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Home My WebLink AboutCamp of the Master_35000240206000_Septic System Permits_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 Whife — Office Yellow — Inspector Pink — Owner Card — Owner (aj 1 Permit NoLEGAL DESCRIPTION AND wLake Sj4_ /3 7 iSt'LOCATION Lake Classif.TWP ■ RangeSec.Lake No.e IDENTIFICATION: Please Print All Information. Zip No.Tel. No.Mailling Address —No. Street, City aid State A'h, First InitialLast Name S i JI O h h 9 U "IfOWNER 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 ' OOP ~7(3 0GIs.Sq. Ft.Sq. Ft.Capacity X/9 3 cksu.p ^ oFt. Ft. Ft.Distance from nearest well nsFt. Ft.Ft.Distance from lake or stream x/o Ft. Ft.Ft.Distance from occupied building / oDistance from property line Ft.Ft.Ft. 3^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 M By ..Z....^:/PERCOLATION TEST DATA:Date of First Test . 1?Rate ' !Data of Second Test.19 , Rate 1st Test Taken By V '.:£r....CFirst 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. AppI leant agrees that plot plan, sketches and specif ications 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.) . 3>U ‘ VDated /T Signature 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. 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: Fee %J0^ .S'XZjB-C]/ S3 f-4- looComments: C OO^I dtM^yO 0~y 3 ^ /LS-eytJlA.--a ( M cmZ I ^ Zc j() Jc3&^7 / ^ ^ OVT O Form No. MKL-0771-003 [Review eAiiiE lake, Minnesota 'i INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORY - Actual Should be Actual Should be Should beActual Capacity S FGIs.GIs.S F S F S F Distance from Nearest Well 75 50FFFF F F Distance, from Lake or Stream .F F F F ,F F 20Distance from Occupied Building 10 20FFFFF F Distance from Property Line 1010 10FFFF F F Distance from Bottom to Water Table 33FFFFF F Inspector's Comments: Date of Inspection 19___ Time of Inspection,M signature of InspectorINTERPRETATION OF ABBREVIATIONS = Gallons = Square Feet F . . = Linear Feet GIs SF Job Title AgencyMKL-0771-003-Backer i CERTIFICATE OF COMPLIANCE SEWAGE SYSTEM E m UM m99 th day n f Vp.c.mbeA 19__ilThis certificate has been issued this % to certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota. :-y^ The premises covered by this certificate are legally described as:iMg" FaAt Lea.^Lake No. 56-11b Sec__21 Twp. _L3A Range Twp. Name. We6l i oi WsAt i oi Soutk^oAt i. I SiMSheZdon TofinovilAt______________ Route. If OtteJitalt. Hinm6otcc Owner: Name. m Address. SS 5657]Zip No. Malcolm K. Lee, Shoreland Administrator 5545Permit No. SP_'P Signed by:. Otter Tail County, Minnesota MKL-0871-009 >35 SOT t 159035 VlCTOfl LUKBICN 4 CO. PHINTCRS. rCKCUt ftLlO, UINN 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 Whi(»-Offfe» Ytlfow — Inspector Pink —Owner Cord — Owner Permit No.,i^J c- i■ V ;LEGAL 0 / DESCRIPTION AND LOCATION TWP NameTWPRangeLake Classif.Sec.Lake NameLake No. IDENTIFICATION: Please Print All Information. Tel. No.Zip No.Mailling Address —No. Street, City and StateInitialFirstLast Name OWNER SEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection .. 19.on. This space for office use only 19 Owner or Agent SignaturePhone Call Rec'd BvDate Rec'd Time 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: ,JVI ByInspection was made on ,, 19 , Time PERCOLATION TEST DATA:, 19...Date of First Test , Rate Date of Second Test 19 , Rate 1st Test Taken By f First Test -I- 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 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 Fee $ certificate issu-'drASSl Comments:. Form No. MKL-0771-003 I^VIIW lAtnC UKi. M1NNIS0TA w-^ ”■ 1 • ’S5WF- -fgt. W”'▼ K INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORY Actual Should be Actual Should be Actual Should be KOO SFCapacityGIs.GIs.S F S F S F /botDistance from Nearest Well /OO^ F75 50FF F F F 060-3^ FDistance from Lake or Stream F F F 3*0Distance from Occupied Building 10 20 20FFFFF F F3KDistance from Property Line 10 10 10FFFF F Distance from Bottom to Water Table 33FFF F Inspector's Comments: Date of Inspection 19___ Time of Inspection .M Signature of inspectorINTERPRETATION OF ABBREVIATIONS GIs * Gallons SP * Square Feet F “ Linear Feet Job Title AgencyMKL-0771-003-Backer c^- F Fj; •i lS8fi fy r Vv/^-e_(^O 21SS02® VICTOR LUNOECH CO.. PRINTEBe, FERCUO F*LLS,PERCOLATION TEST DATAMKL -0871 -028 LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, Minnesota 56537 •3^C f J - 2.fiYaPh. No. Owner:Mailing Address: ri.S7 f Zip No.StateLast Name City/St. & No. i 3 -y // First Middle Legal Description:P> € ‘'-<y3(^ Uk TWP NAMERANGESEC.TWPLAKE OR RIVER NO.NAME //A/fr -r /S h -u y /o // Co a if" f ^ t.K.lI (r rc. TEST HOLE NO. 2TEST HOLE NO. 1 6LU%oDepth to Bottom of Hole inches; Diameter of Hole jnchesDepth To Bottom of Hole.inches;Diameter of Hole inches /y; //13^ y'19 ^ ^Depth, Inches Soil Texture ):Depth, Inches Soil TextureDate Date S I ( f I <7^ >'1LCuf'^yn.0 - m 0-- I ‘ZPercolation Test By____----------T-----------;;;------ Percolation7 JjIH - 3 0 OiY 1/f/i'LU /r /3a u c.Firm Name3/0 - y o DC Firm Name.//>D //14J> - p 4 XoaLU f //DC r-'LU '> ' ’f h (^ ‘ 4yAddress.DC Address < COOtter Tail County License No.Otter Tail County License No..I- coLUMeasure ment, inches Time Intervals minutes Drop in water level, inches Percolation rate minutes per inch I-Time I nterval, minutes Measure ment inches Percolation rate minutes per inch Drop in water level, inches Remarks:Time Remarks:Timeo 9 ' Jd 9 ,Wq /p/'l ') —A3y'A,35°f [6 ar Cs L u? 3? "A 3 B9; ro 3,?:. 6L4 3,0HO11 HT ^y-4S'o .5703./l-,0lOM3 T-t II 2.-^r C3O9 \ iii>r,o N ,C& 1.. o> I 11 : >10; IP - cu ^>0/\n \ Zo ' S't>L SiO4%011 0If%- 130 7f>\ I B f.A/AA AVAn A 'h Ut/y 'J eC / «o f I ^ ^ e... ^ Pr <W, ^j 0 f-c- . ,> «-y jy an.'/’CL y <3tFr t=* // 9 ^mim See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of MN Percolation rate =.utes per inch minutes per inchPercolation rate = (T J 3 ^fl0V^ 3^7^ - ^ ^ SrJ ^2^ yttSL-xy-AiGodf 7 SHORELAIMD MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 — Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM W te — Office^ V low — Inspector PI*.. Owner Card Owner I oC= V^v>^PerliUlo._3vA5LX£X>C_ . p- o o ^ ^ S ^ M "To ^ o D ' ^ 0^5;: ----------------------------------------- vj ^ V- - l V- ^ ^ LEGAL 1 RDate DESCRIPTION AND TWP LOCATION TWP NameRangeLake Cla&sif.Sec.Lake NameLake No. IDENTIFICATION: Please Print All Information. Tel. No.Zip No.Mailling Address —No. Street, City and StateInitialFirstLast Name cr c2 wr v-4- osi■^c\ (2 K\ r:) L i t g;~r r-> n c .\<iOWNER t—C ^ N SOs C!H ■(*VA L- \ v\ \ Kj___________ Kd. C Q.r..v..ux::>-E-EL 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. Ft. Sq.\ ~) r> Sq. Ft.Capacity - ^ O OFt.Ft.Distance from nearest well "T "T Ft.Ft. Ft.-1 <;Distance from lake or stream 3 (T3 Ft.L_0 Ft. Ft.Distance from occupied building Distance from property line \ Q Ft.\ O Ft.t. Ft.Ft\Ft.Distance from bottom to Water Table i4All distances are shortest distance between nearest points RECORD OF TESTS: ^93..^. . Time .V3l..'.30.e)VI By ., 193..S!...- , 19...a...&., Rate .'soInspection was made on PERCOLATION TEST DATA: Y I fPC- W-v 1st Test Taken By C V4 rs c:: ^______ 2nd Test Taken By Date of First Test ..CY\..(S>..^;:S.. Date of Second Test,.....fN/^svO.>:^v...^(o, .So.Rate First Test.......^L -I- 2nd Test 2 Rate 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.) ^ signatureM1,51Dated. 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. Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express rr/ » A 4^ /V) J P) ^Shoreland Management Office ' Issued Date: -7^- ^ . f'l (s . c>Fee $Surcharge $ Comments:. Form No. MKL-0771-003 , ....158906VlCTftl IVWCCH 4 M.. PKIVTtI t44t 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 W to — Office V low —^ Inspector —* Owner Card — Owner \ V—'C_ . c:.- o r-j Permit No., LEGAL ^ ■'Is'-i j ^—c "\ c ^Date DESCRIPTION MV .c ^rI V;.. wAND V-’ T-LOCATION Sec.TWP NameLake Classif.TWP RangeLake NameLake No. IDENTIFICATION: Please Print All Information. Zip No.Tel. No.Mailling Address —No. Street, City and StateFirstInitialLast Name y - . '<:•OWNER SEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection ,- 19on. This space for office use only 5/^3 10-7F ^,, Date Rec'd Owner or Agent Signa^tureTime Rec'd hone 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 Ft.Ft. Ft.Distance from lake or stream Ft.Ft.Ft.Distance from occupied building Distance from property line Ft.Ft.Ft. Ft.Ft.Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points i RECORD OF TESTS: Inspection was made on 19 , Time JVI By PERCOLATION TEST DATA:Date of First Test...19 . Rate Date of Second Test 19.......Rate 1st Test Taken By First Test + 2nd Test ) 2nd Test Taken By 2 Rate 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 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.Ov .'bIssued Date:~T i Shoreland Management Office_^4^ Fee $Surcharge $ T2Comments:. HO CE Form No. MKL-0771-003 ,158906viCToa kuMPCCH t CO.. piiMTcaa, rtaaus rM.Lt. INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PIT DRAIN FIELDSEPTIC TANKCATEGORY Should be Actual Should beActualActualShould be si7 7 ai7>oCapacityGIs.GIs.SF S F SF fc>Distance from Nearest Well 75 50F FF F F zl7^00^F%QorDistance from Lake or Stream FFFF F \f 20Distance from Occupied Building 10 20 FFFF 7 X/iQoo 160 FDistance from Property Line 10 10 10F FF F 4Distance from Bottom to Water Table 4FF F FF IXInspector's Comments: rt 2^ ^ ^.yl^kur\6? A Date of Inspection Time of Inspection,.M ^^Fratureof InspectorINTERPRETATION OF ABBREVIATIONS GIs “ Gallons SF » Square Feet F ■ Linear Feet Job Title Agency MKL-0771-003-Backer A/IM*' ' V-’ ■j' • 1PERCOLATION TEST DATA ! SHORELAND MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Ph. No.<Owner:Mailing Address: Last Name First Middle St. & No.Zip No.City State 2 A/rr^ TWP NAME Legal . Description! 'S ^ ^_________ LAKE OR RIVER NO. l^AF 0¥/ SEC.TWP.NAME RANGE TEST HOLE NO. 2TEST HOLE NO. 1 7^ '-1 o 6Depth to Bottom of Hole.inches; Diameter of Hole inchesDepth To Bottom of Hole.inches;Diameter of Hole inches Depth, Inches Soil Texture Depth. Inches Soil TextureDate.19 Date 19 I lA ■ P,,ol.Oon Firm Name cs - J O Percolation Name. I P - Q ^ - r? s - LU — -----------------t o - Zr.7y CC.'y DaLU CCK LUAddress.CC Address < Otter Tail County License No..Otter Tail County License No..I-C/5LU Drop In Water ■Level. iTKhes Drop In Water Level. Incites Measurement, Inches Measurement, Inches I-Time Remarks Time Remarks o)0' 30 / >>: ^9 o >7 I /6/ : 7 s Al-O: tZL 7 V vs ^ 97~ ■ c>/ 0 ■: S" i cy#71 aA t7 MKL-0871-028183818.® vtcTAt Luaocia » M **ian«8. r(8«u> r*Li.8 See Book!et/"How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn.