HomeMy WebLinkAboutEthel Beach Resort_29000990269000_Septic System Permits_1 '3-:tn LAND & RESOURCE MANAGEMENT
OTTER TAIL COUNTY
FERGUS FALLS, MINNESOTA 56537
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Department of
LAND AND RESOURCE MANAGEMENT
OTTER TAIL COUNTY
Government Services Center - 540 West Fir
Ferous Falls, MN 56537
PH; 218-998-8095
OTTER Tail County’s Website.- www.co.otter-tail.mn.us
October 29, 2009
Allen Chase
27521 Co Hwy 5
Battle Lake, MN 56515-9679
RE: Sewage Treatment System Servicing Tax Parcel Number 29000040027001
Described as N 200' of GL 5 & That Pt GL 5 Lying NIy & NEly & NEly of Ded Rd...,
Section 4 of Girard Township, Ethel Lake (56-193)
As of 10/22/2009, the sewage treatment system (Sewage Treatment Installation Permit
#20185) servicing your property was determined to be in compliance with the provisions of
the Sanitation Code of Otter Tail County for 26 bedrooms.
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
RECEIVEDWHITE - Office
YELLOW -L&R Inspector
PINK - Owner / Contractor (after issue)
www.co.otter-tail.mn.US
MAY 0 7 2009
APPLICATION MUST BE COMPLETE IN ORDER TO BE PROCESSED Permit No.LAND & RESOURCE
TWP NAMELAKE/RIVER NAME LAKE/RIVER SECTION TWP NO.RANGELAKE NUMBER cv^s
Y / 33 3^
E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROADPARCEL NUMBER (S) OF PROPERTY BEING SERVICED
21 63l! -CO < ~no 00,0/0 0 XIOO I
LEGAL DESCRIPTION
A'Jco' o*T C-i ^ t
/yPOiv- ifiicL 'i-Lr/ ~ j ~ 6f
Mailing Address Daytime Phone No.Last Name First Initial
Cl ___, A-IJcn.37- cvfiu^Y S-
P.0 /!ok
Property
Owner
PCL ^3-OcH\3/^ - StContractor
Lie.#
UCL (
THIS SPACE FOR OFFICE USE ONLY
A.M.
>■ This System will be ready for inspection on , the year of P.M.at.
A.M. P.M.
Date Received Time Received L&R Official
SEWAGE TREATMENT SYSTEM DESIGN DATA - AS SHOWN ON DRAWINGTYPE OF INSTALLATION
(CIRCLE ONE)
TANK DRAINFIELD
I/TOO Ft"Size GIs.Add-On/
✓-^^Peplacement
((32)^ank, Septic
^ (33) Tank, Lift
(34) Trench, Rock
(35) Trench, Gravelless
(36) Trench, Chamber
(37) Bed
(38) Mound
(39) At Grade
(40) Combination
New System
(20) Trench, Rock
(21) Trench, Gravelless
(22) Trench, Chamber
(23) Bed
(24) Mound
(25) At Grade
,^0Setback to nearest well Ft.Ft.
\50Setback to OHWL (lake &/or river)Ft.Ft.
w:Setback to wetland Ft.Ft.
InSetback to dwelling Ft.Ft.Collector System
(26) Trench, Rock
(27) Trench, Gravelless
(28) Trench, Chamber
(29) Bed
(30) Mound
(31) At Grade
Setback to non-dwelling Ft.Ft.A.
-/■ loo
-HOO
Setback to nearest property line Ft.Ft.Other
(41) Tank, Holding
(42) Outhouse
(43) Sewer Line
(44) Performance
(45) Miscellaneous
Setback to road right-of-way Ft. Ft.
Elevation above restrictive layer Ft. Ft.
ALL DISTANCES ARE SHORTEST DISTA^^E BETWEEN NEAREST POINTS.DEPTH OF WATER WELL # BEDROOMS.
GARBAGE DISP. Y / N ABATEMENT (^/ N
ABSORPTION AREA FOR MOUNDS
vTg>.R2EFFLUENTDISTRIBUTION
( >) Gravity
( ) Pressure
HOLDING TANK MONITOR/ DISPOSAL CONTRACT
( )Yes
( ) No-L&R Can Not Process
Designer (^v\t a aw P^yo
Designer Lie. # / ,^ ~3 ~~L-—
PERCOLATION
TEST DATA
Date of Test Highest Rate
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 accordance 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 Tall County,
Minnesota. This permit may be revoked at any time upon violation of the Sanitation Code.
NOTE: This permit is valid for a period of six (6) months.
,5 " 5~-- o ") ----Date:Permit Fee $
Signature of Property Owner/Aamt for Own
Date:Rec. No.,
Lands, Resource Management Office
Comments:
-ho ^S/^■^3 / 2.-^1nr><-Vxo/<€^ t r-e vv
Form No. BK — 0906-003 327,315 • Victor Lundeen Co., Printers • Fergus Falls. Minnesota
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 UiK-
Ol
WHITE - Office
YELLOW -L&R Inspector
PINK - Owner / Contractor (after issue)
www.co.otter-tail.mn.us
I0-24'
y
APPLICATION MUST BE COMPLETE IN ORDER TO BE PROCESSED Permit No.
LAKE NUMBER LAKE/RIVER NAME LAKBRIVER
CL/^S
SECTION TWPNO.RANGE TWP NAMEyH .^33 3L~iKDE-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROADPARCEL NUMBER (S) OF PROPERTY BEING SERVICED
216^} -^0 rju^^ 6 -aoori^OO o o I
LEGAL DESCRIPTION T ^ ~ I STA/^t>o' oiT C-i6'4T^trt PtOiSiy^rY^ 5r>i> .
Last Name First Mailing Address Daytime Phone No.Initial
-- -<T f i^- ______
—I.—. — I........................ '^ v' ri ^ y/.;/ L\) ■_______
^Property
Owner
i:
I'Ja-! Ifo 6 ??6=.7/4’'Contractor
Lie.#
u >
/V AV /»^/ tty
k-BTL /
10THIS SPACE FOR OFFICE USE ONLY
>- This System will be ready for inspection on , the year of at
^Date Received' P
lO^d^Oj
Time Received L&R 0fficial
SEWAGE TREATMENT SYSTEM DESIGN DATA - AS SHOWN ON DRAWINGTYPE OF INSTALLATION
(CIRC^ ONE)f
TANK DRAINFIELD
/.Too Ft"Size GIs.Add-On/New System
(20) Trench, Rock
(21) Trench, Gravelless
(22) Trench, Chamber
(23) Bed
(24) Mound
(25) At Grade
\
^ — Replacement
t,^(3^jTank, Septic
(33) Tank, Lift
(34) Trench, Rock
(35) Trench, Gravelless
(36) Trench, Chamber
(37) Bed
(38) Mound
(39) At Grade
(40) Combination
\Setback to nearest well Ft. Ft.\V50 y-,Setback to OHWL (lake &/or river)Ft.Ft.
Setback to wetland Ft.Ft.
iInSetback to dwelling Ft.Ft.Collector System
(26) Trench, Rock
(27) Trench, Gravelless
(28) Trench, Chamber
(29) Bed
(30) Mound
(31) At Grade
Setback to non-dwelling Ft.Ft.
-t loo
■+10^
Setback to nearest property line Ft.Ft.\Other
(41) Tank, Holding
(42) Outhouse
(43) Sewer Line
(44) Performance
(45) Miscellaneous
Setback to road right-of-way Ft.Ft.
Elevation above restrictive layer Ft. Ft.
ALL DISTANCES ARE SHORTEST DISTANCE BETWEEN NEAREST POINTS.
# BEDROOMS :SDEPTH OF WATER WELL ABSORPTION AREA FOR MOUNDS
GARBAGE DISP. Y / N
ABATEMENT N-T 5T 0 Ft^EFFLUENT
DISTRIBUTION
( >) Gravity
( ) Pressure
HOLDING TANK MONITOR/
DISPOSAL CONTRACT
( )Yes
( ) No-L&R Can Not Process
&Designer > < /-v.y
Designer Lie. #
PERCOLATION
TEST DATA i l p 'Z--
Date of Test Highest Rate
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 accordance 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: This permit is valid for a period of six (6) months.
Date:Permit Fee $(ySignature of Property Owner/A^nt for OwT^ ^
Land S Resource Management Office
Date:Rec. No..
Comments:
^ ^ ^ ^ “ '-u-y//'('JcIkA'U (tl '■(•iLd. T a-riyOJd/Lb 'I/\'-•V 4 '
mForm No. BK — 0906-003 327,315 • Victor Lundeen Co.. Printers • Fergus Falls, Min
SEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTS
Inspector must make all measurements
HOLDING
SEPTIC TANK DRAINFIELD OUTHOUSELIFT TANKCATEGORY
Capacity GLS.FT2 FT2GLS.
Setback from Nearest Well FT FT FT FT
Setback from Buried
Water Suction Pipe FT FT FT FT
Setback from Buried Pipe
Distributing Water Under Pressure FT FT FT FT
Setback from OHWL (lake &/or river)FT FT FT FT
Setback from Setback from Wetland FT FT FT FT
Setback from Dwelling FT FT FT FT
Setback from Non-Dwelling FT FT FT FT
Setback from Nearest Property Line FT FT FT FT
Setback from Right-of-Way FT FT FT FT
Elevation above Restrictive Layer FT FT FT FT
Holding Tank/Lift Alarm YES NO
Old System Pumped & Destroyed YES NO
SEPTIC TANK(S^^FILTER Sewer Line to Well Separation DRAINFIELD CALCULATION
4 Actual Minimum# Tanks Installed.
□ YES FTXManuf.«ft"□ NO FT FT20Model#
MOUND CALCULATION
MOUND /AT-GRADE ROCK REDUCTIONInspector’s Comments:
ABSORBTION AREA Rock trenches with inches
of rock under pipe for .%Ft. X Ft
ft" DRreduction / equivalent to,Ft2
SKETCH:
Z - \ CsCic. kJcm-^
( _ uf 1 •
Time Initial / L & R OfficialDate
the above described sewage system installation was found to be compliant with the provisions of the SanitationAs of
Code of Otter Tail County.
(fee Management Official
♦
I
♦
4
SITE DATA WORKSHEETrLAND & 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:
C^~tieL K/ -
TELEPHONE NUMBERMIDDLEFIRSTLAST NAME
ADDRESS:
5 3L / <
STR./RT
tU
ZIP CODECITYSTATE
/ 3~^ r3 7 (lA.13ji RANGE TWP. NAMELAKE NAME SEC. TWP.LAKE/RIVER NO.
LEGAL DESCRIPTION:SOIL BORING LOG
COLOR &
MUNSELL NO.
DEPTH
(INCHES)d i^Tfi^-cXccA.^STRUCTURETEXTURE
BLOCKY
PLATY
PRISMATIC
NONE
bo I
PARCEL NUMBER
or Directions From Nearest Public Roads-BLOCKY
PLATY
PRISMATIC
NONE
Address.> -T,
GAf^GE
^^Sll4i fiEPTH f5^
FLOOC^LAIN; ^ES t^O^
— C o
E-911
»
uBEDROOMS ^ BLOCKY
PLATY
V PRISMATIC
NONE
K^locky
^ATYPI^MATIC
NONE
cPOSAL:
ftt^^WER LINE SEPARATION: Sj> ft.WEL 7BLUFF:
VVEGETATION: AQUATIC TERRESTRIAL
BLOCKY
PLATY
PRISMATIC ,
NONE,.''
vSLOPE AT INSTALLATION.SIT/:%
'--V
)1’ TYPE OF OBSERVATION: *!5te > Pit
PARENT MATERIAL: j/i\ OutVsh
Boring r 1
XLoess Bedrock Alluvium
AORIGINAL SOIL:Yes No Date of Soil Boring,
L^lHI A
7' or restrictive layer):
^TIME
D SOI
ft.Date of Perc Test
PERC TEST #1 PERC TEST *2- TWO TESTS ARE REQUIRED -
WATER DEPTHTES)WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATESTART
TIME DROP PERC TIME PERCDROPTIMEINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES) WATER DEPTH WATER DROP PERC RATEREFILLREFILL
TIME DROP PERC TIME PERCDROPTIMEINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEREFiaREFILL
TIME DROP PERC TIME DROP PERCTIMEINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE INTERVAL (MINUTES!TIME WATER DEPTH WATER DROP PERC RATEREFiaREFILL
sTIMEDROPPERCTIMEDROP PERCTIMEINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATEREFILLREFILL
TIME DROP PERC TIME DROP PERCTIMEINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEREFILLREFILL
TIME DROP PERC TIME DROP PERC
INTERVAL (MINUTES)TIME WATER DEPTH WATER DROP PERC RATE INTERVAL (MINUTES)TIME WATER DEPTH WATER DROP PERC RATEREFILLREFILL
-r_____ =TIME PERCDROP TIME PERCDROPTIMEINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEREFllA.REFILL
TIME DROP PERC TIME PERCDROP
PROPOSED DESIGN:
TRENCH,BED.ATGRADE.MOUND.HOLDING TANK GRAVITY DIST.,PRESSURE DIST..
SEWER LINE.OUTHOUSE.OTHER.SPECIFY:________________
— SYSTEM OESiani 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.
feet, ori L inch(es) equals 5*^ o feetgrid(s) equalsScale:
PTf
MPCA LICENSE #:
DESIGNED BY:
FIRM NAME:
ADDRESS: P.O '?7
LICENSE CATEGORY:
DATE:
SIGNATURE:
b.ii;
Ltx>(y
Co \\I I
1 .received
MAy 07 2009
1I;uxuii■ i land s resource
;: [!315,904 * Victor Lundeen Co., Printers Fergus Falls, MN • 1-800-346-4870BK ~ 1003 - 029
1 III11 1rj^rt
isikEr:i»vraJ:wiQRks'HEETbi:j
LAND i& RESOURCE MANAGEMENTS COUNTY pFJpTjTERrtail '
i GOVERNMENT SER'i/teEstcENTER, 540 WESf ^^^ 56537
I ' www.co.otter-tail.niin.usi~' ‘
i ,n:nI!'■>'r-J T"!t 1 ~r!Ijj
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I I irI I II!1..rI1
11
ij
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Sewage TreatmentfS'ystem Permit # ■
I' 1..1"! i ~ ~ ' ! I I I : I i..i'l h"TT~"".!..[..f..[.I..i..r
i.
L 'OWNER:
I)\1
UAST-NAME TELEPHONE-NUMBER-^MIDDLE--FIRST ---1~-i t t"I I ■■I[ i-t ; .ADDRESS:!j...T 1..I
/k4-
CITY Ti f
OSSVSi-I I[.An 4 31/
’ STF^T
\.J.i..LI£l^..i„
t state ZIP CODE I
\ ~r ■'r—I-L i ^1-3^-L/-J J4.rnT1
I 1iIake/river NOk rAnGE , TWPANAMEI\fwp. 'I SEC.I I- f LAKE-NAME Tt~1I.............LEGAL DESCRIPTION:
rt~!
..L
:rj.-LI-
I jSOIL BORIMG LOG | | | ,I"t..!i depth!
(INCHES)iTEMliRElI I COLOR & r MUNSELL^NOr
IIi„L STRUCjrdjREi1!.L_(t i.1..r I
•j.I..[.i 4 IBLGCKY-
PLATYt"f T■I!I
...172 H o d W b d /
PAR'CEL\nOi\)}BER' ' i i i i '
' 3JzkjU
i.4,I I!■-^RRlSMAtlC
NONE
iIJ_i T "I...I...!"
r I[iIi -t—
-r-7 ^ y'
Direction 's Frorn Nea.
\jBLOGKY' ■
:rpdATY:
PRISMATIC'" IdlNONEt^
I.i.„[...i .j.i- I 4-i
5^I J.
E-9il Wddress or iTearest Public Road . \ <44i_u:.u:LEXil4
;t:M.j;i i' i::r-4 i
1I ■'N ]I
LU-~ I.... ^^ ! I ;+Ir--t [BLpGkY[_, I
PLATY ^ '
NUMBER OF BEDROOMS [I"!"'!'" '!.......VES,.p>[|' ................
WELL!CASING!DEPTH t5l? ftj ;SEWER LINE SEF>ARATI6N: Sh\\\. \
1 "t~|-FLGODPLAI nH~ Y E S"^<Nd^rT B LU FF:4~ Y E STT(^^"'t--H--r —■t4~
1 (, GARBAGE! DISPOSAL PRISMATIC
NONE ‘ZLi - I
I iji '-V\block'y!
- PLAT-Y - -
PRISMATIC
NONE
I
T i I1[I [-j-I i^ VEGETATION: - ^AQUATIC 1 TERRESTRIAL
i4 I f■I-I BL0CKY4
I ' PliATY
, PRISMATIC
: NOI^E-i-
4 ISLOPE ATj INSTALLATION Sim %„ 1 (.
-^T^'PE-OEiOBSERWlONiJ.IBoringjrooe-.I.Ll,|iI„[4iiI! I i
Bedrock i Alluvium"7PARENT MATERIAL:. !~t/|I ; Ou~rhTT..f..f-j-j^r-rr-ri..f..I..i..'ish Loess ....T .y X
[■ j..
I i ORIGINAL S0IL:^_ Yes' ,No'
..1..t r1 1..1..Date: of SoiliBoringI ■ ;V ' 1 I ! I I
fJiiI.......4-t -
: U4-I ^dOMPAGTED SOIL:- Yes! ! No } '
i : i i I ■ l i-t-i-’ - ^tI.ri-i-f f-!
I
r~I'
]... .j„1 r f-■i I
DEPTHIOfTbORING -(-To 7' ior'restrictive 'layer) i'l"' '
I i 'PERC, TEST #1
Tft.[)ate;of Perc Test
TINajTESTS A/?£iflfQL///?£p
+--h f i {..!I !i h ' iI
, i PERC-TEST #2^ . i.1J T I
PERC RATE i I i iINTERVAL* (MINUTES) i WATER DEPTH i WATER DROPl j PERC RATE i :
1
i TIME INTERVAL (MINUTES)WATER DEPTH! WATER DROPTIME I ;IJii'xn:::!:: :__ =Li4
DROP 1LPERC
I 4_iSTART Li I ...^..start_L.!
"Li I.4IIiTIME i ■ ' DROP ir‘T'T‘T'‘T..........
I PERC
I
i TIME
I
i PERC RATE
TIME
INTERVAL (MINUTES)WATER DEPTH i WATER DROP :t i i iPERC RATE I
}TIME
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ILL- I—^t"!
1 ! PERC I
[............1..!TIME' '> DROP I { PERC !
TIME ' ; DROP
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I
I TIME
I
■ y-
■ DROP PERC I
I
REFILL ; - j
i"I ••!■ "IrEFILL1-f-i LiL _4..r.....DROP t r PERC)■ .TIME .
TIME7T
IPERC RATEI- TIME !
INTERVAL4MINUTES)4
WATER DEPTH I ^ WATER DROP: i PERC RATE I -•4-TIME
INTERVAL (MINUTES): WATER DEPTH!....4 WATER DROP !: I i REFILL''I-..
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- ; WATER DEPTH : - WATER DROP L-: r PERC RATE! - f I TIME ^INTERVAL (MINUTES)WATER DEPTH^-WATER DROP t- i ---PERC RATE i X- ■■-I TIME
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1 ]■ 'R^iLL"*....'[ i-'t '!REFILL : " '-i-...!■I I ■4
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DROP i I PERCDROP ! i PERC II ,
TIME I i
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I TIME I
INTERVAL»(MINUTES)i
~i WATER DEPTH WATER DROP !r PERC RATE
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.I□4'^yi. C ' ' I 'I....I REFiLL-fi ! I I ! '
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INTERVAL* (MINUTES) i WATER DEPTH WATER DROP '1 i PERORATE' : 1 t I TIME I INTERVAL (MINUTES)i WATER DEPTH!WATER DROP PERC RATE ! I
TIME i
REFILL ; i [.LjJT].i .[refill; ■
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PERC II!.iTIME DROP PERC iIi-i-TIME i INTERVAL* (MINUTES) I I WATER DEPTH WATER DROP!PERC RATE ' ' I j TIME INTERVAL (MINUTES)' WATER DEPTH WATER DROP I
I
i PERC RATE I ! I;..[... i IRJILL. j. I..I -I-'...I REFILL i •I
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System design must be to scale and must include the proposed location of the sewage system, Vfl
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.
^ feet, orI L inch(es) equals ^2i2.o__feetgrid(s) equalsScale:
MPCA LICENSE #:
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FIRM NAME:_^ir^
ADDRESS: P.Q T7 U__________
r/LICENSE CATEGORY:
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DATE:
SIGNATURE:
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MAy 07 2009
land & RESOURCE
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INSPECTION'HESuifrS
Make all measurements and computations
/f ACTUAL MINIMUM
/Sq. Ft,
/Lot Area (Square feet)Sq. Ft.Sq. Ft./
Water Frontage Ft.Ft.
Building Set Back from 1;))^ Water Level ■3.°l Ft.
<0 jBuilding Set Back from Top of Bluff Ft.30 Ft.
20 Ft.Building Set Back from Hoad Right of Way Ft.
50^
■ Ft.Building Set Back from Lot Line Set Back Ft.Ft. &
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CHRONOLOGY REGARDING THE SEWAGE SYSTEM ABATEMENT
Property Owner:
/93 Lake Name: iETfh^ (Lake No. 56-
Parcel No.:
GIS Address:
Date Issued:
Date Initial Response (owner):
Date Resolved
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Make all measurements and computalions
ACTUAL MINIMUM
Sq. Ft.
Lot Area (Square feet)Sq. Ft,Sq. Ft.
Water Frontage Ft,Ft.
Building Set Back from Water Level 2.^Ft.
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t'^LBuilding Set Back from Road Right of Way Ft.
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Building Set Back from Lot Line Set Back Ft. &
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Elevation Above
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Department of
LAND AND RESOURCE MANAGEMENT
OTTER TAIL COUNTY
Government Services Center - 540 West Fir
Fergus Falls, MN 56537
PH: 218-998-8095
Otter Tail County’s Website: www.co.otter-tail.mn.us
November 3, 2008
Ethel Beach Resort
Allan Chase
27521 County Highway 5
Battle Lake, MN 56515-9679
RE: Sewage System Abatement, Lake Ethel (56-193)
On November 22, 2006 an Abatement Notice was issued to you for your Lake Ethel
property. To date, this matter remains unresolved. Be advised that your septic system
must be brought into compliance with the Sanitation Code of Otter Tail County.
If you have any problems, please contact me so we may work out a solution to your
Sewage System Abatement, otherwise please have this situation taken care of by
November 22, 2009. Failure to do the above will cause us to turn this matter over to the
County Attorney.
Sincerely,
Scott Ellingson
Inspector
Department of
LAND AND RESOURCE MANAGEMENT
OTTER TAIL COUNTY
Government Services Center • 540 West Fir
Fergus Falls, MN 56537
Ph: 218-998-8095
Otter Tail County’s Website: www.co.ottertail.mn.us
July 2, 2007
Ethel Beach Resort
Allen Chase
27521 County Highway 5
Battle Lake, MN 56515-9679
Re: Sewage System Abatement: Lake Ethel (56-193)
Dear Mr. Chase,
It has over 1 year since you received the Abatement Notice on your Lake Ethel property.
To date, this matter remains unresolved. Please be advised that your septic system must
be brought into compliance with the Sanitation Code of Otter Tail County. For your
information, individual property owners on Lake Ethel have been given 1 year to bring
their septic systems into compliance and Resort owners are given 3 years to bring their
septic system(s) into compliance.
There has been a further review of the files of Ethel Beach Resort. Three (3) issues
remain that need to be verified and corrected to resolve the abatement of the septic
systems for this property.
1. There is a tank firom the lounge that is thirteen (13) feet fi:om Cabin #5 and the
roadway. This tank needs to be checked for a solid bottom and brought into
compliance by installing a manhole access and access risers.
2. The tanks for cabins #6 & #7 need to be checked for solid bottoms and brought
into comphance by installing a manhole access and access risers.
3. We must verify that the tanks for cabins #1,2,3,4, 5, & 8 are connected to the lift
station that pumps up to the drainfield. Also, bring these tanks into compliance
with access risers and manhole covers.
If you have any problems, please contact me so we may work out a solution to your
Sewage System Abatement, otherwise please have this situation taken care of by
November 22, 2009. Failure to do the above will result in us turning this matter over to
the County Attorney.
Sincerely,
Scott Eilingson
Inspector
, '
Department of
\LAND AND RESOURCE MANAGEMENT
OTTER TAIL COUNTY
;Government Services Center • 540 West Fir
Fergus Falls, MN 56537
Ph: 218-998-8095
Otter Tail County’s Website: www.co.ottertail.mn.us
i
October 25, 2006 !:
Ethel Beach Resort'(Allan Chase)
27521 Co Hwy 5
Battle Lake MN, 565i15-9679
!.
IRE: Sewage System Abatement Ethel Lake (56-193)
•i
Dear Mr. Chase
.1
Since our first visit on June 28, 2006, we had agreed to come back at a later date
so you could get past your busy season. We are approaching freeze up and to
date you only got two tanks ready for us to check and were almost two months
after Labor Day. ■
Give me a call by Nbyember 2, 2006 to get a date arranged to check all four
tanks.
No action taken by November 2, 2006 will result in an automatic abatement letter
for systems of unknown construction, functions and location.
: . ' !
Any questions feel free to give me a call at (218) 998-8108.
/
Thank you for your attention to this matter.;•
Sincerely,
Scott Ellingson
Inspector
I
Pre-Application Site Inspection Request
Lake / River No Lake / River Name SectionLake/River Ciass Twp Name
JZ-m erLi L /4 Y
Parcei(s) No.Property (E-911) Address
err tf^r S^foooo Hoo^noa I
Property Owner Information:
Name(s):
^75^/ Cty j5'Address:
L/h^/fM/ 5~hS^J S'
tDaytime Phone: 3b I'- ~?^P
Stake Setback
Type of Request:
Bluff:Determination Verify Setback
OHWL:Determination Stake Setback Verify Setback
Stringiest:Determination
vNon-Conforming Repair or Replacement Structure:Confirm Consistency With Existing Structure
Miscellaneous:
(Qntu 4 </KScfe.y___________
Describe Request: /j!
Molf’ilc k
^K')srri€.ir)OuC
A scale drawing must accompany Pre-Application Site Inspection Request
& request must be staked onsite
mm./
Property Owner
Land & Resource Management Staff
Received By:
Date
INSPECTION COMPLETED (Inspection must be done within 10 days of receipt):
9*/^ v/c»^r ? /a A—
Date Onsite Date Property Owngt^otified Inspector
(Inspector must provide site drawing or field notes on other side.)
mbowman Application & Forms Pre-Application Site Insp Request Form!0/1/07
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Department of
LAND AND RESOURCE MANAGEMENT
OTTER TAIL COUNTY
Government Services Center • 540 West Fir
Fergus Falls, MN 56537
Ph: 218-998-8095
Otter Tail County’s Website: www.co.ottertail.mn.us
SEWAGE SYSTEM ABATEMENT NOTICE
November 22, 2006
Allen Close (Ethel Beach Resort)
27521 County Hwy 5
Battle Lake, MN 56515
CURRENT PROPERTY OWNER:
Parcel Number: 29000040027001
Section:4
Township Name: Girard
Lake Name: Ethel Lake (56-193)
Property Address: 27521 Co Hwy 5
You are hereby notified that the sewage system which you maintain on the above identified parcel, is
not constructed and/or located in accordance with minimum standards of the Shoreland Management
Ordinance of Otter Tail County.
Please be advised that you must correct this situation by December 22, 2006. You should contact this
office in order to determine what corrections and permits are required prior to complying with this
notification.
;
7Scott Ellingson
Land & Resource Management Inspector
STATE OF MINNESOTA )
)ss. AFFIDAVIT OF SERVICE BY MAIL
COUNTY OF OTTER TAIL)
Denise Gubrud, of the City of Fergus Falls, County of Otter Tail, in the State of Minnesota,
being duly sworn, says that on the 22^^ day of November, 2006, she served the annexed:
SEWAGE SYSTEM ABATEMENT NOTICE
On the following person, by mailing a copy thereof, enclosed in an envelope, postage
prepaid, and by depositing same in the post office at Fergus Falls, Minnesota, directed to
said person at the following address:
ALLEN CLOSE (ETHEL BEACH RESORT)
27521COUNTY HWY 5
BATTLE LAKE, MN 56515
Denise Gubrud
Land & Resource Management Official
Subscribed and sworn to before me this
22 th day of November in the year of 2006
Notary Publii
My Commission Expires January 31, 2010
AMY X> ANDERSON
Notay Pubic
Mwinctoia
My Conwn. Expires Jan 31,2010I-
FormLtis-CertifiedMailingMS
ABATER/;FIELD iMOTES
: (13 LAKE CLASS:
^^5B/ Co Hct/\
LAKE NAME:
PARCEL NO: OQOO 4CO]
TOWNSHIP NAME: G^’^O.rJ
LAKE NO:
E9ii PROPERTY ADDRESS:7SECTION NO:
LEGAL DESCRIPTION:
/Gfke!
S_________
Bakf/e. /^/
OWNERS NAME(S): B'.liaS'e.
Co.MAILING ADDRESS:
TYPE OF EXISTING SEWAGE SYSTEM:
HOLDING TANK
SEPTIC TANK/DRAINFIELD
OTHER:
SEPTAGE PIT, DRYWELL OR LEACHING PIT
CESSPOOLX
COMMENTS:
MjC -lanK CUxliUu
SEPARATION DISTANCES fIN FEET^
OUTHOUSEABSORPTION AREATANKSEWER LINE
WELL
OHWL
LOT LINE ___________
DWELLING _
NON DWELLING ___________
GROUND ELEVATION @ ___________
REASONrS^ FOR ABATEMENT (SKETCH ON BACK...^
/ 0/\^'id bollon\/l/ol r.a. ^0
//,
' daIe INSPECTOR'S SIGNATURE(S)
EXISTING FILE:NOYES
ABATEMENT FIELD NOTES FORM 01/22/03
(X\
1/AV-*
&^5 sJ !A-5^
CERTIFICATE OF COMPLIANCE
SEWAGE SYSTEM
79_!1DzcmbeA7thday of.This certificate has been issued this
to certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota.
0 The premises covered by this certificate are legally described as:
&GvuvidRangeTwp. ^Sec._A56-/93 Twp. Name.Lake No.
m
Pi ChcU)g'6 EtheZ Bzach Re^oht
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Rail ChaUtgOwner: Name.
Rt. 3, SattZg Lakz, liinnuotaAddress.W-.
565/5•: •Zip No.
#6656Permit No. SP_
Signed by:.‘^Malcolm K. Lee, Shoreland Administrator
Otter Tail County, Minnesota
MKL-0871-009
159035
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SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL
COUNTY COURT HOUSE
Fergus, Falls, Mn. 56537
APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM
White — Office
Ye//ow — Inspector
Pink — Owner
Cord — Owner
Phone 218-739-2271
Permit No.,LEGAL
DESCRIPTION
AND
LOCATION iV\ -2^
JWP NameLake Classif., TWP _Range ,Lake No.Sec..Lake Name .
IDENTIFICATION: Please Print All Information.
Tel. No.Zip No.MaiUjng Address —No. Str^t, City and State _________
VJr 3
InitialLast Name First
OWNER
SEWAGE
SYSTEM
INSTALLER
Name.
This System will be ready for inspection on., 19.
This space for office use only
,19 ■■ M
Time Rec'dDate Rec'd Owner or Agent SignaturePhone Call Rec'd By
NUMBER OF BEDROOMS;ESTIMATED COST:
SEWAGE DISPOSAL SYSTEM DATA:
SEEPAGE PIT -SEPTIC TANK DRAIN FIELD
Sq, Ft.~L.ObC) GIs.>q. Ft.Capacity
SO Ft.Ft. Ft.Distance from nearest well
"iSMSFt.Ft. Ft.Distance from lake or stream
V o Ft.Ft.Ft.Distance from occupied building
\ <o^ MD' Ft.Distance frorh property line Ft. Ft.
J.. Ft.Ft.Ft.Distance from bottom to Water Table
All distances are shortest distance between nearest points
RECORD OF TESTS;
Inspection was made on ,, 19 , Time M By
^ -1-'^
. 19.^:^.PERCOLATION TEST DATA:Date of First Test Rate
.....Date of Second Test 19 Rate
1st Test Taken By
\i%h.= oFirst 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.
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:
loreland Management Office
A t oO Vt.Fee ■2>5US
Comments:.
Form No. MKL-0771-003 [^IVItW gAULt lAKS, MINNESOTA\
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■ i 'INSPECTION RESULTSk
•;Inspector must make all measurementsit
■ ■....” «' *?•?, .4Si ■ '
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SEWAGE DISPOSAL SYSTEM STATISTICS
SEEPAGE PIT DRAIN FIELDSEPTIC TANKCATEGORYActualShould be Should be Actual Should beActual
Capacity s FGIs. GIs.S F S FS F
Distance from Nearest Well 5075 FFF F F F
Distance from Lake or Stream F F FF F F
20 2010Distance from Occupied Building F F F F F F
10 10Distance from Property Line 10 FFFF F F
33Distance from Bottom to Water Table FFF F F F
Inspector's Comments:
Date of Inspection 19___A
j,; ■y'- '1 cTime of Inspection.M
Signature of InspectorINTERPRETATION
OF ABBREVIATIONS
GIs ~ Gallons
SF ■ Square Feet
F - Linear Feet
Job Title
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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
While-Offic»
Ye/fow — fnspecfor
Pink — Owner
Cord —Owner
ClA^ c>wii --«Jl K \ L, «■ 'Jr-b Permit No..\.a> c..LEGAL
DESCRIPTION
AND
V’J c'33 33LOCATION ..J \
TWP NameLake No.Lake Name Lake Classif.Sec.TWP Range
IDENTIFICATION: Please Print All Information.
Tel. No.Zip No.Last Name Initial Mailling Address —No. Street, City and StateFirst
\OWNER
SEWAGE
SYSTEM
INSTALLER
Name,
JdOr)\ o -This System will be ready for inspection on., 19
This space for office use only
-tia.\ O
Date Rac'd Owner or Agent SignatureTime Rec'd Phone Call Rec'd By
NUMBER OF BEDROOMS:ESTIMATED COST:
SEWAGE DISPOSAL SYSTEM DATA:
SEEPAGE PITSEPTIC TANK DRAIN FIELD
GIs.Sq. Ft.Sq. Ft.Capacity
Ft. Ft.Ft.Distance from nearest well
Ft. Ft.Ft.Distance from lake or stream
Ft.Ft. Ft.Distance from occupied building L
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 ..........JM By...........
19 ..,.;.v....., Rate
, 19....3....
\PERCOLATION TEST DATA:Date of First Test
i
■ o c- -Date of Second Test Rate
1st Test Taken By
Rate
-I- 2nd Test....\.:...6..!^.First Test '2‘
2nd Test Taken By
Agreement;
strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn
esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi
cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the
responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection.
The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in
Dated
Signature
Permit;
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 (61 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
0
3..
issued Date;
Shoreland Management Office
Fee $
certificate issued■r
Comments:,
Form No. MKL-0771-003 [^VIEW BATTLE LAKE MINNESOTA
i
- v-wm.< .ifiNU '
5>-
-.• ■
«>\>
INSPECTION RESULTS
Inspector must make all measurements
SEWAGE DISPOSAL SYSTEM STATISTICS Iio’ xro
SEEPAGE PITSEPTIC TANK DRAIN FIELD
coveeEDCATEGORY Actual Should be Actual Should be Actual Should be
91C/OPOsFCapacity
Distance from Nearest Well
Sco^GIs.GIs.S F S F S F
3c><^'^fso 5075FFFF F
IS'^O0‘,r/OH ■nrDistance from Lake or Stream F F F F F
//S^F9020 2010Distance from Occupied Building F F F F F
1Ji'/ F3oDistance from Property Line 1010 10
F F F F F
Ifs F 3Distance from Bottom to Water Table 3FFF F F
Inspector's Comments;
i oF ^oqvw
/ 0-19-1^Date of Inspection.
II.SoTime of Inspection.M
Signature of InspectorINTERPRETATION
OF ABBREVIATIONS
GIs ~ Gallons
SF “ Square Feet
F - Linear Feet
Job Title
L
Agency
M KL-0771*003- Backer
t
i
i
PERCOLATION TEST DATA Price $ 1.00 per pad. •
SHORELAND MANAGEMENT
OTTER TAIL COUNTY
Fergus Falls, Minnesota 56537
Ph. No.Owner:IVIailinq Address:
Last Name Zip No.tityFiiMiddleSt. & No.StateLegal
Description: h (a / ^ i>
LAKE OR RIVER NO.a IS-IASTWP.SEC.NAME RANGE TWP NAME
TEST HOLE NO. 2ETEST HOLE NO. 1
OA /. "Depth to Bottom of Hole ,3'C^Depth To Bottom of Hole,Inches; Diameter of Hole Jnchetinches; Diameter of Hole inches
19Depth, Inches T__2=SSoil Texture Depth. Inches Soil TextureDate.Date
------- Percolation
, -’X 6//Ut-Percolation
Test By____ISQ
loFirmName/QC Firm
Name.
OLUQC
LU
QC Address.
<
l&J f /g itC/)Otter Tail County License No.Otter Tail County License No^I-
coLUMeasurement,
Inches___Depth in Water
Level, Inches
H Measurement,
Inches Depth in Water
Level. Inches
Time Remarks Time Remarks
O^'OO
(0
b
T7U2? IQ'S
I iCtSSI m272;/Ll^L2lO10f'l A
7172 A} /i!0 jOIlO.'uo
JApU7 MSIMl5miA5TB1/LA LAS iDoS I /t LI^:%o L2 >'L J/) o ^h7 25 r<a lAlLAkLLl!.' ^ 0I o>m !Ua 0 M ^*0
(/. / : /n 7amio:o(,MS IMI A r 1'o>:> 7
F fe.77T7E r C.
MKL-0871-028183-818
See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn.
[^CVIEW BATTIE LAKE MINNESOtA
•x >
/
im rr
\'a
.O'OPERATING PERMIT
for
Chase’s Ethel Beach Resort OTTER TAIL COUNTY
Fergus Falls, Minn.
SHORELAND MANAGEMENT
Phone 218-739-2271 y
m F)
This Permit Issued To;
ij
R.R. 2, Battle Lake, MN 56515Ray A. Chase AddressOwner.
AddressOperatorsame Irj■m-Lake No. 56-193 Ethel Twp 133 Rg39Class RD Sec_ALake Name
%
I if/
GirardTwp. Name !
S'-
For:Seven (7) Cabins with water and sewage system
Five
Boat rental service, live bait sales, retail store and ice fishing access
(5) Recreational travel campsites with water and sewage system
Ml
m.P!February 5, 1981Date Issued
■7///-
Malcolm K. Lee, Administrator lls
liJ'
XXXXiXXX Auditor
»
— POST CONSPICUOUSLY-A(Not transferable as to person or place)MK L-0473-036\
-X
c
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16643S-A^^ -F-.^L.-cc
>
CERTIFICATE OF COMPLIANCE
SEWAGE SYSTEM
in
%19 81This certificate has been issued this 21st day of.May
to certify compliance with regulations of Shoreland Management Ordinance.Otter Tail County, Minnesota.- ^
The premises covered by this certificate are legally described as:mm56-193 133 Girard439Lake No.Twp.RangeSec. Twp. Name.
M
Lots 1-4 Ethel Beach
Ethel Beach Resort
•»«Owner:Name.Ray Chase
• -'3
Address.WB Rattlp T.akp, Mn
Zip No.SftSI s
4018Permit No. SP.
Signed by:.
colm K. Lee, Shoreland Administrator
ter Tail County, Minnesota
MKL-0871-009
1S903S vierei
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
W ;te — iBffice
V low — Inspector
Pi^.. •% Owner
Card — Owner
/r~/^
’ D
ee /-4 Permit No.___LEGAL
Date
DESCRIPTION
AND
7^!tt> 4 /?3LOCATION
Lake Classif.Range TWP NameLake No.Lake Name Sec.TWP
IDENTIFICATION: Please Print All Information.
Tel. No.Mailling Address —No. Street, City and State Zip No.First InitialLast Name
7
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 y Agent ignature
NUMBER OF BEDROOMS:ESTIMATED COST:
<SSEWAGE DISPOSAL SYSTEM DATA:
SEEPAGE PITSEPTIC TANK DRAIN FIELD
GIs.Sq.,,Ft.Sq. Ft.Capacity
7 Ft.Ft.Ft.Distance from nearest well
z7._<r Ft.Ft. Ft.Distance from lake or stream
zlHFt.Ft.Ft.Distance from occupied building
16Distance 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 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 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 fouhe 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 ngt commenced within six (6) months.
Permit:
Issued Date:
Shoreland Management OfficeOOrssoiFeeSurcharge $
Comments:.
ffc lo
AbDl w(
^ (v^ VICTO* LUBDECU » CO.. f€»0us r*LL». HIHH.158906
Jo 00
rr\ K L ■CD ^7Form No. MKL-0771-003
//SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL
W te — Office
V low — Inspector Pi!.. — OwnerCard Owner LCOUNTY COURT HOUSE
Phone 218-739-2271 - Fergus Falls, Mn. 56537 r* • #
APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM
I,—
J—4 i'Ui-d-lo4 -\ ,Permit No.LEGAL
Date
DESCRIPTION
AND
} .LOCATION
Lake Classif.Lake No.Lake Name Sec.TWP TWP NameRange
IDENTIFICATION: Please Print All Information.
Initial Mailling Address —No. Street, City and State Zip No.Tel. No.Last Name First
OWNER
SEWAGE
SYSTEM
INSTALLER
IName,
„This System will be ready for inspection on./D ' a a7
This space for office use only0
19 .M
Date Rec'd Time Rec'd Phone Call 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.Distance from lake or stream Ft.Ft.
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 JVl By
PERCOLATION TEST DATA:Date of First Test , 19 , Rate
Date of Second Test 19 , Rate
1st Test Taken By
First Test -F 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. Appiicant 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.)
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
Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express
condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota.
This permit may be revoked at any time upon violation of any said ordinance.
NOTE: Permit void if work is not commenced within six (6) months.
Permit:
Issued Date:
Shoreland Management Office
Fee $Surcharge $
Comments;.
Form No. MKL-0771-003 vierea LuaectN • co.. aatHUM. fi«cu» mihm 15S906
A'
INSPECTION RESULTS i • •
Inspector must make all measurements
SEWAGE DISPOSAL SYSTEM STATISTICS
SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORY
Actual Should be Actual Should be Actual Should be
Capacity GIs.GIs.S F SF S F S F
Distance from Nearest Well F 75FF 50FF F
/op fDistance from Lake or Stream F F F F F
V-Distance from Occupied Building 10 2020FFFFF F
srDistance from Property Line /O1010 10FFFFF F
Distance from Bottom to Water Table 4 4FFFF F
%
^
Inspector's Comments:
/X® 9/&£)To / ^
uaI!^ hf
CvJo I
t!)'
f / ' he r i%c£A/)J>I e\U/'/
Date of Inspection 19___
Time of Inspection,M
Signature of InspectorINTERPRETATION
OF ABBREVIATIONS
GIs = Gallons
SF = Square Feet
** Linear Feet
Job TitleF
AgencyMKL-0771*003-Backer
PERCOLATION TEST DATA
SHORELAND MANAGEMENT
OTTER TAIL COUNTY
Fergus Falls, Minnesota 56537 3 &7 :xPh. No.
/h
p>BsoP>r______
Owner:C
E- BL P>
Mailing Address:
BaTELF L/htrRft P?.Aa zA/// F(s 4'/ F
Zip No.Last Name First Middle St. & No.
/ 13 A/
TWP.
SC O l^VBM C
City StateLegal
Description;BtUff_____
NAME
^ o/fB/IV^ ^/^cp P)BSt/LuB3Nr
/V^BT/v f/[/£s Josfr J-otF-
P,39^ /9/F ASl?
RANGE
^6' / ^ g
LAKE OR RIVER NO.SEC.TWP NAME
Fto/AA/Ss F^rt>cU~
^ V y to' 07A/A/ F/FAO
$ o u T F TEST HOLE NO. 2
(jL !■UJlDepth To Bottom of Hole ^ p-Depth to Bottom of Holeinches; Diameter of Hole inches; Diameter of Hole Jnchesinches
Depth, Inches F J^/Soil Texture Depth. Inches Soil Texture19_^Date,19^Date
7. A A/^ -^^l^colation
SAiA32XlSJ^AlTTl-
43f!L ^ A.A/P Percolation is-i-O i 0 k S R a e- AA n i (b '
! 0 “
aLU
> Firm Name 33R P> 6 frA/h D Fi uMB/ntp-^cc ^ A-'
D
aLUQC
LU// £ A/'y / Afr/' AA ! hiAr
7 ^ ,
Address.tr Address.
<
C/}Otter Tail County License No..Z-I-AOtter Tail County License No«,HC/5UJMeasurement.
Inches Drop In Water
■Levei. Inches
Drop In Water
Level. Inches
Measurement,
InchesTimeRemarksTime Remarks
0
1ilhi L
U ''3 /■"I
b"033/F'3
11 L 01i '■
0 1 S 7 F ->Ft ^ tt^s / AftTrA /
183818 ®MKL-0871-028
VICT98 UiaVtlB • CO • iBTtl
See Booklet/'How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn.
■■W
/r^/
loi ^ /-4;• ■Permit No..LEGAL
DateT
DESCRIPTION
AND
th 4 /?3 3<7sG ~n3LOCATION
Lake No.TWP NameLake Classif.TWPLake Name Sec.Range
IDENTIFICATION: Please Print All Information.
Tel. No.Mailling Address —No. Street, City and State Zip No.InitialLast Name First
4k7OWNER
SEWAGE
SYSTEM
INSTALLER
Numu
. ,90This S)/stem will be ready for inspection on.
♦:
This space for office use only
% /r^ Date Rec'd
<P' Mrj19
Time Rec'd Phone Call Rec'd By Owner Agent ^gna^ure/df
ESTIMATES COST;NUMBER OF BEDROOMS;
3sewage disposal system DATA:
SEPTIC TANK SEEPAGE PIT DRAIN FIELD
3/P3 Gis.Sq. Ft.. Ft.Capacity
Ft.Ft.Ft.Distance from nearest well
7 r-s~7,^Ft.Ft.Ft.Distance from lake or stream
7/ r\Ft.Distance from occupied building Ft.Ft.
7^! 6Distance from property line Ft.Ft.Ft.
XFt.Ft.Ft.Distuiicii from botlum lu Water Table /
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
1Date of Second Test 19 Rate
1st Test Taken By
First Test + 2nd Test 2'Rate'Jnd 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
rict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn-
•oia Department of Health, Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi-
>, shall become a pan 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
■ ■onsibility of the applicant forjhe permit to notify the County Shoreland Management that the job is ready for inspection. (Call or use ettached mailer notice.)
I
>fdted ■A-
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,
NDTE: Permit void if work is ncu 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
'77S':
Issued Date:
Shorulund Managarnunt.Otticu ns5FueSurcharge
'■:r'Comments;.
'1C4
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