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HomeMy WebLinkAboutCarlson_53000230151000_Septic System Permits_m l^ffiSaSW ? BM IWWI. wfrmVI M CERTIFICATE OF APPROVAL SEWAGE SYSTEM HOLDING TANK 15th1^1 m-95Dec emb erThis certificate has been issued this to certify that the sewage system installed as per sewage permit number indicated below has been approved for use by Otter Tail County, Minnesota. day of 19 S I A K i;sis The premises covered by this certificate are legally described as: Range 39 Twp. A/flwipROSH LAKELake No. 56-141 Sec. 23 Twp. 135■Mi n 23 135 39 6. 77 N 680' OF LOT 2 EX W 575' & N 20' OF Sl/2 SWl/4 l>. N 20' OF S 40 RDS OF LOT 2 ' --m M iS m ■ *-j M mmOARl SON. JFFFRFY J K: SUSAN LOwner: Name m 5336 nRFUl AOF R. MINNFAPOI IR. MNAddressi m 55410Zip No. 'ti Permit No. SP 105340 Signed by: m Land & Resource Management Official Otter Tail County. MinnesotaMKL-0987001 fM imh fe'L\jm JT 279005 View Lundeen Co.. Printen, Fergus Fills. Miniiesrti *•' - •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 A >-■ -8 5 iz. A/ ^ AJ ZO /Permit No.LEGAL DESCRIPTION w 8c Yack a hiAND 9-.LOCATION RANGESECTION TWPLAKE/RIVER TWP. NO.LAKE NUMBER LAKE/RIVER NAME "60 >> /^5-' ^sk Lo4sl^s FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER(S) 0-3-OR)->^7-0/^/-q60 IDENTIFICATION: Please Print All Information Zip Code Telephone No.___________________________________ Mailing Address — No. Street, City and StateCG6t^ti>c/n , ,0^0 h/vAA) A\/^ 3,Last Name First Initial Property Owner SSHIDiPC YJjilkAJSewage System Installer Name A.M. ^ This System will be ready for inspection on P.M., 19-at This space for office use only sNUMBER OF BEDROOMS: A.M. NOP.M19 GARBAGE DISPOSAL: ( ) YESPhone Call Rec'd ByTime Rec'dDate Rec’d SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTS. / TYPE OF SEWAGE SYSTEM (/7 Holding tank (Alarm Required) ( ) Septic tank ( ) Lift station ( ) Drain field ( ) Standard ( ) Bed ( ) Trench ( ) Modified ( ) Mound ( ) Outhouse RAIN FIEKDTANK kfOO GIs,Sq Ft.Capacity cn Ft.Distance from nearest well Ft. Distance from lake or stream Ft. Ft. /o Ft.Distance from building Ft. /Q Ft.Ft.Distance from property line 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 Pen Rate of 1 St Testd:[e^of 2nd Test AvfeTage 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 ot 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 infection. DATE: Signature/^ P^i^ormPermit: Permission is hereby granted to the above named applicant to 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. ' i(m^ , A) C-Ci k [ IAS l/viyf<Al “fo the work described in the above statement. This permit is granted upon express condition Issued Date:L Land & Resource Management Office Fee $.Rec ft. yComments: mo a 272.858 - Victor Lundeen Co., Printers, Fergus Falls, MinnesotaFonn Mo. BK-0894003 . APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM•i~a WHITE — Office Yellow — Inspector Pink — Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218)739-2271 - FERGUS FALLS, MN 56537 -/N uA 2 M/ sys 3'/^ Permit No.LEGAL DESCRIPTION AND -t- K1 lo'LOCATION RANGE TWP NAISECTIONLAKE/RIVER TWP. NO.LAKE/RIVER NAMELAKE NUMBER "60 jbr s)ush PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER OI^I-OOO IDENTIFICATION: Please Print All Information Zip Code Telephone No.Mailing Address — No. Street, City and SlateFirst InitialLast Name S/paaI 5. 4 Suscm ' Property Owner Aw 5 5^10 Sewage System Installer Name / i A.M. P.M., 19.This System will be ready for inspection on at This space for office use oniy NUMBER OF BEDROOMS: A.M. ) YES Qx^) NOP.M19 GARBAGE DISPOSAL: (Phone Call Rec'd ByTime Rec’dDate Rec'd SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTS X'TYPE OF SEWAGE SYSTEM Holding tank (Alarm Required) ( ) Septic tank ( ) Lift station ( ) Drain field ( ) Standard ( ) Bed ( ) Trench ( ) Modified ( ) Mound ( ) Outhouse / RAIN FIELDTANK /iroo GIs.Sq Ft.Capacity SO Ft. Ft.Distance from nearest well Ft. Ft.Distance from lake or stream 10 Ft.Distance from building Ft. ZQ . Ft.Ft.Distance from property line Ft.Distance from bottom to Water Table EFFLUENT DISTRIBUTION ( ) Gravity ( ) Pressure All distances are shortest distance between nearest points PERCOLATION TEST DATA: WATER WEI^L DEPTH Perc Tester Date of Pea Rate of 1 st Test^ZL c=r-Rafeof 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. A-".-/. rDATE:—--------1 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. Issued Date: Land & Resource Management Office Fee $.Rec #. Comments: 'kqu-h ■fr mniO’ -', I a 272.868 ■ Victor Lundeen Co.. Printers. Fergus Falls. MinnesotaForm No. BK-0894.003 -tT INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS A SEPTIC TANK DRAIN FIELD CATEGORY Actual MinimumMinimumActual ;rooCapacity SFGLS.GLS. SF ,7^?FT FTDistance from Nearest Well FT FT50 Distance from Buried Water Suction Pipe FT FT FT 50 FT50 Distance from Buried Pipe Distributing Water Under Pressure FTFTFTFT1010 IGti't- FT FTDistance from Lake or River (OHWL)FT FT 10/20 FTFTFTDistance from Nearest Building FT 10 FT FTDistance from Nearest Property Line FT 10 FT 10 FTFT FTDistance from Bottom to Water Table FT 3 YES NOHolding Tank/Lift Alarm DRAINFIELD CALCULATIONSewer Line to Well SeparationINTERPRETATION OF ABBREVIATIONS GLS. = Gallons SF = Square Feet FT = Linear Feet Actual Minimum FTX 56 f FT 20 FT SF Inspector's Comments: SKETCH: \ Inspector's Signature \ Date of Inspection /3<-yA Time of Inspection f/A CERTIFICATE OF APPROVAL SEWAGE SYSTEM day of December to certify that the sewage system installed as per sewage permit number indicated below has been approved for use by Otter Tail County, Minnesota. 19 95. .15thThis certificate has been issued this The premises covered by this certificate are legally described as: kS Lake No. 56-141 Sec. 53 Twp. 135 Twp. A//7w^RUSH lakeRange 39 23 135 39 6. 77 N 680' OF LOT 2 EX W 575' ?< N 20' OF Sl/2 SWl/4 8< N 20' OF S 40 RDS OF LOT 2 iM mCARLSON. JEFFREY J Rr SUSAN LOwner: Name 5SSA nRFUi AOF S. MINNFAPOI IS. MNAddress 55410 [SZip No. Permit No. SP 105SAA Signed by: Land & Resource Management Onicial Oiler Tail County, MinnesotaMKL-0987001 JT 279005 ! 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 6U SDESCRIPTION AND LOCATION ,NGELAKE/RIVER CLASS _ SECTIONLAKE/RIVER NAME TWP. NO.LAKE NUMBER 6L>- lU!(S'4)53 FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER(S) £3- COO'93- OkS/- OOO IDENTIFICATION: Please Print All Information Zip CodeMailing Address — No. Street, Cily and State_________»Telephone No.First InitialLast Name Property Owner ¥ JSewage System Installer Name A.M. ^ This System will be ready for inspection on P.M, 19.at This space for office use only NUMBER OF BEDROOMS: A.M.(><)N0P.M19 GARBAGE DISPOSAL: ( ) YESPhone Call Rec'd ByTime Rec’dDate Rec'd SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) Septic tank ( ) Lift station (^ Drain field ( ) Standard ( ) Bed (^ Trench ( ) Modified ( ) Mound ( ) Outhouse DRAIN FIELDTANK //P/7/7 GIs.Sq Ft.Capacity 6r2m23AFt. Ft.Distance from nearest well Ft.Distance from lake or stream Ft, /3>Ft.Distance from building Ft. A’/3 Ft.Ft.Distance from property line Ft. Ft.Distance from bottom to Water Table EFFLUENT DISTRIBUTION Gravity ( ) Pressure All distances are shortest distance between nearest points PERCOLATION TEST DATA: WATER WELL DEPTH Perc Tester.Date of Perc Test L IIRate 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. // ■DATE:Signature^^^^Y Permit: Permission is hereby granted to the above named applicant to p^jform 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. Issued Date; imn Land & Resource Management Office Fee $.Rec # Comments: 272.858 - Victor Lundeen Co., Printers. Fergus Falls. MinnesotaForm Ho. BK-0894403 APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM- tfWHITf—Office Yellow — Inspector Pink — Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218)739-2271 - FERGUS FALLS, MN 56537 ! »■ r ^ Permit No._____TZlLEGAL ^ t ^ UJ 675 ^ 6[ 5o ' /DESCRIPTION AND o ac6z/LOCATION hANGELAKE/RIVER NAME LAKE/RIVER CLASS SECTION TWP NAMELAKE NUMBER TWP. NO. 57wa5lo- lui FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER(S) 65- 0/6OoO IDENTIFICATION: Please Print All Information Last Name Mailing Address — No. Street, City and Stale_________^ 5 j). . 6>. Zip Code Telephone No.First Initial 5a/A;.Y^2^!Property Owner 066/)'^)Jpjjj.6X '2L Sewage SystemInstaller ^cr4VMAe.Name / y C ’6- G IZi p:MThis System will be ready for inspection on , 19.at NUMBER OF BEDROOMS: A iThis space for office use only (A.M.( > v'19 7 \(><^)N0r-/y P.M..GARBAGE DISPOSAL: ( ) YESDate 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 (^^ Drain field ( ) Standard ( ) Bed (^ Trench ( ) Modified ( ) Mound ( ) Outhouse TANK DRAIN FIELD SqFl./606>Capacity GIs. 3/)6n//65)Distance from nearest well Ft.Ft. 56 56Distance from lake or stream Ft.Ft. /0/6:n/ADistance from building Ft.Ft. /ODistance from properly line . Ft.Ft. s5Distance from bottom to Water Table Ft.Ft. EFFLUENT DISTRIBUTION Gravity { ) Pressure All distances are shortest distance between nearest points '•'V PERCOLATION TEST DATA: WATER WELL DEPTH oAl2r/^ Perc Testqr.Date of Perc Test /IIRate 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. y'£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. 5/6)/ 93Issued Date: Land & Resource Management Office ‘ \Fee $,Rec #, J Comments: ] 272,658 • Victor Lurtdeen Co.. Printers. Fergus Fells. MinnesotaFanil No. BK-0894.003 ■ , ■w INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS f ■’ w 9 SEPTIC TANK DRAIN FIELD CATEGORY Actual Minimum MinimumActual SF/5 CSO GLS.Capacity SFGLS. I'OO PT / lO FTDistance from Nearest Well FT FT50 Distance from Buried Water Suction Pipe FTFTFT FT 5050 Distance from Buried Pipe Distributing Water Under Pressure FTFTFTFT1010 / (irO FT FTDistance from Lake or River (OHWL)FT So FT3^ ft 10/20 FTDistance from Nearest Building 10 FT ft FT FTFT10Distance from Nearest Property Line 10 FT FTDistance from Bottom to Water Table FT YES NOHolding Tank/Lift Alarm DRAINFIELD CALCULATIONSewer Line to Well SeparationINTERPRETATION OF ABBREVIATIONS GLS. = Gallons SF = Square Feet FT = Linear Feet 3MinimumActualILGFTX 50 5 3?? SFFTFT20 Inspector’s Comments: SKETCH: ' 0I S3 Inspector's Signature Date of Inspection Time of inspectionLcc \ 0 PERCOLATION TEST DATA LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, MN 56537I - >OWNER: TELEPHONE NUMBERMIDDLEFIRSTLAST NAME ADDRESS: ZIP CODESTATECITYSTR./RT. RANGE TWP. NAMESEC. TWP.LAKE/RIVER NO.LAKE NAME LEGAL DESCRIPTION: PARCEL NUMBER NUMBER/BEDROOMSFIRE NUMBER — TWO TESTS ARE REQUIRED — TEST HOLE NO. 2TEST HOLE NO. 1 G>2./:Lk Diameter of^ Hole inchesinches Depth To Bottom of Hole inches;inches; Diameter of HoleDepth To Bottom of Hole 9^5 '5^19DateSoil TextureDepth, Inches Date 19Soil TextureDepth. Inches ^okesPercolation Test By, _ Firm Name ___ f?otpS Boh's Percolation Test By. Firm NameBoLs Plui-Yih\Yic/ I8oy fCjO J'/einoinQ hh - I i P-py /9-g kevinimi Am.Address Address-n j) Otter Tail County License No. Otter Tail County License No.IZZ //? PERC TEST # 2PERC TEST # 1 WTEavALfMiwi/rBa PgtCRATB TIMB WAJTO DEPTH WATER DROP PfraRVALflyONUrgS)WATER DEPTHTIME WATER DROP PERC RATESTARTSTART/J ------------4- TBCSBT * DROP PERC 'i'lKiE * ^BACA reRC RATHPERC RATE TIMETIME IKTERVALfMTNtJTES)Water DEPTH WATER DROP INTERVAL <MIWmEm WATER DEPTH WATER DROP/6’-?oIQ3PREFILL RBRILL3/;q:I m....5:...S'. ,a/or>/.1 / TIME ” DROP PBRC'iiMit PERC RATEINTERVAL fMINUTEn WATER DEPTH WATER DROP TIME INTERVAL IMINIHESI WATER DEPTHTIME WATER PROP PERC RATEmREFILL RBPILLI.11.3 .-Sj>a . A /1 -...ii./....LI. TIME t>ROP PEfft"TIME DROP PERC PERC RATEINTERVAL (MPfUTBS)WATER DEPTH WATER DROP TIME INTERVAL (MlNinES)TIMB 1^? WATER DEPTH WATER PROP PERC RATE /W? RBPILL RBPILLi * - .5- 'llMM DROP PBRC / * -X . .5T....J.....I .....13. ■ 1.TIME bkOP PBRC INTERVAL (MINUTBP WATER DEPTH WATER DROP PERC RATE TIME INTERVAL 0»IINirrBS)■ TIME WATER DEPTH WATER DROP PERC RATE/0:SS I0:3tf RBP.ILL RBP.ILL:?. -S'3:/A.I I.T../OiMf. T T 'iKMU DROP PERC Time DROP PERC PERC RATEINTERVAL <MINl/TBS> WATER DEPTH WATER PROP TIME INTERVAL (MINUTES)TIME WATER DEPTH WATER DROP PERC RATS /0-3S /o^RBPILLRBPILLi\....i Li:..1.1 * TtMlt DROP • PERC 'flKiK DROP PERC INTERVAL IMPfUTBSI PERC RATE . >TIME WATER DEPTH WATER DROP TIME INTERVAL IWINUTBSI WATER DEPTH WATER DROP PERC RATE REFILL REFILLI 1 /I - f-I ...J.%.~PtJt/o3%.L TTMU DROP PERC ‘flMMA. PERC RATE TIMETIMEINTERVAL fMTNUTBS>WATER DEPTH WATER DROP INTERVAL IMINUTBSI WATER DEPTH WATER PROP PERC RATEREF^L REFILL /XJl.I ...3D......1 ^ DROP PERCTIME TIME DROP PERC COMMENTS/CALCULA TIONS: \ i\ MKL — 0390 - 005 250,815 — Victor Lundeen Co., Printers, Fergus Falls, Minnesota ♦GRID PLOT PLAN SKETCHING FORM — (Must Be To Scale)y 1 feet/ inchesScale: Each grid equals >■ / S- f - __ ^C-Dated:19 Signature Please sketch your lot indicating setbacks from road rigjii^l-way, lake and sideyard for each building currently on lot and any proposed structures. // 1: - f ( r ■r cO i ■-■'■'05 ;%! — <S=s «Ci. -Ov. i I KI ttS «r. CERTIFICATE OF APPROVAL SEWAGE SYSTEM jml m15thDecember95This certificate has been issued this to certify that the sewage system installed as per sewage permit number indicated below has been approved for use by Otter Tail County, Minnesota. day of 19 mim I The premises covered by this certificate are legally described as:■ni. Lake No. 56—141 Sec. S3 Twp. LAKETwp. 135 Range 39I nP* 23 135 39 6. 77 N 680' OF LOT 2 EX W 575' ?< N 20' OF Sl/2 SWl/4 N 20' OF S 40 RDS OF LOT 2 m• j iSik]CARLSON. JEFFREY J SUSAN LOwner: Name Ml 5386 DRFUi AVE S. MINNEAPOLIS. MNAddress *11 55410Zip No. Permit No. SP 1 0534 Signed by: Land & Resource Management OfTtcial Otter Tail County, MinnesotaMKL-098700! ft. lil JT 279005 VirtorLundeen Co.. Priirtcra, Fergus Falls. Mhmesota '§ . 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 ' LAKE/RIVER SECTION DESCRIPTION AND LOCATION LAKE/RIVER NAME RANGE TWP NAMELAKE NUMBER TWP. NO. 64 37/35 }o-, PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER S3-CCO-^3- O/SJ^OOO IDENTIFICATION: Please Print All Information Mailing Address — No. Street, City and State________^ 633^ (UlI. (3 Zip CodeLast Name First_____ 4 3C7ir3j73j.3. Initiai Telephone No. ry^JAp^yrTiProperty Owner ¥■ Sewage System Installer Name 1 A.M. ^ This System will be ready for inspection on P.M., 19.at This space for office use only NUMBER OF BEDROOMS: A.M. P.M19 (Xi NOGARBAGE DISPOSAL: ( ) YESDate 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 Drain field ( ) Standard ( ) Bed j>^) Trench ( ) Modified ( ) Mound ( ) Outhouse TANK DRAIN FIELD Sq RCapacityGIs. Sdl/OO760Distance from nearest well Ft.Ft. 6z2Distance from lake or stream Ft.Ft. /o/oo/6Distance from building Ft. Ft. /6Distance from property line Ft. Ft. Distance from bottom to Water Table Ft.Ft.oEFFLUENT DISTRIBUTION (X) Gravity ( ) Pressure All distances are shortest distance between nearest points PERCOLATION TEST DATA: WATER WELL DEPTH Perc Tester.Date of Perc Test * 5 • 6'5"Rate of 1st Test / VRate 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. A.S- 3 p ~ Z-3DATE: Signm)/re Permit; Permission is hereby granted to the above named applicant^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. Issued Date: Land & Resource Management Office Fee $.___ _____________________ Comments: 272.858 • Victor Lurtdecn Co,. Printers. Fergus Falls. MinnesotaFonii Mo. BK-0894«03 APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM WHITt— Office Yellow — Inspector Pink — Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218)739-2271 - FERGUS FALLS, MN 56537 Permit No.LEGAL /DESCRIPTION AND ^0 ^rLOCATION SECTION RANGE TWP NAMELAKE/RIVER NAME LAKE/RIVER TWP. NO.LAKE NUMBER I'9 KajA-77/97 FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER(S) 0/SJ--006 IDENTIFICATION: Please Print All Information Zip Code Telephone No.Mailing Address — No. Street, City and SlateLast Name First Initial !y■S3oIp CUU-( 'f iAt/Property Owner 9 55^___________fiy / //|/ byj Vi' A U 9^ 'UlcMJc/) t. {(/771a.iTr2 ( Y . jJj-AcJ '9 i /p JjJ/jjcJ /Sewage System Installer [■JlU.Name 0>This System will be ready for inspection on . 19-at This space for office use only NUMBER OF BEDROOMS:(a5>/’.'C <2U*LP.M19 ) 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 ()<(^ Drain field ( ) Standard ( ) Bed ^) Trench ( ) Modified ( ) Mound ( ) Outhouse DRAIN FIELDTANK SqFtCapacityGIs. soZ/no60Distance from nearest well Ft.Ft. 7^30Distance from lake or stream Ft. Ft. 10/00/oDistance from building Ft.Ft. /d /O RDistance from property line Ft. Ft.Distance from bottom to Water Table Ft. EFFLUENT DISTRIBUTION (X) Gravity ( ) Pressure All distances are shortest distance between nearest points PERCOLATION TEST DATA: WATER WELL DEPTH vO Szt ^ f^jy -do'^5zr Perc Tester.Date of Perc Test •5 •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 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. DATE: r‘ *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. Issued Date: 357a Land & Resource Management Office Fee $.Rec A y,Comments: 272.8S6 - Victor LuPHJeeri Co.. Printers. Fergus Fails. MinnesotaForm No. BK-0894003 INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS t ! •s > SEPTIC TANK DRAIN FIELD CATEGORY Actual Minimum Actual Minimum js<yv ^ FT < 7<f SFCapacityGLS. GLS.SF /OO FT FTDistance from Nearest Well FT50 Distance from Buried Water Suction Pipe FTFTFTFT 5050 Distance from Buried Pipe Distributing Water Under Pressure FT FTFT10FT10 ft FT FTDistance from Lake or River (OHWL)FT FT 10/20 FTFT FTDistance from Nearest Building 10 c^O ftSl'Ya ft io FTDistance from Nearest Property Line FT10 3.8^ 3 FTFT FTDistance from Bottom to Water Table YES NOHolding Tank/Lift Alarm DRAINFIELD CALCULATIONSewer Line to Well SeparationINTERPRETATION OF ABBREVIATIONS GLS. = Gallons SF = Square Feet FT = Linear Feet llA 3ActualMinimumFTX FT FT20 SF K Cl /jciInspector’s Comments: SKETCH: 0 I Inspector's Signature G -aDate of Inspection /W:(jo Time of Inspection • i' GRID PLOT PLAN SKETCHING FORM — (Must Be To Scale) Scale: Each grid equals feet/inches .a<^2JL£-Dated:19 Signature Please sketch your lot indicating setbacks from road right-of-way, lake and sideyard for each building currently oli lot and any proposed structures. I . : V V-" 4i 4c z;.ra 4 r j J \ n■< JCQ,4 ,X' VJN I \ ■c:5 i I V 3 PERCOLATION TEST DATA LAND AND RESOURCE MANAGEMENT^ Otter Tail County Fergus Falls, MN 56537 'k OWNER: MIDDLE TELEPHONE NUMBERFIRSTLAST NAME ADDRESS: STATE ZIP CODECITYSTR./RT SEC.RANGE TWP. NAMELAKE/RIVER NO.LAKE NAME TWP. LEGAL DESCRIPTION: ; PARCEL NUMBER FIRE NUMBER NUMBER/BEDROOMS — TWO TESTS ARE REQUIRED — TEST HOLE NO. 1 TEST HOLE NO. 2 AbL ADepth To Bottom of Hole inches; Diameter of Hole inches Depth To Bottom of Hole inches; Diameter of Hole inches - 3o IQ 9,<r .S^' ^ 0DateDepth, Inches Soil Texture 19DateDepth. Inches Soil Texture Ro kg<;Percolation Test By Firm Name Percolation Test By____ Firm Name ____ RoL fe/r^s- SohiS PlurnlpMn RK ) /S’cA.'s t Q1 /?£)/?/ / e<.ox 190 H ».-t u ^ hy>- £rS7 IAp hi’Oi /y>i. S~e>9s"ihAddressAddress Otter Tail County License No. Otter Tail County License No.ill ill PERC TEST # 1 PERC TEST # 2 INTERVAL fMPJUTBm water depth TIME WATBRDROP PERC RATH TIME * INTERVAL rMINUTBS)WATER PEPTW WATER DROP PERC RATEP^p^Llisd RitSpJiLcSa■ TART STA^TIDlS^2.I.. /O.'t®2•r re®" • DROP PERC TIME * DROP PERC INTERVAL IMINUTEa WATER DEPTH WATER DROP PERC RATE PERC RATE ; TIME TTME INTERVAL rMINUTBS)WATER DEPTH Water drop ioM REFILL RB^LL52 - , 3s M.)/.{.-11...T •fTSS" * DROP PERC 'nMh INTERVAL (M1NI/TSS1 WATER DEPTH WATER DROP PERC RATETIME TIME INTERVAL IMINUTES^Water depth WATER DROP PERC RATEio:a mo!/o'm REFILL REFILL /1 * -2 . , S' 'ilMij ^ DROP PERC 1loo'>I.... re®” DROP PERC INTERVAL IMlNUTBa Water depth WATER DROP PERC RATETIME TIME INTERVAL (MPOiTEST WATER DEPTH WATER DROP PERC RATE16.0^ I2i2?fomREFILL RB^LL .S'.....I.__ 'i'ImM *bhbf psss~TTMB DROP I^BRC INTERVAL IMINt/TBa WATER DEPTH WATER DROP PERC RATETIME TIME INTERVAL (MINlfTBa WATER DEPTH WATER DROP PERC RATE/D.vs /6:ou RBPILL aAA . ,SCl :::zz:a./ 4 re® DROP PERC nr-ov FERCRATB INTERVAL IMINUTEa WATER DEPTH WATER PROP INTERVAL fMTNl/TBSyTIMETIME WATER DEPTH WATER DROP PERC RATEiq:oo ZoXi/REFILL RBPILL . s'I'lKik regg i ::u Cl.....i. PERC RATETIMEINTERVAL fMINUTEa WATER DEPTH WATER PROP TIME INTERVAL fMPnnEa WATER DEPTH WATER PROP PERC RATEREFILLREFILL TTIME DROP PERC TIME I5R5P" PERC INTERVAL IMlNUTEa WATER DROP PERC RATETTMEWATER DEPTH TIME INTERVAL fMTNUTBg)WATER DEPTH WATER DROP PERC RATEREFILLREFILL T TIME ’ DROP fERC TIME • ’ DROP PERO S' ii cr ‘I e/COMMENTS/CALCULA TWNS: •-r t-\AA MKL — 0390 - 005 250,815 — Victor Lundeen Co., Printers, Fergus Falls, Minnesota AIR TEST CERTIFICATION ^ ^ Date),an air test of the sever line Installed under SevageOn Disposal System Permit Number / f) S for (7 was made.on ^ C (Lake/Rlver)At that tlmc» the severOvner>, pounds per square Inch for minutes.line held ^LjZ. ^ License Number DateInstaller's Signature M2991 i r Tfcl ^1^ I- f - .—-- :is____r _:3 •T"r'J, Ml] T .,V- .*i.. V.:V^.vR'V*4 V- *:!.•««/ ^ vV. ■ \.A-"' 7/ c AI=7 ? /:4<“r^0 __,__^ y cx.r“ 'SiCYVe rv\cC P.oS.lvCon/ov. /\ Ct R-e'^.cyrl' i7 •^vo- Sin-^iki- cd( I irv hf-t9 .. (V-r^- :oo X cr\'i>i. OH-uj/ - c/X ---- ..^\ aif 0/ ~Zb^ifV er • i- '^■Vi3 --’•’I us¥La^T.135N. - R.59W.m 02000 Cloud Cartographies. Inc. St. Cloud. MN S630! ____1.See Faqe 113 illo ^o • moThTt'”'400THSTa I !!! v%!a *'^5 395TH ST -(4 3 2 1 *L.i fe!>Cv< SI <#-a i >X I «a iIIo390TH ST 390TH ST ig reo;^!!^7aI !!•■t !!!m ST ^ "1.-- MISTY /49%a§ P ” I?I 375TH ST t ’**13 " RICHVILLE m o # 3O ! ?lu ROUND ROUNDLAKE LN m LAKETRL a?SSWANy 20!•./Sf o !! Is '<h360THSL__ig aW.:I 1!!a !\t '^^’Ssm'sT O 3aSOTHST Ik a a LONG LAKE RD m 40000 41000 4500044000 46000 a 340TH ST.. 350TH ST... 355TH ST... 359TH ST.. 360TH ST.. 365TH ST.. 375TH ST.. 384TH ST.. 385THST.. 390TH ST... 395TH ST.. 400TH AVE 400TH ST.. 405TH AVE 430TH AVE 437TH AVE .34 438TH AVE.................. 439TH AVE.................. 447TH AVE.................. 450TH AVE.................. 454TH AVE.................. 455TH AVE.................. 457TH AVE.................. 458TH AVE ................. 460TH AVE.................. ACCESS RD................ ALICE DR..................... ALICE LN.................... BLUE SPRUCE DR..... BOEDIGHEIMER DR N BREEZY LN................ CANARY DR................ .27 COUNTY RD 127............ CRIMSON DR.................. eSAH 14.......................... eSAH 49.......................... eSAH 54.......................... HEAD LAKE RD .............. HIDDEN RD..................... HIDDEN TRL..................... JEFF LAKE RD................ KLEINS DR....................... LONG LAKE DR............... LONG LAKE LN............... LONG LAKE RD .............. MARION DR N.................. MARION DR S................. MCGOWAN ESTATES RD.......23 MCGOWANDTRL .... MILLER BEACH RD . MISTY RD................. MISTY TRL............... PIONEER DR........... PLENTYWOOD RD... ROUND LAKE DR .... ROUND LAKE LN..... ROUND LAKE LOOP ROUND LAKE TRL.... RUSH LAKE LOOP... RUSH LAKE LN ....... RUSH LAKE TRL..... SANDY LN ............... SOUTHVIEW LN....... STATE HIGHWAY 78. .36 .23 .29/30 .27,29 .22 .35 .26/35m.35 ,12/30 .7 .27 .13 .4/17 .7 .19,22 .36 .35/36 .17/22 .36a.19 .36 .13/14 .13 .36 .27 .22 .10 ........1/12 .12/13, 36 .27 .22 a .7 .17/32 .22 ,1/3 .22 .7 .22 .4 .30 .34 .23/26 .7/18 .30 .34 .23a......1/2, 3/5.........19/31 .4/18, 27/34 .31/34.15/16 .26 ,10 .5/6 1 .26 .7 .6 a ..27 .36 .2/35 95a ^-20-HsDate Resolved CHRONOLOGY REGARDING THE SEWAGE SYSTEM ABATEMENT CArflsoti CMf-f ^Property Owner: mLake No. 56-Lake Name: S'boooxyois/ oo^Parcel No.: A^r^'etittjhy /q 'X yCftn To ^If ff^f^rhy / @ IH 30 - iN^fA-llAf/ON rtjis mir. caL-^ \ © Ltiicr Ho ^%er Ca-Uh% tv HI \ t/A/'^•‘// O^tUf^ e>u \ ^ A^ll oU rto^f A< ret/t>»tfj ^ froce^is J'fi.r ^/XCr Urh.r, fZZ-fL.,. 1(9-3-^/^', jo^ W^tkr Wvtl [iAbtai\ 'y^h^J Owner's Initial Response (date): 4-l,^ierjeN-}'r<2-.' CArUoN /US'^ '■^Xf ^ abatement.file.chronology7-94 September 8, 1994 j ■ Department of Land and Resource Management County of Otter Tail Court House Fergus Falls, MN 56537 Re: Abatement Notice Dear Mr. Eckert: I spoke with Marsha on Thursday September 8 regarding the difficulty we are having in getting timely stimates for the installation of a new sewer system at our Rush Lake property. I received your Abatement Notice on August 15 and have made every effort to have things completed by now but due to the very busy workload of the installers, and the fact that I live in Minneapolis and my brother in California we will not meet the 30 day deadline. Marsha suggested that I give you a more realistic date of when we will have the permit taken out by. Based on the schedules of the installers I have contacted such as Peter Paul Excavating, McGowan Clearing and Sodding, Rush Lake Lumber, and Alf Jorgenson, I believe the permit could be taken out by October 17. I appreciate your consideration with this matter. If you need to contact me please call (612) 926-8353. Also in closing I wanted to let you know that I am in receipt of your memo cancelling the previous violation since the requested actions were taken. Sincerely, Susan Carlson PS Form 3P Cn '’‘’1 '^^AV. " s I A, ^ I .. ?| I I s IIinfO5 ■a sff»® t- “■?5i.S —O S II % ■SiS-^ -H JT“ I f a. O -c </>■V> -C o03/ -i.It STICK POSTAGE STAMPS TO ARTICIE TO COVER flRST CtASS PUSVAGF. CERTIFIED MAIL FEE, AMO CHARGES FOR ANT SELECTED OPTIONAL SERVICES liM front). 1. If you want tills receipt postmarked, stick the gummed stub to the right of the return ,iddress leaving the receipt attached and present the article at a post office service window^ or hand it to your rural carrier too eitra charge!.(n>£ 2. If you do not want this receipt postmarked, stick the gummed stub to the right of llw riturft address of the article, dale, detach and retain the receipt, and mail the article. o><T) 3. If you want a return receipt, write the certified mail number and your name and address on a return receipt card, Form 3811, and attach it to the front of the article by means of the gummed ends if space perniits. Otherwise, affix to back of article. Endorse front of articie RETURN RECEIPT REQUESTED adiaceiit to the number. _3 oor00 4. If you want delivery restricted to the addressee, or to an authorized agent of the add««ssee, endorse RESTRICTED DELIVERY on the front of the article • 5. Enter fees tor the services requested in the appropriate spaces on the from of tnis ^^eipt. If return receipt is requested, check the applicable blocks in item 1 of Furm 3811. CO c oLL (Oa. 6. Save this receipt and present it if you make inquiry.^ U.S. GPO: 1991 —3C2-916 ^ SENDER; « •I also wish to receive the following services (for an extra fee): Complete items 1 and/or 2 for additional services. • Complete items 3, and 4a & b. ^ • Print your name and address on the reverse of this form so that we can O return this card to you. ^ • Attach this form to the front of the mailpiece, or on the back if space ^ does not permit. f • Write "Return Receipt Requested" on the mailpiece below the article number. ^ * The Return Receipt will show to whom the article was delivered and the date g delivered.____________________ -o 3. Article Addressed to: « > 1. □ Addressee's Address ^ 2. □ Restricted Delivery ‘5 oConsult postmaster for fee.oc4a. Article NumberSPlol ICARLSON, JEFFREY J CARLSON, SUSAN L 5336 DREW AVE S 2.!a 4b. Service Type□ Registered □ Insured . ^0ii:ertified □ COD □ Express Mail □ Return Receipt for 3Merchandise 0)E ocIoO)o % 1(A (AUJ MINNEAPOLIS, MN 55410!oco 7. Date of DeliveryO 3O >z p. Sigtoure (Addressee) - "" I 6*s^ddressee's Address (Only if requested ^ I ^ j'^l^qnature (Aoem) c(Q I I I > PS Form 3811, December 1991 «u.s. GPO: 1993-3S2-714 DOMESTIC RETURN RECEIPT ■s.UNITED STATES POSTAL SER\!7Je^^^W>^ PM Official Business fjx®! 8 694 V pf Prinf-^UfSafne, address and ZIP Code here land & RESOURCE MANAGEMENTCounty of Otter Tail Court HouseP6rgus Falls, Minnesota 56537 I ( \ \ n tin ABATEMENT NOTICE Land and Resource Management COUNTY OF OTTER TAIL Court House Fergus Falls, MN (218) 739-2271 56537 August 12, 1994 CARLSON, JEFFREY J CARLSON, SUSAN L 5336 DREW AVE S MINNEAPOLIS, MN 55410 You are hereby notified that the sewage system which you maintain on the following described property: Parcel #: Lake #: Lake Name: RUSH 53000230151000 56- 141 23 135 39 6.77 N 680' OF LOT 2 EX W 575' & N 20' OF Sl/2 SWl/4 & N 20' Lake Assoc/Fire #: Section; 23 Twp; 135 Range; 39 Twp. Name; RUSH LAKE is not constructed and/or located in accordance with minimum standards of the Shoreland Management Ordinance of Otter Tail County. • Please be advised that you must correct this situation within 30 days. You should contact this office in order to determine what corrections and permits are required prior to complying with this notification. Land & Resource Management Official --;>r