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Home My WebLink AboutChaffee_02000990360000_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 W to — Office V low — Inspector Pi... Card wner wner ?r- Permit No.,LEGAL. Date DESCRIPTION AND LOCATION Lake No. Lake Name Lake Classif.Sec.TWP TWP NameRange IDENTIFICATION: Please Print All Information. Mailling Address —No. Street, City and State Zip No.Tei. No.Last Name__________________^ First Initiai rOWNER7 SEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection on.., 19. This space for office use only .19 ,M Date Rac'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 /yO Sq. Ft.GIs.Sq. Ft.Capacity Ft.Ft.Ft.Distance from nearest well Ft.Ft.Distance from lake or stream Ft. Distance from occupied building Ft.Ft.Ft. Distance from propierty line Ft.Ft.Ft. Ft. Ft.Distance from bottom to Water Table Ft. Ail distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on PERCOLATION TEST DATA:Date of First Test Date of Second Test 1st Test Taken By First Test 2 Rate2nd Test Taken By The undersigned hereby makes appiication for permit to instaii or extend Sewage Disposai System herein specified, agreeing to do ail 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, sketchesand 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 untiUthas 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 readyf^mspection. (Call or use attached mailer notice.) Dated. /X 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 ? / 9 ?!^Issued Date: Shoreland Management Office __¥3i3/ __5^.Surcharge ____Fee $ /yoComments: z Form No. MKL-0771-003 Victot kU«et(l> » C« . PlINTfRI. FKaiU* SALLS m<mm 158906 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 te — Office V low — Inspector Ph.. - O' Card —>Dwner wner v| 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 StateFirstInitialLast Name OWNER SEWAGE SYSTEM INSTALLER Name. ,, 19j21TThis System will be ready for inspection on. This space for office use only //-/? Date Rec'd ia Owner or Agent SignatureTime Rac'd Phone Call Rac'd By NUMBER OF BEDROOMS;ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT 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 RECORD OF TESTS: Inspection was made on „ 19,, Time JW By PERCOLATION TEST DATA:Date of First Test .., 19..... .., 19.... , Rate Date of Second Test Rate 1st Test Taken By First Test + 2nd Test 5‘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 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. C Issued Date:\G^Shoreland Management Office Fee $Surcharge $ Comments:. Form No. MKL-0771-003 viCToa LuH0C(ii « C9-. vaiattaa. Fcasus rALL*. minn.158906 V, INSPECTION RESULTS V Inspector must make all measurements . ,;-c. V.. SEWAGE DISPOSAL SYSTEM STATISTICS SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORY Actual Should be Actual Should be Actual Should be Capacity GIs.GIs.S F S F S F S F Distance from Nearest Well F 75FF 50FF 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 4FFFFF F Inspector's Comments; Date of Inspection .19___ Time of Inspection,M Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF » Square Feet * Linear Feet Job TitleF AgencyMKL-0771-003-Backer 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 White — Office Yellow — Inspector Pink — Owner Card — Owner A Permit No.LEGAL Date DESCRIPTION AND y L.LOCATION TWP TWP NameLake Name Lake Classif.Sec.RangeLake No, IDENTIFICATION: Please Print All Information. MaiHing Address —No. Street, City and State Zip No.Tel. No.InitialLast Name First ^yr->s's?OWNER SEWAGE SYSTEM INSTALLER Name, This System will be ready for inspection on., 19. This space for office use only M.19 Date Rec'd Phone Call Rec'd By Owner or Agent SignatureTime Rec'd SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD ^ Sq. Ft./pA <3 GIs.Sq. Ft.Capacity 5"^Ft.Ft.Ft.Distance from nearest well Ft. Ft.Ft.Distance from lake or stream Ft.Ft.Ft.Distance from occupied building /o/ ^Distance from property line Ft.Ft.Ft. Ft.Ft. Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on 19,, Time M By ,, ..... , 19..?.I.... PERCOLATION TEST DATA;Date of First Test Rate /'IDate of Second Test , Rate 1st Test Taken By 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. (Call or use attached mailer notice.) Dated /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 vojtLif 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 r. LiIssued Date:7"Shoreland Management Office S'’//yFee $Surcharge $__i. Comments:. Form No. MKL-0771-003 viCToa LuttecEH a c».. PBinn**. rtotua fau.*.... 1S8906 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 Card Owner C/wner # Permit No.,LEGAL Date DESCRIPTION AND LOCATION Lake No. Lake Name Lake Classif.Sec.TWP Range TWP Name IDENTIFICATION: Please Print All Information. Mailling Address —No, Street, City and State Zip No.Tel. No.First InitialLast Name OWNER SEWAGE SYSTEM INSTALLER Name, This System will be ready for inspection , 19.on. This space for office use only 19 .M Date Rec'd Phone Cali Rec'd ByTime Rec'd Owner or Agent Signature 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.Distance from occupied building Distance from property line Ft. Ft.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 PERCOLATION TEST DATA;Date of First Test ,, 19 , Rate....(. Date of Second Test 19 Rate 1st Test Taken By 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. (Call or use attached mailer notice.) .N't? Dated \Signature Permit: Permission is hereby granted to the above named applicant to perform the work described in thi^^ie statement. This permit is granted upon express condition that the person to whom it is granted, and his agents, employees and workmen shall conform irv^MSpects 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:xO Shoreland Management Office Fee $Surcharge $ Comments:. ----6--^. T 6/. Form No. MKL-0771-003 158906 VtCTO* kUNDCCN t CO.. OOiMTIOO. rCOfUO roLLO. 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 75 50F F F F F Distance from Lake or Stream F F F F F Distance from Occupied Building 201020FFFFF F Distance from Property Line 10 10 10F F F F F F Distance from Bottom to Water Table 4 4FF F F F F y y/K-UiInspector's Comments: / /Ir- VJ! ~ rd / b' 7f lT>^ 23Date of Inspection 19 7f 31)Time of Inspection. V ■S'Signature of Inspec^ror^IINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF “ Square Feet F “ Linear Feet Job Title Agency M KL-0771 -00 3- Backer 's SOIL ABSORPTION SYSTEM VJORKSHEET 7 Oximer Name; Average Percolation Rate Number Bedrooms 7.Critical Slope ft.Bedroom Absorption Area;sq. X Number of Bedrooms a: 0Sq. feet required Septic Tank Requirements in Gallon Capacity 750 Gals.2 Bedrooms or less 900 Gals.3 Bedrooms 1,000 Gals.4 Bedrooms For each additional bedroom add 250 Gals. Percolation Rate Per BedroomPercolation Rate Per Bedroom 19817170 20285182 206191003 210115 204 214215125 218135 226 222237140 226815024 25 2301609 2341652610 2382711170 2421217528 2461802913 a25014185 30 a3001545190b3306016194 a Unsuitable for seepage pits b Unsuitable for absorption system PERCOLATION TEST DATA Price $ 1.00 per pad. SHORELAND MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Ph. No, Owner:Mailing Address: ROBERTMADSEN,Rlchville MnRte 1 Last Name First Middle St. & No.City State Zip No.Legal Description:,56 242 Ottertail 40WI39W Amor12 SEC. TWP.RANGE TWP NAMELAKE OR RIVER NO.NAME TEST HOLE NO. 2TEST HOLE NO. 1 Depth To Bottom of Hole 36 6 36.ADepth to Bottom of Hole inches; Diameter of Hole Jnchesinches;Diameter of Hole inches April 14 S* J. Eifert April 14Depth, Inches Soil Texture 19 73.Soil TextureDepth, InchesDate.Date 1-36 Med Sand1-16 Med Band Percolation Test By____ Percolation Test By .S, J, Eifert orLUFirm Name.(T FirmName.DoLU cr Perham, Mn -----------—n- Perham, MnUJ Address.OC Address < C/5Otter Tail County License No..Otter Tail County License No..I-COLUMeasurement, Inches Depth In Water Level, Inches H Measurement, Inches Depth in Water Level. Inches Time Remarks Time Remarks o V5- V;?§/T,;/ I- / O/P0Ot> /O 4 V // y///n y c> /<? 5o .RL Vs au Vu -3 f % ^ < V;g' /I I S'n yo //L ~7L:>h ^ Or', 3o V ) L LIS- ‘/t 'V f ^V 33L-^Q c'y' 5^y; 5=^--- AV; 6^ PERCOLATION RATE » (1.6) or 2 Mn/lneh~MKL-0871-028159179 01 «iCfO* LuHOCrM 4 CO P»IHT(«| FCWOuS F4I.L.(. See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn.