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Faith Haven Camp_18000100063001_Septic System Permits_
JO 15 30 60 900 ______DENOTES TWO FOOT CONTOUR INTERVALS BASED ON ALL SPOT ELEVATIONS TAKEN NOVEMBER & DECEMBER 2014 (NAW 88 DATUM)SCALE IN FEET SCALE: 1 INCH = 30 FEET DENOTES TEN FOOT CONTOUR INTERVALS BASED ON■1340- BEARINGS ARE BASED ON OTTER TAIL COUNTY COORDINATES AU SPOT ELEVAVONS TAKEN NOVEMBER * DECEMBER 2014 (NAVD 88 DATUM) 2011 ADJUSTMENT /!S DETERMINED BY THE MNOOT CORS/VRS NETWORK.I % DENOTES IRON MONUMENT FOUND. ® DENOTES IRON MONUMENT SET MARKED 'PLS 13620 & 17825“ ^DENOTES CAST IRON MONUMENT FOUND. MS3 i THL A DENOTES TELE COMMUNICADONS PED BY VISIBLE OBSERVATION. DENOTES UNDERGROUND TELE COMMUNICAVONS LINE AS FLAGGED.TEL .'1340.2 1340.8 t ■ ~ —■• 1340.71/2-ppm DENOTES CUT OFF POWER POLE BY \4SiBLE OBSERVATION.J340^-~TT=cI PP A DENOTES POWER OR LIGHT POLE BY VTSBtE (mSERVARON.1338.5 13i8.5-----1338.9 1339.1 - DENOTES OVERHEAD ELECTRIC UNE BY \^StBLE OBSERVAVON.OH 1336.3 DENOTES A REBUTS SCALE OF THE BUILDING SET BACKELEC # DENOTES ELECTRIC PED BY VISIBLE OBSERVAVON.L~1336.;ENVELOPE DEmVED ERm THE LAND AND ^SCAJRCE SHORELAND —1DENOTES BURIED ELECTRIC UNE AS FLAGGED.-UGE MANAm/ENT ORDINANCES AS APPLIED TO THE TRACT BOUNDARIES 133V.8 SyPINE 1336.3 emc 20 FEET FROM THE SlY R/W UNE OF EAGLE LAKE ROAD NIXTHH;N86-45'35"W 1336.1DENOTES UNDERGROUND GAS LINE AS FLAGGED.G 0.72 \rv BEING W FEET FROM TIE: PROPERTY StOEUNESC SlY R/W LINE EAGLE LAKE ROAD NORTH M.APLE 12 KDENOTFS M.APLE TREE WITH TRUNK DIAMETER IN INCHES.BETNB 75 FEET FROI THE OMU' LINE AT EAGLE LAKE AND 30 FEET FRCM THE TOP OP THE BLUFF, mUCHEmi IS &TEATBT.133T7 —-------f«4.6................1334.1. . . .1334.4 16 PENOTES ASH FREE WITH TRUNK DIAMETER IN INCHES.IT IS RECOMMENDED THE OTTER TAIL COUNTY-■« LAND AND RESOURCE OFFICE BE CONTACTED U374-PRIOR TO ANY CONSTRUCTION PLANNING REGARDING I other REQUIREMENTS WHICH MAY NEED TO BE MET^DENOTES BOXELDER TREE WITH TRUNK DIAMETER IN INCHES.—r~.^ORELA THE TO NEW CONSTRUCTION AND/OR VARIA TIONS TO to Oi THIS SET BACK UNE WHICH MA Y BE ALLOWED. ) DENOTES COTTONWOOD TREE WITH TRUNK DIAMETER IN INCHES.COTTON 1333.4 1333.3 ,1333.3 1333.2I------ ~ — ^sy^o-E . — ■ \ ^6.;5 1 BOUNDARY NOm NO DEED TO FAITH I 1 nDENOTES BASSWOOD TREE WITH TRUNK DIAMETER IN INCHES.Z".I IhTS: 'HAVEN CAMP, INC. II.IP DENOTES PINE TREE WITH TRUNK DIAMETER IN INCHES.ri6i-T334ro---------- I WAS FOUND FOR THIS AREA ~J335.9-Z1 1333.4 N» CORNER OF LOT 1, OLSON'S NORTH SHORE ‘0i \>~l { 7 9 \oENCTES ELM®IS ' PARCEL NO. \\l8000030018000\ I __ . A ...... \ELM TREE WITH TRUNK DIAMETER IN INCHES.I fS; OAK .DENOTES OAK TREE WITH TRUNK DIAMETER IN INCHES. CO »DENOTES SEWER CLEANOUT BY VISIBLE OBSERVA TION. MH ®DENOTES SEWER MANHOLE BY VISIBLE OBSERVARON. DENOTES UNDERGROUND SEWER UNE AS FLAGGED.SS-----mI 6»'A DENOTES mu. BY VISIBLE OBSERVADON.s-oi?|B s ® ft: 2 iiiii,, § u WV/HYD/CS DENOTES WATER VALVE, HYD OR CURB STOP BY VISIBLE OBSERVAVON. 0BVO7ES STORM DRAIN CONDUIT BY VISIBLE OBSERVATION.SO 1/2-PP t/^P j /1338.2T7 133S.3 1339^^ 1339 3 (UGW DENOTES UNDERGROUND WATER UNE AS FLAGGED.00\359.2 WIRE MESH m.VLIS TYPE AND COLOR HATCHING DENOTES CONCRETE SURF.ACE.1337.4 1337-5 U CN IS 133^4^ 1/2-PP .. "^4 • AIn•ftPH/S- TYPE AND COLOR DCNOTES CONCREIE <51338.7 1 339. J '/^-T337.7 .1 '■ ’ I ®' K 0A■f'ASURFACE UNDER OVERHEAD DECK.</4 .A pis ^ ■ -S . : 4 <lSj7 4 ■ •>$. -. 1339,4 iJ 339,6 ’<1338.7 1337.3 .13Z8.1 I 1/2-PP 1/2-PP ^WEST LINE or «4 . s-o1 539.3Q0\YT LOT 5 1339.1 SEC. 3-131-40 • 1338r1- 1/2-PF^<? •Ll-I i1^39.3 UJ4 ^ ><-, .1339.-1 5^1/^ppIB39.I lO fr O'. -5 4 I pp 1339.1 C>uoI• 4 3'j-fi 1/2-PP ^4 , V 13 . 1339.6 '■5. *o1338.8 (/) 1/2-PP *K -J o1/2-PPI 39.6339.81339 1/2-PP SW CORNER Of 1/2-PP 1/2-P ^LdGOV’T LOT 5 ,1339.4 SEC. 3-131-4G id\i:^9.4SOUTH 1/4 CORNER ^5T3?---- S89‘14’10"W —.SEC. 3-131-40IIi 00/1 lQ_J3.4P..13! SPLIT RAILFBVCE^rnM^Sf^ theIi SOUTH UNE OF SEC. 3-131-40 WEST 1338.6 350.00 feet or GO/T.13.39.11340.0I LOT 5, SEC. 3•1371.0 1340.4 1339.7 s 1339.7 133S.6 ----t33a.4___i ------■"3+''-.-!BOUNDARY NOTE: ■BOUNDARY UNES SHOWN PER1370.9 •136R,a Sa&^RED_TBE5~ATlh-BRUSH--------"QCD DOC. NO. 734893 (PREPARED UNDER AN1330ASSUMED BEARING DATUM) BIRCH \--------------fQ_iO__JNs--RECOVERED IRON MONUMENT___/O IS 0.4 OF A FOOT EAST OF LINE DESCRIBED IN QCD DOC. NO. 734893 ----1320 1314i6 ~ ~ 1314.6 i S'LY R/W UNE I EAGLE LAKE I 11314.9 1314.51314.11314.1 1_---------^ JFIRE PITROAD NORTH ------h3t4.t)1314.615151315.5( 314'4 .2^ 131S.3131316.4 1313.4 \'v\ —' — ROCK RIP RAP TV i5 \ 1313^: 1313. digs 1313.1 Siis THE FOLLOWING DEED DOCUMENTS WERE OBTAINED ■4t; C5 ct 2> p ogag BY THE SURVEYOR THROUGH 4 LIMITED ELECTRONIC-3 ON LINE SEARCH OF THE RECORDERS OFFICE.s: AN UPDATED ABSTRACT OF THE FAITH HAVENCQ CAMP, INC. PROPERTY CITING THE PRECISELUBOUNDARIES WAS NOT PROVIDED TO THE SURVEYOR. O, NO. 700323 EVANGELICAL LUTHERAN ZION CHURCH OF AMOR TO FHC, INC. DOC. NO. 700824 SWEC/SW EVANGELICAL LUVLERAN CHURCH OF EAGLE LAKE TO FHC, INC.1314.1314.5 m> DOC. NO. 700825 OtACE LUTHERAN EVANGELICAL CHURCH OF HENNING TO FHC. INC.1314.2 V,1314.7 PROJECT BENCHMARK INFORMATION:1314.1 1314.1 WO DOC. NO. 70082B FHC, INC. TO ROBERT AND RHOOA HAWmSON.V'Ll /JMiiiA DENOTES TOP OF LARGE SPIKE SLIGHTLY BaOW GROUND - ELEVAVON OF 1339.8 FEET (NAW 88 DATUM)1314.2 WO DOC. NO. 700827 ROBERT AND RHODA HAWKINSON TO FHC, INC.r1314.1 (TO DOC. NO. 729293 ROBERT AND RHOOA HAWKINSON TO FHC, INC.'A DENOTES TOP OF LARGE SPIKE SLIGHTLY BELOW GROUND - ELEVAVON OF 1336.3 FEET (NAVO 88 DATUM) >■ I- o oca DOC. NO. 734893 FHC. INC. TO PAUL AND SHIRLEY LOHMEYER.O denotes TOP OF LARGE SPIKE SUGHTlY BELOW GROUND - ELEVAVON OF I.J15.5 FEET (NAW 88 DATUM)CP (TO DOC. NO. 741309 ARNOLD AND GRACE N09BERG TO FHC. INC.S 2 to DENOTES TOP OF LARGE SPIKE SUGHTLY BELOW GROUND - ELEVAVON OF 1315.6 FEET (NAW 88 DATUM)1361.9'1® DOC. NO. 845335 ARNOLD AND GRACE NORBERG TO ARTHUR AND DENISE NORBERG.UJ y/A DENOTES TOP OF LARGE SPIKE SUGHTLY BELOW GROUND - ELEVAVON OF 1327.1 FEET (NAVD 88 DATUM) A DENOTES TOP OF LARGE SPIKE SUaLTLY BELOW GROUND - ELEVAVON OF 1335.5 FEET (NAW 88 DATUM)o>THE BOUNDARIES AND NOTATIONS REGARDING SUCH, ARE INDICATED ,):;A DENOTES TOP OF LARGE S^IKE SU&ITLY BELOW GROUND - ELEVAVON OF 1336.9 FEET (NAVO 88 DATUM) elevation or HEREON AND ARE BASED ON THE SURVEYORS REVIEW ANDUJINTERPRETATION OF THE ABOVE DEED DOCUMENTS.W > I JiV ?r]© DENOTES TOP OF IRON MONUMENT FLUSH WITH GROUND - ELEVAVON OF 1314.1 FEET (NAW 88 DATUM)lak£IT IS RECOMMENDED AN ABSTRACT OF THE FHC, INC. LANDS ® DENOTES TOP OF IRON MONUMENT FLUSH WITH GROUND - ELEVAVON OF 1339.4 FEET (NAW 88 DATUM)BE UPDA TED OR PREPARED, INCLUDING TO THE ADJOINERS, ® DENOTES TOP OF IRON MONUMENT FLUSH WITH GROUND - ELEVAVON OF 1335.4 FEET (NAVD 88 DATUM)AND PROVIDED TO /I REAL ESTA TE 7l TTORNEY FOR THEIR REVIEW<r ^-J ® DENOTES TOP OF IRON MONUMENT FLUSH VWTH GROUND - ELEVAVON OF 1359.6 FEET (NAW 88 DATUM)AND PREPARATION OF A TITLE OPINION TO SAID LANDS. n.;,-:;® DENOTES TOP OF IRON MONUMENT FLUSH WITH GROUND - ELEVAVON OF 1369.2 FEET (NAVD 88 DATUM)if)CORRECTIVE TITLE WORK WILL BE REQUIRED TO ENSURE GOOD TITLEUJALL SANITARY S.FAITH HAVEN CAMP TO THE LANDS 4S SURVEYED HEREON.CURVE TABLEul«4S PULLED FROL .__AND RESOURCE OFFICE.Ll /fCURVERADIUSDELTA ANGLE ARC LENGTH CHORD BEARING CHORD LENGTHHOWEVER. THE SKI .. -.mWN on those permits IS NOT ADEQUATE TO ACCURATELY LOCATE THE DRAIN HELD SITES. \w RECEIVEDCl'27'29'I4“627.00 N7929'48"E300.80 297.92o CERTIFICATE OF BOUNDARYWE HAVE ATTEMPTED TO ROUGHLY SKETCH IN THE DRAIN HELD SITES BASED ON THE C2 57.44627.00 05T5'04“\57.46 N63Vr39"E RECOUECVON OF THE FAITH HAVEN CAMP CARETAKER.C3 32'44'I8“627.00 AND TOPOGRAPHY SURVEY FOR:N7652'16’E358.26 353.41 JAN 0 6 2C 3NO CERVnCAVON IS GIVEN BY THE SURVEYOR /IS TO THE LOCAVON OF THE DRAIN FIELDS. THIS SURVEY IS INTENDED TO PROVIDE TOPOGRAPHY OVER FAITH HAVEN CAMP, INC.land & RESOURCE FAITH HAVEN CAMP, INC.% SURVEYOR’S CERTIFICATE SURVEYORS UTILITY NOTES: h I hereby certify that this survey, plan or report UNDERGROUND UVUVES ARE SHOWN PER A UVUTY RESPONSE TO GOPHER STATE ONE CALL VCKET 043080787(vas prepared by me or under my direct supervision REQUESTED ON NOWMBER 3, 2014 AND FLAGGED ON NOVEMBER 14. 2014 FIELD BOOKCONTRACT NO.FOLDER DRAWN BYand that I am a Professional Land Surveyor licensed AND under the laws of the State of Minnesota.ALS-221/HDERSON LAND SURVEYING, INC.JHE MARKINGS PLACED BY PRIVATE CONTRACTORS HIRED BY FAITH HAVEN CAMP AND LOCATED ON APRIL 20, 2015.272-14272-14 GEHDated this 4th day of May, 2015. ADDIVONAL BURIED UVUVES MAY EXIST THAT (VEV?f NOT FLAGGED ON THAT LOCATE VCKET OR BY THE PRIVATE CONTRACTORS.FIELD CREWDWG FILE CRD FILE CHECKED BYCONTACT GOPHER STATE ONE CALL AT 1-800-252-1166 ANO/OR A PRIVATE LOCATE CONTRACTOR PRIOR TO ANY CONSTRUCTION.JAK/GEHPROFESSIONAL LAND SURVEYORS & LAND DEVELOPMENT CONSULTANTS 272-14272-14 LIB/GEHTHE CERVnCAVON GIVEN BY THIS SURVEYOR IS UMITED TO THE. ACTUAL LOCAVON OF THE FLAGS AND MARKINGS AS NOTED ABOVE.313 SOUTH MILL STREET. FERGUS FALLS. MN 56537 (218) 739-5268 DRAWING. NUMBERTHE CONTRACTORS ARE RESPONSBLE TO CONTACT GOPHER STATE ONE LOCATE AND/OR A PRIVATE LOCATE CONTRACTORGlenn Howe SEC-TWP-RG(800) 300-9276 REVSION:FOR ANY ADDIVONAL BURIED UVUVES NOT LOCATED UNDER THIS LOCATE VCKET PRIOR TO CONSTRUCVUN ACVVIVES.7Q.‘=iQProfessional Land Surveyor .1 in-1.51-41Minnesota License No. 17825 'jM.1^6'^S <w - uH^ _ go S'O :(1 3^ lS^^M€-iV\ ■—• (Cr-civxn '*’S'^ (exJli^lfv^ /v<>vca<^ tib \ ^i^\i^t4v^____^ftci _______ yC>t da^ nV /7A c? Kcoy -I- :?'7y -/7 G>^)- 2-^ i A: /7;L ‘-ts/ujjfic! ^ OxtJ^tW ~— Iff 'XliLi^ )afi /j.^ A V-S** ~ ^ 7O fm . '*^1 -^1Ws m V mrf.^IV ■i CERTIFICATE OF APPROVAL SEWAGE SYSTEM I?-. SEPTIC TANK * m>'• mm 55This Certificate has been issued this 1ST of FEBRUARY, 1999 , to certify that the sewage system installed as per Sewage Treatment System Permit Number 12251 has been approved for use by Otter Tail County, Minnesota. li I# W:The property served by this Sewage System is legally described as:*• J iti FAITH HAVEN YOUTH LODGE W 850' OF GL 1 IN NE H NE H EX TR AND BG AT NE COR OF NW ^ NEl/4 N 10.53'.... (.23 AC) mm M m\p'i Parcel Number(s): 18000100063001 & 18000100064006 Section: 10 Township:131 Range:040 Township Name: EAGLE LAKE TOWNSHIP Lake Number: 56-253 Lake Name: EAGLEI if m miP Current Property Owner: FAITH HAVEN CAMP INC. Number of Bedrooms: 3 «)E.?Pim\ mm j/^ REPLACED SEPTIC TANK SERVICING RESIDENCE & NEW SEWER LINE TO DF i ffi m mmr-'Wn I 284.709 • Victor Lundeen Co. Primers • Fergus Falls. MN • 1-600-346-4870 APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENTOTTER TAIL COUNTY COURT HOUSE Phone; (218) 739-2271 - FERGUS FALLS, MN 56537 WHITE — Olfice YELLOW — Inspector PINK — Owner I •\|ca/Ma lo(keLEGAL Permit No. DESCRIPTION Abatement: ( ) Yes ) NoAND CIOLOCATION Mfr-H <4 hrvJ LAKE NUMBER LAKE/RIVER NAME SECTIONLAKI TWP. NO.RANGE :TWP NAME Gl) [^1 ^CSLjf^ / IFIRE OR LAK^ASSO(£aTION NUMBER S1/--LS3> € PARC^ NUMBER(S) iy-coo-(o-oQ^^-ooi / aSfd-o% IDENTIFICATION: Please Print All Information ^ ' f Last Name _____ / First Initial Mailing Address — No. StreetjCily and State Zip Code Telephone No. Property Owner fiL, kat jo.roTmc- Sewage System Installer Name State Lie. H A.M. > This System will be ready for inspection on the year of .at..PM. This space tor office use only NUMBER OF BEDROOMS: A.M. ,RM.GARBAGE DISPOSAL: ( ) YESDate Rac'd Year of Time Rac’d Phone Call Ree d By TYPE OF SEWAGE SYSTEM SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTS TANK RAINFIELD,( ) Holding tank (Alarm Required) ( Septic tank ( ) Lift station (Alarm Required) /,i)0Q Ft"Capacity GIs. CTODistance from nearest well Ft.Ft.( ) Drainfield ( ) Trenches ( ) Bed ( ) Mound ( ) Outhouse ( ) Sewer line £TJDistance from lake or stream Ft.Ft. 10Distance from dwelling Ft.Ft. IDDistance from non-dwelling Ft. ZODistance from property line Ft.Ft. EFFLUENT DISTRIBUTION ( ) Gravity ( ) Pressure Distance from bottom to Water Table Ft.■I All distances are shortest distance between nearest points PERCOLATION TEST DATA:fATER WELL DEPTH Perc Tester Date^ Rate 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^wage Disposal Code Minimum Standards set forth by Minnesota Department of Health. Applicant agrees that plot plan sketches and spe©if)cations submitted herewith and which are approved by Shoreland management Official shall become a part of the permit. Applicant further agrees that no parf of th^ystem shall be cov^edjuntil it has been inspected and accepted. It shall be the respon sibility of the applicant for the permit to notify the County Shoreland ^anag^ent th^the job i^'fe^j^ inspection. 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 con dition 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 .S Resource Management OfficeHP13Fee $Rec It Comments: ?91.09b * Victor i.iiurii'on ()(;. Pfiiiii!i‘, • li'iiius F,'ili>, MTicunBK 0795-003 APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEi LAND & RESOURCE MANAGEMENTOTTER TAIL COUNTY COURT HOUSE Phone; (218) 739-2271 - FERGUS FALLS. MN 56537 WHITE — Office YELLOW — Inspector PINK —Owner - I a?'") IIoMq. W tto' & gl I LEGAL Permit No. DESCRIPTION Abatement: ( ) YesAND LOCATION /jc 'H iJt 'NU \- LAKE NUMBER LAKE/RIVER NAME SECTIONLAKE/RIVER CLASS TWP. NO.RANGE TWP NAME Iclo r^iL- PARCEL NUMBER(S)D cfi f u V . FIRE OR LAKE ASSOQIATION NUMBER vajo-Kj-ooyG-ooi IDENTTFICATION: Please Print All Information Last Name First Initial Mailing Address — No. Street, City and State Zip Code Telephone No. pl\ icf- iWf h iJ 'rif \ b Property Owner Tnc /> Sewage System Installer Name State Lie. ft ..m ?>■ This System will be ready for inspection on.the year of PM> This space for office use only NUMBER OF BEDROOMS: Date Rec’d GARBAGE DISPOSAL: ( ) YES ) NOPhon# Call Rac'd By TYPE OF SEWAGE SYSTEM SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTS PRAINFIELD/TANK( tu /. ()06l( Septic tank /t; j-1n t \ H/i z t' ( ) Lift station (Alarm Required) ( ) Drainfield ( ) Trenches ( ) Bed ( ) Mound ( ) Outhouse ( ) Sewer line Ft'Capacity GIs. ^'0Distance from nearest well Ft.Ft. SVDistance from lake or stream Ft.Ft. 10Distance from dwelling Ft.Ft. iODistance from non-dwelling Ft.;t. inDistance from property line Ft.Ft.' 1EFFLUENT DISTRIBUTION ( ) Gravity ( ) Pressure Distance from bottom to Water Table Ft.Ft. All distances are shortest distance between nearest poirfts PERCOLATION TEST DATA:WATER WELL DEPTH , r' ' I _Date of Pere Test,Perc Tester ? 1Rate of 1st Test Rate of 2nd Test Average Rate Agreement: The undersigned hereby makes application for permit to install of 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 piot plan sketches and specifications submitted herewith and which are approved by Shoreland management Official shall become a part of the permit. Applicant further agrees that no part of the system s^all be covered until it has been inspected and accepted. It shall be the respon sibility of the applicant for the permit to notify the County Shoreland Management tha^the job Is ready for inspection. 0„E: ___________________ / J,V/'}iOU 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 con dition 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. Kl \Issued Date: Land & Resource Management Office(V 1 Fee $Rec#1 1Comments:■j 291.096 • Vtctor LufKji!*:r> Qi. pHittfits • F«rrgus Falls M'niw>s«ltiBK 0795-003 INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS DRAINFIELDHOLDING SEPTIC TANK LIFT TANKCATEGORY Actual Minimum Iq-o-QCapacity FT=^FT2GLS.GLS. FTDistance from Nearest Well Fr FT FT Distance from Buried Water Suction Pipe 7^FT FT FT FT50 Distance from Buried Pipe Distributing Water Under Pressure sFT FT FT FT10 ftDistance from Lake or River (OHWL)4FT FT FT Distance from Dwelling FT FT FT 10/20 FT ft Distance from Non-Dwelling FT FT FT Distance form Nearest Property Line FT FT FT 10 FT Distance from Bottom to Water Table FT FTFT FT 3 Holding Tank/Lift Alarm YES NO Old System Pumped & Destroyed NO Sewer Line to Well Separation DRAINFIELD CALCULATIONINTERPRETATION OF ABBREVIATIONS GLS. = Gallons FT® = Square Feet FT = Linear Feet Actual Minimum FTFTX ls°ir FT .ft^FT20 ROCK REDUCTION Inspector's Comments: inchesRock trenches with of rock under pipe for .% .ft® DF.reduction / equivalent to SKETCH:r 1 Inspector's Signature Date of tnspection J3I^ Time of inspection PERCOLA TION TEST DA TA Price $1.00 per pad. SHORELAIMD MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Ph. No.Owner:Mailing Address: f^oee^T~P p Last Name First Middle St. & No.Zip No.City State Legal Description: SEC.LAKE OR RIVER NO.NAME TWP.RANGE TWP NAME TEST HOLE NO. 2TEST HOLE NO. 1 ^9" Depth to Bottom of Hole zrinches; Diameter of HoleDepth To Bottom of Hole Jnchesinches;Diameter of Hole inches Depth, Inches Soil Texture Depth, Inches Soil TextureDate19 Date 19____ £>. 8 aA <g/A^8/ 0'/l7-a~ sPercolation Test By____ Percolation Test By____S-2.3.8. 3a. Sran.oQ LUFirm Name./g>- 42.QC Firm Name.^s/friSCtrjO D ■22-^ gXT .SStnd'Ty^OLU oc LUAS86y, AlfMA/.Address.QC Addressi< CO Otter Tall County License No.Otter Tall County License No..HcoLUMeasurement, Inches____Depth in Water Level, Inches I-Measurement, Inches Depth in Water Level, Inches Time Remarks Time Remarks O "s:cS:sro smreT H 3% "/ 7 "3"^!00 AO V '3: A6 31^Cfnfiry A ^y'L-/V 3! /rS /Z3?=^L./zeAtic vW 3: 2J53:20 29%3''7."3 ■ 2.S‘3 ! SC /7'1'3%"3 .‘3^3-38 AS"re^A^rAe. 3 ''i "A3'(i,3 - VZ)3.'3 S’AT 'I 3'^"XO “3 tvs'AT"8/00 3 *'3'S’S'28AVO PePC AZAn^T ^ vlotj/ e&rs’ ^ s, s MKL-0871-028 183-818 See Booklet, "How to Run a Percolation Test" by Agriculture Ext Service, Un. of Minn. (^EVItW BATTLE LAKE. MINNESOTA 5 I ir Deep lAjeu. -- QJ fA8/iJ / / i D(16II^ -<--/------X------X-X ;L ■-> jC .•j cP^ 'P >c ! .GRID PLOT PLAN SKETCHING FORM• Scale: -Each grid equals Application for Building Permit Dated. Application for Sewage System Permit Dated Building Permit Number_________________ Applicant agrees that this plot plan is a part of application (s) indicated above. .feet/inches. .19. r -t-K19 Sewage System Permit Number. )^OiAXh jJ^( CtUJU-\19.Dated S ig n atu r9 On this fom moke a drawing of your lot. Indicate all present buildings with solid lines and ell proposed buildings or additions with dotted lines. Also indicate in feet; lake setback, side yard setback and rear yard setback. i 1 I \ T-ri: 4. 5 t.! l-j-f-r A/ ■ I 1V - ^-1 .0ID SeI4- u:4.4 t T i4'^±t■4-L T fi'1 : <4 a! 4 ■t -1“I .; 4-; -t' ' r -P-HT :T I -14- I +I—I ^’ISSKM ' ®4otw 4.. nu^ui.■H _ MKL-t087lB)^4 3 i 13:1fi 1I1 :■ 2o’o “; 1 ; ^ e-■^“ f r ;— ' ■r' — » ^ ■ ■s. . -f ;* • ■? - - •. •r- ^ >' ri-'^r. 7\j V -.i pyd 'zz¥pp/pf . J"/PPPC^: /ihy/y ------V //I u HAIAAOUT~! C C f'o Q n p(Pi \'^ t 'i %r^'\ 't t ■?/ /■ / I /■ r\/ K"'' X' ' /■ I (X I or \-0^I /t /II'=■/i / I r |£ 1 Gi>‘e 0/LO■V fec'-ci 9 tl \o -1 -Tt S'VvK <^<1. 1 ' (^ A n ‘S'cXrOoV <5, C_N—»JV—tLj'T /§0 aP^App^r-eiy S^co ir%> iY<?sS~0 "7 I 2-S~ ^l-?S^ V..iiiJiil XI1 r-j X -f \X^i;•■f* ;i /s-o ;•» ^oX f 3U‘X> 7.2-7X ✓ !!fii rri /-X.i: 1 : i;ii »i i| lO-lT^-^^ 1 CP^ ^ b 4-0 _Jofr..i!j|j__^ i7 Pr^(pv.rx^\,6 V\ ■ I oN'SoTT •VxsN^ -5^0 O"^ 'X'®-'v\XV- Cxv^^7''XI;* H! i . i•fiH;ux.■il loO P i-i pa rv-As^ p i n, Lo 1. (juo m a'/ ^ t n4" G / c^'iT So CZ,n S-C WA J2_'- /ooc? -f /O 0 ^ K. j.^CJ — pJt.^5 Q ^-r\ CP- fl‘1'^3-f^^pi4J /dOc3:S<|A4- - 4 /(7/4, /V\ r^(K V ^303 qsv^ ^ (tTr" (, CL^ pol^.V a r ^>2--rSQ'^S loo y. 2^ q^’(L \Jc^ ^ X ^ ^0^CgO^ PTVA. —• L|(3 e_ L-O ' (>=^pVj>-'S ><: $/o^AU yo^a iL-L^.^ - P!^f7b3 y: ’»f3 (Coo X /7J2V 4s^X H- /^ 75" ~L"^2j:j3 2^ /'E. J^ferMigg^Mu^ CERTinCATE OF APPROVAL SEWAGE SYSTEM VRAWFIELV <I m m 90NovejnbeA2ndThis certificate has been issued this to certify that the sewage system installed as per sewage permit number indicated below has been approved for use day of 19 P,by Otter Tail Counts , Minnesota. 0 The premises covered by this certificate are legally described as: Eoio^lz Lafee40Twp. ^37Sec. 7 0Lake No. 56-253 Range Twp. Namem. Faith Haven Youth Lodge [Vining HaZJt]%■ sg- Faith Haven Youth Lodge Inc.S-.T Owner: Name0-Wl Ratti.e. Lake^ MMAddress m 56515Zip No. Permit No. SP_1MM Signed by: Land &. Resource Management Official Otter Tail County. MinnesotaMKL-0987001 253.617 Vidor Lundeen Co. Prinlers. Fergus Falts. Minnesota ■ fc ‘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 — Cmce Yelkm — Inspector Pink — Owner Permit No.,LEGAL DESCRIPTION Parcel Number AND Lake N^i^e a.T) //) JM.LOCATION ^ Lake No.Lake Classif.Sec.TWP TWP NameRange IDENTIFICATION: Please Print All Information. Mailing Address — No. Street, City and State ________________________________________________________Initial Zip No.Tel. No.Last Name First OWNER 'v SEWAGE SYSTEM INSTALLER LZName, This System will be ready for inspection on., 19. This space for office use only 19 Date Rec'd Time Rec'd Phone Call Rec'd By NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD .7 Sq. Ft.Is.Capacity Sq. Fit. Ft.Ft.Ft,Distance from nearest well Ft.Distance from lake or stream Ft.Ft. A2Ft.Distance from occupied building Ft.Ft Distance from property line Ft.Ft.Ft. 7".5IfvFt.Distance from bottom to Water Table Ft. AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was"19 , Time .M By...on PERCOLATION TEST DATA:itst Test , 19 , Rate Date of Second Te;19 , Rate 1«t Test Taken By First Test + 2nd Test 2 R?2nd Test Taken B' Agreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set for esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Martagement/^ffi- 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 accep|W. It shall responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. I understand that I have been granted a sewage system site permit in accordance with the requirements of the Shoreland Management Ordinance of Otter Tail County. I understand I must contact my township in order to determine whether or not any addi tional permits are required by the township for my proposed project. Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six (6) months. The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work In Minn- the 7Signature1 / Permit: Issued Date: Shorelana Manag^ent Otfii Fee $Rec # Comments: ITT Form No. MKL-032085 237,443 — Victor Lundeen Co.. Printers. Fergus Falls, Minnesota f- <• > SHORELAND MANAGEMENT — COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 • Fergus Falls, MN 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM White — Office Yellow — Inspector Pink — Ownes Permit No.,LEGAL ,1? DESCRIPTION Parcel Number AND //) /■?/ ^^Vn'fOT'y'f /AI_ Lake Name CnDLOCATION Lake No.Lake Classif.TWP TWP NameSec.Range IDENTIFICATION: Please Print All Information. Mailing Address — No. Street, City and StateInitial Zip No.Tel. No.FirstLast Name iaddt/ .AAy/J/A/di /f/) //eWi t'd^u/A OWNER ^V y Li 7 AfA Hy i )hv-SEWAGE SYSTEM INSTALLER Name. ij-tOO^0This System will be ready for inspection on.. 19 This space for office use only % 19_Z_Z-'3cP .M Date Rec'd Time Rec'd Phone Call Rec'd By NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA:■■ISEPTIC TANK SEEPAGE PIT Zc^DRAIN FIELD 7 \/7y9/J Sq. Ft.^Is.Capacity Sq. Ft. /Ft./Ft.Distance from nearest well C-V/ Y Ft.Ft.Distance from lake or stream Ft /Al7Ft.Distance from occupied building Ft.Ft Distance from property line Ft.Ft.Ft7 f Ft.yDistance from bottom to Water Table Ft.Ft. AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection warTTw4e on 19 , Time By... PERCOLATION TEST DATA;itst Test , 19....:, "Rate Date of Second Tes]19 , Rate 1st Test Taken By First Test + 2nd Test ■2'2nd Test Taken By le 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 Minn esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management/^ffi- cial shall become a part of the p>ermit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall ^ the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. I understand that I have been granted a sewage system site permit in accordance with the requirements of the Shoreland Management Ordinance of Otter Tail County. I understand I must contact my township in order to determine whether or not any addi tional permits are required by the township for my proposed project. Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six (6) months. Agreement: Atc 7/<jJo 'Signature / / !> Permit: ■ /"1-70 ■7Issued Date:a Manaydmenf Qm Fee $Rec #CERT a/aoo__iOYCtddjy?Comments:r fa s<l /'4^ 4 Form No. MKL-03206S 237,443 — Victor Lundeen Co.. Printers. Fergus Falls, Minnesota r INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORYActualShould Be Actual Should Be Actual Should Be IM m.Capacity GIs.GIs.S F S F S F SIDistance from Nearest Well F F F F SODistance from Lake or Stream F F F F %kDistance from Occupied Building F F F F F /oMtDistance from Property Line F F F F F F 90Distance from Bottom to Water Table 3 3F F F F F F Lcfhem^i^Inspector’s Comments: of- c.ne)JsiZ€j c(>iatrK root ^(cu0cho^ F( l4-€r CJpf^ Date of Inspection 19 MTime of Inspection t Signet!^Of InspectorINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF » Square Feet F = Linear Feet < ifM/pl Job me MKL • 03208$ - Badctr Agency i :•4r Z—10 iOO DRAIN FIELD g Hi 4. -m.22nd 19 81This certificate has been issued this Decemberday of. mn to certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota. The premises covered by this certificate are legally described as: Lake No. 56-253 Sec. 10 Twp. 131 Range_kQ.Twp. Name Eagle LakeWA /A Faith Haven Youth Lodge mm 11 Owner: Name.Faith Haven Yont’h Address.Battia I.alfgj Mlrmaaota /56515Zip No.W-. 4454Permit No. SP_ Signed by:.A M^cnlm K. Lee, Shoreland Administrator Otter Tail County, Minnesota MKL-087 1-009 15903S 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 te - Office V low •- Inspector Pli.. Card —» Owner Owner Permit No..LEGAL Date DESCRIPTION AND l^ke Name LOCATION Lake No.Lake Classif.Sec.TWP Range TWP Name IDENTIFICATION: Please Print All Information. La^ Name^_______________________First Mailling Address —No. Street, _City and State Zip No.Tel. No. ^^5/6'OWNER SEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection on.., 19. This space for office use only .19 .M Date Rac'd Time Rac'd Phone Call Rec'd By Owner or Agent Signature NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: ^ SEEPAGE PITSEPTIC TANK DRAIN FIELD Sq. Ft.^Capacity Is.Scr Ft. 7Ft.^^■67o//ooDistance from nearest well Ft. zDistance from lake or stream Ft.Ft.Ft. zDistance from occupied building Ft.Ft.Ft. Distance from property line Ft.Ft.Ft. 7 3Distance from bottom to Water Table Ft.Ft.Ft.AH distances are shortest distance between nearest points RECORD OF TESTS:5^ 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 '2'2nd Test Taken By Rate Agreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted hei^i cial shall become a part of the permit. Applicant further agrees that no part of the system shall be^ responsibility of the appli^nt for the permit to notify the County Shoreland Management that ^ef\ob k ready for inspection. The undersigned hereby makes application for permit to install or extend Sewage DispoMl System herein specified, agreeing to do all such work in ge Disposal Code Minimum Standards set forth by Minn- and which are approved^ Shoreland Management Offi- v^red until it has been insp^^d and accepted. It shall be the ttached mailer notice.) \ Signature 3 AT /Dated 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 worjf is ii^t commenced within six (6) months. Issued Date: Shoreland Management Office Fee $Surcharge $ -no —A/f/ '—__O'^ B Comments:. e6e^ Form No. MKL-0771-003 vicToa cuaeiCM t C«.. eaiariaa. Ftasut wi«m 15S906 SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 - Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM W te — Office V low Ph.. - Card — /— InspectorOwner Owner ,,Sj ■fe C )I Permit No..Ir'lLEGAL Date DESCRIPTION AND cLOCATION : Lake No.Lake Classif.Lake Name Sec.TWP TWP NameRange IDENTIFICATION: Please Print All Information. Mailling Address —No, Street, City and State Tel. No.Last Name First Initial Zip No, OWNER SEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection on.., 19. This space for office use only ,19 ,M Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signature NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD GIs.Capacity Sq. Ft.Sq. Ft. Ft.Ft.Ft.Distance from nearest well Ft.Distance from lake or stream Ft.Ft. Ft.Distance from occupied building Ft.Ft. Distance from property line Ft.Ft.Ft. Ft.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 PERCOLATION TEST DATA:Date of First Test , 19 , Rate I 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 for the permit to notify the County Shoreland Management that the job is ready for inspection. (Call or use attached mailer notice.) Dated. Signature Permit: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. Issued Date: Shoreland Management OfficeCi:-HT ISSUED 2-82’Fee $Surcharge $ -1\r ■-rr-Comments:. Form No. MKL-0771-003 vierpH LUMSCfN t e«.. pkihtcbi. riaaus r*«.L«. minm.156906 \ INSPECTION RESULTS -f Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORY Actual Should be Actual Should be Actual Should be 7 i-jQdCCapacityGIs.GIs.SF SF S F S F loo fDistance from Nearest Well LF 75F 50F F F goDistance from Lake or Stream F F F F f/__10 h 10 Distance from Occupied Building 20FF F !0 pDistance from Property Line 10 10FFF F 3 FDistance from Bottom to Water Table 4FFF F Inspector's Comments: V A 19_^Date of Inspection i£.MTime of Inspection. ^/C Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF “ Square Feet F - Linear Feet Job Title i AgencyMKL-0771-003-Backer S' > (2^0 mM ii r> II m fapi«i CERTIFICATE OF COMPLIANCE SEWAGE SYSTEM 19 77day of Jnrtnn r~-y to certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota. This certificate has been issued this 1 Oth r-t ftiS isaThe premises covered by this certificate are legally described as: Lake No.^(i~Pf3 _ Sec. JJl ‘S'*: WRange.\jfl Twp. Name oTwp. 1 3~lpiW§ m Faith Haven Youth Lodge Inc. 11 mu- ti P?ii mmii?i Fa^th TTp~rf:r! Ynnth Tin.-^gn Trip.Owner: Name. RflFaiR MFAddress. 5Ac:i5Zip No. Malcolm K. Lee, Shoreland Administrator Otter Tail County, Minnesota 23QAPermit No. SP_ Wi Signed by:. mkMym.MKL-087 1-009 fS mmmm®159035 V'CTO* i.u<)0ti>i f CO. p*i>ir(ai. *c«cue 'aulb. mink SHORELAIMD 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 ite — Office W.low — Inspector Ph.. Card Owner Owner Permit No..LEGAL (•V Date DESCRIPTION AND fUtcJpr203LOCATION £-jO vr;0 L^e NameLake No.Lake Classif.Sec.TWP P NameRange IDENTIFICATION: Please Print All Information. Tel. No.Initial IVIailling Address —No. Street, City and State Zip No.Last Name First i'k t'/L I).7 < •) <'OWNER 'Xr- r 1 SEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection on., 19. This space for office use oniy .19 .M 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 i GIs.11 i'>if Sc/. Ft.Capacity Sq. Ft.\' A Ft.Ft.Ft.Distance from nearest well r >'3 n Ft.Ft.Distance from lake or stream Ft.‘ re' Ft.rii. nDistance from occupied building Ft.Ft./r' Distance from property line Ft.Ft.Ft..'O ICl '4-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 19s /aPERCOLATION TEST DATA:Date of First Test Rate •7 A Date of Second Test 19 Ratel_Li 1st Test Takfen By >/ ^ "T'"' ).First Test -I- 2nd Test Rate2nd Test Taken By The undersigned hereby makes application for permit to instali 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 Heaith. 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 shaii be cpvered 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 j«b i$ ready for inspection. (Cal^^ use attached mailer notice.) / Signature Dated r_ 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 CY /:-C;Issued Date:■VO Shoreland Management Office 4o oFee $ “S'Surcharge $ ££H hA '' Cf ic\ KlC’r-h f'nrr\P’vonComments;. r. o “I F j (SI £±i /ft Form No. MKL-0771-003 VICTOR LUHOECH I CO.. PaiNTCOI. FCROUS TALLO. HIHN.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 W :te — Office V Uiw Irfspector Owner Owner Ph.. Card Permit No.,LEGAL Date ;DESCRIPTION AND LOCATION Lake No. Lake ClassW.Lake Name TWPSec.TWP NameRange IDENTIFICATION: Please Print All Information. Last Name First Initial Mailling Address —No. Street, City and State Zip No.Tel. No. OWNER SEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection on.., 19. This space for office use only i9_aSJ 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. Ft.Distance from occupied building Ft.Ft. Distance from property line Ft.Ft.Ft. Ft.Ft.Distance from bottom to Water Table Ft. AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on 19,, Time .M By PERCOLATION TEST DATA:Date of First Test . 19 , Rate Date of Second Test 19 , Rate 1st Test Taken By First Test -I- 2nd Test 2 Rate2nd Test Taken By Agreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn- The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Official shall become a part of the permit. Applicant further agrees that no part of the systern,rt2nSc>e covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Managem^iUjjhSf . the job is ready for inspection. (Call or use attached mailer notice.) Dated Signature Permit: Permission is hereby granted to the above named wf^c^nt 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 agep|^mployees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation t^ali^said ordinance. NOTE: Permit void if work is not commenced withinl^TC) months. Issued Date: Shoreland Management Office Fee $Surcharge $ Comments:. Form No. MKL-0771-003 VICTO* kUHBCCH 4 C*.. PMlIinil*. FtMtUI rM.L« HINN 15S906 ■ %INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORY Actual Should be Actual Should be Should beActual /OOO ^ s FCapacityGIs.GIs.S F S F SF . Distance from Nearest Well F 75 50FFFF 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: I*- %r..! tDate of Inspection Time of Inspection..M •V \ ______________Signature of Inspector17INTERPRETATION OF ABBREVIATIONS GIs = Gallons SF “ Square Feet F - Linear Feet Job Title AgencyMKL-0771-003-Backer i PERCOLATION TEST DATA Price $1.00 per pad. SHORELAISID MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Ph. No.Owner:Mailing Address: Last Name First Middle St. & No. 13/ City State Zip No.Legal Description:^^4-Q,ZALAKE OR RIVER NO. 'NAMEl^OuAj}pKnrsS>C>n SEC.TWP.RANGE TWP NAME £.a. TEST HOLE NO. 2TEST HOLE NO. 1 30 3 LDepth To Bottom of Hole.inches; Diameter oi Hoie.Depth to Bottom of Holeinches; Diameter of Hole inches inches 7 6Depth, Inches Soil Texture I 19 Depth, Inches Soil TextureDate Date 19_____ g0 - &Q "Percolation Test By____ Percolation Test By____.5.0 -30 "aUJFirmName.QC Firm Name. oLU CC lUAddress.CC Address< COOtter 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 o5'.2 ", I n6, 3-3.'. IS" 4 '/I 3‘'a; 30 30 4Jjg 5'3*^M' q ^A /r Vo "3- ''3.A /\ s' "t ___ 3. "3-0 0 HOP 3V4 “A-rfjJ) 4 /J "3'. I O 3*.a l' a"3:'S-3: 30 4ri /£“ ^ 7^:3IS -=.15 %a¥ *7 MKL-0871-028 See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn. .i* P&!M) S^MJy/ is: CERTIFICATE OF COMPLIANCE m pi kI SEWAGE SYSTEM feiihM /9_J1^Qth day of_.Tflrm a r»yTJiis certificate has been issued this to certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota. The premises covered by this certificate are legally described as: Lake No. ^6-2^3 Sec. 10 Range I4.O Twp. Name Eagle LakeTwp. 131 MMmi Faith Haven Youth Lodge w.If 14wl Faith Haven Youth LodgeOwner: Name. .4ddress Battle Lake, Minneaota m r'4-%|Zip No. mS9&n Permit No. SP_ Signed by:. mMMalcolm K. Lee, Shoreland Administrator Otter Tail County, .Minnesota MKL'087 1-009 m •! ®259035 iuastCN 4 CO. rftiNTiBt. fcisut r«i.i.4. 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 r Whitfe — Office .^Yellow — Inspector Pink — Owner Card.— 0wneV Permit No.. LEGAL Date DESCRIPTION 3*AND no lO. jlH '/nSiLOCATION TWP NameLake Classif.Sec.TWPLake No. Lake Name Range IDENTIFICATION: Please Print All Information. Zip No.Tel. No.Mailling Address —No. Street, City and StateFirstInitialLast Name *T. / /Z. /OWNER ~Ty SEWAGE SYSTEM INSTALLER Name This System will be ready for inspection on., 19. This space for office use only .M19 Date Rac'd Phone Call Rec'd By Owner or Agent SignatureTime Rec'd SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD GIs.. Ft.Sq. Ft.Capacity Ft.Ft.Ft.Distance from nearest well Ft.Ft.Ft.Distance from lake or stream Si aFt. Ft.Ft.Distance from occupied building Distance from property line /O Ft.Ft.Ft./n 7 £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 .^.yZ^..lo.PERCOLATION TEST DATA:Date of First Test ,, 19 Rate , 19....?3...Qd jsl.Date of Second Test RateZy" r 1st Test Taken By Q.)First Test....../SL.+ 2nd Test 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.) ^44./XDated.-c2. 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 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. 5"7^ -I Shoreland Management Office /3! /^3 Issued Date: — o O Surcharge $_j7.Fee /3?y 4 fi i~LJZL%Comments:.it t < VICTOK LUNOttH 4 CO.. PRIHtt**. fflitUS fXLCt 158906Form No. MKL-0771-003 SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 - Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM White — Office Yellow — Inspector Pink — Own^r Car<^. —‘OWner , Permit No.LEGAL Date DESCRIPTION AND LOCATION TWP NameLake Classif.Sec.TWP RangeLake No. Lake Name IDENTIFICATION: Please Print All Information. Mailling Address —No, Street, City and State Zip No.Tel, No.InitialFirstLast Name OWNER SEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection on., 19. This space for office use only M19 Phone Call Rac'd ByDate Rac'd Time Rac'd Owner or Agent Signature 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 Ft.Distance from property line 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 , 19 , Rate Date of Second Test , 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 for the permit to notify the County Shoreland Management that the job is ready for inspection. (Call or use attached mailer notice.) Dated Signature Permit: condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six (6) months. Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express Issued Date: Shoreland Management Office Fee $Surcharge $ Comments:. ISSUEDCFPTIFICATE VICTO* LUNO€CH i CO.. MlMTCM. FEIUuS fALLl. 158906Form No. MKL-0771-003 INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORYActualShould be Actual Should be Actual Should be Capacity GIs.GIs.S F S F S F SF Distance from Nearest Well F 75FF F 50F F Distance from Lake or Stream F F F F F F Distance from Occupied Building 10 20 20FFFFF F Distance from Property Line 10 10 10FFFFF F Distance from Bottom to Water Table 4 4FFFFF F !J,/ f'*■ /ylj >Inspector's Comments;.‘Vi. s Ci . <5%. . r / ? t- ■■ Date of Inspection.19___ Time of Inspection M —1 Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF » Square Feet F ■ Linear Feet !fi Job Title j 1 AgencyMKL-0771-003-Backer iy ■ r V ■ •*' - ** . , f.-'( ‘4 V V i'r >4,--^' - f {f4-i •-. t f i ;<I I ! w T5»i 00 ■1*T \*'f41^ 3 , .y n^ IQk4i>jg, *A r.r OTk^i/K8i.aU4£0 i//V/(fMT/f^rD /n/isa^ 4 »=y '>: mi ' '<■*- -• DfTAiL OF J/v^fj^r/o/^ F/r ■^1 J\* -riS \ _u^. ;/4 ■V*--’ VA'<- »7jO/F Llpr STAF/O/rh4- nrr~~1 \I i t iV n f I/<*(FDOmiF^.b'^1 1vf V. ,'V />'f I I $§m )llf-^lylA'/Sl .:{ ri2 ‘p/F MAN HOLE Z^OIF '. 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