HomeMy WebLinkAboutChar-Mac Resort_12000990413000_Septic System Permits_CERTIFICATE OF APPROVAL
(si SEWAGE SYSTEM
m 9317THDE CcMBERThis certificate has been issued this day of 19m
to certify that the sewage system installed as per sewage permit number indicated below has been approved for use
5?;by Otter Tail County, Minnesota.
E The premises covered by this certificate are legally described as:
Twp. 1 37 Range 3 ?5A-147 31 Twp. Name C 0 R L13 SLake No.Sec.
PLEASURE BEACHPLEASURE BEACH
LOTS 4 3 5 EX TRIANGULAR TRACT ILOTS 2 ^ 3 " VAC ALLET ADJ
THE SE PT CF LOTS 455PARCEL NOT TC PE SPLIT
PARCEL NOT TO BE SPLIT
w.r-z
5 VTC K T JrHR^'STFNPgN, MARK C.i; J Owner: Name
m Address POX PI, PF.RHAW^ i/Nif-
m 5)^573Zip No.
Lijnd & Resource Mimagcmcnl Onicial
Permit No. SP .9 HO 6.
Signed by:
Oiler Tail Counly. MinnesotaMKL-0987001
JT-263191 Vidor Lundeen Co.. Primers, Fergus Falls. Minnesota
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 — Impector
Pink — Owner
^ \/o.ty rlU-^y 4-J he
-irr S£ p-^ o-f' Ie4-^‘*■5
Cpnt.i Ki4r be.
QS'dCPermit No,LEGAL
DESCRIPTION
yA.io- rANDjLo4-js Ji^fLOCATION
SECTION TWP RANGE TWP NAMELAKE/RIVER NAME LAKE/RIVER
CLASSLAKE NUMBER
Cer h SS3^/37&S>
FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER(S)) X~QOO^^^ O^il I -d)0 0
/-L-OQO ~OH)3 -OOP kP !SX
IDENTIFICATION: Please Print All Information
Telephone No.Mailing Address — No. Street, City and Stale Zip CodeLast Name First Initial
3m
l/, (L, U,,
Property
Owner S'^S?3
r ^Sewage
System
Installer
Name
A.M.
P.M.This System will be ready for inspection on.. 19.at
This space for office use only XNUMBER OF BEDROOMS:
A.M.
P.M19 (X) NOGARBAGE DISPOSAL: ( ) YESDate Rec'd Time Rec'd Phone Call Rec’d By
SEWAGE DISPOSAL SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM
( ) Holding tank
( ^ ) Septic tank
( ) Drain field
( ) Standard ( ) Bed ( \) Trench
( ) Modified
( ) Mound
TANK DRAIN FIELD
SqFt.7^0Capacity GIs.
S(D//oo50Distance from nearest well Ft. Ft.
50Distance from lake or stream 50Ft.Ft.
/£>/7 0y(DDistance from building Ft. Ft.
Distance from property line ^ /oFt. Ft.
EFFLUENT DISTRIBUTION
( -<) Gravity
( ) Pressure
Distance from bottom to Water Table Ft.Ft.
All distances are shortest distance between nearest points
WATER WELL DEPTH:
93Q> =2 O f. 0PERCOLATION TEST DATA: Date of First Test Rate. 19
5 i&X 7-0 1P 93 . 57Date of Second Test Rate
1st Test Taken ByT-t o! kocoskf First Test L 0 . 57 kS7 =+ 2nd Test 22nd Test Taken By 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 infection.
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.
r
Issued Date:
Land & Resource Management Office3^^//Z3XZ.Fee $.Rec if
^■4~oComments:
Form No. BK — 0292-003 260.771 — Victor Lundeen Co., Printers, Fergus Falls, Minnesota
1 /!'-
‘ «SHORELAND MANAGEMENT — COUNTY OF OTTER TAIL
COUNTY COURT HOUSE
Phone: (218) 739-2271 • FERGUS FALLS, MN 56537
APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM
WHITE — Office
Yelloiv — Inspector
Pink — Owner
P\£L<K$ W r e Ir^Permit No.LEGAL
) /v3{fral AJoi-h^ \/<X d. /((/■‘i-DESCRIPTION
^ St p+ o-f ^
be
AND
LOCATION Cl\cir-'M
SECTIONLAKE NUMBER LAKE/RIVER NAME LAKE/RIVER
CLASS
TWP RANGE TWP NAME
O r /( S S3S--o ‘/37^ I ^}£)I
FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER(S))X -000-9^^ 09H-ood
/Z'OQO - ~09l3 -OpO LP 15 X
IDENTIFICATION; Please Print All Information
Last Name First Mailing Address — No. Street. City and State Zip Code Telephone No.Initial
SJiyyi f
PdfX'hk. <b l/i C-
I 31553^/L~iProperty
Owner 5'4:t7j
PcJ fSewage
System
Installer
Name V r
3'>05^13//-► This System will be ready for inspection on , 19-at
This space for office use oniy -)NUMBER OF BEDROOMS:■^■<^sC3p -J-Z,//' 2-
GARBAGE DISPOSAL: ( ) YES (^) NODate Rec’d Time Rec’d Phone Call Rec'd By
SEWAGE DISPOSAL SYSTEM DATA; MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM
( ) Holding tank
( /< ) Septic tank
( ) Drain field
( ) Standard ( ) Bed ( ''O Trench
( ) Modified
( ) Mound
TANK DRAIN FIELD
^ Sq Ft.Capacity GIs.
5oJ/oqDistance from nearest well Ft. Ft.
i? C>Distance from lake or stream Ft.5’0 Ft.
/o/jlDyoDistance from building Ft. Ft.
Distance from property line /OFt. Ft.
EFFLUENT DISTRIBUTION
( K) Gravity
( ) Pressure
Distance from bottom to Water Table Ft.Ft."5
All distances are shortest distance between nearest points
WATER WELL DEPTH:
y
P 0PERCOLATION TEST DATA: Date of First Test
r -c:- ~f -«L
Rate. 19
^3 r 5^t ^ ODate of Second Test , 19 Rate
1st Test Taken By3-/ oi First Test , ^f, 0 7 /r S 7 =-F 2nd Test
2nd Test Taken By 2 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.
7 --^7:.-try'-'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.
-73•AIssued Date:
Land S Resource Management Office3S^ —/f 5-lXX.Fee $.Rec #.
3 r 3, F<0 T~ ^Comments:
: fi,? ' c:-4 k/uj ■3-a
Form No. BK ~ 0292-003 260.771 — Victor Lundeen Co.. Printers. Fergus Falls, Minnesota
* »INSPECTION RESULTS
Inspector must make all measurements
SEWAGE DISPOSAL SYSTEM STATISTICS
SEPTIC TANK DRAIN FIELDCATEGORYActualMinimumActualMinimum
/6-Ot)sFCapacityGLS.GLS.SF
tT'S" FTDistance from Nearest Well FT FT50 FT
Distance from Buried
Water Suction Pipe FT FT FT50 FT50
Distance from Buried Pipe
Distributing Water Under Pressure FT 10 FT FT FT10
/ (X^ FTjoCi ^ ftDistance from Lake or River (OHWL)FT FT
Distance from Nearest Building FT 10 FT FT 20 FT
FT 10Distance from Nearest Property Line FT10 FT FT
‘jfDistance from Bottom to Water Table FT FT FT 3 FT
Sewer Line to Well Separation DRAINFIELD CALCULATIONINTERPRETATION
OF ABBREVIATIONS
GLS. = Gallons
SF = Square Feet
FT = Linear Feet
Actual Minimum 3L3cFTX FT
FT FT20 SF
^ luiInspector’s Comments:
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SKETCH:
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Inspector's Signature
ll-i "13
Date of InspectionI} S 3 C/
Time of Inspection
rr ■
AIR TEST CERTIFICATIOM
,*
(Date), an air taat of the aewer line Inatalled under SewageOn
‘zM.forOlapoaal Syeten Permit Number
r (Lake/Rlver) waa made. At that time, the eewer
inch for /
Owner), on X.
£mlnutee.pounde per oquareline held
U Llcenae Number DateInataller'a Signature
042991
/^- ;io- 93
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19^000 9?o‘il3 ooo
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GRID PLOT PLAN SKETCHING FORM — (Must Be To Scale)
Scale: .Each grid equals feet/Inches
Dated:19 Signature
Please sketch your lot Indicating setbacks from road ^(^t-of-way, lak^and sideyard for each building currently
on lot and any proposed structures.
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PERCOLATION TEST DATA
LAND AND RESOURCE MANAGEMENT
Otter Tail County
Fergus Falls, MN 56537
OWNER:
<' FIRSTLAST NAME TELEPHONE NUMBERMIDDLE
ADDRESS;
inT / (SoA- ^/
LAKE NAME (/
\CtTY
ZIP CODE!STR./RT.
3^ yj "sSm'V'jp
LAKE/RIVER NO.SEC.TWP.RANGE TWP. NAME
LEGAL DESCRIPTION.
PARCEL NUMBER
4-^ /$~ ?
NUMBER/BEDROOMSFIRE NUMBER
— TWO TESTS ARE REQUIRED —
TEST HOLE NO. 1 TEST HOLE NO. 2
n-Depth To Bottom of Hole..inches; Diameter of Hole.inches Depth To Bottom of Hole inches: Diameter of Hole inches
DMe/^(^T ol ^ 19 ^ 3
t(Pa,A CZ-
19
^,h //faM S/-y,
fe /of T'
Depth. Inches Soil Texture Depth. Inches Soil Texture/o(p S'2>/(;Percolatioi
Test By_Z
Firm ^ Name/<A/
(^^lA1 aAddress Address ary?
Otter Tail County
License No.
PERC TEST # I PERC TEST # 2
rwravfcLrMPitrrBy)WATBRDBPTH WATMtPKOr PgtCKATB Tliitttm’DnMrflU.fl»gNlfTTO WATBltDItOP PERC RATE/ J-7..G6
m?B“ * DROP PERC
/<.r %S^KT I^RT / 4. . '■ 5°
DROP' PERCIKTBKVSU.<MIIiUrB«WATBRIMtOPTIME rotCKATH TIIkB INTERVAL rVIWUTBg^wytEwynt WATER DROP PERC RATH
:^:i:INFILL R^ILL
DROP PBRC
■Lb-^ ^0^iAi -.8.■f
DROP PBRC
WATER PROPINTERVAL flrfPttJTHS^ PERC RATETIME TIME INTERVAL rMTMtmm WATER DEPTH WATBRDROP
PERC RATHLiPHRC
/ 4
'H!MB PiCop PBRC^
R^ILL REFILL
(A9^-
omtNALtuttamsiTIME 7T.DROP iHRCRATH7T TIME IKTBR>aa.<MIWtJTR«l WWHRDBPTH WAT^^ROP
PERC RATH
--
/^>REFILL /
TTOH~^PgSF PERe~
ILL
'j'4I -AwjavMtatLorPHICRATBINTERVAL OiCiNUTBP WATHR DEPTH TIME INTERVAL IMPftnroTIME
WATER DEPTH WATER DROP PBRC RATE
:g3;-“
%•••■
'nMfc ^ DROP PERC
/L L?g.R^ILL RB^L
f XzQ,
INTERVAL fMOWTEn WATER DROP PERC RATEWATER TIME INTERVAL IMINLfTRRITIME water DEPTH WATER DROP PERC RATEZfR^ILL /.II'lMM *BHOP ~PEftC~
KBFILL I^n/iU ^ d/oP PERC /■
3^
nnatVALiMMirrm mtCRATBTIMEWAnni Mtop TIMEDEPTH MTEEVALfMPnnm WATER DEPTH PATHlttDROP PERC RATE3^/o 7T?Ik,
'HmU * DROP feRC
R^ILL R^ILL
■I'lMIi “
%-9-i -H-perO
INTERVAL IMIMUTESI TIMETIMEWATER PROP PBRC RATEDEPTH INTERVAL IMINITTHRI WATER DEPTH WATER PROP PERC RATE0^I h‘A !.K •‘S'/( .‘Jo^
DROP PfiJiCz...r::.REFILL U4W-TIME ^TIME DROP PERCTr
COMMENTS/CALCULA TIONS:
MKL — 0390 - 005 250,815 Victor Lundeen Co.. Printers, Fergus Falls. Minnesota
/
SHORELAND MANAGEMENT — COUNTY OF OTTER
COUN
Phone 218-739-2271 • Ferg
APPLICATION FOR PERMIT TO INSTALL SEWAGE-DISBQSAL SYSTEM
>URT HOUSEWhitB — Office
Yellow — Inspector
Pink — Owner MN 56537
{2?((p(n^
Permit No.LEGAL
DESCRIPTION
V^13 Ihj-j. Q\i.oDo‘\<\ om\ax>(g;0 -^1 l?r ?g't
AND
LOCATION
^..ec.Lake No.Lake Name Lake Classif.TWP TWP NameRange
IDENTIFICATION: Please Print All Information.
Last Name Mailing Address — Np-. §t/eet, City
7.TZI ~
First Initial and State Zip No.Tel. No.
f-lx^a n h '
OWNER
ftiA)-/
\SEWAGE
SYSTEM
INSTALLER
Name.
This System will be ready for inspection on., 19.
This space for office use only
.19 .M
Date Rec’d Owner or Agent SignatureTime Rec'd Phone Call Rec'd By
NUMBER OF BEDROOMS;ESTIMATED COST;
SEWAGE DISPOSAL SYSTEM DATA:f-SEEPAGE PIT /SEPTIC TANK DRAIN FIELD
sOt.750 Z50 Sq.Capacity GIs.Ft.
^ Ft So/i'^V\Ft.Ft.. Distance from nearest well
So\sostre§^ ^' Distance from lake or Ft.Ft.Ft.
m
\'20Distance from occupied building Ft.Ft. Ft.
LoDistance from property line Ft. Ft. Ft.
3I'KT Ft.Ft.Ft.Distance from bottom to Water Table
An distances- are shortest distance between nearest points
RECORD OF TESTS:V.I-
Inspection was made on . , Time ...JM By
2',.3PERCOLATION TEST DATA:Date of First Test 19 Rate
/ ^Date of Second Test Rate19
1st Test Tal^n^By
First Test + 2nd Test 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 inspectejd and accepted. It shall be the
responsibility of the applicant for the permit to notify the County Shoreland Management tlfaTTbe job is ready for inspectfon../,/?
y/lO^/gS IDated
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.orK IS not commenceo wi
Issued Date:O Shoreland Management Office'20,00Fee $Rec #
^ (s' slo^^y V Of f fO < 4^DLo n /Comments:
-■JZ
CFRT [RSI] ££>
Form No. MKL-032085 225239 — Victor Lundeen Co.. Printers, Fergus Fals, KM
INSPECTION RESULTS
Inspector must make all measurements
SEWAGE DISPOSAL SYSTEM STATISTICS
DRAIN FIELDSEPTIC TANK SEEPAGE PITCATEGORYShould Be Should BeShould Be ActualActualActual
7SC>:z9oCapacityS F S F S F S FGIs.GIs.
uDistance from Nearest Well F FF FF F
uTILDistance from Lake or Stream F F F FF F
Distance from Occupied Building F F F F FF
n 412,Distance from Property Line F F F FF
73 3Distance from Bottom to Water Table F F F F F F
Inspector’s Comments:
' ^
T
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ik]4 lo )\tvel{
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a Uo
'■n'
IdET
/ oi T<p
Date of Inspection 19
Time of Inspection M
z Signature of InspectorINTERPRETATION
OF ABBREVIATIONS
GIs = Gallons
SF = Square Feet
F = Linear Feet
Job Title
MKL ' 032085 • Backer Agency
Page 1 of 1OTC Parcel GISMO Output- NOT a Legal Document
http://www.ottertailcounty.net/servlet/com.esri.esrimap.Esrimap?ServiceName=pc&Clien... 02/28/2011
l.v®„Ci •■^4
MEiS-'^ilhJ Fmm
CERTIFICATE OF COMPLIANCE
SEWAGE SYSTEM
kV
W/3Ut JanuoAij j9_B^day of_This certificate has been issued this
'!
W/to certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota.
The premises covered by this eertificate are legally deseribed as:
mConLa>^56-142 Sec.137 Range Twp. Same.Twp.Lake No.
wm
lot 2 oi Vlzcu,vJiz Bzach
MMae VobbiOwner: Name [!
pm6421 5th Avz. South, flinnzapotAJ>, MWAddress.
55423Zip No.—-o
6663 7Permit No. SP.
Signed by:_^
Malcolm K. Lee, Shoreland Administrator Otter Tail County, Minnesota
MKL-087 1-009
If.
159035
kill. WH
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
I
Whits — Office
Yellow — Inspector
Pink — Owner
Lot "2-Permit No.
LEGAL
DESCRIPTION
AND
2L J21 J:"
Sec. TWP Range
r.LOCATION
TWP NameLake Classif.Lake NameLake No.
IDENTIFICATION: Please Print All Information.
Mailing Address - Np»^tfeet, City and State
fA r»i-(cLp6!MA) $ V
Zip No.Tel. No.InitialFirstLast Name I/. S'.In g?bbOWNER
SEWAGE
SYSTEM
INSTALLER
Name.
Tfiis System will be ready for inspection on., 19.
This space for office use only
.19 M
Owner or Agent SignatureDate Rec'd Phone Cali Rec'd ByTime Rec'd
NUMBER OF BEDROOMS:ESTIMATED COST;
SEWAGE DISPOSAL SYSTEM DATA:
SEEPAGE PITSEPTIC TANK DRAIN FIELD
750 Sq. Ft.GIs.r Ft.Capacity
So/i'^fio Ft.Ft.Ft.Distance from nearest well
vS o50Ft.Ft. Ft.Distance from lake or stream
m '20Ft. Ft.Ft.Distance from occupied building
LOFt.Distance from property line Ft.Ft.
3iiaFt.Ft. Ft.Distance from bottom to Water Table
AH distances are shortest distance between nearest points
RECORD OF TESTS:
Inspection was made on , Time ,JVI By
..■2r,....S.PERCOLATION TEST DATA;Date of First Test . 19 S Rate
I I ^Date of Second Test 19 ., Rate
1st Test Takft S-O-S-^1..L.SFirst Test
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 t ’tlw job is ready for inspec^n.
^/l <^/£S
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 irat commenced within six (6) months.>rx IS TOt cominencea wi
'AIssued Date:
ShoreienO fJienegement Office'20,130Fee $Rec #
^ ill"Comments:
Form No. MKL-032085 225239 ~ VictDr Lundaen Co., Printers. Fergus Fals, MN
f '-W 'tC,' '
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[
i
;
Loi "Z. fje<?5u\^f 43^^fci Permit No.,VLEGAL
DESCRIPTION
AND
( o yL:-fiU rJi (^\j \3i ClLOCATION
Range TWP NameTWPLake Classif.Sec,Lake NameLake No.
IDENTIFICATION; Please Print All Information.
Tel. No.Mailing Address - No. Street, City and State Zip No.First InitialLast Name
i)'' yp h s . 3-OWNER
, m-ec-rpd' b
7^^fi cffia 1^ h ’ SSEWAGE
SYSTEM
INSTALLER
Name
i
This System wifi be ready for inspection .. 19.on.
This space for office use only
19 .M
Owner or Agent SignatureDate Rec'd Phone Call Rec'd ByTime Rec'd
NUMBER OF BEDROOMS:ESTIMATED COST:
SEWAGE DISPOSAL SYSTEM DATA:f-SEEPAGE PIT /SEPTIC TANK DRAIN FIELD
75c3 Z5C Sqsift.GIs.. Ft.Capacity
So/1'00SoFt.Ft.Ft.Distance from nearest well
\So5.0Distance from lake or stre&rR^Ft.Ft. Ft.I
;1-t-Ft.Ft. Ft.Distance from occupied buildingr.i LofDistance from property line Ft Ft.Ft.;
fl Qi Ft.Ft.Ft.Distance from bottom to Water Table
AH distances are shortest distance between nearest points
RECORD OF TESTS:
Inspection was made on , Time JM By
PERCOLATION TEST DATA;Date of First Test 19 , Rate
(SJ—Rsliji / <Date of Second Test 19 , Rate
1st Test Tal^n^By ??. 0 5^IS...First Test + 2nd Test 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. 'j\
I
'/ ADated
Signature
/A
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&s
Permit;
Issued Date:
Shoreland Management Office'20,00Fee $Rec #
rt5/’yyfa-ic’ r°j:.wrf (py^v-ovu n /rComments:
i
CFRT issued
Form No. MKL-032085 225239 — Victor Lundeen Co., Printers. Fergus Fate. MN
»■
««.
INSPECTION RESULTS
Inspector must make all measurements
SEWAGE DISPOSAL SYSTEM STATISTICS
SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORYActualShould Be Should BeActual Actual Should Be
Capacity Qls.GIs.S F S F S F S F
u 5" 2.Distance from Nearest Well F F F F F F
21TILDistance from Lake or Stream F F F F F F
2ZDistance from Occupied Building F F F F F F
■ fC12,Distance from Property Line FF F F
73Distance from Bottom to Water Table 3FF F F F F
Inspector’s Comments:
I \
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Mau I
\
'Jt '7<7 37’^/
l/p,
f-zT- 19^7
/ t>l 1£>
z:____
Date of Inspection I
Time of Inspection M
Signature of InspectorINTERPRETATION
OF ABBREVIATIONS
GIs Gallons
SF = Square Feet
F = Linear Feet
Job Title
MKL • 032085 • Backer Agency
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VICTOR LUNOCEH CO.. RRINTCR*. PEROU9 FACLS. MINN.PERCOLATION TEST DATAMKL -0871 -028
LAND AND RESOURCE MANAGEMENT
Otter Tail County
Fergus Falls, Minnesota 56537 Ph. No.
Mailing Address:Owner:
Zip No.StateCitySt. & No.First MiddleLast Name
Legal
Description:TWP NAMERANGETWP.SEC.NAMELAKE OR RIVER NO.
TEST HOLE NO. 2TEST HOLE NO. 1
Depth to Bottom of Hole inches; Diameter of Hole JnchesDepth To Bottom of Hole Diameter of Holeinches;inches
7/7/■7/31 ,.3£
I! f-4n ■TX'Z'^/73//
Depth, Inches Soil Texture Depth, \ nches Soil TextureDate Date
-((Xj/yjScin^^-/ccj,*T\
ciiiPercolation
Test By____
Percolatio
Test Bv .Ih.Q
UJFirm
Name.
QC FirmName,DaLU
OC
LUAddress.q:Address
<
CO
Otter Tail County License No..Otter Tail County License No..h-coLUMeasure
ment,
inches
Percolation
rate minutes
per inch
Drop in
water level, inches
Percolation
rate minutes
per inch
HTime
Intervals
minutes
Time
interval,
minutes
Measure
ment
inches
Drop in
water level. Inches
Remarks:Remarks:Time Timeo
I-/7
/ ;zz
f ^
l-MX 22,22^
ZUz JL 2 2 ^If122J-~77tzEHZjA 52^ilZ '? )22
/ 3^231. -T5
I! ll. 5
^: ST
Ei 2^2^22la2V 32^
r 2.1 32!^.£321UL
See Booklet, "How to Run a Percolation
Test" by Agriculture Ext. Service, Un, of MN.
Percolation rate minutes per inchminutes per inch Percolation rate =
110' ABATEMENT NOTICE
Shoreland Management
COUNTY OF OTTER TAIL
Court House
Fergus Falls, Minn. 56537
V
2nd .day of 19Dated this.
May Vo bb4>To.
6421 5th Aue SouthAddress_____
City and State UcnmapoLU, MSI Zip Code 55423
thz 6mape iy^te/nYou are hereby notified that.
Which you maintain at (Legal Description and Location) - Plus Fire No.
VlzaAnAz Bzaah:
Loti, 4,5,6,7 and 1,2,3
56-142 IJtt/p PJnp 11 137GfL liRangeLake No.Twp. NameLake Name Class.Twp.Sec.
conhtAacttd and!oh. tocatzdis not.
in accordance with minimum standards of the Otter Tail County, Minnesota Shoreland Management Ordinance.
You are hereby ordered to abate the above described condition within 30 days from this date. If you fail to
correct the above defect you may be subject to a fine, impri.sonment or injunction proceedings.
Shoreland Management Official
PROOF OF SERVICE
State of Minnesota
County of Otter Tail
Fergus Falls, Minnesota 56537
The above notice and order was served by me on._______________ 7 9____ by handing a copy thereof
fthe (owner-occupant-agent} of the above describedto
premises. *By posting a copy thereof upon the above described premises.
Otter Tail County Sheriff Department
*Strike out words that do not apply.
CC: Otter Tail County Attorney
MKL0372-036.01
320S33 VUi«r Cf Co..
9 SENDER; Complete items 1, 2,3 and 4.
Put your address in the "RETURN TO" space on the
reverse side. Failure to do this will prevent this card from
being returned to you. The returJiye^ipt fee will provide you the name of the person delivilrdBKcLand the date of
delivery. For additi>~nal fees the foliB'/\tn^
available. Consult postmaster for feet and%
for service(s) requested.
1. Show to whom, daq^^ addre^^
2. n Restricted Delivery. ^
P bOM lEM flTfi •n
3RECEIPT FOR CERTIFIED MAIL
NO INSURANCE COVERAGE PROVIDED
NOT FOR INTERNATIONAL MAIL vvices are’‘1^2■<(See Reverse)
!SSent to May VobbAK.u
g Street and^N^2 / Sth AvZ SoVith IcnCO 3. Article Addressed to:
P.O., State and ZIP Code ,MinmapotU .MM 5542 5 May Vobbi
6421 5th Avz South
MlnmapotU, MW 55423
6
Postage iq
3
Certified Fee♦
4. Type of Service:
□ Registered □ Insured
KbcCertified □ COO
□ Express Mail
Article NumberSpecial Delivery Fee
P604 124 S7SRestricted Delivery Fee
Return Receipt Showing
to whom and Date Delivered Always obtain signature of addressee SLaoeht and
■* DATE DELIVERED.evCOO)Return receipt showing to whom,
Date, and Address of Delivery ;5. Signature — A' d-ddressee
£;.STOTAL Postage and Fees $X«II.
6. Signature — AgentoPostmark or Date
, Os X
X 7. Date of DeliveryE7-2-S5 . .mo-f
u.X 8. Addressee's Address (ONLY if requested and fee poUIJinZQ.X
X
rV
j 111 field notesLink. P>n<St, t/VA
7T-i|lfB Idm DATE
UKS MO.fire no.
5/~/S7-SS‘ C<,r/,.SLEGAL DECRIPTION OF LOT;
Loi~ ^
'4-S,6,7 ^/,a,3 ^ TaicW,s30
OUNSRS NAME
OUNERS ADDRESS £l/i'<V-
TYPE OF SEWAGE SYSTEM (Inspector's Comments)
■frsJr
31 j' Ui^
fydrcii cl rod
^>t5/vi.<ArD
J
ji^'o -(uU(^3 Q>^J)}
c5>u^(Ty^ ^rU■5&rCC-iy\d:,
Ho $;le:
^ C<f-$ ^ycdi 5Aj6: f 2h>^r5/eA
SEPARATION DISTANCES - FEET -
a^frtJ^c TankCategory Soil Disposal Area
Well -
/y'yLake -^3^
Lot Line -
o/<(Occupied Rulldlng -0<
Elevation of Area 7 '/7/fREASON SYSTEM WAS ABATED;
-la^^ 5- o-f-
~h'o <dpx_. 7^
Cc>^^o(rr^ y\
'oJC
SKETCH OF LOT ON BACK
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Ww —-'i CERTIFICATE OF COMPLIANCEm%
m
SEWAGE SYSTEM Wm»1ifirf
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28th 19 76day of_DecemberThis certificate has been issued this
to certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota.
mmmf»imf 11ill
The premises covered by this certificate are legally described as:
Lake No. bh'-'jtfl
tel
Twp.Sec._JS!C Range ^-3^Twp. Name Perham
/3'7 3?3/1*tM Char Mac Resort
Lots 2,3,4,5j6 and 7 of Pleasure Beach 11E*-?
W.M
ill
ite§M
Wh
m-i
John BagleyOwner: Name.
pte
__________
.4driress R.R. I. Perham^ Minnesota
56573Zip No.
Permit No. SP_20807
Signed by:.a Malcolm K. Lee, Sliorcland Administrator
Otter Tail County, Minnesota
i
MKL-087 1-009
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