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Home My WebLink AboutDeer Lake Resort_25000050030000_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 SEWAGF DISPOSAL SYSTEM te — Office V low — Inspector Pit- Card OwnerOwner 3^73Permit No..LEGAL Date DESCRIPTION AND 0Xic.P,rnv- Luff ^Azji mhLOCATION Lake No.Lake Classif.Lake Name Sec.TWP Range TWP Name IDENTIFICATION: Please Print All Information. Last Name Initial Mailling Address —No. Street, City and State Zip No.Tel. No.First &f ^ p '/'h a HoV. 7 / U(fvL S'GflS'tkt/-OWNER SEWAGE SYSTEM INSTALLER Name. 1 SoThis System will be ready for inspection on.V / 1 .A I.A t’.. 19. This space for office use only .19 Date Rac'd Time Rec'd Phone Call Rec'd By Owner or Agent Signature LkNUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD / I ;XO Sq. Ft.Ss/pt.V, OCPO GIs.Capacity y I IS Jl±_Ft.Ft.Ft.Distance from nearest well X /6oI So Ft.Distance from lake or stream Ft.Ft. JO HOFt.Distance from occupied building Ft.Ft.7 \ZOO 1.^0Distance from property line Ft.Ft.Ft. X 7Ft.Distance from bottom to Water Table Ft. Ft. AH distances are shortest distance between nearest points RECORD OF TESTS: ..... 19.SQ , Time..,5!r..C>.a...AjVl ByInspection was made on I 'PERCOLATION TEST DATA: 7\n Tst Test Taken By Date of First Test 19 , Rate .mZ Date .1...:of Second Test 19 ., Rate /'First Test -I- 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. (Call or use attached mailer notice.) AyO--y^ 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: 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 S.H- 9rrsIssued Date:, Shoreland Management Office S'. 00 a 50Fee $Surcharge $ Comments:. Form No. MKL-0771-003 . .... 158906VlCTttN LUHBIIM « C«.. 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 Pl».. Card — Owner Owner Permit No.,LEGAL Date DESCRIPTION AND LOCATION Lake No.Lake Name Lake Classif.TWPSec.TWP NameRange IDENTIFICATION: Please Print All Information. Last Name First Initial Mailling Address —No. Street, City and State 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 Owner or Agent Signature 1/NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD GIs.Sq. Ft.Capacity 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....'.M By PERCOLATION TEST DATA:Date of First Test , 19 , 19 ..r Rate Date of Second Test ,, Rate X 1st Test Taken By First Test -I- 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 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: iShoreland Management Office 1Fee $Surcharge $ Comments:. Form No. MKL-0771-003 viCToa LuHetCM t ee.. miinii*. Fcasus raiL* «h>h 15S906 INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORYActualShould be Actual Should be Actual Should be 1^0 Sf ]\l^Capacity GIs.GIs.S F SF S F 5-^(S FDistance from Nearest Well F 75F 50F F fpo $0 !Ot>,G9.Distance from Lake or Stream F F F F T go FDistance from Occupied Building 10 2020FFFF F Distance from Property Line 10 F1010 10FFFF F Distance from Bottom to Water Table ^K. F 4FFFF F Inspector's Comments: — c>Ji^ ^ ____/ >o7~ c ^i t c/>«w _<l-4 ::za^ #19_S!?Date of Inspection •• dc itviTime of Inspection, /^/C Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF " Square Feet =■ Linear Feet Job TitleF AgencyMKL-0771»003-Backer (Lf^htrsJ :d' -2 0N<d HocK.* /2/*>v'^ //ff A»<o^ C-9-6//v>_(Lf^loitJ -M X.. Aio </e V cL »w.» /\) fi d ci ( f"' ^ P/?<9 |OOSft/ ------ /e/9/s: •f «/? aJ / N \ aJ<2 i-4jS I <:j kT 1 ii! •f 1 I 5 i ! >)«; ! ^ I ^\ VNi ? 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