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HomeMy WebLinkAboutDoll_53000150090001_Septic System Permits_Department of LAI® RESOURCE MANAGEMENTOTTER TAIL COUNTY GpvERNMENT Services Center - 540 West Fir Fergus Falls, MN 56537 PH: 218-998-8095 OTTER TAIL County’s Website: www.co.otter-tail.mn.us May 7, 2009 Greg & Rose Mader 156 23rd Ave E West Fargo, ND 58078-7800 Sewage Treatment System Servicing Tax Parcel Number 53000150090001 Described as PART GL 2 COM W 1/4 COR SEC 15 S 89..., Section 15 of Rush Lake Township, Boedigheimer Lake (56-213) RE: As of 5/6/09, the sewage treatment system (Sewage Treatment Installation Permit #20173) servicing your property was determined to be in compliance with the provisions of the Sanitation Code of Otter Tail County for a 2 bedroom home. If you have any questions regarding this matter, please contact our office. Sincerely, Scott Ellingson Inspector APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095) GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 www.co.otter-tail.mn.usWHITE - Office YELLOW - L&R Inspector PINK - Owner/ Contractor (after issue) Permit No. 7^APPLICATION MUST BE COMPLETE IN ORDER TO BE PROCESSED TWP NAMERANGETWP NO.SECTIONLAKE/RIVER CLASSLAKE/RIVER NAMELAKE NUMBER La2aiLh PARCEL NUMBER (S) OF PROPERTY B^G SERVICED ‘O^OODN'bcoSO Oo\________________ E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROAD LEGAL DESCRIPTION CLCx 6:tL^ Q.ar>r\ \OM ^ * Daytime Phone No.Mailing AddressInitialFirstLast Name Avr FTytcfift )TProperty Owner Co ^ tno tA Y ff yra-v/cdrt. ,~XvtC> ^ -...Contractor Lie.*M<Dc£flo^ THIS SPACE FOB OFFICE USE ONLY A.M. P.M., the year of at>■ This System will be ready for inspection on AM. P.M. L&R OfficialTime ReceivedDate Received SEWAGE TREATMENT SYSTEM DESIGN DATA AS SHOWN ON DRAWING NSTALLATION (circle one)TYPE OF Other Est. (E) New (F) Replacement CollectorResidential (S^New (B) Replacement (C) New (D) Replacement Soil Tank L ift Treatment AreaEffluent Distribution { ^ Gravity ( ) Pressure Design Flow (Gallons/Day) 1 — 2,499 (H) 2,500 — 4,999 (I) 5,000 — 10,000 GIS Ft.GIs/sooSize Setback To Nearest Well Ft.7o R-Ft.Type IIType I /03L (27) Rapidly Permeable(20) Trench, Rock Ft.90 R-Setback To OHWL(28) Flood Plain(21) Trench, Gravelless (jS)Trench, Chamber (29) Privies J/J-Ft.Ft.Setback To Bluff(30) Holding Tank ( ) Monitoring/Disposal Contract (23) Seepage Bed (24) Mound Ft.Ft.30Setback To Dwelling (25) At Grade Type III Setback To Non-Dwelling Ft.Ft.Ft.(31) Other/Problem Soils/<12“ Soil(26) Greywater /O^/O-f- Type IV Setback To Nearest Lot Line Ft.Ft.fc(32) Public Domain & Proprietary TechnologiesD^lh of Well .Sr\aHr>iA > Total # Bedrooms Setback To Road Right-Of-Way Ft.4SXX-Ft.Type V a (33) Performance Elevation Above Restrictive Layer Ft.3-f- Ft.Y / (g)Garbage Disposal Y / ^Abatement PERC TEST DATA De-csigner Agreemelft: The undersigned hereby n^es application for permit to install, alter, repair or extend Sewage Treatment System herein specified, agreeing to do all such work in strict accor­ dance with Sanitation Code of Otter Tai County, Minnesota. Applicant agrees that the Site Data Worksheet submitted herewith and which is approved by a Land & Resource Management Official 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 approved for use. It shall be the responsibility of the applicant for the permit to notify Land & Resource Management that the installation is ready for inspection. 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 Sanitation Code of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of the Sanitation Code. NOTE: t.This permit Is valid for a period of six (6) months. 2.This permit does not include the building sewer (sewer line). //-Qg?Highest RateDate of TestLicense # / 7o /V7/97 Permit Fee $Date: feature of Property Owner/Ageanor Owner Date:Rec. No., Lana& Resource Man^ement Office Comments: Form No. BK — 0209-003 335.612 • Victor Luncteon Co.. Printort • Fergus Falis, MIrtnssoU APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM - LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095) GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 www.co.otter-tail.mn.usWHITE - Off'te YELtOW - L & R Inspector PINK - Owner / Contractor (after issue) Permit No. /APPLICATION MUST BE COMPLETE IN ORDER TO BE PROCESSED TWP NAMETWPNO.RANGESECTIONLAKE/RIVER CLASSLAKE/RIVER NAME l^..- r.xi P/^CEL NUMBER (S) OF PROPERTY B^ING SERVICED '~}L(^00\"'y.>0^\0 oo\___________ LAKE NUMBER 2Q V , l.-i ^I h 1 'J-jr-. \ ^ w E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROAD r V.L.C \Nt LEGAL DESCRIPTION ? •CLC- 'r' i 1 \ ^ ^ u -rr\ >. » Daytime Phone No.Initial Mailing AddressFirstLast Name r«(n ^\Jf. y VkY-_\ 'VttV'vr^ Property Owner l'\YP S, \'\h d"ii B iot Co VIr Vyrrt \7a-Vt y vno trContractor Lie.# '0 THIS SPACE FOR OFFICE USE ONLY /:oo‘YYXcla^. (p ^P.M. ^, the year of at>■ This System will be ready for inspection on /JU)^^O (k^ Time Received ^ 5-L -O?P.M. L & R OfficialDate Received SEWAGE TREATMENT SYSTEM DESIGN DATA AS SHOWN ON DRAWING TYPE OF NSTALLATION (circle one) Other Est. (E) New (F) Replacement CollectorResidential (A) New (B) Replacement (C) New (D) Replacement Soil Treatment Area Tank Lift Effluent Distribution ( Gravity ( ) Pressure Design Flow (Gallons/Day) (QL'' 1 — 2,499 (H) 2,500 — 4,999 (I) 5,000 — 10,000 ' GIs Ft.GIs/OOPSize Setback To Nearest Well Ft. Ft.Ft.Type IIType I (27) Rapidly Permeable(20) Trench, Rock yvFt.Ft.90Setback To OHWL(28) Flood Plain(21) Trench, Gravelless (22|Trench, Chamber (29) Privies Ft.t Ft.Setback To Bluff(30) Holding Tank ( ) Monitoring/Disposal Contract (23) Seepage Bed v/,-' . !(24) Mound Ft. Ft.Ft.Setback To Dwelling 3-0 *s \I (25) At Grade Type III Setback To Non-Dwelling Ft.Ft.Ft.(31) Other/Problem Soils/<12" Soil(26) Greywater Type IV Setback To Nearest Lot Line Ft.Ft.i Ft.(32) Public Domain & Proprietary Technologies Depth of Weii I Setback To Road Right-Of-Way Ft.- .'cCw- Ft.Ft.Type VTotai # Bedrooms (33) Performance<r*-Elevation Above Restrictive Layer Ft.Ft.Ft.'T^Abatement Y / ,fJ;Garbage Disposal Y / PERCTEST DATA Designer /'n 5~- /'09 Highest RateLicense #___CZ.Date of Test Agreement: The undersigned hereby tjwrkes application for permit to install, alter, repair or extend Sewage Treatment System herein specified, agreeing to do all such work in strict accor­ dance with Sanitation Code of Otter T^il County, Minnesota. Applicant agrees that the Site Data Worksheet submitted herewith and which is approved by a Land & Resource Management Official 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 approved for use. It shall be the responsibility of the applicant for the permit to notify Land & Resource Management that the installation is ready for inspection. 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 Sanitation Code of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of the Sanitation Code. NOTE: I.This permit is valid for a period of six (6) months. 2.This permit does not include the building sewer (sewer iine). K-Permit Fee $ f ^Date: j^^;^gna^re of Property^'Ovmer/Agaqf^ O^er / 9 1/9 9Rec. No..Date: Land & Resource Management Officei Comments:i1 X Form No. BK — 0209-003 335.612 • Victor Lundeen Co.. Printers • Fergus Fails, Minnes^ SEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTS Inspector must make all measurements kr SOIL TREATMENT AREA HOLDING SEPTIC TANK OUTHOUSELIFT TANKCATEGORY loco GLS.Capacity FT® FT®GLfS. 7'' FTloHFTFTFTSetback from Nearest Well I04' FTSetback from Buried Water Suction Pipe FTFTFT Setback from Buried Pipe Distributing Water Under Pressure 16+ FT )0+FT FT FT ^5" ftSetback from OHWL (lake &/or river)FT FTFT Setback from Setback from Bluff FT FT FTFT •±30'Setback from Dwelling FT FT FTFT ISb')5b'Setback from Non-Dwelling FT FTFT FT -f-}0CX^ FT)COSetback from Nearest Property Line FTFTFT /tx5t ftICO^ ft FTSetback from Right-of-Way 3"FTElevation above Restrictive Layer FT FTFT Holding Tank/Lift Alarm YES Old System Pumped & Destroyed ■YE& TRENCH REDUCTION H'.qVv Cc* now tronoh SOIL TREATMENT AREA CALCULATION MOUND / AT-GRADESEPTIC TANK(s) # Tanks, Installed FILTER tWj.'K\Uv5ROCK BED to. incheses-with □ YES of sidewall for___tP^Manuf.%Ft. Ft.Ft. XSC ,fpreduction / equivalent to Soil Treatment Area. Model #Ft*Ft*lOno r Inspector's Comments: Sketch: Ll u HZ m I /<k/ WLI)7^ J}n'^ oufa \ lu / CX> Initial/L & hofftdal the above described sewage system installation was found to be compliant with the provisions of the SanitationAs of Code of Otter Tail Couhty. f }nt OfficialLand & Resourc Form No. BK — 0209-003 336.656 • Victor Lundoon Ca. Printan • Fargus Fade. Mlnnasota SITE DATA WORKSHEET s , 'NLAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 ' '■ 218-^998-8095 ' ' www.co.otter-tail.mn.us ■ Sewage Treatment System Permit #OWNER: YYAfi rdo V"_______: LAST NAME ADDRESS: \<^n STR./RT. % MIDDLE TELEPHONE NUMBERFIRST I iUV,\V nnA t ZIP CODESTATE :t‘9Lo-[<, t m(\:Jrr. TLVP.'^NAMEIBANGE, TWPSEC.LAKE/RIVER NO.LAKE NAME i SOIL BORING LOGLEGAL DESCRIPTIOM:! % (iJU foAir bL3 ; COLOR &Munsell no.i DEPTH (INCHES)STRUCTURETEXTURE.;\I 7oy(?BLOCKY PLATY PRISMATIC I■( \ 500 ^ 6 CbO \I 0-/0i I ■,gMeNpPARCEL NUMBER BLOCKY PLATY PRISMATIC I E-911 Address or Directions From Nearest Public Road Ii !;I ! «>V/? 3^ NUMBER OF BEDROOMS GARBAGE DISPOSAL: YES | ^ j WELL: CASING DEPTH SEWER LINE SEPARATION: .^3) ft. FLOODPLAIN: YES vNo) ; BLUFF: YEsJ ~ "1 i VEGETATION: AQUATIC CLER^TrI^ SLOPE AT INSTALLATION SITE:} BLOCKY ! PLATY ; PRISMATIC ; ;i !/!«iy4 BLOCKY PLAT-Y - : PRISMATIC} 4101^ I !I — I !!Ii !!BLOCKY PLATY : PRISMATIC NONE i% I :TYPE OF OBSERVATION: Probe | Pit, gSem^. PARENT MATERIAL: <X^ Outvtash ORIGINAL SOIL: ^ COMPACTED SOIL: Yes (go) | DEPTH OF BORING (To 7' or Loess Bedrock ! Ailuyium :I [ <-/ -g>?Date of Soil Boring.No !t1 restrjctive layer):_____^(<g~-/ - 09 PERC TEST #2 ft.Date of Perc Test !PERC} TEST #1 - nvo TESTS ARE REQUIRED -if WATER DEPTH WATER DROP PERC RATETIMEINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)■ i ~Cr • ~D^ ]STARTSTART c•TIME ' ' DROP PERC:rr .c:e...ST. !WATER DROP PERC RATEINTERVAL (MINUTES)WATER DEPTH I WATER DEPTH WATER DROP I PERC RATE TIMETIMEINTERVAL (MINUTES)!?!REFILL•'^1 fTlME * DROP PERC !....;z:ir:s:.TIME PERC!DROP INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATETIMEWATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES!1 Z.!..r......REFILL REFILL1^.4^ =1^! PERC 1 PERCTIMEDROP(TIME •DROP TIME WATER DEPTH WATER DEPTH WATER DROP PERC RATEINTERVAL (MINUTES)WATER DROP I •PERC RATE TIME INTERVAL (MINUTES))REFILLREFILL[• TIME PERCPERCDROP.-TIME DROP PERC RATETIMEINTERVAL (MINUTES)WATER DEPTH WATER DEPTH WATER DROPWATER DROP t PERC RATE TIME INTERVAL (MINUTES)REFILLIREFILLj PERCTIMEDROPTIMEDROPPERC TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEWATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)IREFILL REFILL PERCTIMEDROPPERC(TIME DROP TIME WATER DEPTH WATER DROP PERC RATEINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES!REFILLREFILL s PERC• TIME DROPPERC ■TIME DROP TIME INTERVAL (MINUTES)WATER DROP PERC RATEWATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTHREFiaREFILL PERCTIMEDROPTIMEPERCDROP PROPOSED DESIGN: TRENCH >r BED.A:PRESSURE DIST..ATGRADE.HOLDING TANK. SPECIFY:____ — SYSTEM DESIGN ON BACK — GRAVITY DIST.MOUND. SEWER LINE.OUTHOUSE.OTHER. T ■ -t. System design must be to scale arid must include the proposed location; of the sewage system, all existing/pfoposed buildings, property lines, the ordinary high water level of the water body, wetlands, ; bluff and all water wells within 150' of the sewage system. If there are any questions, see,the University of Minnesota Site Evaluation worksheets. \.grid(s) equals /^Scale:.feet, or Jnch(es) equals feet ;:S !MPCA LICENSE #: ■ LICENSE CATEGORY: I DATE: - DESIGNED BY: \ n vP'mio (\gyr FIRM NAME: fyTMffifri ADDRESS: I ft J SIGNATURE: 1 1!1 L )i*!! f ( :! “ /K \I t ;!‘ :i (tpiiI4 1 !■; (<fof 9 uctfTk-jje^PI^«-—C*g».yacr )i TT!1 ••r[I i [ !iI !:i i \ \II\\!\\. -.44 ; f i i i ; i'; ;i i BK — 1003 — 029 315,904 • Victor Lundeen Co.. Printers •. Fergus Falls. MN • 1-800-346-4870i SITE DATA WORKSHEET*>LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 218-998-8095 www.co.otter-tail.mn.us 3^/73Sewage Treatment System Permit #OWNER: rAa rici V % TELEPHONE NUMBERMIDDLEFIRSTLAST NAME ADDRESS: STR./RT. uV.sV A cIty U 5amZIP CODESTATE LAKE NAME riW NAMERANGESEC. TWP.LAKE/RIVER NO. LEGAL DESCRIPTION: (iJL’ Poij& bL3 (0Y\0 VL^ SOIL BORING LOG COLOR & MUNSELL NO. DEPTH (INCHES)STRUCTURETEXTURE• » > BLOCKY PLATY PRISMATIC ,;Newp BLOCKY PLATY PRISMATIC ^nI^ BLOCKY PLATY PRISMATIC \ ^ 6 OO \ PARCEL NUMBER V fo~ 3^e»V/vE-9H Address or Directions From Nearest Public Road 3^ro'litNUMBER OF BEDROOMS GARBAGE DISPOSAL: YES ^ WELL: CASING DEPTH SEWER LINE SEPARATION: ^2 ft. FLOODPLAIN: YES tNq) BLUFF: YES VEGETATION: AQUATIC CL^RESfm^ SLOPE AT INSTALLATION SITE: <3. 5A /oY4-BLOCKY PLATY PRISMATIC w-?*/ BLOCKY PLATY PRISMATIC NONE % TYPE OF OBSERVATION: Probe Pit cSyTii^ PARENT MATERIAL: ORIGINAL SOIL: No COMPACTED SOIL: Yes Outwash Loess Bedrock Alluvium Date of Soil Boring. c 'y ft.~ 09_________ PERC TEST #2 DEPTH OF BORING (To 7' or restrictive layer):.Date of Perc Test PERC TEST #1 - TWO TESTS ARE REQUIRED - PERC RATEWATER DEPTH WATER DROPINTERVAL [MINUTES)PERC RATE TIMEWATER DROPWATER DEPTHINTERVAL (MINUTES)TIME J................ START Cs^T 4Xz .is:.o Cx DROPTIMEDROPPERCTIME PERC RATEWATER DEPTH WATER DROPTIMEINTERVAL (MINUTES)WATER DROP PERC RATEWATER DEPTHINTERVAL (MINUTES)TIME ?REFILL .X.yc......s:.PERCTIMEDROPPERCTIMEDROP PERC RATEWATER DEPTH WATER DROPTIMEINTERVAL (MINUTES)PERC RATEWATER DROPWATER DEPTHINTERVAL (MINUTES)TIME ZREFILLREFILL -?oCc-miT • 4^zz^:...PERCPERCDROPTIME PERC RATEWATER DEPTH WATER DROPINTERVAL (MINUTES)TIMEWATER DROP PERC RATEWATER DEPTHINTERVAL (MINUTES)TIME REFILLREFILL TIME DROP PERCTIMEDROPPERC PERC RATEWATER DEPTH WATER DROPINTERVAL (MINUTES)TIMEWATER DROP PERC RATEWATER DEPTHINTERVAL (MINUTES)TIME REFIUREFILL PERCTIMEDROPDROPPERCTIME WATER DROP PERC RATEWATER DEPTHINTERVAL (MINUTES)TIMEWATER DROP PERC RATEWATER DEPTHINTERVAL (MINUTES)TIME REFILLREFILL PERCDROPTIMEDROPPERCTIME PERC RATEWATER DEPTH WATER DROPINTERVAL (MINUTES)TIMEWATER DROP PERC RATEWATER DEPTHINTERVAL (MINUTES)TIME REFILLREFILL PERCTIMEDROPTIMEDROPPERC PERC RATEWATER DEPTH WATER DROPINTERVAL (MINUTES)TIMEPERC RATEWATER DEPTH WATER DROPINTERVAL (MINUTES)TIME REFiaREFia PERCDROPTIMEDROPPERCTIME PROPOSED DESIGN: TRENCH BED.A:PRESSURE DIST..GRAVITY DIST..HOLDING TANK.MOUND.ATGRADE. SPECIEY:.OTHER.OUTHOUSE.SEWER LINE. — SYSTEM DESIGN ON BACK — System design must be to scale and must include the proposed location of the sewage system^ all existing/proposed buildings, property lines, the ordinary high water level of the water body, wetlands, bluff and all water wells within 150' of the sewage system. If there are any questions, see the University of Minnesota Site Evaluation worksheets. grid(s) equals jnch(es) equals feetfeet, orScale: MPCA LICENSE #: ^ YQI LICENSE CATEGORY: DATE: __________ DESIGNED BY: \ r. vPmto (Vi FIRM NAME:?Xur^J^ f^Criiia ADDRESS: fcs _______\^\V\ V r SIGNATURE: -—r-A i I ^73 Jo"]■$! <t<^ 1^ -i—> V'UcW —opy \,r ’1'^^4—- ;<fV \ BK — 1003 — 029 315,904 • Victor Lundeen Co., Printers «. Fergus Falls. MN • 1-800-346-4870 ^ FILE MEMO PARCEL # Odf) 00^000J LAKE/RIVER/WETLAND NAME PROPERTY OWNER I0l^9lndDate L&R Official I'jtAJ tuJU^ H>jt^X)4^aJu^'tn UHth P%- fHddi/tJ Arsi ^i- Juj/v!/ Action/Comments. Ma/ryiM/O; ////i. UUiAut} 'ZSmw pdMjMj. hH^/AJJy MflDateL&R Official Action/Comments. f2^ ': C^-CW.S'Tt'i ^ SfjjSUL^ Yjic ■irflL<^t/i^Tu>,J ^ \t\t\JtD Uj/i-l j ^ rJfir rpc /f © Di>Lu £T^u Date Mavis SamuelsonFebruary 20, 2009 Spoke with Laremie Barry today by phone regarding Peter Doll et al (Gregory & Rose Mader) property (cluster) which they are constructing a new dwelling on. He stated that Mr. Mader had told him that I had stated that they needed to install the septic system before our offiee would issue them a Site Permit for the new structure.I find no file memo notes on file (1 always try to make notes for anything that would affect the issuance of the permit in case someone other than me is reviewing/issuing the permit). After reviewing their proposed plans and discussing this with Marsha B. & Eric B., we can find no why this would be required. There is an existing Sewer Permit for a system which appears to service the existing RV and existing garage (RV is self-contained per note on Site Permit #13286) and they plan installing a new system to service the new dwelling. Should the existing garage/shelter be used/become a dwelling than we would require them to increase the size of the system to accommodate both the RV and the garage/shelter as the existing system is only for 2 “ bedroom dwelling (the minimum system allowed for a dwelling is a 2 bedroom system). I informed 9 Laremie of this today by returning a call to him at his cell number. 9 Action/Commer reason on ia L&R OfficialDate. Action/Comments. L&ROfTidalDate. Action/Comments. L&R OfficialDate. Action/Comments. L&R OfficialDate Action/Comments. SEWAGE SYSTEM m 15 th day of December 19 95This certificate has been issued this to certify that the sewage system installed as per sewage permit number indicated below has been approved for usemby Otter Tail County, Minnesota. ml The premises covered by this certificate are legally described as: Lake No. 56-212/TR 15 Twp. 135 Range 39B,Twp. Name Rush LakeSec. 15 135 39 8.81 Acres0 Ft of GL 2 i Peter Doll Et A1Owner: NameK^l'i Address 6720 20th Ave. South Fargo, ND 58104Zip No. 10441Permit No. SP Signed by: Lund & Resource Management Ofriciu) Oiler Tail County, MinnesotaMKL-0987001 Vt a.-\ JT*263191 Victor Lundecn Co.. Primers, Fergus Falls, Minnesota 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 \ QL. Sk.Permit No.LEGAL DESCRIPTION AND LOCATION RANGE TWP NAMESECTIONTWP. NO.LAKE/RIVER NAME LAKE/RIVERLAKE NUMBER 6o 5 /C /Cu-S 4/3S^S(p ?-i X /S FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER(S) ooo- j^~oo^o - oo / IDENTIFICATION; Please Print All Information Zip CodeMailing Address — No. Street, City and State Telephone No.Last Name First Initial ^ ~7.?0 ‘ ^ V \P_____ doLLProperty Owner 0 d j/u i6cfSewage System Installer Name A.M. P.M.This System will be ready for inspection on , 19.at This space for office use only NUMBER OF BEDROOMS: A.M. P.M19 (^) NOGARBAGE DISPOSAL: ( ) YESPhone Call Rec'd ByTime Rec'dDate Rec'd SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) (^ ) Septic tank ( ) Lift station ( ) Drain field ( ) Standard ( ) Bed Cy) Trench ( ) Modified ( ) Mound ( ) Outhouse TANK DRAIN FIELD //rrro GIs.Capacity Ft. Jt)Ft. Ft.Distance from nearest well 7T Ft.Distance from lake or stream Ft. yo/>o/oDistance from building Ft.Ft. 7 QJODistance from property line Ft. Ft. Ft.Distance from bottom to Water Table Ft. EFFLUENT DISTRIBUTION (^) Gravity ( ) Pressure All distances are shortest distance between nearest points PERCOLATION TEST DATA: WATER WELL DEPTH j\j eJ> (A^^ ^77 OclaJ /!>Perc Tester.Date of Perc Test / ?/■ ?/■ YRate of 1 St Test Rate of 2nd Test Average 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. Lf- ^9DATE: 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. Issued Date: Land & Resource Management Office3 S'-.Fee $.Rec #. Comments: 272.858 • Victor Lundeen Co.. Printers, Fergus Falls. MinnesotaPorm Mo. BK-0894003 *f- :>o "»ir |,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 sPerrnit No./o\yy /Cl XLEGAL ' DESCRIPTION AND LOCATION TWP NAMERANGELAKE/RIVER CLASS SECTION TWP. NO.LAKE/RIVER NAMELAKE NUMBER So 3 /L /3T//9 /S5G'7> X FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER(S) 5 3 ■- ooo' IK- oo / IDENTIFICATION; Please Print All Information Mailing Address — No. Street, City and State Zip Code Telephone No.First InitialLast Name A/P(ui U /jDqLL~7JC>* /TProperty Owner TU iP ho)l)o /t f< ySewage System Installer Name at J S ~^0 <el^A.M.y- yo► This System will be ready for inspection on , 19. This space for office use only NUMBER OF BEDROOMS: NOGARBAGE DISPOSAL: ( ) YESPhone Call Rec'd ByTime Rec’dDate Rec’d SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) (y) Septic tank ( ) Lift station ( ) Drain field ( ) Standard ( ) Bed Cy^) Trench ( ) Modified ( ) Mound ( ) Outhouse TANK DRAIN FIELD /irtro GIs.Capacity Ft.Ft.Distance from nearest well 5^ 3r7C Ft.Ft.Distance from lake or stream yp/^ o/o Ft. Ft.Distance from building 7 6^Ft. Ft.!0Distance from property line >Distance from bottom to Water Table Ft. Ft. EFFLUENT DISTRIBUTION i^) Gravity ( ) Pressure All distances are shortest distance between nearest points PERCOLATION TEST DATA: WATER WELL DEPTH tL. t CCn Oo/U Jh C( y( y 5-/9- 9rPerc Tester,Date of Perc Test. / 7a/Rate of 1st Test_Zi Rate of 2nd Test Average 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 irtspectlon. (c/^A')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. / LJ Issued Date: Land & Resource Management Office Fee $____ J^^Comments: Rec #. 272.858 - Victor Uirtdeon Co.. Printers. Fergus Fells. Minrtesotevm No. BK-08S4e03 r INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS Tr SEPTIC TANK DRAIN FIELD CATEGORY Actual Mlnimuni Actual Minimum /<rtr^^0 y SFCapacityGLS. GLS.SF IM 11.'*^jao FTDistance from Nearest Well FT FTFT50 Distance from Buried Water Suction Pipe FT FTFTFT 5050 Distance from Buried Pipe Distributing Water Under Pressure FT FT FT 10 FT10 ! (TO-K ft FTDistance from Lake or River (OHWL)FT Distance from Nearest Building 10/20 FTFT10 tO '^3 ft FTFTDistance from Nearest Property Line FT 10 10 FT FT FTDistance from Bottom to Water Table FT 3 YES NOHolding Tank/Lift Alarm DRAINFIELD CALCULATIONSewer Line to Well SeparationINTERPRETATION OF ABBREVIATIONS GLS. = Gallons SF = Square Feet FT = Linear Feet H w'Actual Minimum 7 .FTFTX V __SFFTFT20 Inspector’s Comments: SKETCH: A 1 rJe- 0m0 / " V 2M-Inspector's Signature A/' ^ V Date of Inspection IH/O ^ Time of Inspection Department of LAND & RESOURCE MANAGEMENT,• ■ COUNTY OF OTTER TAIL Phone: (218) 739-2271 Court House FERGUS FALLS, MINNESOTA 56537 • ■V ■/ i Pe /lO a f(> IfLo S, : Inspection on Sewage System Pennit # /Lake # 3 ^ run ^r/O^ RE: This is Co inform you that an inspection was made on the above mentioned Pennit. At that time we could not complete the inspection and certify the sewage system for the following reason(s): .___There was not a visual alarm on the lift station. ___There was not an alarm on the holding tank. ^ There was not a dwelling onsite. ___The non-conforming sewage system had not been destroyed. There was not a well onsite. ___The Installer had not completed the air test. ___Our office has not received a letter from the Twp, allowing the sewage system to be from the road right-of-way. ___Our office has not received a letter from the neighbor allowing the sewage system to be less than 10 feet (___feet) from the lotline. V feet Please contact oiu: office for a reinspection of your sewage system when the problem is corrected. Certification of the sewage system can not occur until this matter is resolved. Inspector LTR.SEWAGE;SYSTEM.INSPECnON071594 *PERCOLATION TEST DATA LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, MN 56537 OWNER: IaI '?ol ^77 -/2-~73 TELEPHONE NUMBERMIDDLEFIRSTLAST NAME ADDRESS: A/DCi'lZivi g?o AJf ^ STATE ZIP CODEClSTR./RT. e/'rX 3^ RANGEM-'dKE NAME TWP. NAMESEC.TWP.LAKE/RIVER NO. LEGAL DESCRIPTION: //9Yfr <5^9 ^loc/o/$ dos^o-OO i PARCEL NUMBER ANUMBER/BEDROOMSFIRE NUMBER — TWO TESTS ARE REQUIRED — TEST HOLE NO. 2TEST HOLE NO. 1 Depth To Bottom of Hole p? ^ail inchesinches; Diameter of Holeinches; Diameter of Hole inchesDepth To Bottom of Hole f /f A^ r-t / /J 19>9^Date DateDepth, Inches Soil Texture Soil TextureDepth. Inches TofO 5q///ci//) So 'if0 - (c Percolation Test By Firm Name Percolation Test By. Firm Name o~>^ 6?'-a,Arc // AIc'ctT/L^l_33UhP'_M.Address Address Otter Tail County License No. Otter Tail County * ,License No. <0 Lc> C APo^o PERC TEST # 2PERC TEST # 1 PERCRATB TIME imBRVALfMpnnBS)Water depth WATER DROPWATER DROP PERC RATEPTTERVALfMIWIfrBnWATER DEPTHTIME ■ly...(ip.:...ini STARTSTART.Qi.....YC......ZLEd..JO.____—O-SizziU TlMli PERC TIME INTERVAL rMPfUTBS)WATER DROP PERC RATH WATER DEPTH WATER DROP PERC RATEINTERVAL (MlNUTBa WATER DEPTHTIME 3^0 REFILLREFILL 'iiMM • bft6t» <»aRC . /A■3t£o ?!£l J.£'flMB}/YL ■J PERC Rate TIME INTERVAL rMINUTHS)WATy DEPTH WATER DROPWATER DEPTH WATER DROP PERC RATEINTERVAL ObimUTBSI REFILL TIME .3^ ‘33o_ REFILL .../.Q......A.%. TIMB DROP PERC ..5:rv--PBl/c:/d ....3.t^.......i.l/i(..... TIME WATER DEPTHWATER DRCff PERC RATH INTERVAL (MIWTESI WATER DROP PERC RATEINTERVAL IM1NUTB5I WATER DEPTHTIME REFILLREFILL 4 T YIMB lC>ttbt» PbAC 'rtMB DROP PERC PERC RATE TIME INTStVALtMINinES)WATER DEPTH WATER DR^WATER DROP PERC RATEINTERVAL (MPn/TBSl WATER DEPTHTIME REFILLREFILL •P ■f 'HMU DROP t»ERC 'ilMti DROP PERC PERC RATE TIME INTERVAL IMINUTBS)WATTO DEPTH WATER DROP PERC^TBINTStVALfMINUTBSTWATER DEPTH WATER DROPT1I.C REFILLREFILL 4 ▼nMK' DROP PERC“'nMK' DROP PERC PERC RATE TIME INTERVAL (MTNUTByi water DEPTH WATER DROP PERC RATEPnSRVALO>gNUTES>WATER DEPTH WATER DROPTTMB REFILLREFILL i 'I'lMti DROP PERC TIMM DROP PERCTIMEPERORATEINTERVAL TMINUTESI REFILL WATER DEPTH WATER DROPINTERVAL IMIWUTSn WATER DEPTH WATER DROP PERC RATETIME REFILL V T TIME * DROP PfeRC TIME DROP PERC 1‘H0COMMENTS/CALCULA TIONS: MKL — 0390 - 005 250,815 — Victor Lundeen Co., Printers, Fergus Falls. Minnesota 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 right-of-way, lake and sideyard for each building currently on lot and any proposed structures. \ \ u: X rV- 1 S’V Cf X V.'\ 1^ s V \