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Home My WebLink AboutHaven Hill Resort_16000020010006_Septic System Permits_^ ,.3».. ^ .|ra., ^,. ^.s®,. ^..®» -*^ *■* **• ^m111 »37' i I. v^0 t'y. CERTIFICATE OF APPROVAL SEWAGE SYSTEM Wm:% DRAIN FTtLD 21st ?397FebruaryThis certificate has been issued this to certify that the sewage system installed as per sewage permit number indicated below has been approved for use by Otter Tail County, Minnesota. day of 19 i? m m The premises covered by this certificate are legally described as: L Range Twp. Name5A-523 1362ALake No.Sec.Twp. 2 136 41 G'L 2 EX FARM EX FLAT HAVEN HILLS RESORT 2&; m■ %RDSEMTRETER, MELVIN A g< DQNMAS.Owner: Namem mRR 2 BOX 234, VERGA5, MNAddress m 56587Zip No. 1Q993Permit No. SP Signed by: Land & Resource Management Onicial Otter Tail County. Minnesotalu MKL-0987001 1 v) Mki I'i % JT 279005 Victor Umdeai Co.. Prinlen.|:erf»«F*lli.MiiinMott APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM WHITE — Office Yellow — Inspector Pink — Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 - FERGUS FALLS, MN 56537 LEGAL Permit No.Hi-DESCRIPTION ) Yes ( X) NoAbatement: (AND LOCATION LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS SECTION RANGETWP. NO.TWP NAMEZ_C O )\J V//lo X I 3C. PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER/i>-0O6 a X. -ooto-oox IDENTIFICATION: Please Print All Information Last Name First Initial Mailing Address — No. Street, City and State Zip Code Telephone No. /^n f ^ j fluLProperty Owner Sewage System Installer Itame LlLt* A.M. This System will be ready for inspection on.. 19.P.M.at This space for office use oniy NUMBER OF BEDROOMS: A.M, 19 P.M GARBAGE DISPOSAL: ( ) YES { ) NODate Rec'd Time Rec'd Phone Call Rec’d By SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMgITSf/TYPE OF SEWAGE SYSTEM { ) Holding tank (Alarm Required) ( ) Septic tank ( ) Lift station (Alarm required) (^C3 lield ( yO Trenches ( ) Bed ( ) Mound ( ) Outhouse ( ) Sewer line TANK IN FIELD /O'^ SqFt.Capacity Gis. Distance from nearest well Ft.Ft. •7J~Distance from lake or stream Ft.Ft. /0/4aDistance from building Ft.Ft. Distance from property line /6Ft.Ft. 3Distance from bottom to Water Table Ft.Ft. EFFLUENT DISTRIBUTION ()c) Gravity ( ) Pressure All distances are shortest distance between nearest points PERCOLATION TEST DATA: WATER WELL DEPTH ___Date of Perc Testr>vJkPerc Tester. Rate of 1st Test Rate of 2nd Test Average Rate Agreement: The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in strict accordance with Ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minnesota Department of Health. Applicant agrees that plot plan sketches and specifications submitted herewith and which are approved by Shoreland Management Officical shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibilty of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. S- J '7B WS 'jTT'i ^^ignature DATE: Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of any said ordinances. NOTE: Permit void if work is not commenced within six (6) months. C>" Cf *7 ^Issued Date: Land & Resource Management Office 3 .\ ■ —Fee $.Rec #. Comments: 277,212 ■ Victor Lundoon Co.. Prirtiers • Fergus Falls. MinrteostaBK 0795-003 :li 0 ' -:^APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM WHITE — Office Yellow — Inspector Pink — Owner XLAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 - FERGUS FALLS, MN 565374, -j /aiLEGALPermit No.K JcODESCRIPTION )Yes ( V)NoAbatement: (AND LOCATION LAKE NUMBER LAKE/RIVER NAME C O A) LAKE/RIVER CLASS SECTION TWP. NO.RANGE TWP NAMELrO56- V .7^V/fzo a >0/t c\ PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER/6 ■ CfOO 0 X 'OOlo -OOX Px IDENTIFICATION: Please Print All Information Last Name First Initial Mailing Address — No. Street, City and State Zip Code Telephone No. ^0AJ / r? <■ //O/ Xfh,LexProperty Owner Sewage System Installer Name i l-\OP- i ^ at A.M.IC>'^■JThis System will be ready for inspection on.. 19.P.M. This space for office use only NUMBER OF BEDROOMS: /O S- „ 9C. o no P.M GARBAGE DISPOSAL: ( ) YES { ) NODate Rec'd Time Rec'd Phone Call Rec'd By SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREM^TS / |/(>t'E)rtAIN FIELD G's. /Q^ SqFt. TYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) ( ) Septic tank ■( ) Lift station (Alarm required) (y^"&rain field ( yO Trenches ( ) Bed ( ) Mound ( ) Outhouse ( ) Sewer line TANK , ICapacity Distance from nearest well Ft.Ft.O/Xo<Distance from lake or stream •7rFt.Ft. /0/6oDistance from building Ft.Ft. Distance from property line Ft./6 Ft. 3Distance from bottom to Water Table Ft.Ft. EFFLUENT DISTRIBUTION (X) Gravity ( ) Pressure All distances are shortest distance between nearest pointsf PERCOLATION TEST DATA: IWATER WELL DEPTH ___Date of Perc Test,Perc Tester, Rate of 1st Test Rate of 2nd Test Average Rate Agreement: The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in strict accordance with Ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minnesota Department of Health. Applicant agrees that plot plan sketches and specifications submitted herewith and which are approved by Shoreland Management Officical shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibilty of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. 4 TX/ .Jr,:/DATE: Permit; Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit Is granted upon express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of any said ordinances. NOTE: Permit void if work is not commenced within six (6) months. L- L ^Issued Date: Land & Resource Management Office Fee $.Rec #. Comments: 277.212 • Victor Lundeen Co.. Printers • Fergus Falls. MinneostaBK 0796-003 % INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS H DRAIN FIELDHOLDING SEPTIC TANK LIFT TANKCATEGORY Actual Minimuin /5V5 SF SFCapacityGLS. GLS. lOl FTFT FTDistance from Nearest Well FT Distance from Buried Water Suction Pipe FT FTFTFT 50 Distance from Buried Pipe Distributing Water Under Pressure /O^FT FT FTFT10 75JUe^FT FTDistance from Lake or River (OHWL)FT FT 51'^ FT 10/20 FTDistance from Nearest Building FT IQ^ FT FTFT10Distance from Nearest Property Line FTFTDistance from Bottom to Water Table FT 3 to Ov/wfYESNOHolding Tank/Lift Alarm YES NOOld System Pumped & Destroyed Sewer Line to Well Separation DRAINFIELD CALCULATIONINTERPRETATION OF ABBREVIATIONS GLS. = Gallons SF = Square Feet FT = Linear Feet Actual Minimum S/5 FTX 55 /SVSFT20FT SF Inspector’s Comments: |0 (j cn./^ 5ce LSKETCH:AU T '.i i f ■ 76 N|/1^' lOC'^ s'ToICO f'oJ*■ 'hb I/O i\ 1I ,v\-C u >( Inspector’s Signature /0-S‘lL Date ot InspectionVHO* \wt^ln\pec tion r‘ t GRID PLOT PLAN SKETCHING FORM — (Must Be To Scale) I i ' t feet / inches ■ ' - : 'Scale: Each grid equals I 1.1 Dated:19 Signature ■ Please sketch your lot Indicatirtg setbacks from road right-of-way, lake and sideyard for each building currently on lot and any proposed structures. . : LoO'TL /X \/ r" \ ■' ; i;I .•5^ 1 ' ; • :] i • •V f 45wa^_Ur^ I 0 :A!i I P■ Ve'w Jr Sevuet V , ■i;" i i.r:i ..I1 <1 I : I. . , 'bi'. 1- .H , :v •;;. •. i'.! '. i'-i-!.I i lt.7I II:; r r.if i >;iI--1' I: t I > i :■+^H0 ^_i I I, . I .-}-4 • . -: I 'Is I GRID PLOT PLAN SKETCHING FORM — (Must Be To Scale) feet/inchesScale: Each grid equals <8 , Signature OjlK^txA,12-^19^Dated: Please sketch your lot indicating setbacks from road right-of-way, lake and sideyard for each building currently on lot and any proposed structures. 'S. '4" «s‘ <5is5^ I &0O a<4\ )100 f ----------- g~iTn . 0 B |i|, DEC 2 7 1995 juj 4 resource PERCOLATION TEST DATA LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, MN 56537 OWNER: FlliST > « t ;yv ^ TELEPHONE NUMBERMIDDLE ADDRESS: "Vtvna j ZIP CODESTATECITYSTR./RT. X nJ\j\ ■» TWP. NAMETWP.RANGESEC.LAKE NAMELAKE/RIVER NO. LEGAL DESCRIPTION: H s PARCEL NUMBER NUMBER/BEDROOMSFIRE NUMBER — TWO TESTS ARE REQUIRED — TEST HOLE NO. 2TEST HOLE NO. 1 inches; Diameter of Hole inches.inches Depth To Bottom of Holeinches; Diameter of HoleDepth To Bottom of Hole 19Date 19DateSoil TextureDepth. Inches Depth. Inches Soil Texture Percolation Test By _ Firm Name ____ Percolation Test By____ Firm Name ___ Address Address Otter Tail County License No. Otter Tail County License No. PERC TEST # 2PERC TEST # 1 TIMHWATER DROP PERC RATS INTERVAL <MlWirrBS>WMER DEPTH WATER PROPINTERVALWATER DBPTH PERC RATEjm ITARTSTART r r*HRH“ VKSF PERC nMU DROP PERC PERC RATEPERC RATE TIME INTERVAL fMPfVT”^WATER DEPTH WATER DROPINTERVAL tVCKUTES^WATER DROPTllig REFILLREFILL TTIMU DROP PBRC 'IIMU bRCTF P'SitLc PERC RATS TIMEWATER DEPTH WATER DROP INTERVAL fMIMirTBSI WATER DEPTH WATER DROPINTERVAL fVtlNirrBST PERC RATETIME IREFILLREFILL 4 4 TURB” DROP PERC DROP PBRCTIMEWATER DEPTH WATER DROP TCRCRATE INTERVAL AONinRRi WitfER DBPTH WATER DROP PBRC RATHINTERVAL Q»flNUTES>TIMB REFILLREFILL 4 «TOUB” DROP PBRC *nRH“ bkop PBRCTIMEINTERVAL (MParrSDPERC RATS WATER DEPTH WiPERDROPINTERNAL IMlNl/TEl)WIPER DBriH W^OERDROP PBRC RATETIME REFILLREFILL 4 4 DROP PERC 'IIMM DROP PkRc PERC RATE TIME INTERVAL (MimnESIINTERVAL IMTNinESI WATER DEPTH WATER DROP WATER DBPTH WATER DROP PBRC RATETILC REFILLREFILL 4 4 DROP PERC TIMK DROP ^ERC PERC RATE TIME INTERVAL (MlNinElT WATER DBPTHINTEKWU.<W«VTfm WIOBR DBPTH WATBRpanp PERCILATBTIME REFILLREFILL TIMU DROP PBRC DROP" 4^r0TIMEPERC RATE PrrSRVALIMINUTBmWlflERDROP WATER DEPTH WATER DROPINTERVAL IMimnERI WAT PERC RATETTItffi REFILLREFILL **TU»t0~ DROP <*EKC”TIME DROP PERC COMMENTS/CALCULA TIONS: MKL — 0390 • 005 250,815 — Victor Lundeen Co., Printers. Fergus Falls, Minnesota \Xv\\5 <2 a- S <S ;<iV\ V\^wo^ \n '(I S I V. Vv C Ov w>- y9<- V 5A. c_. Tv•^fic- /f^^Y y is" 1^ Vi V 1^ ^ VA ^Vjl/v,\ A py\<_ o •> cA«-./-T - 33 7S^c?.<5(.S' X ?s J*. V r • ) ^ o ^ - ■7^ «| )“Tbv’(s'<«.to *'"\Y fbiOVp ^»vl\-' kS-ci CM w ov V t »\. iC S-CT7 I ^I 'I -Y eK S3 ^re:^I I 3315^ j ^j SOa-S^ > 'SJ "sT^^s-ciPh Qv*'*'N 'C7'7K i- ‘'/1-lr^ ' ^5"^ 'tyr <1 i>Q •(• fl «JX (i- Vv •^w^■P 4" Vm v>v <ZA d<A iY\on C,0»- |r\\ CX Sa.VjW-^ yNsV*v\VA-c5 /?7<^ V\ ocs O'f Av^ —rv\ y *wC^*vv \ Ual-rs 3PZ- ^“^28 i5/V»r j o K n s-c^ 4-f- v\'--Vv«v^\, ( J-> d < t«-«-c(pjfajpr^ li^ p/acO<u//vJU -y-(jx kvi}^ 7o X! 't’ *' P (P<.«\v s c^ 4~o I i 4“ ^ ^ I 7 ■I'k^'l-^^ -f-U C^S<L^ {■ {poo o'f' al^orfft I n ’^-'75 :> 0v.t>v*o\U i<5\r\rv8-<^ 11 Q-reiX ^7^' I>jw j \050' ]^oo — "X^Vny\ vTvciV'V'z, Vk\j' p"(‘ \yv\ iil vJ! ^ O Y ^\x. Yt\\d 's V v\ c^l-^TSO VXY- 3570.^'* £^-,^,,.4) (■ ^s~so J 0‘~f'^ o-^ m Hvry^ ~Ty fZti^ ZU* JSr^<^C^ cjur^p^ QY'q^ l^<_iod5 , O ■:il> iMi)'^? ^ /Jcins^ "I ^ [fV iA\l^‘ /I M ,1vxi *- I iim g»feftg»aAl^AaAaiJlAjl^^>:^'W IKX&.--“y.V rm mmm '-i\'v; CERTIFICATE OF COMPLIANCE SEWAGE SYSTEM € m % W ^ lOth March 19.__29This certificate has been issued this day of_____ to certify compliance with regulations of Shorelu)id Management Ordinance, Otter Tail County, Minnesttta. The premises covered by this certificate are legally described as: Twp. 136Sec. __256-523 Range Twp. Name DunnLake No. it I G.L. 2, 3 & 4 Haven Hill ResortM Mu M mh Melvin RosentreterOwner: Name. ‘I Address Vergas. Minnesota «56587Zip No. 2116Permit No. SP_ wSigned by:. Malcolm K. Lee. Shoreland Administralor Otter Tail County. Minnesota MKL-0871-009 a fy @ IS9035 • ='" 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 W ;te V low — Inspector Pli.. Card Office Owner Owner 2//^Permit NoLEGAL Date DESCRIPTION h\AND 2- V/ _J>.5^'"' ^00LOCATION TWP NameLake No.Lake Name Lake Classif.Sec.TWP Range IDENTIFICATION: Please Print All Information, Last Name First Initial Mailling Address —No. Street, City and State Zip No.Tel. No. /hOWNER 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 Slgna^ture NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD /(o ^ 0 IlkGIs.Capacity Sq. Ft.Sq. Ft. SC TT>£21 Ft.Ft.Ft.Distance from nearest well zr Ft.Distance from lake or stream Ft.Ft. V2-t?Zj2 Ft.Distance from occupied building Ft.Ft. /C^/()Distance from property line Ft.Ft.Ft. Ft.Distance from bottom to Water Table Ft.Ft. All distances are shortest distance between nearest pofnts RECORD OF TESTS: Inspection was made on 19 , Time .M By A JPERCOLATION TEST DATA:Date of First Test 19 , Rate k oDate of Second Test 19 , Rate 1st Test Taken By 2. ^4 hJK . J- }AJ.r First Test -I- 2nd Test 2'Rate2nd Test Taken By Agreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. (Call The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in use attached mailer notice.) 6Dated Signature Permission is hereby granted to the above named applicant to perform the work describi condition that the person to whom it is granted, and his agents, employees and workmen shall confom This permit may be revoked at any time upon violation of any said ordinance. / NOTE: Permit void if wpilc is not Obmmenced within six (6) months. / Permit:no the above statement. This permit is granted upon express in all respects to ordinances of Qtnr Tail County Minnesota. Issued Date:7 £2.SJ>6reland Management Offici Fee $Surcharge $ (fUl -s -u ________LoU'pid ~ iXbjJ /D___________ v~09Comments:. Tihj //£>jir(yZL Form No. MKL-0771-003 viCTea uiHec(n • co . pamTcat. rtaaut fall*. MiMH.15S90e SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone* 2'l8-7^9-2271 — Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM W :te — Office V low — Inspector Ph.. Card :rOwner Owner Permit No..LEGAL Date DESCRIPTION AND LOCATION Lake No.Lake Name Lake Classif.Sec.TWP Range TWP Name IDENTIFICATION: Please Print All Information. Last Name First Initial Mailling Address —No. Street, City and State Zip No.Tel. No. OWNER SEWAGE SYSTEM INSTALLER Name. This System will 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. Distance from occupied building Ft.Ft.Ft. Distance from property line Ft.Ft.Ft. Ft.Distance from bottom to Water Table Ft.Ft. AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on 19,, Time .JVI By PERCOLATION TEST DATA:Date of First Test , 19 > Rate Date of Second Test 19 , Rate 1st Te« Taken By First Test + 2nd Test Rate2nd Test Taken By Agreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. (Call or use attached mailer notice.) 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 resF>ects 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 .158906 victee LuMDtCM 4 c«.. eeiarcM. rc*4us r«4.Li INSPECTION RESULTS* • Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORY Actual Should be ^Actual Should be Actual Should be I-/00Capacity GIs.GIs.S F S F\ \/fDistance from Nearest Well F 75F 50F F h Distance from Lake or Stream \F F F F F /c>//1Distance from Occupied Building 10 2020FFFF F \ /o\Distance from Property Line 10 10 10FFFF F Distance from Bottom to Water Table 4 4FFFF F / ^ y £ 0Inspector's Comments: ( X Uooo X ?To Io ' y 19r_'^Date of Inspection / ^ ■Time of Inspection,M {I - /V Sijjni^ure of I nspectorINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF ” Square Feet “ Linear Feet I I / Job TitleF AgencyMKL-0771-003-Backer 'S PERCOLATION TEST DATA Price $1.00 per pad. SHORELAIMD MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 - :?S 7‘ZPh. No._^ Mailing Address:Liwnef^ Last Name ^7L^U- //^City ~P'First Middle St. & No.Zip No.State X_ rhc uiLegal Description: LAKE OR RIVER NO.SEC. TWP.NAME RANGE TWP NAME TEST HOLE NO. 2TEST HOLE NO. 1 //71^Depth to Bottom of Hole inches; Diameter of Hole jnchesDepth To Bottom of Hole,inches;Diameter of Hole inches Depth, Inches Soil Texture Depth, inches Soil TexturevOates__________________ 19______;Date 19_____ ‘r I ^ ^ ^ X y<2.-o~<SL /O "'.0Percolation Test By____ Percolation Test Bv .S*CUy.<L/ OAcu Clr}^\Jxi / ^ axciL /- Xl/,'‘~¥x FirmName/' 7^y^ famcc/(V.e^,cT^LUAddress.CC Address7<7 wOtter Tail County License No.,Otter Tail County License No..H LUMeasurement, I nches Depth in Water Level, Inches I-Measurement, Inches Depth In Water Level, Inches Time Remarks Time Remarks i 9:3d 7 7; 91^/7 7F IL-/79-' 7^23'f^ . T 4:27 7 T 79JYI 91 ',9: Sa /LjLy3y. 7L7A2±9:5o 7*/u75^il/6 /6:o6 /?%/<J \ Oo / // r XuApl!^yUL/-f-AJl2L'^U/zj ; Or-j irAW 777T'2//d . / ^ A j> A^Jl.23^77 /6'/6f : f a 77717 A/9 /6 • Aqf/J : Xc 2U '7>:da/dl^A 7^ TV u 010 :jo(7: 3c> MKL-0871-0281M179® L3 (^aaa .xJ^vicro> i.uN0Ctx 4 CO.. »*iNrt»a. rt*eus See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn ■ ,:>i: vV v-i V i^P PCERTIFICATE OF COMPLIANCE SEWAGE SYSTEMw\• ■: ■tcl7 ''^1in7thday nf JairuBPy l9Jn^.This certificate has been issued this T--I s'I>T' ■■ii? \■X«W*'to certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota.fn.IMe".-" ■ ■•■' v-J :: The premises covered by this certificate are legally described as: Sec. ^ Twp. 136 Range Ul r’ -fVk It.3k ■'%Lake No. 5^~523 Dora m Twp. Name. Hic; telJ J-*"-Haven Hill Resort pi •Mme •JJ.,, miiti Melvin Rosentreter ir. •Owner: Name. iS .2m-Route #1, Vergas, MinnesotaAddress. mi\ Zip No. r^ NIalcolm K. Lee, Shoreland Administrator Otter Tail County, Minnesota #4.Permit No. SP_I Signed by:Ir MKL-087 1-009 S?,A'..i"- mi:-- mmgmmI m159035 *'CT*o uaMi* t M. MIITIM, ru««« r*LU. mmi 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 White — OfficeYellow — Inspector^ Pink — Owner Card — Owner «• jxC Permit No.__LEGAL /O -9Date DESCRIPTION AND ~i0)ALOCATIONOe>/>v 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.Last Name First Tel. No. OWNER z/, yT?^. —. .. J JLjjOt-'tuo1)TZSEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection , 19.on. This space for office use only .M19 Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signa^tu re ESTIMATED COST: «3L OOO .NUMBER OF BEDROOMS: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD ^ SqGIs.Sq. Ft.. Ft.Capacity 75^bo Ft.SdFt.Ft.Distance from nearest well /5 7^15*Ft.Ft.Ft.Distance from lake or stream j:?o1 0 Ft.Ft.Distance from occupied buildinq Ft. /o /oy<bDistance from property line Ft.Ft.Ft. 7Ft.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 ..... (p..PERCOLATION TEST DATA:Date of First Test , 19 Rate 7S(s.0 A rp A 1st Test Taken By .zDate of Second Test 19 , Rate / ^= O?. J)First Test -I- 2nd Test 2 Rate.2nd 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.) )b - ? - 7^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 expressPermit: 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. J-Issued Date: Shoreland Management Office Fee S ^Surcharge $ Comments:. t Form No. MKL-0771-003 VICTO* LUHOCCN 4 CO.. PRiHUai. flAflUS rULt. >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 White — Office Yellow — Inspector Pink — Owner Card — Owner V -t Permit No.,LEGAL - /Date / DESCRIPTION AND /rT)5 „- f ' - -4^ LOCATION , n / Sec.Lake No.Lake Name Lake Classif.TWP Range TWP Name IDENTIFICATION: Please Print All Information. Initial Mailling Address —No. Street, City and State Zip No.Tel. No.FirstLast Name y/r /. ■/<..OWNER \ c J ' : V rT , SEWAGE SYSTEM INSTALLER //-•Name. , 19This System will be ready for inspection on.£>o/y ,lO >i5 This space for office use only ^■ O O Amy/19 Phone Call Rac'd ByDate Rec'd Time Rec'd Owner or Agent Signature ESTIMATED COST: /NUMBER OF BEDROOMS: SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD r iGIs.Sq. Ft.Sq. Ft.Capacity ' r* 's Ft.Ft.Ft.Distance from nearest well I'1 f.Ft. Ft.Ft.Distance from lake or stream Ft. Ft. Ft.Distance from occupied building Distance from property line Ft.Ft. Ft. f C iLFt.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 V'J7:yr.’■S’PERCOLATION TEST DATA:Date of First Test „ 19 . 19.....'..?n:..., Rate , Rate 'r.[.t Date of Second Test---------------------i-iJ 1st Test Taken By f.— c.First Test + 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 jsTiot commenced within six (6) months. /,L) ‘■iQ. C l C. /IIssued Date: Shoreland Management Office \ r : >Fee $Surcharge $ 1SSUE.D 1Comments:. Form No. MKL-0771-003 I .1.. IS8906vtcToa uiaoeca t ea.. aaiarti INSPECTION RESULTS Inspector must make all measurements - 7 SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORYActualShould be Actual ShoukJ be Actual Should be /OTOfCapacityGIs.s F S F S F FDistance from Nearest Well J/Oa r-p y F 5 50FFF F Distance from Lake or Stream F F F F 5 /O F Distance from Occupied Building 2010FF F \ io\Distance from Property Line 10 10FF F Distance from Bottom to Water Table 4 4FF F F Inspector's Comments: 'TO ^ Date of Inspection Time of Inspection, Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF = Square Feet * Linear Feet Title F Agency MKL-0771-003-Backer ■ Ul I • m ' ^1 . J'-;: V.;:, *i. ‘ \ '-'i -'.r. V- t Ie. • '"K'ivr »>a:i PERCOLATION TEST DATA Price $1.00 per pad. SHORELAIMD MANAGEMEWT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Mailino Address: Ph. No.Owner: Last Name md.Ci«VFirst^ l^iddle rtn-v> ytkJEC.. ^ NAME St. & No.State Zip* No.Legal Description:-//12A LAKE OR RIVER NO.SEC.TWP.RANGE TWP NAME Lai-^ TEST HOLE NO. 2TEST HOLE NO. 1 OL //d-c^Depth To Bottom of Hole.Depth to Bottom of Hole inches; Diameter of Holeinches; Diameter of Hole inchesinches (2v6^:±l£h^19_ZJ' y/.cy^ /c, - < / Depth, Inches Soil Texture ^»-2S Depth, Inches Soil Texture, -idpy Date Daten Xr!Oi Percolation Test By______Vdt.Percolation Test By___cy. r'. ^ t / S’, L % ir' I ..4 oXf■ r'^o yy •.Firm Name. oHI cc yi't'f'yx)LUAddress.^(T Address7^< Otter Tail County License No..Otter Tail County License No^I-coLUMeasurement, Inches Depth in Water Level, Inches f-Measurement, Inches Depth in Water Level, Inches Time Remarks Time Remarks OZAld.CddA jrA- IdM jum.mM.MM.d:L<~/ /w//’y/y f C .7A~ // L t^O A } ^ K(2 bC:US"22 kr 34 kL k ■' ■L rL/r //L\-ykT 7'Af) 20 M LA 31-tyft k hUJj TEdT' 3 4k 2} J42H JJk y',60 ^16 6 7-f^ml la^7:/^» A 32 2o ^ 721^7:/6" r;so (2-k_n kt 1:36 rj _/ 6 MKL-0871-028See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn. kryl /, 32*3 / 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 — InspectorPink — Owner^‘ Card — Owner V M.il ?v-rPermit No.,LEGAL y > ADate DESCRIPTION AND o,^-553 I _23LLOCATION rt r/i Lake Classif.Sec.TWP TWP NameRangeLake No.Lake Name IDENTIFICATION: Please Print All Information. Mailling Address —No. Street, City and State Zip No,Tel. No.First InitialLast Name 7C^i )t J-\^OWNER r / c»—SEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection , 19.on. This space for office use only 19 Phone Call Rac'd ByDate Rec'd Owner or Agent Signa.tureTime Rec'd SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD Sq. Ft.GIs.Sq, Ft.Capacity s~c>Ft.tS'Cl Ft-Ft.Distance from nearest well 73"Ft. Ft.Ft.Distance from lake or stream Ft.Ft. Ft.JrbDistance from occupied building )0/ o /oDistance 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 ........M By. „ 19 .>3.., . 19...Z^.., PERCOLATION TEST DATA:Date of First Test Rate M Date of Second Test RateuKt- 1st Test aken By LL..j?, 6'First Test + 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.) 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 Office. 5TO Fee $ '.'J ■nfiA)oSurcharge $ Comments:. Form No. MKL-0771-003 viere* Luaetca i co.. matiaa. »t*«us r«tta 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 White — Office Yellow — Inspector Pink — Owners Card — Owner Permit No.,LEGAL Date DESCRIPTION AND LOCATION Sec.TWP TWP NameLake Classif.RangeLake No. Lake Name IDENTIFICATION: Please Print All Information. Zip No.Tel. No.MaiHing Address —No. Street, City and StateInitialFirstLast Name OWNER SEWAGE SYSTEM INSTALLER Name, This System will be ready for inspection on., 19. This space for office use only ,M19 Phone Call Rec"d By Owner or Agent SignatureDate Rec'd Time Rec'd SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD Sq. Ft.GIs.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.Ft.Distance from property line Ft. Ft.Ft.Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS: ,, 19 ,JVI ByInspection was made on , Time 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 for the permit to notify the County Shoreland Management that the job is ready for inspection. (Call or use attached mailer notice.) Dated Signature Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon expressPermit: 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 Office Fee $Surcharge $ Comments:. NQTCALI,F;n FOR INSFLC^ Form No. MKL-0771-003 VICTOD LUHOCftl t CO.. MINTIM rfUSUS FM.Lt. HIHN 158906 ■*> ,i 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 SF S F S F Distance from Nearest Well 75FF 50F F F F Distance from Lake or Stream F F F F F F Distance from Occupied Building 10 2020FFF F F F Distance from Property Line 10 10 10FFFFF F Distance from Bottom to Water Table 4 4FF F F F F Inspector's Comments: Date of Inspection 19___ Time of Inspection,M Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF = Square Feet F = Linear Feet Job Title AgencyMKL-0771-003-Backer ^ •' .u V \ PERCOLATION TEST DATA Price $ 1.00 per pad. SHORELAND MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 . »• Ph. No. Owner:IVIailinq Address: Last Name First Middle Zip No.St. & No.City State Legal Description: SEC. TWP.RANGE TWP NAMELAKE OR RIVER NO.NAME 7 TEST HOLE NO. 2TEST HOLE NO. 1 'a •'o't ^63 V3Depth to Bottom of Hole inches; Diameter of Hole.JnchesDepth To Bottom of Hole,inches;Diameter of Hole inches r- ^ ,o 'f’d 'B'/a) Depth, Inches Soil Texture Depth. Inches Soil TextureDate.19 Date7^IQ .'2^9' 73/g c J:rS'Cr' JPercolation Test By____ Percolation Test By_^__LcXie>\.f I UJVtfi T>a.' ^Firm Name.FirmName.CC DoHi oc LUAddress.GC Address. < COOtter Tail County License No..Otter Tail County License No..I-coLUMeasurement, Inches Depth in Water Level, inches Measurement, Inches Depth in Water Level. Inches Time Remarks Time Remarks ot 9; I ^ : S'^ 30 q:s6 3 2. £■//2^ai3 /^ sy''SQ/3 33/yd/c ! d 0 z/6.’ 06 3//o jfa /> / /■pt^ec F/?r^‘^^•crcL iP y MKL-0871-028159179 ®v<CT0* wNbCCN i »■>■>'{•« reasut rk4.Lt See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn.