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HomeMy WebLinkAboutHeart Beach Resort_14000080063000_Septic System Permits_V V. FIELD NOTES LAKE NO.: 56- 383 DATELAKE NAME: DEAD FIRE NO.:Parcel No.: 14000080063000LEGAL DESCRIPTION 8 135 40 .96 PT GL 1 S OF RD BG 253' W OF NW COR LOT 9 HART BCH SLY 190.84' TO LK, SWLY 43.8 ^ u J60H / A7 ^ io Cxihlv^s © /X "3 X ^ O ^ ^ c/^et. y / Cr 00 a OL^ / OWNERS NAME AND ADDRESS: POULSEN, WILLIAM C POULSEN, SANDRA KAY 2607 N 125TH CIR r ^ * / r* 68164OMAHA, NE /Comments: 3^ SEPARATION DISTANCES(IN FEET) OUTHOUSEABSORPTION AREATANKSEWER LINE WELL OHWL LOT LINE DWELLING NON DWELLING GROUND ELEVATION § REASON(S) FOR ABATEMENT: SKETCH ON BACK... Inspector's Signature(s) i SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 - Fergus Falls. Mn. 56537 APPLICATION FOR PERMIT TO INSTALL S^AGE DISPOSAL SYSTEM White - OfficeYellow — InspectorPink — OwnerCerd — Owner i 5 y ^ dly > 'J- '^H3 Di/i »Q Lake No. Lake Name iXoj iv Permlt No..LEGAL Date DESCRIPTION AND Sec. tWp Q.LOCATION Lake Classif.Range TWP Name IDENTIFICATION; Please Print All Information. Tel. No,Initial Matlliiffii Addre« —No. Street, City end StateUiujf /nv> -Last Name First Zip No.Su 111[J<Z^n I) ^OWNER SEWAGE SYSTEM INSTALLER This System will be ready for inspection on.19____ This space for office use only .M,19_____ Phone Call Rac'd ByDate Rac'd Time Rw'd Owner or Agent Signature NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PIT DRAIN FIELDSEPTIC TANK OLljOf; GIS.H y-0 Sq. Ft.Sq. Ft.'Capacity Ft.yVd_Ft,—Jg ITU.li)^ Ft. Ft.Distance from nearest well Y^ Ft.Ft. ^ Ft. f rs'.Ft.Distance from lake or stream Distance from occupied building Ft. ,y LiL /o ^6Distance from property line Ft.Ft. Ft. rf-f ■ 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 I2XPERCOLATION TEST DATA: Date of First Test 19 Rate.■rLi—,2’XDate of Second Test..19 Rate. 1ft Test Taken By \r »,LFirst 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 end Minnesota Individual Sewage Disposal CodeMinimum Standards set forth by Minn­esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are a^rbved by Shoreland Management Offi­ cial shall become a part of the permit. Applicant further agrees that no part of the system shaf^be cover^ until it has^enyispected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the jo^ is/eady for ihspKti^. (O^fToV use attached mailer notice.) Vj&L ‘ ■=li 1,-Lf-} PDated. Signature Permission is hereby granted to the above narned 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: it’ Issued Date:fiend Managemen^pffice Fee $,Surcharge $7 6 3iAComments:. /kr>tJ Form No. MKL 0771-003 @ .'•re* isnii* t e»_ fliiul rtLil.....1S8906 . fafz 'J" oF Rock m fielJ SL! andtr /«/> of <^n>anJ 5' ahoi^t. iJ^cdk.r table. u.r€jio u3 0£ to 1 » Z .1- O !>>u S USi . 5 “ 2 l60'Frot« UKe. fidare. [ li,! O' ^5 ? m 1.1 s ^cJ<are.Z <S I clean otdOz O. tilI J “ uJ CltQ/J-Oid >■ oo < O II 8 yylohde do/JJe.. I Itio/ne.I Io o. 9 0 0 0 0 0 0Q r>sh yj o <A oV ^ •f I.iSi I'frd 1 Le r\I Pv fc L I C Mo <v\e. UiviTUWiTUrti'T UAiirXaP-C^<^eUMlTl.rpr I •ie I B4,A-¥ I V ' ^. 00 '1 ^■/ 41I V K-I '?orc KV6 I ^ • •// P^’rrC /lm ® r\.o. M M m w^CERTIFICATE OF COMPLIANCE SEWAGE SYSTEM M§PI?19 76 ^June3rdday of_This certificate has been issued this %ifuiIIto certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota. §M The premises covered by this certificate are legally described as: Lake No. Sfe-383 Sec. 8^17 Twp. 135 StnRange UQ Dead LakeTwp. Name.mm mtiIB'STr. 283' & W adj, to Hart Beach of Lot 1 S of road ex E 261* and North Ely Pt, Lot 3m m W^mm& Vernon SullivanOwner: Name. sDent, MinnesotaA ddress. mm 56528mZip No.in fm1|180UPermit No. SP. Signed by:.&■!Ma](/olm K. Lee, Shorelana Administrator Otter Tail County, Minnesota wM p 6 Cabins, 1 Mobile Plome 2 Campers MKL-087 1-009 p. m 159035 luvBrm 4 ce. r4iktr*t. rt»eu« riLii. hum 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 (^<ui Si nfoHf|zz/~7r~ Permit No.,LEGAL Date DESCRIPTION AND r-;? ] ?c- Ho • Sec. TV/P Rangee.LOCATION Lake Classif.Lake No. Lake Name TWP Name IDENTIFICATION: Please Print All Information. First Initial Mailliip8 Address —No. Street, City and StateLast Name Zip No.Tel. No. [y(Z^noIOWNER “rSEWAGE SYSTEM INSTALLER Nam This System will be ready for inspection on.., 19. This space for office use only .M19 Phone Call Rac'd ByDate Rac'd Time Rec'd Owner or Agent Signature NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEP^EJ>u___DRAIN FIELD 0-^00 /( Sq. Ft.Sq. Ft.GIs.Capacity ym.Ft.Ft.Ft.Distance from nearest well /rz^7-^Ft.Ft.Distance from lake or stream Ft. //jjI:'hFt.Ft.Distance from occupied building Ft. yM/ODistance from property line Ft.Ft.Ft. rFt.Ft.Distance from bottom to Water Table Ft. AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on 19 , Time ,JVI By !.zi;PERCOLATION TEST DATA:Date of First Test 19 , 19 Rate rL_4Si. 1st Test Taken By -21..-f! 0^Date of Second Test.,Rate \r <I.1.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 Minn- prbved by Shoreland Management Offi- until it has t)6en jnspected and accepted. It shall be the of use attached mailer notice.) esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are cial shall become a part of the permit. Applicant further agrees that no part of the system shaffbe cover responsibility of the applicant for the permit to notify the County Shoreland Management that the job is/eady for inspebtiqif. ! i-V 7 yDated. 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: land Managemen Fee $Surcharge $ 3AComments: / /Nlg/m-e Jkncj '2, Iq .Q.^ Form No. MKL-0771-003 1S8906 YieroB uiHMCii A c*.. paiMTca*. M««ut fm.li mihh r-,..v ■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 — InspectbrPink — Owner ^ Card — Owner 4 7 . *• j V:'j'/\r ;Permit No., S ^ ^ 2- 6 / ^ '■ U-f ^ /<=‘~^LEGAL /I'Date DESCRIPTION -X'''.1- "^7 _f.'' frAND T WT Z.O ■'/LOCATION Lake Classif.Lake No.Lake Name Sec.TWP Range TWP Name IDENTIFICATION: Please Print All Information. First Initial Mailling Address —No. Street, City and State Zip No.Tel. No.Last Name ! , V/ JL-,^OWNER SEWAGE SYSTEM INSTALLER Name. ^ This System will be ready for inspection A/cFtA^on. This space for office use only /a-/r.cm/o 19-2. Date Rec'd 1Time Rec'd Phone Call Rec'd By Owner or Agent Signature NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD GIs.Sq. Ft.Sq. Ft.Capacity >r0 Ft.Ft.Ft.Distance from nearest well / sFt.Ft.Ft.Distance from lake or stream i. Ft.Ft.Distance from occupied building Ft. Distance from property line Ft.Ft. Ft. (/Ft.(/Ft.Ft.Distance from bottom to Water Table All distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on ,, 19,, Time .....JVI By 19 i9..:>> PERCOLATION TEST DATA:Date of First Test Rate ■> Date of Second Test Rate /1st Test Taken By -N\> First Test -I- 2nd Test 2 Rate2nd Test Taken By ; The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work inAgreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn­ esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi­ cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. (Call or use attached mailer notice.) ^ ■Dated Signature Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express A 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 Minnesot^J*^ 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. . ’ . - yIssued Date: Shoreland Management Office pn/ilFee $Surcharge $ y y-it'x^c9 /hoc.' '-My / hldtytJ V .?o ->Comments:. 2 h rv S/C ■' > - m/ 7 /7''I' r 'C.i ^PUPS X. Form No. MKL-0771-003 M.. PiimTfB>. FCaeus fail*. ■)hh.158906vicroa Lwaecta « *INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORYActualShould be Actual Should be Actual Should be Capacity GIs.GIs.S F S F S F SF Distance from Nearest Well F 75F 50FFF F Distance from Lake or Stream F F F F F F Distance from Occupied Building 10 2020FFFFF F Distance from Property Line 10 10 10FFFFF F Distance from Bottom to Water Table 4 4FFF F F F C , Inspector's Comments: Date of Inspection 19___ \Time of Inspection .M A 1 Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs ■ Gallons SF “ Square Feet * Linear Feet Job TitleF -■Agency ;i ■A>. - ,t ■1. ^ jar’t..-'*?' jV '-'OJ -t:i‘ M KL-0771-003- Backer ■> *1 \J*i J '■ 5 I. t Ti ■ I TO BE CQMPLSTilD SY PERSON INSTALLING SYSTEM I hevijfcy aDte;:T. thai: I <ur, fauiiiiar v'a i-.r. the nsiniatua s'car.diirds required ty the OTThR TAXI, COUNTY SliOREL/iAl) MANAGEMENT ORDINANCE regarding iiewage systems and that I have installed the above system in accordance with those standards. Legal Description: 3T5'License No.Tyi Owners Name Signature «f Installer.in, !^y6ate of Installation 3? j/7<^D Date Please return when completed to Shoreland Management Zoning Office - Court House, Fergus Falls, Minnesota 56537. 1Phone 758-2495 p GARY E. HONER CONSTRUCTION General Building Complete Line Of Barn Equipment DENT, MINN. 56528 ) jJu i/j Uoorh 7l(A^2^'J Cl^Ah’t U-^ ^)V/6/ i ■Uiv^'. j -z o J J) D sP Phone 758-2495 GARY E. HONER CONSTRUCTION General Building Complete Line Of Barn Equipment DENT, MINN. 56528 tT-rCi oSi. 's :r> ■sii y ^5 ■r>^ . p)<KN Ci il So . <>r 'Tj ^ ft> •S- V. :r^ r.4> «■ PERCOLATION TEST DATA Price $ 1.00 per pad. SHORELAND MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Ph. No. Owner: ,Mailing Address: I/ Last Name First Middle St. & No.City State Zip No. VSEC! Legal Description: y,IM LAKE OR RIVER NO.NAME TWP.RANGE TWP NAME TEST HOLE NO. 2TEST HOLE NO. 1 3.LO’Depth to Bottom of HoleDepth To Bottom of Hole.inches; Diameter of Hole.inchesinches; Diameter of Hole inches 19 7 ^Depth, Inches Soil Texture Depth. Inches Soil TextureDate.4 C-Mt Date2i'AJt rpercolation ^est By_____L Percolation Test By____r soc 9^11 Firm Name.FirmName.DaUlcc ''aUJAddress.IT Address < COOtter Tail County License No..Otter Tail County License No^1-COLUMeasurement, Inches Depth in Water Level, Inches H Measurement, Inches Depth in Water Level, Inches Time Remarks Time Remarks ¥ ' S'L T' oi' O3^I-^ ' : o It v^fp J 3 1—*—jy^£yi- f/-t^/2 A MKL-0871-028« See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn. TO BE CO>1PLETED BY PERCOLATION TESTER I hereby attest that I am familiar with the minimum standards required by the OTTER TAIL COUNTY SHORELAND ’lANAOEMENT ORDINANCE regarding; sewage systems and that the land elevation where soil absorption portion of sewage system will be Installed is not less than six (6) feet above the high water level of the lake, stream or flowage involved. r Legal Description: -t'v—-Ip Signature of Percolator Testei:Owners Name jfis DatedLake Name Please return when completed to Land and Resource Management Office, Court House, Fergus Falls, Minnesota 56537. percolation test results. Attach a copy of the MKL-0574-045