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Bladow Beach_53000230138000_Septic System Permits_
OTTER TAIL COUNTY COUNTY AUDITOR’S OFFICE FINANCIAL SERVICES DIVISION WWW.CO.OTTER-TAIL.MN.USOTTER TflllOOlITT-attltPOTI wstein@co.ottertail.mn.us OFFICE-218-998-8030 DIRECT-218-998-8041 FAX- 218-998-8042 GOVERNMENT SERVICES CENTER 510 WEST FIR AVENUE FERGUS FALLS, MN 56537 September 26,2014 TIMOTHY N SUCHER 36052 RUSH LAKE LOO.=> OTTERTAIL, MN 56571 First National Bank PO Box 40 Ottertail MN 56571 received OO 2 2 2014 “^NDtRSiOORCE RE: Parcel No(s). Document No. #53-000-23-0138-000 1149300 To Whom It May Concern: We received documents for filing in the above mentioned transaction. Unfortunately they do not comply with the "Otter Tail County Sanitation Code for Subsurface Sewage Treatment Systems", which was amended effective April 15, 2014. The "Otter Tail County Sanitation Code for Subsurface Sewage Treatment Systems" requires property owners or other persons acting with iegal authority on behalf of a property owner to provide a currently valid Compliance Inspection to the County at the time of transfer/conveyance, if a currently valid Compliance Inspection is not submitted to the County, the buyer shall provide a currently valid Compliance Inspection to the County within 30 days of the property transfer/conveyance and the buyer is responsible for any required upgrade should the system be noncompliant. A valid Compliance Inspection is an inspection, conducted by an MPCA Certified Professional, which is three years old or less, indicating that the system is in compliance or is out of compliance. An Otter Tail County Sewage Treatment System Property Transfer Form, signed by the buyer(s) must be filed with the County Auditor at the time of the sale or transfer/conveyance of the property. The Otter Tail County Sewage Treatment System Transfer Form is available on the Otter Tail County Website: http://www.co.otter-tail.mn.us/546/Septic-Svstem-Forms. The full text of the "Otter Tail County Sanitation Code for Subsurface Sewage Treatment Systems" is available on the Otter Tail County Website: http://www.co.otter-tail.mn.us/472/Sanitation-Code Please note Section 80.1500 "Compliance Criteria" Subpart A "Point of Sale Compliance Inspection" found on Pages 3 and 4 of the "Otter Tail County Sanitaiion Code for Subsurface Sewage Treatment Systems" for a detailed infonnatloii legarding trie requirements. Note - please remember to attach to the Otter Tail County Sewage Treatment System Property Transfer Form a "Compliance inspection Report" as completed by an MPCA Registered Professional within the last three years. The Compliance Inspection Report completed by an MPCA Certified Professional should bo submitted to the County Land & Resource Management Office, Government Services Center, 540 West Fir, Fergus Fails, MN along with a copy of this letter. Failure to submit the Certificate within 30 days of the date of this letter will result in the denial of all future permits for the property and possible enforcement actions. ; i For questions about obtaining the Certificate of Compliance, or other questions about the Sanitation Code, please contact the Land and Resource Management Office (218-998-8095). Thank you for your cooperation in our efforts to protect the environment. Sincerely, Wayne Stein Wayne Stein County Auditor Compliance Inspection FormMinnesota Pollution Control Agency 520 Lafayette Road North St PauLMN 55155-4194 Existing Subsurface Sewage Treatment Systems (SSTS) Doc Type: Compliance and Enforcement For local tracking purposes:Inspection results based on Minnesota Pollution Control Agency (MPCA) requirements and attached forms - additional local requirements may also apply. Submit completed form to Local Unit of Government (LUG) and system owner within 15 days System Status System status on date (mm/dd/yyyy): 10/16/2014 G Noncompliant- Notice of Noncompliance (See Upgrade Requirements on page 3.) G Compliant - Certificate of Compliance (Valid for 3 years from report date, unless shorter time frame outlined in Local Ordinance.) Reason(s) for noncompliance (check all applicable) □ Impact on Public Health (Compliance Component #1)- Imminent threat to public health and safety □ Other Compliance Conditions (Compliance Component #3) - Imminent threat to public health and safety □ Tank Integrity (Compliance Component #2) - Failing to protect groundwater n Other Compliance Conditions (Compliance Component #3) - Failing to protect groundwater □ Soil Separation (Compliance Component #4) - Failing to protect groundwater □ Operating permit/monitoring plan requirements (Compliance Component #5) - Noncompliant Property Information Property address: 36052 Rush Lake Loop, Ottertail, MN 56571 Property owner: Tim Sucher___________________________ Parcel ID# or Sec/Twp/Range: 53000230138000 Reason for inspection: property transfer Owner’s phone: ___________________ or Representative phone: __ Regulatory authority phone: Owner’s representative: _______________ Local regulatory authority: Ottertail County Brief system description: lift to bed______ Comments or recommendations: Certification / hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. Inspector narne: Randy Anderson Business name: Anderson On-Site Inspector signature: Certification number: 3044 License number: 634____ Phone number: 849-3072 Necessary or Locally Required Attachments ^ System/As-built drawing ^ Forms per local ordinance^ Soil boring logs □ Other information (list): TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 1 of 3 www.pca.state.mn.us • 651-296-6300 • 800-657-3864 wq-wwists4-31b • 6/4/14 Property address; 36052 Rush Lake Loop, Ottertail, MN 56571 Inspector initials/Date;I 10/16/2014 (mm/dd/yyyy) 1. Impact on Public Health - Compliance component #1 of 5 Verification method(s): S Searched for surface outlet ^ Searched for seeping in yard/backup in home □ Excessive ponding in soil system/D-boxes S Homeowner testimony fSee Comments/Explanation) □ “Black soil" above soil dispersal system □ System requires “emergency” pumping □ Performed dye test D Unable to verify (See Comments/Explanation) D Other methods not listed (See Comments/Explanation) Compliance criteria: □ Yes I3 NoSystem discharges sewage to the ground surface.______________ □ Yes S NoSystem discharges sewage to drain tile or surface waters. ____ □ Yes S NoSystem causes sewage backup into dwelling or establishment. Any “yes” answer above indicates the system is an imminent threat to public health and safety. Comments/Explanation: 2. Tank Integrity - Compliance component #2 of 5 Compliance criteria:Verification method(s): S Probed tank(s) bottom El Examined construction records □ Examined Tank Integrity Form (Attach) □ Observed liquid level below operating depth □ Examined empty (pumped) tanks(s) □ Probed outside tank(s) for “black soil" O Unable to verify (See Comments/Explanation) S Other methods not listed (See Comments/Explanation) □ Yes I3 NoSystem consists of a seepage pit, cesspool, drywell, or leaching pit. Seepage pits meeting 7080.2550 may be compliant if allowed in local ordinance. □ Yes S NoSewage tank(s) leak below their designed operating depth. If yes, which sewage tank(s) leaks: Any “yes” answer above indicates the system is failing to protect groundwater. Comments/Explanation: camera 3. Other Compliance Conditions - Compliance component #3 of 5 a. Maintenance hole covers are damaged, cracked, unsecured, or appear to be structurally unsound. □ Yes* H No □ Unknown b. Other issues (electrical hazards, etc.) to immediately and adversely impact public health or safety. □ Yes* S No □ Unknown *System is an imminent threat to public health and safety. Explain: c. System is non-protective of ground water for other conditions as detemiined by inspector. *System is failing to protect groundwater. Explain: TTY 651 -282-5332 or 800-657-3864 • Available in alternative formats Pase 2 of 3 www.pca.state.mn.us • 651-296-6300 • 800-657-3864 wq-wwists4-31b • 6/4/14 < s I 10/16/2014Inspector initials/Date;Property address: 36052 Rush Lake Loop, Ottertail, MN 56571 (mm/dd/yyyy) 4. Soil Separation - Compliance component #4 of 5 n UnknownDate of installation: 5/11/1990 (mm/dd/yyyy) Shoreland/Wellhead protection/Food beverage lodging? Compliance criteria:_____________ Verification method(s): Soil observation does not expire. Previous soil observations by two independent parties are sufficient, unless site conditions have been altered or local requirements differ. Conducted soil observation(s) (Attach boring logs) □ Two previous verifications (Attach boring logs) □ Not applicable (Holding tank(s), no drainfield) □ Unable to verify (See Comments/Explanation) Q Other (See Comments/Explanation) S Yes □ No □ Yes □ NoFor systems built prior to April 1, 1996, and not located in Shoreland or Wellhead Protection Area or not serving a food, beverage or lodging establishment: Drainfield has at least a two-foot vertical separation distance from periodically saturated soil or bedrock._____ E Yes □ NoNon-performance systems built April 1, 1996, or later or for non-performance systems located in Shoreland or Wellhead Protection Areas or serving a food, beverage, or lodging establishment: Drainfield has a three-foot vertical separation distance from periodically saturated soil or bedrock.* Comments/Explanation: soils; 0-10 sand 10yr2/2 10-56 sand 10yr5/3 □ Yes □ No“Experimental", “Other”, or “Performance” systems built under pre-2008 Rules; Type IV or V systems built under 2008 Rules (7080. 2350 or 7080.2400 (Advanced Inspector License required) Drainfield meets the designed vertical separation distance from periodically saturated soil or bedrock. Indicate depths or elevations 20A. Bottom of distribution media 56B. Periodically saturated soil/bedrock 36C. System separation D. Required compliance separation* 36 *May be reduced up to 15 percent if allowed by Local Ordinance. Any “no” answer above indicates the system is failing to protect groundwater. 5, Operating Permit and Nitrogen BMP* - Compliance component #5 of 5 K Not applicable □ Yes n No If "yes”, A below is required □ Yes □ No If “yes”, B below is required Is the system operated under an Operating Permit? Is the system required to employ a Nitrogen BMP? BMP = Best Management Practice(s) specified in the system design If the answer to both questions is “no”, this section does not need to be completed. Compliance criteria a. Operating Permit number: ___________________ Have the Operating Permit requirements been met?□ Yes □ No □ Yes □ Nob. Is the required nitrogen BMP in place and properly functioning? Any “no” answer indicates Noncompliance. Upgrade Requirements (Minn. Stat §115.55) An imminent threat to public health and safety (ITPHS) must be upgraded, replaced, or its use discontinued within ten months of receipt of this notice or within a shorter period if required by local ordinance. If the system is failing to protect ground water, the system must be upgraded, replaced, or its use discontinued within the time required by local ordinance. If an existing system is not failing as defined in law, and has at least two feet of design soil separation, then the system need not be upgraded, repaired, replat^sLi^ its use discontinued, notwithstanding any local ordinance that is more strict. This provision does not apply to systems in shorelaixfate^iy^^^fjQ Wellhead Protection Areas, or those used in connection with food, beverage, and lodging establishments as defined in law. TTY 651-282-5332 or 800-657-3864 . Available in alternative formats Pase 3 of 3 www.pca.state.mn.us • 651-296-6300 • 800-657-3864 wq-wwists4-31b • 6/4/14 Department of LAND AND RESOURCE MANAGEMENT RECEIVED OCT 2 9 20^ LAND & RESOURCE OTTER TAIL COUNTY Govcrnment Services Center - S40 West Fir Fergus Falls, MN 56537 Ph. 218-998-8095 Otter Tail County’s Website: www.co.otter-tail.mn.us OTTER TRII Otter Tail County Compliance Inspection Form Addendum This form is a required attachment to MPCA Compliance Inspection Form for all Existing Subsurface Sewage Treatment Systems in Otter Tail County as of June 1,2011. Property Information Parcel Number: C/ Township: Property Owner Name(s): 77^ Section: .^2 5 LoLe. L<?fcp_______Property Address: ~760<Tc3 Reason for Inspection Number of Bedrooms nIn Shoreland Area? Lake/River Name, Number, & Class Yes No System Compliance Status: ^ Compliant Non-Compliant Does the soil treatment area have less than 3 feet of vertical separation? Is the septic tank located less than 50 feet from any well? Is the soil treatment area located less than 50 feet from any deep well? Is the soil treatment area located less than 100 feet from any shallow well? Does any part of the septic system fail to meet the minimum OHWL setback requirements for the public water classification? Yes No Yes No Yes Yes No't- No fYes No "Yes" indicates that the system is failing to protect ground water and is noncompliant. If "Yes", describe the condition noted: Required Attachments: System drawing to scale on next page. Completed MPCA Compliance Inspection I hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. Certification Number^^p Business License Name & Number: Name: A- Signature:Date: Excel/Compitance Form for OTC 1/15/2014 Page 1 of 2 Otter Tail County Compliance Inspection Form Addendum (cont, v:: K3|V uu w.-T ;j A ;U >i! ^ t i X). . .L.J t -------- »t- >*4H•f — ■‘V* ■ ;•“•■ r -----: ' V- 1 ' T i; i I ; •t --|-TH 4; 1 -i-i mi h f f ■;:ki 11MP-4i » O ii>0 ! “ r1' ;. .1...." T-!I t } I-^— -•- I t!LJ_^„ ...r I §riai^'4^-Tsfe- f" 1 't —• f •: I ^ S^cJ?e,^ ../A’xe T Compliance Inspection FormMinnesota Pollution Control Agency 520 Lafayette Road North St. Paul, MN 55155-4194 Existing Subsurface Sewage Treatment Systems (SSTS) Doc Type: Compliance and Enforcement For local tracking purposes:Inspection results based on Minnesota Pollution Control Agency (MPCA) requirements and attached forms - additional local requirements may also apply. Submit completed form to Local Unit of Government (LUG) and system owner within 15 days System Status System status on date (mm/dd/yyyy): 10/16/2014 Q Noncompliant - Notice of Noncompliance (See Upgrade Requirements on page 3.) lEl Compliant - Certificate of Compliance (Valid for 3 years from report date, unless shorter time frame outlined in Local Ordinance.) Reason(s) for noncompliance (check all applicable) □ Impact on Public Health (Compliance Component HI) - Imminent threat to public health and safety □ Other Compliance Conditions (Compliance Component #3) - Imminent threat to public health and safety □ Tank Integrity (Compliance Component #2) - Failing to protect groundwater □ Other Compliance Conditions (Compliance Component #3) - Failing to protect groundwater □ Soil Separation (Compliance Component #4) - Failing to protect groundwater □ Operating permit/monitoring plan requirements (Compliance Component #5) - Noncompliant Property Information Property address: 36052 Rush Lake Loop, Ottertail, MN 56571 Property owner: Tim Sucher___________________________ Parcel ID# or Sec/Twp/Range: 53000230138000________ Reason for inspection: property transfer Owner’s phone: ____________________ or Representative phone:__ Regulatory authority phone: Owner’s representative: _______________ Local regulatory authority: Ottertail County Brief system description: lift to bed______ Comments or recommendations: Certification / hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, Inadequate maintenance, or future water usage. Inspector name: Randy Anderson Business name: ^nderson On-Site Inspector signature: Certification number: 3044 License number: 634 Phone number: 849-3072 Necessary or Locally Required Attachments S System/As-built drawing '9^ IEl Forms per local ordinanceE Soil boring logs □ Other information (list): TTY 651 -282-5332 or 800-657-3864 . Available in alternative formats Page 1 of 3 www.pca.state.mn.us • 651-296-6300 • 800-657-3864 wq-wwists4-31b • 6/4/14 I 10/16/2014Inspector initials/Date;Property address: 36052 Rush Lake Loop, Ottertail, MN 56571 (mm/dd/yyyy) 1. Impact on Public Health - Compliance component #1 of 5 Verification method(s): E Searched for surface outlet 0 Searched for seeping in yard/backup in home □ Excessive ponding in soil system/D-boxes S Homeowner testimony (See Comments/Explanation) □ “Black soil” above soil dispersal system □ System requires “emergency” pumping □ Performed dye test □ Unable to verify fSee Comments/Explanation) D Other methods not listed (See Comments/Explanation) Compliance criteria: System discharges sewage to the ground surface.______________ □ Yes 0 No □ Yes S NoSystem discharges sewage to drain tile or surface waters. ___ □ Yes El NoSystem causes sewage backup into dwelling or establishment. Any “yes” answer above indicates the system is an imminent threat to pubiic heaith and safety. Comments/Explanation: 2. Tank Integrity - Compliance component #2 of 5 Verification method(s): E Probed tank(s) bottom E Examined construction records □ Examined Tank Integrity Form (Attach) □ Observed liquid level below operating depth □ Examined empty (pumped) tanks(s) □ Probed outside tank(s) for “black soil” □ Unable to verify (See Comments/Explanation) E Other methods not listed (See Comments/Explanation) Compliance criteria: _____ System consists of a seepage pit, cesspool, drywell, or leaching pit. Seepage pits meeting 7080.2550 may be compiiant if allowed in local ordinance. Sewage tank(s) leak below their designed operating depth. If yes, which sewage tank(s) leaks: Any “yes” answer above indicates the system is faiiing to protect groundwater. □ Yes E No □ Yes E No Comments/Explanation: camera 3. Other Compliance Conditions - Compliance component #3 of 5 a. Maintenance hole covers are damaged, cracked, unsecured, or appear to be structurally unsound. □ Yes* H No □ Unknown b. Other issues (electrical hazards, etc.) to immediately and adversely impact public health or safety. □ Yes* H No □ Unknown *System is an imminent threat to public health and safety. Explain: c. System is non-protective of ground water for other conditions as determined by inspector. □ Yes* H No *System is failing to protect groundwater. Explain: TTY 651 -282-5332 or 800-657-3864 • Available in alternative formats Page 2 of 3 651-296-6300 • 800-657-3864Nwwv.pca.state.mn.us • wq-wwists4-31b • 6/4/14 Property address: 36052 Rush Lake Loop, Ottertail, MN 56571 Inspector initials/Date;I 10/16/2014 (mm/dd/yyyy) 4. Soli Separation - Compliance component #4 of 5 □ UnknownDate of installation: 5/11/1990 (mm/dd/yyyy) Shoreland/Wellhead protection/Food beverage lodging? Compliance criteria: Verification method(s): Soil observation does not expire. Previous soil observations by two independent parties are sufficient, unless site conditions have been altered or local requirements differ. E Conducted soil observation(s) (Attach boring logs) □ Two previous verifications (Attach boring logs) □ Not applicable (Holding tank(s), no drainfield) □ Unable to verify (See Comments/Explanation) □ Other /See Comments/Explanation) S Yes □ No □ Yes □ NoFor systems built prior to April 1, 1996, and not located in Shoreland or Wellhead Protection Area or not serving a food, beverage or lodging establishment: Drainfield has at least a two-foot vertical separation distance from periodically saturated soil or bedrock. S Yes □ NoNon-performance systems built April 1, 1996, or later or for non-performance systems located in Shoreland or Wellhead Protection Areas or serving a food, beverage, or lodging establishment: Drainfield has a three-foot vertical separation distance from periodically saturated soil or bedrock.* Comments/Explanation: soils: 0-10 sand 10yr2/2 10-56 sand 10yr5/3 □ Yes □ No“Experimental”, “Other”, or “Performance" systems built under pre-2008 Rules: Type IV or V systems built under 2008 Rules (7080. 2350 or 7080.2400 (Advanced Inspector License required) Drainfield meets the designed vertical separation distance from periodically saturated soil or bedrock. Indicate depths or elevations 20A. Bottom of distribution media 56B. Periodically saturated soil/bedrock 36C. System separation 36D. Required compliance separation* *May be reduced up to 15 percent if allowed by Local Ordinance.Any “no” answer above indicates the system is faiiing to protect groundwater. 5. Operating Permit and Nitrogen BMP* - Compliance component #5 of 5 ^ Not applicable □ Yes □ No If “yes”, A below is required □ Yes □ No If “yes”, B below is required Is the system operated under an Operating Permit? Is the system required to employ a Nitrogen BMP? BMP = Best Management Practice(s) specified in the system design If the answer to both questions is “no”, this section does not need to be completed. Compliance criteria a. Operating Permit number: _____________________ Have the Operating Permit requirements been met? □ Yes □ No □ Yes □ Nob. Is the required nitrogen BMP in place and properly functioning? Any "no” answer indicates Noncompliance. Upgrade Requirements (Minn. Stat. §115.55) An imminent threat to public health and safety (ITPHS) must be upgraded, replaced, or its use discontinued within ten months of receipt of this notice or within a shorter period if required by local ordinance. If the system is failing to protect ground water, the system must be upgraded, replaced, or its use discontinued within the time required by local ordinance. If an existing system is not failing as defined in law, and has at least two feet of design soil separation, then the system need not be upgraded, repaired, replaced, or Its use discontinued, notwithstanding any local ordinance that is more strict. This provision does not apply to systems in shoreland areas. Wellhead Protection Areas, or those used in connection with food, beverage, and lodging establishments as defined in law.1\»' .r www.pca.state.mn.us • 651-296-6300 • 800-657-3864 wq-wwists4-31b • 6/4/14 TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 3 of 3 ..'gg.;.':Jt CERTinCATE OF APPROVAL SEWAGE SYSTEM 5^:i 2nd day of Hovmb^90This certificate has been issued this 19V to certify that the sewage system installed as per sewage permit number indicated below has been approved for uses. by Otter Tail County , Minnesota. m The premises covered by this certificate are legally described as: RangeTwp. ^2356-141Lake No.Sec.Twp. Name Wl Hook Lfm S SuchcA ivm- Tijn SaohpAOwner: Name OtX.QJVioJJif MM£RAddress 56571Zip No. k3mPermit No. SP Signed by: Land & Resource Managemenl Official Olter Tail County. MinnesotaMKL-0987001 253.617 Vicior Lunde«n Co . Primers. Kergus Falls. Minnesota 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 Permit No..LEGAL yOoiC, ^ SVACxlo DESCRIPTION 1 AND 15_ H .^ /3r~LOCATION Lake No.Lake Classif.Lake Name Sec.TWP TWP NameRange IDENTIFICATION: Please Print All Information. Mailing Address — No. Street, City and State Tel. No.Last Name First Initial Zip No. cjTTc€. . ni rjt 'ypOWNER f \f |rvC ^ ^SEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection on.., 19. This space for office use only 19 M SignatLireCy P S ( -f ^ < Date Rec'd Time Rec'd Phone Call Rec'd By Owner or /^ent ! 32 C‘A (HcmJ NUMBER OF BEDROOMS:ESTIMATED COST:iSEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD S ciO , Sq. Ft.6//3 GIs.Capacity Ft. Ft.Ft.Ft.Distance from nearest well svFt.Distance from lake or stream Ft.Ft. /d?Ft.Distance from occupied building Ft.Ft. lO /QDistance from property line Ft.Ft.Ft. 3Ft.Distance from bottom to Water Table Ft.Ft. AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on 19 , Time M By la...PERCOLATION TEST DATA:Date of First Test , 19 Ratei.I / 6?\lT^ce 19..30Date of Second Test Rate 1st Test Taken By J!. (/First Test + 2nd Test 2'Rate2nd Test Taken By The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work inAgreement; strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready^for inspection. I understand that I have been granted a sewage system site permit In accordance with the requirements of the Shoreland Management Ordinance of Otter Tail County. I understand I must contact my township in order to determine whether or not any addi tional permits are required by the township for my proposed project. //y- Signature Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six (6) months. y - - y QIssued Date: Shore^enP Managemenr^ice Fee $Rec # Cnmmantt*^Crn^^ -TdZL UenCl-pj ^ „ S \ ~Z- I ^ Cj Ct Ir L'-v't-KTy Qt ^ (j W I / ' ' fForm No. MKL-032085 237.443 — Victor Lundeen Co.. Printers, Fergus Falls, Minnesota . wr-: «• 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 Yeifow — Inspector Pink — Owner \ S'- 11-90 D r=i 0.U f /<r Permit No.,LEGAL DESCRIPTION AND inO /3rLOCATION Lake No.Lake Name Lake Classif.Sec.TWP Range TWP Name IDENTIFICATION: Please Print All Information. Mailing Address — No. Street, City and State Tel. No,Last Name First Initial Zip No,?77~t ^ Tin lyOWNERt kt-f PJifsSEWAGE SYSTEM INSTALLER , iName. , 19^^./O'MThis System will be ready for inspection on. This space for office use only 6v /O-00/1 ft! ^i>/Jk>kd19^^ _v5z2^m Time Rec'd/ /0-^4 Owner or Agent Signature JDate Rec'd Phone Call Rec'd By NUMBER OF BEDROOMS;IESTIMATED COST;^2 C I SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD G//3 SqJ Ft.3 S“cto , Sq. Ft.GIs.Capacity // Ft.Ft.Ft.Distance from nearest well 7 sr>Ft.Distance from lake or stream Ft.Ft. /C?Ft.Distance from occupied building Ft.Ft. 7/O /oDistance from property line Ft.Ft.Ft. //Ft.Ft.Distance from bottom to Water Table Ft. AH distances are shortest distance between nearest points RECORD OF TESTS; Inspection was made on 19 , Time ...........JVI By. , 19 5^M...z3:£.z.. /-I ^ ■2-3“- PERCOLATION TEST DATA;Date of First Test Rate I lL?..Date of Second Test Rate 1st Test Taken By ■.//G,<rFirst Test + 2nd Test —2 Rate2nd Test Taken By Agreement: 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. I understand that I have been granted a sewage system site permit in accordance with the requirements of the Shoreland Management Ordinance of Otter Taii County, i ' understand i must contact my township in order to determine whether or not any addi- tionai permits are required by the township for my proposed project. Permit; condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six (6) months. The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in /7 7"-'rL-tr77Signature Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express ■V- - ^0 Shoreland Management .^ce Issued Date: y 03''Fee $ -- -Rec # !••-V •UfyPiCrn-l TV7/2T'Comm6r)tsy^cnT?^ <£ 'I'fiT ( ^rsY-cA- AM-3 rOdDQ sS •. 7T'y ^ 1 K1 r2 /r )T\ C^ \ rForm No. MKL-032085 237,443 — Victor Lundeen Co., Printers, Fergus Falls, Minnesota \ INSPECTION RESULTS Inspector must make all measurements /!SEWAGE DISPOSAL SYSTEM STATISTICS ISO X /OOO' jo-z<t -*?c7c SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORYActualShould Be Actual Should Be Actual Should Be SoOOiscoCapacityGIs.Qls.S F S F S F S FTi. Distance from Nearest Well 200 /?/F F F F F F FDistance from Lake or Stream F F F F F I IUS¥oDistance from Occupied Building F F F F F F ilr/O^V Distance from Property Line }F F F F F F T 3Distance from Bottom to Water Table 3 3FF F F F F Tt T7\VLno6 ^ Inspector's Comments: CC*' ^'■V.-yC^V Lo ^/ovj o L (a M ) r\CSLp >v* C- 'j i liv /- t-Yi! t ocMSk. I~~ i I L <^i/^ (3 /" i r )yps t 0 i( /!>90Date of Inspection 19 i 2.1^0Time of Inspection M Signatuf% of Inspector l0rt INTERPRETATION OF ABBREVIATIONS GIs = Gallons SF = Square Feet F = Linear Feet c , ■rrJob Title !r MKL - 032085 - Backer Agency I -4**^ - W.\' ^50, C?/- iJo^Uc, 2^a “1-0 3oc> 4-0 bPttU1 wA'' I SNl 0(?gso4r ^0 3"o.aw.»v>.L< L^vt.\r^ 0 (v>4(4 3^flL(A4ru4 ^r\—S VArt, 0,k® r«oA¥\\r>^3fe"S -v> O Y*? I ; I -..-i____I I!t 1 IL lUT- /f I /5^«>« !Wcf I i> I -4 ----------]i -1 }. ii914<b“!> I \ i 1>\. < -X I •vA t ' I -.y,7~- (7 X!X . —-1\< J < /'T”il;-.1 .«- 4 I i i |_3^d1I3i-ift yi1 m ifife;W _4■n :c^._-i6)'1 i 'Z\ -fl\ II h Tt:^„ V •4>t 3 ”~J -i;I4- Ii«>ii i rro;• rn^' ts^l~ i«4- 5!It I r#T N - .._c0:A-t yuI i6°;»sii ;:; I!...I >L-4-4 4IIi1I ff-V1 1 t I!J OHER TAIL COUNTY DEPARTMENT OF PUBLIC HEALTH SUB OFFICE: 222 2nd AVENUE S.E. PERHAM, MINNESOTA 56573 MAIN OFFICE OHER TAIL COUNTY COURTHOUSE FERGUS FALLS. MINNESOTA 56537 218-739-2271 October 27, 1989 (l^Tim Sucher Hook Line & Sucher RR Ottertail, MN 56571 RE: Proposed update of Sewage Disposal Tim, At this time I would like to write down a few of the requirements for updating your present sewage disposal system. A minimum of 7300 gallons of capacity will be needed for septic tanks. A reduction in the size of drainfield will be given for seasonal operation (as per Chapter 7080.0210, subg. 4). The area for drainfield shall be a minimum of 3125 ft if pressure distribution S'OCDis to be used. The spike driven at the base of the light pole nearest to the propane tank has been determined to be approximately 4 feet above the high water mark of 5.80 as measure at the outlet of Rush Lake. Sincerely, Doug Johnson, Sanitarian Division of Environmental Health cc; Melvin McGowan Bill Kalar, Shoreland Management DJ/sd 215502® VICTOR LUNDCEN CO.. PRINTERS. FERGUS FALLS. UINN.PERCOLATION TEST DATAMKL -0871 -028 LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, Minnesota 56537 Mailing Address: S'(^S7! State Zip No. Ph. No. Owner: . A St. & No.Middle s21Last Name f..A zliL-' yTWP NAME /3S 3?Legal Description -/V/RANGETWP.SEC.. /■ LAKE OR RIVER NO. NAMErr^k' ,z^ TEST HOLE NO. 2TEST HOLE NO. 1 6-/f■ Depth to Bottom of Hole inches; Diameter of Hole inchesDepth To Bottom of Hole.inches;Diameter of Hole inches; ~ „?<PDepth, Inches Soil Texture Soil TftxtureDepth. Inches Percolation Test By. Percolation Test By____z 29 Firm Name. Firm Name. DC S 3o OTTERTAII-. MN 56571 ^67-2384 QTTERTAIL, MN 56571 367-2384_____ LU DC LU AddressAddress.q: <!7A_kCOOtter Tail County License No.Otter Tail County License No..h-COLUMeasure ment, inches h-Measure- ment inches Percolation rate minutes per inch Drop in water level, inches TimeInterval, minutes Drop in water level, inches Percolation rate minutes per Inch Time Intervals minutes • Remarks:Remarks:TimeTimeo I-f'3 o3'oo3'' 3=^ 53 .3c^o.S L 3:o 1?3 . 3:3 5 3 ^5" -- 3:/n 3J3S.333-V-^^4?.'V2.tl See Booklet, "How to Run a .Percolation . Test" by Agriculture Ext. Service; Un. of MN. Percolation rate =.rninutes per inch minutes per inchPercolation rate = f ■f-t .-^1—,]—1 !i i i.tjssb0 l^yc^otoe6 i-*stUrua >?JU f t--/fvs 4------:a i ' *»4 I 3t i-H»*•OtiO--i I 4I--j -.!!N.-4--------- I ;\ j-------1 -I Yl AI1 r » ;4 — «« : ckOST'44 7* / i t ft I — u 5)I 4.1»,r- 03 -&P1/o*-'__0^/i ' '^1i -.'4--------;S B^A i 1?-^t .- i •*l|_ i !i.t 1 i 4 Jt I Ii’ I • I I +T Vince’s Repair Water Heater, Plumbing. Sewer. Wells, appliances. Pumps, Water Conditioners, Cabin Close & Open Refrigeration Commercial a Residential ' (( VINCENT COULTER (218)367-2384 ROUTE ^ OTTERTAIL. MN 56571 I y l> y ' ■d-c-c.^ / <y:P-y.c-yz.y^ <yy./ t *•;C SHORELAND MANAGEMENT — COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 • Fergus Falls, MN 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM White — Office Yellow — Inspector Pink — Owner Permit No.LEGAL I )oKDESCRIPTION AND SI Range ,S> I__LA\UlLOCATION Lake No. Lake Name Lake Cla$$if.Sec.TWP TWP Name IDENTIFICATION: Please Print All Information. Mailing Address — No.^Street, City and StateLast Name First Initial Zip No, Tel. No. —f7lOWNER V\ « ( \^ _______^ AA. SEWAGE SYSTEM INSTALLER 4Name,J o,v -V ^__JJ' o cr/7/s System will be ready for inspection on. This space for office use only 19 M Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signature NUMBER OF BEDROOMS;ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD 5 1C6 GIs.Capacity Sq. Ft.Sq. Ft. 5)Ft.Ft.Ft.Distance from nearest well 50 Ft.Distance from lake or stream Ft.Ft. In.Ft.Distance from occupied building Ft.Ft. IQDistance from property line Ft.Ft.Ft. Ft.Distance from bottom to Water Table Ft. Ft. 0q>AH distances are shortest distance between nearest points t n ^ JSSeRECORD OF TESTS: Inspection was made on 19 , Time ,)VI By PERCOLATION TEST DATA:Date of First Test 19 , Rate Date of Second Test ,, Rate 1st Test Taken By First Test + 2nd Test 2 Rate2nd Test Taken By Agreement: 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 ins I understand that I have been granted a sewage system site permit in accordance with the requirements of the Shoreland Management Ordinance of Otter Tail County. I understand I must contact my township in order to determine whether or not any addi tional permits are required by the township for my proposed project. Permit: condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six (6) months. The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in :tion. 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 Issued Date: Shoreland Management Officea321Fee $Rec # /te / -7 ______Si? ^ ^__________________________________________________________________fO T^C. ✓ ) Ci t ^ Folm No.l MKL-032085 ' ' 1 1 Q ________________________(^Cuhy' g_ <2. /Comments:fC 237.443 — Victor Lundeen Co., Printers. Fergus Falls, Minnesota t f SHORELAND MANAGEMENT — COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 • Fergus Falls, MN 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM o'-White — Office Yellow — Inspector Pink — Owner ' V / CP - Li Permit No.,LEGAL A( r'N e of ^ u cl4oo KDESCRIPTION AND M 7^2^ /36jlLiM iLOCATION Lake No.Lake Name Lake Classif.Sec.TWP Range TWP Name , IDENTIFICATION: Please Print All Information. Mailing Address — No. Street, City and StateLast Name First Initial Zip No.Tel. No.I' t (-^1 ry I ; JOWNER SEWAGE SYSTEM INSTALLER V ,>> Cl 'll t 'v LName_i 19i^U'66Tfj/s System will be ready for inspection on. This space for office use only 19 ,M Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signature NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD / ICO GIs.Capacity Sq. Ft.Sq. Ft. I— 2Q Ft.Ft.Distance from nearest well Ft. 1).)Ft.'Distance from lake or stream Ft.Ft. Distance from occupied buildinq Ft.Ft.Ft.~X Distance from property line Ft.Ft.Ft. Distance from bottom to Water Table Ft.Ft.Ft. AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on 19 , Time JVl By PERCOLATION TEST DATA:Date of First Test 19 , Rate Date of Second Test , Rate 1st Test Taken By First Test + 2nd Test 22nd Test Taken By Rate Agreement: 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. I understand that I haye been granted a sewage system site permit in accordance with the requirements of the Shoreland Management Ordinance of Otter Tail County. I understand I must contact my township in order to determine whether or not any addi tional permits are required by the township for my proposed project. Permit: The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in Signature Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance.NOTE:Permit void if work is not commenced within six (6) n^onths. IA Issued Date:y -V Shoreland Management OfficeV'X Fee $ .Rec # A-P J>^/crc > '^9 iH- r>-//c . -fa , ^ Co ■2k (V S~ICL^ IComments:/c A'C ^ // /4^^ h 2- Fottn No. MKL-032085 V;237,443 — Victor Lundeen Co., Printers, Fergus Falls, Minnesota * ■• : ■>^.• \ INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORYShould BeActual Actual Should Be Should BeActual ^1/ fyiC(ja^*i^75c?Capacity GIs.GIs.S F S F S F S F -ADistance from Nearest Well F F F F F F 7^Distance from Lake or Stream F F F F F F //O 6Distance from Occupied Building F F F F F F f 17Distance from Property Line F F F F F F 3Distance from Bottom to Water Table 3F F F F F F Inspector’s Comments: V Qt_Q r ^ fr\ov<-C>C-r /o~~ 5~'Date of Inspection 19 Time of Inspection M / Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF = Square Feet F = Linear Feet Job me MKL - 0320BS - Backar Agency f I • V 4 ! hi •rOc>■\;^/ P- m >S-Sv'ryf- WBm Wk 'rT, 5 ri' CERTIFICATE OF COMPLIANCE SEWAGE SYSTEMm pwi|# Si mm 7 8019.June19thday of_This certificate has been issued this to certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County. Minnesota. t m WiThe premises covered by this certificate are legally described as: '1 Twp. iVfime Rush LakemmRange2.3_ Twp. _.lliSec.Lake Mo. 56-IAl I. I r€ Andy's Resort L m 'em Leon D. AndersonOwner: Name.rpi /V .Adrircs-: RFD 1. Ottertail. Minnesota 56571Zip No. mPermit No. SP 368 Signed by: ^ SI ''53 m K. Lee, Shofcland Administraior Tail County. Minnesota MKL-087 1-009 'S \ @ 159035 m«i>K' I ea 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 KV cl )c ^/ € ^ c> r T' A /c ^ 0 Permit No., LEGAL 9-, /Datek LI iDESCRIPTIONU ^ AND g.D- 2'^ OT ,?9 ItkeIin-HiLOCATION u s TWP NameSec.TWPLake Classif.RangeLake NameLake No. IDENTIFICATION: Please Print All Information. Zip No.Tel. No.^ First Initial I Mailling Address —No. Street, City and State(lilrU) /<>FD I 7 ton p| Last Name O T" T^<L r g T6 r s 0*^OWNER M C-SEWAGE SYSTEM INSTALLER Name This System will be ready for inspection on., 19. This space for office use only ,M.19_____ Phone Call Rec'd By Owner or Agent SignatureDate Rec'd Time Rec'd SJr -X) 0. SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD H QO'^ Sq. Ft.(W GIs.Sq. Ft.Capacity Sl-O-Ft. Ft.Ft.Distance from nearest well Ft. Ft. Ft.Distance from lake or stream 5.^Ft.Ft. Ft.Distance from occupied building Distance from property line JOFt.Ft. Ft. Ft.Ft. Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on 19 , Time JVl By ^lll ./........ 19PERCOLATION TEST DATA:Date of First Test Rate /2....a,i 1Date of Second Test 19 Rater 1st TestvTaken By ,, . t^aken By II /J/First Test -H 2nd Test 2 Rate2nd Test 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 johriSTSiidy for inspection. (Call oryHse attached mailer notice.) ^ ^ 'y XGU^fDated t- Signature Permit;Permission is hereby granted to the above named applicant to perform the work describra 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 uV-all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six (6) months. ^ r fIssued Date:f ^^Sfnoreland Management Of^e /./ pfR ^ - 0 0Fee Surcharge $ [jJu/J U JLujksi^ ■ // V'■/y 1 t / '/• <g 3771-003 r ^ )L^ / Comments: 'p'^yXrT ^ OX^/./ S', 7 Form No.viero* uidDCCM « c»., PKinttii*. Pioflu* rw.Lt. wi*« 1S8906 * » :: V , - J ?: k i - •>1 ■ ;t• 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 Office — InspectorOwner Owner White - Yellow ^Plnk - Card — Permit No. LEGAL Date DESCRIPTION AND LOCATION TWP NameLake Classif.Sec.TWP RangeLake No.Lake Name IDENTIFICATION: Please Print All Information. Zip No.Tel. No.Mailling Address —No. Street, City and StateInitialFirstLast Name OWNER SEWAGE SYSTEM INSTALLER Name This System will be ready for inspection on., 19. This space for office use only ,19 Owner or Agent SignaturePhone Call Rec'd ByTime Rec'dDate Rec'd 0 SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PIT DRAIN FIELDSEPTIC TANK Sq. Ft.Sq. Ft.GIs.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: , Time ,JV1 By19Inspection was made on PERCOLATION TEST DATA:Date of First Test 19 , 19 , Rate Date of Second Test , Rate 1st Test Taken By First Test -f 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. AppI leant 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 expressPermit: condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six (6) months. Issued Date: Shoreland Management Office 0Fee $Surcharge $ Comments:. 158906Form No. MKL-0771-003 T- 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 SF S F S F Distance from Nearest Well 75F 50FF F F F Distance from Lake or Stream F F F F F F Distance from Occupied Building 10 2020FFFFF F Distance from Property Line 10 10 10FFFFF F Distance from Bottom to Water Table 4 4F F F F F F Inspector's Comments: Date of Inspection 19___ Time of Inspection,M Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF * Square Feet F * Linear Feet Job Title Agency MKL-0771-00 3-Backer r- • / / > ' tV Price $1.00 per pad. *PERCOLA TION TEST DA TA SHORELAND MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Ph. No. Owner:Mailing Address: M-rn ^ c n-D'p •yi-l- ^ ^~l City-Last Name First Middle St. & No.State Zip No.Legal Description:c''_] ’n_ SEC.LAKE OR RIVER NO.NAME TWP.RANGE TWP NAME TEST HOLE NO. 2TEST HOLE NO. 1 A12SLDepth to Bottom of Hole inches; Diameter of Hole.JnchesDepth To Bottom of Hole,Diameter of HoleInches;inches Aiir- ?i h9 Aurr 2l'^.2Depth, Inches Soil Texture 19:22.Depth. Inches Soil TextureDate,19 Date 1-1^II.i c i1-^9 Percolation 2 .J .9ifert Percolation ~Test By , ^Q LUFirmName.Firm Name.GC aaicc. LU P-~rh'^r:, A-nPerhaa, MnAddress.CC Address < CO Otter Tail County License No.,Otter Tail County License No^HcoLUMeasurement, Inches Depth in Water Level, Inches H Measurement, Inches Depth in Water Level. Inches Time Remarks Time Remarks Oe I §t l-l'lj I-/ % Vg/ VLI./ GC3) o ^ 3C. ^Lir ^y- U-fl3 3'%9•V 2. 1— / y/ ? ^4-/ ^ /ir / 7 f 3o %? V-.'/L3 T 7a i!7 / f } 7 ■* 1‘J / ^‘b. %h3 /7 f J^o LJ_Jk / ffotsO 3.3 3%/ £P n / f/a ! t o <ors 3 ^//3 4 // a ^// /£> f ? M 3"77^f t'k / fdlLAY:I / I'lin/incV. tabe vertical. p::acci "1 'MKL-0871-028159179 ®vieTO* LuaoiEH 1 CO . rcoous fallo Area rae9t.s the min r fm 7Z.« ) N I t ^X.yt£cU^cJt^^ i }'CL U.'-iLidi Uj-iCtLY- cS^'yCfTc^ JhY. lyy£t^ Ih ‘ i / 4033:^q4O JUoISt>f>^^nAr tA J\ fifn/y I0OX6 I -f,IBX D Lw . 35^ Cv Q ^ -v^ y ■M \j i^w i!^/©____=^ ->UL4> \ r c._J5t/i <o « ^ o ^ V 'tcj^ i^lc^ O L-Z/' G) 5'^^?'' /Q ^a-> n ^/* ■v^ A*’ \ F O VD» lo »All c a MINNESOTA DEPARTMENT OF HEALTH Section of Hotels', Resorts and Restaurants 717 Delaware St. S.E., Minneapolis, Minnesota 55440 [ce ffice MOBILE HOME PARK AND/OR RECREATIONAL CAMPING AREA INSPECTION REPORT Lin. Pr^stpri _ V.Qi________________ Location Address y rrk or Camp Name Licensee y^. LO No. Occupied ^ No. Occupied____ ____ Sewage Disposal___ ____ h. Toilet, Bathing and ____ Laundry Facilities ____ i. Incinerators______ ____ j. Garbage and Refuse _ ____ k. Vermin Control___ No. Dep. R.C. SitesMo. Ind. R.C.Sites Mo. M.H. Sites____ Location____ 3. Caretaker____ 3. Spacing _____ d. Animals_____ i. Water Supply_ f. Plumbing____ ,V1HD 152 . ^ y y ’ yPARAGRAPH: /t yX j __Jfefi__. rAsT-y^C —y^Syfi^CyjiSf} No. Occupied l. Night Lighting ___ m. Community Kitchen n. Bottled Gas______ o. Fuel Oil Systems__ p. Fire Protection____ Other________■ J. yi. rA/y?y xP^yy^yyJ y9yyy '^y20^ ^ >4y ^—y^ —^ZySL ylyT^ya -_____________ yy<S<yJ y^fyjjrJyTf^gfd -fz ^^^^^ived By' JLCDist.zDist. Office and Phone No. yy^~ ’^3^-' yyy^ IVI IIVI V/fice Section of Hotels, Resorts and Restaurants 717 Delaware St. S.E., Minneapolis, Minnesota 554,40/Office MOBILE HOME PARK AND/OR RECREATIONAL CAMPING AREA INSPECTION REPORT Lie. Pnstfid/-’ark or Camp Name . Licensee : No. Ind. R.C.Sites .-<' P No. M.H. Sites ■-rc:!:v:v/■> / ./ _____ Location Address ■- K yy- C No. OccupiedNo. Dep. R.C. Sites.'"No. Occupied No. Occupied l. Night Lighting ___ m. Community Kitchen n. Bottled Gas______ o. Fuel Oil Systems__ p. Fire Protection____ Other____________ g. Sewage Disposal___ h. Toilet, Bathing and Laundry Facilities i. Incinerators______ j. Garbage and Refuse _ k. Vermin Control___ a. Location___ b. Caretaker___ c. Spacing ____ d. Animals____ e. Water Supply f. Plumbing___ MHD 152 PARAGRAPH: _ A A/•yytvv r yyA^^^ /i ypypyga /.ryp,_____ y /tyy y ^^yjy~ yyJy~ 3z^\y.AOk‘- ^yyy.c ypPyi, - yyytyy^^yy^^y -AALA A ■'^'^^yAAJyyJLiP)X/Dist. Inspector^ Dist. Office and Phone No. .X/X— ^7/ MINNESOTA DEPARTMENT OF HEALT-H Section of Hotels, Resorts and Restaurants ^35 State Office Bldg., St. Paul, Minn. 55101 al Office nseecrict Office nt y TRAILER COACH PARK INSPECTION REPORT ^/. riATR Lie.POSTEDNOiNAlNO, A^-/ /■ ~Z? < /T. C.P. LOCATIONP. 0.CO. ADDRESSLICENSEE ATTENDANTNO. SITES NO. TRAILERS Sir: (X) Indicates NO COMPLIANCE. COMPLIANCE MUST BE MADE ON OR BEFORE DATE INDICATED. CENTRAL BUILDING ooth, good repair, sloped to drain, clean ( 3-DOORS & WINDOWS—Effectively screened, doors open outward, self-closing ( ION--Adequate, no odors or condensation, heaters properly vented (-Z 7-TOIIETS—Adequate, convenient location, separate foreach sex, 8-LAVATORIES—Adequate, convenient to toilets or compartment; no absorbent floor co^ring («Z lO-LAUNDRY—Adequate, 11-ADEQUATE HOT WATER FACILITIES (/fT 2-WALLS & CEILING—Smooth, wa^^ble.1-FLOORS—Impe rvlous, sm good repair, clean (Z- 4-LIGHTING--Adequate (-Z 5-VENTI^ 6-PLUMBING—Complies State Code <y\ 9-SHOWERS—marked, good repair, clean, enclosed ( Adequate, satisfactory dressing ar^ separate from toilet and shows (Z* GENERAL REQUIREMENTS 12-WATER—Adequate; under pressure; accessible; complies State Standards 13a-SpVERAGE SYSTEM—Public or other approved; sewers, water lines, stop and waste valves properly separated (iZ^-T.C. properly con nected ( c-Sewers on unoccupied sites closed ( ) , d-No slop creating practices 14-GARBAGE DISPOSAL-^ -Metal, adequate, good repair, fly-tight covers, covered clean container, wash rack, frequent collection (>fT 15-RUBBISH DISPOSAL—Adequate; satIsfactoi^ containers, frequent collection (Z- 16-INgECTS AND R0DENTS-- vfL 17-ANIMALS--In utility bldg., at large 18a-ELECTRICAL--,No evidence on premise, under control ( Outlets for each site, extensions not on ground or crossing sites, heavy^uty rubber cover, 14 gauge(yf. 19-I^HTING--Adequate Park Lights (ZT 20a-FIRE SAFETYp^ *Z) each T.C. ( ), c-No obvious fire hazards (Z7 d-Bottle gas cylinders properIjf.-located, connected 2la-PARK LAYOUT--Dralned, sites abut dj^veway, access to highway or alley (Z^I^-Sites proper s^ze (Z> c-T.C. and vehicles properly parked (yf. 22a-SUPERVISI0N — Attendant at all times, registration records kept (.Z^U-Park conducted with strict regard for health, safety and comfort of guest dequate.b.No obvious safety hazards approved extinguishers; convenient ( REMARKS: A (Vy \ RECEIVErf'jJ.DIST. INSPECTOR MINNESOTA DEPARTMENT OF HEALTH Section of Hotels, Resorts and Restaurants 435 State Office Bldg., St. Paul, Minn. 55101 SAFETY INSPECTION RECORDPUBLIC HEALTH AND DATE C '/ay/ ay /OWNERP.O.CO. /f^a5 4 A// ADDRESSLICENSEE P.O.ADDRESS NO. OF EMPLOYEESBUSINESS NAME , CABINS, SLEEPING ROOMS____, UNITSPOSTEDNO. OF: BEDS TOURIST CAMP TENT SITES /cJ TRAILER SITES J!TYPE OF BUSINESS ORDERS WRITTEN BELOW MUST BE COMPLIED WITH BY DATE INDICATED y^a - j~z y'c- ~~7^ czz' /r Z' ZV' y/yyj Lf / ^ t* t*/y >•<» iZ-rc4' /'z-ySyyy/y isLT y/4’<f J^O ^ 7^ y»" <S WELL - SEWER DIAGRAM COMPLIANCE PREVIOUS ORDERS DISTRICT OFFICES - 1. BemidjL (PL 1-5050) 2. Mankato (345-4883) 3. Rochester ^ (AT 2-3861) 4. Duluth (RA 7-7204) 5. Worthington (376-6543) 6. St. Paul (221-2534) 7. Fergus Falls (RE 6-3728) 8. Little Falls (ME 2-8626) YES NO iReCBtve^bv V COPIES - Central Oljice, Licensee, District Office District Sanitation Inspector