse osmosis
Salt in recharge water may affect system performance.
Recharge water may hydraulically overload the system.
These sources produce water that is not sewage and should not go into your septic system.
Reroute water from these sources to another outlet, such as a dry well, draintile or old drainfield.
When replacing consider using a demand-based recharge vs. a time-based recharge.
Check valves to ensure proper operation; have unit serviced per manufacturer directions
Surface drainage Footing drains
Water from these sources will likely overload the system.
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- 6 -
Maintenance Log
Track maintenance activities here for easy reference. See list of management tasks on pages 3 and 4.
Activity Date accomplished
Check frequently:
Leaks: check for plumbing leaks
Soil treatment area check for surfacing
Lint filter: check, clean if needed
Effluent screen: if owner-maintained
Check annually:
Water usage rate (monitor frequency____)
Caps: inspect, replace if needed
Water use appliances – review use
Other:
Notes: ________________________________________________________________________ ______________________________________________________________________________Mitigation/corrective action plan: _________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
“As the owner of this SSTS, I understand it is my responsibility to properly operate and maintain the sewage treatment system on this property, utilizing the Management Plan. If requirements in this Management Plan are not met, I will promptly notify the permitting authority and take necessary corrective actions. If I have a new system, I agree to adequately protect the reserve area for future use as a soil treatment system.”
Property Owner Signature: Date
Management Plan Prepared By: Certification #
Permitting Authority:
©2009 Regents of the University of Minnesota. All rights reserved. The University of Minnesota is an equal opportunity educator and employer. This material is available in alternative formats upon request. Contact the Water Resources Center, 612-624-9282. The Onsite Sewage Treatment Program is delivered by the University of Minnesota Extension Service and the University of Minnesota Water Resources Center.
Section 13: Forms and Reference n 13-91
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www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats wq-wwists5-15 • 4/13/09 Page 1 of 6
<Insert logo/address here> Wastewater Treatment andDispersal Operating Permit
Operating Permit No. ____________
Note: To unlock this form for editing, select the Tools Menu/Unprotect Document.
Facility Information Permittee name: Phone number:
Mailing address:
City: State: Zip code:
Property ID number (GPS location):
authorizes the Permittee to operate a wastewater treatment and dispersal system
at the address named above in accordance with the requirements of this operating permit. The attached Management Plan is hereby incorporated as part of the requirements of this operating permit.
Issuance date: Expiration date:
System type: Treatment level:
System design flow: Residential/Commercial:
System components:
Monitoring Requirements
Parameter Target limits Frequency Location Flow CBOD TSS Fecal Coliform bacteria Total Nitrogen Field Tests: Temperature and Dissolved Oxygen Ponding/Surfacing in soil treatment CBOD = Carbonaceous Biochemical Oxygen Demand TSS = Total Suspended Solids
Maintenance Requirements Maintenance requirements shall be performed as specified in the Management Plan as prepared by the system’s Advanced Designer.
System component Maintenance Frequency Septic tank/Trash tank Pump tank and controls Effluent screen Advanced treatment product UV light disinfection device Soil treatment and dispersal Ponding/Surfacing in soil treatment UV = Ultra Violet Light
Page 1 of 4
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Monitoring Protocol Any sampling and laboratory testing procedures shall be performed in accordance with the proprietary treatment product’s protocol,Standard Methods, and at a Minnesota Department of Health approved laboratory. Results shall be submitted to the permitting authority at:
Contingency Plan In the event the wastewater treatment system does not meet required performance requirements as contained in this operating permit, the owner shall notify the local unit of government within 30 days of non-compliance. The owner is responsible to obtain the services of a Minnesota Pollution Control Agency (MPCA)-licensed Service Provider to complete the required corrective measures.
Authorization This permit is effective on the issuance date identified above. This permit and the authorization to treat and disperse wastewatershall expire in year(s). The Permittee is not authorized to discharge after the above date of expiration. The Permittee shall submit monitoring information and forms as required by no later than sixty (60) days prior to the above date of expiration for operating permit renewal. This permit is not transferable.
The owner is required to obtain the services of a Minnesota Pollution Control Agency (MPCA) licensed 1) Service Provider to provide ongoing system operation, maintenance, and monitoring and 2) Maintainer to pump the system’s sewage tanks and components. The owner is responsible to provide the name of the Service Provider business prior to the issuance of this operating permit. The owner has secured the services of as the Service Provider for this system (signed Service Provider contract attached).
I hereby certify with my signature as the Permittee that I understand the provisions of the wastewater treatment and dispersal system operating permit including maintenance and monitoring requirements. I agree to indemnify and hold harmless from all loss, damages, costs and charges that may be incurred by the use of this system. If I fail to comply with theprovisions of this operation permit, I understand that penalties may be issued. If I sell this property during the life of the permit, I will inform the new owner(s) of the permit requirements and the need to renew the operating permit.
The Operating Permit is hereby granted to:
Permittee(please print):
Permitting Authority (please print):
Title: Date: Title: Date:
Signature: Signature:
Page 2 of 4
Section 13: Forms and Reference n 13-93
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Instructions for Completing an Operating Permit
The following instructions provide an explanation for local units of government to complete the operating permit template. This is intended to provide guidance to local units of governments (LGU) in developing operating permits for Type IV and Type V systems,including both residential and commercial systems. The template could be modified for holding tanks. Since the Management Plan is considered part of the operating permit, it needs to be attached to the operating permit. A signed contract, between the owner and Service Provider, should be attached to the operating permit to help ensure the owner has made the necessary arrangements to have the system maintained and monitored.
LGU Name, Department and Address – fill in the name, department and address of local unit of government at the top of the operating permit.
Wastewater Treatment and Dispersal Operating Permit No. – assign an operating permit number to be able to track the system over the years.
Permittee Name, Telephone Number, and Address – fill in the name, address and phone number of the owner.
Property Id. Number (GPS Location) – these are simply identifiers used by local units of government in the event the property address changes over time.
Name of Local Unit of Government – fill in the name of the local unit of government. This authorizes the Permittee to operate the wastewater treatment system at the address named above, according to the operating permit, attached Management Plan and contract with the Service Provider.
Issuance Date – fill in the date the operating permit is issued. The operating permit should not be issued until all required information is submitted.
Expiration Date – fill in the date when this operating permit expires. The first time an operating permit is issued to an owner, it should be issued for one (1) year. This helps ensure the owner actually does the required maintenance and monitoring during thefirst year. If the owner complies, the operating permit can then be issued for a longer period of time as determined by the local unit of government (typically 3 to 5 years). However, if the owner does not comply the first year, the second operating permit could,again, be issued for a period of one (1) year.
System Type – fill in as Type IV or Type V system. Holding tanks also require operating permits (Type II system).
Treatment Level – specify Treatment Level A, B, C, TN or TP. Treatment Level A = Carbonaceous Biochemical Oxygen Demand (CBOD) 15 milligrams per liter (mg/L), Total Suspended Solids (TSS) 15 mg/L, Fecal Coliform Bacteria 1000 per 100 ml; TreatmentLevel B = CBOD 25 mg/L, TSS 30 mg/L, Fecal Coliform Bacteria 10,000 per 100 ml; Treatment Level C = CBOD 125 mg/L, TSS 80 mg/L, Oil and Grease 20 mg/L; TN = 20 mg/L, or TP = 2 mg/L.
System Design Flow – fill in the design flow specified on the construction permit for the system. You may want to note both design flow and average daily flow, if applicable.
Residential/Commercial – specify if the system is residential or commercial. You may specify additional information, such as classification of dwelling, number of bedrooms; or type of commercial establishment.
System Components – provide a brief description of the system components. An example would be the following: 600 gallon trash tank, 600 gallon ECOPOD treatment device, 1 Salcor Ultra Violet (UV) light disinfection unit, 500-gallon pump tank, pump, floatsand controls, and 250-foot shallow trenches using pressure distribution.
Monitoring Requirements (Table)
The monitoring requirements specified in an operating permit are unique to the site and soil conditions of the property (its environmental sensitivity) and system complexity. The monitoring requirements include specific parameters to be monitored, targetlimits and the frequency and location of monitoring. The monitored parameters, at a minimum, would include: 1) wastewater flow -the most basic parameter to know in understanding system performance, 2) ponding in the soil treatment system and 3) surfacing ofthe soil treatment system. Monitoring for CBOD, TSS, fecal coliform bacteria and nitrogen are unique to the site, its receivingenvironment and complexity of the wastewater system. Field tests for temperature, pH and dissolved oxygen can be performed by the Service Provider to serve as general indicators of system performance.
1. Flow – flow to each system needs to be determined as specified in the Management Plan or as determined by the local unit of government. Flow can be determined several ways, using water meters, event counters, and running time clocks. Telemetry can also be used and has the advantage that flow can be determined continually.
The determination for the frequency of flow measurement is done on a case-by-case basis. At first, daily flow monitoring may be needed to determine average flow and peak flows to a system. After a period of time, weekly or monthly flow determination may be acceptable. Flow determinations once a year generally provide limited information.
Page 3 of 4
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www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats wq-wwists5-15 • 4/13/09 Page 4 of 6
2. CBOD – monitoring for CBOD is not typically required for the majority of wastewater systems used for single-family homes generating typical domestic strength effluent. However, monitoring for CBOD may be needed periodically. For example, there may be a need to audit systems as part of the product registration process in Minnesota or if the Service Provider is trying to troubleshoot a system. For commercial systems, monitoring for CBOD is generally necessary to determine CBOD removal efficiencies of proprietary treatment devices and/or organic loading rates to the soil’s infiltrative surface.
3. TSS – monitoring for TSS is not typically required for most residential wastewater systems that generate typical domestic strength effluent. However, turbidity measurements may be taken in the field by Service Providers. Monitoring for TSS may be needed periodically as part of an audit process for the registration of proprietary treatment products in Minnesota. For commercial systems, monitoring for TSS may be necessary.
4. Fecal Coliform Bacteria – monitoring for fecal coliform bacteria will generally be required for systems listed as Treatment Level A and Treatment Level B systems where reduced vertical soil separation is used.
5. Total Nitrogen and Total Phosphorus – monitoring for Total Nitrogen (TN) may be needed in areas identified as nitrogen sensitive environments. Monitoring for Total Phosphorus (TP) may be required in phosphorus sensitive lake environments.
6. Field Tests – these are tests performed by the Service Provider to help ‘monitor’ system performance and identify problems (troubleshooting a system). Although field tests are not a strict monitoring requirement, they are appropriate to list in the operating permit if specified in the Management Plan or in the product’s Operation and Maintenance Manual. The local unit of government will determine if the permittee is required to report field test results as part of the operating permit.
7. Ponding/Surfacing in Soil Treatment – all systems should be monitored periodically as specified in the Management Plan to determine extent and frequency of ponding in soil treatment systems. A check for surfacing is needed.
Maintenance Requirements (Table)
This table lists some of the basic maintenance requirements for each major component of the wastewater system. Since you can’t possibly list all the maintenance requirements in this table, it is best to reference the Management Plan. You could reference theproprietary product’s Operation and Maintenance Manual.
1. System Component – list each system component, including the septic tank, trash tank, effluent screen, pump tank and controls, proprietary treatment product, disinfection device, and soil treatment and dispersal system.
2. Maintenance – briefly identify the maintenance requirements of each major system component. For additional information, you could also reference the proprietary product documents listed on the MPCA Web site at http://www.pca.state.mn.us/programs/ists/productregistration.html.
3. Frequency – briefly identify the frequency of maintenance as per the systems Management Plan and Operation and Maintenance Manual.
Monitoring Protocol – this section of the operating permit states that testing needs to be performed in accordance with approved methods and the results submitted to the local unit of government.
Contingency Plan – briefly describes requirements if the system does not function as intended. The owner must notify the local unit of government when non-compliance occurs. The Management Plan may identify some of the corrective actions required or you will need to consult your Service Provider. The owner is responsible to obtain the services of a MPCA-licensed Service Provider to complete the required corrective measures. More detail could be added here by the local unit of government.
Authorization – fill in the length of time of the operating permit; this is typically one to five years. Fill in the name of the local unit ofgovernment in the second blank space. Next, fill in the name of the MPCA licensed Service Provider identified by the owner in contract; this is needed to help ensure the owner has made the necessary arrangements to have the system maintained and monitored.
The Operating Permits Hereby Granted to – print the name of the owner who signed the operating permit.
Signature of Permittee (and date of signature) – the owner signs and dates the operating permit.
By Order of – signature of the permitting authority, title, and date.
Page 4 of 4
Section 13: Forms and Reference n 13-95
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© 2009, Regents of the University of Minnesota. All rights reserved. For additi onal copies or for Americans with Disabiliti es Act accommodati ons, please call (800) 322-8642. University of Minnesota is an equal opportunity educator and employer.
How often a septic tank needs to be pumped depends on the system design and how your household uses the system. Complete this chart, repeating every few years to gauge how often you should have your tank inspected or pumped. Remember these are guidelines. Your Maintainer or Service Provider can give you a better estimate of your pumping needs. State and local codes may dictate the maximum amount of time between tank cleanings.
Mai
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Car
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FACTOR POINTSEFFECTS
Add your TOTAL score, enter here. (Compare your score to the risk level chart below)
Do you use a garbage disposal or dishwasher with a food grinder?
Is sewage pumped out of your basement to the septic tank (instead of using gravity flow), and/or is a sump pump connected to the septic system?
Do you have a water-conditioning unit for which recharge water is connected to the septic system? (water softener, iron filter or other devices)
How often do you wash laundry?
Do you have a water-conserving top-loading washer, or a front-loading washing machine?
Do you use low flow showerheads, toilets, not leave the faucet running, and repair leaks quickly?
Do you use few and mild cleaning products and detergents, limiting anti-bacterial products?
Do you have an in-home business that increases water use? (such as a daycare, taxidermy shop, hair salon)
Do you have 3 or more overnight guests at a time, or have large groups visit your house?
When was the last time your septic tank was pumped or evaluated (inspected)?
Is your septic tank (not including pump tanks) smaller than…
Are there more people living in your home than there are bedrooms?
Score Risk Level Outcome
0 - 8 Low Risk Based on your system and positive use habits, your system should be evaluated once every 2-3 years to determine if tank cleaning is necessary. Do not go more than 3 years without an evaluation. Some counties and municipalities require pumping or inspection every 3 years.
9 - 18 Medium Risk Based on your tank size and use habits, your system should be evaluated every 1½ - 2½ years to determine if tank cleaning is necessary.
19 - 26 High Risk Based on your tank size and use habits, your system should be evaluated annually to determine if tank cleaning is necessary.
Number of people Bedrooms 3 2 or fewer 4 3 5 4 6 or more 5 or more
Tank Capacity Bedrooms 1,000 3 or fewer 1,500 4 – 5 2,000 6 or more
more, enter 2
Spread out during the week with no more than 2 loads/day, enter 02
More than 3 loads/day, several times/week, enter 4
0
metimes or have made some changes, enter 1make repairs quickly, enter 0
0
onth, enter 0
large gatherings in your home, enter 4
1
more than 5 years ago, enter 3
Septic Tank Pumping Frequency Guidelines
13-96 n Section 13: Forms and Reference
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Equations and Constants
TABLE OF CONTENTS
A. FORMULAS Perimeter/Circumference ........................................................................................ 2 Area ......................................................................................................................... 3 Volume .................................................................................................................... 4 Temperature ............................................................................................................ 5 Velocity ................................................................................................................... 5 Flow/Pumping Rate ................................................................................................ 5 Loading/Pounds ....................................................................................................... 6 Solids ....................................................................................................................... 6 Tanks & Clarifiers ................................................................................................... 6 Filters and Recirculation ......................................................................................... 7 Collection ................................................................................................................ 8 Other Formulas and Constants .............................................................................. 10
B. CONVERSION FACTORS Length ...................................................................................................................... 2 Area ......................................................................................................................... 3 Volume .................................................................................................................... 4 Flow ........................................................................................................................ 5 Weight ..................................................................................................................... 6 Master List ............................................................................................................. 12 C. SYMBOLS AND ABBREVIATIONS ................................................................. 10 D. METRIC SYSTEM ............................................................................................... 11 `
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PERIMETER/CIRCUMFERENCE 1. Rectangle or Square: S1 P = S1 + S2 + S3 + S4 S4 S2 S3 2. Circle: C = x D Where: R D = 2 x R D
LENGTH CONVERSION FACTORS 1 inch = 2.54 centimeters = 25.4 millimeters 1 foot = 12 inches = 0.31 meters 1 yard = 3 feet = 0.91 meters 1 mile = 5,280 feet = 1,760 yards 1 meter = 39.37 inches = 3.28 feet 1 kilometer = 0.62 miles = 1,000 meters
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AREA L1. Square or Rectangle: W A = L x W 2. Circle: A = x R2 R Where: D = 2 x R D
3. Triangle: A = B x H 2 H B
AREA CONVERSION FACTORS 1 square foot = 144 square inches 1 square yard = 9 square feet 1 square mile = 640 acres or 1 section 1 square meter = 10.76 square feet 1 square meter = 10,000 square centimeters 1 acre = 43,560 square feet 1 hectare = 2.47 acres
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VOLUME L
1. Rectangle Volume = Area x Height H V = L x W x H W 2. Cylinder: R Volume = Area x Height H V = x R2 x H
Where : D = 2 x R D D
VOLUME CONVERSION FACTORS 1 cubic foot = 1,728 cubic inches 1 cubic foot = 7.48 gallons 1 cubic yard = 27 cubic feet 1 acre-inch = 27,152 gallons 1 acre-foot = 43,560 cubic feet 1 acre-foot = 326, 000 gallons 1 gallon = 3.79 liters 1 gallon = 231 cubic inches 1 gallon = 4 quarts 1 cubic meter = 35.3 cubic feet 1 cubic meter = 1.3 cubic yards 1 liter = 0.26 gallons 1 liter = 1,000 milliliters
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TEMPERATURE 1. Fahrenheit to Celsius: °C = 5 (°F - 32) 9 2. Celsius to Fahrenheit: °F = (°C x 9) + 32 5
VELOCITY 1. Velocity = distance traveled time 2. Velocity(C) = flow rate = Q area A
FLOW/PUMPING RATE 1. Flow Rate (Q) = velocity (V) x area (A) 2. Pumping Rate = volume pumped time pumped 3. Calibrated Pumping Rate (gallons per minute): = drawdown volume (gallons) time to drawdown ( minutes) = (Reading 1 in inches - Reading 2 in inches) x gallon per inch of tank Time (min)
FLOW CONVERSION FACTORS 1 cubic foot/second = 449 gallons/minute (GPM) 1 gallon/second = 0.13 cubic feet/second (CFS) 1 gallon/second = 8.03 cubic feet/minute (CFM) 1 gallon/minute = 0.002 cubic feet/second (CFS) 1 gallon/minute = 1440 gallons/day (GPD)
Section 13: Forms and Reference n 13-101
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LOADING and SOLIDS 1. Loading ( lb/day) = concentration ( mg/L) x flow (gallons/day) x 8.34 lb/gallon/1,000,000 2. Organic Loading (lb/day) = population ( people) x population equivalent factor (lb/person/day) Note: Population equivalent factors for: BOD = 0.17 lb/person/day TSS = 0.20 lb/person/day
WEIGHT CONVERSION FACTORS
1 gallon = 8.34 pounds of water 1 cubic foot = 62.4 pounds of water 1 foot of water = 0.433 pounds per square inch 1 pound = 0.454 kilograms 1 kilogram = 2.2 pounds 1 kilogram = 1,000 grams 1 pounds per square inch = 2.31 feet of water 1 liter = 1,000 grams 1 mg/kg or 1 ppm or 1 mg/l = 0.0022 pounds/ton or 0.0001% 1 mg/l = 1,000 µg/l
3. Total Suspended Solids (mg/L) = weight of suspended solids (mg) volume of sample (liter) 4. Organic Nitrogen = Kjeldahl Nitrogen - Ammonia Nitrogen
SOILS1. Percolation rate = min/in 2. Ksat = 3. Contour Loading Rate (CLR) = gal/ft
TANKS & CLARIFIERS 1. Surface Settling Rate (SSR): SSR = flow rate surface area 2. Tank capacity in gallons TC= L(ft) x W (ft) x Liquid depth(ft) x 7.48 gal/ft3 3. Detention Time (DT): DT = volume of tank flow rate to or from tank 4. Percent Removal (PR): PR (%) = influent - effluent x 100% influent
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FILTERS
1. Hydraulic Loading Rate (HLR): HLR = total flow to filter * surface area of filter * Where total flow = influent flow + recirculation flow 2. Organic Loading Rate (OLR): (lbs per day per 1000 cubic feet) OLR = pounds per day applied to the filter volume of filter media ( in 1000 cubic feet units) CALCULATING RECIRCULATION RATIOS AT SYSTEM STARTUP To set recirculation at the time of system startup, the flowing information is needed:
Forward flow through the system – this will be assumed from available records and/or interviews or design flow
Pump delivery rate of the pump dosing the media filter (in gallons per minute) Dose volume Amount of pipe drainback to the pump after a dose Desired recirculation ratio, based upon forward flow (usually determined by the designer or manufacturer –
3:1 – 5:1) Number of minutes in a day = 1440
Before media filter startup occurs, it is important that the startup person understand how the regulatory jurisdiction and/or manufacturer determines recirculation volume to the filter. Most proprietary technologies use the following basic formula: [(forward flow) multiplied times (desired recirculation)] plus (forward flow) = volume to the filter. Other entities/manufacturers may calculate recirculation differently, for example [(desired recirculation) multiplied by (forward flow), so always verify before startup. For the following example the manufacturer-determined pump dose volume per pump cycle (15 gallons) will not be altered. The pump off time needed to meet the desired recirculation ratio will be determined. The following values will be assumed for this example:
Forward flow = 200 gallons per day (gpd) -made by assumption Pump delivery rate (PDR) = 30 gallons per minute (gpm) Pump on time = 15 gallons/dose / 30 gpm = 0.5 minutes (min) on Pump dose volume = PDR X Pump run time = 30 gpm X 0.5 min = 15 gallons per dose No pipe drainback is assumed to simplify this example Desired recirculation ratio of 3:1 as required by manufacturer (Using the first formula noted above, the
filter surface will see four times the amount of forward flow or [200 gpd x 3] + 200 gpd = 800 gpd Given the above information, let’s calculate what the pump off time needs to be: Note, that to simplify the example, the entire pump dose volume (15 gallons) reaches the media filter surface with no pipe drainback.
Section 13: Forms and Reference n 13-103
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Number of pump dose events needed to meet the 3:1 ratio = 800 gpd ÷ 15 gallons per dose event = 53.3 dose events per day. Because we can’t have a fraction of a dose event, this is rounded down to 53 events. Note that for each dose event there is a corresponding pump rest cycle—or 53 rest cycles a day. Number of minutes per day = 24 hours x 60 min per hour = 1440 min/day Pump off time (minutes) = (number of minutes per day ÷ pump rest cycles per day) minus pump on time. Substituting in numbers, the math is: (1440 min/day ÷ 53 pump rest cycles) – 0.5 min = 26.7 min Answer: 26.7 minutes off time between pump doses To double check the math, the combined pump on and off times multiplied by the number of dose events per day should equal the total number of minutes in a day (or 1440 minutes). Check: (0.5 min + 26.67 min) x 53 dose events = 27.2 min x 53 dose events = 1440 min To double check the math on the timer settings; multiply the pump on time by the dose events per day, and multiply this number by the pump delivery rate (or PDR). The result should equal the total gallons needed to meet the desired recirculation ratio (or 800 gpd). Check: (0.5 min per dose x 53 dose events/day) x 30 gpm = 795 gpd
Note that the answer above is very close to the 800 gpd needed to meet our desired recirculation ratio. The difference is because we could not utilize a portion (0.3) of a dosing event, so earlier in our calculations we decided to round down to 53 dose events per date.
COLLECTION 1. Hazen Williams Equation
V = 1.318*C*R0.63*S0.54
V = Velocity in feet per second C = Hazen-Williams Roughness Coefficient = 130 D = Diameter of pipe in inches R = D/2 S = Hf/L
Hf = Friction head loss (feet) L = Length of Pipe (feet)
Hf = (10.5/D4.87) X (Q/C)1.85 X L
Q = Flow in gallons per minute
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2. Manning Equation V = k/n(A/P)2/3S1/2 where k = 1.486, and n = 0.013 n = 0.013 should be used for PVC pipe.
Inserting the constants in the equation: V = 114.3 (A/P)2/3S1/2
A = πD2/4 P = Wetted Perimeter (assume full pipe) = πD
Simplifying the equation by inserting A and P in terms of D: V = 114.3(D/4)2/3S1/2
S = Slope (feet/foot) (usually given, and assumed 1/8 inch per foot, which equates to 0.01 feet/foot) Manning Equation Constants
Other Collection Constants Minimum slope in pipe =1/8 inch per 1 foot ~ 1% Maximum slope in pipe = 0.2 feet/foot = 2%
Maintains velocity below 15 feet/sec
OTHER FORMULAS
1. Convert Gallons Per Minute to Gallons Per Day: Gallons/day = gallons/minute x 1,440 minutes/day 3. Percent Removal (%) = influent concentration – effluent concentration x 100% influent concentration 5. Slope or Grade (%) = rise or drop (difference in height) x 100% run (difference in length)
Pipe Diameter
Velocity (V) ft/s
Area (A) ft2
Qf (GPM)
4” 2.18 0.087 85.2 6” 2.85 0.197 253.0 8” 3.46 0.349 542.2
Section 13: Forms and Reference n 13-105
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10
SYMBOLS/ABBREVIATIONS
A = Area Ac-Ft = Acre-feet B = Base BOD = Biochemical Oxygen Demand C = Circumference CEC = Cation Exchange Capacity CFM = Cubic Feet per Minute CFS = Cubic Feet per Second Cu In. = Cubic Inches °C = Degree Centigrade D = Diameter Ft = Foot or Feet Ft2 = Square Feet Ft3 = Cubic Feet °F = Degree Fahrenheit F/M = Food to Mass Gal = Gallons Gal/Min = Gallons per Minute Gal/Sec = Gallons per Second GPD = Gallons per Day GPM = Gallons per Minute GPS = Gallons per Second H = Height hr = Hour In. = Inch In2 = Square Inch In3 = Cubic Inch L = Length lb = Pound Mi = Mile Mi2 = Square Mile Min = Minute mg = milligrams
ml = milliliters MG = million gallons MGD = million gallons per day mg/kg = milligrams per kilogram mg/L = milligrams per liter MLSS = mixed liquor suspended solids MLVSS = mixed liquor volatile suspended solids N = Nitrogen NH3-N = Ammonia Nitrogen Org. N = Organic Nitrogen P = Perimeter PE = Population Equivalent ppm = Parts per Million ppb = Parts per Billion PSI = Pounds per Square Inch Q = Flow R = Radius RPM = Revolutions per Minute S = Side Sec = Second Sq. In. = Square Inches SVI = Sludge Volume Index SRT = Solids Retention Time SS = Suspended Solids TSS = Total Suspended Solids V = Volume Vel = Velocity W = Width Yd = Yard pi or 3.14 / = Per (as gallon/day) % = Percent µL = Microliters
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METRIC SYSTEM
LENGTH One kilometer (km) = 1,000 meters One meter (m) = 100 centimeters One decimeter (dm) = 0.1 meter One centimeter (cm) = 0.01 meter One millimeter (mm) = 0.001 meter WEIGHT One kilogram (kg) = 1,000 grams One gram (g) = 1,000 milligrams One decigram (dg) = 0.1 gram One centigram (cg) = 0.01 gram One milligram (mg) = 0.001 gram VOLUME One kiloliter (kl) = 1,000 liters One liter (l) = 1,000 milliliters One deciliter (dl) = 0.1 liter One centiliter (cl) = 0.01 liter One mililiter (ml) = 0.001 liter AREA One hectare (HA) = 10,000 square meters One square kilometer = 1,000,000 square meters
Section 13: Forms and Reference n 13-107
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12
MASTER LIST - CONVERSTION FACTORS
MULTIPLY BY TO OBTAIN Acres 43560 Square Feet Atmospheres 33.9 Feet of Water Centimeters 0.40 Inches Cubic Feet 7.48 Gallons Cubic Feet 28.32 Liters Cubic Feet/Second 449 Gallons/Minute Cubic Meters 35.31 Cubic Feet Cubic Meters 264.2 Gallons Cubic Meters 103 Liters Cubic Yards 27 Cubic Feet Cubic Yards 202 Gallons Feet 30.48 Centimeters Feet 0.31 Meters Feet of Water 62.43 Pounds/Square Foot Feet of Water 0.43 Pounds/Square Inch Gallons 3785 Cubic Centimeters Gallons 0.13 Cubic Feet Gallons 3.79 Liters Gallons water 8.34 Pounds of Water Gallons/Minute 2.2 x 10-3 Cubic feet/Second Gallons/Minute 1440 Gallons/Day Gallons/ Minute 0.06308 Liters/Second Gallons/Day 6.9 x 10-4 Gallons/Minute Gallons/Day/Square Foot 1.604 Inches/Day Grams 2.21 x 10-3 Pounds Grams/Liter 1000 Parts/Million Hectares 2.47 Acres Horsepower 33,000 Foot-pounds/Minute Horsepower 0.7457 Kilowatts Inches 2.54 Centimeters Inches/Day 0.62 Gallons/Day/Square Foot Kilograms 2.21 Pounds Kilowatts 1.34 Horsepower Kilowatt-hours 2.66 x 106 Foot-pounds Liters 103 Cubic Centimeters Liters 0.04 Cubic Feet Liters 0.26 Gallons Meters 3.28 Feet Milligrams/Liters 1 Parts/Million Million Gallons/Day 1.55 Cubic Feet/Second Parts/Million 8.34 Pounds/Million Gallons Pounds 453.50 Grams Pounds of Water 0.12 Gallons Pounds/Square Inch 2.31 Feet of Water Pounds/Square Inch 2.04 Inches of Mercury Temperature (°C) + 17.78 1.8 Temperature (°F) Temp. (°F) - 32 5/9 Temp. (°C)