Loading...
HomeMy WebLinkAboutHead Lake Camp Assoc Inc_53000210125001_Septic System Permits_Department of LAND AND RESOURCE MANAGEMENT OTTER TAIL COUNTY Government Services Center - 540 West Fir Fergus Fau_s, MNJ 56537 Ph: 218-998-8095 OTTER Tah. County’s Website. www.co.oTTER-TAn.,MN.usOTTER Tim Q O Otter Tail County Compliance Inspection Form Addendurn^ This form is a required attachment to MPCA Compliance Inspection Form for all Existing Subsurface Sewage Treatment Systems in Otter Tail County as of June 1, 2011. Property Information Parcel Number: Z/o/Z S'cC i Township: 4-ic Property Owner Name(s): _______________ Property Address: H23O0 L^-h. /A ///a/ Reason for Inspection: Number of Bedrooms: ^ In Shoreland Area? Lake/River Name, Number, & Class /?S"Section: 2/ □YesH No System Compliance Status: ^ Compliant [Non-Compliant X NoDoes the soil treatment area have less than 3 feet of vertical seperation? Is the septic tank located less than 50 feet from any well? Is the soil treatment area located less than 50 feet from any deep well? Is the soil treatment area located less than 100 feet from any shallow well? Does any part of the septic system fail to meet the minimum OHWL setback requirements for the public water classification? Yes Yes X No X NoYes X NoYes yYes No "Yes" indicates that the system is failing to protect ground water and is noncompliant. If "Yes", describe the condition noted; Required Attachments: System drawing to scale on next page. Completed MPCA Compliance Inspection I hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. Name: Certification Number; Phil Stoll 7526 Business License Name & Number; Signature; X.__^Stoll Inspections 2982 Date; Excei/Compliance Form forOTC 1/15/2014 Page 1 of 2 Otter Tail County Compliance Inspection Form Addendum (cent.) Parcel Number: SS0DO2^/0JZ510/ Date & Initial: ________P.\S System Drawing The system drawing must be to scale and include all septic/holding/lift tanks, drainfields, wells within 100 feet of system (indicate depth of wells), dwelling and non-dwelling structures, lot lines, road right-of-ways, easements, OHWLs, wetlands, and topographic features (i.e. bluffs). [roo\|sW| 1L O' Additional Comments: Excel/Compliance Form for OTC 1/15/2014 Page 2 of 2 Compliance Inspection FormMinnesota Pollution ^ Control Agency 520 Lafayette Road North St. Paul, MN 55155-4194 I Existing Subsurface Sewage Treatment Systems (SSTS) Doc Type: Compliance and Enforcement For local tracking purposes:inspection results based on Minnesota Pollution Control Agency (MPCA) requirements and attached forms - additional local requirements may also apply. Submit completed form to Local Unit of Government (LUG) and system owner within 15 days System Status System status on date (mm/dd/yyyy); 3/24/2016 ^ Compliant - Certificate of Compliance (Valid for 3 years from report date, unless shorter time frame outlined in Local Ordinance.) Q Noncompliant - Notice of Noncompliance (See Upgrade Requirements on page 3.) Reason(s) for noncompliance (check all applicable) Q Impact on Public Health (Compliance Component #1)- Imminent threat to public health and safety □ Other Compliance Conditions (Compliance Component #3) - Imminent threat to public health and safety O Tank Integrity (Compliance Component #2) - Failing to protect groundwater Cl Other Compliance Conditions (Compliance Component #3) - Failing to protect groundwater Q Soil Separation (Compliance Component #4) - Failing to protect groundwater [~~l Operating permit/monitoring plan requirements (Compliance Component US) - Noncompliant Property Information Property address; 42300 Head Lake Rd. Richville, MN 56576 Property owner: Head Lake Camp Assoc. Inc____________ Parcel ID# or Sec/Twp/Range: 53000210125001 Reason for inspection; Permit Owner’s phone: ____________ or Owner’s representative; _______________ Local regulatory authority: Ottertail County Brief system description: 1000 gal, concrete tank to seepage bed drainfield. Comments or recommendations: Representative phone: ________________ Regulatory authority phone: 218-998-8095 Certification / hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of future system perfonrtance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. Inspector name; Phil Stoll______ Business name; Stoll Inspections Inspector signature; ___________ Certification number: 7526_______ License number; 2982_______ Phone number: 218-839-1849 rf Necessary or Locally Required Attachments □ System/As-built drawingS Soil boring logs O Other information (list): S Forms per local ordinance www.pca.state.mn.us • 651-296-6300 • 800-657-3864 wq-wwists4-31 • 3/16/12 TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 1 of 3 Property address; 42300 Head Lake Rd. Richville, MN 56576 Inspector initials/Date: PJS | 3/24/2016 (mm/dd/y/yy) 1. Impact on Public Health - Compliance component #1 of 5 Compliance criteria:Verification method(s): S Searched for surface outlet ^ Searched for seeping in yard/backup in home □ Excessive ponding in soil system/D-boxes ^ Homeowner testimony fSee Comments/Explanation) □ “Black soil" above soil dispersal system □ System requires “emergency” pumping D Performed dye test CD Unable to verify (See Comments/Explanation) CD Other methods not listed fSee Comments/Explanation) □ Yes lElNoSystem discharges sewage to the ground surface.______________ O Yes □ NoSystem discharges sewage to drain tile or surface waters. □ Yes □ NoSystem causes sewage backup into dwelling or establishment. Any “yes” answer above indicates the system is an imminent threat to public health and safety. Comments/Explanation: 2. Tank Integrity - Compliance component #2 of 5 Compliance criteria:Verification method(s): □ Probed tank(s) bottom □ Examined construction records □ Examined Tank Integrity Form (Attach) □ Observed liquid level below operating depth □ Examined empty (pumped) tanks(s) □ Probed outside tank(s) for “black soil” □ Unable to verify (See Comments/Explanation) □ Other methods not listed (See Comments/Explanation) □ Yes □ NoSystem consists of a seepage pit, cesspool, drywell, or leaching pit. Seepage pits meeting 7080.2550 may be compliant if allowed in local ordinance. □ Yes □ NoSewage tank(s) leak below their designed operating depth. If yes, which sewage tank(s) leaks: Any “yes” answer above indicates the system is failing to protect groundwater. Comments/Explanation: 3. Other Compliance Conditions - Compliance component #3 of 5 a. Maintenance hole covers are damaged, cracked, unsecured, or appear to be structurally unsound. □ Yes* H No □ Unknown b. Other issues (e/ectnca//?azartts, etc.) to immediately and adversely impact public health or safety. QYes* 0 No □ Unknown *System is an imminent threat to public health and safety. Explain; c. System is non-protective of ground water for other conditions as determined by inspector. □ Yes* S No *System is failing to protect groundwater. Explain: vww.pca.state.mn.us • 651-296-6300 • 800-657-3864 wq-wwists4-31 • 3116/12 TTY 651 -282-5332 or 800-657-3864 • Available in alternative formats Page 2 of 3 •• r Inspector initials/Date; PJS | 3/24/2016Property address; 42300 Head Lake Rd. Richville, MN 56576 (mm/dd/yyyy) 4. Soil Separation - Compliance component #4 of 5 Date of installation:0 Unknown Verification method(s): Soil observation does not expire. Previous soil observations by two independent parties are sufficient, unless site conditions have been altered or local requirements differ. S Conducted soil observation(s) (Attach boring logs) D Two previous verifications (Attach boring logs) n Not applicable (Holding tank(s), no drainfield) □ Unable to verify ("See Comments/Explanation) O Other (See Comments/Explanation) (mm/dd/yyyy) Shoreland/Wellhead protection/Food beverage lodging?□ Yes S No Compliance criteria: □ Yes □ NoFor systems built prior to April 1, 1996, and not located in Shoreland or Wellhead Protection Area or not serving a food, beverage or lodging establishment: Drainfield has at least a two-foot vertical separation distance from periodically saturated soil or bedrock. 1 I 2." is® Yes □ NoNon-performance systems built April 1, 1996, or later or for non-performance systems located in Shoreland or Wellhead Protection Areas or serving a food, beverage, or lodging establishment: Drainfield has a three-foot vertical separation distance from periodically saturated soil or bedrock.* Comments/Explanation; ZS“ <■ ^4Sr (fC □ Yes □ No"Experimental", “Other", or “Performance” systems built underpre-2008 Rules; Type IV or V systems built under 2008 Rules (7080. 2350 or 7080.2400 (Advanced Inspector License required) Drainfield meets the designed vertical separation distance from periodically saturated soil or bedrock. Indicate depths or elevations 20"A. Bottom of distribution media >56"B. Periodically saturated soil/bedrock > 36"C. System separation 36"D. Required compliance separation* *May be reduced up to 15 percent if allowed by Local Ordinance. Any “no” answer above indicates the system is failing to protect groundwater. 5. Operating Permit and Nitrogen BMP* - Compliance component #5 of 5 ^ Not applicable □ Yes S No If “yes”, A below is required □ Yes S No If “yes”, B below is required Is the system operated under an Operating Permit? Is the system required to employ a Nitrogen BMP? BMP = Best Management Practice(s) specified in the system design If the answer to both questions is “no”, this section does not need to be completed. Compliance criteria a. Operating Permit number: _____________________ Have the Operating Permit requirements been met? □ Yes □ No □ Yes □ Nob. Is the required nitrogen BMP in place and properly functioning? Any “no” answer indicates Noncompliance. Upgrade Requirements (Minn. Stat. §115.55) An imminent threat to public health and safety (ITPHS) must be upgraded, replaced, or its use discontinued within ten months of receipt of this notice or within a shorter period if required by local ordinance. If the system is failing to protect ground water, the system must be upgraded, replaced, or its use discontinued within the time required by local ordinance. If an existing system is not failing as defined in law, and has at least two feet of design soil separation, then the system need not be upgraded, repaired, replaced, or its use discontinued, notwithstanding any local ordinance that is more strict This provision does not apply to systems in shoreland areas. Wellhead Protection Areas, or those used in connection with food, beverage, and lodging establishments as defined in law. www.pca.state.mn.us • 651-296-6300 • 800-657-3864 wq-wwists4-31 • 3/16/12 TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 3 of 3 I Minnesota Pollution Control Agency 520 Lafayette Road North St. Paul, MN 55155-4194 Compliance Inspection Form Existing Subsurface Sewage Treatment Systems (SSTS) Doc Type: Compliance and Enforcement For local tracking purposes:Inspection results based on Minnesota Pollution Control Agency (MPCA) requirements and attached forms - additional local requirements may also apply. Submit completed form to Local Unit of Government (LUG) and system owner within 15 days System Status System status on date (mm/dd/yyyy): 4/24/2016 ^ Compliant - Certificate of Compliance (Valid for 3 years from report date, unless shorter time frame outlined in Local Ordinance.) □ Noncompliant - Notice of Noncompliance fSee Upgrade Requirements on page 3.) Reason(s) for noncompliance (check all applicable) □ Impact on Public Health (Compliance Component #1) - Imminent threat to public health and safety □ Other Compliance Conditions (Compliance Component #3) - Imminent threat to public health and safety □ Tank Integrity (Compliance Component #2) - Failing to protect groundwater O Other Compliance Conditions (Compliance Component #3) - Failing to protect gmundwater □ Soil Separation (Compliance Component #4) - Failing to protect groundwater □ Operating permit/monitoring plan requirements (Compliance Component #5) - Noncompliant Property Information Property address: 42300 Head Lake Road, Richville, MN 56576 Property owner: Head Lake Camp Association Inc.__________ Parcel ID# or Sec/Twp/Range: 53000210125001 Reason for inspection: Permit Owner’s phone: ____________ or Owner’s representative: Hilary Barry_____ Local regulatory authority: Ottertail County Representative phone: 507-360-9261_______ Regulatory authority phone: 218-998-8095 Brief system description: 2-1000 gal, concrete septic tanks to 1000 gal, concrete lift tank to 700 sq. ft. drainfield bed. 10x70 Comments or recommendations: Certification I hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. Inspector name: Phil Stoll Business name: Stoll Inspections Inspector signature:___________ Certification number: 7526______ License number: 2982_______ Phone number: 218-839-1849 /A Necessary or Locally Required Attachments □ System/As-built drawing^ Soil boring logs □ Other information (list): 0 Forms per local ordinance www.pca.state.mn.us • 651-296-6300 • 800-657-3864 wq-wwists4-31 • 3116/12 TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 1 of 3 Property address: 42300 Head Lake Road, Richville, MN 56576 Inspector initials/Date: PJS | 4/24/2016 (mm/dd/yyyy) 1> Impact on Public Health - Compliance component #1 of 5 Compliance criteria:Verification method(s): ^ Searched for surface outlet ^ Searched for seeping in yard/backup in home G Excessive ponding in soil system/D-boxes G Homeowner testimony (See Comments/Explanation) □ “Black soil” above soil dispersal system □ System requires “emergency” pumping □ Performed dye test G Unable to verify (See Comments/Explanation) G Other methods not listed (See Comments/Explanation) G Yes G NoSystem discharges sewage to the ground surface.______________ G Yes G NoSystem discharges sewage to drain tile or surface waters. G Yes G NoSystem causes sewage backup into dwelling or establishment. Any “yes” answer above indicates the system is an imminent threat to public health and safety. Comments/Explanation: Per Assosciation Representative, they have never had any problems with the septic systems that service Head Lake Association in the past. 2. Tank Integrity - Compliance component #2 of 5 Compliance criteria:Verification method(s): G Probed tank(s) bottom G Examined construction records G Examined Tank Integrity Form (Attach) G Observed liquid level below operating depth G Examined empty (pumped) tanks(s) G Probed outside tank(s) for “black soil” G Unable to verify (See Comments/Explanation) G Other methods not listed (See Comments/Explanation) G Yes G NoSystem consists of a seepage pit, cesspool, drywell, or leaching pit. ■ Seepage pits meeting 7080.2550 may be compliant if allowed in local ordinance. G Yes G NoSewage tank(s) leak below their designed operating depth. If yes, which sewage tank(s) leaks: Any “yes” answer above indicates the system is failing to protect groundwater. ■ Comments/Explanation: 1 3. Other Compliance Conditions - Compliance component #3 of 5 a. Maintenance hole covers are damaged, cracked, unsecured, or appear to be structurally unsound. □ Yes* 0 No □ Unknown b. Other issues (electrical hazards, etc.) to immediately and adversely impact public health or safety. □ Yes* 0 No □ Unknown *System is an imminent threat to pubiic heaith and safety. Explain: c. System is non-protective of ground water for other conditions as determined by inspector. □ Yes* S No *System is faiiing to protect groundwater. Explain: vl. www.pca.state.mn.us • 651-296-6300 • 800-657-3864 . TTY 651-282-5332 or 800-657-3864 • wq-wwists4-31 • 3/16/12 Available in alternative formats Page 2 of 3 Property address: 42300 Head Lake Road, Richville, MN 56576 Inspector initials/Date: PJS | 4/24/2016 (mm/dd/yyyy) 4, Soil Separation - Compliance component #4 of 5 □ UnknownDate of installation: 8/6/1997 (mm/dd/yyyy) Shoreland/Wellhead protection/Food beverage lodging? Compliance criteria For systems built prior to April 1, 1996, and not located in Shoreland or Wellhead Protection Area or not serving a food, beverage or lodging establishment: Drainfield has at least a two-foot vertical separation distance from periodically saturated soil or bedrock. Verification method(s): Soil observation does not expire. Previous soil observations by two independent parties are sufficient, unless site conditions have been altered or local requirements differ. ^ Conducted soil observation(s) (Attach boring logs) □ Two previous verifications (Attach boring logs) n Not applicable (Holding tank(s), no drainfield) O Unable to verify (See Comments/Explanation)\tX\r n Other (See Comments/Explanation) □ Yes SNo □ Yes □ No lepsc-l □ Yes □ No IO“Comments/Explanation:Non-performance systems built April 1, 1996, or later or for non-performance systems located in Shoreland or Wellhead Protection Areas or serving a food, beverage, or lodging establishment: Drainfield has a three-foot vertical separation distance from periodically saturated soil or bedrock.* 51" □ Yes □ No“Experimental”, “Other”, or “Performance” systems built under pre-2008 Rules; Type IV or V systems built under 2008 Rules (7080. 2350 or 7080.2400 (Advanced Inspector License required) Drainfield meets the designed vertical separation distance from periodically saturated soil or bedrock. Indicate depths or elevations 22"A. Bottom of distribution media >58"B. Periodically saturated soil/^drock C. System separation____________>36" 36"D. Required compliance separation* ‘May be reduced up to 15 percent if allowed by Local Ordinance.Any “no” answer above indicates the system is failing to protect groundwater. 5. Operating Permit and Nitrogen BMP* - Compliance component #5 of 5 ^ Not applicable □ Yes □ No If “yes”, A below is required □ Yes □ No If “yes”, B below is required Is the system operated under an Operating Permit? Is the system required to employ a Nitrogen BMP? BMP = Best Management Practice(s) specified in the system design If the answer to both questions is "no”, this section does not need to be completed. Compliance criteria a. Operating Permit number:_____________________ Have the Operating Permit requirements been met? □ Yes □ No □ Yes □ Nob. Is the required nitrogen BMP in place and properly functioning? Any “no” answer indicates Noncompliance. Upgrade Requirements (Minn. Stat §115.55) An imminent threat to public health and safety (ITPHS) must be upgraded, replaced, or its use discontinued within ten months of receipt of this notice or within a shorter period if required by local ordinance. If the system is failing to protect ground water, the system must be upgraded, replaced, or its use discontinued within the time required by local ordinance. If an existing system is not failing as defined in law, and has at least two feet of design soil separation, then the system need not be upgraded, repaired, replaced, or its use discontinued, notwithstanding any local ordinance that is more strict. This provision does not apply to systems in shoreland areas. Wellhead Protection Areas, or those used in connection with food, beverage, and lodging establishments as defined in law. www.pca.state.mn.us • 651-296-6300 • 800-657-3864 wq-wwists4-31 • 3/16/12 TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Page 3 of 3 Department of m LAND AND RESOURCE MANAGEMENT OTTER TAIL COUNTY Government Services Center - 540 West Fir Fergus Falls, mn 56537 Ph: 218-998-&095 OTTER TA«- COUNTY S WEBSITE: WWW.CO.OTTER-TAIL.MN.USOTTCR TRIl o o • « I I Otter Tail County Compliance Inspection Form Addendum This form is a required attachment to MPCA Compliance Inspection Form for all Existing Subsurface Sewage Treatment Systems in Otter Tail County as of June 1, 2011. Property Information Parcel Number: SSCjOO^(Oi2.^00l Township; ~ Property Owner Name(s): Hggvci I iY)r Property Address: M Z SGO b^K.e' Zd . S^S 7^ Reason for Inspection: pfCvy\i f Number of Bedrooms: In Shoreland Area? Lake/River Name, Number, & Class WqcaA LckWL SQ -2.1^ Section; 7 I □0Yes No System Compliance Status: ^ Compliant ^ Non-Compliant Does the soil treatment area have less than 3 feet of vertical separation? Is the septic tank located less than 50 feet from any well? Is the soil treatment area located less than 50 feet from any deep well? Is the soil treatment area located less than 100 feet from any shallow well? Does any part of the septic system fail to meet the minimum OHWL setback requirements for the public water classification? Yes No XYes No XYes No Yes No XYes No "Yes" indicates that the system is failing to protect ground water and is noncompliant. If ’Yes", describe the condition noted: Required Attachments: System drawing to scale on next page. Completed MPCA Compliance Inspection I hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. N Name: ^ Certification Number: Business Licehse Name & Number: Signature: Phil Stoll 7526 Stoll Inspections 2982 H-ZH-thDate: Excel/Compliance Form forOTC 1/15/2014 Page 1 of 2 Otter Tail County Compliance Inspection Form Addendum (cont.) f ,Parcel Number: SSOQOZIOlZSOOl Date & Initial: __________£)S System Drawing The system drawing must be to scale and include all septic/holding/lift tanks, drainfields, wells within 100 feet of system (indicate depth of wells), dwelling and non-dwelling structures, lot lines, road right-of-ways, easements, OHWLs, wetlands, and topographic features (i.e. bluffs). La,/Q I Z S ^ ^ 7 ^ q (0 II |2 I? /'r /s- /7 /y I /J iCa/r^^er-s in CjQy^plianre^Additional Comments: Excel/Compliance Form for OTC 1/15/2014 Page 2 of 2 SEWAGE SYSTEM ©lim:This Certificate has been issued this 18th of August, 1997 certify that the sewage system installed as per Sewage Treatment System Permit Number 11573 has been approved for use by Otter Tail County, Minnesota. , to WtPS:: • V *• The property served by this Sewage System is legally described as:iM UNPLATTED PART GL 3 & PART GL 4 COM Nl/4 COR SEC 21 W 1294' S 3013' TO BG W TO SHORELN OF LAKE SELY P’iS mm iM m Parcel Number(s): 53000210125001 Section: 21 Township: 135 Range: 039 Township Name: RUSH LAKE TOWNSHP Lake Number: 56-213 Lake Name: HEAD mit ili ■m.Current Property Owner: HILARY BARRY Number of Bedrooms: 16 (campers) L\^ i4 Land & Resource Management Official 264,709 • Victor Lurtdeen Co.. Printors ■ Fergus Falls. MN • 1 ■600-346-4670 APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM WHITB— mice Yellow — Inspector Pink — Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218)739-2271 - FERGUS FALLS, MN 56537 LEGAL Permit No. pr G<- HDESCRIPTION Abatement: ( ) Yes (NoAND LOCATION LAKE/RIVER CLASS SECTION RANGELAKE NUMBER LAKE/RIVER NAME TWP NAMETWP. NO. s U L*< -^7SZ-Z13 |3iT PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER 33 I 2,5- _ I IDENTIFICATION: Please Print All Information Initial Mailing Address — No. Street, City and StaleLast Name First Zip Code Telephone No. P'.okvt 11 rv\ tJ^ ^ X k ' >r» c« lY Scv\ H \ I O v'Property Owner /1 S ^S~') 0V\ I V' y-Sewage System Installer Name A.M. This System will be ready for inspection on.19.P.M.at DEBnOOMS: / (yThis space for office use oniy NUMBER OF A.M. 19 P.M GARBAGE DISPOSAL: { ) YES (^) NOPhone Call Rec’d ByDate Rec'd Time Rec'd SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM ) hl^lding tank (Alarm Required) tank ( i/'fLift station (Alarm required) (yy'^rain field ( ) Trenches ( ) Bed ( ) Mound ( ) Outhouse ( ) Sewer line TANK DRAIN FIELD( Capacity GIs.Sq Ft.( 5o‘3 opfDistance from nearest well Ft. \(Distance from lake or stream Ft.Ft. /I Z-0Distance from building Ft. Ft. i Cr ^lo‘Distance from property line Ft.Ft. 3Distance from bottom to Water Table Ft.Ft. . EFFLUENT DISTRIBUTION ( ) ^avity (•^xfPressure Aii distances are shortest distance between nearest points PERCOLATION TEST DATA: WATER WELL DEPTH L ^ t o rPerc Tester,Date of Perc Test. y.37 /t^Z.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 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. iDATE:/Signature Permit: Permission is hereby granted to the above named applicant to perform the work described in the above sfatement. This ^mit 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 Crdinance of Ctter 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. idlrS f Issued Date: esource Management OfficeIFee $ Comments: ^ Z-i __ Rec #. ^ / Cl? Tvn ^5 Vv) i-kkov^"i“ l»<-v4-U Vvc'WSJe,. P(oA^II li^) 7 ■"b-ohiifc. bcjkL 277,212 • Victor Lundeen Co,. Printers • Fergus Falls. MinneostaBK 0795-003 APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTE VWHITER - Office Yellow — Inspector Pink — Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 - FERGUS FALLS, MN 56537 Permit No.LEGAL pr ^DESCRIPTION Abatement: ( ) Yes (NoAND LOCATION LAKE NUMBER SECTIONLAKE/RIVER NAME LAKE/RIVER CLASS TWP NAMETWP. NO.RANGE i3'i-<1^1 PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER - CJ - 2^ I - <D \ 2, S - I IDENTIFICATION; Please Print All Information First Mailirrg Address — No. Street, City and StateLast Name Initial Zip Code Telephone No. ick vi II t /Ha/^il o X ^ v ^Q r' ■.<Property Owner /7 royyo -'v/ 1 K •;tt So \U:dSewage System Installer C’- i r- /Name f A.M. This System will be ready for inspection on.P.M.at C ; .S . , ^ NUMBER OF BEDROOMS: / (yThis space for office use oniy (S A.M.£19 P.M <;<) NOGARBAGE DISPOSAL: ( ) YESRioneCairRe?d^7Rec'd Time Rec’d SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM ( )jHolding tank (Alarm Required) ( Septic tank ( ^Y’) Lift station (Alarm required) (v-'"') Drain field ( ) Trenches ( ) Bed ( ) Mound ( ) Outhouse ( ) Sewer line TANK DRAIN FIELD (okL/ Sq Ft.Capacity GIs. ISoDistance from nearest well Ft.Ft.SO/rc iso'IDistance from lake or stream IS'O Ft.Ft. lo*Iz,0Distance from building Ft.Ft. I o'Distance from property line Ft. Ft. 3Distance from bottom to Water Table Ft. Ft. EFFLUENT DISTRIBUTION ( ) Gravity ( ) Pressure All distances are shortest distance between nearest points PERCOLATION TEST DATA: WATER WELL DEPTH LPerc Tester.Date of Perc Test J O/, V3-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. i >DATE;AjSignature f !/ /■Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This pdrmit 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. I Land & Resource Management Office Issued Date: IFee $_____________ Comments: S , Z- Rec #. ! C-c ’A rn c Y St O ifc. 5' w'. yL 277.212 • Victor Lundoon Co.. Priniors • Fergus Falls, MinneostaBK 0796-003 INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS 4 flb DRAIN FIELDHOLDING SEPTIC TANK LIFT TANKCATEGORY MinimumActual ^TirO SF SFCapacity FT FTQOC -f FT FTDistance from Nearest Well Distance from Buried Water Suction Pipe FTFT50FTFT Distance from Buried Pipe Distributing Water Under Pressure FT FTFT10FT hcf- FTFT FTDistance from Lake or River (OHWL) ft36I 10/20 FTFT FTDistance from Nearest Building ^004- FT ft(s^Vlr FT FT10Distance from Nearest Property Line FTFTDistance from Bottom to Water Table YES NOHolding Tank/Lift Alarm YES NOOld System Pumped & Destroyed DRAINFIELD CALCULATIONSewer Line to Well SeparationINTERPRETATION OF ABBREVIATIONS GLS. = Gallons _ SF = Square Feet FT = Linear Feet 7 oActualMinimum FTX ft FT20 SF / Inspector’s Comments: SKETCH: ^ Inspector's Signature IM lI Date of Inspection Time of Inspection SITE DATA LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, MN 56537 OWNER: / • FIRSTLAST NAMB 2 0^ TELEPHONE NUMBERMIDDLE ADDRESS: r 7/ Qua U LA,/<'g- MifO STR./RT.CITY STATE ZIP CODEft/ LAKE/RUf'ER NO. W^^Si (✓CcliC.C- a?g>tj/ M/f£ /VA/W£SEC.rn/E SAA/GE rH/E AMME LEGAL DESCRIPTION:SOIL BORING LOG COLOR & MUNSELL NO. DEPTH(INCHES)TEXTURE STRUCTURE BLOCKY PLATY PRISMATIC NONE?APARCEL NUMBER 1^BLOCKY PLATY PRISMATIC NONE y-J2FIRE NUMBER V// NUMBER OF BEDROOMS /e>y/^BLOCKY PLATY PRISMATIC NONE •? cfGARBAGE DISPOSAL: YES V?WELL CASING DEPTH:BLOCKY PLATY PRISMATIC NONE 7f'S9FLOODPLAIN: YES VEGETATION: AQUATIC BLOCKY PLATY PRISMATIC NONE SLOPE AT INSTALLATION SITE: TYPE OF OBSERVATION: Probe Pit 6*COMMENTS. f -ftPARENT MATERIAL:Outwash Loess Bedrock Alluvium ORIGINAL SOIL: No COMPACTED SOIL:Yes 1DEPTH OF BORING:.ft. PERC TEST # 1 PERC TEST #2- TWO TESTS ARE REQUIRED - WATER DEPTH*TIME INTERVAL (MINUTES)WATER DROP PERC RATE INTERVAL (MINUTES)WATER DROPTIMEWATER DEPTH PERC RATE m 3 15::18 1....7-4^7 =/iy3. DROP PERC START ...JO.—TIME TIME TIME INTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATE INTERVAL (MINUTES!WATER DROPTIMEWATER DEPTH PERC RATEI5TIME DROP PERC 7'6 REFia TIME * DROP PERC ^ 'l.S....JJDl... TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE WATER DROPTIMEINTERVAL (MINUTES)WATER DEPTH PERC RATE!¥i[lr4/iVa-1REFILL REFILL ..X .timP • ~....LO—....lO—PERC TIME DROP PERC TIME INTERVAL (MINUTES!WATER DROPWATER DEPTH PERC RATE INTERVAL (MINUTES!WATER DROP PERC RATETIMEWATER DEPTHREFILLREFILL TIME DROP PERC TIME PERCDROP INTERVAL (MINUTES)TIME WATER DEPTH WATER DROP PERC RATE WATER DROPTIMEINTERVAL (MINUTES)WAT PERC RATEREFta wfJmDRQP W ffERC' Herb ^te i REFia timet PERCTIME DROP TIME INTERVAL (MINUTES!WATER DEPTH WATER DROP INTERVAL (MINUTES) WATER DEPTH WATER DROP PERC RATETIME REFia REFia LjfV—__5 ''fi'tRj/AL IMINUTES) TIME DROP PERC TIME DROP PERC TIME INTERVAL (MINUTES)WATER DROP-WATER DROPWATER DEPTH PERC RATE WATER DEPTH PERC RATETIME REFia -f- ERC TIME DROP PERCW ERC RAT^ W ^ I PERC TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP INTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATETIME REFia REFia DROPTIME TIME DROP PERC PROPOSED DESIGN: PRESSURE DIST.TRENCH.ATGRADE.BED.MOUND.HOLDING TANK. GRAVITY DIST.T SEWER LINE.OUTHOUSE.OTHER. SPECIFY:. — SYSTEM DESIGN ON BACK — System design must be to scale and must include the proposed location of the sewage system, all existing/proposed buildings, property lines, the ordinary high water level of the water body and all water wells within 150' of the sewage system. GRID PLOT PLAN inch(es) equals /^feet SKETCHING FORM ___________ //Scale;.grid(s) equals feet, or SIGNATURE: DATE:_____ MPCA LICENSE #: LICENSE CATEGORY: J- < ^ SUBMITTED BY: FIRM NAME: OA r? H 2f , J ADDRESS: ^ /?<?V ____________^-tL /A /Djtf,\- 7V c: BK— 0496— 029 F»T0UI Falls. MN • 1-800-346-4B70Victor Lundaao Co.. Prmtort • 10 ( 3 I ^"2^ ^ X '^3 ^J(D < /(o (j,S^O -T'/Z. X ,g^3.;-5~ ■f-°'V,^ovpfi0 2.^? >JY> 1 \^OCD \ZO(^ ^<JS- \%o<D CERTIFICATE OF APPROVAL SEWAGE SYSTEMft HOLDING TANK 19TH DECEMBERThis certificate has been issued this day of to certify that the sewage system installed as per sewage permit number indicated below has been approved for use by Otter Tail County, Minnesota. m.The premises covered by this certificate are legally described as: 56-213 21 Twp. 1^ ^39 Twp. Name RUSH LAKE m Lake No.Sec.Range 21 135 39 13.4 1)P/SRT GL 3 a PART GL 4 COM Nl/4 C SEC 21 W 1294' S 3013' TO BG W T SVORELN OF LAKE SELY NLY NELY AL SHORELN TO LN E FROM 3G W TO 0G gr-. c-BARRY/ HILARYOwner: Name ^3 BOX 98/ LAKE VIILSON/ MNAddress 56151Zip No. 9885Permit No. SP Signed by: Lund & Resource Managcmcnl OfTicial Oucr Tail Counly. MinnesotaMKL-0987001 f/. Sas39 m JT-272472 Victor Lundeen Co.. Printers. Fergus Falls. Minnesota APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM WHITE — Office Yellow — Inspector Pink — Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218)739-2271 - FERGUS FALLS, MN 56537 Permit No.LEGAL do Ls '7'/ia.= « tv /-Of' ^ ^ jpDESCRIPTION AND LPCATION SECTION RANGE TWP NAMELAKE/RIVER NAME LAKE/RIVER CLASS TWP. NO.LAKE NUMBER OLJ /-V /f*'AJE /3r n FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER(S) 5-3 j - 5--00 I IDENTIFICATION: Please Print All Information Zip CodeMailing Address — No. Street, City and State Telephone No.Last Name First Initiai ETx^iUi /aProperty Owner f f UJi^-raiv ,t/\U/i■A /)<^J -0.Sewage System Installer bvv. 10Name 5 A.M. P.M., 19.This System will be ready for inspection on.at This space for office use only NUMBER OF BEDROOMS: A.M. P.M19 GARBAGE DISPOSAL: ( ) YES ( ) NOPhone Call Rac'd ByTime Rac’dDate Rac’d SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM (3C ) Holding tank (Alarm Required) 2_ ) Septic tank ( ) Drain field ( ) Standard ( ) Bed ( ) Trench DRAIN FIELDTANK A2.(Oao Gis.Sq Ft.Capacity( 5o Ft.Ft.Distance from nearest well /S^O Ft.Ft.Distance from lake or stream ) Modified ) Mound Ft.Distance from building Ft./Q( JO Ft.Distance frorn property line Ft. EFFLUENT DISTRIBUTION ( ) Gravity ( ) Pressure , Distance from bottom to Water Table Ft.Ft. All distances are shortest distance between nearest points WATER WELL DEPTH: PERCOLATION TEST DATA: Date of First Test Rate. 19 Date of Second Test Rate, 19 1st Test Taken By First Test + 2nd Test 2 Rate2nd 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 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. .. DATE: Signature ^ Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of any said ordinances. NOTE: Permit void if work is not commenced within six (6) months. H- YIssued Date: Land & Resource Management OfficeaO3 r-Fee $.Rec #. Comments: Form No. BK-0993-003 268,559 - Victor Lundeen Co.. Printers • Fergus Palls, MN - 600-346-4870 r APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTl WHITE — Office ' Yellow — Inspector Pink — Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218)739-2271 - FERGUS FALLS, MN 56537 9S-f{Permit No.LEGAL Co Li 7 ‘ < tv ttv jp/LCt .DESCRIPTION AND 1-01 ^LOCATION RANGE TWP NAMESECTIONLAKE/RIVER CLASS TWP. NO.LAKE/RIVER NAMELAKE NUMBER n L/| <loJl P //va)E ns 9% 9(3 FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER(S) ^3 -OOO-) - O/^ -Go 1 IDENTIFICATION: Please Print All Information Zip Code Telephone No.Mailing Address — No. Street. City and StateFirst InitialLast Name LLtOj A il Ec') X-O t r' ^Property Owner (/j , I s 5Ic2M- 7/^Sewage System Instaiier Name S/r'O 9--30 A.M. P.M., 19.This System wilt be ready for Inspection on at This space for office use only NUMBER OF BEDROOMS: Time Rec’d ^ ^ 5/i 19 GARBAGE DiSPOSAL: ( ) YES ( y ) NOPhone Call Rec^d ByDate Rec’d SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM^----- (^ ) Holding tank (Alarm Required)(^DRAIN FIELDTANK ^ OO O GIs.Sq Ft.Capacity \( ) Septic tank ( ) Drain field ( ) Standard ( ) Bed ( ) Trench ( ) Modified ( ) Mound 50 Ft.Ft.Distance from nearest well /SO Ft.Ft.Distance from lake or stream Ft.Ft.Distance from building /Q Distance from properl^ine Ft.Ft./oEFFLUEN;rDISTRIBUTION ( ) Gravity^ ( )PJ Ft.Distance from bottom to Water Table Ft. All distances are shortest distance between nearest pointslure WATER WELL DEPTH: Bate-PERCOLATION TEST DATA: Di First Test 19 RateDate of Second T^, 19 1st Test Taken By + 2nd TestFirst Ti Rate2nd Test Taken By Agreement: The undersigned hereby makes application tor 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. /3 if- 7 9 7^DATE:7Signature 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 vioiation of any said ordinances. NOTE: Permit void if work is not commenced within six (6) months. // 7 VIssued Date: Land 81 Resource Management Officec-O \Rec #.Fee $.j_ Comments: Form No. BK-0993-003 268.559 ‘ Vidor Lundoon Co.. PrMoro - Fergus Ftfs, MN - 809-346-4870 J.INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS t SEPTIC TANK DRAIN FIELDCATEGORYActualMinimumActualMinimum g(WG SLS.Capacity GLS. SF SF Distance from Nearest Well FT FT FT FT50 Distance from Buried Water Suction Pipe FT 50 FT FT 50 FT Distance from Buried Pipe Distributing Water Under Pressure FT 10 FT FT 10 FT IXf ft Vt ft Distance from Lake or River (OHWL)FT FT FT ^ ft FT Distance from Nearest Building 10/20 FTFT10 Distance from Nearest Property Line FT FT1010 Distance from Bottom to Water Table FTFT FT FT 3 & Holding Tank/Lift Alarm DRAINFIELD CALCULATIONSewer Line to Well SeparationINTERPRETATION OF ABBREVIATIONS GLS. = Gallons SF = Square Feet FT = Linear Feet Actual Minimum FTX FTFT20 SF Inspector’s Comments: SKETCH:i.:,-s 1 I r i Inspector's Signature Dale ol Inspectim /O K Time of Inspection PERCOLA T!ON TEST DA TA Price $ 1.00 psr pad. SHORELAND MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Ph. No.Owner:Mailing Address: o ' O Ea C-,/i ic:/--/id J Li C Fii^Last Name Middle /■li'Qb L k dE St. & No.City State Zip No.Legal Description:L - X/ 3 )A L. /■>- dd ; ■2x1 .J- >■/ sv? TWP.LAKE OR RIVER NO.'NAME SEC.RANGE TWP NAME e 3 zav;i i Oy yd-£~ X i2 d Sy, if /V /> ir. ' /> r TEST HOLE NO. 1 A' 2 id 1 Z " TEST HOLE NO. 2 3c 3Depth To Bottom of Hoie Depth to Bottom of Holeinches;Diameter of Hole inches; Diameter of Hole inchesinches 3/->■ 2 r?Depth, Inches Soil Texture 7>Depth, Inches Soil TextureDate19 Dote 19_fC A f?/ - ///^ o /‘Y ■ 3 > Percolation Test By .//A SOr^iYG. UJFirmName.q:Firm Name,r)aLU cc Address ^/■/ UJ CC Address < Otter Tail County License No.,Otter Tail County License No^.h-C/) LU .Measurement, Inches Depth in Water Level, Inches H Measurement, Inches Depth In Water Level, Inches Time Remarks Time Remarks Oy t/L/ ^33-dPf 3 c> A g o yt-i,L//■3>/ X -2 -7 / 7^ ■'c>/ 6 •- 71Z/V <? 9 s S'// >" y¥jr//.7 />2 f//AT 1 /// / >v-/9 -/A/dS /"7 /> -ZD/1L 1 7-1 3 7 id31-/y-io 22c-. ~7Ty3 1IS ^/Vl‘V 1 ^/> //?j.2 A// /?z.A //3 3)f /f,r>rd /C X if 'yycA''. Vr‘ :Tl 79 © '’ftTPr I _rin-7CTJ» L-j"J£l' I CS . »’ivTC»>. W'I'I "7K -it <3 l.kt-<>i u>X \ \ I ■% /'<V ic: T*r s.r y lOQl ■4- I\. -H.'mX /X ?■£ kitii pT*»t r ot £fV 1 .!V .1 Iiit II Ifti:I ily :r.1?:}'V.I rri:!* •V; ■ I VI' I .'LSV i ? . ■y Pi i-/. LA]fcEm;-. ^.t - f- ^ 215502® VICTOR LUMOetH CO.. PRINTERS. FERQUS FALLS. UINN.PERCOLATION TEST DATAMKL -0871 -028 LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, Minnesota 56537 Ph. No. Mailing Address:Owner: Last I Name Zip No. /?V7 StateCityMiddleSt. & No. Legal Description:;.i< aJ wai TWP NAMERANGESEC. TWP.NAMELAKE OR RIVER NO. aO' TEST HOLE NO. 2TEST HOLE NO. 1 Depth to Bottom of Hole inches; Diameter of Hole JnchesDepth To Bottom of Hole,Diameter of Holeinches;inches Depth, i nches Soil Texture Soil TextureDepth, I nches 19_____Date 19 Date Percolation Test By____ Percolation Test Bv .Q LUFirm Name. QC Firm \‘----- / (NameJ____✓D oLU c LU Address.OC Add ress< -y- 4^/y< 'LU Ott^T/fl Couj Pertwiation rate minutes per inch Dfop in water level, inches ty License No,^ Measur ment, inches Drop In water level, inches Percolation rate minutes per inch Time Intervals minutes Time Interval, minutes Measure­ ment inches Remarks:Remarks:Time TimeO$I- See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of MN. f^ercolation rate minutes per inch minutes per inchPercolation rate = h:^r:D 56-215 ! II ! i 1! .031’ica11■r ST. 900 I iii \;)<ST>900 \ y■ ;S■ Situ*.. oXS ■ i ■I/! !l ;/X /•,-•/\iTx 900 .DB> \ . / /\/\\/_y \i/y I DR^.IN FIELD - 20 X 40» _8D0 Sq.=F^ I R-Li. Jdrai;nIFIEIJD i15x^0' i HBOjSq Ft >■T-‘ C,..L'S TRaILLF CA>1P, HKkD lake, Cv/ner: Clarence Mielke, Richville, l-'n Head Lake 56-213 (L'E) ‘ ■ ■ ; Sec 21 Twp 1351; 239vJ Lot #4 LEGi-.ND; Septic Tanks -i •Q Trailer Hookups i . or>-■'•r'Or '-.V Vi/? (< P'; m wmIm fccpi Wm.fel)ft€ m CERTIFICATE OF COMPLIANCE SEWAGE SYSTEM m■ te SM M M 24 th February I9_2AThis certificate has been issued this day of. I to certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota. The premises covered by this certificate are legally described as: 21 Twp. 13556-213 Range 39 Rush LakeTwp. Name.Lake No.Sec. v.,j^ Cal's Trailer Camp of Lot IIhmIS Is MM mm Clarence MielkeOwner: Name. Richville, MinnesotaAddress. 56576Zip No. 2420Permit No. SP_ k Signed by:. Malcolm K. Lee, Shoreland Administrator Otter Tail County, Minnesota^_____________________________________________________ MKL-087 1-009 159035 '"sto* Luwott’" i ea, rcii;ua mi"<« 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 — Inspector Ph.. Card Owner Owner Permit No., LEGAL Date DESCRIPTION AND i ■iAE 2J_ /.7r ,7‘fLOCATION Lake Classif. TWP NameSec.TWP RangeLake No.Lake Name IDENTIFICATION: Please Print All Information. Zip No.Tel. No.First Initial Mailling Adrlress —No. Street, City and StateLast Name O /a r c €—i u I // •€/^n ■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 Slgna^ture NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD p<4~ /'<\ D H ^ ' Sq. Fl /2SD3I 000 GIs.Sq. Ft.Capacity Ft.Ft.Ft.Distance from nearest well />Ft.Z-TAFt.Ft.Distance from lake or stream la Ft.Distance from occupied building Ft.Ft. / Distance from property line ZJi 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 "llh.x /22...,PERCQLA=l\ION TEST DATA: Date of First Test ,, 19 Rate /7 19..Z.Z.Date of Second Test , Rate 1 St 'Jest Taken By/i/f n i //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 Shorelan^anagement that the job is.j;eadv for inspection. (Call or use attached mailer notice.) ignature 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 confofl^ in all respects to op;{lnances of Otter Tall 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. / y.f/77 JT)Issued Date: foreland ManagementjOffIce0- rer IU^P\ Afproi/k ( Fee $Surcharge $ llkComments: iForm No. MKL-0771-003 viCToe LUH9IIN « CO , peiMUMt. rteeus rstL*. mitii.156906 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 \ low Inspector Pli.. Card Owner Owner Permit No..LEGAL Date DESCRIPTION AND LOCATION Lake No.Lake Name Lake Classif.Sec.TWP Range TWP Name IDENTIFICATION: Please Print All Information. Initial Mailling Address —No. Street, City and StateLast Name First 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. Distance from bottom to Water Table Ft.Ft.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 , 19 , Rate Date of Second Test , Rate 1st Test Taken By First Test + 2nd Test 2'2nd Test Taken By 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 Minn­ esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi­ cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. (Call or use attached mailer notice.) Dated Signature Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six (6) months. Permit: Issued Date: Shoreland Management Office Fee $Surcharge $certificate issued Comments:. Form No. MKL-0771-003 vicToa LuHeciH t c» . aamnaa. ri««u> r*LLt 158906 INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORY Actual Should be > kctual Should be Actual Should bet SFCapacityGIs.GIs.S S F SF i-~ 'ST' F St)Distance from Nearest Well F 75FF 50F F iQDistance from Lake or Stream F F F F/F hiDistance from Occupied Building 10 2020FFFF F YDistance from Property Line 10 10 10FFFF F Distance from Bottom to Water Table 4 4FFF F 77/nc ks -2 0Inspector's Comments: ir ^9^ GS/s- li' Date of Inspection Time of Inspection.M signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF “ Square Feet F “ Linear Feet Job Title AgencyMKL-0771-003-Backer V /"\ .. 'uJi .L V j./T.. i , 1 ''•■"N,I C O U M T V O := OTTER T A i L Phone 2.8-739-2271 Court House FG/gui Fa!;3, lViinsiiS30l:£ 56537 \.\XN ,A- iVIALCOL.V; K. LcE, Administrotof.-■^07 ...- IF •w'" •' April 13, 1977 7Ir, Rich:3"c Astruo iiiuuerota Dcpartwient of Health State Kospitai Grocudo Fergus Falls, Fiitinesota 56537 Dear Dick; This will coafira that Otter Tail Cou:aty coasiders the Head Lake Resort, owned by Cai Kielke, to be in existence via grandfather rights. Sincerely, heicois; K. Lee Aduinistrator iitb •fJim Johnson Cal Kielke cc; S:-;ORELAND MANAGEMENTORDINANCE - DIVISION OF EiViERGENCY SERVICE - SUBDIVISION CONTROL GRDIMANCE RIGHT-Or-WAY SETBACK ORDINANCE FUEL AND ENERGY COORDINATIONSOLID WASTE ORDINANCE SN'V -.OE SYSTEM CLEANERS ORDINANCE - RECORDER, OTTER TAIL COUNTY FLAMMING ADVISORY COLA.::'::, O' r Department of LAMB RESOURCE iUANAGEMEMT COUNTY OF OTTER TAIL Phone 218-739-2271 Court House Fergus Falls, IWInnesota 56537 iV.ALCOLM K. LEE, Administrator April 13, 1977 Mr, Richard Astrup Minnesota Department of Health State Hospital Grounds Fergus Falls, Minnesota si /tk h f' 56537 Dear Dick: This will confirm that Otter Tail County considers the Head Lake Resort, owned by Cal Mielke, to be in existence via grandfather rights. Sincerely, Malcolm K. Lee Administrator Imb ^^cc:Jim Johnson Cal Mielke SHORELAND MANAGEMENT ORDINANCE - DIVISION OF EMERGENCY SERVICE - SUBDIVISION CONTROL ORDINANCE SOLID WASTE ORDINANCE SEWAGE SYSTEM CLEANERS ORDINANCE - RECORDER, OTTER TAIL COUNTY PLANNING ADVISORY COMMISSION RIGHT-OF-WAY SETBACK ORDINANCE FUEL AND ENERGY COORDINATION i- April 19,1977 After consideration, motion was made by John Snowberg, seconded by Hub Nordgren, and carried, to accept the bid of Murphy Oil Company, Superior, Wisconsin, In the amount of .3678 for M.C., it being the lowest bid.The Board, having previously ad­ vertised for bids for seasonal culvert supplies, proceeded to open bids which were found to be as follows:Steel AN Steel Products Co., Inc., Chaska, Minnesota MINUTES OF THE ADJOURNED MEETINGOF THE BOARD OF COUNTY COMMISSIONERS OTTER TAIL COUNTY MINNESOTA Pursuant to adjournment, the Board of County Commissioners of Otter Tail County Minnesota met at 1:00 P.M., Tues­day,Ahcont Upon motion made by Hub Nordgren, seconded by Bert Hovland and unanimously carried, the sum of $1,000 was appropriated for the East Otter Tail Soil & Water Conservation District. The Board, having previously ad­ vertised for bids to be received for the construction of Bridge No. 56519 and high­ way approaches, proceeded to open bids 1 April 19, 1977, Sydney G. Nelson $13,065.46 May 10, 1977Milliceni Charfraw, Kingswood Resort, Star Lake Township Edgar Splittstoesser, South Turtle Lake Resort, Sverdrup Township Fred L. Evans. Babe's Resort, Perham Township Keith McKay, Sleepy Hollow Resort, -Tordenskjold Township Motion was made by Hub Nordgren, seconded by Bert Hovland and unanimously carried, to "grandfather In" the "Head Lake Resort" for Department of Health License. Upon motion made by Hub Nordgren. seconded by John Snowberg and unanimously carried, the following ap­ plications for sewage disposal system cleaners license were approved:Robert Palubicki, BJB Excavating, Dent, Minnesota Kenneth A. Svare. Svare's Cal Service, Audubon, Minnesota John Leick, Jack's Pumping Service, vergas, Minnesota Upon motion made by John Snowberg, seconded by Bert Hovland and unanimously carried, the following ap­ plications for sewage disposal installers license were approved, subject to pending bonds: James A. Carlisle, Carlisle Heating & Pibg., Detroit Lakes. Minnesota John Leick. Vergas, Minnesota Robert Palubicki, BJB Excavating, Dent, Minnesota Gordon C. Ekre, Ekre Trenching & Ditching, Hawley, Minnesota Kenneth A, Svare, Svare's Cat Service, Audubon, Minnesota Marvin j. Wegseheid, Bluffton Hard­ ware, Bluffton, Minnesota Bill Walker, Walker Excavating, Wah- peton. North Dakota Motion was made by John Snowberg, seconded by Bert Hovland and unanimously carried, to delay action on the preliminary plat of "Little Pine Estates" lor planning commission review. Mark III, Inc., Paynesville, Minnesota Stan Morrill, Inc., Fergus Falls, Minnesota Alley Constr., Co., Inc., Alexandria, Minnesota Sellin Bros., inc., Hawley, Minnesota Kern & Tabery, Inc., Wadena, Minnesota 212,603.73 213,600.68MINUTES OF THE ADJOURNED MEETING OF THE BOARD OF COUNTY COMMISSIONERS OTTER TAIL COUNTY MINNESOTA Pursuant to adjournment, the Board of County Comrnlssioners ot Otter Tall County Minnesota met at 9:30 A.M., Tues­day, May 10, 1977, all members present. After full consideration of the request from the City of Dent, dated April 30, 1977, motion was made by Sydney Nelson, seconded unanimousl County wil street maintenance work when there is equipment and personnel available to perform the work, at rates established for that purpose; all work to be requested by the clerk, as needed, with the under­ standing that County work shall have top priority. Upon motion made by John Snowberg, seconded by Bert Hovland and unanimously carried, the county auditor was authorized to advertise.for bids to be received until 9:30 A.M., Tuesday, June 7th, for the following; C.P. 77;SS -- Bituminous Seal coat; Approximately 86.65 miles of County State Aid Highways, County. Highways, Township Roads and City Streets, com­ prising 243,900 gallons of bituminous material for seal coat and 7,125 cubic yards of seal coat aggregate. 216,891.81 222,006.02 224,325.82 After consideration, motion was made by Sydney Nelson, seconded. by John Snowberg and unanimously carried, to accept the bid of Minnerath Const., Inc., Cold Spring, Minnesota in the amount of $162,393.93, it being the lowest bid. The Board, having previously ad­ vertised for bids to be received for C.P. 77:136, grading & surfacing, proceeded to open bids which were found to be as follows: Lincoln Construction Co., Lynd, Minnesota Al Minnerath, Inc. & Martin Fruth, inc.,St. Cloud. Minnesota 142,248.25 Dwire. inc.,Marshall, Minnesota 157,454.62 Alley Const. Co., Inc., Alexandria, Minnesota 161,370.55 Stan Morrill, Inc., Fergus Falls, Minnesota 175,046.49 Donald Conroy Construction Co., Dumont, Minnesota 176,963.03 Strom Construction Co., Moorhead, Minnesota Sellin Bros., Inc.,Hawley, Minnesota Ackling Construction Co.,Frazee, Minnesota " Kern & Tabery, Inc.,Wadena. Minnesota After consideration, motion was made by Hub Nordgren, seconded by Sydney Nelson and unanimously carried, to ac­ cept the bid of Lincoln Construction Co., Lynd, Minnesota, in the amount of $134,016.33, it being the lowest bid. The Board, having previously ad­ vertised for bids to be received for S.A.P. 56-679-01, grading and aggregate sur­ facing, proceeded to open bids which were found to be as follows'. Lincoln Construction Co., Lynd, Minnesota Clifford Strom, Brandon, Minnesota Al Minnerath, inc., & by Hub Nordgren and y carried, that Otter Tail 1 continue to perform future $134,016.33 184,295.15 191,521.16 195,247.35 Motion was made by Andy Leitch, seconded by Hub Nordgren and unanimously carried, to appoint Mrs. Charles (Margorie) Anderson, to the Nursing Service Board, to replace Mrs. Hansel who has resigned. Upon motion made by John Snowberg,, seconded by Bert Hovland and unanimously carried, the Board Chair- authorized to sign a 204,724.82 Motion was made by Hub Nordgren, seconded by John Snowberg andunanimously carried, to approve the following applications for special use permit: John R. Magnuson, Girard Township, Add six camp sites Owen Stowman, Rush Lake Township, Expand existing campground Motion was made by John Snowberg, seconded • by* Bert Hovland andunanimously carried, to approve the preliminary . plat of 1st add'n. to Boedigheimer Development, located in Section 6 of Otto Township, and the special use permit for construction of road, subject to conditional requirements. Motion was made by John Snowberg, seconded by Bert Hovlandunanimously carried, to man was proclamation naming the week of May 23rd as "Health and Safety Week in Otter Tail County."Upon motion made by John Snowberg, seconded by Hub Nordgren and unanimously carried, the County Auditor was authorized to publish notice of hearing on the proposed use of Federal Revenue Sharing Funds, hearing to be held June 7th, 11:00 A.M. Tjhe Board, having previously ad- ventised for bids to be received for S.A.P.- 56-627-04, grading & aggregate surfacing, proceeded to open bids which were found to be as follows:• Donald Conroy Construction Co., Durnont, Minnesota Dwire, Inc., Marshall, Minnesota Mafk HI. Inc.,’• Paynesville, Minnesota ‘'Stan Morrill, Inc., Fergus Falls, Minnesota ■Sellin Bros., Inc.; Hawley. Minnesota Keitn & Tabery, Inc., Wadena, Minnesota Alley Const. Co., Inc., Alexandria, Minnesota Al Minnerath, Inc. & Martin Fruth, Inc., Cold Spring-, Minnesota Strom Construction Co.. Moorhead, Minnesota After consideration, motion was made by Bert Hovland, seconded by Hub Nord­gren arid unanimously carried, to accept Ihe bid of $300,923.72 from Donald Conroy Construction Co.. Dumont, Minnesota, it being the lowest bid.The Board, having previously ad­vertised for bids to be received for S.A.P. 56-641-03, grading and aggregate sur­facing. proceeded to open bids which were found to be as follows; Minnerath Const, inc., Cold Spring, Minnesota Al Minnerath, Inc. & Martin Fruth, Inc., Sf. Cloud, Minnesota Ed Zimmerman, $ 96,605.39 100,420.35 Martin Fruth, Inc., St. Cloud, Minnesota Ed Zimmerman, Barrett, Minnesota Minnerath Const., Inc., Cold Spring, Minnesota Mark III, Inc., Paynesville, Minnesota Donald Conroy Construction Co., Dumont, Minnesota Dwire, Incorporated, Marshall, Minnesota Alley Construction Co., Inc., Alexandria, Minnesota Stan Morrill, Inc,, Fergus Falls, Minnesota Strom Construction Co., Moorhead, Minnesota Ackling Construction Co.,Frazee, Minnesota Kern & Tabery, inc.,Wadena, Minnesota Sellin Bros., Inc.,Hawley, Minnesota After consideration, motion was made by Hub Nordgren, seconded by John Snowberg and carried, to accept the bid of Lincoln Consf., in fhe amount of $96,605.39, it being the lowest bid. Motion was made by John Snowberg, seconded by Bert Hovland and unanimously carried, to rescind a resolution of April 19, 1977, requesting grant of $135,000.00 in connection with the construction of Bridge No. 56519 over the Dead River. Motion was made by Bert Hovland, seconded by Hub Nordgren and unanimously carried, to participate in the bituminous surfacing of two miles of township road in Pelican Township running between Sections 2 and 11 and 3 and to.Motion was made bv Sveinev Nelson, 101,863.39 102,214.95 103,044.85 114,542.15 $300,923.72and approve the preliminary plat ot Glen Moen's, as yet unamed, located in Section 19-133-42.Motion was made by Hub Nordgren, seconded by John Snowberg and unanimously carried, to approve fhe preliminary plat of Sunset Heights, located in Section. 20-133-39. Upon motion made by Hub Nordgren, seconded unanimously carried, approval was given to Aaron Johnson, Girard Township, to change a recreational campground to a mobile home site. Motion was made by Bert Hovland, seconded by John Snowberg and u^nimousiy carried, to cancel an N.S.F. check written by David Peterson to Shoreland Management in 1975. Motion was made by Bert Hovland, seconded by Hub Nordgren and unanimously carried, to 116.323.95 319,587.55 116,701.70 326,776.98 119,474.25 335,796.67 126,844.20 367,525.20 127,726.15 372,546.66by Bert Hovland and 128.985.40 379.159.24 131,189.72 132,533.45412,744.76 415,244.94 approve the preliminary plat ot "Rose Acres" located in Section 17-137-40, subject to requirements as stipulated by Land Surveyor Don Busker. Upon motion made by Hud Nordgren, seconded by Bert Hovland and unanimously carried, the following ap­plications for homestead classification and-or reduction of assessed valuation were approved:Eddie Ojata, Otto Township. Homestead classification Georoe Banc. Maine To\A/n«hin a $162,393.83 166,142.92 n r.rr-a