HomeMy WebLinkAbout58000060034000_Variances_03-20-20071018753 OFFICE OF COUNTY RECORDER
OTTER TAIL MINNESOTA
I hereby certify that i
this instrument #_____________
was fiied/recorded Lp this office for rec^d on the, K day of
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THE ABOVE SPACE IS RESERVED FOR THE COUNTY RECORDER
APPLICATION FOR VARIANCE
COUNTY OF OTTER TAIL
GOVERNMENT SERVICES CENTER
540 WEST FIR, FERGUS FALLS, MN 56537
(218) 998-8095
Otter Tail County’s Website: www.co.ottertail.mn.us
Application Fee
/ ^//6>SCOMPLETE THIS APPLICATION IN BLACK INK Receipt Number
Accepted By / Date y
PROPERTY OWNER V
MAILING ADDRESS 1>~S /T^jJ
DAYTIME PHONE
AJ£_____LAKE CLASS
OhrI<ti\ <,Aj tlfcCLAKE NAME
TOWNSHIP RANGE
LAKE NUMBER
TOWNSHIP NAME ,SECTION
Coo E-911
ADDRESS
PARCEL
NUMBER
LEGAL DESCRIPTION . t , ^ ^ v—_P+ 5 iU£(^ Corn S£ Ccr Sea Q AJ XU9-01 foO I>ey-OU ^7S,17
//Ac of SS- Ae P+ of 6«/r A/ S”7 Day U) ^CS>. fj’yu
S-J 1>5' ui jef 77 A' f Day £ 3^7.97 5 !><y £ m.SS
<. A/.3. . tJL Tl',
TYPE OF VARIANCE REQUESTED (Please Check)
fo c’cvr
Structure Setback X Structure Size " Sewage System Misc.Subdivision Cluster
3'oa u y
SPECIFY HOW YOUR PROJECT VARIES FROM ORDINANCE REQUIREMENTS. PLEASE BE BRIEF AS
THIS WILL BE USED FOR PUBLIC NOTIFICATION.
'Madi -hi up / O
/^O feef 'F(X" Uo-^C. U
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 &
RESOURCTMANAGEMENT regarding THIS MATTER.
A~ycjp
SIGNATO^ OF PROPERTY OWNER DATE
APPLICANT MUST BE PRESENT AT THE HEARING
(Applicant Will Receive Notification As To The Date/Time Of Hearing)
SCANNED
-.FDate Of Hearing Time
z
Motion
Denny and Kelly Bosek- Denied. (8:25 p.m.)
After consideration and discussion, Randall Mann made a motion, second by Steve Schierer and unanimously carried,
to deny the variance as requested as no adequate hardship unique to the property had been shown that would allow
for the granting of the variance as requested and noting that the applicants have substantial room to place the
proposed structure in a complying location.
il County Board of Adju^fmenthairman/Otte
Permit(s) required from Land & Resource Management
Yes (Contact Land & Resource Management)
Copy of Application Mailed to Applicant, Co. Assessor and the MN DNR 7l
bk 0106-001
V. Lundeen 324855
May 3, 2007
Page # 4
Timothy and Lori Crompton - Denied. (8:15 p.m.)
Timothy and Lori Crompton, Lots 11 and 12, Anderson Beach Addition and part of Government Lot 3,
Section 11 of Scambler Township by Pelican Lake, requested the following; Does not meet 75’ lake
setback. The front side new building will be 38’ from the front property pin (OHWL) on the lake side. The
proposed building has storage area with possible bedroom in the future on the lower level. The two stall
garage will be on the upper level. Each level will be 864 square feet upper and lower. The proposed
building will be 864 square feet attached to the existing building. Need 37’ variance. The audience was
polled with no one speaking for or against the variance as requested. After consideration and discussion,
Paul Larson made a motion, second by Carl Zick and unanimously carried, to deny the variance as
requested as no adequate hardship unique to the property had been shown that would allow for the
granting of the variance as requested, the proposed development area has very fragile terrain features and
the only identified hardship is self imposed.
Denny and Kelly Bosek- Denied. (8:25 p.m.)
Denny and Kelly Bosek, part of the South Half of the Northeast Quarter, Section 6 of Tordenskjold
Township, requested a variance of 40’ from the required ordinary high water level setback of 200’ for the
placement of a shed 160’ from the ordinary high water level. The audience was polled with no one
speaking for or against the variance as requested. After consideration and discussion, Randall Mann
made a motion, second by Steve Schierer and unanimously carried, to deny the variance as requested as
no adequate hardship unique to the property had been shown that would allow for the granting of the
variance as requested and noting that the applicants have substantial room to place the proposed structure
in a complying location.
Gary and Kim Kamrowski - Tabled. (8:35 p.m.)
Gary and Kim Kamrowski, part of Government Lot 3, Section 24 of Elizabeth Township by Jewett Lake,
requested the following: a variance of 19’ from the required ordinary high water level setback of 75’ for the
construction of an 8’ by 16’ addition on existing deck, with storm shelter under the new addition, being
approximately 56’ from the ordinary high water level. Current impervious surface coverage is
approximately 29%. The audience was polled with no one speaking for or against the variance as
requested. After consideration and discussion, Randall Mann made a motion, second by Steve Schierer
and unanimously carried, to table, with the verbal permission of the applicants, this public hearing until the
June 2007 Board of Adjustment meeting to allow the applicants an opportunity to consider possible
alternatives to reduce the impervious surface coverage on the lakeside of the applicants' property.
Martin L. Toso - Withdrew prior to the meeting.
Martin L. Toso, part of Government Lot 1, Section 14 of Pelican Township by Prairie Lake, requested the
following: to replace a portion of existing dwelling that is 22’ from the ordinary high water level with new,
construct a 26’ by 7’ addition to dwelling at 52’ from the ordinary high water level and construct a new roof
over all of the new construction and the remainder of the original dwelling. April 5, 2007 meeting - Dennis
Ouren, Contractor, appeared with the applicant at the public hearing. The audience was polled with no one
speaking for or against the variance as requested. After discussion and consideration, Michael Harris
made a motion, second by Carl Zick to approve the variance as requested. This motion failed with Paul
Larson, Randall Mann and Steve Schierer voting no. The motion to approve failed; therefore, the variance
request was denied. Those voting in favor of this motion noted that the proposed development would be
no closer to the ordinary high water level then the existing development. After additional discussion and
consideration, Steve Schierer made a motion, second by Randall Mann to approve a variance of 60’ from
the required ordinary high water level setback of 100’ for the replacement of the mobile home at least 40’
from the ordinary high water level and any new addition to equal the 17’ by 18’ area must go to the back of
this area.
Notice of Hearing for Variance
Otter Tail County
Government Services Center
510FirAveW
Fergus Falls, MN 56537
(218)998-8030/998-8041
Email - wstein@cp.ottertail.mn.us
www.co.otter-tail.mn.us
Applicant mustibe present at the scheduled hearing.
To Whom It May Concern:
benny and Kelly Bosek
21585 County Highway 35
Underwood, MN 56586
has made application to the Otter Tail County Board of Adjustment for a variance as per requirements of the Otter Tail
County Shoreland Managernerit Ordinance, the Otter Tail County Set Back Ordinance and/or the Subdivision Controls
Ordinance. The Otter Tail County Board of Adjustment will assemble for this hearing on .
Thursday, May 3, 2007 at 7:30 p.m.,
in the Commissioners’ Roorn of the Otter Tail County Government Services Center, Fergus Falls, MN. (Please use the
: public entrance located on the northeasterly side of the Government Services Center The second leftpff Fir Ave.)
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 the South Half of the Northeast Quarter,
Property Address - 21585 County Highway 35.
Section 6, Towriship 132, Range 41 - Township Name - Tordehskjold
Lake No. 56-425, Lake Name - Unnamed; Class - NE ,
The variance requested is-
a variance of 40’ from the required ordinary high water level setback of 200’ for the placement of a shed 160’ from the
ordinary high water level.
Date: April 13, 2007 'Wayne Stein , ‘
Board of Adjustment 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 16th, day of April, 2007 the attached Notice of Hearing for Variance was duly served
upon the individuals listed below and/or included in the attachment:
Kelly L & Dennis R Bosek, 21591 County Highway 35, Underwood, MN 56586
Sylvan Lein, Twp Clerk of Tordenskjold, PO Box 4, Underwood, MN 56586
Otter Tail County Cola, % John Matteson, 23674 W Silver Lake Rd, Battle Lake,MN 56515
Richard West, OTC HWY Engineer, 505 S. Court St. Suite #1 Fergus Falls, MN 56537
Terry Lejcher, 1509 1®‘Ave N., Fergus Falls, MN 56537
DNR Regional Administrator, 2115 Birchmont Beach Rd. NE, Bemidji, MN 56601
Town Clerk
Board of Adjustment:
Paul R. Larson, 21283 County Highway 65, Henning, MN 56551-9573
Richard S. Shierer, 32117 260th Ave, Erhard,MN 56534
Carl Zick, 25850 Lida Shores Loop, Pelican Rapids, MN 56572
Randall Mann, 532 N. Ann St., Fergus Falls, MN 56537
Michael Harris, 35387 Northern Lights TrI, Richville, MN 56576-9672
Joe Maske, 14833 Lake Olaf RD S, Pelican Rapids, MN 56572
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: April 16th, 2007
Wayne Stein, Secretary
Otter Tail County Board of Adjustment
By:
Vi Manderud
■:
S'.
MARK O & KATHRYN PEDERSON -
29999 225TH ST
UNDERWOOD MN 56586 9300 '
ORVILLE N & GLADYS V FURRENESS
21734 COUNTY HIGHWAY 35
UNDERWOOD MN 56586 9705
KELLY L & DENNIS R BOSEK
21591 COUNTY HIGHWAY 35
UNDERWOOD MN 56586 9505
RCE FAMILY FARM PARTNERSHIP
34814 46TH AVE S
AUBURN WA 98001 9021
-l!
• -f;.
L
4/13/2007LIST PARCELS IN BUFFER
CountryCS2Addr3Sortname Addr2Parcel Number Namel Name2 Street Addr
|217^COUNTY HIGHWAY 35 [lUNDERWOODMN 56586 9705
VunderwoodIwn
58000050027000 iFURRENESS,ORVILLE N & GLADYS VlORVILLE N & GLADYS V FURRENESS |
58M0"0M032000^iFURREJNlSS7ol^]LLE ¥ & Gi^'DYS'v
58Mb06d03^'60~~jPEDEi^ON,MARKOTK/^^N ~ iil^KoXKATHRYNPEDERSdN |
!21734 COUNTY HIGHWAY 35
I29999 225TH ST JUNDERWOOD MN 56586 9300
ssbobbebbsiboo |BOSEK,kElLY L & dennis r jUNDERWOOD MN 56586 9505IKELLY L & DENNIS R BOSEK |
58bbb060041000 ~;^CE"FAMILY FA^IpARTNERShTp IRCE FAIvEYFARMb^fNERSHiP f
121591 COUNTY HIGHWAY 35
SAUBURN WA 98001 9021J34814 46TH AVE S
m .
Page 1
4/13/2007Buffer Mail
CountryCSZAddr2 AddrSSortnameNamelStreet AddrName2
lUNDERWOOD MN 56586 9505 i
lUNDERWOOD MN 56586 9705 i
UNDERWOOD MN 56586 9300 |
AUBURN WA 98001 9021
BOSEK,KELLY L & DENNIS R
FURRENESS,ORVILLE N & GLADYS V ORVILLE N & GLADYS V FURRENESS i
PEDERSON,MARK O & KATHRYN !MARK O & KATHRYN PEDERSON [
RCE FAMILY FARM PARTNERSHIP IRCE FAMILY FARM PARTNERSHIP ‘
KELLY L & DENNIS R BOSEK 21591 COUNTY HIGHWAY 35
21734 COUNTY HIGHWAY 35
129999 225TH ST
134814 46TH AVE S
< .
Page 1I
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.ottertail.mn.us
November 22, 2004
Dennis & Kelly Bosek
21591 Co. Hwy 35
Undenwood, MN 56586
RE: Sewage Treatment System Servicing Tax Parcel Number 58000060034000
Described as Pt SI/2 NE1/4 Com SE Cor..., Section 06 of Tordenskjold
Township, Unnamed Lake (56-425)
As of November 17, 2004, the sewage treatment system (Sewage Treatment
Installation Permit #17308) servicing your property was determined to be in compliance
with the provisions of the Sanitation Code of Otter Tail County for a 3 bedroom home.
If you have any questions regarding this matter, please contact our office.
Sincerely
Mark Ronning
Inspector
SCAHNED
V
»
APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM
LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095)
GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537
www.co.otter-tail.mn.us
WHITE - Office
YELLOW- L&R Inspector
PINK - Owner / Contractor (after issue)
T
/7U.YPermit No.APPLICATION MUST BE COMPLETE IN ORDER TO BE PROCESSED
SECTION TWP NO.RANGE TWPNAMELAKE/RIVER NAME LAKE/RIVER
CLASSLAKE NUMBER
LLnhAjyneo.6 tiliO C
PARCEL NUMBER (S) OF PROPERTY BEING SERVICED E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROAD 4
I/ 5 T '■>S8 006 nC -L L—>
LEGAL DESCRIPTION
/’a .^'/a Ne'/Y donn Co IT.
*■,. / r--:■r r
Daytime Phone No.Last Name First Initial Mailing Address
^/S9/ Pjr. Mo/u3e
LLndeA'uJooJ.
h I'Property
Owner I-
/(g/^ •^Dtnfu's Ftose.k'
Contractor
Lie.#
THIS SPACE FOR OFFICE USE ONLY
///7 A.M.
P.M.>■ This System will be ready for inspection on.the year of
J///7/aV
Date Recewed 7
P.M.
L&R OfficialTime Received
SEWAGE TREATMENT SYSTEM DESIGN DATA - AS SHOWN ON DRAWINGTYPE OF INSTALLATION
(CIRCLE ONE)
DRAINFIELDTANK
Size GIs. Ft'Add-On/New System
(20) Trench, Rock
(21) Trench, Gravelless
(22) Trench, Chamber
(23) Bed ^4) Mound
(25) At Grade
Replacement
(32) Tank, Septic
(33) Tank, Lift
(34) Trench, Rock
(35) Trench, Gravelless
(36) Trench, Chamber
(37) Bed
(38) Mound
(39) At Grade
(40) Combination
Setback to nearest well Ft. Ft.n j
Setback to OHWL (lake &/or river)Ft.Ft.
Setback to wetland Ft. Ft.I2-i o
Setback to dwelling Ft. Ft.Collector System
(26) Trench, Rock
(27) Trench, Gravelless
(28) Trench, Chamber
(29) Bed
(30) Mound
(31) At Grade
Setback to non-dwelling Ft. Ft.
Setback to nearest property line Ft. Ft.
I,)Other
(41) Tank, Holding
(42) Outhouse
(43) Sewer Line
(44) Performance
(45) Miscellaneous
^ ■
Setback to road right-of-way Ft. Ft.
Ft.Ft.Elevation above restrictive layer
ALL DISTANCES ARE SHORTEST DISTANCE BETWEEN NEAREST POINTS.
ABSORPTION AREA FOR MOUNDSDEPTH OF WATER WELL ff BEDROOMS
GARBAGE DISP. Y / N
ABATEMENT Y / N Ft^HOLDING TANK MONITOR/
DISPOSAL CONTRACT
( )Yes
{ ) No-L&R Can Not Process
EFFLUENT
DISTRIBUTION
( ) Gravity
( V) Pressure
Designer
Designer Lie. # , ■ j .
Highest Rate
PERCOLATION
TEST DATA
£7Date of Test,
Agreement; The undersigned hereby makes application for permit to install;>alter, repair of extend Sewage Treatment System herein specified, agreeing to do all
such work in strict accordance with Sanitation Code of Otter Tail County, Minnesota. Apfilicant agrees that the Site Data Worksheet submitted herewith and which is
approved by a Land & Resource Management Official shall bebome 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 valid for a period of six (6) months.
A 30-^"
Permit Fee $Date:
Signature of Property Owner/Agent for Owner7^/! // {'/‘7 Rec. No. J IDDate:■1- 7’ 7 ^Land S Resource Management Office
Comments:
Form No. BK — 0203-003 315,609 * Victor Lundeen Co.. Printers * Fergus Falls, Minnesota
- ^ r -
SEWAGE TREATMENT SYSTEM F*ERMlt INSPECTION RESULTS
Inspector must make all measurements
-UOLDINCr
SEPTIC TANK DRAINFIELD OUTHOUSELIFT TANKCATEGORY
Capacity /Qua ^ GLS.GLS.FT2
Setback from Nearest Well /o«» f" FTfoa -h- FT /Qoy- ft FT
Setback from Buried
Water Suction Pipe / oo / FTI O i—FT /ooy, ft FT
Setback from Buried Pipe
Distributing Water Under Pressure FT /d FT-t— FT FT
Setback from OHWL (lake &/or river)/<r O^-FT / 4- FT FT
Setback from Setback from Wetland FT FT FT FT
1 i FTSetback from Dwelling 3T FT
Setback from Non-Dwelling FT FT FT FT
Setback from Nearest Property Line /o 7^ ft lO-H FT lo^ ft FT
Setback from Right-of-Way FT / o ^ ^fo^ ft FT
Elevation above Restrictive Layer FT FT 3 FT FT
Holding Tank/Lift Alarm NO
Old System Pumped & Destroyed NO
SEPTIC TANKfSt FILTER Sewer Line to Well Separation DRAINFIELD CALCULATION
Actual Minimum# Tanks Installed.
FTX^/Q□ YESManuf..%ybo .ft^/FT 20Model #
✓MOUND CALCULATION
MOUND /AT-GRADE
ROCK REDUCTIONuInspector’s Comments:.
?ABSORBTION AREACs-y/ Q e Rock trenches with inches
3/az o of rock under pipe to %Ft. X
;pt30 .tl^DRreduction/^uivalent toFt2
SKETCH:
t
yo/- t/o
ZOAVO3
Time Initial / L S R Official
As of
Code of Otter Tail County.
the above described sewage system installation was found to be compliant with the provisions of the Sanitation
Land & Resource Managemeniptffaal
APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM
LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095)
GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537
www.co.otter-tail.mn.us
WHITE - Office
YELLOW-L & R Inspector
PINK - Owner / Contractor (alter issue)
/71pSAPPLICATION MUST BE COMPLETE IN ORDER TO BE PROCESSED Permit No.
SECTION TWP NO.RANGE TWP NAMELAKE/RIVER NAME LAKE/RIVER
CLASSLAKE NUMBER
6Hty 02,
E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROADPARCEL NUMBER (S) OF PROPERTY BEING SERVICED
OOP o
LEGAL DESCRIPTION
S~ /9crYS
First Initial Mailing Address Daytime Phone No.Last Name
)uHy Z! G«-Property
Owner 3(S~~
(X P CrJtuiOO Of
Contractor
Lie.#
THIS SPACE FOR OFFICE USE ONLY
A.M.
the year of P.M.>■ This System will be ready for inspection on..at.
.A.M. P.M.
L & R OfficialTime ReceivedDate Received
SEWAGE TREATMENT SYSTEM DESIGN DATA - AS SHOWN ON DRAWINGTYPE OF INSTALLATION
(CIRCLE ONE)
TANK D
GIs.SizeAdd-On/New System
(20) Trench, Rock
(21) Trench, Gravelless
(22) Trench, Chamber
(23) Bed
Mound
(25) At Grade
Replacement
(32) Tank, Septic
(33) Tank, Lift
(34) Trench. Rock
(35) Trench, Gravelless
(36) Trench, Chamber
(37) Bed
(38) Mound
(39) At Grade
(40) Combination
Setback to nearest well Ft.Ft.
Setback to OHWL (lake &/or river)Ft.Ft.
Ft.Ft.Setback to wetland 2-ro
Ft.Setback to dwelling Ft.VOCollector System
(26) Trench, Rock
(27) Trench, Gravelless
(28) Trench, Chamber
(29) Bed
(30) Mound '
(31) At Grade
Ft. Ft.Setback to non-dwelling
Ft.Setback to nearest property line Ft.SOOther
(41) Tank, Holding
(42) Outhouse
(43) Sewer Line
(44) Performance
(45) Miscellaneous
Ft.Setback to road right-of-way Ft.
2-^1.Ft.Elevation above restrictive layer Ft.
ALL DISTANCES ARE SHORTEST DISTANCE BETWEEN NEAREST POINTS.# BEDROOMS *3
GARBAGE DISP. Y / 6S>
ABATEMENT Y / (P
ABSORPTION AREA FOR MOUNDSDEPTH OF WATER WELL
Ft^HOLDING TANK MONITOR/
DISPOSAL CONTRACT
( )Yes
( ) No-L&R Can Not Process
EFFLUENTDISTRIBUTION
( ) Gravity
[yx:] Pressure
i-VDesigner
Designer Lie. # "1 .l/o
PERCOLATION
TEST DATA
Date of Test II Highest Rate /~7
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.
/oo*^
py<r^J
L
Signature of Property Owner/Agent for O^er
Permit Fee $Date:/
///r-iVW Rec. No.Date:
Land & Resource Management Office
Comments:
Form No. BK — 0203-003 315,609 • Victor Lundeen Co.. Printers • Fergus Falls, Minnesota
SITE DATA WORKSHEET
LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL
GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537
218-998-8095
www.co.otter-tail.mn.us
Sewage Treatment System Permit #OWNER:
FIRSTLAST NAME MIDDLE TELEPHONE NUMBER
ADDRESS:
ci/
CITYSTR./RT.STATE ZIP CODE
U/ 7 i'; •'(J
RANGE
L y>2-<-/2_r
LAKE/RIVER NO.LAKE NAME SEC.TWP.TWP NAME
LEGAL DESCRIPTION:SOIL BORING LOG
ooo PC, (50j i OOP______
COLOR &
MUNSELL NO.
DEPTH
(INCHES)TEXTURE STRUCTURE
BLOCj^
"PLATY
PRISMATIC
NONE
Lo'^0-IY
PARCEL NUMBER
PLATY
PRISMATIC
NONE
Lo IE-911 Address or Directions From Nearest Public Road
3NUMBER OF BEDROOMS BLOCKY
PLATY
PRISMATIC
NONE
GARBAGE DISPOSAL: YES l$0
SEWER LINE SEPARATION:ft.
FLOODPLAIN: YES BLUFF: YES dSB
VEGETATION: AQUATIC (TETfRESTRjafe
WELL: CASING DEPTH BLOCKY
PLATY
PRISMATIC
NONE
BLOCKY
PLATY
PRISMATIC
NONE
/SLOPE AT INSTALLATION SITE:%
PitTYPE OF OBSERVATION:Probe
PARENT MATERIAL: <1jtl
ORIGINAL SOIL: No
Outwash Loess Bedrock Alluvium
/ / - TDate of Soil Boring.
COMPACTED SOIL: Yes MS
2y1DEPTH OF BORING (To 7’ or restrictive layer):Date of Perc Test
PERC TEST #1 PERC TEST #2- TWO TESTS ARE REQUIRED -
INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATETIME TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE5:?//,
TIME Prop perc
/START START
......a__TIME DROP PERC
WATER DROPTIMEINTERVAL (MINUTES)WATER DEPTH PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEm.Ik
TIME DROP PERC
REFILLA REFILLO.IZ7J/.H 17-TIME DROP PERC
TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE'7i (LkjL -JArREFILLREFILL
"jiy/k-J.IZTIMEDROP TIME DROP PERC
INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTHTIME WATER DROP PERC RATEJW77.'2.^1;—-'VaREFILL REFILL A.3L-IAOr.IZr.TIME DROP PERC TIME DROP PERC
INTERVAL (MINUTES)WATER DROPTIMEWATER DEPTH PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEfiL.m 7LA.lL-lkTIMEDROPPERC TIME DROP PERC
WATER DROPTIMEINTERVAL (MINUTES)WATER DEPTH PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEREFILLREFILL
TIME DROP PERC TIME DROP PERC
WATER DROPTIMEINTERVAL (MINUTES)WATER DEPTH PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEREFILLREFILL
TIME DROP PERC TIME DROP PERC
INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATETIME
REFILLREFILL
TIME DROP PERC TIME DROP PERC
PROPOSED DESIGN:
BED.ATGRADE.MOUND (,HOLDING TANK. GRAVITY DIST..PRESSURE DIST..TRENCH.
SPECIFY:.OUTHOUSE.OTHER.SEWER LINE.
— SYSTEM DESIGN ON BACK —
n HHr.II x|-ii, , , . ..IX-XX-l.i..t................L.I..Li.[in i__i i_ [E-4_.JEEiEi..j j j M 'I n-
System design4mustLbpLto|-scale|and |must infclude-the-fp[roposecl-!Qcajtiph of^the-sewage] system,j a I^i^i^]^p|^p|os^-^lGlirigs[.]propeptYiine:^^4th[e|lorditjiary^M^fwat^lt^lfptj4t>ie
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-- of l^irinesbta $ i t e Eva I i at i o ri-wo r ks h|e ets. Lt------_j_4....| [ El| 4... (, 1 [ |-[-]E| -:TI]X]Ef.4l4.XI - ft]-1 L;4lb ■■■
—[.-.......-.........I I , [ jui : ' f' ' I- - ^ _L ^ t ^ I ■
----------- . . ^ . --------( . i ^ _i 'I ^ T 1 I 1 I J _______’ ' .
-1-l-Sca e:4-.IX - X -iaridfs) equals 1- 44- i feet^Lorh M B-iXinGhfeS) equals 4XinX i Lfeet.i-4..1..1....i..l..-iX-iX-lX -I..I...I..-4-X-'-,.
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DESIGN 3YXED •r^ 5 CJ<^
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.1..I...u.LiL,tilX:LLi:l:j
Falls.IMN • 'Ix-P-tI)., L !. ..1.
315.904 •
L..X_i...L. i 1J f.. .1
LundeeniCo^ Printers 4 Fergus!
4- .. t----- -[ -i.........i.......t... ..L..,_,j... .4
I I ! I I II : ' 1 I j
4"ep0 346-4870'..[ " |Victor
t.r.rXxi.i.E.Liliirt ■I-1 i i i i
Mound Design Worksheet (For flows up to 1200 gpd)
All boxed rectangles must be entered, the rest will be calculated:
A. FLOW
Estimated
or measured
450 gpdfsee figure A-1)
' X1.5 (safety factor) =0___gpd
B. SEPTIC TANK LIQUID VOLUMES
Septic tank capacity gallons (see figure C-1)1500
C-1 Septic Tank Capacity in Gallons
Capacity with
Garb. Disp.
Capacity with
Disp. and Lift
Number of Minimum
CapacityBedrooms
750 1125 15002 or less
3 or 4
5 or 6
7,8 or 9'
1500 20001000
22501500 3000
30002000 4000:-
C. SOILS (Site evaluation data)
1. Depth to restricting layer=
2. Depth of percolation tests =
3. Texture |
4. Soil loading rate (see Figure D-33)
Percolation rate
5. % Land Slope
feet2
12 inches
loam
]gpd/ft^0;6
1.5 ,MPI
%. 1
D. ROCK LAYER DIMENSIONS
1. Multiply average design flow (A) by 0.83 to obtain required area of rock layer: Item A x 0.83=
373.5 ft^450 gpdx 0.83 ft^gpd =
2. Determine rock layer width = 0.83 ft^/gpd x Linear Loading Rate (LLR) (see LLR chart)
10.0 ft
D-34SI(
0.83fl^/gpd X 12
Land
LLR Chart Slope,
Perk Rate LLR in%
<120 MPI <=12
>=120 MPI <=6
0
3. Length of rock layer = area divided by width =
373.5 ft^ /
1
10 feet= " 37.5 feet 2
E. ROCK VOLUME
1. Multiply rock area by rock depth to get cubic feet of rock
3
4
373.5 ft^373.5 X 1 ft =5
6
2. Divide fl^ by 27 ft^/yd^ to get cubic yards
373.5 / 27 =
7
13.8 yd^8
9-
3. Multiply cubic yards by 1.4 to get weight of rock in tons;
13.8 yd^ X 1.4ton/yd^ =
10.
19.4 tons 11
12
F. ABSORPTION WIDTH
1. Absorption width equals absorption ratio (see Figure D;33) times rock layer width
10.0 ft 20.0 ft2X■ =Page 1 of 8
.
G. MOUND SLOPE WIDTH & LENGTI
1. Absorption width (F): f
be^han oTeaual to 1%)
20.0 . fepf
2. Calculate minimum mound size
a. Determine depth of dean sand at'upslope edge of rock layer - 3 feet minus distance to restricting layer(C1)
1.0 feetft2.0 ft =3;0
b. Mound height at the upslope edge of rock layer = depth of clean sand for separation (G2a)
plus depth of rock layer (1 foot) plus depth of cover (1 foot)
1.0 ft+1ft+1ft =3.0 feet
c. Berm width = upslope mound height(G2b) times 4 (4 is recorfirhended, but could be 3-12)
3.0 x4 =12.0 feet
d. The total landscape width is the sum of berm (G2c) width plus rock layer width (D2) plus berm width (G2c)
12.0 feet +10.0 feet +12.0 feet =34.0 feet
e. Additional width necessary for absorption = the absorption width (F) minus the landscape vyidth (G2d)
34.0 feet= -14.0 feet20.0 feet -
if number is negative (<0) skip to g
f. Final berm width =additional width (G2e) plus the berm width (G2c)
-14 feet +12 feet =-2 feet
g. Total mound width is the sum of berm width(G2f or G2c) plus rock layer width (D2)
plus berm width (G2f or G2c)
12.0 ft +10.0 ft +12:0 ft =34:0 feet : r
h. Total mound length is the sum of berm (G2f or G2c) plus rock layer length (D3) plus berm (G2f or G2c)
12.0 ft +37.5 ft +12.0 ft =61.5 feet
i. Setbacks from the rockbed are calculated as follows: the absorption width (F) minus the rock bed. width
(D2) divided by 2: (10.0 feet)/ 2 =5.0 feet20.0 feet
]I Final Dimensions (slope <1%)34.0 61.5 ftft X
eb
)
i 1
•to
I hereby certify that I have completed this work in accordance with all applicable ordinances, rules and laws.
O J (license #)(signature).(date)
Page 4 of 8
s .
<=1% land slope
f L L t r c E r t j ! E t f. Ti^ttOpif'i TopstiiiniHiHL^.r
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6" Topsal
/
an rMMM-■n
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I
Berm VMdth (G2f or G2c) h-L ft
' Berm Width (G2f cr C^2c)
ft IRock WidtIi(D2)
ft
4AbsotpUop^idtl|^( F)
settsadc <G2i)
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ft7b(a1 Length (G2h)
Page 8 of 8
LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL
GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537
218-998-8095
www.co.otter-tail.mn.us
APPLICATION FOR SITE PERMITWHITE - Office
GOLDENROD'- Inspector
YELLOW-fOwner (after issue)
FiiVK - Assessor
Permit No. ^ ^ ~7PLEASE PRINT OR TYPE ALL INFORMATION
EXPIREBfeTWP NO.SECTION.LAKE/RIVER
CLASS..LAKE/RIVER NAMELAKE / RIVER NO.
L-''
'fordigA sk-j^r>Vc\<4!aJS,/ 3^
PROPERTY (E-911) ADDRESSPARCEL NUMBER (S)
Co i-Ko
LEGAL DESCRIPTION
Daytime Phone No.Mailing AddressFirstInitialLast Name
Property
Owner
(jLrc^-c-r LQo<3ci!) pdAy
Contractor
Name
Lie.# ^/77y
PROPOSED PROJECT (please circle the appropriate number)
(2 ) Add'n to Dwelling
( 5) RCU/Year_____
(7) Add’n To Non-Dwelling Storage Structure /L* (9) W.O.A.S.
(10) Non-Conf. Replacement (identify).
(11) Other (identify)______________
•Existing Dwelling to be removed prior to
ONSITE SEWAGE
TREATMENT SYSTEM
;
ONSITE WATER SUPPLY
(^)4 Individual ( ) Public ( ) None
NOTE: MN Rules Chpt. 4725 (MN Well
Code) requires a 3' (minimum) structure
setback to a well.
(3) ‘Replacement Dwelling
(6) Attached / Detached Garage
(1 ) New Dwelling
(4) MH/YR____Permit No.
( ) OTWMD 'Must have Sewage System Approval
from OTWMD prior to issuing Site Permit.
Contact Rollie Mann at 218-864-5533
AJe'/'O-
m^C^ACTERISTICS OF PROPOSED NON-DWELU^
Outside . I It /' lyDimension Ft. x ^
\M4o
HARACTERISTICS OF PROPOSED W.O.A.S.
(WATER ORIENTED ACCESSORY STRUCTURE)
Ft.*^
CHARACTERISTICS OF PROPOSED DWELLING
(Must Include Attached Garage)
Outside Dimension jf O Ft. x Ft.**
Sq. Ft.
Setback to Lotline
Setback to Right of Way,_Setback to Ordinary Higti'Wqt^ Level ___
Elevation Above Ordinary-ffloh Water Level
Setback to Septic TanX
Setback to Drainfiel6 _
Setback to Blu(f
Total Bedroprfis
Maximuip-Proposed Height_____
Roof ^ange ( ) Yes ( ) No
Baserfient ( )Yes ( )No
Walkout Basement ( ) Yes (s/de profile required) '■ ( ) No
Outside
Dimension • MFt.**
Ft. X\Sq. Ft.
Setback to Lotline
Setback to Right of Way
Setback to Ordinary High Water Level
Elevation Above Ordinary High Water Level
Setback to Septic Tank
Setback to Drainfield
Setback to Bluff : Ft.
Maximum Proposed Height
Roof Change ( )Yes ('^)No
Bathroom Proposed ( ) Yes
4^\Sq. Ft.
Setback to Lotline
2. Ft. & 'f*-*2y*
i Ft.**
Ft.
Ft.**Ft.i Ft.**'Ft.&Ft.**
Setback to Right of Way _i
Setback to Ordinary High Water Level (2-* Ft.
Ft.V
Ft.Ftf 2.Ft.Elevation Above Ordinary High Water Level__^
Ft.i^Ft.Ft.Setback to Septic Tank
Setback to Drainfield _
Setback to Bluff ' Ft.
Maximum Proposed Height / ( ' Ft.”
( ) Boathouse ( ) Screen Porch
( ) Gazebo
' Ft..r.T.+Ft.
i i
Ft.
(/^No\I' f Storage Structure
**Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Applicatioji / Inspection
■A MTopographical Alteration / EarthmovinQAil F S
□ None □ 20 Cubic Yards or Less * 21 Cubic Yards ■ 299 Cubic Yards*
Must include on scale drawing,
additional Permit may be required.o /-yv\
□ 300 Cubic Yards or More*
^ )0 A XCHARACTERISTICS OF LOT:
- Sq.l4r"Bluff ( )Yes (>.-) No
" j '<2.-
Water FrontageLot Area,
3 S ^ ,c>”?\/'X100 =Impervious Surface Ratio:Impervious Surface RatioTotai Lot Area (FT*)Total Impervious Surface Onsite (FT^)
THIS IS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STATE STATUTES.
Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above set forth
and according to the provisions of the Ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewith shall become
a part of this permit application. I also understand that this permit is valid for a period of six (6) months.
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 Ordinances of Otter Tail County, Minnesota.
This permit may be revoked at any time upon violation of said Ordinances.
I understand that it is my responsibility to inform the Land & Resource Management office once the building footings have been constructed.
7 0 - (97 $CANNE&Date:/
Signature of Property Owner/Agent hr Owner
\£Date:
Lands Resource Management dffice n ^ /OPERMIT FEE $ <7^00^ f'P NlSOOPR0JECT(S) TOTAL SQ. FT. / W ^RECEIPT NO.
/a J/ /t /Comments:UP
><
329,582 • Victor Lundeen Co.. Printers • Fergus Falls, MinnesotaForm No. BK —1003-0407
SITE PERMIT
INSPECTION RESULTS
Inspector must make all measurements and computations
s'Lf
Structure Set Back from Ordinary High Water Level Ft. Ft.
Structure Set Back from Top of Bluff Ft.Ft.
9-0^Structure Set Back from Road Right of Way Ft. Ft.
Ft. & — Ft.structure Set Back from Lot Lines Ft.
f.
/O^
Structure Height Ft. Ft.
Structure Set Back from Septic Tank Ft.
Structure Set Back from Drainfield Ft. Ft./O ^
Elevation Of Lowest Floor Above Ordinary
High Water Level 7 Ft. Ft.
Land Slope at Building Site % %
Inspector’s Comments / Sketch:
-9
\
r.
\A^\
Inspector’s Signatui
Date of Inspectionij:>r //
T* ^ime of Inspection
^ Project Approved
X rDate/Initial
WHITE-Office
GOLDENROD - Inspector
APPLICATION FOR SITE PERMIT
LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL
GOVERNMENT SERVICES CENTER, 540 WEST FIR. FERGUS FALLS, MN 56537
218-998-8095
www.co.otter-tail.mn.us
YELLOW-.Owner (after Issue)
PtNK - Assessor
Permit No.PLEASE PRINT OR TYPE ALL INFORMATION
LAKE / RIVER PNAME,,4:AKE/RIVER SECTION ,^JWP NO. RANGE CLASSKE/RIVER NAME
OPERTY (E-911) ADDRESSPARCEL NUMBER (S)
6c> /-Ko _______5~ycocoo tot) ;?W0QC^
LEGAL DESCRIPTION
Daytime Phone No.First Mailing AddressInitialLast Name
Property
Owner
P- \s ysr C<y
SLK^
Contractor
Name
Lie.#
PROPOSED PROJECT (please circle the appropriate number)
(I) New Dwelling
(4) MH/YR____
(7) Add'n To Non-Dwelling ^IT^torage Structure (9) W.O.A.S.
(10) Non-Conf. Replacement (identify).
(II) Other (identify)____________
•Existing Dweliing to be removed prior to
ONSITE WATER SUPPLY
(^ Individual ( ) Public ( ) None
NOTE: MN Rules Chpt. 4725 (MN Well
Code) requires a 3’ (minimum) structure
setback to a well.
ONSITE SEWAGE
TREATMENT SYSTEM
^) Permit No.
( ) OTWMD 'Must have Sewage System Approval
from OTWMD prior to issuing Site Permit.
Contact Rollie Mann at 218-864-5533
(3) ‘Replacement Dwelling
(6) Attached / Detached Garage
(2 ) Add’n to Dweiling
(5 ) RCU/Year____I'TS^
AJOAJ- 6b0aL
m^^ACTERISnCS OF PROPOSED NON-DWELU^
DimenLn Ft. x ^
Sq. Ft.
Setback to Lotline
Setback to Right of Way | DO Ft.
Setback to Ordinary High Water Level
Elevation Above Ordinary High Water Level
Ft. ^
HARACTERISnCS OF PR0P0SED#M!A.S.
(w/^rrn nnirHirn Arorrmny rTniinTiinr)CHARACTERISTICS OF PROPOSED DWELLING
(Musfhiclude Attached Garage)
Outside Dirhqnsion SO Ft. x
Sq. Ft.
Setback to LotlineX
Setback to Right of W^_
Setback to Ordinary HighV
Elevation Above Ordinal^
Setback to Septic Tanjy
Setback to Drainti^
Setback to Blurt/______
Total BedroQ#«
Maximurn/roposed Height
Roof Change ( ) Yes ( ) No \
Basement ( ) Yes ( ) No \
Walkout Basement ( ) Yes (side profile required)
Outside
DimensionV.X'Z^ Ft.xFt.**Ft."
\MHo 2^100+ Ft***^^
Setback to Lotline
3 'Setback to Right of Way | OO Ft."
^ 'Setback to Ordinary High Water Level
’ Elevation Above Ordinary High Water Level
Setback to Septic Tank
Setback to Drainfield
lOP Ft. & / CXP^t.Ft.**Ft.Ft.&
Ft.**
Ft.ir Level ___
Water Level
■V-2X0 Ft 4^Ft.
Ft.Ft*^
/(PO+^Ft . ^Setback to Septic Tank
Setback to Drainfield _
Setback to Bluff
Maximum Proposed Height Roof Change ( )Yes ('^No
Bathroom Proposed ( ) Yes
Ft.
-rFt.lOO^Ft.Ft.
/M/lAr Ft.f\\(^ ift^t.Setback to Bluff
Maximum Proposed Height
( ) Boathouse
( ) Gazebo
a=t./n FtFt.
IIU ^t/)No ( ) Sjieen Porch
L'^TStorage Structure)No
**Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Applicatiop / Irispection
Topographical Alteration / Earthmovinq»^^ <2f4 F S
□ None □ 20 Cubic Yards or Less * 21 Cubic Yards - 299 Cubic Yards*
* Must include on scale drawing,
additional Permit may be required.o fyvv
□ 300 Cubic Yards or More*
CHARACTERISTICS OF LOT:
Water Frontaoe- 3f~)Q
Blurt ( )Yes (
1^^r 2X7, = a .02^7
Total Lot Area (FT^)
Sq.Rr Ft.Lot Are
S -S.Impervious Surface Ratio:X100 =.%Total Impervious Surface Onsite (FT»)impervious Surface Ratio
THIS IS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STATE STATUTES.
Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above set forth
and according to the provisions of the Ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewith shall become
a part of this permit application. I also understand that this permit is valid for a period of six (6) months.
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 Ordinances of Otter Tail County, Minnesota.
This permit may be revoked at any time upon violation of said Ordinances.
I understand that it is my responsibiiity to inform the Land & Resource Management office once the building footings have been constructed.
AAjl.,S~-JLn - 07Date:
Signature of Property Owrier/Agent for Owner
LandS Resourc^M^^^r^^ ^
Date:
ItllsooPR0JECT(S)TOTAL SQ. FT. /</VO PERMIT FEE $RECEIPT NO.
Comments:
Form No. BK — 1003-0407 329,582 • Victor Lundeen Co., Printers • Fergus Falls, Minnesota
SCALE DRAWING FORM
*
Tax Parcel Number(s)
The scale drawing must include the outside dimension (lotlines) of the property above the ordinary high water level, and must identify the type,
size (square feet), and location of all existing and proposed structures, additional onsite impervious surfaces, road right-of-way(s), ordinary high
water level(s), septic tank(s), drainfield(s), bluff(s) & wetland(s). Must also include all proposed topographical alterations.
%
Impervious Surface Ratio
(Must Complete Worksheet On Other Side)
Scale
Ii
i
i
0
£
f
i
;
*6 of Property Owner !BK — 0207 )86 • Victof Lundeen Co., Priruers • Fergus Falls. MN • 1-800-346-4870
IMPERVIOUS SURFACE CALCULATION WORKSHEET:
List of Onsite (Existing and Proposed) Impervious Surfaces (must be shown on scale drawing):
:^(c5^_Ft2
Structure(s):
Ft2Deck(s);
Ft2Driveway(s):
Ft2Patio(s):
Ft2Sidewalk(s):
Ft2Stairway(s):
Ft2Retaining Wail(s):
Ft2Landscaping:
(Piastic Barrier)
Other:Ft2
Ft2
Ft2TOTAL IMPERVIOUS SURFACE:
LOT AREA:
%X100 =
IMPERVIOUS SURFACE RATIOLOT AREATOTAL IMPERVIOUS SURFACE
r
k
APPLICATION FOR GRADE & FILL PERMIT APPLICATION
LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL
GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537
218-998-8095
www.co.otter-tail.mn.us
Permit No.PLEASE PRINT OR TYPE ALL INFORMATION
j^/rWP NAMELAKE/RIVER^ SECTIOI^^-f' TWP. RANGE
CLASS
LAKE/RIVER #LAKE/RIVER NAME
L k<\
atvArcLoaxP
LEGAL DESCRIPTION ^
Ami Pi- Gm ^ ^ •
MiAIL.]_S^
PROPERTY (E-911) ADDRESSPARCEL NUMBER(S)
;o U Q(h .^Q-OCD
Last Name First Initial Mailing Address DAYTIME Phone No.
pr_At\K rnHoo?<r (ArvlUrurf.^)Property
Owner fTjJJ CT.F'ib1/
Contracti
Name mu 6f.if
Lie.#
NOTES: 1. The lotlines and project area(s) must be staked.
2. If project disturbs more than 1 acre of land you are required to obtain a General
Storm Water Permit from the MPCA.
Received
L&R Official DATE
PROJECT REQUEST (You may use the grid on back for required scaie drawing):
DESCRIBE YOUR PROJECT(S): C\<^rP nrCcx
Vci cSVxf^trvi^
A (oO^^V
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DETAILED INFORMATION:
3Q/
fFt. X A/0 Ft. X
Width
Yds'AREA TO BE CUT/EXCAVATED:Ft. - 27 =
Length Max Depth
Yds'WALK-OUT BASEMENT PROJECTS:Ft. X Ft. X Ft. - 27 =
Length Width Max Depth
Max Depth
InO Yds'AREA TO BE FILLED/LEVELED:Ft. X Ft. *27 =t. X
Length Width
Yds'TOTAL EARTHMOVING REQUESTED =
SLOPE OF BACKFILL AT FOUNDATION:Ft.Ft.
Max. Depth Distance Extended From Foundation
CULVERT:If Yes, must indicate size and location on drawing.
Yes No
TYPE OF SOILS AND/OR FILL MATERIAL: C’/a ^ ^ ^
SIGNATURE OF PROPERTY OWNER/AGENT FOR OWNER DATE RECEIPT NUMBER
BK003/07
J,
APPLICATION FOR SITE PERMITVWITE -Office
GOLDENROD - mspector
YELLOW - Owner (after issue)
PINK - Assessor
;
LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL \
GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 5653
218-998-8095
www.co.otter-tail.mn.us
J
Permit No<^/ ^ ~2PLEASE PRINT OR TYPE ALL INFORMATION
TWP NO.RANGE TWP NAMELAKE/RIVER
CLASS
SECTIONLAKE / RIVER NO.LAKE/RIVER NAME
H25
PROPERTY (E-911)AD[^ESSc Y T TO <_)iArAo ^uVrd
PARCEL NUMBER (S)
) j rLEG^ DESCRIPTION
Daytime Phone No.Initial Mailing AddressFirstL^st Name
?/S9/ Co
Ta=>^c
\Ji/cK)^ \4u>jProperty
Owner Co)) (zr^^cS-IcQ^Say»i2_L-c;
A\i-<Q>crContractor
Name
Lie.#
ONSITE SEWAGE
TREATMENT SYSTEM
ONSITE WATER SUPPLY
(^ Individual ( ) Public ( ) None
NOTE: MN Rules Chpt. 4725 (MN Well
Code) requires a 3’ (minimum) structure
setback to a well.
J^O^pOSED PROJECT (please circle the appropriate number)
( 2 ) Add’n to Dwelling ( 3 ) ‘Replacement Dwelling
( 6 ) Detached Garage
(9) W.O.A.S.
(T4)lew Dwelling
( 4) MHA'R
( 7) Add’n To Non-Dwelling
(10) Other____________
( ) Permit No.
( ) OTLSD * This permit is only valid alter verification
from the O.T.L.S.D. that a conforming
sewage system will be installed to service
this lot contact Rollie Mann at 864-5533.
( 5 ) RCU/Year______
( 8 ) Storage Structure
_ ‘Existing Dwelling to be removed before.
i-
r9r
CHARACTERISTICS OF PROPOSED W.O.A.S.
(WATER ORIENTED ACCESSORY STRUCTURE)
Outside
Dimension
CHARACTERISTICS OF PROPOSED NON-DWELUNG
Outside
Dimension
CHARACTERISTICS OF PROPOSED DWELLING
Outside
Dimension Ft. X (y _ Ft." CfCo J ^
7*'Ft.‘‘
Ft. X Ft."
Ft. XTool-Sq. Ft.
Setback to Lotline ___
Setback to Right of Way
Setback to Ordinary High Water Levei 2 S O Ft.
Eievation Above Ordinary High Water Levei ^7 Ft.
Setback to Septic Tank j ^ '"Ft.^., ^
Sq. Ft.
Setback to Lotline ___
Setback to Right of Way
Setback to Ordinary High Water Levei/
Eievation Above Ordinary High V^r Level
Setback to Septic Tank
Setback to Drainfield _
Setback to Bluff
Maximum Proved Height
Bathroom Proposed ( ) Yes ( ) No
Sq. Ft.
Setback to Lotline ____
Setback to Right of Way
Setback to Ordinary High Water Level_
Elevation Above Ordinary High Wat/r Level
Setback to Septic Tank
Setback to Drainfield _
Setback to Bluff____/
Ft.&Ft.&Ft."•70 -/ft."Ft.&
Ft.*;Ft.*!
Ft.
Ft.Ft.
Ft.Setback to Drainfield Ft.
Setback to Bluff ' R ^
Maximum Proposed Height (_!> 7 'b ft.
Ft.Ft.
Ft.Ft./Basement \/ Yes
Walkout Basement Yes
Total Bedrooms
No Ft./Maximum Proposed Height
( ) Boathous
( ) Gazeljo
Ft.No
( ) Screen Porch
( ) Storage Structure
i **Project/Lotllnes/Right-of-ways Must be Staked Onsite Prior to Application / Inspection
El 21 Cubic Yards - 299 Cubic Yards* □ 300 Cubic jirds or More*
I 0 I) * Must include on scale drawing
Permit may be required
Topographical Alteration / Earthmovinq
□ None
/
□ 20 Cubic Yards or Less *
CHARACTERISTICS OF LOT:
Lot Area ^
^ No
Inn.Sq. Ft.BluffWater Frontage .Ft. .Yes
?/7/ao ■Impervious Surface Ratio:X100 =.%Total Impervious Surface Onsite (FT')Total Lot Area (R^)Impervious Surface Ratio
THIS IS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STATE STATUTES.
Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above set forth
and according to the provisions of the Ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewith shall become
a part of this permit application. I also understand that this permit is valid for a period of six (6) months.
Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express
condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinances of Otter Tail County,
Minnesota. This permit may be revoked at any time upon violation of said Ordinances.
I understand that it is my responsibility to inform the Land & Resource Management office once the buildiho footings have been constructed.
S,"fv ^
Signatyr&yf Property
1,7Date:
Date:
.Larxi & Resource Management OfficeT
/ 7 ?¥77! Y7 7 L2^PERMIT FEE $PR0JECT(S)T0TAL SQ.FT.RECEIPT NO.
Comments:
f
f'7
VForm No. BK — 1003-0501 315,901 • Victor Lundeen Co., Printers • Fergus Falls, Minnesota
SITE PERMIT
INSPECTION RESULTS
Inspector must make all measurements and computations
zso-Structure Set Back from Ordinary High Water Level Ft.Ft.
Structure Set Back from Top of Bluff Ft.Ft.
Structure Set Back from Road Right of Way Ft. Ft.
Ft. & ~ Ft./Ot?'*"Structure Set Back from Lot Lines Ft.&Ft.
Structure Height Ft.Ft.At<| S
-T6\Structure Set Back from Septic Tank Ft.Ft.
Structure Set Back from Drainfield Ft.Ft.Tfci
Elevation Of Lowest Floor Above Ordinary
High Water Level Ft.Ft.
Land Slope at Building Site %%I- T
Inspector’s Comments / Sketch:
Ofl'^(
C-4tT(4''' f
*
0
0
■7^
1
t-7
• \1/
"»p/Vv' Inspector’s Signature
7/y/y
Date of Inspection
Time of Inspection
''^^i^i^ectApproved
Date/Initial
e-» %
Vi^lTE - Office ■
GOLDENROD - Inspector
APPLICATION FOR SITE PERMIT
LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL
GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537
218-998-8095
www.co.otter-tail.mn.us
YELLOW - Owner (after issue)
PINK - Assessor
Permit NS01iw-
LAKE/RIVER NAME LAKE/RIVER
CLASS
RANGELAKE / RIVER NO.SECTION TWP NO.TWP NAME
V25
PROPERTY (E-911) ADDgESS ~
0(pAJ^
__aS o 7~ STra/u & O
LEGAL DESCRIPTION
A^^yLT TO X
iki I
S^c. I n ^
Last Name First Initial Mailing Address Daytime Phone No.
*Sgt/Aa_ ^ ‘Coy\ (2i>^'diS--7d^q
2i^i£ell^
Property
Owner
Contractor
Name
Lie.#
SED PROJECT (please circle the appropriate number)
( 2 ) Add’n to Dwelling
( 5 ) RCU/Year_____
( 7) Add'n To Non-Dwelling ( 8 ) Storage Structure
'Existing Dwelling to be removed before
PRO^
^(■■♦^ew Dwelling
ONSlJE WATER SUPPLY
(''findividual ( ) Public ( ) None
NOTE: MN Rules Chpt. 4725 (MN Well
Code) requires a 3’ (minimum) structure
setback to a well.
ONSITE SEWAGE
TREATMENT SYSTEM( 3 ) 'Replacement Dwelling
( 6 ) Detached Garage
(9) W.O.A.S.
( ) Permit No.
( ) OTLSD * This permit is only valid alter verification
from the O.T.L.S.D. that a conforming
sewage system will be installed to service
this lot contact Rollie Mann at 864-5533.
(4) MH/YR.
r/fr(10) other.
CHARACTERISTICS OF PROPOSED W.O.A.S.
(WATER ORIENTED ACCESSORY STRUCTURE)CHARACTERISTICS OF PROPOSED DWELLING
Outside
Dimension
CHARACTERISTICS OF PROPOSED NON-DWELLING
Outside
DimensionU(j Pi -C/ZbTAFt. X Outside
DimensionFt. X Ft."
Ft. X Ft."s, R #77'^Sq. Ft.
Setback to Lotline ___
Setback to Right of Way
Setback to Ordinary High Water Level/
Elevation Above Ordinary High Wpter Level
Setback to Septic Tank__
Setback to Drainfield /
Setback to Bluff /
Maximum ProM^ed Height
Bathroom Proposed ( )Yes ( ) No
)‘^Ft. & -h?
2.04^"
Sq. Ft._______
Setback to Lotline ___
Setback to Right of Way
Setback to Ordinary High Water Level
Elevation Above Ordinary High Wqjw Level
Setback to Septic Tank
Setback to Drainfield
Setback to Bluff
Maximum Propose/Height
( ) Boathous/^
( ) Gazetj/
**Project/Lotlines/Rlght-of-ways Must be Staked Onsite Prior to Application / Inspection
Setback to Lotline ___
Setback to Right of Way
Setback to Ordinary High Water Level 2.S O Ft.
Elevation Above Ordinary High Water Level ^ Ft.
Setback to Septic Tank
Setback to Drainfield
Setback to Bluff
Maximum Proposed Height
Basement
Walkout Basement
Total Bedrooms
t."Ft.&Ft."Ft.&Ft."
Ft.'y
Ft.'>
Ft.Ft.
Ft.Ft.
Ft.Ft.
Ft.Ft.
Ft.
\/ Yes Ft.No Ft.Ft.No
( ) Screen Porch
( ) Storage Structure
M 2t Cubic Yards • 299 Cubic Yards' □ 300 Cubic Ya
■liiiMMMMkiMliantios
□ 20 Cubic Yards or Less '□ None rds or More'
CHARACTERISTICS OF LOT:f/ No
Water Frontage _T/)0.Sq. Ft.Lot Area,.Ft.Bluff Yes ■
■Z,ll2GO .Impervious Surface Ratio:X1CX) =.%
Total Impervious Surface Onsite (FTO Total Lot Area (Rr)Impervious Surface Ratio
ms IS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STATE STATUTES.
Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above set forth
and according to the provisions of the Ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewith shall become
a part of this permit application. I also understand that this permit is valid for a period of six (6) months.
Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express
condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinances of Otter Tail County,
Minnesota. This permit may be revoked at any time upon violation of said Ordinances.
I understand that it is my responsibility to inform the Land & Resource Management office once the buildilyg footings have been constructed.
7/2YT/o‘Y
Date:
iPropwt^
Date:
Land & Resource Managemeni Office
! Hll,U7Y27L2APROJECT(S) TOTAL SQ. FT.PERMIT FEE $RECEIPT NO.
Comments:
A7LT' J
Form No. BK — 1003-0501 315,901 • Victor Lundeen Co.. Printers • Fergus Falls, Minnesota
cn
Grade & Fill Permit #ns 3b<a3
PROPERTY OWNER __________
LAKE NO. £U W SEC. ^ TWP. NAME <1^^ !>kj ol A .
LEGAL DESCRIPTION:
Q/\ Y\^v^ Ay'vycvNK^
V *-4 *•
WORK AUTHORIZED
Vjo'v^V \*^ lQ4r«U^ V*v^2-4o' /v^oUcovA-Y Ck
Zx) vhV«^ W«^ zq* ^ . \^v«>L^C\.lV
^yov.yvA' V\.V.v4 V^or»-C. VfJ'vVV \ 2/ <^sAJUp QvicV »f« ^Jpf ,
"X^rOP — 03y\-Vv*».<JrCT»^__________________
OVN oQr V^oirvA^ .
?\Vx.Y^OVJ '\yy
NOTE: This card shall be placed in a conspicuous place not more than 4 feet above grade on the premises on which
work is to be done, & shall be maintained there until completion of such work. NOTIFY LAND & RESOURCE MAN
AGEMENT, 218-739-2271 WHEN AUTHORIZED WORK HAS BEEN COMPLETED.
1. EARTHMOVING SHALL BE DONE BETWEEN ^3-oW ^ ia —
2. Entire area shall be stabilized within 10 days of completion of any earthmoving.
3. Owner is legally responsible for all surface water drainage that may occur.
4. No fill shall enter or be taken from the beds of public water without a valid permit from the
MN Department of Natural Resources.
5. If the terms of this permit are violated, the entire permit may be revoked and the owner may
be subject to legal prosecution.
c*
GRADE & FILL APPLICATION
LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL
GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537
218-998-8095 www.co.otter-tail.mn.us
PERMIT NO.Application Fee___________
Receipt Number ( 3 T H 1 ^
PROPERTY
MAILING ADDRESS^ I QjC
CITY, STATE, ZIP
iiiA
[ )l^0i/UY](x\.^ AA>^/
lA^oDAYTIME PHONE NUMBER__
-LAKE NAME
PARCEL NUMBER (S)________
SECTION np TWPl^ritf>^ ,
_ , CLASS
tWH&me \A.
LEGAL DESCRIPTION
2IS9/^-911 PROPERTY ADDRESS
NOTES: 1. The lotlines and project area(s) must be staked.
2. If project disturbs more than 1 acre of land you are required to obtain a General
Storm Water Permit from the MPCA.
L&RWficialReceived
DATE
PROJECT REQUEST
lu— I r ,mi
I
s-v0MAXIMUM DEPTH OF CUT:FT. MAXIMUM DEPTH OF FILL:FT.
YDS’TOTAL CUBIC YARDS OF EARTHMOVING REQUESTED:
DESCRIBE YOUR PROJECT BELOW:
\
/SIGNATURE OF PROPERTY OWNER/AGENT FOR OWNER DATE j- ■ • -
BK0404 no- 3M0?.318,312 • Victor Lundeen Co.. Primers • Fergus Falls, Minnesola
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BK — 0404 — 029 318.312 • Victor Lundeen Co.. Printers • Fergus Falls. MN • 1-800-346-4870
iSCALE! / INCH = 50 FEET
BEARINGS ARE BASED ON AN ASSUMED DATUM.
• DENOTES IRON MONUMENT FOUND.
O DENOTES IRON MONUMENT SET MARKED “PLS 13620 4 17325".
J
S2-4I
PROPOSED LEGAL DESCRIPTION
All that part of the South Half of the Northeast Quarter of Section 6,
Township 132 North, Range 41 Nest of the 5th Principal Meridian, Otter
Tail County, Minnesota, described as follows:
Commencing at the southeast corner of said Section 6;
thence North 0 degrees 31 minutes 06 seconds Nest on an assumed
bearing along the east line of said Section 6, a distance of 2613.01
feet to the east quarter corner of said Section 6;
thence North 60 degrees 54 minutes 13 seconds Nest a distance of
773.37 feet to the centerline of County State Aid Highway No. 35,
the point of beginning of the land to be described;
thence North 37 degrees 16 minutes 03 seconds Nest a distance of
403.93 feet;
thence North 32 degrees 51 minutes 23 seconds Nest a distance of
20H.37 feet;
thence North 3 degrees OH minutes 54 seconds East a distance of
317.HH feet;
thence South 32 degrees 44 minutes OH seconds East a distance of
317.33 feet to said centerline of County State Aid Highway No. 35;
thence South 42 degrees 56 minutes 52 seconds Nest along said
centerline, a distance of 351.12 feet to the point of beginning.
Containing 5.00 acres more or less. Subject to County State Aid
Highway No. 35. Also subject to easements and reservations of public
record, if any. Together with an ingress and egress easement aver and
across said ^uth Half of the Northeast Quarter, being a strip of land
66 feet in width, tying southerly of and adjoining the following
described line-
Commencing at the southeast comer of said Section 6;
thence North O degrees 31 minutes 03 seconds Nest on an assumed
bearing along the east line of said Section 6, a distance of 2613.01
feet to the east quarter corner of said Section 6;
thence North 60 degrees 54 minutes 13 seconds Nest a distance of
773.37 feet to the centerline of County State Aid Highway No. 35,
the point of beginning of the line to be described;
thence North 37 degrees 16 minutes 03 seconds Nest a distance of
403.H3 feet and there terminating.
V. •
150too505025 .O
1
SCALE IN FEET
SCALE: / INCH = 50 FEET
BEARINGS ARE BASED ON AN ASSUMED DATUM.
• DENOTES IRON MONUMENT FOUND.O DENOTES IRON MONUMENT SET MARKED “PL5 13620 4 17325".
K
1ST t'
ISOso- so 25 lOOO
SCALE IN FEET
W
SCALE- I INCH = SO FEET
BEARINGS ARE BASED ON AN ASSUMED DATUn
• DENOTES IRON MONUMENT FOUND.
O DENOTES IRON MONUMENT SET MARKED “PLS 13&20 t 17825".
/^OF.ae,/
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Ms. AS
t)7’l£, ‘03*‘ H___J 403.^3
sPROPOSED ingress 4 EGRESSva'easement\alO
/oI. } .
SCALE: I INCH = 50 FEET
BEARINGS ARE BASED ON AN ASSUfTED DATUM
• DENOTES IRON MONUMENT FOUND.
O DENOTES IRON MONUMENT SET MARKED “PLS 13&20 * 17625*
■ ...
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PROPOSED §INGRESS ^ EGRESS\a PASEriENT
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