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Home My WebLink AboutElks Point_13000040018000_Septic System Permits_5 Department of LAMD RESOURCE MANAGEMENT OTTER TAIL COUNTY iGOVERNMEtsIT SERVICES CENTER - 540 WEST FiR Fergus Fau_s, MN 56537 Ph: 218-998-8095 Otter Tail County’s WEBSITE: www.co.otter-tail.mn.us June 23, 2009 Fergus Falls Lodge No 1093 PO Box 1046 Fergus Falls, MN 56538-1046 Sewage Treatment System Servicing Tax Parcel Number 13000090052000 Described as PT GL 8 .LYING WLY LN COM El/4 COR SEC 9, N 2644.47' TO NE..., Section 09 of Dane Prairie Township, Wall Lake (56-658) RE: As of 06/22/09, the sewage treatment system (Sewage Treatment Installation Permit #20276) servicing your property was determined to be in compliance with the provisions of the Sanitation Code of Otter Tail County for a 2 Holding Tanks servicing 28 Campers. If you have any questions regarding this matter, please contact our office. Sincerely, Scott Ellingson Inspector APPLICATION FOR PE IIT TO INSTALL SEWAGE " zATMENT 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 PINR- Owner / Contractor (after issue) Permit No.APPLICATION MUST BE COMPLETE IN ORDER TO BE PROCESSED TWP NAMERANGETWP NO,LAKE/RIVER CLASS SECTIONLAKE/RIVER NAMELAKE NUMBER /3a 0<a./? e. Pro.9o E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROADPARCEL NUMBER (S) OF PROPERTY BEING SERVICED !3 oryDcD <000 LEGAL DESCRIPTION PF LiL i4- Daytime Phone No.Mailing AddressFirstInitialLast Name S LiesProperty Owner Fla^/5> rmiJ fS/of.3 7 3 iTir A<je. P.Contractor Lie.# _____________<5^63 7no THIS SPACE FOR OFFICE USE ONLY A.M. P.M., the year of at.>■ This System will be ready for inspection on A,M. P,M, L&R OfficialTime ReceivedDate Received SEWAGE TREATMENT SYSTEM DESIGN DATA AS SHOWN ON DRAWING TYPE OF INSTALLATION (circle ONE) Other Est. New Replacement CollectorResidential (A) New (B) Replacement g(C) New (D) Replacement Soil Treatment Area Tank Lift Effluent Distribution ( ) Gravity ( ) Pressure Design Flow (Gallons/Day) (G) 1 — 2,499 (H) 2,500 — 4,999 (I) 5,000—10,000 ___ GIs ____.Ft.I5o0 Mu.g TAk)< >ySize /Setback To Nearest Well 390 Ft.Ft.Ft.Type IIType I (27) Rapidly Permeable(20) Trench, Rock ./■t. ■t.Setback To OHWL(28) Flood Plain(21) Trench, Gravelless (29) Privies ((3^)HoldingTank ( ) Moniloring/Disposal Contract (22) Trench, Chamber Ft.Ft.Ft./Setback To Bluff MoiU(23) Seepage Bed /(24) Mound Ft.Ft.SCO ■t.Setback To Dwelling Type III(25) At Grade Setback To Non-Dwelling Ft.■t.(31) Other/Problem Soils/<12" Soil(26) Greywater Type IV Setback To Nearest Lot Line iX a Ft.Ft. (32) Public Domain & Proprietary TechnologiesDepth of Well Setback To Road Right-Of-Way Ft.Ft.Type VTotal # Bedroomc 2^ CAryiPens Abatement Y /(N^ (33) Performance Elevation Above Restrictive Layer Ft.•t.Garbage Disposal Y / N PERCTEST DATA ^OulJ I License # Highest Rate ^Date of TestDesigner Agreement: The undersigned hereby makes application for permit to instali, aiter, repair or extend Sewage Treatment System herein specified, agreeing to do ali such work in strict accor dance with Sanitation Code of Otter Tail County, Minnesota, Appiicant agrees that the Site Data Worksheet submitted herewith and which is approved by a Land & Resource Management Officiai shaii become a part of the permit. Applicant further agrees that no part of the system shail 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 line). Slg^ure of Property Owner/Agent tor Owner Permit Fee $Date: Land St Hesou^ Management Office 7Rec. No..Date: Comments: Form No. BK — 0209-003 335,812 • Victor Luncteen Co., Printers * Fergus Falls, Minnesota APPLICATION FOR PE IT TO INSTALL SEWAGE ' ZATMENT SYSTEM ^ LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (Z18-998-8095) 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)r. Permit No.APPLICATION MUST BE COMPLETE IN ORDER TO BE PROCESSED RANGE TWP NAMELAKE/RIVER CLASS SECTION TWP NO.LAKE NUMBER LAKE/RIVER NAME OcX/7C. Pro./^/g>} 4G- OU)riJi PARCEL NUMBER (S) OF PROPERTY BEING SERVICED E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROAD !3 non LEGAL DESCRIPTION PF inL Ifi l:iL <8 4 Daytime Phone No.Mailing AddressLast Name First Initial On9yO B\ic.^ Po/icf" P PV. /X-Q < y S y / J5> rr~t rJ_____ _________________^ 7 Property Owner 3 P'A// JTX//V. -__________________ L i r y4-r y<L,Contractor Lie.# no THIS SPACE FOR OFFICE USE ONLY , the year of at.>• This System will be ready for inspection on Atm L & R Offidal 0?A.M. Time ReceivedDate Received SEWAGE TREATMENT SYSTEM DESIGN DATA AS SHOWN ON DRAW NG TYPE OF NSTALLATION rc/RaEO/VE; Other Est.Residential (A) New (B) Replacement Collector (C) New (E) New (D) Replacement i^F} Replacement Soil Treatment Area Tank Lift Design Flow (Gallons/Day) (G) 1 — 2,499 (H) 2,500 — 4,999 (I) 5,000 — 10,000 Effluent Distribution ( ) Gravity ( ) Pressure GIs ___Ft.GIsQ. T4Kik I5ooSize /Setback To Nearest Well ..Ft.330 Ft. Ft.Type IIType I (27) Rapidly Permeable(20) Trench, Rock J5^^Ft.-~Tt.— Ft.Setback To OHWL(21) Trench, Gravelless (28) Flood Plain (22) Trench, Chamber (29) Privies ____ Ft.Ft.Ft.Setback To Bluff zf30)Tfolding Tank ( ^ ( ) Monitoring/Disposal Contract (23) Seepage Bed / , (24) Mound ___Ft.Ft.Ft.Setback To Dwelling GOu(25) At Grade Type III Setback To Non-Dwelling /Ft._ Ft.(31) Other/Problem Soils/<12" Soil(26) Grey water 1/Type IV Setback To Nearest Lot Line ____ Ft.Ft.(32) Public Domain & Proprietary Technologies Depth of Well Setback To Road Right-Of-Way ,__ Ft.Ft.Type VTotal It Bedrooms 9 (33) Performance Elevation Above Restrictive LayerAbatement - Ft.--------ft.Y /;N,5 Garbage Disposal Y / N 1 PERCTEST DATA n n m n r' License #Highest RateDate of TestDesigner Agreement: The undersigned hereby makes 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 Tail 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 vaiid for a period of six (6) months. 2.This permit does not inciude the buiiding sewer (sewer iine). i^n.or>Permit Fee $Date: Signature of Property Owner/Agent for Owner t A'!Liyi£y, Land & Resound Management Office Rec. No..Date; Comments: Form No. BK — 0209-003 33S.612 • Victor Lundeen Co.. Printers • Fergus Falls,isota SEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTS Inspector must make all measurements (HOLDING J SEPTIC TANK SOIL TREATMENT AREA OUTHOUSELIFT TANKCATEGORY Capacity FT2 FT23000 GLS.GLS. FT FTFTFTSetback from Nearest Well Setback from Buried Water Suction Pipe FTFTFTFT Setback from Buried Pipe Distributing Water Under Pressure FTFTFT FT FTSetback from OHWL (lake &/or river)FTFTFT Setback from Setback from Bluff FTFT FT FT FT FTSetback from Dwelling FTFT ;cer4 FT FTSetback from Non-Dwelling FT FT FTSetback from Nearest Property Line FTFT FT !o3 FT FT FTSetback from Right-of-Way FT FTFT FTElevation above Restrictive Layer FT Qa2Holding Tank/Lift Alarm NOco: CyeOOld System Pumped & Destroyed NO TRENCH REDUCTIONSOIL TREATMENT AREA CALCULATION MOUND / AT-GRADESEPTIC TANK(s) # Tanks Installed FILTER V, ROCK BED Rock trenches with inches □ YES □ NO Manuf.of sidewall for.,%R. X Ft.Ft. X Ft. reduction / equivalent toModel #\FPFt*Soil Treatment Area. Inspector's Comments: / Sketch: y. 4 V J'AfiO Initial/L a R OfficialTimeDate /■ - y /the above described sewage system installation was found to be compliant with the provisions of the SanitationAs of Code of Otter Tail County. Land & Resource Mana^ment Official Form No. BK — 0209-003 336,656 • Victor Lundeen Co.. Prirtters • Fergus Falls. Minnesota scArreneo nees S 57'25 04 ■» M. /7~^ ■mokup * m»r----—°FoirJafi<jp O Nvrry QpRousd iftnfr fMC -5<§ 1180 i SITE DATA INDIVIDUAL SEWAGE TREATMENT SYSTEM Building and Zoning Office City of Fergus Falls P.O. Box 868,112 W. Washington Fergus Falls, MN 56538-0868 OWNER: LAST NAME FIRST MIDDLE TELEPHONE NUMBER ADDRESS: cJty'^ S'/o STR./RT STATE ZIP CODE ^Q-A)p. Pr<xlM6> TWP. NAMESEC.^23LAKE/RIVER NO.LAKE NAME TWP.RANGE LEGAL DESCRIPTION:SOIL BORING LOG COLOR & MUNSELL NO. DEPTH (INCHES)TEXTURE STRUCTURE BLOCKY PLATY PRISMATIC NONEPARCEL ADDRESS A BLOCKY PLATY PRISMATIC NONE PARCEL NUMBER 0 M()t.rsNUMBER OF BEDROOMS BLOCKY PLATY PRISMATIC NONE(3>GARBAGE DISPOSAL: YES ft.WELL CASING DEPTH:BLOCKY PLATY PRISMATIC NONE FLOODPLAIN: YES NO VEGETATION: AQUATIC TERRESTRIAL BLOCKY PLATY PRISMATIC NONE SLOPE AT INSTALLATION SITE:% TYPE OF OBSERVATION: Probe Pit Boring PARENT MATERIAL: Till Outwash Loess Bedrock iuvlum COMMENTS?! ORIGINAL SOIL: Yes No Vsi_COMPACTED SOIL: Yes No NXDEPTH OF BORING:.ft. PERC TEST # 1 PERC TEST #2- TWO TESTS ARE REQIMRED - WATER DEPTHTIMEINTERVAL (MINUTES)WATER DROP PERC RATE INTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATESTARTSTART TIME DROP ME DROP PERC INTERVAL (M1NU11STIME WATER DEPTH WATER PRO!PERC RATE INTERVAL (MIKUTES)TIME WATER DEPTH WATER DROP PERC RATEXREFIU.REFia TIME * DROP ” PERCTIMEDROPPERC VWTER depth'TIME INTERVAL (MINUTES)WATE/ DROP PERC RATE WATER DEPTHTIMEINTERVAL (MINUTES) WATEiKDROF PERC RATEREFiaREFILL TIME PERCDROP TIME DROP PERCTIMEINTERVAL (MINUTES!WATER OEPTI /ATER DROP PERC RATE TIME INTERVAL (MINUTES!WATER PEP'WATER DROP PERC RATE\REFILL REFia TIME DROP PERC TIME DROP PERC W/^fl droFTIME INTERVALIMINUTESI WATER DEPTH.PERC RATE TIME INTERVAL (MINUTES)WA^R DEPTH WAflR DROF PERC RATEREFiaREFia -----------T _______ =TIME DROP PERC DROPTIME PERCTIWINTERVAL (MINUTES!WATER DROP XWATER DE^TH PERC RATE WATER DROP \TIME INTERVAL {MINUTESI WATER DEPTH PERC RATEREFiaREFia ------ =^---------- sTIMEDROPPERCDROP PERC^EflCTIMEINTERVAL (MINUTESI WATE/^ DEPTH WATER PROPRATE TIME INTERVAL (MINUTESI WATER DEPTH PERC RATEWATER DROP"VREFia REFILL sTIMEDROP PERC TIME DROP PERCTIMEINTERVAL (MINUTES) WATER DEPTH PERC RATEWATER DROP TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEREFiaREFILL TIME PERCDROP TIME DROP PERC PROPOSED DESIGN: TRENCH,BED ATGRApE.MOUND.HOLDING TANK. GRAVITY DIST,PRESSURE DIST, SEWER LINE.OUTHOUSE.OTHER.SPECIFY: — SYSTEM DES/Gni ON BACK — System design must be to s. ^le and must include the propos. location of the sewage system, all existing/proposed buildings, property lines, the ordinary high water level of the water body and -all water wells within 150' of the sewage system. GRID PLOT PLAN feet SKETCHING FORMScale:.grid(s) equals inch(es) equalsfeet, or SorSUBMITTED BY: FIRM NAME: /?^ ADDRESS: y^/V AX)^. ^ SIGNATURE:)fy7nH /9-d>9DATE: /7DMPCA LICENSE #: LICENSE EGORY: I ..Li l_:I: I ;1•;1 IJ .I-.1 i1-I . i•• \\I:!I 1\T I1 - I•i 1-!1 :i..J..1 1’TJ I :;r 1i J —T-----1-111!■1r II. -i I !!T !1Ih-i !:(:•1 i --1-i r I . iIr i :1—J__-----1, r ••iL I•|:•T 1..L.-i ';I I I !ji iI I IrrtT"!I :i Ii i1 I!;:!i'i I Ir—1‘:';n-i 1!!:!1i-.L I i rr :r ■;4 ;1 It :1-J :I , J. ...j... L i IjJ.1•-1' -J-i4 ;r II :I!ITr-! ^ !1II .1i\If-I;■1 ■ r.1 ;I.j* );)I :r !■r i !i 1■ -i-I :I 1 i 11;i. .II-i ’ -i -i4-.1-1 ii-I!i-:1;1 1 ■ i !I L I )■ I1!!-.1 . -.1t -r-;‘I*T It • i r...... 1 i iiII-r I 1:- ■; Ir !;I .J ..;ii Ir-((T ;:i 1 ! ._L..*i..I. ■'T •l1 i r ;:F I — • t—I"1il--E ii} —1 t+-...1 . . 4. ..ii-4-11 1.U.t !;Ir 't- 'I-f-i ;:•• • T !4:T'p i_ — I—'T T i!1 I !I1It4+:1 1 I . !}--1 !1 - :t i;1I!“r"I:xr:r:j4;I 1 ;!!.....IrTI-1J. ;I ;;!!I :L •:fIII-1!?:i L4..J-!f ;■ I'iT :III{ -;1 i .I -Ii[ ■L-1 Ii ;I11i I•i 1-i■ -r- •t : 1 • T ' II ;i Ii uI1 I-----------i. -tL1II!-r !1 I ;1i i 44 ^4;•:T*'r 1:I;f r_l ■; -!-11!IrI I :I-.1- - 4—•r;1i:i ;:■ • 1 ;!; 1 ;;li1']I!' !:■ II r'fi4i-J-:: ..i 1:1‘:::I -------7-i' . -iTi. I !i . Ii ;-rH :i ;■;iIIi l4r•“f •- IT ■f-lit'-■y;i.I- ’!4 !r I i!j4-:;■f-•ir1- r r4-r ■T I I;i 1;‘t t Iii !f-4-r-»-r :4 !;■4'r ;r :I II;^4 ..l-j!1 "“I7:!-4-1 ::I;■ (...L_t r-I 1-Ir I;i t -H-1-I,1I I4 i!:: t :1 I fi'1 i1 -L 1I 1!■ i - iIJ;!!:•i-IT IT1}■11 -i I:!I ;I .4- .7 ”r:iT 1—i71;1-( i I 1I1.;I•J*;;i.4J ;L_.i.I - i -I 1 r4i.'[;ri ! r!'i II-!-4-: i .-1V-T * r11—I I-!I1r-r i i■1 ..L fi I':-L-.|-1T JI44t! ;-Li1 .:-T-'•r-T!IiL 1 i-I JJ!:1 Ir <yw Cv iS pf hm CERTIFICATE OF COMPLIANCE SEWAGE SYSTEM X S'*! fa day of_19.__22This certificate has been issued this 22nd Novetnber to certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota. fil m Um The premises covered by this certificate are legally described as:Wmfern91 m Twp. 132 Range 42 Twp. Name. T)anp Pral rl p3l 25 acres In Government Lot 8 of Elks Point-6:1 mmi6^ rM mOwner: Name.WMElks Clnlx PiAddress_R.R.l,Fergus Falls,Minnesota m Zip No.56531 m2254Permit No. SP_ Signed by.j M^coIm K. Lee, Shoreland Administrator Otter Tail County, Minnesota MKL-087 1-009«!! M&m X?% xfyN @ 159035 VICTO* I.VNatE'l 4 CO. rtlS • 'ALLS. Ul><«% SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 — Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTFM W ite - Office^ V low — lrvspe®tor Ph.. — «0>Aner Card ^Owner LEGAL Date DESCRIPTION G-L-ft “Z cP--er/5rrf=:i AND OjQ ^ /3^I r/gLOCATION Lake Classif.Lake No.Lake Name Sec.TWP TWP NameRange IDENTIFICATION: Please Print AM Information. Last Name First Initial Mailling Address —No. Street, City and State Zip No.Tel. No. / /^rg\ Li S if rjoy i^iK^ CJu.h>%OWNER /^Of>tl) ■ 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 Rac'd By Owner or Agent Signa^ture NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD /4m Sq. Ft.GIs-Sq.yFt.Capacity 6TO Ft.Ft.Ft.Distance from nearest well :^i:i Ft.Distance from lake or stream Ft.Ft.T-Q Ft.Distance from occupied building Ft.Ft. Distance from property line zo20___Ek Ft.Ft. 7 VFt.Ft.Distance from bottom to Water Table Ft. All distances are shortest distance between nearest fioints RECORD OF TESTS: Inspection was made on 19,, Time ..........JVI By „ 19 ...Z.4..PERCOLATION TEST DATA:Date of First Test Rate /^iQ K 1st Test TakefJ By J3Date of Second Test 19 , Rate 7T6~/O/1 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 m^er notice.) Signature 0A. uDated, 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. Shoreland Management Office / /~?<Q yS uIssued Date: SO<3>es~.Fee $Surcharge $ CD cL O f'JComments:. -T4so/>6. rx tk // r'Form No. MKL-0771-003 vtctoa uivecfM • eo . eaitiTcei rt*«ui fall* ,158906 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 Office Inspector Owner ard —* OwnerI •• Permit No.,LEGAL S'Date DESCRIPTION AND LOCATION Lake No. Lake Name Lake Classif.Sec.TWP Range TWP Name IDENTIFICATION; Please Print All Information. Last Name Mailling Address —No. Street, City and StateFirstInitial Zip No.Tel. No. OWNER SEWAGE SYSTEM INSTALLER Name. (3 .r*^-b- WThis System will be ready for inspection on., 19-22-//', Jo - /3..oa This space for office use only .s22 Date Rec'd Time Rec'd Phone Cal) Rec'd By Owner or Agent Signature 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.Ft.Distance from lake or stream 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 ■JVI By PERCOLATION TEST DATA:Date of First Test 19 , Rate Date of Second Test 19 , Rate 1st Test Taken By First Test -I- 2nd Test s: Rate2nd Test Taken By The undersigned hereby makes application for prermit 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.) r3 '2Dated 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 25Issued Date: Shoreland Management Office Fee $Surcharge $ Comments:. certificate: tssu Form No. MKL-0771-003 viCTOd umeccM t eo.. etiMnM. rtatut rM.i.1 «...158906 INSPECTION RESULTS Inspector must make all measurements “f ■ SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORY Actual Should be Actual Should be Actual Should be Capacity GIs.GIs.S F S F S F SF Distance from Nearest Well F 75FF F F F Distance from Lake or Stream F F F F F F Distance from Occupied Building 10 2020FFFFF F Distance from Property Line 10 10 10FFFFF F Distance from Bottom to Water Table 4 4FFFFF F Inspector's Comments: ! V Date of Inspection 19___ Time of Inspection,M Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF “ Square Feet F - Linear Feet Job Title AgencyMKL-0771-003-Backer _r >4 4 ^ G ^ Ly„ // Z < '^r r/d?£) !<C^ f //* I 6 /c::c:>^ UL>^ Z^ F7jJ2^ ^ ^ ^Z7 C^'<^/sP 3^^ y iVdu^'-42j> I I ftfei) CERTIFICATE OF COMPLIANCE SEWAGE SYSTEMK tm li '^''3 19jh27 th Aucts tday oJLThis certificate has been issued this to certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota.fiSSa.ia im4,m-W&ti&M The premises covered by this certificate are legally described as:miMmmIM 56-658 P|/ mmtel U2Sec. ^132 Dsne PrairieTwp. Name.Twp.RangeLake No. Ifi M Elks Point rwp»If designed for 375 gallon per day flow2 shov/ers & 2 sinks fM Mli,fi m Kd B.P.O.E. Lodge Ifo. 1093Owner: Name.Wi Fergus Falls, Minnesota 55537iiAddress. Zip No. M9U6Permit No. SP_ Signed by:.fy.Malcolm K. Lee, Shoreland Administrator Otter Tail County, Minnesota SMKL-087 1-009 <y. Vi. ®159035 vieTJD Lui9(c« 1 ce fRi^Tfix 'C*:u« r<u« 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 OWce YeMovy — Inspector ^ink -« Owner OwnerCard Permit No..LEGAL Date DESCRIPTION AND LOCATION Lake Classif.Lake No.Lake Name Sec.TWP Range TWP Name IDENTIFICATION: Please Print All Information. First Initial Mailling Address —No. Street, City and StateLast Name_________________ r//< Zip No,Tel. No. /:t/A5Ci <,OWNER SEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection on.., 19. This space for office use only .19 Date Rec'd Phone Call Rec'd ByTime Rec'd Owner or Agent Signature NUMBER OF BEDROOMS:ESTI MATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD Sq./^t. /OOP GIs.Capacity O Sq. Ft. Ft.Ft.Ft.Distance from nearest well 50 Ft.Ft.Distance from lake or stream Ft. Ft./<PDistance from occupied building Ft.Ft. /PDistance from property line Ft.Ft.Ft. Ft.Ft.Distance from bottom to Water Table Ft. AH distances are shortest distance between nearest points 7 RECORD OF TESTS: Inspection was made on 19 , Time ..........M By. 19 , 19.....5.t2^'..., )PERCOLATION TEST DATA:Date of First Test Rate f//../Date of Second Test Rate'eHnij 1st Test Tak^ By ///■/First Test -H 2nd Test 2 Rate2nd Test Taken By The undersigned hereby makes appiication 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 responsibility of the applicant for the permit to notify the County Shoreland Management that the j er^ until it has been inspected and accepted. It shall be the for inspection. (Call or use attached mailer notice.) VDated Signatui 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 ab^e statement. This permit is gr pon express ^ /> y y/*_________________________________ Shorelan^.Management (d^iceIssued Date: oOsFee $Surcharge $ e r 9Comments:.<3 c7 5 7 Form No. MKL-0771-003 VICT0B kUMSCflt 4 CO.. P4lltT(0i. fC««UI r«4L4. HIMH 158906 !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 ^^hlte Office — Inspector JPInk — Owner* Card 1- Owner 1 / cL //f-s Permit No../ c- . n /1 LEGAL Date 1DESCRIPTION AND ■ A\nr /)(ILOCATION/ Lake No.Lake Name Lake Classif.Sec.TWP Range TWP Name 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 hp ready for inspection on.19. This space for office use only 19 Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signa.ture NUMBER OF BEDROOMS:ESTIMATED COST; SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD r'V GIs.Sq. Ft.3^3 C >Capacity Sq. Ft. Ft.Ft.Ft.Distance from nearest well *1 Ft.Distance from lake or stream Ft.Ft.L. Distance from occupied building Ft.Ft.Ft. Distance from property line Ft.Ft.Ft. Ft.Distance from bottom to Water Table Ft.Ft./AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on ,, 19 , Time .JVI By IPERCOLATION TEST DATA:Date of First Test ., 19 , 19 , Rate /Date of Second Test,., Rate 1st Test Takeri 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 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. ' U Permit: y j ' / ) Issued Date:. Shorelanjd-Management Office .i - rFee $Surcharge $ “ ' / S..h■) Comments:. / r nf' c/^ rIn,-._____)A,.- r ao-3 7} T Form No. MKL-0771-003 1S89M viCTca uiMoetB t e«.. Mianat. rca«u$ falli. hihh / • r4INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORYActualShould be Actual Should be Actual Should be SFCapacity' OOP GIs.GIs.S F S F SF FY-Distance from Nearest Well 75FFF F F FDistance from Lake or Stream F F F F F 7^Distance from Occupied Building 201020FFFF F Distance from Property Line 10 10 10FF F F F fjl' 4Distance from Bottom to Water Table 4FFF F F Inspector's Comments: / /^ * m/f a t 9 Date of Inspection. Time of Inspection .)r\ lature of InspectorINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF - Square Feet = Linear Feet Job TitleF Agency MKL-0771-003-Backer ;d‘r ri\;e i '-vit * >,• -f ' . j 1 PERCOLATION TEST DATA Price $1.00 per pad. SHORELAIMD MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Ph. No.Owner:Mailing Address: Last Name F^Middle St. & No.City Zip No.StateLegal Description;1 /3as-G - U rP Q'uu.\jjc SEC.LAKE OR RIVER NO.NAME TWP.RANGE TWP AME TEST HOLE NO. 2TEST HOLE NO. 1 66IPUj-2.Depth To Bottom of Hole.Depth to Bottom of Hole inches; Diameter of Holeinches; Diameter of Hole Jnchesinches Depth, Inches PSoil Texture Depth. Inches Soil Texture Date>/Ac/r Jac Ir^ P - 3P O - ,P [IPercolation Test By____ Percolation Test By____ly' € L-u D I— Firm Name.!)i Firm Name. T)UJQC LUAddress.QC Address <a 3^7 toOtter Tail County License No..Otter Tail County License No^h-COLUMeasurement, Inches Depth in Water Level, Inches H Measurement, Inches Depth in Water Level, Inches Time Remarks Time Remarks o T777J!3C> (j)A\ /.vr; p.-K ±J4l -P^ /; ^0 p EG .9--^ o?^ yv^vzz §'A1 I- Zdj ■' a pm /; ^5~ p/v\ J ■ P/^ / ', UT p/^ 3,5-f 1?T3 T/V/7-i;'i E59~¥ /?^ p//pg.p/-// la3y 3-/ ■tr MKL-0871-028 See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn. TO BE CO'IPLETRD BY PERCOLATION TESTER I hereby attest that I am familiar with the minimum standards required by the OTTER TAIL COUNTY SHORELAND T-IANAOE^iENT ORDINANCE rep,ardinp, sewape svsterns and that the land elevation where soil absorption portion of sewape system x^ill be installed in not less than six (6) feet above the high water level of the lake, stream or flowape involved. Legal Description: E efterSignature''of Percolator TOwners Name -Tru., ,P /77V Lake Name Dated Please return when completed to Land and Resource Management Office, Court House, Fergus Falls, Minnesota percolation test results. 56537.Attach a copy of the !KL-0574-045