HomeMy WebLinkAboutCamp Idlewile Resort_08000260204000_Septic System Permits_CERTIFICATE OF APPROVAL
SEWAGE SYSTEM
COLLECTOR
of FEBRUARY, 1999This Certificate has been issued this 1ST , to
ir certify that the sewage system installed as per Sewage Treatment System
Permit Number 11911 has been approved for use by Otter Tail County,2
Minnesota.m
The property served by this Sewage System is legally described as:
PT GL 9 & 10 (7.57 ACRES)
Pi LOT 2 EX .04 ACRES
1:;
0^. »•<
ii Parcel Niimber(s): 08000260204000 08000350263000
Section: 26 Township:137 Range: 041 Township Name: CANDOR TOWNSHIP
Lake Nvimber:56-523.3 Lake Name: LOON,LAWRENCEi?:.^2
Current Property Owner: NEIL & DONNA STRAWHORN
Number of Bedrooms: 5
* SERVICES 3 DWELLINGS IN CLUSTER DEV
Land & Resource
• ^4* ,
284.709 • Victor Lundeen Co , Printers • Fergus Falls, MN • 1-800-346-4870
APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM
WHITE — Office
Yellow — Inspector
Pink — Owner
LAND & RESOURCE MANAGEMENT
OTTER TAIL COUNTY COURT HOUSE
Phone: (218) 739-2271 - FERGUS FALLS, MN 56537
Permit No.LEGAL
Ch'Lf / b 9^DESCRIPTION
) Yes ) NoAbatement: (AND
LOCATION
LAKE/RIVER SECTIONLAKE NUMBER LAKE/RIVER NAME RANGE TWP NAMETWP. NO.
6b'6>5
PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER
OZ-OOO'-^ - 4^-000 /35 ' o 7^^3'OOQ /o5
IDENTIFICATION: Please Print All Information
Mailing Address — No. Street, City and StateFirstInitial Zip Code Telephone No.Last, Name
6/n c(%^._________Property
Owner (J_
Sewage
System
Installer
Name
A.M.
► 7/?/s System will be ready for inspection on P.M., 19-at
This space for office use only 5'NUMBER OF BEDROOMS:
A.M.
P.M19 )YES (^)NOGARBAGE DISPOSAL: (Date Rec'd Time Rec'd Phone Call Rec’d By
SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM
( ) Holding tank (Alarm Required)
(^ Septic tank
( ) Lift station (Alarm required)
( ^) Drain field
( ) Trenches
TANK DRAIN FIELD
9 S3 SqI S'o oCapacity GIs.Ft.
Distance from nearest well Ft. Ft.
7-rDistance from lake or stream Ft. Ft.
Bed Distance from building Ft.io Ft.
Mound
( ) Outhouse
( ) Sewer line
toloDistance from property line Ft.Ft.
3Distance from bottom to Water Table Ft.Ft.
EFFLUENT DISTRIBUTION
( ) Gravity
Pressure
All distances are shortest distance between nearest points
PERCOLATION TEST DATA:3WATER WELL DEPTH
rzbPerc Tester.Date of Perc Test
//. /5.^Rate 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 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 pari
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.
DATE:Signature/ff
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 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.
.and & Resound
Issued Date:
Management Officeoo3S.111Fee $.Rec #.
Comments:
277.212 • Victor Lundeen Co.. Primers • Fergus Falls. MinneostaBK 0796-003
"T'-’-f’ -r
APPUCATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM
■* i 'V I
WHITE — Office
Yellow Inspector
Pink — Owner
>LAND & RESOURCE MANAGEMENT
OTTER TAIL COUNTY COURT HOUSE
Phone:(218)739-2271 - FERGUS FALLS, MN 56537
-j
I
I l^//LEGAL Permit No.
Abatement: ( ) Yes ()/ ) NoDESCRIPTION
AND
/LOCATION
LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER
CLASg
SECTION RANGETWP. NO.TWP NAME
./ V71c-.
PARCEL NUMBER(S)
^, '' 0 -
FIRE OR LAKE ASSOCIATION NUMBER
3b' '^'?(o3-noo
IDENTIFICATION; Please Print All Information
Last Name First Initial Mailing Address — No. Street, City and State Zip Code Telephone No.
111 ' :.. v f y^c yj/aProperty
Owner
y
(D.'1
.-L, t .I
Name ■ ( ' } jJ f- //Sewage
System
Installer
3 Jr.x (X--" P ■ -)/(yi
.
\
.iA.M.t^'.oo5TL- H-t
This System will be ready for inspection on., 19-P.M.at
This space for office use only
NUMBER OF BEDROOMS:
A.M.
P.M GARBAGE DISPOSAL: ( ) YES ( NODale Rec'd Phone Call Rec’d ByTime Rec'd
SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM
( ) Holding tank (Alarm Required)
()3) Septic tank
( ) Lift station (Alarm required)
( Drain field
( ) Trenches
DRAIN FIELDTANK
SqFt./ SCapacity GIs.
SODistance from nearest well Ft. Ft.
7rnsDistance from lake or stream Ft. Ft.
( ) Mound
( ) Outhouse
( ) Sewer line
Bed Distance from building !0 Ft.Ft.
/O!0Distance from property line Ft.Ft.
3Distance from bottom to Water Table Ft.Ft.
EFFLUENT DISTRIBUTION
( ) Gravity
( y) Pressure
All distances are shortest distance between nearest points
PERCOLATION TEST DATA:
WATER WELL DEPTH ]
2,2'r ^ •rz/Perc Tester.Date of Perc Test.
1// /Rate 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 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.^
■n /
DATE:
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 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.
/
3Issued Date:(X
Tand & Resource Management Officei /. Ho T 1Fee $.Rec #.
Comments:
277.212 • Victor Lundeon Co. Primers • Fergus Falls. MinneostsBK 0795-003
r
INSPECTION RESULTS
Inspector must make all measurements
SEWAGE DISPOSAL SYSTEM STATISTICS
DRAIN FIELDHOLDING SEPTIC TANK LIFT TANKCATEGORY Actual Minimum
6)(J SF/ 500 GLS.^oOO GLS.SFCapacity
FTFTFTFTDistance from Nearest Well
Distance from Buried Water Suction Pipe FTFTFTFT 50
Distance from Buried Pipe Distributing Water Under Pressure loy FTFTFTFT10>0^
75 ^ FTft FTDistance from Lake or River (OHWL)FT
^0 +ft 10/20 FTFT FTDistance from Nearest Building
FT FT10FTFTDistance from Nearest Property Line
H0 FT FT3FTFTDistance from Bottom to Water Table
S* r
C3)NOHolding Tank/Lift Alarm
s NOOld System Pumped & Destroyed
DRAINFIELD CALCULATIONSewer Line to Welt SeparationINTERPRETATION
OF ABBREVIATIONS
GLS. = Gallons
SF = Square Feet
FT = Linear Feet
Actual Minimum IL FTX
FT FT20 SF
&
Inspector’s Comments:
I
Ulc^^^KETCH:
Inspector's Signature
Date of Inspection
Time of Inspection
AIR TEST CERTIFICATION
On (date), an air test of the sewer line installed under
hd-rn_______Sewage Disposal System Permit Number //*?//
(owner), on J^^oh
line held
for
________________ (lake/river) was made. At that time, the sewer
pounds per square inch for minutes.
y'rni^ 'Sr
Installer's Sign 17License No.Dateure
iU^ ^ ^ MvclctJui
M?n
%oK M<UlO fW
^-/^§r
WuMmj - 'nU: (X.
/ciuUz j(Lo ymua€'
Oi^ /UjoiC^
5jpe
6l^.jy^yK
-Dnhfink^
Aaxic ® M'^
'tyu/'WA/.
<24^XA.^<zJ
p- -/idAk-iTTUl',
e24^^2M2J^
I£^p^£ s- a^iums/ietr
MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring
Sealing No.
Minnesota Unique No.
or W-series No.
(Leave blank il not known)
H 101796WELL OR BORING LOCATION WELL AND BORING SEALING RECORDCounty Narr.e
Minnesota Statutes, Chapter 1031
Towiisiiip No. Range No.Township ['Ja“e Section No.Fraction (sm. !g.)Date Sealed Date Wei! or Boring Constructed
1 '..iVyiC.nl Street Address or Fire Number and City of Well or Borina Location £S^lAt^L&on —fut—C L !oS
SfioiJi^ exact locatidri of wefi or boring ' Sketch mapHii^;ell or boring
in section grid w'Uh "X". location, showing property
lines, roads, and buildings.
it.Depth Before Sealing Original Depth
AQUIFER(S)
[^Single Aquifer □ Multiaquifer
STATIC WATER LEVEL
□ Measured D EstimatedWELL/BORING
3^ Water Supply Well □ Monit. Well
□ Env. Bore Hole D Other_____
N
4^rTT"ft. □ below n above land surface!i-CASING TYPE(S)
[j£steel □ Plastic □ Tile □ Other
EW
T
% mile CASING1"tiTi i I T Diameter Depth
O to ft.
Sex in oversize hole?Annualar space initially grouted?
□ Yes G ''c Lj Ur'known
S Jih □ Yes □ Noin. from£)S-34JL’37031 mite I
\j.r,r\ov/n□ Yes □ .0ft. □ Yes □ Noin. from toPROPERTY O^NER’ajilAf^E ^ .
well location address indicated above.
.j
□ f.'o '.J ‘..Unknown□ Yes□ Yes □ Noin. from ft.Projje to
SCREEN/OPEN HOLEA//y.£<S.t
ft. Open Hole from ft.Screen from to to
OBSTRUCTION/DEBRIS/FILL
□ Obstruction □ Debris □ Fill f^jljvio Obstruction
Type of Obstruction/Debris/Fill __________________________
WELL OV'.'NER’S NAME
Well owneLsi,mailing ad«iress if differei'iH|ifln proberty ia/C 3tnqie^^ri\/£j
T77
owner’s address indicated above.
Obstruction/Debris/Fill removed? D Yes D No
PUMP
Type
Removed D Not Present O OtherHARDNESS OF FORMATIONGEOLOGICAL MATERIAL COLOR FROM TO
METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND BORE HOLE:
D No Annular SpaceS^its y
n Annular space groute^yath tremie pipe y
□ Casing Perforation/Removak y
If not known, indicate estimated formation log from nearby well or boring.
N,
□ Perforated n Removedin. from•S.ft.to
□ Perforated □ Removedin. from ft.
Type of perforator
□ Other
GROUTING MATERIAL(S)
ft..^L tofromGrouting Material yards bags
from ft.bagstoyards
from ft.bagstoyards
from ft.yards bagsto
REMARKS, SOURCE OF DATA, DIFFICULTIES IN SEALING UNSEALED WELLS AND BORINGS
Other unsealed well or boring on property? D Yes ^C*No
LICENSED OR REGISTERED CONTRACTOR CERTIFICATION
This well or boring was sealed in accordance with Minnesota Rules, Chapter 4725. The information contained in this report is
true to the best of my knowledge.
License or Registration No.
Date
3rtyi ci m)k)
Name of Person Sealing Well or Bokng
KLSe
H 101796IMPORTANT-FILE WITH PROPERTY
PAPERS-WELL OWNER COPY
HE-01434-02 10/95R
SITE DATA
LAND AND RESOURCE MANAGEMENT
Otter Tail County
Fergu^^ls, MN 56537
OWNER:
laSt name FIRST MIDDLE TELEPHONE NUMBER
ADDRESS:
PO /7S
!_7r ✓r<r
STR./RT.CITY STATE ZIP CODE
/[2L CtK'^cffr'
LAKE/RIVER NO.LAKE NAME SEC.TWP.RANGE TWP. NAME
LEGAL DESCRIPTION:SOIL BORING LOG Date.
COLOR &
MUNSELL NO.
DEPTH
(INCHES)TEXTURE STRUCTURE
BLOCKY
PLATY
PRISMATIC
NONE
O-i,
PARCEL NUMBER
a.!£pr BLOCKY
PLATY
PRISMATIC
NONE
/&y/^
5?^
4-/2FIRE NUMBER
sNUMBER OF BEDROOMS BLOCKY
PLATY
PRISMATIC
NONE
'Z.ry
GARBAGE DISPOSAL: YES
WELL CASING DEPTH:ft.
BLOCKY
PLATY
PRISMATIC
NONE
FLOODPLAIN: YES
/tfRRESTRIAIVEGETATION: AQUATIC
BLOCKY
PLATY
PRISMATIC
NONE
/SLOPE AT INSTALLATION SITE:%
TYPE OF OBSERVATION: Probe Pit
COMMENTS: 3^ ^
s~/j^ K«/ -y 0 /• z,y
PARENT MATERIAL:
ORIGINAL SOIL: No
Outwash Loess Bedrock Alluvium
COMPACTED SOIL:Yes
■7-^’
DEPTH OF BORING-
PERC TEST # 1 PERC TEST #2- TWO TESTS ARE REQUIRED -
TIME INTERVAL (MINUTES)WATER^^PTH WATER DROP PERC RATE TIME INTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATE
7IME * DROP PERC
START START lo^^rr_Ald>'97?/i?
TIME DROP PERC
INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEH'.l'i.REFILL REFILL
—/i?.—TIME DROP PERC TIME DROP PERC
TIME INTERVAL (MINUTES)WATER DEPTH
-V44/--
WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH
£-7^-
WATER DROP PERC RATE%REFILL tos7'bLTIMEDROPPERC TIME DROP
PERC RATE
PERC
TIME INTERVAL [MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP
m MeREFILLREFILL/JO
TIME DROP PERC TIME DROP PERC
TIME INTERVAL (MINUTES) REFILL WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE71^1.0REFILL
DROP*.~PERTTIMEDROP
WATER DROB««*^TIME INTERVAL (MINUTES)WATER DEPTH PERC RATE______ I ^TIME INTERVAl IINUTES)WATER DEPTH WATER DROP PERC RATEREFILLREFILL
TIME DROP TIME DROP PERC
TIME INTERVAL (MINUTES)WATER DEPTH FATER DROP PERC RATE TIME INTERVA^IMINUTES)
WATER DEPTH WATER DROP PERC RATEREFILLREFILL
TIME ‘ DROPTIMEDROPPERC PERC
.TWUjROPTIMEINTERVAL(MINUTES)WATER DEPTH PERC RATEWA Time INTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATEREFILLREFILL
TIME DROP PERC
PROPOSED DESIGN:
/PRESSURE DIST. XMOUND.HOLDING TANK.GRAVITY DIST.TRENCH BED.ATGRADE.
SPECIFY:,■ SEWER LINE.OUTHOUSE,OTHER.
— SYSTEM DESIGN ON BACK —
System design must be to scale and must include the proposed location of the sewage system, all
existing/proposed buildings, property lines, the ordinary high water level of the water body and all water
wells within 150' of the sewage system.
GRID PLOT PLAN
feet SKETCHING FORM/Scale:,grid(s) equals inch(es) equalsfeet, or
/rSUBMITTED BY: IEf M _________
FIRM NAME:t)i^
ADDRESS: t Hov 'Ti'')
^ ^ ^_________________________
SIGNATURE:
cDATE:
fy'MPCA LICENSE #:
7
T pr--*43Uys "Bp
!
BK >- 0496 — 029
Print Key Output Page 1 02/11/99 14:18:275769SS1 V4R3M0 980729 OTTER
Display Device User ....QPADEV0053LAND
Inquiry Taxpayer/Legal InfoTC906D 10 T56 BRC Tax System Bill No. Parcel No.R 08000260204000 NameNEIL & DONNA STRAWHORN OSSIAN IN 46777 0R1999
District CodeTax CodesTwn/Sch 0008 0549
Spec Dist User Codes TIP DistrictAddress PAS RECORD
804 Taxpayer NEIL & DONNA STRAWHORN 510 INGLE DR OSSIAN IN 46777
95359
Property
AlternateLegal DescriptionSect/Twn/Range 26 137 041
PlatLot/Block
PT GL 9 Sc 10 COM MC#10 W 333.3' N 82 DEG W 283.08' TO BEG N 140.54' NELY 497.82' N 168.46' TO CENTERLINE OF RD ELY ALONG RD 349.73' S 60.46'A=CSM B=ASM C=DQ D=NAL E=TR F=SP P=PA S=GS U=CAMA
EscrowDeeded7.57 AC
Other DONNA STRAWHORN95360 OWNER
More Legal? Y More Addresses? Y Mod? Action?
7
r
V
Print Key Output Page 1 02/11/99 14:19:04OTTER5769SS1 V4R3M0 980729
Display Device
User ....
QPADEV0053LAND
Inquiry Taxpayer/Legal Info
NEIL & DONNA STRAWHORN OSSIAN IN 46777
TC906D 10 T56 BRC Tax System Bill No. Parcel No.R 08000350263000 Name 0R1999
District CodeTax CodesTwn/Sch 0008 0549
Spec Dist
User Codes TIE District
Property
804 Taxpayer 95359NEIL & DONNA STRAWHORN 510 INGLE DR
OSSIAN IN 46777
Address PAS RECORD
AlternateLegal Description < Sect/Twn/Range 35
■ Plat Lot/Block
LOT 2 EX .04 AC.
^ •137 041 EscrowDeeded.66 AC
Other DONNA STRAWHORN95360 OWNER
More Legal? N
A=CSM B=ASM C=DQ D=NAL E=TR F=SP P=PA S=GS U=CAMA
More Addresses? Y Mod? Action?
>-v
. «' I
'
-1