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Home My WebLink AboutClitherall Lake Campground_10000110071002_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 White — Office Yellow — Inspector Pink — Owner 15(1^Permit No., LEGAL (DESCRIPTION UAND 3^ U-c> OLOCATION TWP NameLake Classif.Sec.TWP RangeLake No.Lake Name IDENTIFICATION: Please Print All Information. First___________mitial Moling Address — N^Street, City and State _________* _Last. Name Zip No.Tel. No.5^4i2y^Sc>nOWNER SEWAGE SYSTEM INSTALLER Name, r/j/s System will be ready for inspection on., 19. This space for office use only 19 ,M Date Rac'd Owner or Agent SignatureTime Rec'd Phone Call Rec'd By 51NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD sP/ik:) 7r n^o Gis.Sd Ft.Sq. Ft.Capacity 50 Ft.Ft.Ft.Distance from nearest well 75 Ft.Ft.Ft.Distance from lake or stream /O Ft.Ft. Ft.Distance from occupied building V!0 !0Distance from property line Ft.Ft.Ft.7?“ 3Ft.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 ,JVI By 7PERCOLATION TEST DATA:Date of First Test , 19 Rate ¥S7,,Date of Second Test , 19...Rate S'First Test + 2nd Test 2 Rate2nd TestvTaken 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. Dated 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: ina Management Office2,0Fee $Rec # Comments: Form No. MKL-032085 225239 — Victor Lundeen Co.. Printers, Fergus Falls. MN -»'^> »Vr; /er: 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 Permit No.,LEGAL DESCRIPTION Pc^UsL CG.T^(\\(J\Jyy\0 n\h^^-xcJiX [-D ^ l( 1 lQ-^00~. H-OOll-OO'^AND t 0 ,ILOCATION TWP NameLake Classif.Sec.TWP RangeLake No. Lake Name IDENTIFICATION: Please Print All Information. Mailing Address — No. Street, City and State Zip No,Tel. No.InitialFirstLast Name I i t LC(, ^ I f J.. \u (( ; v'.-i V ctiOWNER (I; r3i>0+"SEWAGE SYSTEM INSTALLER V )Name 57S'- 'tr-0 wThis System will be ready for inspection on.. 19 This space for office use only 99 7/3o 1- (o »19 .M Date Rec'd Owner or Agent SignatureTime Rec'd Phone Call Rec'd By >3,NUMBER OF BEDROOMS;ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAI FIELD aH9D'JGIs.Sd. Ft.Sq. Ft.Capacity XFt.Ft.Ft.Distance from nearest well 7r7iFt.Ft.Distance from lake or stream Ft. io Ft.Ft.Distance from occupied building Ft. \»!0 fODistance from property line Ft.Ft.Ft. 3Ft.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 JVI By g.,z.5.zl.3PERCOLATION TEST DATA:Date of First Test . 19 , 19... Rate 7 2^ Test' Taken By s2...Date of Second Test Rate ‘i..First Test + 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. 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 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. Permit: 5 -3Issued Date: c£—aoFee $.Rec # Comments: Form No. MKL-032085 225239 — Victor Lundeen Co.. Printers. Fergus Falls, MN INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS / o y SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORYActualShould Be Actual Should Be Should BeActual / 3CXSCapacityLon GIs. GIs.SF S F S F S F IMiDistance from Nearest Well F F F F F I7^2oo 7rDistance from Lake or Stream "ZoaFFFF F F /^O rCO ZoDistance from Occupied Building F F F F F F -fDistance from Property Line F F F F F F 4-/r3Distance from Bottom to Water Table 3F F F F F F rv^ 0»^ piyvv (S *C VaSqlo__Inspector’s Comments: I M■4” 4- ^ Vj ^ \\ V\ Q \J\ ---3 Q ^ S>. w ^ y I / ^^I K.\l(7 / 4-75 <^1 O ■f// 'i 17' yps ■ Date of Inspection 19 Is-- I Time of Inspection M Signature ol InspectorINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF = Square Feet F = Linear Feet Job Title MKL • 03208S • Backer Agency '•'I r; 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 Yeiiow — inspector Pink — Owner i f ^ //• 7/7^Permit No., LEGAL DESCRIPTION AND IL^ 432z rJM errsif * - - - TWP Name LOCATION Lake Classif.Sec.TWP RangeLake NameLake No. IDENTIFICATION: Please Print All Information. Mailing Address — No. Street, City and State Zip No.Tel. No.InitialLast Name____________________ First y P^.i!€f~Son. j /L'ckfcr^jM/OWNER SEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection on.., 19. This space for office use only 19 Owner or Agent Signa:tureDate Rac'd Phone Cali Rec'd ByTime Rec'd NUMBER OF BEDROOMS;ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD GIs.Sq. Ft.Sq. Ft.Capacity 5'0 Ft.Ft.Ft.Distance from nearest well 21^Ft.Ft.Ft.Distance from lake or stream Ft.Ft.Ft.Distance from occupied building /&/a.Ft.Distance from property line Ft.Ft. 3Ft.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 ,JVI By . 19PERCOLATION TEST DATA: 1st Test Taken ByP-___First Test.....‘fi^.:? Date of First Test Rate Sfe...2.6At,5«9 7v Date of Second Test , 19..<Rate t-0'TiO+ 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 insp, responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready f ited. It shall be theam ipection. Signature Dated Permit: Permission is hereby granted to the above named applicant to perform the work described in the above'ltatSment. 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. J9€h 6^Issued Date: Shoreland Management OfficeFee$_26^^5310Rec # Comments: Form No. MKL-032085 225239 — Victor Lundeen Co.. Printers. Feryus Fans. MN F i/\juJKa^J)i_*i 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 /_^'' l''~J /Permit No..yLEGAL //. 3/y .'"5.5DESCRIPTION '< AND LOCATION Lake Classif.TWP NameLake No.Lake Name Sec.TWP Range IDENTIFICATION: Please Print All Information. Mailing Address — No. Street, City and State Zip No,Tel. No.First InitialLast Name OWNER SEWAGE SYSTEM INSTALLER Name. jn-(^This System will be ready for Inspection on. This space for office use only / IJO Date Rec'd i Time Rec'd mM /Phone Call Rac’d By Owner or Agent Signaturei 7 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.Distance from occupied building Ft.Ft. ■'■yDistance from property line Ft.Ft. Ft. Ft.Distance from bottom to Water Table Ft.Ft. All distances are shortest distance between nearest points f RECORD OF TESTS: Inspection was made on 19 , Time M By PERCOLATION TEST DATA:Date of First Test 19 ..., Rate i . , /7/;-■Date of Second Test . 19 , Rate 1st Test Taken By 4>'First Test + 2nd Test Rate2nd Test Taken By Agreement: 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. The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in 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. Issued Date: Shoreiend Management Office Fee $Rec # Comments: ». —^ r Fonri No. MKL-032085 -225239 — Yclor Lundian Co.. Prinm. Ftrguo FaA. MN i PJ^H5- . /y '7 INSPECTION RESULTS Inspector must make all measurements * I SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PIT DRAIN FIELDSEPTIC TANKCATEGORY Should BeShould Be Should Be ActualActualActual 334f FCapacity s Fs F s Fis. GIs. S^hc) ^St)Distance from Nearest Well F F FFF 75*r>^75 7£Distance from Lake or Stream FF F FFF r ±lO AODistance from Occupied Building FFFFFF rr F /dDistance from Property Line FFFF F 33Distance from Bottom to Water Table FFF FFF Inspector’s Commits: ^ - ^ ^ A. ;^tsJUAJ 7^ ^ t .^2dL&^ .J " ------------------- s Date of Inspection /!? MTime of Inspection tiK /O- 4-K*^ Signature of Inspector INTERPRETATION OF ABBREVIATIONS GIs = Gallons SF = Square Feet F = Linear Feet K u ^ \s> Cr\A \r b ft u UL.Job TitleOV S\ 0 fiJL- b i^\\VvA/\» tl (t»t »;R ),»4r^A y ■20' £HI:"A — ■ C^v ««s. MKL - 032085 • B«ck«r Agency \ —/14- Vi?''' y.ji3iV i r f■/ / if *?5 TT VAnao^ T w\ s«0< • vj^y'j /»4^/I./ ' 0 „'.V/.0'V .- ....... t /'-fLI I ____(^ «23 <^^<i-o',,j^.o3^*<i\ affi? ^ ___2J'I^.£'___ 4 11 ;!5'.C> - ^3 2 3 ^ 33^7,5- (S> 7^21SS02@ VICTOR LUNOEE** CO.. PRINTERS. FERGUS r*LLS, yiNN.PERCOLATION TEST DATA LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, Minnesota 56537 Ph. No Mailing Address:Owner: ^ g a{/U FirsK C. a. r?nrr. $o ^ Zip No.StateCitySt. & No.MiddleLast Name Legal Description;/!// C TWP NAMESEC. ^ TWP. , .'/'ya^y A ^3/ ‘>1 ^// ^ o aT jA'Ci RANGENAMELAKE OR RIVER NO. /if ^ f *< 7^-5 <U^ TEST HOLE NO. 2TEST HOLE NO. 1 43ALR(L,y Depth to Bottom of Hole inches; Diameter of Hole jnchesDepth To Bottom of Hole inches;Diameter of Hole inches /<1&Y <*/ft?)/ «$^7Soil TextureDepth, Inches Depth, Inches Soil TextureDate19 Date C-la J ^i4y 7 »a-ycka A,O- 'S'4 0' —ercolation est By___ Percolation Test By .cAV,L zu2-0 7 ?Q LU hJ / 3‘{F irm Name.F irm Name,E 2.C - A 7^-LO - ooi isr CC LU AddresAddress.CCsarfSl < CO Otter Tail County License No.Otter Tall County License No..COLUMeasure ment,inches Drop in water level. Inches Time I ntervals minutes Percolation rate minutes per Inch Percolation rate minutes per inch Time I nterval, minutes Measure ment Inches Drop in water level, inches Remarks;Remarks:Time Timeo H7>>o / .0 2^^J 6 A z a ^Ia.(3 i-6 I; t-t>.n\ •/'/ ^7 H S'a^_4.31.0316 . 2^7^J2^l V ^ ^0, H o, 6,6 3'Lr 'fn.tA2l1I V /o.c>3,<7 ,/ IZ- I 7. ^11 y?.z? VT- o 2-,giT.- )J %0_2_,1,0 /, o' rM 1 7 ti.OH<ua V y 2.1-f I )(TiA I V, oy?»6 3?C - ^ f1^r*7P -A/y4/g>7 /C>See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of MN, Percolation rate =minutes per inch minutes per inchPercolation rate = 215502® VICTOR LUNOteM CO,. PRIMTER6, TERGUS FALLS, UIHN.PERCOLATION TEST DATAMKL -0871 -028 /f / eJ 9 '<L^LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, Minnesota 56537 <9 ^S ^ ^ J ^/-O- <1^ (e OC> ^ /oe> ^ /it "^Ph. No. Mailing Address:Owner:% /nf. /‘f/¥7^ “^o ‘7 <L. Zip No.. StateCitySt. & No.MiddleLast Name d/c )<- & /Legal Description:IL /3Z^e p-A- TWP NAMEj ^RANGEM.0-TWP. 0 OC SEC.LAKE OR RIVER NO/./ NAME , rS S: / 2- ^ /‘euc/ <rA TEST HOLE NO. 2TEST HOLE NO. 1 c3 r 3^Depth to Bottom of Hole Inches; Diameter of Hole jnchesDepth To Bottom of Hole Diameter of Holeinches;inches 19 ^3?Depth, Inches Soil Texture Soil/TextureDepth, InchesDate19 DatessA <?t/y /J. ca.i^ Said s^‘id C/-/7'e'} 0'~'G6- ^a *w-tPercolation Test By____ Percolation Test By ,^ " ~l^0DQ/ f U ' / /IXI -3 9 Firm Name.F irm Name,QC ?^r> --Z3S, fd aA-Pf C LUQC LU ■dL Uvl.Address.AddressQC /< COOtter Tail County License No.,Otter Tail County License No..COLUMeasure ment, inches Percolation rate minutes per inch Drop in water level, inches Time I nterval, minutes Measure mentInches Drop in water level, inches Time Intervals minutes Percolation rate minutes per inch Remarks;Remarks:TimeTimeo ;H in33X zo,a)f\±. ^.ziIrO3 ^HX I /i-./4^3V.0 "b 3'S^Hdl 2v (A u ¥rCj^ A ,NHiI (A Ot'^.?<P'0 m-36.UL •? (t\1/2.I 3'?i /,iSLA3 t<o ZjlAitUC/( /I 3 to A1 37.iP / ,0 2,,0/ "73AdLLfL5-i MO /i 0 ■x.o2.-IL ^5'TV 0 3^t, 0■L-- ;3^drQ_i 2., Oit\T f.d4i. 0IM /fgg pfuJe - In ' / See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of MN.Percolation rate =minutes per inchminutes per inch Percolation rate = ^0) C-\i, X a «„ ^y LA^ ^ •’t^ L4/ 2 <? y? i ( /' /^ /^*sJ / tty) cl ^ ^ f ^ '‘^''^i ti^ tf /// / / (>' «'erj> / /^i> l-"(AJ (Ac/’e^^ M ' Y^eAi^ i Sh ^[ \^«=^c/ / Jye “7fX//6„//r./ / ^fT ir’^'^ ^ O <»*t // ^ 2^c/S' oe>>^ / 'P^css’^ / F,'->/^ " / ^fjF<^/ Sfr^-^f ¥■■/Y'5>.fi® o Q ^•y' S'^ t-u