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HomeMy WebLinkAboutCross Point Resort_39000050030000_Septic System Permits_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 DESCRIPTION SS P~rAND LPCATION SECTIONLAKE/RIVER CLASS RANGE TWP NAMELAKE NUMBER LAKE/RIVER NAME TWP. NO. FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER(S) IDENTIFICATION; Please Print All Information Mailing Address — No. Street, City and State Zip Code Telephone No.First InitialLast Name Property Owner Sewage System Installer Name A.M. P.M.This System will be ready for inspection on 19.at This space for office use oniy NUMBER OF BEDROOMS: A.M. P.M19 GARBAGE DISPOSAL: ( ) YES ( ) NOPhone Call Rac’d ByTime Rec'dDate Rec’d SEWAGE TREATMENT SYSTEM DAIArWffliMUMREQUIREMENTi^ TANK TYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) ( ) Septic tank ( ) Drain field ( ) Standard ( ) Bed ( ) Trench ( ) Modified ( ) Mound DRAIN FIELD'’^'^apacity ' Kc Distance from nearest well GIs.Sq Ft. Ft. Ft. Distance from lake or stream Ft. Ft. Ft. Ft.Distance from building Distance from property line Ft. Ft. EFFLUENT DISTRIBUTION ( ) Gravity ( ) Pressure Distance from bottom to Water Table Ft. Ft. All distances are shortest distance between nearest points C-arw v-f S' yv dSl ^ ^ YCK V 'L-V'\ ^ -Rrzjm7-OL,WATER WELL DEPTH: tvJC -VvD PERCOLATION TEST DATA: Date of First Test , 19 Rate Date of Second Test , 19 Rate 1st Test Taken By First Test + 2nd Test Rate2Ind Test Taken By 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: Sigrtature 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 Office11M ^ ^Rec #, r.nmmr^nfs-X ~7~A ST7? CU^ g fY\ S Fee $. n VI r -f~z« XX - Form No. BK-0993-003 268,559 • Victor Lundeen Co.. Printers • Fergus Falls. MN • 800-346-4670 I# ■*• APPUT/itlON FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM« V WHITE — Olfhe 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 LOCATION SECTION RANGE TWP NAMELAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS TWP. NO. FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER(S) IDENTIFICATION: Please Print All Information First Mailing Address — No. Street. City and State Zip Code Telephone No.Last Name Initial Property Owner u I4~<^r>k ) S Ot\\'/ wSewage System Installer Name ftporY-^ /cb>o I'rhi^ ^A.M. P.M.This System will be ready for inspection on . 19.at This space for office use only NUMBER OF BEDROOMS: (-0-1^ ll'-Sji GARBAGE DISPOSAL: ( ) YES ( ) NOPhone Call Rec’d ByDate Rec’d Time Rec’d SEWAGE TREATMENT SYSTEM DAJAHKINIMUM REQUIREMeTiTC^ TANK TYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) ( ) Septic tank ( ) Drain field ( ) Standard ( ) Bed ( ) Trench ( ) Modified ( ) Mound DRAIN FIELD‘Vxapacity iz X< S"r (^CjO Sq Ft. s.Ft.”Distance from n Ft. Ft.Ft.Distance from iake or stream Ft.Distance from building Ft. Ft.Distance from property iine Ft.■T- EFFLUENT DISTRIBUTION ( ) Gravity ( ) Pressure Ft.Distance from bottom to Water Table Ft. All distances are shortest distance between nearest points ^ ^Gtv/7 0'(' -p 03TV\P^ iviL, . ^ rO«I < 3r^/nWATER WELL DEPTH: PERCOLATION TEST DATA: Date of First Test , 19 Rate Date of Second Test Rate 1st Test Taken By First Test + 2nd Test fnd Test Taken By Rate2 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. (TQ<L.-') .SterzrtE: Signature mission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition 1 to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinance of Otter Tail County, Minnesota, he revoked at any time upon violation of any said ordinances, if work Is not commenced within six (6) months. Lartd & Resource Management Office rv\vjk<H-^__S-x Rec #. 1 < J o ri 1rI . 1 ^ f -? 268,559 • Vidor LundMnCa.Pimtm • Forouo FaBs. MN • 800-346-4870 4i KINSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEPTIC TANK DRAIN FIELDCATEGORYActualMinimumActualMinimum GLS.Capacity GLS.SF SF Distance from Nearest Well FT FT FT FT50 ADistance from Buried Water Suction Pipe FT FT FT FT50 50 iDistance from Buried Pipe Distributing Water Under Pressure FT FT FT FT1010 ISVDistance from Lake or River (OHWL)FT FT FT FT /ODistance from Nearest Building 10/20 FTFT FT FT10 Distance from Nearest Property Line FT 10 FT FT FT10 Distance from Bottom to Water Table FT FT FT 3 FT YES NOHolding Tank/Lift Alarm Sewer Line to Well Separation DRAINFIELD CALCULATIONINTERPRETATION OF ABBREVIATIONS GLS. = Gallons SF = Square Feet FT = Linear Feet Actual Minimum FTX FT FT20 SF Inspector’s Comments: /nspecfoT's Signature * Date of Insp^f- Time of. % - / r^/I'^OO 1^00 J'^~'^ X ,7^ \^oo X , g3 ^ /7?3 ^7"^ £>.; - S') \ 3 So j- 11 ^ S Qi7^1^06 X y. 77>I 52?4 /^r ^ c@ ■j D J <.C. NO. 57 - G o V t-’’ nn,e n 1 ni •_ a , ‘ > c c Cj t ■ cJ •; i 1 q liuoi- \ ‘ >. t • • Area of the c ut- >■ 192 +/-.^ N 84' 04 08 E I I h tM ■ e b V my d i r c-r t t hflg>u of ♦ / \0 I i1 ■■ 7 -.o' I :'i 57.08U 2 •♦8.29 89' 2.9’ 04” W 273’ 4-/. I ! r/.vs's rark II ivRsr! -I 1 i p 0\vxVCroS5 Y o •)PC f*.<^D(^Y ^&■ {s d o^Y0 Be s X 5 “p Ay 3oo/.3 C^-yv. jj I IX (ao■Cv- i po.r'Y 4-flXJ./7~z: *-V d( C~-•^'^0 0 /P / TS %,V \ ‘sre -h 2.S" yT^L^ 's/O - ^(V.W\-b 3n s F ^ Bes ^ /ro ^>^C. pty Aa^ :=. dpvVv> Sooo 3 <30nloo “J3^r F ^ ?3 Z30CP :!X 7$-^ iT?3 Pf'.j 7r 4-! II zr- 'TAf/k Ovp i. A («OCi ie Xf|!^ 'I D *'P/? c«,v-().y sl/->-i - IS X IQO - /?00!»■ /^oo, /^OO X ]3SV i y. ?3 HHH 9 ? 0 73sp ■=-9Q0I 0-tA.>rr-Cl^v*v ^ S‘iLa_ 1/7r~9oou/2_- 3-I}3o2)/oo (-ZOZ) O ^QO/ Zi^ c?7Y 941 1 /-Co. -----------ib ▲UGMENIIN’ onwiain/dovulanotepotassiurTi li^_^ I C'~ C_^o Cp i - ie>^.vjV?3 ' Cft >VN fP<-'/'_S Vr^'v^>C'5^ tA ^ O o I -K-A< .If ao ‘ P S k«/wvX U i/ Qvc s Lovjo't')'l^«wvJ— Sig: q8h with food/snack o y ' >? u.'5 •j* ---:!----- V '- 4 ' ir,yj a/ t'-tv. ■ a(-L,(:tr SHORELAND MANAGEMENT - COUNTY OF OTTM TAIL COUNTY COURT HOUSE Phone 218-739-2271 - Fergus Falls, Mn. 50521^ APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM W .t# - Office V low — InspCfCtor Ph.. — Owner Card — Owner /72’'\3>Permit No..;*■ .C' ■'LEGAL C^- T o Date DESCRIPTION AND oLOCATION-=^ . TWP Nam»Laka NamaLaka No.Lake Claasif.TWPSac.Range IDENTIFICATION: Please Print All Information. Last Name First Initial Mailling Address —No. Street, City and State Zip No.Tel. No. -■> OWNER ■.vrj / SEWAGE SYSTEM INSTALLER Name. ^/\n cso^ This System will be ready for mspection on., 19^T This space for office use only CL f=K.f*. 3^ M?7LJ.____19 Date Ree'd Time Rec'd Phone Call Rec'd By Owner or Agent Signa.ture ■5". NUMBER OF BEDROOMS;ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD GIs.Capacity Sq. Ft.' Sq. Ft. Ft.Ft.Ft.Distance from nearest well Ft.Distance from lake or stream Ft.Ft. Ft.Distance from occupied building Ft.Ft. Distance from-property line Ft.Ft.Ft. Ft.Ft.Distance from bottom to Water Table Ft. AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on 19,, Time ,JV1 By PERCOLATION TEST DATA; Date of First Test 19 .r..» Rate Date of Second Test , 19 Rate 1st Test Taken By First Test + 2nd Test 2 Rat«2nd T€«t 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 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: Shoreland Management Office Fee S_Surcharge $• -■•r '<■ ;Comments:.• '*■ - / iZ-V . rl. J i.'i^ '-r.,• > No. MKL-0771 003 CERTIFICATE OF APPROVAL • A SEWAGE SYSTEM 19th December 94This certificate has been issued this day of 19 w-'Mito certify that the sewage system installed as per sewage permit number indicated below has been approved for use iMby Otter Tail County, Minnesota. The premises covered by this certificate are legally described as: mm56-747 1355 Range 42 Twp. Name MAPLEWOODLake No.Sec.Twp. iM5 135 42 53. 35 1GL 1 EX TR EX PLATTED Si STEgM. NANCY LOwner: Name 5127 QREENBUSH AVE. SHERMAM OAXS. CAAddress <9142.^Zip No. <?«907Permit No. SP %Signed by: Land & Resource Managemeni Official Otter Tail County, MinnesotaMKL-0987001 Wa \h rifc-lAiv. JT-272472 Victor Lundecn Co.. Printers, Fergus Falls, Minnesota APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM i •WHITE*—^Office Yellow — Inspector Pink — Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218)739-2271 - FERGUS FALLS, MN 56537 9^0^ /hQu-yJrLEGAL Permit No. DESCRIPTION AND LOCATION SECTIONLAKE NUMBER LAKE/RIVER NAME LAKE/RIVER RANGE TWP NAMETWP. NO. 5 /3^ PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER - rPOiO-aoO IDENTIFICATION: Please Print All Information Mailing Address — No. Street, City and State Zip CodeFirst Initial Telephone No.Last Name Property Owner Sewage System Installer w Vv^Name A.M. P.M.This System will be ready for inspection on., 19.at This space for office use only AoNUMBER OF BEDROOMS: A.M. (X)NOP.M19 GARBAGE DISPOSAL: ( ) YESPhone Call Rac'd ByTime Rac'dDale Rac'd SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required)DRAIN FIELDTANK mm{ )^) Septic tank iO j -300 (^) Drain field ^ GIs.Ft. hoJian.c5r0 Ft.Ft.Distance from nearest well 6^( ) Standard ( ) Bed (^) Trench ( ) Modified ( )Mound SODistance from lake or stream Ft. Ft. 10/3.010Distance from building Ft. Ft. iO10Distance from property line Ft. Ft. EFFLUENT DISTRIBUTION ( Gravity ( ) Pressure 3Distance from bottom to Water Table Ft.Ft. All distances are shortest distance between nearest points WATER WELL DEPTH: PERCOLATION TEST DATA: Date of First Test Rate, 19 .6 - SDate of Second Test , 19 Rate ^^1 Test Taken By .)azXJ//yrylJ 7 3Jasi60First Test + 2nd Test Rate22nd Test Taken By 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. 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. DATE: Land & Resource Ma^gement Office Vto—,Issued Date: 3^' , I Ki, Q-'>v>v'' '| 1» pla.c/lts,<^ Li ptLsJ Rec ft.Fee $. orients:--X S', P^i-Zi43 Z-2 bicf Co .gUoLvL-ir t-kcus-^ -Jfr.C ITSr</C'>v-i $ Lx— pi'~Thg- o(<A Sys-|~<^v-^ \ ' FormNo.BK-0993-DD3"7uc^ A- ^r\X wx C L-U t >^V\ ou r — ' 1V «-o\rl ^0 S’a-f>4 ^3 [~268.559 - Victor Lundoen Cp.. Printers ■ Fergus Falls. MN - 800-348-48704/U^ Cho we-'v''llW V i <L>^t « APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM^]‘ »i •%WHITE —\mce Yellow — Inspector Pink — Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271FERGUS FALLS; MN 56537 Permit No.LEGAL Writ % “-5..DESCRIPTION \AND ^ \LOCATION i SECTION TWP NAMELAKE/RIVER NAME LAKE/RIVER TWP. NO.RANGELAKE NUMBER 6 10../36 PARCEL NUMBER(S) '7' 9^ oao - - ooo FIRE OR LAKE ASSOCIATION NUMBER V. , ■ . \ IDENTIFICATION: Please Print All Information First Zip Code Telephone No.Mailing Address — No. Street, City and StateInitialLast Name V JProperty Owner i1AU-je>0 STTi XSewage System Installer Name u r\/^ A.M.V This System will be ready fdr Inspection on P.M.. at This space for office use oniy ^0BEDROOMS: 19 s \ \il^OSAL: ( )YES (X)NO Time Rec’dDate Rec'd I MINIMUM REQUIREMENTSTTYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) ( V) Septic tank U)! ^OQ (^) Drain field ( ) Standard ( ) Bed (^) Trench ( ) Modified ( ) Mound DRAIN FIELDTANK &b0-/4^^^-sqFt /oo/z/on ___6^ f GIs.j_ Capacity 6/0 Ft.Distance from nearest well an Ft.Distance from lake or stream 10 lO/sn »Ft.Distance from building 6 /n10Ft.Distance from property line Distance fr^ bottom to Water TableEFFLUENT DISTRIBUTION ( X) Gravity ( ) Pressure /? Ft.Ft. - All distances are shortest distance between nearest points ! WATER WELL DEPTH:I "\ >' >6 -^6PERCOLATION TEST DATA: Date of First Test Date of Second Test 1 3Jaill I4^:+ 2nd TestFirst Test V Rate22nd Test Taken By ‘ rf 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. ___________________ ,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. iDATE: /Q: '-/1.3Issued Date: Land & Resource Management OfficeGOliL//V72^Rec #.Fee $. jnvnents: Z-Z V>Vct Co ofS yil-pla cir^n^\jOWK > IS C ^ WrOOr*n \ , Vac- C,a V> 1^ C-r\yv^pS !•!-r \ i jP-jf , i, F 1' , ThO- Ol.^ Sv\4^0 r v>C> ' > V «-cA-l ^0 V><_ ^«-r-V rV . ',a ''-..o r, 'k:r >1’.S' aForm No. -0993-003 268.S69 - Vidor LundMnCa.PrinlBn • FaiguB Fata, MN • 80&446-4670rT'> t - * INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS * • » SEPTIC TANK DRAIN FIELD CATEGORY Actual Minimum Actuai Minimum 4~ /Coctgls.<^I(T0 sfGLS.SFCapacity lor>-^ ft FTDistance from Nearest Well 50 FT Distance from Buried Water Suction Pipe FT FT FTFT5050 CpO f FTDistance from Buried Pipe Distributing Water Under Pressure FT FT10FT10 FT FTFT FTDistance from Lake or River (OHWL) Yo 10/20 FTFT FT10Distance from Nearest Building /6-0 3CCXfFTFT FTFTDistance from Nearest Property Line 10 10 d^C> FTFT FT FTDistance from Bottom to Water Table 3 NOHolding Tank/Lift Alarm T DRAINFIELD CALCULATIONSewer Line to Well SeparationINTERPRETATION OF ABBREVIATIONS GLS. = Gallons SF = Square Feet FT = Linear Feet Actual Minimum 3imFTX ^/crt\iCfXS FT FT20 SF Inspeclor'B Comments: ' TtC UA f P rcg xC '' rcClYlmcX. ’ / ^ KETCH: -i i Inspector's Signature i Date ot Inspection / 3o ^N > «< > TV . Time of Inspection r.’ ~J HD j <-C. NO. 57 Go VE-T nn,t.-n 1, ; ,■, t 1 ni ii^^, n c c o r ij 1 T, Q Huoi- “o 1 iJ 3 , I Area of t ri e f:opi- 1 N 84!I hoi- <iny ct i r c*r t u V-w 'j of I e D V c o' ' . T I 1ig>Gf / Oi (o •A, u-7 t \0 \ACf^ \ V / ■ '-A 75 I I ’ • ! : • . i (N!CDh.h O ?o o N 89‘ 5C 58" W 57.08I ?4fl.?9 89- 29' 04"W 273' +/- I 1I I r^A^lNS'S PARK i^RS TV # II Il I II II Barnu mTowards drain field top of hill0 R~1 Denotes Prexisting Sites w/sewer, water, elecCabips'■V Denotes Septic tanks and lift stations O Well 145’ deep 0 I Drain fieldI m 7 PERCOLATION TEST DATA LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, MN 56537OWNER: LAST NAME FIRST MIDDLE TELEPHONE NUMBER ADDRESS: STR./RT.CITY STATE ZIP CODE SEC.LAKE/RIVER NO.LAKE NAME TWP.RANGE TWP. NAME LEGAL DESCRIPTION: PARCEL NUMBER FIRE NUMBER NUMBER/BEDROOMS — TWO TESTS ARE REQUIRED — TEST HOLE NO. 1 TEST HOLE NO. 2 inches; Diameter of Holeinches; Diameter of Hole.Depth To Bottom of Hole.inches Depth To Bottom of Hole inches r'- rDate19Depth, Inches Soil Texture Date _ 19.Depth, Inches Soil Texture MAM'lA Percolation Test By _ Firm Name___ Percolation Test By___ Firm Name ___ :x(% Address Address Otter Tail County License No.Otter Tail County License No. PERC TEST # 1 PERC TEST # 2 P4TE»v<a.fMimrrBr>WATBR DBFrUTll>g WATHKPKOP PBRCRATB IMTHRVALfl>rmiUTM>WAjmpgrra WAT«tP»0» PERC RaTBaa/ rTTMU DROl^ i*hRC nMU DROPTll>g INTERVAL WAJBRPgrTH WiCTBRPROP PERC RATB BHB INTERVAL nnOmJTBH WAJBRDBrTH WATHRDROP raRCRATH ..yM'.a../IREFILLREFILLIJ/A.Tii. Tlfcg tKTERVAL WAJBR DBPTMJflt.__ - WitfBRDROP PERC RATE TIME INTERVAL fMlWlfTBl^m w.WATER DROP PERC RATB2y2ipREFILLREFILL.U ,115-in 'lIMit DROP PBR<X 3 4 TIME INTERVAL (MINIITBR>W>gHR DEPTH WATER DROP PERC RATH TIME INTERVAL IMIWUTBRI WATER DEPTH WATER DROP PERC RATEajiv '11L1U ' DROP PBJtc REFILL REFILL M.3 ■3;ua X£Li miH'* INTERVAL tMTWUTEPTIME WATER DEPTHBUT".WATER DROP PERC RATE TIME INTERVAL (VflNlfTBg)WATER DEPTH WATER DROP PERC RATE .f.%—0^REFILL REFILL .......34-3 4TTMU INTERVAL fMINUTBST FERCRATE reRCRATETIMEWATER DBFTH WATER DROP TIME tNTERVALrMINtnrBR^DEPTH WATER DROP.a COREFILL REFILLTitig~*E^^~ragl~.L'lr. INTERVAL tMlNUTEm PERC RATETIMEWATER DEPTH WATER DROP TIME INTERVAL fMlWUTEa WiPHRl5^WATER DROP PERC RATE ......REFILL REFILL TOBB* PlEtSF' rartC".U--4.VJ-i TOwffi" TIME INTERVAL <MIWlJrBS>WATER DEPTH WATER DROP PERC RATE TIME INTERVAL <Mim/TE«WATER DEPTH WATTODROP FERCRATE Xvt .j-'j-h:.-./Mi..... .M‘.U----- REFILL REFILLK..U__^3^TIME i. COMMENTS/CALCULA TIONS:j MKL - 0390 - 005 250,815 — Victor Lundeen Co., Printers, Fergus Fails. Minnesota. GRID PLOT PLAN SKETCHING FORM — (Must Be To Scale) feet/ inches 1 rScale: Each grid equais « Dated:19 Signature Please sketch your lot Indicating setbacks from road right-of-way, lake and sideyard for each building currently on lot and any proposed structures. : 1 1--1ti J 1 i1fU'i Iri t:l I ! ' r i -t ^" TI";)- ' Lj U 1 : i_i i_!;I[ 1 ■■H ■ -•I tfi r: urriiij r:j1 ! !ti d 1 di;.[ dd_L n1I ;h i'|j rLJud d 17! dt'ti if-t 1 It d d^tL id) Liii d J1 d Ld dd d Hd d d d rd.n i 11 r; n rIL! :J1t ri 1I11 I r ri-d-iT;d.ii : d d:■dJt i--t d1^, J J di I I1-4.d;lddi-dd! r r L I-1 d id a rj‘! L'di d ltd t r I I d r II :I ’ 1ti tI :Id.f al..t.l 1..: nj-dt r.I dJ Jt IL-dij Idlidir : 'I t4--1 i LdI 3+4-Ui. )-!144I4|:ri ril-t tT i]4in 4:4 t-dd-t I T t L! I ;t d L L I 4Ii I I ii I I I, I ^ M \i V.Ii.i I I ! I I ! SrV mii BEARING DISTANCE 57.14 64.98 67.29 51.93 22.93 72.09 UNECHORD 101.35 94.14 145.07 201.46 198.44 190.68 158.35 129.82 106.37 TANGENT 51.75 47.93 83.39 100.75 99.24 98.34 81.66 65.96 54.04 CHORD BRG N ar 33' 06" E S 75- 54‘ 02” E S 35- 29’ 22” E S 04* 28’ 06” E S 04* 28’ 06” E S 1 9* 57’ 34” E S 1 9* 57’ 34” E S 44* 22’ 23” E S 44* 22’ 23” E ARCDELTA 23*23’ 25” 21*42’ 20” 59*07’ 00” 2*37’ 19" 2*37’ 19" 28*21’ 35” 28*21’ 35” 20*28’ 04" 20*28’ 04” RADIUS 250.00 250.00 147.04 4402.68 4336.68 389.20 323.20 365.34 299.34 CURVE S 39* 44’ 02" W S 1 9* 48’ 57" W S 86* 45’ 12” E S 54* 36’ 25” E N 54* 36’ 25” W S 59* 06’ 43" W 1102.06 94.71 151.71 201.47 198.45 1 92.64 159.97 130.51 1 06.93 1 22 33 44 55 66 7 8 9 i 3001 CO 50 1 OO 200O □IQSCALE IN FEET UJ CL 5;cj SCALE: BEARINGS ARE BASED ON AN ASSUMED DATUM. m DENOTES IRON MONUMENT FOUND. DENOTES IRON MONUMENT SET MARKED "RLS 13620”. © DENOTES CAST IRON MONUMENT FOUND. INCH = 1 OO FEET ;j1 (2)U © I1 iN.W. CORNER OF GOV* T. LOT 1, SEC. 5 DEDICATED READ PER! S 89* 28’ 03” E 888.81 f f Si I DESCTF? 1 r-^"T I arsiL„i: I I otter Tail County, dedicated in F LAT ! N ’ S PAf^K WfiL I , tract of land described in Recor dec. To^-jnship 135, Range 42, r o aci as tliereof and except a the 011 Tail Count y fiGovernment Lot 1, Section 5, HinnesQta, except *. bed ; _ t-...-c according to the r*,-curdea .i 1 a t Book 517 oi Dec?ds, page , f i i ec ot mm Imo re or less.Area of the property = 48.35 acres CD ie: F? r I 1 c: nr e; 1plan or report was prepared Py me or under 1 am a duly Registered Land Surveyor u rider the 19GS. I hereby certify t Ci a t this survey, my direct super v i v. i on and mat laws of the State of Hi nnc-ao i ^ . Dated this Btti day of October ,if*¥I i 7 E (Dv- David A'. Anderson Land Surveyor Hinn. Reg. No. 13620 I!\ • -K' -4‘ 1 Im. I ii ;# ' ____________S' ^5^oF ^ «*: >. s7-2_8j(y E I i' >9.50. " m#- --1 — -p—i <0 i /^4; ^S'■' 1 ! A-S.* \ X, I I SOUTH LAKEL-J Ii 11 MW‘. I! fi IM IVS.W. CORNER OF GOVT. LOT 1. SEC. 5 I /.OI Llh/i^ pusuc (e-^CLiAoc-o'^ CERTIFICATE OF SURmY FOR:I 1 EEATINS'S PARK WEST IRUSSELL BARNES IS I5 ! FIELD BOOKCONTRACT NUMBER ALS-54/5192-88NDERSON LAND SURVEYING, INC. 4-03 SOUTH UNION AVENUE FERGUS FALLS, MINNESOTA 5S53T (21 S) T39 —52SS DRA7/JNC- NUMBERCOMPUTER FILE 192-88 Iia1J IIDISK NUMBER !23 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 Y^low — inspector Pink — Owner Permit No.arc!53LEGAL DESCRIPTION Parcel Number AND W 5 UsLOCATION Lake No.Lake Name Lake Classif.Sec.TWP TWP NameRange IDENTIFICATION: Please Print All Information. Mailing Address — No. Street, City and StateLast Name ^rst Initial Zip No. Tel. No. OWNER SEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection on., 19. This space for office use only .19 .M Date Rec'd Time Rec'd Phone Call Rec'd By NUMBER OF BEDROOMSV 'ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK seejXTge pit DRAIN FIELD GIs.Capacity Sq. Ft.Sq. Ft Ft.Distance from nearest well .TODistance from lake or stream Ft.Ft.Ft. Distance from occupied building Ft.Ft.Ft Distance from property line Ft.Ft.Ft Distance from bottom to Water Table Ft,Ft.Ft. AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on ,, 19,, Time M By PERCOLATION TEST DATA: Date of First Test , 19 Date of Seconi 19 , Rate 1st Test Taken By First Test + 2nd Test '2'2nd Test Taken By Rate 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. I understand that I have been granted a sewage system site permit in accordance with the requirements of the Shoreland Management Ordinance of Otter Taii County. I understand I must contact my township in order to determine whether or not any addi­ tional permits are required by the township for my proposed project. 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. The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in Signature Permit: Issued Date; S/TOre/anc/ Menegement Office Fee $Rec # Comments: Form No. MKL-032085 237,443 — Victor Lundean Co.. Printers, Fergus Falls, Minnesota V, ,y (*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 Whim — Office Yellow —Inspector Pink — Ownw /7 R-e:o Permit No.,ai0S5LEGAL DESCRIPTION Parcel Number AND 5(,-7in lAjj'd • ' TWP NamewuL5^-i ,, A13SLOCATIDN / TWPLake No.Lake Classif.Sec.RangeLake Name IDENTIFICATION: Please Print All Information. Mailing Address — No. Street, City and State Zip No.Tel. No.Last Name InitialFirst KiL3 /uJOWNERt '7tfS 7 >'SEWAGE SYSTEM INSTALLER Name. , 19^L This System will be ready for inspection on. This space for office use only 19^ NUMBER OF BEDROOMS^ / y g^2^M J Date Rec'd Time Rec'd Phone Call Rec'd By ESTIMATED COST: 2SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEflBGE PIT DRAIN FIELD GIs.Sq. Ft.Sq. FtCapacity 5D Ft.Ft.-t.Distance from nearest well .TO Ft.Ft.FtDistance from lake or stream Ft.Ft.Distance from occupied building Ft 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 PERCOLATION T^ST DATA:Date of First Test........ Date of SecojitL TeSfTT^. 19 19 Rate 1st Test Taken By First Test + 2nd Test 2 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. I understand that I have been granted a sewage system site permit in accordance with the requirements of the Shoreland Management Ordinance of Otter Tail County. I understand I must contact my township in order to determine whether or not any addi­ tional permits are required by the township for my proposed project. 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. The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in y' it -H /f:t Signature Permit: RlliIssued Date: Shoreland Management Office ^Fee $Rec # Comments: .X y Form No. MKm)32085 Printers, Fergus Falls, Minnesota 1 INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORYActualShould Be Actual Should Be Actual Should Be Capacity GIs.GIs.S F S F S F S F Distance from Nearest Well F F F F F F Distance from Lake or Stream F F F F F F Distance from Occupied Building F F F F F F Distance from Property Line F F F F F F Distance from Bottom to Water Table 3 3FF F F F F Inspector’s Comments: ( 272^ /Lf ''C«fc'>v\C>ILirAOo>o ^ \^Cf piA-V Qw 19^-5^ -2^ -Date of Inspection 3> oTime of Inspection M Signature ol ln\p»ctor INTERPRETATION OF ABBREVIATIONS GIs = Gallons SF = Square Feet F ■ Linear Feet Job We MKL • 032085 < Becker Agency AIR TEST CERTIFICATION (Date), an air teat of the sewer line installed under SewageOn forDisposal System Permit Humber .(Lake/Rlver) was made. At that time, the sewer line held pounds per square Inch for AS^ minutes. Owner), on 7-/7- License Number DateInstaller's Signature 042991 i I 1 ) i i I 1 I !I I : TO BE COMPLETED BY PERSON INSPECTING SYSTEM I hereby attest that I am familiar with the minimum standards required by the OTTER TAIL COUNTY SHORELAND MANAGEMENT ORDINANCE regarding sewage systems and that this system is in accordance with those standards. Please complete and return along with a plot plan of the land within 150' of the subject sewage system which includes the separation distances between the sewage system and any existing or proposed buildings, property lines, water supply wells, buried water pipes, the ordinary high water mark of lakes, rivers, streams or flowages as well as the location, size and design of all parts of the sewage system within 10 days to Land & Resource Management Office, Court House, Fergus Falls, Minnesota 56537. Soutk LIaa- Range Twp. Name ClassificationLake NameLake No.. Sec, Twp.Permit No. Legal Description: Owners AddressOwners Name- .Stoyt'/i o.\ Date of InstallationLicense No. Septic Tank //qLP,a:(^ Fill in below:Drainfield Capacity Distance from Nearest Well Distance from Lake or Stream Distance from Occupied Building O I t-v. ^ !M.T.<lhoS9 p • S Distance from Property Line cKfDistance from Bottom to Water Table (0 U LQ-_9 9 1 c(o'<r DateSignature •u7 ^\ cS'^ai Cv O ' !!f \ > X- \/ i." ' a A \> \\ V\\ ;— -I*® \ .s\ / SOUTH LIDA LAKE/ /,///// /?3 ///A /“/ // &-/I III :!!II TI I II1/i;CERTIFICATE OF SURVEY FOR:J I 1 1 RUSSELL BARNESI■: i^\ - iL7 ^I |011 ” \i»j X .1ST FIELD BOOKCONTRACT NUMBER NDERSON LAND SURVEYING, INC, 4-03 SOUTH UNION AVENUE FERGUS FALLS, MINNESOTA 56S3‘7 <21 S) T39 —S26S ALS-54/5192-88 DRAWING NUMBERCOMPUTER FILE 192-88i 2279DISK NUMBER 23