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HomeMy WebLinkAbout60000100088001_Variances_08-05-1999850212 OFFICE OF COUNTY RECORDER OTTER TAIL MINNESOTA I hereby certify that this instrument #____________ was filed/recorded in this office for record on .the 11 day of --------1999 at ^-.ISApm -^^e^^J^fecordii^e^ ---------------------_well certificate 850212 Deputy THE ABOVE SPACE IS RESERVED FOR THE COUNTY RECORDER APPLICATION FOR VARIANCE COUNTY OF OTTER TAIL COURTHOUSE, FERGUS FALLS, MN 56537 (218) 739-2271 ***COMPLETE THIS APPLICATION IN BLACK INK Application Fee Receipt Number PROPERTY OWNER White Oak Metals, ADDRESS pn Rr~>v I'Kl ^ PFy Pr>piiT R9 DalFcin^ MN RAT94 LAKE NUMBER 56-596 DAYTIME PHONE 21 8 589-7120Inc LAKE NAME Unnametl LAKE CLASS _GD SECTION 1 n TOWNSHIP 1 T1 RANGE D42 TOWNSHIP NAME Tnmiili Township FIRE / LAKE I.D. NUMBER 1171-1PARCEL NUMBER R 6 0 0 0 010 0 088001 LEGAL DESCRIPTION Sect-10 TWP-131 Range-042 Beg SE Cor G.L. 4 W 80 RDS N 40 RDS, E 80 RDS, S 40 RDS to Beg TYPE OF VARIANCE REQUESTED (Please Check) structure Setback Structure Size X__Sewage System Subdivision Cluster Misc. SPECIFY VARIANCE REQUESTED Request variance for 60'x100' Building to have 26' Height, buildings are all over 18'. Surrounding I UNDERSTAND THAT I HAVE APPLIED FOR A VARIANCE FROM THE REQUIREMENTS OF THE SHORELAND MANAGEMENT ORDINANCE/SUBDIVISION CONTROLS ORDINANCE OF OTTER TAIL COUNTY. I ALSO UNDERSTAND THAT OTHER PERMITS MAY BE REQUIRED, IT IS MY RESPONSIBILITY TO CONTACT/LAND & RESOURCE MANAGEMENT REGARDING THIS MATTER. ■7jrhV#<f/ SIGNATU IE APPLICANT MUST BE PRESENT AT THE HEARING DATEOF PROPERTY OWNER (Applicant Will Receive Notification As To The Date/Time Of Hearing) J XU2X^ //Al(L 10 BS~OOo 8i - oo / /-omo / 3/^ cOD/dcy' /O. i~00Z ^8-000 cU<^ laJAccepted By Land & Resource R Officvrfl/Date <r ^999 7:3aDate Of Hearing Time yg»./n Motion White Oak Metals ^ Approved As Requested Motion was made by Cecil Femling, second by David Trites and unanimously carried, to approve a variance of 8’ from the 18’ maximum height of a non-dwelling structure for the construction of a 60’ by 100’ building having a height of 26’.. It was noted that the variance is necessary to continue a permitted use as approved by the Planning Commission. It should be noted that this is a commercial venture requiring a structure with added height for its commercial purpose. Chairman/Otte/Tail County Boand of Adjustment Permi^) required from Land & Resource Management Yes (Contact Land & Resource Management) No Copy of Application Mailed to Applicant And the MN DNR LR Official/Date bk 0198-001 291,306 • Victor Lundeen Co., Printers • Fergus Falls, Minnesota 1 i Augusts, 1999 Page 4 Alvin and Jean Meier - Denied Alvin and Jean Meier, Ottertail, MN, requested a variance of 19’ from the required ordinary high water level setback of 75’ for the construction of a gazebo on a deck 56’ from the ordinary high water level. The property is described as part of Sub Lot 5 of Government Lots 3 and 4, Section 23 of Rush Lake Township by Rush Lake. The audience was polled with no one speaking for or against the request. After consideration, motion was made by David Trites, second by Cecil Femling and unanimously carried, to deny the variance as requested as no adequate hardship had been shown and as other alternatives not requiring a variance are available to the applicants for their consideration. David and Sonja Vovos - Denied David and Sonja Vovos, Sioux City, lA, requested a variance of 19’ from the required ordinary high water level setback of 100’ for additions to the north side of the existing dwelling located 8T from the ordinary high water level. The property is described as Lot 1, Walvatne Addition, Blanche Lake in Everts Township. A letter from Richard and Lorna Treptow in favor of the applicant’s request was read for the record. The audience was polled with no one speaking for or against the request. After consideration, motion was made by Cecil Femling, second by Randall Mann and carried with John Everts abstaining, to deny the variance as requested noting that the application of the string line test would be consistent with past action of the Board of Adjustment and would allow the applicants the ability to enjoy the same rights and privileges as others enjoy in the immediate area. Dale Campbell - Denied Dale Campbell, Erhard, MN, requested a variance to build a 24’ by 32’ garage with a floor on the second level for storage plus a pull down or small staircase to the second level. It should be noted that the height of the garage would be 18’ or less. The property is described as Lot 1, Heilberger Lake Estates, Heilberger Lake in Friberg Township. The audience was polled with no one speaking for or against the request. After consideration, motion was made by David Trites, second by Cecil Femling and carried with Randall Mann voting no, to deny the variance as requested as no adequate hardship has been shown and reasonable use of the proposed structure can be obtained without the granting of a variance. White Oak Metals - Approved As Requested White Oak Metals, Inc. Dalton, MN, requested a variance of 8’ from the 18’ maximum height of a non­ dwelling structure for the construction of a 60’ by 100’ building having a height of 26’. The property is described as part of Government Lot 4, Section 10 of Tumuli Township by an unnamed lake. The audience was polled with no one speaking for or against the request. After consideration, motion was made by Cecil Femling, second by David Trites and unanimously carried, to approve a variance of 8’ from the 18’ maximum height of a non-dwelling structure for the construction of a 60’ by 100’ building having a height of 26’. It was noted that the variance is necessary to continue a permitted use as approved by the Planning Commission. It should be noted that this is a commercial venture requiring a structure with added height for its commercial purpose. V Notice of Hearing for Variance Otter Tail County Courthouse 121 West Junius Ave. Fergus Palis, MN 56537 (218) 739-2271 Ext. 240 Applicant must be present at the scheduled hearing. To Whom It May Concern: White Oak Metals, Inc. PO Box 737 Dalton, MN 56324 has made application to the Otter Tail County Board of Adjustment for a variance as per requirements of the Otter Tail County Shoreland Management Ordinance and/or the Subdivision Controls Ordinance. The Otter Tail County Board of Adjustment will assemble for this hearing on Thursday, August 5,1999, at 7:30 p.m.. in the Commissioners’ Room of the Otter Tail County Courthouse, Fergus Falls, MN. (Please use the west Law Enforcement entrance.) Individuals requiring special accommodations should contact the County Auditor’s office prior to the date of the public hearing. The property concerned in the application is legally described as part of Government Lot 4, Fire# 1171-1 Section 10, Township 131, Range 42 - Township Name - Tumuli Lake No. 56-596, Lake Name - Unnamed, Class - GD The variance requested is; a variance of 8’ from the 18’ maximum height of a non-dwelling structure for the construction of a 60’ by 100’ building having a height of 26’. uJ of ^UStl Date: July 16,1999 Board of ustment Secretary : OTTER TAIL COUNTY Fergus Falls, Minnesota State of Minnesota ) )SS County of Otter Tail) I, Wayne Stein, Secretary for the Board of Adjustment for Otter Tail County, Minnesota, do hereby certify that on the 19th, day of July, 1999 the attached Notice of Hearing for Variance was duly served upon the individuals listed below and/or included in the attachment: White Oak Metals Inc., PO Box 737, Cty Road 82, Dalton, MN 56324 Harland Martinson, Twp Clerk of Tumuli, RR 1 Box 241, Dalton, MN 56324 Otter Tail County Cola, % John Matteson, Rt 2 Box 40W, Battle Lake, MN 56515 Richard West, Otter Tail County Highway Engineer, Courthouse, Fergus Falls, MN 56537 Terry Lejcher, DNR 1221 1/2 E. Fir Ave., Fergus Falls, MN 56537 DNR Regional Administrator, 2115 Birchmont Beach Rd. NE, Bemidji, MN 56601 Town Clerk Board of Adjustment: David H. Holmgren, RR 1 Box 188B, Henning, MN 56551 John Everts, RR 2 Box 434, Battle Lake, MN 56515-9492 Cecil B. Femling, 13 6th St. NE, Pelican Rapids, MN 56572 Randall Mann, 532 N. Ann St., Fergus Falls, MN 56537 David Trites, RR 1 Box 208, Parkers Prairie, MN 56361 Mark Steuart, RR 1 Box 82, Richville, MN 56576 by placing a true and correct copy thereof in a sealed envelope, postage prepaid, and depositing the same in the United States Mail at Fergus Falls, MN, property addressed to each of the individuals listed above and/or listed in the attachment. Dated: July 19th, 1999 Wayne Stein, Secretary Otter Tail County Board of Adjustment By: Vi Manderud . \ LARRY R &. HOLLY K SOHMOR RR i BOK 109 DALTON, KK 56324-9705 WHITE UkK METALS PO BOX 737 DALTON, MN 56324-0737 -sV ' •• WILLIAM 0 &: JOANNE LARSON 317 GUSTaVUS AVE W FERGUS FALLS, MN 56537-331© WILLIAM K SONMOR / . RR 1 BOX 277B DALTON, MN 56324-9759 y/ / / V ACS Tax System 07/19/1999 09:43:40 OTTER TAIL COUNTY TG670RFreeform Image Print COVERPAGE *♦****★**■**■**★**★*******★♦***♦*****■**★★★★*******★*******♦*****★****★***■*■******* C N E L S O NC N E L S O NC N E L S O NC N E L S O N ** * * •k it "k* * ** * * k k -k k * k k * * k k k k kk kk kk Selection:Report Freeform Type : U Freeform Number: 61 LABELS Length: 6 Width: 35 Multiples: Select Model: 95 Sort Model: 127 Paper: LBL Run Time Changes: N 1 Summarize Keys: N Use Current Taxpayer: Y 095 SELECT UP TO 300 PARCELS 2000ALLR 60000100088000 R 60000100088001 R 60000110098000 R 60000150124003 SELECT MODEL, PAYABLE YEAR ROLL TYPES PARCELS •i- SORT MODEL , 127 LAND&RESOURCE SORT AS IS Run Instructions:, Jobq Banner L CNELSON 01 Copies Form Printer Hold Space...LPI. Lines CPI 066 10PIYS6 >* 'L OTTER TAIL COUNTY PLANNING COMMISSION: DATE OF HEARING;APPLICANT: YES NO ABSTAIN MOTION BY: 2ND gy.BER6ERUD BOYER ESTES REPRESENTED APPLICATION: LACHOWITZER MASKE OLSON SHA SCHWARTZ TRITES ZIMMERMAN ^ 2A) Standing on N side of Lake-Looking straight S(Zoom) j / 007!:;;Nf-l!--iH tS .JUI..„20‘":'9 3 x 5 ' V <L ^’'' \ \« I '( 2) Standing on N side of Lake-Looking straight S i .JIJL..2099 3 X 5,007SHNNH 9/ // - / ' - //,/ >'Ji) ,'T*f r\t .4. V“, f (x-sAt^'Sr.iy -;*»J v<* tl LS3 R t-' - *' Mi(iv4\'i.,’, fr 1; 1 A) Standing at NW Comer of Lake-Looking SE(Zoom) ^ P '' I 00?'SHh^l-JH S .JUL..2099 3 / ,I W/ iS^i *'V .\*j ^4 .y^'-v, 3) Standing at N end of Gravel-Looking South to facility \' l: 007Sh-!NNf-l 4 • . JUL.2090 3 x ’ 5 -i I 3 A) Standing at N end of Gravel-Looking South to facility(Zoom) | .T!,..il....209':;i 3 3007^'SN!-IHf-l 0 1 :. .Ti.iL.:;;;i3'=''9 3 x 500;"SHNNh-i 7 ; Vi' 4)Standing on N/S Gravel-Looking into N entrance of facility B 007SNHHH 3 JUL2099 3 x 5 1/ , ' >' y' ■ 'H'iyHi /j 1 315 U' 4A) Standing on N/S Gravel-Looking into N entrance of facility(Zoom) / -iya(CC. - r\' >:I 6 00?:-;;i-!h^|--l!M 1 .JUL,2000 3 x 3 1> IL i»j 4. -I.'~v<L I5) Standing on N/S gravel-Looking into S entrance of facility 00?-S'HHNN-10 JUL2099 3 x 5 \ 140’-0 SLIDING DOOR KA "AUe 1’ 11999 55 GAL. FUEL OIL BBL 4 SLIDING DOOR OVERHEAD DOOR SLIDING DOORS\ (/)UJ o X LjJ >PROPANE TANK cnLul LxJ LjJO XXoLjJCOIO> oo crCMOLjJLj_LiJ N oIXozX PARKING FOR NINE VEHICLES XCM <X XO OVERHEAD DOORLl. oo1zI X CO <X OVERHEAD DOOR —PARKING FOR TWO VEHICLES OVERHEAD- DOORS OVERHEAD DOOR-----^ GATE #2 OPEN 7:00AM UNTIL 5:00 PM \ 86’-0 '1 ; 9'1999 Ac« #_woptara___ ;■ 11 ; •1 1 i ; ; : Septic System Permits Barcode 128 CHRONOLOGY REGARDING THE SEWAGE SYSTEM INSPECTION PROGRAM Primary Owner White Oak Metals Alternate Owner White Oak Metals 56-596 Unnamed NELake 60000100088001Parcel No GIS Address 14122 NORWAY PINE RD Date of Compliant Letter Date of Non-Compliant Letter Date Initial Response (owner) Date Sewer Permit Issued Date Abatement Notice Date Violation Issued Date to County Attorney Date Resolved No Further Action Comments: Chronology Sewage System Inspection Program 1-2013 Department of LAND AND RESOURCE MANAGEMENT OTTER TAIL COUNTY Government services Center - 540 west Fir Fergus Falls, MN 56537 PH: 218-998-8095 Otter Tail County’s Website: www.co.otter-tail.mn.us 07/11/2013 White Oak Metals Po Box 737 Dalton MN 56324 0737 RE: Result of Onsite Sewage System Inspection, Compliant Parcel(s) 60000100088001 Lake Name Unnamed Lake/River No 56-596 Dear White Oak Metals As part of Otter Tail County’s ongoing Sewage System Inspection Program, our Office inspected your sewer system located at 14122 NORWAY PINE RD on 06/14/2013. At that time we found that your sewage system located at 14122 NORWAY PINE RD was compliant with the Sanitation code of Otter Tail County. If you have any questions regarding this inspection, please contact our Office at 218-998- 8095. Sincerely, George Hausske Inspector Michael Douglas Inspector SCANNED SEWAGE SYSTEM INSPECTION PROGRAM FIELD NOTES LAKE NAME Unnamed LAKE NO 56-596 LAKE CLASS NE PARCEL NO 60000100088001 14122 NORWAY PINE RD TOWNSHIP Tumuli Township SECTION NO 10 PROPERTY OWNER White Oak Metals TAXPAYER White Oak Metals Po Box 737 Dalton MN 56324 0737 ONSITE INSPECTION FINDINGS - SKETCH ON BACK: Holding Tank Leaching Pit Sink Drain Septic Tank/Drainfield Cesspool Porta Potty Seepage Pit Surface Discharge Outhouse Drywell Straight Pipe Primitive Dwelling SEPARATION ! SETBACK DISTANCES (in feet): TANK ABSORPTION AREA OUTHOUSE OHWL RESTRICTIVE LAYER WELL ONSITE INSPECTION RESULTS: ii COMPLIANT _ / (Send Compliant Letter)IMMINENT THREAT TO PUBLIC SAFETY OR HEALTH (Send 10 Day Abatement Notice) NON-COMPLIANT (Send Non-Compliant Letter) REVISIT NO FURTHER ACTION NECESSARY COMMENTS: SCANNED A Date Inspector’s Signature(s) Existing File;Yes No Sewage System Inspection Program - Field Notes Form 6-1-2011 i 4^^ r< 0^ - , $»"4\i4-i - ® 34'’ 1^3 XV i; ./ i. ':' . ■ .t Department of LAND AND RESOURCE MANAGEMENT OTTER TAIL COUNTY Government SERVICES Center - 540 West Fir Fergus Falls, MN 56537 PH: 218-998-jB095 Otter Tail County’s, Website; www.co.otter-tail.mn.us 05/01/2013 White Oak Metals Po Box 737 Dalton MN .56324 0737 •• RE: Primary Owner: White Oak Metals Onsite Sewage System Inspections . Parcel: 60000100088001 Lake: 56-596 Unnamed Dear White Oak Metals: As part of Otter Tail County’s ongoi^ effort, to preserve and enhance water quality, the County Board of Commissioners ha^irectfd our Office to conduct onsite inspections of existingiseptic systems for ei^^ahc^i^l^lhe Sanration Code of Otter TaiLCounty order to complete this proc^- a: rnap vyas created (July 10, 2008) which identifies the year in which an area of the ^^n^^ould be inspected. It appears your property is iricluded in the.area that will be inspected in 2013. Since this is the case, please be informed that starting in early Jiljne 2013 Inspectors from pur Office - will be checking existing'septic systems in your area. Should a non-compliant septic systerh be discovered, our Office will contact the property owner and inform them of the need-for their septic system to be .brought into compliance with the provisions of our Sanitation Code. If you have any questions regarding this matter, please contact our Office (218-998-8095). Sincerely . In t \ c , >• Scott Ellingson Inspector sSt,^Ss^- It. fti %v.Jgp- 4 Ki''A®i ^(2i^C^:,* I a/,* -3 « ' . «- > c * > so.m CERTIFICATE OF APPROVAL SEWAGE SYSTEM <1^k 'ft This certifies that as of the 2"'* day of April, 2002, the sewage treatment system serving the following described property is compliant with the provisions of the Sanitation Code of Otter Tail County. wmM'ki 5,': ,mmX'-. BEG SE COR G.L.4 W 80 RDS N 40 RDS, E 80 RDS, S 40 RDS TO BEG N 132* OF NEl/4 NEl/4 - 4.00 AC 13.80 AC k W/ JM ¥ Parcel Number(s):60000100088001 and 60000150131001 Section; 10/15 Township:131 Range:42 Township Name; Tumuli Lake Number; 56-596 Lake Name: Unnamed (Madson)t i V Current Property Owner: White Oak Metals, Inc. Number of Bedrooms: NA ifN )Land 6 Resource Management Official -oi (. Pi m284,709 • Victor Luivleeri Co, Printots » Fergus Falls. MN • 1-800-346-4870 3 APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENTOTTER TAIL COUNTY COURT HOUSE 121 W. JUNIUS AVE. • SUITE 130 Phone:(218) 739-2271 • FERGUS FALLS, MN 56537 WHITE-Office YELLOW - L & R Inspector PINK - Owrier / Contactor PLEASE PRINT OR TYPE ALL INFORMATION Permit No. LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER SECTION TWP NO.R,^NGE TWP NAME l;T9 (o 11 )' i/ U/, .•/ j PARCEL NUMBEFUS; 6^5/- CO /E-911 ADDRESS /vnx{^0 OQO-0 I'OO^r-OO f Sf ^ LH - /5-f- rfc 'oT A) £'/~r LEGAL DESCRIPTION HC(c^ Last Name First Initial Mailing Address Daytime Phone No. U) U L QotC j fa C ! Co^fS^i’OProperty Owner 73 Oi r j)/'J oContractor Lie.*o ! S'OO- f^ooD a. a'-oo AM.C!2>► This System will be ready for inspection on.the year of This space for office use only ^/a^jnn Date Received ' /0--58 4m)P.M. Time Received ifficial SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF INSTALLATION TANK DRAINFIELDv( 1 ) System ( 2 ) Holding Tank (Alarm Required) ( 3 ) Septic Tank ( 4 ) Lift Station (Alarm Required) ('5) Drainfield A) Trenches, Rock ( B ) Seepage Bed (C ) Trenches, Graveless ( D ) Mound ( E ) Trenches, Chamber ( F ) At-Gjfade (6) Collector (7) Outhouse ( 8 ) Greywater System ( 9 ) Sewer Line (10) Performance (11) Other Ft^Size GIs. hiSetback to nearest well Ft. Ft. Jj^ •Setback to OHWL (lake &/or river)Ft.50 Ft.hiK' 50 t 0 Ft.Setback to wetland Ft. Po Ft.Setback to dwelling Ft. 7 lO Ft./(9 Ft.Setback to non-dwelling /c7 Ft.Setback to property line Ft./ I?Ft.Elevation above water table (OHWL)Ft. All distances are shortest distance between nearest points iABSOFaiON AREA FOR MOUNDS(Vi Gravity ( ) Pressure EFFLUENT DISTRIBUTION - =Ft^jWATER WELL DEPTH HOLDING TANK MONITOR/DISPOSAL CONTRACT yy], ju d ^ 6/ >>< 7DesignerPERCOLATION TEST DATA( )Yes ( ) No - L & R Can Not Process \ J Q C O) OS'Designer Lie. It L3.5"- /<f - 0 0Date of Test Highest Rate Agreement: The undersigned hereby makes application for permit to install, alter, repair or extend Sewage Treatment System herein specified, agreeing to do all such work in strict accordance with Sanitation Code of Otter Tail County, Minnesota. Applicant agrees that the Site Data Worksheet submitted herewith and which is approved by a Land & Resource Management Official shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and approved for use. It shall be the responsibility of the applicant for the permit to notify Land & Resource Management that the installation is ready for inspection. Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express con­ dition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Sanitation Code of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of the Sanitation Code. NOTE: This permit is vaiid for a period of six (6) months. O Cr 'O)Date: Signaturs of Property Otvnwer/Agertt for Owner \Date: 4Land & Resource Management Office S-Q./jpglCPERMIT FEE $RECEIPT NO. j6o//J ..5.Comments: Xf- Form No. BK — 1099-003 300.815 • Victor Lundeon Co. Ptmiers • Fergus Fells. MN • 1-800-346-4870 ■/ SEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTS Inspector must make all measurements y HOLDING SEPTIC TANK DRAINFIELD OUTHOUSELIFT TANKCATEGORY Capacity FT2GLS. Setback from Nearest Well ^ 0 ^ FT Si.FT FT Setback from Buried Water Suction Pipe ^ FT FT FT Setback from Buried Pipe Distributing Water Under Pressure >0^lo^FT FT FT Setback from Lake, Wetland or River (OHWL)^00"^ FT FT,FT Setback from Dwelling So^So"FT FT FT Setback from Non-Dwelling So*FT FT FT + -Setback form Nearest Property Line / S/o FT FT FT Elevation from Bottom to Water Table / Restrictive Layer FT FT FT FT Holding Tank/Lift Alarm YES NO I Old System Pumped & Destroyed YES NO SEPTIC TANK Sewer Line to Well Separation DRAINFIELD CALCULATIONFILTER Actual Minimum Manuf..FTX□ YES toModel #.NO FT FT20 MOUND CALCULATION ROCK REDUCTIONInspector’s Comments: ABSORBTION AREA Rock trenches with inches Ft. X /of rock under pipe for .% Ft2 ft* DF.reduction / equivalent to SKETCH: !st \ T i CV\ > p'r/ fi67f o Print lnspector's~hlameJ I.^ 00 Inspector's Signature /CPQO/S'Date / Time of inspection Sk 'p^istallation Approved 2- / L & R Official Initial / Date CffiiunL Tf 0/CmZ ‘f/s./eg Cjuj<^ APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE 121 W. JUNIUS AVE. • SUITE 130 Phone:(218) 739-2271 • FERGUS FALLS, MN 56537 WHITS- Office YELLOW-L & R Inspector PINK - Owner / Contactor PLEASE PRINT OR TYPE ALL INFORMATION Permit No. LAKE NUMBER LAKBRIVER NAME LAKE/RIVER SECTION TWP NO.R\NGE TWP NAME. \ CLASSS~^3? G U /3f Hj->5 PARCEL^UMBE^.S) G(^5/-OG / ^0-CCC''C l-OO^^-OO / E-911 ADDRESS Core 4 LYLEGAL DESCRIPTION Last Name First Initial Mailing Address Daytime Phone No. / C^o ^ fQ vro Property Owner II Or t>KJ DContractor Lie.#O ! AM. >• This System will be ready for inspection on_the year of ,PM..at. This space for office use only A.M. P.M. Date Received Time Received L & R Official SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF INSTALLATION ( 2 ) Holding Tank (Alarm Required) TANK DRAINFIELD P''/C-rrOSize GIs. ( 3 ) Septic Tank ( 4 ) Lift Station (Alarm Required) Drginfield yfAVJrenches, Rock^^ Setback to nearest well To Ft. Ft. -r<"Setback to OHWL (lake &/or river).5~rJ Ft. Ft. ro( B ) Seepage Bed 'XC ) Trenches, Graveless ( D ) Mound ( E ) Trenches, Chamber ( F ) At-G,fade ( 6 ) Collector ( 7 ) Outhouse ( 8 ) Grey water System ( 9 ) Sewer Line (10) Performance (11) Other Setback to wetland Ft.Ft. Setback to dwelling Ft.Ft./n yO Ft./6)Setback to non-dwelling Ft. d /OSetback to property line Ft. Ft./ 17Elevation above water table (OHWL)Ft.Ft. All distances are shortest distance between nearest points ABSORilON AREA FOR MOUNDSGravity ( ) Pressure EFFLUENT DISTRIBUTION Ft^WATER WELL DEPTH HOLDING TANK MONITOR/DISPOSAL CONTRACT ^ -e u’ iK fDesigner____ Designer Lie. # PERCOLATION TEST DATA( )Yes ( ) No - L & R Can Not Process O) S'-/T' o 0 L3Date of Test Highest Rate Agreement: The undersigned hereby makes application for permit to install, alter, repair or extend Sewage Treatment System herein specified, agreeing to do all such work in strict accordance with Sanitation Code of Otter Tail County, Minnesota. Applicant agrees that the Site Data Worksheet submitted herewith and which is approved by a Land & Resource Management Official shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and approved for use. It shall be the responsibility of the applicant for the permit to notify Land & Resource Management that the installation is ready for inspection. Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express con­ dition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Sanitation Code of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of the Sanitation Code. NOTE: This permit is ^lid for a period of six (6) months. Date; Signature of Property Ownwer/Agent tor Owner Date: Land & Resource Management Office SD&/PERMIT FEE $RECEIPT NO. /(90r iJ ../yComments: jsa. Form No. BK — 1099-003 300.815 • Victor Lundenrt Co.. Printers • Fergus Falls. MN • 1-800-346-4870 Department of LAND & RESOURCE MANAGEMENT COUNTY OF OTTER TAIL Phone: (218) 739-2271 Court House FERGUS FALLS. MINNESOTA 56537 oS iM.i.)S c Po &cx_^ 737 ¥ U altcJ 594/?)'7<f5RE: Inspection on Sewage Treatment System Permit #Lake# This is to inform you that an inspection was made on the above mentioned Permit. At that time, we could not complete the inspection and approve the system for use, for the following reason(s): There was not a visual alarm on the lift station. There was not an alarm on the holding tank. There was not a dwelling onsite. The non-conforming sewage system had not been destroyed. There was not a well onsite. The Installer had not completed the air test. Our Office has not received the Well Abandonment Certification. A variance is required for non-complying setbacks: ______ Ordinary High Water Level ______ Lotline ______ Road Right-Of-Way ______ Structure ______ Wetland Miscellaneous CC/INSTALLER: A)qy Be aware that failure of obtaining the variance will result in removal of the non-complying portion of the system. Please contact our office for a reinspection of your sewage system when the problem is corrected. Approval of the system can not oceijfnunti :er is/esolved. Inspedg^^ FRMLTRS/ss~noi System design must be to scale and must include the proposed location of the sewage system, all existing/proposed buildings, property lines, the ordinary high water level of the water body and all water wells within 150' of the sewage system. GRID PLOT PLAN inch(es) equals feet SKETCHING FORM__grid(s) equalsScale:feet, or SUBMITTED BY:SIGNATURE: HxuixFIRM NAME:DATE: fADDRESS:MPCA LICENSE #: CATEGORY: __i_ -----L 1 4- l._i)UD.r-xo'fe 4" 'T V r V o-€ 4- L @ 'b>€ef=> UOelL\ooo 0^4 IdOo C»«4 * is «6. 2.01 ^ 'Trewi>~- ^oo ■ , -—LkD L .-*tiao< — H O __ •200 4 Uf 1 T 1 ! BK — 0496 — 029 SITE DATA LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, MN 56537 OWNER: Vs «s- LAST NAME FIRST MIDDLE TELEPHONE NUMBER ADDRESS: O V-V STR./RT.CITY STATE ZIP CODE \ Va-Vv^ > \~ \ LAKE/RIVER NO.LAKE NAME SEC.TWP.RANGE TWP. NAME LEGAL DESCRIPTION:SOIL BORING LOG — Date COLOR & MUNSELL NO. DEPTH (INCHES)TEXTURE STRUCTURE BLOCKY PLATY PRISMATIC o- iz. PARCEL NUMBER Cn5WF) BLOCKY PLATY PRISMATIC s;;1non'b 2SVi. •'■a- iSFIRE NUMBER NUMBER OF BEDROOMS .^r'BLOm PRISMATIC NONE GARBAGE DISPOSAL:74 WELL CASING DEPTH:BLOCKY PLATY PRISMATIC NONE (n5)FLOODPLAIN: YES 7 VEGETATION: AQUATIC TERRESTRIAL BLOCKY PLATY PRISMATIC NONE SLOPE AT INSTALLATION SITE:% BoringTYPE OF OBSERVATION: PARENT MATERIAL: (jijD ORIGINAL SOIL: No Probe Outwash Loess Bedrock Alluvium COMMENTS:, YesCOMPACTED SOIL: Luz.DEPTH OF BORING:.ft. PERC TEST #1 PERC TEST #2- TWO TESTS ARE REQUIRED - TIME INTERVAL (MINUTESI WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE3_L9P giio impSTART START \ \ -Jiu^__1 P -r 05^ = iJi- TIME DROP PEflC = >0PERCo_~TIME DROP TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE2-1 '4 :s<34:::Su_o :£oI74::\W1J=> U REFILL REFILL INTERVAL IMINUTESt TIME DROP ^RC JH.1J9 o .L J__= toPERCTIMEDROP TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME WATER DEPTH WATER DROP PERC RATE.2.1)4—.UHiC’ II (MO -2.P- -4-9-1^-- REFILL REFILL TIME DROP PERC 'AO i -LQ--TIME DROP PERC TIME INTERVAL [MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE9: SO -LJ Kt ii'SIS:::U-J4PREFILL REFILL \o ^87=?- IIq'.HO TIME DROP PERC PERC RATETIMEINTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP9 WO u_s:oREFILL REFILL -87?.DROP-ipja;::4-;!^~liMF" •H0TIMEPERC DROP TIMETIMEINTERVAL IMINUTESI | WATER DEPTH REFILL WATER DROP PERC RATE INTERVAL [MINUTES]WATER DEPTH WATER DROP PERC RATE91S.0 REFILL 3l!So.jSS"= . V> _ / TIME DROP PERC/ \D\UC. ^ IDROPTIMEPERC7TIMEINTERVAL (MINUTESI WATER DEPTH WATER DROP PERC-flATEPERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROPREFILLREFILL ---------r DROP ■ PERCTIMEDROPTIME INTERVAL (MINUTES)PERC RATETIMEWATER DEPTH WATER DROP TIME INTERVAL (MINUTES)WATER DEPTH WATER DROPREFILLREFILL 4- ___ pc^;TIME DROP PERC PROPOSED DESIGN: TRENCH X BED.ATGRADE.MOUND.HOLDING TANK,GRAVITY DIST. 3/ PRESSURE DIST. SEWER LINE.OUTHOUSE.OTHER.SPECIFY:. — SYSTEM DESIGN ON BACK — fc" ll i r iCERTinCATE OF APPROVAL SEWAGE SYSTEM‘i:-I ;i V 791®FEBRUARY16THThis certificate has been issued this to certify that the sewage system installed as per sewage permit number indicated below has been approved for use day of i i by Otter Tail County, Minnesota.mr ’1.:i ,\The premises covered by this certificate are legally described as:j •ii Range ^^Twp. Name TU*1 jLITwp. ^56-5R6 10Sec.Lake No.0 M15 131 42 4 H 132' OF NE1/4 NEl/4 10 131 42 13.b BEG SE COR G.t. 4 W 80 RDS N 40 RDS/ E 80 RDS/ S 40 RDS TO BEG .1^•4 i w m I W' mDIESETH SPECIALTY COOwner: Name W WJ413 W STANTON AVE / FERGUS FALLS/ HNAddress %i\ 56537Zip No.L M.ii 5 ?y. . Lind & Resource Kfanagement Administralar 7454Permit No. SPii Signed by:. M^o\m K. Lee Otter Tail County, MinnesotaMKL-0987001 ■') y[L wm 237,987 - Victor Luodeen 0>.. Printers. Fafus FalU. Minaesaia SHORELAND MANAGEMENT — COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 • Fergus Falls, MN 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM White -^Office Yellow — Inspector Pink — Owner Permit No.,LEGAL Itp-ozxy-iG-OoS^-'X’l yo~ cro-/r- DESCRIPTION AND IQi-lS'/?/ 4-3.SIf-5% Mo (I son Lake No. Lake Name &0LOCATION Lake Classif.TWP TWP NameSec.Range IDENTIFICATION: Please Print All Information. Mailing Address — No. Street, City and State Ual A W Last Name First Zip No.Tel. No.Initial OWNER SEWAGE SYSTEM INSTALLER Name, u 8'-/0 nr/j/s System will be ready for inspection on... 19, This space for office use on! i Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signature NUMBER OF BEDROOMS:ESTIMATED COST:1 SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD 3 \ /I OOP GIs.Sq. Ft.Capacity Sq. Ft. S9/|cjgFt.Ft.Ft.Distance from nearest well POFt.Distance from lake or stream Ft.Ft. ir lO Ft.Distance from occupied building Ft.Ft. /a:Distance from property line Ft.Ft.Ft. 3Distance from bottom to Water Table Ft.Ft.Ft. AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on 19 , Time 73PERCOLATION TEST DATA:Date of First Test ,, 19 Rate ucuk3—/j~~Date of Second Test , 19......, Rate 1st Test Taken By IS"g-rT? /71072—First Test + 2nd Test 22nd Test Taken By Rate The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn- Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi­ cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. Agreement: esota l\Jk.A IT Dated zCT 7^Signature Permit:Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six (6) months. H-VIssued Date: >horeland Management Office£3Fee $Rec # CERT ISSUEDComments: Form No. MKL-032085 225239 — Victor Lundaen Co., Printers. Fergus FaHs. hM L wm^ '*W r■j. t"'INSPECTION RESULTS1' Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS -P I(o X SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORYActualShould Be Actual Should Be Actual Should Be 4-/Ooo STo 38>\loooCapacity4GIs.GIs.S F S F S F S F 4-toDistance from Nearest Well F F F F F F /SO ;st)Distance from Lake or Stream F F F F F /!?Distance from Occupied Building -1^00 F F F F F F r1-t6 I 0 fo.Distance from Property Line F F F F F F Distance from Bottom to Water Table 3 3FFFFF F ; Inspector’s Comments: 3 Vr 0 (A ^ V<- T1Date of Inspection 19I t70 4=, _ Time of Inspection r I ^v^ Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF = Square Feet F = Linear Feet r Job Title MKL • 032085 - Backer Agency r: ■ r. • f-. ■i%• 3 SHORELAND MANAGEMENT — COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 • Fergus Falls, MN 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM White -^6mc Yellow — Inspector Pink — Owner e Permit No..LEGAL yo^ax>~[s- /^Aadson 6rp IOhS^ !3\ ^ Lake No. Lake Name DESCRIPTION AND LOCATION TWP NameLake Classif.Sec.TWP Range IDENTIFICATION: Please Print All Information. Mailing Address — No. Street, City and StatellcUirn , MKI Zip No.Tel. No.First InitialLast Name OWNER SEWAGE SYSTEM INSTALLER aName. This System will be ready for inspection on. This space for office use only . 19. .19 .M Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signature 3]f\oJ>NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD 31/loop GIs.Sq. Ft.Sq. Ft.Capacity ^hgosnFt.Ft.Ft.Distance from nearest well IQ ■TOFt.Ft.Distance from lake or stream Ft. JO X2C)Ft.Distance from occupied building Ft.Ft. 10lODistance from property line Ft.Ft.Ft. 3•Ft.Ft.Distance from bottom to Water Table Ft. AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on , 19 , Time M /3PERCOLATION TEST DATA: 1st Test Taken By Date of First Test 19 ....Rate......$..... uDate of Second Test , 19....Rate ISFirst Test + 2nd Test 2 Rate2nd Test Taken By The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work inAgreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn­ esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approve cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been insp^cteTi and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. Shoreland Management Offi- Dated Signature Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six (6) months. Permit: OiIssued Date: ihoreland Management OfficecPIFee $Rec # Comments: Form No. MKL-032085 225239 — Victor Lundeen Co.. Printers, Fergus Falls, MN 215502® VICTOR LUNOCEN CO.. PRINTERS. FERGUS FALLS. UtNN.PERCOLATION TEST DATAMKL -0871 -028 LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, Minnesota 56537 Ph. No. Mailing Address:Owner: Zip No. L^rOrA Last Name StateCityTSt. & No.First Middle Legal Description;To rn. ’/ Li<} / iS'o /O TWP NAMERANGETWP.SEC.NAMELAKE OR RIVER NO. lUP TEST HOLE NO. 2TEST HOLE NO. 1 Cp3 I t inches: Diameter of HoleDepth to Bottom of Hole jnchesDepth To Bottom of Hole Diameter of Holeinches;inches ^ - a, ig <§^7 j A______-r^r7 J'r r~> 19Depth, Inches Soil Texture Depth. Inches Soil TextureDate Date l\xAck n/gT 3AAcVC_D|ILT3 "CPn m 9Percolation Test By____ Percolation Test By .11'^c>QkQis,Q IXI■—4 F Irm Name.F irm Name, QC k-13 JoLit CC i(^nQ7knf\^LU Address.DC Address < CO Otter Tail County License No.Otter Tail County License No..I-COUJMeasure­ ment, inches Drop in water level, inches Time Intervals minutes Percolation rate minutes per inch Time I nterval, minutes Measure­ ment inches Drop in water level, inches Percolation rate minutes per inch Remarks:Remarks:Time Timeo a 5 p -7/T 3qOo/4/a o oo a 9 3 ^7r3""-JSj 3o H3q 3o'3 P^FicX^£T\ Ail3^/I QO Pi^rTu (5 r>3rD R.Ef.L.L,(^ 3/^SL^P.1: 3n 3n!<r', i.rs I :/z:>•5 lx 3i/ /O ^3j^5. ■' oo ki (-*; I -< j?.Q ■3o / / IM /X(9^1 JOa:3o Pm£lLU££i £M£iLus£^ grkj AMl l/ -•,2^/V ■■3=5. O'O 3^5 /3. 3/0.9 3o3:QQ ^fT/- / r_-/ ,./-TO ^ r\2JL 97/^•.3 0 /3-3ZX /3,3 7/mX_aJ9 X ! /5.393aX'djQ,C.i4s(>.Pf~C\TRc>d. il See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of MN, Percolation rate =minutes per inch minutes per inchPercolation rate = cm >. j 1 'va / CERTIFICATE OF APPROVAL SEWAGE SYSTEM S'.iS1 6TH FEiROA^Y^71 This certificate has been issued this to certify that the sewage system installed as per sewage permit number indicated below has been approved for use by Otter Tail County, Minnesota. day of 19 J m LIIs m The premises covered by this certificate are legally described as: Sec.J[2 ; M Twp. Name ^ ^ -I LITup. ^ ^Range ^ - 15 131 42 4 Y 132' OF NE1/4 NEl/4 56-3^aLake No. m.10 131 42 13.3 REG SE COR G.L. 4 W 30 R03 N 40 ROS^ E '’U ROS/ S 40 KOS TO 3 = 0 iM M M 0IE3ETM SPECIALTY COOwner: Namem 1413 H ETftNTO^i Ayc / FERGUS FALLS/ YNAddress m I56537Zip No. / r / ^7^Malcolm Land & Resource Management Administrator Otter Tail County. Minnesota 71^1Permit No. SP Signed by:. MKL-0987001 -t 237.9(7 - Vicnr Unkca Co . Piiiwn. Fr(ib Fill.. Minncou 1 3 f SHORELAND MANAGEMENT — COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 • Fergus Falls, MN 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM —* Office • Yellow — In^iector Pink — Owner i r '£20 /!I a- ___ iQ -OUD^ O^y ElLEGAL/ DESCRIPTION AND gp /.:/ 4z TWP Name OLOCATION0/ Lake Classif.Sec.Lake No.Lake Name TWP Range IDENTIFICATION: Please Print All Information. Mailing Address — No. Street, City and State Zip No.Tel. No.Initial_______y First aali'i^ ro Last Name i£e-j-T)V/3 /A£, Sdn i~pp A ££xOWNER tSEWAGE SYSTEM INSTALLER Name, S ;qO 4This System will be ready for inspection on.. 19 This space for office use only OPPlCEr Date Rec'd ^ Time Rec'd Phone Cali Rec'd By OwnSi—d^A^ient Signature. NUMBER OF BEDROOMS;ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD /oaO Gis.F ?-2Sq.Sq. Ft.Capacity Ft. LJw££.Ft.Ft.Ft.Distance from nearest well 0 Ft.Ft.Distance from lake or stream Ft./ /o 3 OFt.Distance from occupied building Ft.Ft. /V /oDistance from property line Ft.Ft.Ft. Ft.Ft.Distance from bottom to Water Table Ft.7 AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on ,, 19 , Time M By £zkPERCOLATION TEST DATA:Date of First Test ,, 19 Rate Iz...rJ Date of Second Test 19or Rate 1st Test Taken By f'T /o.^Itf/'First Test + 2nd Test 2 Rate2nd Test Taken By The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn­ esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi­ cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. Agreement: VC IVDated j Permission is hereby granted to the above named applicant to perform the.work described in tW above statement. This permit is granted upon express condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six (61 months. Permit: ’r~-p.-2T>■V Issued Date: Sfyoreianri Management OfficeK-29/oFee % 2 O YCO Rec #\S^ Comments: _ Form No. MKL-032085 225239 — Victor Lundeen Co.. Printers. Fergus FaNs. MN V ipp<p Jl II • M I|>I wv pp % 1- •* %4 V 5 '•% INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS 4- X( SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORYActualShould Be Should BeActual Actual Should Be py-£1^Capacity f 60 O ja-oe>GIs.GIs.SF S F S F S F Distance from Nearest Well SOlodF F F F F F /50 2S-DDistance from Lake or Stream F F F F F F iV 2o/oDistance from Occupied Building F F F F F F T / olaDistance from Property Line /OtoFFFFF F 3Distance from Bottom to Water Table 3F F F F F ' Vv-iInspector’s Comments: i k t i> 'y g- §■- Date of Inspection 19 '7 / /Time of Inspection M I ItCf Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF = Square Feet F = Linear Feet Job Title MKL • 032085 • BeCker Agency W #' .i o G3^ Ir I5o c*h IdQ cy ET 5 Ioe t I^ ( \\» »-U) La'Acr i J-.: 7'' SHORELAND MANAGEMENT — COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 • Fergus Falls, MN 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM Wpiie — Office \ Yellow, — Inspector Pink''— Owner LirSfl 72^aCj^Permit No.,LEGAL DESCRIPTION ! AND a p /o»/r /?/ Tu^J:LOCATION Lake Classif.TWP NameLake No.Lake Name Sec.TWP Range IDENTIFICATION: Please Print All Information. Mailing Address — No. Street, City and State Zip No.Tel. No.Last Name____________________» First■PSjpe?c-la{^^ (Je> Initial 4^/? iV. A KiL'^ OWNER fSEWAGE SYSTEM INSTALLER Name, This System will be ready for inspection on.. 19. This space for office use only 19 ,M Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signature NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD /OCO 5~72sp.GIs.Ft.Capacity Ft. Ft.Ft.Ft.Distance from nearest well ff'O Ft.■•rt)Distance from lake or stream Ft.Ft. /o ^ OFt.Distance from occupied building Ft.Ft. /ODistance from property line Ft.Ft.Ft. Ft.Ft.Distance from bottom to Water Table Ft.O AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on ,, 19 , Time M . By JPERCOLATION TEST DATA:Date of First Test , 19 Rate .^.Z,Date of Second Test 19 Rate 1st Test Taken By !trti First Test + 2nd Test 2 Rate2nd Test Taken By The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work inAgreement; strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn­ esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi­ cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. Dated I Permission is hereby granted to the above named applicant to perform the work described in tlM above statement. This permit is granted upon express condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six (6) months. Permit: r-7-2-?Issued Date: Shoreland Management OfficeFee $ 2 0 ^CO Rfic # Comments: Form No. MKL-032085 225239 — Victor Lundeen Co., Printers, Fergus Falls, MN J 215502® VICTOR LUNOEEN CO.. PRIMTERS, f£R0u5 FALLS. UINN.PERCOLATION TEST DATAMKL -0871 -028 LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, Minnesota 56537 Ph. No. Mailing Address:Owner: Last Name ^ V/^ i/} . rJ State Zip No.CitySt. & No.First Middle Legal Description:VA.jlk/ULLb-J3!^srSqiQ TWP NAMERANGETWP.SEC.NAMELAKE OR RIVER NO. 3 Bf-p T?no/>7 TEST HOLE NO. 2TEST HOLE NO. 1 3}/<Lo U>SO Depth to Bottom of Hole inches; Diameter of Hole jnchesDepth To Bottom of Hole Diameter of Holeinches; inches -6~ (h 19.2-2.Soil Texture Soil TextureDepth, 1 nches Depth. Inches Date 19Date //3 BTark ni/tTni&r 0sGt r~r><>0Percolation Test Bv . Percolation Test Bv____/>P5"3 CLpr<.Q tLLI7 F irm Name.FirmName.QC C‘^"r-t£fjh. 3 aLU CC LU*7^ .AddressAddress.CC < CO Otter Tail County License No..Otter Tail Countv License No.COLUMeasure­ ment, inches Percolation rate minutes per inch Time I nterval, minutes Measure­ ment inches Drop in water level, inches Drop in water level, inches Percolation rate minutes per inch h-Time I ntervals minutes Remarks;Remarks:TimeTimeo I--30 05O3;O/'oO O 3c:>O/yc go Oo AM33l ko.3A ‘8o 30cT■30 ^ a /■'•'cc. igJ vA-V J£/(£>‘lo305loo 3:i<3 0 3^30<32 aiA3(5 V 3 5T 3-.4S3:3<d 30/p<a ^ii^tLLejD 9^ ^O_ci IS OS/3 3/3N.'oo V//5 3.030 /PiririLL <ZO Ol%-^zV.LLSD4 M 00.9.9,’35319-'3o 3o3dzg^o f^eP/LLeo0 o J0.9 5//S <37.^1B'o<y 30 ■3o 3^/'?i<rp'icLcii /(5/JSL ■ZlaiN30 PSEtt-ieDSVJOiPsAl/ ,-:n 30 AX/IT \__15iL30So(qIP/3 = ih See Booklet, "How to Run a PercolationPercolation rate minutes per inchminutes per inch Percolation rate Test" by Agriculture Ext. Service, Un. of MN.f. J ----------------f* —»•■-.-f \'- CERTIFICATE OF APPROVAL SEWAGE SYSTEM MOLOINg r<^Nl< 1 7TH 58f =08UA^YThis certificate has been issued this to certify that the sewage system installed as per sewage permit number indicated below has been approved for use day of 19 J% I rj by Otter Tail County, Minnesota,;l iaf.^ The premises covered by this certificate are legally described as: '6-5'^6 </>■ M ■"m4 2 TUMJLI13 V-Lake No. 1U 131 42 15.3 Sc COX 3 N 40 XD3r P SO XOS/’ S 40 X'">3 TO 3'3 Sec.Twp.Range 15 131 42 4 M 132* OF .MP1/4 NS1/4 Twp. Name \/.\,i''lb M 4 W 80 ROS• U • "4?i i->:ES=T4 Sf^ECTALTT COOwner: Name ■i413 STa.^TON AVH / FEOjUS FALLS^Address n 56537Zip No. 7> 43Permit No. SP Signed by:.i| Malc^mi K. La, Land & Resoum Managemeni Administrator Otter Tail County. MinnesotaMKL-0987001 237.9C7 - Vidor Lundeea Co.. Printers, Feifus FiUs. Minneiott r i SHORELAND MANAGEMENT — COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 • Fergus Falls, MN 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM White — Office ^ Yellow — Inspector Pink — bwner /12:■j)-f of Q'L. il ifiLloJ lo-ooS?-^l N f) M i H Mi ^ (^2 IS ) ' rc- s'/v- Tiolsoo Permit No..LEGAL DESCRIPTION AND 7a. 0 H-\iLOCATION3J TWP NameLake No. Lake Name Lake Classif.Sec.TWP Range IDENTIFICATION: Please Print All Information. Mailing Address — No, Street, City and State Zip No,Tel. No.InitialLast Name First W-OWNER SEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection on. This space for office use only .19 M Time Rec'd Ph Call Rec'd ByDate Rec'd Owner or Agent Signatureone H2LNUMBER OF BEDROOMS:ESTIMATED COST:V I •SEWAGE DISPOSAL SYSTEM DATA:/i SEPTIC TATIK SEEPAGE PIT DRAIN FIELD \sq. Ft.GIs.Capacity Sq. Ft. 3D Ft.Ft.Distance from nearest well t. \<50 Ft.Distance from lake or stream Ft. TO Ft.Distance from occupied building /Ft.Ft. oDistance from property line Ft.Ft.Ft. \5FTDistance from bottom to Water Table Ft. AH distances are shortest distance between nearest points RECORD OF TESTS; Inspection was made.^on^., 19 , Time ,JVI By PERCOLATION TEST DATA:Date of First Test r^9 , Rate Date of Second Test , 19 1st Test Taken By -..1^ First Test + 2nd Test 22nd Test Taken By Rate The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work inAgreement; strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn­ esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi­ cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection.. ^ : ,.T,Dated Signature Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance.NOTE: Permit: Permit void if work is not commenced withjn six (6) months. Issued Date: Shoreland Management Office20/Fee $Rec #,•2.CERT'Comments: Form No. MKL-032085 225239 — Victor Lwtdeen Co.. Pmters, Fergis Fals. MN INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORYActualShould Be Actual Should Be Actual Should BeV \Soo \^0DCapacityGIs. Qls.SF S F S F S F 5^Distance from Nearest Well F F F F F F r50 SoDistance from Lake or Stream F F F F F F MlDistance from Occupied Building in.F F F F /o10Distance from Property Line F F F F F F Distance from Bottom to Water Table 3 3FFFF F Inspector’s Comments: (rtei r-' 19 "^7Date of Inspection ft M1(0 '.0^Time of Inspection 6i Signature of hspectorINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF = Square Feet F = Linear Feet Job me MKL - 0320S5 - Backer Agency 4 SHORELAND MANAGEMENT — COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 • Fergus Falls, MN 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM White — Office Yellow —^Inspectd^ Pink — (jKvner of 6-L- d (utAist. (C)') N /y) madioo go i3i ’-rutyuJU Permit No.,LEGAL DESCRIPTION AND LOCATION TWP NameLake No.Lake Name Lake Classif.Sec.TWP Range IDENTIFICATION: Please Print All Information. Mailing Address — No. Street, City and State Zip No.Tel. No.First InitialLast Name i)OWNER SEWAGE SYSTEM INSTALLER Name, Tfits System will be ready for Inspection on., 19. This space for office use only 19 ,M Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signature NUM ROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC lANK SEEPAGE PIT DRAIN FIEL Gu.Iq. Ft.Sq. Ft.Capacity 3D Ft.Ft.Distance from nearest well N <5,0 Ft.Distance from lake or stream Ft. m \ Ft.Distance from occupied building Ft. 10 \ Distance from property line Ft.Ft.Ft. \VFT3:Ft.Distance from bottom to Water Table Ft. AH distances are shortest distance between nearest pdJ^ RECORD OF TESTS: Inspectioi , 19 , Time ,JM By PERCOLATION TEST DATA:Date of First Test r^9 Rate Date of Second Test....19 1st Test Taken By irst Test + 2nd Test rz 2 Rate2nd Test Taken By The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work inAgreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn­ esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi­ cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspecticm / / Cryytdpf-.Dated Sign^ure Permit:Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six (6) monthsL Issued Date: Shoreland Management Office20Fee $Rec # Comments: P' Form No. MKL-032005 225239 — Victor Lundeen Co,, Printers, Fergus Falls. MN