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HomeMy WebLinkAbout45000250150000_Conditional Use Permits_10-07-1992YOlonllcpi? # * APPLICATION FOR CONDITIONAL USE PERMIT Shoreland Management Ordinance Otter Tail County Fergus Falls, Minnesota 56537 Receipt No. 7S‘^Application Fee $ f^or-knsoio, yMelvitn -^-73'^-V375Owner.Phone: First MiddleLast Name /AfJ)l*l LCity Zip No.Street & No.State Lake ClassLake NameLake No. /M Twp. NameSec.Twp. Range Afc ;a.7^A<- p-{ (ol^ ^ Legal Description:Fire # or Lake ID # Parcei Number EXPLAIN YOUR REQUEST:To fittMovtS- fot] Tll'^ To u.'ie M,r f/toM Cp.^4 0n,rp,Lefts') (0fi4UnJi 4ft.') I y To I'/huiU T 'Tb MA'fSn h''^ I'" ST&rl 7^ 0(\xT ^ Tip Ui/ct ffl-'OO In order to properly evaluate the situation, please provide as much supplementary information as possible, such as: maps, plans, information about surrounding property, etc. APPLICANT SHALL BE PRESENT AT THE SCHEDULED HEARING. I understand that I have applied tor a Conditional Use Permit from Otter Tall County. I understand I must contact my township in order to determine whether or not any additional permits are required by the township for my proposed project. I.H 1921Application dated Signature Of Applicant - 00 NOT USE SPACE BELOW - Date of hearing: The Pianning Commission recommends to the County Board of Commissioners the foliowing: 19 . Time:M Chairman The County Board of Commissioners on this Approves the request as recommended by the Planning Commission. Denies the request. Approves as foiiows: ia , hereby:day of Chairman Conditional Use Permit issued in accordance with compiiance with existing Conditionai Requirements and Speciai Regulations and Minnesota Commissioner of Natural Resources notified this day of , 19. CONDiTIONAL USE PERMIT NO.. Land & Resource Management Official Otter Tail County, Minnesota sewmailed copy of Application to Applicant.(Date/Initial) MKL — 0390>006 258,370 — Victor Lundeen Co., Printers, Fergus Falls, Minnesota r ! I Scale: Each grid equals feet/inches GRID PLOT PLAN SKETCHING FORM 7 t *>•f Dated: Signature Please sketch your lot indicating setbacks from road right-of-way, lake and sideyard for each building currently on lot and any proposed structures. J I I\ -i i/J I!1 i! i.1 \x n1 m ;P ri •.-j.'i L TI;-I M^'Ip-1^1 I1 iV 2i I\\:if;\1 •f ■ -i<2r i \L' I''i!■ ‘tJi i-m :!Ii i !f ft f12 -T’-r-r-r^ I 1 I ‘-ii :i 'i II[. i;i- - — r\1 Lj; M . t; ; 7^.Iv_, S-i f It -i '4Ii I ): M J 5i -:\I 1 1!Xt-tt----------t t [ - 1 I 4. J i :i +t-4^tr —^ ■V '■'k Ir— ■ - Ni 7 'V— N :o I \}o X O1 !i:T 1.I LlJI, i i I f <r D4o1 r-I -:4=;:QtkegCM (Si MKL-0871-029 21598 7®VICTOR LUHOCCN CO.. RRINTCR*. FCRGUS FALLS. UINN, feet/inchesScale: Each grid equals GRID PLOT PLAN SKETCHING FORM Hof n 'I 19 .Dated:!//T Signature Please sketch your lot indicating setbacks from road right-of-way, lake and sideyard for each building currently on lot and any proposed structures. /2a I- f— *» 1 9 • % : \ ^ L: A t‘t V■i 'w, f r j1 ^ '*' ,I 1uIi!■ 1 :: X :1,■: :j f r ^ :::»; r k I r ;n^]-I ■ 1 » V-■!--h ■N I IK../: fs ' \ : :rI 1 )-/\:i Iit\1I t[ I1It'+T r - ■ ’ '1 t-1 i r t +--J--f- .-i-1- 4 ti^ i 4-,J T !+i I I [I;i. I iI t I ' I I I i ' T“t i-Ii ; !4:t ! r I I !I ; 21598 7®MKL-0871-029 ViCTON LUNOCtN CO . PHINTEKS. FERGUS FALLS. UINN. i OSCAR c» ♦jQ 7T ^/WVNSHIP: 134 N.RANGE- 44 W. *OPTB • CODE: OR TOWNSHIP i^57£‘ll |42 US-IO |3/.UO-^ ^ *Arvid ^ I /*^ I .mJi Ar lent I 4b 48-1 I 4b 63-1Ca^l •4i r<-< I 4fc,0(.-3 Obtrf I H«berg^ ‘iOl'I-Z I 7i-l L ^Ie ^ IPe11 a Johnso|n 4b.bU'ZI 4b b2-/ Inez. I L«fSon AUo«‘5 47.04-3 47,43-2 I 47 77-; EduilrJl Moen ^ Q 47 48-4 *?«lph f A CaroU-’'' MalbaWken «.204^i@1Ii Arl<|Hau V)»V%.en, 5®-b2:43 44 Ari’hu*' 4 Edna Gv-unetoald 8S.5I £x M (O 01 EM."3T.o5-'5 S:Klv^»“on i Joann H e K urn w iHRiSTOAtCUn ©Lvinde.4-C a »■ I +o n • Fe *■ n S t r a /lake:I ZJ4b,47L 42 Arnold ‘ K 8 ^ ' ^ Moen Q 271 “X.»40 0 T^4 25-b |»a30-©:®»44 lU25-liRuSStlll Ande*-Son U4, U7 I©■'^l 2/pVH I Donald c Janice B«nrud 200 ArtV»ur"^ r ’v*i"vr® »04 ZSJ «25 W 6 ^ Av14man 24 25-4it’274, >4 Marl.n G. Chriiton^n(^®w®2 * m m € r®@ 200 ■200 —Leonard. Kjono ( y 37. 50-5 >nyH@Ii-tI ©?«n i AuS + in P Mokanson e.lal Poqcr t OoKna Oru»m A ^ ^A^nes U^i^daM 2Ul.^l 'TDonald f Jan.ce Bcnrud LaNJcrn 't Clara 4b©£Wi^daVil Junta! Green AAnna Rian 23R©%Bertha ] ^lorfen-* Son' 5 ©;r MpOIbU.OI <^4.44 €ibo^7.21 ©c..i\2.23*3 V3Jus-lm < ^ Delores.Lerbakken D o r o-l- Dokirer Oacobsol^-'''®-* 34“l.55 ©I ©jer &r u«U --IocCViarles Jr ^ Ida L Aab Charles * Alice Fosse .94/ 144.So Obert Aabcr^Arthur &rcndene-Vat •/— Charles Jr. 33£>o i* >.so !.©rb"?)IIbO240 7— /i»o45 IZO too (b / S4,20-IN Ricbard t ormaLysne .1 i -^1 f?aj^mond Dohrer Le&lie UKli^AusVin P Ho kanson Wal + er Rasmussen I *Jda Aaber^rI40 ill. 55 ...0-8 , /v- 40 MArsirt^ I Carlkwn^^l\©©I48 00-7© Ol.f V « Clarice ^ N/eljon Ward S^iaver 1 ‘'f1^\145,40^ 504S-2 |CKarlcs|S2 T\153.40 /f?140.07 I otArno Id ♦Thel Don ^ Mary An<iMildred tmi Ha IvorsonFlatin hielsorvno e+al Mr Id red153 II N/dson e'lal306.4 u ®□f‘h Evelyn an i tl-^rv Sckhfi- ars+ad JV/id WJohnson Jrus-^ Mike eDean *juiius ^ ri L.nda©rente S-feve ^Lorra me Haarstad Mo br* +en Nei^rFon Diane 2/7 70 ®StencrAon (56 SZ // no 80 r(oM«rd Ordean •Lorraine i Ji ^rlouard Lorrajne lJ?a 3|r 3k i^-VaaTheodore<220 2c4 21 i ^ ___ J UJ Gertrude • Ju d 1 f h:t LokenHen aekh ILou .sc 1 " I2is 14 ®|5o 4^ T; 'iww^wio j6 2/25/02 WaterAVast2water-ISTS4.3i Compliance Inspection Form for Existing Individual Sewage Treatment Systems Minnesota Potiution Control Agency Completion of (his form fulfills fhe minimal requirements of Minn. Stat. § 115.55 (2001) and Minnesota R. ch. 7080 (1999y. Please refer to local ordinances for other psquirements or information, espedally forcompfiance reQuirements for bedroom additions. General; Reason for inspection: d^rA'f^ ____________ Telephone Telephone fa/iOi T'.gr^- £>~00 Zip Code 53 Fire No./ Parcel No. 0/^0/)06> County T/^/L. Township _ Legal Description Ad^ Local Regulatory Authority ~yA7L- d/?74j~fn/ lri/U'6 i4/Jd ________ Date system constructed /993 Date of Inspection: Property Owner(s) MELViJ ^ MlLA ________ Person requesting inspection A\T A^/f/T'V CitySite Address 6<P. /ftOV /O System in Shoreland /treaf^^no System in Wellhead Protection Area: System serving a MDH licensed facility; yesc^ Local Permit # (if any)______ Systems located in Shoreland or Wellhead Protean j Areas or Serving, a-Food, Beverage or Lodging Establishment, or systems Built after ________ March 31,1996 ______ Systems built prior to April 1, 1996 and not located in Shoreland or Wellhead Protection Area or Serving a Food, Beverage or Lodging Establishment Is the system an imminent threat to public health or safety? fa yes answer is an ITPHS system) ' ' " - Discharge of sewage to (he ground surface? - Discharge of sewage to draintiie or surface viststs? YES NO ,'YES NO ' Is the system an imminent threat to public health or safety? fa yes answer is an UPHS system} ^ - Discharge of sewage to the ground .surface? - Discharge of sewage to drainffle or surface waters? YES - Sewage backup into dwelling? - Situation with the potential to immediately and adversely impact or threatai public health or safety? YES NO :YES - Sewage backup into dwelling? ' Situation iwlh the potential to immediately and adversely impact or threaten public health or .afety? YES YES NOYES / Is the system failing? Ya^ves answer is a failing system) * Less than THREE feet of v^'cai separation betv/een .. system ibottom and satorated soil or bedrock? - A seepage pit, cesspool, drywell, or leadiing pit? Is the system failing? fa yes answer is a falling system) - Less than TWO feet of vertical separabon between system bottom and saturated soil or bedrock? YES - A seepage pit, cesspool, drywell, or leaching pit? YES YES, NO ye9 no/ Is the system non-comoliant? " Is the system regulate^ operating permit? (if no. goto page 2) .If yes, y/ - Has the required mpnitoring taken place?/ (lino, the sysfem is/hon-complying) / Is the system non-compliant? - Is the system regulated under a monitoring plan or operating permit? (if no. go to page 2) If yes, ~ Has the required monitoring taken place? (If no, the system is non-complying) under a montoring plan or /' YES NOYES/ YES NOYES NO / Does the monitt^g Indicate that the system meets j perfonrtance expectatijt/ns? YES- Does the monitorirjg indicate that the system meets performance expectations? (Ifno, the system is non-complying) NOYES NO /(If no, the system is ngri-complying)/L__/ /I / wq-wwists4.3lPage .1 of 2 / Property QvineLr{si\A(f.LV'lA^ ^Fire No./ Parcel No. ^SoqD;k^o/$00£>0 / System Components fPiease describe the system components and attach s'te sketch showing system location}: UaJ£ 3 C^£/j^£><i?rfA TV -THjJtdi 4 'TKEKldi^fFt. - /*^A\/fJJJF^F tAd^i rLo/J6:> What methods were used to make the determinations for the compliance inspection? (Note: No standard protocol exists. The following fist is not exhaustive, or in sequential order nor indicates which combinations may necessary to make a determination} Vertical Separation Distance Conductec) soi! borings Depth to limiting layer Depth to sy.stem bottom Examined records Hydraulic Functioning Searched for surface outlet Watertight tank(s) Probed tank bottom ca^ Observed tow liquid level tat' Examined const records tS'□ Performed hydraulic test ^ Searched for seeping in yard i/ ChecJced for back-up in home s/ Probed outside tank for ''black soil" Excessive potrding in soil system/O-faoxes □ LGU Limiting Layer Verification Examined empty (pumped) tank Homeowner testimony □ Oiliera Pressure/vacuiim check □ Other_____________□ Examined for surging in tank □ "Black soil" above soil system □ Other_________________ Status of the system Based on the compliance criteria, the system status is; (check one) □ failing (to pjptect groundwater) O an imminent threat to public health or safety (ITPHS), □ non-compliant {monitoring issue) (M compliant (none of the 3 previous conditions). Therefore, this document is a; O Certificate of Compliance □ Notice of Noncomplianoe Certification I hereby certify as a state of Minnesota licensed Inspector and/or Designer I or Qualified Employee Inspector and/or Qualified Emptoyee Designer i that I conducted an investigation that accurately determined the compliance status of this system and that my recorded observations are accurate as of this date. No determination of future hydraulic performance has been nor can be made due to unknown conditions during system construction, abuse of the system, inadequate maintenance, or future water usage. ____________ Phone Address ^37J-S' ___________ Employed by Address F Signature ________ Oate 7/7jcdi^ Inspector's name (print) License and/or Registration Number Z- Upgrade Reouirements (derived h-om Minnesota Statutes § U5.S5) An ITPHS must be upgraded, replaced, or its use discontinued within ten monttis of receipt of this notice or within a shorter period if required by local ordmarKe. If the system fails to provide suffident groundwater protection, then the system must be upgraded, replaced, or its use discontinued within the time required by rule or the 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 does not apply to systems in shoreiand areas, wellhead protection areas, or those used in connection with food, beverage, and lodging establishments as defined in law. Suggested Attachments 1) Site sketch could also include: vrell, well setback to system, dwelling or other buildings, tank(s),reserved soi! treatment area, surface water and soil boring locations. Include as-built drawing if available. 2) Soil baring togs, showing each horizon. Indicate the texture, color, redoximorphic featiires depth to bedrock, standing water and whether the materia! is ftii. 3) A list of any and all requirements of tiie local ordinance that are different from the state requirements referred to on this form. 4) A homeowner survey of system performance, signed by the homeov/ner as beir^ factual. 5) Monitoring data as appropriate. Page 2 of 2 System design must be to scale and must include the proposed location of the sewage system, all existing/proposed buildings, property lines, the ordinary high water level of the water body, wetlands, bluff and all water wells within 150' of the sewage system. If there are any questions, see the University of Minnesota Site Evaluation worksheets. /___inch(es) equals _^^__feetfeet, orgrid(s) equalsScale; MPCA LICENSE BY: I61U^ FIRM NAME:____________________ ADDRESS:______________________ LICENSE CATEGORY: ___________ 7/7 ULt______________DATE; SIGNATURE: Lamb n~~ II- - (I - - “V. '^2^1 OhiU^ ■i /PW Mlu/J 57/^, Br. ! /hiBt \1 [ i 315,904 • Victor Lur>deen Co.. Printers • Fergus Falls. MN • 1-800*346-4870BK — 1003 — 029 ------5- ; i : i i, ki !{{ ...i i.i.i..li . .,.........,^n-1-rrr^ Si^Ei-P»^jM<^RKsyiEEljj:|:t:±^:-fftJ ""'tl'fj^P l« l?ESOl!ll|lci!«^N)^5|iM^^ GOVERNMENT-SERVIGES GENTiER 540 WEST FIR, FERGUS|FALLS,4MN 56537 ........ p i-!iV>-“t.1..r't-..+....I..I.t-+-“i.........^.. www.co.otter-tail.mn.us I : ' f ‘ " i r M ^iLp::::: 1:1:14^ .1 i 1 i 1 j 1 1 :,ri-j- j ' 1 4; ; ; ; [ r T t [ [[ I 1 'Sewage Treatment Sys^^ T Tin I..ffPi IT(■!■■ __L.i.L..L U_..LiM..i •4—1-i'i:I I t-f- !■ ■r L.-4T' t" i..4-iI I . , ^ -.[-r!aEm::::: itj,:] ' ' ffl ' OWI ■-H-: :1..U.- ..^ t !I ttt T-i!.1 I I I [ -iII I FT4" I IiI TELEP^HONE-NUMBER-:J__iFIRST-r■A-\L^ASt-NAME-;f IJ.MIDDLE-1....... L j.H•I-f ( i ‘ Irjli 'i:.._i.■i_. [_■■ ' T - t f- IADDRESS:I .1..r L -H 1.....4...t T 14I.1..r4 r f r4I t t i It t t -Istr]/rt.' t ^ZH^EODESTATE ,I S.1..1, I 1fTTr'i"!I 1 !I T T ITiji i i III TWPXNAMEt^rtwp. , rAng 'eiSEC\LAKE nAmEc IijAke/river no..1, ] [1 .j...]lpI !\SOlMBQRINGhliQG3AL-DESCRIPTION: thU.ti'Tif4“”1..i..hr i iI ^.m:q -j.taxil COLOR miIjnseXno:Xerth! (INCHES)'.. i 4 TEXTORE STRUCTURE7Ii t-t 1.4blocky[ PLATY ' PRISMATIC : NONE i f"'4 RIi -1I1.....i....r ....f....[•• I !. Ih I1..i.1 IfpAr'ceeMmber -t'II \ I.....I -(; blogkyI : plW'y.... ■1 f i-f-r...-rfPRISMATIG •~~~Kl6r^E~rT 1 Ii'! I 1 ._Ll !_1(i r- f-..' . Li.1IL •h4--f I ^E-97T~A(ddress Wearesf Public kda'd “-I..L!.;4.j£iu:ixx4j.LlTl444x4i|: NUMBER OF-BEDROOMSt^ ■ ) 4 I ' , , > ' i itilt.ill f It. 44 4X ' ! 1 1 U t q 4 ) .GARBAGE|DISPPSAL:| , YES NO ; j ! ' , ! ! \|/ELb::cAb^ FLOODPrAIN:--^ YES t iI1 ILLtUit ! ! L i J_ r f :'r1 " 'blocky^Lj I +4 I Xt (!I !PLATY-. 1. L I.....L rII1I[PRISMATIC'- NONE 1 14ILri..L.I t fTft. SEWER LINE SEPARATjlON: !ijft 1 i blogky' - pLat-'X-- RRlsMATICi ^ NONE ' ' , 4 11 I I II11I bluffH yes 4-“no "[..f '“t ' I I M r b )4«4NO"X TT-f 1 i 4iJM I I ii- --VEGETATION:* i AQUATIC.... 1! t 4 i.... SL0PE|-AT| INSTALLATION SITE:,__ terr'eXrial I •Xlih'41 I 1.I r~r r I 1 II'. BLOGKY-i I 1.1=l-4:..4|..Li:-t; i-11-XXjX^liXXit I ■h tiI%+4 PLATY-t L (..II-. ....+.....t■t..I.j..hf fn iQ PRISMATIC I NONE , : i i, :_M 1 i 44 r j-i i i-j ■ , Pit! ; Rnririg, , ‘ _....4 "4TII!TYRElbEj-OBSERyieiTION: 4 ....I..I..[..j ; ' ' i 11''. _i . ^PARENT MATERIAL':; i Till I Outwash ; Loess. Bedrock 4 1 ! j 1 ; I 4 ,X 4 4) 4 ;4J i ORIGINAL SOIL Yes No ’ I i t ; _X ----'* '■i)I IProbe If .41Alluvium!i_..I ItTtII1[■T'i..r.....rrt.1Date of SqillBoring V[r:1..1..[..r T'1'^ i'I ■fi triI " i r .I..J.. ..IIL,:.L:±.Lp'Jt I GOMPAGTED; SOIL: , Yes No'4 I ^ :tr Ii -I I DEPl H OF BORING (To 7'lor- fe^rictive-layef):[4 - X"' r i I r- }|^R|c[:TEstpX^Date I of Perc TeX"' 'I..[..i-4.1..L .=.ft.1.........i. 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I !...r-r fI 4.■~r TfPROPOSED'DESIGN: " I ' TRENCfflllliqiJBfeliriQ.,T^R/ivDEir " |...}..I..I..I-..'..[..i..i-- [..[.QlJTi-lbuSEr ■i-i-L T -1 fr q !_t 4_ , _ GRAVITY [DIST.LLXX [PRESSURE DISP. -[ I ' ( 1 ' -4 —4 i ; i I-- - r - -'-i-hi-.-i-.4-hr 1■' r r "i holding tank ; I 'sPECiFY:4 rh’..! :■ ~ ^SYSTEM DESIGN ON BACK mound_I 1 ■I..f... 1.T'other!I _..L_...^SEWER-LINE rr 1:1:4:-)• ' ■ f ■qI i !- i I 1 1I I }.••••>•-r-; 1-XX 4 -f....I.....i-...r T ■1 ; IT T~