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HomeMy WebLinkAbout29000990865002_Conditional Use Permits_05-02-1984Conditional Use Permits 1 Barcode 128 OTTEK TAIL COUNTY ? Special Use Pennit SUP No.-J.fTi r^^xjjXix, ____________________ VTToO 9\VIC>V^ TX\>^b>0 _ \ \ I c.s:> OWNER'S NAME; \v<^vv C> VA^ IA Address 5LiOCfttlOnf Lake No.'^i_Sec.^i^Twp.Z33. RangeJ^Tw,. Name 7-> I Mo^^pU. QjiM t\ \ ^~jpL t __________ Issued^5:jS^__19ii—f Expires - %__19^s Work Authorized Rm >vc ^liy.poi. ^)U&p«ai jya uooAju. U L^jl* s\^ vX. NO dj>Jr -k^JjbU *»:\aQJul/K) . NOTP; Tliis card shall be placed in a conspicuous place not more nian 4 feet above grade on the premises on which work is to be done, and shall be maintained there until completion of such work. Notify Department of Land and Resource Management. Telephone (218) 739-2271 when authorized work has been completed. ^0^ T.\ I^JL.r c:i— 0^ fsj VA>nr>^A>fcl^doy-( -tJUMi A' V /T-xT" =-4•d shall C‘J2ro~A[~ Jl^CU\£l^ OTTER TAIL COUNTY, MINNESOTA Board of County Commission rs ADMINISTRATOR, Land and Resource Management ^ A. 1. Entire area shall be stabilized within 10 days of the completion of the moving project. 2. Owner is legally responsible for all surface water drainage that may occur. 3. No fill shall enter or be taken from the beds of a public water without a valid permit from the State of Minnesota Depart­ ment of Natural Resources. u •% - Ri£CEIV£0 APR e 1334 IAND & RESOURCE APPLICATION FOR SPECIAL USE PERMIT Shoreland Management Ordinance Otter Tail County Fergus Falls, Minnesota 56537 White - Office Y6II0W — Applicant X-IT-O 20.00MoA-ch 19 .19_il Application Fee $. Legal description of land: Lake No. 56-79? Sec. 34 Twp. ?33 Range 39 Twp. Name StucuiX Permit No.,Date. GiAMld WLake ClassLake Name Lot 2, &£ocfe 2, Map£e kcAeA Lot ^ BlockMaple Acaza r 3Sketch and supporting data submitted, PROPOSED USE OF LAND: Rewoue Ice fvidqe and pull It landwaad to make a beltea beach afiea for a distance oi 150 ^eet along shoAellne. koLlig MAddress ]rr\ m Applicant. I ! iApplicant Signatuits^^^^^£..^d- Bus. PhoneJ^^^in^^Cp IHome Phone Time 1 ' M,19iiNTY^Date of Hearing CONDITIONAL REQUIREMENTS: \^o->v_LAv_ VJl/vw ci.O'sJL.^ iO (M-AyAJcJ- o»>vt.a>v jtA<^O-T'V^ vooAJlA.^ JyJJL ~X>Jl_ •'*>Vs.O C/ ; ..iiCOa;.-- County of Otter Tail ’.:r;by csrtiiV fr'■ wiiJiln liistni- ii--. :l :vc3 fi'ci in tti3 G;fice for record CO fir. rth<?___ ea^pirty This application is hereby recommended for approval by the Otter Tail County Planning Advisory Commission. ChairnnaS^ ^ ^ Approved by the Board of County Commissioners of Otter Tail County this. Special Use Permit issued in accordance with compliance with existing Conditional Requirements and Special Regulations and kk:4t.19.day of.Minnesota Commissioner of Natural Resources notified this SPECIAL USE PERMIT NO.2^tr^ Malcolm K. Lee, Shoreland Administrator Otter Tail County, Minnesota MKL-0871-010 171988@ vieroN lun»ech ee.. PMincM. rtR«w« »mm. feet/inchei GRID PLOT PLAN SKETCHING FORMScale: Each grid equals roro 19Dated:6 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. -4ff) oC >o7}'/-!-I-r iP-m r. 1 ' I ■Vo I T\X To t hi I t/H T■s 5^ I • rt jrV?- W^Z-\ tD 1 if's ,iz 0_i r >I .1 ---------1- -» ^4 'f ^kR■<r t f'"t- ■UI \ -I 2! 598 7®MKL-0871-029 VICTOa LUNDCCN M.. ^RIRTCII*. fC*6U* FULLS. aiMM. 3 feet/inches GRID PLOT PLAN SKETCHING FORMScale: Each grid equals ■ O'^7^ro /ro 19Dated:6 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. vj 0) oC > 5 m oX r rIoi I I-!i 1 1 I / ; V i -4-1 - ) . ^15987©MKL-0871-029 VICTQ1I LUNOCEN CQ.. PIMItTEIIS. rCNCUS r«LL$. «)MN. 1 I 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 July 7, 2006 Jeffrey & Kay Lukken P.O. Box 262 Battle Lake, MN 56515 RE; Sewage Treatment System Servicing Tax Parcel Number 29000990865002 Described as Lot 2 Blk 2 & Vac Rd Adj Lot 1 Blk 3, Section 34 of Girard Township, Stuart Lake (56-191). As of July 6, 2006, the sewage treatment system (Sewage Treatment Installation Permit #18368) servicing your property was determined to be in compliance with the provisions of the Sanitation Code of Otter Tail County for a 4 bedroom home. If you have any questions regarding this matter, please contact our office. Sincerely, I2 Eric Babolian Inspector I f 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 WH\TE - Office YELLOW- L&R Inspector PINK - Owner / Contractor (after issue) APPLICATION MUST BE COMPLETE IN ORDER TO BE PROCESSED Permit No. /LAKE/RIVER NAME LAKE/RIVER Th 3v 3? SECTION TWP NO.RANGE TWP NAMELAKE NUMBER cJ^ E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROADPARCEL NUMBER (S) OF PROPERTY BEING SERVICED /9 7 - OOO- 70g6^- 003- LEGAL DESCRIPTIONI /y)Ap/tr «First Initial Mailing AddressLast Name Daytime Phone No. LciLH. ^ ^1/ •____P JcFf,Property Owner ¥- fsn/l 3// T PLR po dcContractor Lie.# U h Jr a >4u13^2^V7 ^ y-1 y j ^ ^ >I /)f2-e/z. J.o^THIS SPACE FOR OFFICE USE ONLY A.M. This System will be ready for inspection on the year of P.M. De/ulpi--nUoU P.M. Date Received Time Received L&R Official SEWAGE TREATMENT SYSTEM DESIGN DATA - AS SHOWN ON DRAWINGTYPE OF INSTALLATION (CIRCLE ONE) TANK DRAINFIELD Ft^Size GIs.Y ! •r, / 'r i /D»/Add-On/New System (20) Trench, Rock (21) Trench, Gravelless (22) Trench, Chamber (23) Bed (24) Mound (25) At Grade 1 Replacement (32) Tank, Septic (33) Tank, Lift (34) Trench, Rock (35) Trench, Gravelless /^■'(36) trencTi7Chamber3>'^f37)'*Bdd-------------------- (38) Mound (39) At Grade (40) Combination /O 0 v/tSetback to nearest well Ft. y 9ooSetback to OHWL (lake &/or river)Ft. -f Oo mSetback to wetland Ft. 3rSetback to dwellingCollector System (26) Trench, Rock (27) Trench, Graveliess (28) Trench, Chamber (29) Bed (30) Mound (31) At Grade 30^ i~3 Setback to non-dwelling MSetback to nearest property line Ft.Other (41) Tank, Holding (42) Outhouse (43) Sewer Line (44) Performance (45) Miscellaneous /- / 6 ^ kFtSetback to road right-of-way Ft. 'V /FtEievation above restrictive iayer Ft. ALL DISTANCES ARE SHORTEST DISTANCE BETWEEN NEAREST POINTS. DEPTH OF WATER WELL ABSORPTION AREA FOR MOUNDS# BEDROOMS^____ GARBAGE DISF>JL7 N ABATEMENT Yf/ N; ^-- Designer f'.r oa.^ Designer Lie. #, .Ft^EFFLUENTDISTRIBUTION i'y;) Gravity ( ) Pressure HOLDING TANK MONITOR/ DISPOSAL CONTRACT ( )Yes ( ) No-L&R Can Not Process PERCOLATION TEST DATA Highest Rate__/LMDate of Test 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 Taii County, Minnesota. Applicant agrees that the Site Data Worksheet submitted herewith and which is approved by a Land & Resource Management Officiai shail 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 vioiation of the Sanitation Code. NOTE: This permit is valid for a period of six (6) months. /(R/)-nr) J^~//y. R(^ Ulj ih%R} ’ Date: 6?' / ^ C' ^S^natuie^ Pr^xrty Owner/Agmtfm^^^Permit Fee $ 77// Rec. No Land & Resource Management Office .1 ^ /) 1.2/jit. /U/Mt "UfA'HX^Aj VComments: U Form No. BK — 0203-003 315.609 ■ Victor Lundeen Co., Printers • Fergus Falls, Minnesota SEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTS Inspector must make all measurements HOLDING SEPTIC TANK DRAINFIELD OUTHOUSELIFT TANKCATEGORY Capacity e'/oGLS.FT2 FT2GLS.f H9tSetback from Nearest Well 31 FT FT FT Setback from Buried Water Suction Pipe FT FT FT FT Setback from Buried Pipe Distributing Water Under Pressure FT FT FT FT Setback from OHWL (lake &/or river)FT FT FT ■hSetback from Setback from Wetland FT FT FT FT6D Setback from Dwelling FT FT FT FT Setback from Non-Dwelling FT FT FT FT Setback from Nearest Property Line FT FT FT FT/ O Setback from Right-of-Way FTFTFT FT Elevation above Restrictive Layer FT FT FT FT3 Holding Tank/Lift Alarm YES ^0 Old System Pumped & Destroyed YES NO FILTER Sewer Line to Well Separation DRAINFIELD CALCULATION Actual Minimum# Tanks Installed. □ YES Xno GoT FTXManuf.. .fPFT20Model #_MO^ND CALCULATION MOUND /AT-GRADE ROCK REDUCTION /Z /lo ^Q-*-/Inspector’s Comments: ygfc £xtiri^/j 7./ce>>' f Chai^ j Rock trenehoo with _ of reek under pipe for ABSORBTIOfj>FtfA /2-inchesStpT.c TVl/>K \ •Z-D .%Ft. X reduction / equivalent to Syo fp dF.Ftz '4 Date Time Initial / L & R Official As of '7-1. - O U Code of Otter Tail County. the above described sewage system installation was found to be compliant with the provisions of the Sanitation Land & Resource Management Official . 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) /msAPPLICATION MUST BE COMPLETE IN ORDER TO BE PROCESSED Permit No. LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER SECTION TWP NO.RANGE TWP NAME ■Fd 3V /33 3?cX— PARCEL NUMBER (S) OF PROPERTY BEING SERVICED E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROAD 4^3 A3y97 - ooo-7f- Qg6',r- OO'X LEGAL DESCRIPTION /yjAp/^ s Last Name First Initial Mailing Address Daytime Phone No. / /?7<■_______ ^ e.F^-e.trProperty Owner // PLr o ^0 8oJ? iContractor Lie.#u ^>*1. /Xfyt-y', y THIS SPACE FOR OFFICE USE ONLY AM. >• This System will be ready for inspection on.the year of P.M..at. ,A.M. P.M. Date Received Time Received L & R Official SEWAGE TREATMENT SYSTEM DESIGN DATA - AS SHOWN ON DRAWINGTYPE OF INSTALLATION (CIRCLE ONE) TANK DRAINFIELD Ft'.^y// < Fr £eSize GIs.r i lb^/<rIr'n-Add-On/New System (20) Trench, Rock (21) Trench, Gravelless (22) Trench, Chamber (23) Bed (24) Mound (25) At Grade /6 0 XReplacement (32) Tank, Septic (33) Tank, Lift (34) Trench, Rock (35) Trench, Gravelless r^(36) Trench, ChambeQf (37) Bea ■ (38) Mound (39) At Grade (40) Combination Setback to nearest well Ft. Y" Lo ^ Setback to OHWL (lake &/or river)Ft. Setback to wetland Ft. 3rSetback to dwelling Ft.Collector System (26) Trench, Rock (27) Trench, Gravelless (28) Trench, Chamber (29) Bed (30) Mound (31) At Grade Setback to non-dwelling Ft. Setback to nearest property line Ft.Other (41) Tank, Holding (42) Outhouse (43) Sewer Line (44) Performance (45) Miscellaneous f- / ^ ^Setback to road right-of-way Ft. Ft.Elevation above restrictive layer Ft. ALL DISTANCES ARE SHORTEST DIS^NCE BETWEEN NEAREST POINTS. DEPTH OF WATER WELL # BEDR00MS_ GARBAGE DISI ABATEMENT Y ABSORPTION AREA FOR MOUNDSl(^N vTn)Ft^HOLDING TANK MONITOR/ DISPOSAL CONTRACT ( )Yes ( ) No-L&R Can Not Process EFFLUENT DISTRIBUTION Gravity ( ) Pressure Designer , Designer Lie. #U - ts-oh PERCOLATION TEST DATA Highest Rat Agreement: The undersigned hereby makes application for permit to install, alter, repair or extend Sewage Treatment Systefn-aSSSIfTspecified, 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 valid for a period of six (6) months. Date of Test Signature of Property Owner/Agent fo^jwner Permit Fee $Date: ( Land & Re^urce Management Office '^X^yyUjJu , U Rec. No.Date: Comments: Form No. BK — 0203-003 315,609 • Victor Lundeen Co., Printers * Fergus Falls. Minnesota SysiJenT 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. Jo/J___grid(s) equals r 'inch(es) equals feetScale:feet, or T>ir MPCA LICENSE »:£E f oDESIGNED BY: FIRM NAME:_ ADDRESS: r i/Vn,/LICENSE CATEGORY: Li ' 6DATE: e.o g o SIGNATURE: ... .i1 .;. ..i. I f (.i..i I.1-.....']■Ir:t:;1 i ■-r r_I ; i [t i L4.-4 -I I i7 r....3® f *'Kl/o i-1 *T ■ I' ri I :j-■[i i J [■I "T•-f' r •tr IL.I I I. tT' 14I 4.4.4 1 ;t"X44 4?f !6’ 1 t i•T~- .hV/V,...4 .1 r- .r '4 *-4 I- I1.rt ; ...i. r .[ i • Victor LuMdoen Co.. Printers • Fergus Falls, MN ■BK «- 1003 — 02s 1-800-346-4870316,904 r-rr- -1 J r 1IIi.. i L !! :SITE DATA WORKSHEETT I-i .1 *1 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 « t /S5/JSewage Treatment System Permit #OWNER: TELEPHONE NUMBERFIRSTMIDDLELAST NAME ADDRESS: r / /! MnLSTATE ZIP CODECITYSTR./RT / ? /03. L 13Vri IT' TWP NAMESEC.TWP RANGELAKE NAMELAKE/RIVER NO. !LEGAL DESCRIPTION:SOIL BORING LOG /yiftpic COLOR & MUNSELL NO. DEPTH (INCHES)STRUCTURETEXTURE BLOCKY PLATY PRISMATIC NONEPARCEL NUMBER BLOCKY PLATY PRISMATIC NONE ll-l?-E-911 Address or Directions From Nearest Public Road Si lb 3'i NUMBER OF BEDROOMS____ GARBAGE DISPOSAL; NO WELL: CASING DEPTH SEWER LINE SEPARATION; BLOCKY PLATY PRISMATIC NONE BLOCKY PLATY PRISMATIC NONE />Yi*(to)/. 0FLOODPLAIN: YES BLUFF: YES V3(jERRESrmA^ VEGETATION: AQUATIC BLOCKY PLATY PRISMATIC NONE %SLOPE AT INSTALLATION SITE: TYPE OF OBSERVATION: Probe Pit PARENT MATERIAL;Outwash Loess Bedrock Alluvium C' /) (£> ORIGINAL SOIL:No Date of Soil Boring. (£)I COMPACTED SOIL: Yes r f :ZDEPTH OF BORING (To 7' or restrictive layer);.ft.Date of Perc Test i-t PERC TEST #2PERC TEST # 1 - TWO TESTS ARE REQUIRED - INTERVAL (MINUTES)WAT^DEPTH WATER PROP PERC RATEWATE^EPTH WATER PROP PERC RATE TIMETIMEINTERVAL (MINUTES) ..3;.;z.3i./3fa:j.:TIME DROP PERC WA~^DEPTH PERC RATEINTERVAL (MINUTES)WATER DROPINTERVAL (MINUTES)WATE EPTH WATER DROP PERC RATE TIMETIME im.£1 TIME DROP PERCT.REFia .sr../ TIME DROP PERC _________PERC RATE I TIME DROP ~V^PERC ^ WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH ----??-----WATER DROPTIMEINTERVAL (MINUTES)WATER^PTH 3..^.REFILL .2./ PERC RATEWATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROPINTERVAL (MINUTES)TIME REFILLREFILL TIME DROP PERCTIMEDROPPERC WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES) WATER DEPTH WATER DROP PERC RATETIMEINTERVAL (MINUTES)REFIUR^ia -r--------- =PERC TIME DROP PERCTIMEDROP WATER DEPTH WATER DROP PERC RATEWATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)TIME INTERVAL (MINUTES)REFIUREFIU TIME DROP PERCTIMEDROPPERC WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES) REFIU WATER DEPTH WATER DROP PERC RATEINTERVAL (MINUTES)TIME R?IU TIME DROP PERCTIMEDROPPERC WATER DEPTHWATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DROP PERC RATEINTERVAL (MINUTES)TIME REFIU PSFIU DROPTIMEDROPPERCTIME PROPOSED DESIGN:-X?GRAVITY DIST..PRESSURE DIST..TRENCH.ATGRADE.MOUND.HOLDING TANK.BED. OUTHOUSE.OTHER. SPECIFY:.SEWER LINE. — SYSTEM DESIGN ON BACK —I f-11..I-T-1 ■t't' SEWAGE SYSTEM m]15th Dec emberThis certificate has been issued this day of to certify that the sewage system installed as per sewage permit number indicated below has been approved for use mW'by Otter Tail County, Minnesota. m The premises covered by this certificate are legally described as:v« Range 39 Twp.Sec. 34 Twp. 133S.^-191Lake No.m.Ml MAPLE ACRESitLOT 2 BLK 2 &. VAC RD ADJj y *' s.LUKKEN. JEFFREY AOwner: Name nnx 2A2. RATTLE LAKE, MNAddressS-T m 5A515Zip No. iJUJLSlutU*yPermit No. SP 1 Ofll 5 Signed by: Land & Resource Management Official Otter Tail County. MinnesotaMKL-0987001 Vi JT 279005 Victor Uindeea Co.. PrifUm. Fergus Falls, Minnesou ■ J . APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM 4 WHIT^ - Office Yellow — Inspector Pink — Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218)739-2271 - FERGUS FALLS, MN 56537 I OK'SLo4 »LEGAL Permit No. DESCRIPTION Abatement: ( ) YesAND LOCATION LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER SECTION TWP. NO.RANGE TWP NAME I33 PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER IDENTIFICATION: Please Print All Information FirstLast Name Initial Mailing Address — No. Street, City and State Zip Code Telephone No. Property Owner LL,/tasI S(/SIS-' Sewage System Installer Name / A.M. ► This System will be ready for inspection on . 19.P.M.at This space for office use oniy NUMBER OF BEDROOMS: A.M. 19 P.M GARBAGE DISPOSAL: ()YES ( ) NODate Rec’d Time Rec'd Phone Call Rec'd By SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) ( 'TS Septic tank ( ) Lift station (Alarm required) Drain field Trenches TANK DRAIN FIELD 51,5 f ;0 rCapacityGIs.O Sq Ft. SODi^nce from nearest well Ft.Ft. ISDistance from lake or stream Ft. Ft. m lO jMO( )Bed ( ) Mound ( ) Outhouse ( ) Sewer line Distance from building Ft.Ft.MSL-fU IDistance from property line Ft.Ft. a\s 4^Distance from bottom to Water Table - Ft.Ft. EFFLUENT DISTRIBUTION All distances are shortest distance between nearest points('^X^ Gravity PERCOLATION TEST DATA:( ) Pressure WATER WELL DEPTH Perc Tester.Date of Perc Test. 1 Rate of 1st Test Rate of 2nd Test Average Rate Agreement: The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in strict accordance with Ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minnesota Department of Health. Applicant agrees that plot plan sketches and specifications submitted herewith and which are approved by Shoreland Management Officical shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibilty of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. >7 Crm the(work descried in the above statement. This -permit is granted upon express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of any said ordinances. NOTE: Permit void if work is not commenced within six (6) months.% To 5-^s DATE: jSignature Permit: Permission is hereby granted to the above named applicant to pert Issued Date: y Land & Resource Management Office -1Fee $.Rec #.1-«i\Comments: 3 r\JLd^K/eiit'UtrVV 277,212 • Victor Lundecn Co.. Printars • Fargus Falls. MinnaostaBK 079B-003 ■ •rw -V' ^'WT^- .T-,pj 1 » »* INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS HOLDING SEPTIC TANK DRAIN FIELDLIFT TANKCATEGORY iActualMinimum L 5"-^ GLS.(pOO SFCapacitylOOO gls.SF ! Well wv /3ji ;/7Distance from Nearest FT FT FT FT5^ Distance from Buried Water Suction Pipe ftFTFT FT50 Distance from Buried Pipe Distributing Water Under Pressure FT OkFT FT10 FT FT i^iC^Cy FTDistance from Lake or River (OHWL)FT //S' ft /S^10/20 FTDistance from Nearest Building FT 3S FT ;c5^ ftFTIDistance from Nearest Property Line FT 10 FT/ <£? i4-Distance from Bottom to Water Table FT FT FT FT3 yesHolding Tank/Lift Alarm YESOld System Pumped & Destroyed Sewer Line to Well Separation DRAINFIELD CALCULATIONINTERPRETATION OF ABBREVIATIONS GLS. = Gallons SF = Square Feet FT = Linear Feet V 3'sro'Actual Minimum FTX FT\ *2 2.^ FT FT20 SF Inspector’s Comments: SKETCH: I i ^0<l VJ / inspector's Signature IQ- U- Date of Inspection Time of Inspection GRID PLOT PLAN SKETCHING FORM — (Must Be To Scale) Scal&: Each grid equals feet/inches 19_^! Dated: Signature Please sketch your lot indicating setbacks trom road right-of-way, lake and sideyard for each building currently on lot and any proposed structures. v/ 7 rc --QT cr > i\ <9 1\ I T/5si'\ o 5^ 1 3 K ^SL/7 ( PERCOLATION TEST DATA LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, MN 56537 OWNER: I I, k lA FIRST TELEPHONE NUMBERMIDDLELAST NAME ADDRESS: ZIP CODESTATECITYSTR./RT. 3V lL3_RANGtfWP.TWP. NAMESEC.LAKE NAMELAKE/RIVER NO. LEGAL DESCRIPTION: PARCEL NUMBER 4/ N UMBER/BEDROOMSFIRE NUMBER — TWO TESTS ARE REQUIRED — TEST HOLE NO. 2TEST HOLE NO. 1 Depth To Bottom of Hole 5-^Iq-inches; Diameter of Hole inchesDiameter of Hole inches Depth To Bottom of Holeinches; 95T 9- 3?19DateSoil TextureDepth, Inches Date 19Soil TextureIDepth. Inches ^ QQQL)J^Q hc/Percolation Test By _ Firm Name ___ ffof-ejS’ polos P/uW'b|v>, /Q(0 Percolation Test By. Firm Name Ph^pn b>)io /?-/■ / Bok /?o f-khn}piG. hr,, S'tyTS'l 5R4.1 M-e hvi Nv.. ^5^!TtAddress 'fyAddress Otter Tail County License No.Otter Tail County License No.113 //3 PERC TEST # 1 PERC TEST # 2 TIME INTERVAL (MIKUTBSy -WATER DCFTH WATER DROP PERC RATE TIME INTERVAL fMINUTBSI WATER DEPTH WATER DROP PERC^TB aSTART RTART m 14-4-Y1MH“ * DROP PERC TlMti ■ DROP PERC[MB INTERVAL (MINUTEg)Water depth PERC RATEWATER DROP TIME PERC RATEINTERVAL OKIWUTEST WATER DEPTH 'WATER DROPREFILLREFILL :h:3,IliiDi1 VVJ •timL ~b^p TIME INTERVAL (MIWOTEn WATER DEPTH WATER DROP PERC RATE TIME INTERVAL IMIWUTBS)Water depth WATER DROP PERC RATEREJILLREFILLI\1 bRLp PERCVilay.L4 'ItWH BRSF ^Bi^c TfMfi TIME INTERVAL fMINUTBa water depth WATER DROP PERC RATE TIME INTERVAL IMPfUrasi WATER DEPTH WATER DROP PERC RATELaiuOlREFILLREFILL1i.i Ifi^6d6l L 'llJm ^ DR^~ PI^C*rbiu ^DROP TIME INTERVAL 0>flNUTBS>WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MlNl/TBSI WATER DEPTH WATER DROP PERC RATELiilREFILLREFILL\S . ^.1(sMkfiU._____4 I____ ______ TLMl* DROP PERC PERC INTERVAL (MINUTERTIME WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATTO DEPTH WATER DRW PERC RATE imREpLL REFILLy4 ^ "p^cm.:sm::iIjCO^* TIME INTERVAL (MINUTBR WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTER water DEPTH WATER MlOP PERC RATEm.x'lREFILL.k.REFILL:2;TIME ~ I^ROP :x:^■pk->v.I 4-TIMMTIME INTERVAL (MINUTER WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTER WATER DEPTH WATER DROP PERC RATE .Xl.REFILL RE|>1LL &.7^::y TIME ^ l$ROP P^CJ DROP PERC“ COMMENTS/CALCULA TIOlWS: MKL — 0390 - 005 250,815 — Victor Lundeen Co., Printers, Fergus Falls, Minnesota APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM WHITE — Offibe Yellow — Inspector Pink — Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218)739-2271 - FERGUS FALLS, MN 56537 lomU4Permit No.LEGAL DESCRIPTION Abatement: { ) YesAND LOCATION SECTIONLAKE/RIVER NAME LAKE/RIVER RANGELAKE NUMBER TWP NAMETWP. NO. I I35 (j\v'ixrc FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER(S) oou - -OD^ IDENTIFICATION: Please Print All Information Mailing Address — No. Street, City and Slate 50/- E L , A/vl First Initial Zip Code Telephone No.Last Name Property Owner Sewage System Installer Name A.M. This System will be ready for inspection on., 19-P.M.at This space for office use only 14-number OF BEDROOMS: A.M. 19 P.M YES ( ) NOGARBAGE DISPOSAL: (Phone Call Rec’d ByDate Rec’d Time Rec'd SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) ( Septic tank ( ) Lift station (Alarm required) Drain field Trenches ) Bed ( ) Mound ( ) Outhouse ( ) Sewer line TANK DRAIN FIELD ;,5rK)Capacity GIs.Sq Ft. Dig^nce from nearest well Ft. Ft. IS ( ’) Distance from lake or stream Ft. Ft. /O pomDistance from building Ft.Ft.M-5 TOtoDistance from property line Ft.Ft. avs Distance from bottom to Water Table •Ft.Ft. EFFLUENT DISTRIBUTION (''^ Gravity ) Pressure All distances are shortest distance between nearest points PERCOLATION TEST DATA:( WATER WELL DEPTH Perc Tester.Date of Perc Test 4Rate of 1 St Test Rate of 2nd Test Average Rate Agreement: The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in strict accordance with Ordinances of the County of Otter Tail, Minnesota and Minnesota Individuai Sewage Disposal Code Minimum Standards set forth by Minnesota Department of Health. Applicant agrees that plot plan sketches and specifications submitted herewith and which are approved by Shoreland Management Officicai shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibilty of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. Permit: Permission is hereby granted to the above named applicant to perform the/work descrig^ 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 ail respects to the Ordinance of Otter Taii County, Minnesota. This permit may be revoked at any time upon vioiation of any said ordinances. NOTE: Permit void if work is not commenced within six (6) months. DATE: Issued Date: Land & Resource Management Office Fee $.Rec #. ^7} Qic^\JidL ^Comments: 277,212 • Victor Lundeen Co,. Printers • Fergus Falls, MinnoostaBK 079B-003 U ' 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 Whlt»-Offic» Yellow — Inspector Pink — Owner Cord—Owner Permit No. LEGAL DESCRIPTION AND LOCATION TWP NameTWPLake Classif.Sec.RangeLake NameLake No. IDENTIFICATION: Please Print All Information. Zip No.Tel. No.Mailling Address —No. Street, City and StateInitialFirstLast Name OWNER O ■SEWAGE SYSTEM INSTALLER Name, This System will be ready for inspection on., 19 This space for office use only ^ -'lA '-L -SS l> „ Owner or Agent SignatureTime Rec'd Phone Call Rec'd ByDate Rec'd NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD Sq. Ft.GIs.Sq. Ft.Capacity Ft.Ft. Ft.Distance from nearest well Ft.Ft. Ft.Distance from lake or stream Ft. Ft. Ft.Distance from occupied building Ft. Ft. Ft.Distance from property line Ft.Ft.Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS: , 19 ,JVI By, TimeInspection was made on PERCOLATION TEST DATA:Date of First Test 19 , 19 , Rate Dat-e of Second Test , Rate 1st Test Taken By First Test + 2nd Test ■2'Rata2nd 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. (Call or use attached mailer notice.) 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 arty time upon violation of any said ordinance. V NOTE: Permit void if work is not commenced within six (6) months. Permit: Issued Date: Shoreland Management Office Fee $ .' '.n ^NO certificate issuedComments;. {^VNW »ATn.l IMU. MlNNCSOf*Form No. MKL 0771-003 -.■r INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORYActualShould be Actual Should be Should beActual ^OQO1/00 y\ov~^—' Capacity GIs.GIs.S F S F S F S F Distance from Nearest Well 75 50 F F F F F F Distance from Lake or Stream F F F F F F 17Distance from Occupied Building 2010 20FFFFF F■ Distance from Property Line ' O 10 10 10FF F F F F Distance from Bottom to Water Table 33FFFFF F Inspector's Comments:__________ rA Q w <L \\ O Y\n■. fL^a ( (r\J0 X if 'y\JIK /o cty^cX/*T T / 77 / 19^£1Date of Inspection. Time of Inspection M \ C j? signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs - Gallons SF - Square Feet F « Linear Feet Job Title AgencyMKL-0771.003-Backer 5 • ;-X \J ■C'J ! . V.4 ■7 V 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 Card — Owner 5 vsiO^Permit No.. LEGAL DESCRIPTION AND i3>3 jAli-kLOCATION TWP NameLake Classif.. .TWP .RangeLake Name Sec.Lake No. . IDENTIFICATION: Please Print All Information. Zip No.Tel. No.Mailling Address —No. Street, City and StateinitialFirstLast Name WDyv avAe.OWNER rJr\(K/Tv>j^\X>k ^ SEWAGE SYSTEM INSTALLER Name, This System will be ready for inspection on., 19. This space for office use only 19 .M Owner or Agent SignatureDate Rec'd Time Rec'd Phone Call Rec'd By NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD \ GIs.Sq. Ft.Sq. Ft.Capacity Ft.Ft.Ft.Distance from nearest well ns Ft.Ft. Ft.Distance from lake or stream Ft.Ft.Ft.Distance from occupied building vODistance from property line Ft.Ft.Ft. Ft.Ft.Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS; , 19Inspection was made on M, Time By PERCOLATION TEST DATA:Date of FirsftTest , 19 , Rate Date of SaspndtTest 19 , Rate 1st Test Taken By First Test -H 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. (Call or use attached mailer notice.) 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 Af any said ordinance. NOTE: Permit void if work is not commenced within ax (6) months. Permit: -sIssued Date: Shoreland Management Office [0Fee $ Comments:. Form No. MKL-0771-003 I^EVItW BATTLE LAKE. MINNESOTA INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORYActualShould be Actual Should be Actual Should be Capacity GIs.GIs.S F S F S F S F Distance from Nearest Well 5075FFFFF F Distance from Lake or Stream F F F F F F Distance from Occupied Building 20 2010FFF F F F ■ Distance from Property Line 1010 10FFF F F F Distance from Bottom to Water Table 33FFF F F F Inspector's Comments: Date of Inspection 19___ Time of. Inspection M Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF » Square Feet = Linear Feet Job TitleF ' AgencyMKL-0771-003-Backer PERCOLATION TEST DATA Price $ 1.00 per pad. SHORELAND MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Ph. No. Owner:Mailing Address: HoH ^ CjjLA.rc/jg^ Cjh T9rr)pf/tJ St. & No. ’ City ■?,H /.V3 Last Name SS-3LU/. A *i/1 ^ First ^T<5u) A ir~f~ NAME Middle State Zip No.Legal Description:- /9/ RANGESEC.LAKE OR RIVER NO.TWP.TWP NAME LoT 0- /Vc'/c/zV/ T/fmk TEST HOLE NO. 2TEST HOLE NO. 1 Depth to Bottom of Hole.inches; Diameter of Hole.JnchesDepth To Bottom of Hole.inches; Diameter of Hole inches Depth, Inches Soil Texture Depth, Inches Soil TextureDate 19 Date 19_____ Percolation Test By____ Percolation Test By____OLUFirmName.QC FirmName.DaLU QC UAddress.q:Address < inOtter Tail County License No..Otter Tail County License No.^HcoLUMeasurement, Inches Depth in Water Level, Inches Measurement, Inches Depth in Water Level. Inches Time Remarks Time Remarks o MKL-0871-028 See Booklet, "How to Run a Percolation Test" by Agriculture Ext Service, Un. of Minn. i'. : ;!.