HomeMy WebLinkAboutHohenstein_14000990314000_Septic System Permits_■ I-
Department of
LAND AND RESOURCE MANAGEMENT
OTTER TAIL COUNTY
Government Services Center • 540 West Fir
Fergus Falls, MN 56537 '
Ph: 218-998-8095
Otter Tail County’s Website: www.co.ottertail.mn.us
December 1, 2004
Mary Hohenstein
38186 Co Hwy35
Dent, MN 56528
RE: Sewage Treatment System Servicing Tax Parcel Number 14000990312000 &
14000990313000 Described as Lots 4 & 5 of Borup's Maple Beach, Section 08 of
Dead Lake Township, Dead Lake (56-383)
As of November 30, 2004, the sewage treatment system (Sewage Treatment
Installation Permit #16977) servicing your property was determined to be in compliance
with the provisions of the Sanitation Code of Otter Tail County for a 4 bedroom home.
If you have any questions regarding this matter, please contact our office.
Sincerely
Mark Ronning
Inspector
- APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM
LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095)
GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537
www.co.otter-tail.nnn.us
WHir-E - Office
YELLOW -L&R Inspector
PINK - Owner / Contractor (after issue)
I (fillPermit No.APPLICATION MUST BE COMPLETE IN ORDER TO BE PROCESSED
LAKE/RIVER
CLASS TWP NO,RANGELAKE NUMBER LAKE/RIVER NAME SECTION TWP NAME
2 IhS HOaJ c-
PARCEL NUMBER (S) OF PROPERTY BEING SERVICED E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROAD
Co /L 35OOO
LEGAL DESCRIPTION
I^cr«/p3
Daytime Phone No.Last Name First Initial Mailing Address
Co 3>s
VLA up S
Property
Owner
Contractor
Lie.#ts
THIS SPACE FOR OFFICE USE ONLY
A.M.
► This System will be ready for inspection on_the year of P.M..at.
A.M. P.M.
L&R OfficialDate Received Time Received
SEWAGE TREATMENT SYSTEM DESIGN DATA - AS SHOWN ON DRAWINGTYPE OF INSTALLATION
(CIRCLE ONE)
TANK DRAINFIELD
Size GIs./ OOPAdd-On/ew System
ench. Rock
(21) Trench, Gravelless
(22) Trench, Chamber
(23) Bed
(24) Mound
(25) At Grade
Replacement
(32) Tank, Septic
(33) Tank, Lift
(34) Trench, Rock
(35) Trench, Gravelless
(36) Trench, Chamber
(37) Bed
(38) Mound
(39) At Grade
(40) Combination
5oSetback to nearest well Ft. Ft.
Setback to OHWL (lake &/or river) ^Ft. Ft.
5oSoSetback to wetland Ft.Ft.
d^o/oSetback to dwelling Ft. Ft.Collector System
(26) Trench, Rock
(27) Trench, Gravelless
(28) Trench, Chamber
(29) Bed
(30) Mound
(31) At Grade
toSetback to non-dwelling Ft. Ft.lO
10Setback to nearest property line Ft.Ft.Other LO
(41) Tank, Holding
(42) Outhouse
(43) Sewer Line
(44) Performance
(45) Miscellaneous
lO loSetback to road right-of-way Ft.Ft.
3Elevation above restrictive layer Ft. Ft.
ALL DISTANCES ARE SHORTEST DISyNCE BETWEEN NEAREST POINTS.
# BEDROOMS GARBAGE (jt)
abatemen^yJ N
depth OF water well ABSORPTION AREA FOR MOUNDS
Ft^HOLDING TANK MONITOR/
DISPOSAL CONTRACT
( )Yes
( ) No-L&R Can Not Process
EFFLUENT
DISTRIBUTION
j^^Gravity
( ) Pressure
Designer__:
Designer Lie. #
PERCOLATION
TEST DATA
^ Highest Rate
Agreement: The undersigned hereby makes application for permit to install, alter, repair or extend Sewage Treatment System herein specified, agreeing to do all
such work in strict accordance with Sanitation Code of Otter Tail County, Minnesota. Applicant agrees that the Site Data Worksheet submitted herewith and which is
approved by a Land & Resource Management Official shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it
has been inspected and approved for use. It shall be the responsibility of the applicant for the permit to notify Land & Resource Management that the installation is
ready for inspection.
Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express con- '
dition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Sanitation Code of Otter Tail County,
Minnesota. This permit may be revoked at any time upon violation of the Sanitation Code.
i A 2Date of Test.r !
NOTE: This permit is valid for a period of six (6) months.
raoPermit Fee $ _Date:
LG
Ilf I
Rec. No.Date:
To X^s>^iv^U A by I aJW (J<4 rujL,Comments:
Form No. BK — 0203-003 315,609 • Victor Lundeen Co.. Printers • Fergus Falls. Minnesota
tl
APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM
LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095)
GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537
www.co.otter-tail.mn.us — —r
uvh/Te - Office
YELLOW -L&R Inspector
PINK - Owner / Contractor (after issue)
IQPtTlAPPLICATION MUST BE COMPLETE IN ORDER TO BE PROCESSED Permit No.
LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER
CLASS
SECTION TWPNO.RANGE TWP NAME
b)t>iD 2 SOaJ c.
PARCEL NUMBER (S) OF PROPERTY BEING SERVICED E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROAD
Co //^35000
LEGAL DESCRIPTION
ftcfvps LoH ^S'dT'f^r^cp's BectcJi
\
7)e^y^ fW -95/6
Last Name First Initial Mailing Address Daytime Phone No.
. !AAc.L\j 3SProperty
Owner
r \ Y 35
/ LA, «
Contractor
Lie.#
“t
3
THIS SPACE FOR OFFICE USE ONLY
lljlX>■ This System will be ready for inspection on_the year of
y//yWr)</mnuL&R Offici/Time Received C_/
P.M.
Date Received
SEWAGE TREATMENT SYSTEM DESIGN DATA - AS SHOWN ON DRAWINGTYPE OF INSTALLATION
(CIRCLE ONE)
TANK DRAINFIELD
Size GIs./ OOPAdd-On/^ Jjew System
(20) Trench, Rock
(21) Trench, Gravelless
(22) Trench, Chamber
(23) Bed
(24) Mound
(25) At Grade
^^//06Replacement
(32) Tank, Septic
(33) Tank, Lift
(34) Trench, Rock
(35) Trench, Gravelless
(36) Trench, Chamber
(37) Bed
(38) Mound
(39) At Grade
(40) Combination
5oSetback to nearest well Ft. Ft.
Setback to OHWL (lake &/or river) ^66Cfi(j7 Ft.Ft.
5o 5oSetback to wetland Ft.Ft.
c? 0Setback to dwelling /G Ft.Ft.Collector System
(26) Trench, Rock
(27) Trench, Gravelless
(28) Trench, Chamber
(29) Bed
(30) Mound
(31) At Grade
Setback to non-dwelling fOFt. Ft./G
Setback to nearest property line toFt.Ft.Other
(41) Tank, Holding
(42) Outhouse
(43) Sewer Line
(44) Performance
(45) Miscellaneous
/ 0
fO !oSetback to road right-of-way Ft.Ft.
3Elevation above restrictive layer Ft. Ft.
ALL DISTANCES ARE SHORTEST DISTANCE BETWEEN NEAREST POINTS.
# BEDROOMS Y
GARBAGE DISR^Y (jt)
ABATEMENT Y J N
DEPTH OF WATER WELL ABSORPTION AREA FOR MOUNDS
D e oO Ft"EFFLUENT
DISTRIBUTION
l/KO Gravity
( ) Pressure
HOLDING TANK MONITOR/
DISPOSAL CONTRACT
( )Yes
( ) No-L&R Can Not Process
Designer •
Designer Lie. #___________________
/Highest Rate
uPERCOLATION
TEST DATA
C'l^
/.Date of Test.
Agreement: The undersigned hereby makes application for permit to install, alter, repair or extend Sewage Treatment System herein specified, agreeing to do all
such work in strict accordance with Sanitation Code of Otter Tail County, Minnesota. Applicant agrees that the Site Data Worksheet submitted herewith and which is
approved by a Land & Resource Management Official shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it
has been inspected and approved for use. It shall be the responsibility of the applicant for the permit to notify Land & Resource Management that the installation is
ready for inspection.
Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express con
dition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Sanitation Code of Otter Tail County,
Minnesota. This permit may be revoked at any time upon violation of the Sanitation Code.
NOTE: This permit is valid for a period of six (6) months.
(yC^-/C
^riSture of
Date;Permit Fee $
I y/ /Date: O Rec. No.
Land & Resource Management i=~Rj fSfi by i —•3/■j' ■Comments:
%Form No. BK — 0203-003 315,609 • Victor Lundeen Co., Printers • Fergus Falls. Minnesota
f«
SEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTS
Inspector must make all measurements
'>■
DRAINFIELD OUTHOUSELIFT TANKSEPTIC TANKCATEGORY
Capacity /Oo<£) GLS.FT2LS.
jO-h ftft FTFTSetback from Nearest Well
Setback from Buried
Water Suction Pipe FTFTFT FT
Setback from Buried Pipe
Distributing Water Under Pressure (o FT /0/> ^FTFT
/gOf- FTSetback from OHWL (lake &/or river)ftFT FT
Setback from Setback from Wetland FT FT FT FT
/(eP 3XSetback from Dwelling FT FT FT FT
Setback from Non-Dwelling /Q^ FT FTFT
*
Setback from Nearest Property Line /Of- ft FT /Qy- ft FT
Setback from Right-of-Way /o ftFTFT 1 FT
J 7^ FTElevation above Restrictive Layer FTFT FT
Holding Tank/Lift Alarm NO
Old System Pumped & Destroyed NO
SEPTIC TANKfS)FILTER Sewer Line to Well Separation DRAINFIELD CALCULATION
Actual Minimum# Tanks Installed.XVES
□ NO
FTX(nManuf.
.ff/O 20Model #
MOUND CALCULATION
MOUND /AT-GRADE
ROCK REDUCTION
CL^tJL
Inspector’s Comments:
ABSORBTION AREA Rock trenches with inches
of rock under pipe/ror %.Ft. X
DF.reduction / ^uivalent toFt2
SKETCH:
ell 1X
4 i3(2.lA 0
TO iW*IlCf> -t-
0->
fo
/c /o Initial/L & FI OfficialTime
., the above described sewage system installation was Ts^d To be compliant with the provisions of the SanitationAs of
Code of Otter Tail County.
(^ (\0 <3
Land & Resource ^j)^g6nent Official
Aik TEST CERTIFICATION
On (date), an air test of the sewer line installedy/^/o ___________
under Sewage Disposal System Permit Number
^ '-i /' J r(owner), on
97y for
____pounds
^01/3 0
I lIl^r Jo ^ /
(lake/river) was made. At that time, the sewer line held
inch for ^004
'^^OUf^CE
minutes.
Instalief^^Signature License No.Date
- 4
r
SITE DATA WORKSHEET
LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL
GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537
218-998-8095
www.co.otter-tail.mn.us
Sewage Treatment System Permit # ^77OWNER:
^fc<rxYjtjo.
LAST NAME FIRST MIDDLE TELEPHONE NUMBER
ADDRESS:
¥■
STR./RT.CITY STATE ZIP CODE
LAKE/RIVER NO.LAKE NAME SEC. TWP.RANGE TWP. NAME
LEGAL DESCRIPTION:SOIL BORING LOG
COLOR &
MUNSELL NO. to
DEPTH
(INCHES)TEXTURE STRUCTURE
BLOCKY
PLATY
PRISMATIC
^igjlONF
BLOCKY
PLATY
PRISMATIC
/<J£a
PARCEL NUMBER
/YC An X ________
E-911 Address or Directions ^rom Nearest Public Road
S/S
NUMBER OF BEDROOMS BLOCKY
PLATYS<^'id p^\<-GARBAGE DISPOSAL: YES PRISMATIC
<^NONB'v)/r)6*/*nlyr/ft. SEWER LINE SEPARATIONi^-^ ft.WELL: CASING DEPTH BLOCKY
PLATY
PRISMATIC
NONE
FLOODPLAIN: YES BLUFF: YES
VEGETATION: AQUATIC RRESTRI
BLOCKY
PLATY
PRISMATIC
NONE
/r:SLOPE AT INSTALLATION SITE:%
TYPE OF OBSERVATION: Probe Pit
PARENT MATERIAL:
ORIGINAL SOIL: CYe^
Outwash Loess Bedrock Alluvium
No Date of Soil Boring
COMPACTED SOIL: Yes
*7DEPTH OF BORING (To 7' or restrictive layer):.ft.Date of Perc Test
PERC TEST #2PERC TEST #1 - TWO TESTS ARE REQUIRED -
WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATETIMEINTERVAL (MINUTES)WATER DEPTH S'. 06,±S-START7^.tTme drop ^rc
60.o TIME DROP PERC
INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATETIME
2S6IAm.wi.o -OTIMEDROPPERC TIME DROP PERC
INTERVAL {MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATETIME
m.REFILL %S._o S-1 PERCTIMEDROPPERCTIMEDROP
WATER DROP PERC RATEINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTHTIME
REFILLREFILL
^___ =TIME DROP PERCTIMEDROPPERC
WATER DEPTH WATER DROP PERC RATEINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)TIME
REFILL REFILL
TIME DROP PERC TIME DROP PERC
WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATETIMEINTERVAL (MINUTES)WATER DEPTHREFILL REFILL
DROP PERC TIME DROP PERCTIME
WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATETIMEINTERVAL (MINUTES)WATER DEPTH REFILLREFILL
DROP PERC TIME DROP PERCTIME
WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATETIMEINTERVAL (MINUTES)WATER DEPTH REFILLREFILL
DROP PERC TIME DROP PERCTIME
PROPOSED DESIGN:
HOLDING TANK.GRAVITY DIST..PRESSURE DIST..ATGRADE.MOUND.TRENCH.BED.
OTHER.SPECIFY:________________
— SYSTEM DESIGN ON BACK —
OUTHOUSE.SEWER LINE.
1
System design must be to scale and must include the proposed location of the sewage system', all
existing/proposed buildings, property lines, the ordinary high water level of the water body, wetlands,
bluff and all water wells within 150' of the sewage system. If there are any questions, see the University
of Minnesota Site Evaluation worksheets.
feet, or inch(es) equals feet.grid(s) equalsScale:Z
MPCA LICENSE #:
ChT/\^
FIRM NAME:
DESIGNED BY:LICENSE CATEGORY:.7
17 DATE:
?
ADDRESS:SIGNATURE:
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BK — 1003 - 029 315.904 • Viclor Lundeen Co.. Primers * Fergus Falls, MN • 1-800-346-4870
Department of
LAND AND RESOURCE MANAGEMENT
OTTER TAIL COUNTY
Government Services Center • 540 West Fir
Fergus Falls, MN 56537
Ph: 218-998-8095
Otter Tail County’s Website; www.co.ottertail.mn.us
November 12, 2004
Don Hohenstein
38136 Co Hwy 35
DentMN 56528
RE; Sewage Treatment System Permit (SP) #16977, Dead Lake (56-383)
f .Dear Mr. Hohenstein;
This letter will confirm our November 5, 2004 telephone conversation during which we discussed an
alternative site for your proposed sewage system installation.
As I mentioned, SP #16977 (copy enclosed) was issued on August 16, 2004 in accordance with the
site'design (copy enclosed) provided by Leigh Barry (State Licensed Sewage System Designer)
which was dated June 1, 1998. Mr. Barry’s site design indicated and SP#16977 allowed the
installation of the proposed sewage system southwesterly of the existing residence.
It is my understanding that you would prefer the proposed sewage system be installed
southeasterly of the existing residence in accordance with the site plan (copy enclosed) you
submitted to our Office on October 9, 2004.
As we discussed, our Office would not object td this alternative location for the proposed sewage
system installation under the following conditions;
T. Our Office is provided a revised site design prepared by a State Licensed Sewage System
Designer which confirms that the proposed alternative is .compliant with the provisions of the
Sanitation code of Otter Tail County.
2. Our Office receives written confirmation of the depth of your neighbor’s well. V*
Please keep in mind that our Office must approve in vyriting your proposed change prior to the
actual installation of the proposed sewage system and that we expect this installation to be
completed on or before December 31,2004.
If you have any questions regarding this matter, please contact me at 218-998-8095.
. y
V ■'
^Sincerely,
5lX1
BillKalar
Administrator //A Ay
CC; Dan Barry, 3330 Co Hwy 35, Dent, MN 56528 Ok 61^
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OCT 2 9 2004
* 1/1 *'Ts P«-
lands RESOURCE
APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM
LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095)
GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537
www.co.otter-tail.mn.us
WHllt - Office
YELLOW - L & R Inspector
PINK - Owner / Contractor (after issue)
APPLICATION MUST BE COMPLETE IN ORDER TO BE PROCESSED Permit No.
LAKE/RIVER
CLASS
RANGELAKE/RIVER NAME SECTION TWP NO.TWP NAMELAKE NUMBER
bie<x4. Iht-A-O54'2 ihS HOa) ti
PARCEL NUMBER (S) OF PROPERTY BEING SERVICEDfi'OOP-'^9 V 'h/Jl/ij 5 E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROAD
Co //w 35-poo
LEGAL DESCRIPTION
2)cfvp3
Initial Mailing AddressFirst Daytime Phone No.Last Name
^ C 2) SAryProperty
Owner j
-^3^0 <^. /Z____X f O, W*-V S'(V'.Contractor
Lie.#ts
TH/S SPACE FOR OFFICE USE ONLY
A.M.
> This System will be ready for inspection on.the year of .P.M..at.
A.M. P.M.
Date Received Time Received L & R Otficiai
SEWAGE TREATMENT SYSTEM DESIGN DATA - AS SHOWN ON DRAWINGTYPE OF INSTALLATION
(CIRCLE ONE)
TANK DRAINFiELD
Size / 00 (9 GIs.Add-On/
Replacement
(32) Tank, Septic
(33) Tank, Lift
(34) Trench, Rock
(35) Trench, Gravelless
(36) Trench, Chamber
(37) Bed
(38) Mound
(39) At Grade
(40) Combination
ew System
ench. Rock
(21) Trench, Gravelless
(22) Trench, Chamber
(23) Bed
(24) Mound
(25) At Grade
ScSetback to nearest well Ft.Ft.
Setback to OFIWL (lake &/or river) ^Ci.4? 6?Ft.Ft.
5o boSetback to wetland Ft.Ft.
^'0Setback to dwelling /O Ft.Ft.Collector System
(26) Trench, Rock
(27) Trench, Gravelless
(28) Trench, Chamber
(29) Bed
(30) Mound
(31) At Grade
Setback to non-dwelling Ft.Ft.10
Setback to nearest property line 10Ft.Ft.Other LSl(41) Tank, Holding
(42) Outhouse
(43) Sewer Line
(44) Performance
(45) Miscellaneous
to icSetback to road right-of-way Ft.Ft.
3Elevation above restrictive layer Ft.Ft.
ALL DISTANCES ARE SHORTEST Dj^NCE BETWEEN NEAREST POINTS.
GARBAGE (j3
ABATEMENlCv N
DEPTH OF WATER WELL # BEDROOMS.ABSORPTION AREA FOR MOUNDS
Ft^EFFLUENT
DISTRIBUTION
Gravity
( ) Pressure
HOLDING TANK MONITOR/
DISPOSAL CONTRACT
( )Yes
( ) No-L&R Can Not Process
__Designer__
Designer Lie. #
PERCOLATION
TEST DATA
Date of Test,Highest Rate
Agreement: The undersigned hereby makes application for permit to install, alter, repair or extend Sewage Treatment System herein specified, agreeing to do all
such work in strict accordance with Sanitation Code of Otter Tail County, Minnesota. Applicant agrees that the Site Data Worksheet submitted herewith and which is
approved by a Land & Resource Management Official shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it
has been inspected and approved for use. It shall be the responsibility of the applicant for the permit to notify Land & Resource Management that the installation is
ready for inspection.
Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express con
dition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Sanitation Code of Otter Tail County,
Minnesota. This permit may be revoked at any time upon violation of the Sanitation Code.
NOTE: This permit is vaiid for a period of six (6) months.
QC-
COODate:Permit Fee $
iture of^
137 YffTRec. No.Lafid S {Source Management
io X\S'kl t A b I <Vi(y\/ 0^Comments:
'’vOv.f
-orm No. BK — 0203-003 315.609 * Victor Lundeen Co., Printers * Fergus Falls, Minnesota
SITE DATA
LAND AND RESOURCE MANAGEMENT
Otter Tail County
Fergus Falls, MN 56537
OWNER:
LAST NAME FIRST MIDDLE TELEPHONE NUMBER
ADDRESS:
STR./RT CITY STATE ZIP CODE
LAKE/RIVER NO.LAKE NAME SEC.TWP.RANGE TWP. NAME
LEGAL DESCRIPTION:SOIL BORING LOG
COLOR 6
MUNSELL NO.
DEPTH
(INCHES)TEXTURE STRUCTURE
BLOCKY
PLATY
PRISMATIC
NONEPARCEL NUMBER
BLOCKY
PLATY
PRISMATIC
NONE
/ ^
FIRE NUMBER
2V
NUMBER OF BEDROOMS BLOCKY
PLATY
PRISMATIC
NONE
GARBAGE DISPOSAL: YES
WELL CASING DEPTH:ft.c BLOCKY
PLATY
PRISMATIC
NONE
6^FLOODPLAIN: YES
(Terre'sti^lVEGETATION: AQUATIC
BLOCKY
PLATY
PRISMATIC
NONE
SLOPE AT INSTALLATION SITE:%
TYPE OF OBSERVATION: Probe Pit
}
PARENT MATERIAL: • Till
ORIGINAL SOIL: Yes No
COMPACTED SOIL;
Outwash Loess Bedrock Alluvium COMMENTS:
Yes CN.O-'
DEPTH OF BORING:.ft.
PERC TEST # 1 PERC TEST #2- TWO TESTS ARE REQUIRED -
WATER DEPTHTIME
■QjT
INTERVAL (MINUTES)WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DROPWATER DEPTH PERC RATE
sVtg-K 7S--START START
...JlL...it: ^/o r .-i~0-OROPTIME PERC TIME DROP PERC
INTERVAL (MINUTES)TIME WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)
REFILL
___
WATER DEPTH WATER DROP PERC RATE^77•S'.IQ T’S.7REFILL-u::iZiM'LO JD€DROPTIME PERC TIME DROP PERC
TIME INTERVAL (MINUTES)PERC RATEWATER DEPTH WATER DROP TIME .
m
INTERVAL (MINUTES!WATER DROP PERC RATEWATER DEPTH
SIX!9fAJS-.LA^rREFILLREFILLIS fo cyIC
DROP PERC TIME DROPTIME PERC
TIME TIME WATER DROP PERC RATEINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE INTERVAL (MINUTES)WATER DEPTH
REFILL REFILL
T- ------------- = ------------TIME DROP PERC
u,tu
TIME DROP PERC
MW "N/VATER DEPTHTIMEINTERVAL (MINUTES) WATER DROP PERC RATE VAL (MINUTES)WATER DROP PERC RATEWATER DEPTH J■:
REFILL REFILL
DROP TIMETIMEPERC DROP PERC
TIME WATEt^^^ThT
INTERVAL IMINUTES)WATER DROP PERC RATE TIME INTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATE
REFILL REFILL
-5------- =TIME DROP PERC TIME DROP PERC
TIME INTERVAL IMINUTES)PERC RATEWATER DEPTH WATER DROP-TIME INTERVAL (MINUTES) WATER DEPTH WATER DROP PERC RATEREFILLREFILL
s ______DROP PERC TIME DROPTIME PERC
TIME INTERVAL (MINUTES)PERC RATE PERC RATEWATER DEPTH WATER DROP TIME INTERVAL (MINUTES!WATER DEPTH WATER DROPREFILLREFILL
DROP TIME DROP PERCTIMEPERC
PROPOSED DESIGN:
TRENCH GRAVITY DIST.,PRESSURE DIST.BED.MOUND.HOLDING TANK.ATGRADE.
SEWER LINE.OUTHOUSE.SPECIFY:______________
— SYSTEM DESIGN ON BACK —
OTHER.
System cIrpi ' 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
feet SKETCHING FORM//jnch(es) equalsfeet, orgrid(s) equalsScale;
7I4 rSUBMITTED BY: _________
FIRM NAME: a-Y-- V 5i" V.; >vf
ADDRESS; {1^7^ TT _____________
LitTijOT v>AW-> -'.5^ __________
SIGNATURE:
/
~ n-'DATE:
ft"MPCA LICENSE #;
J^C > yLICENSE CATEGORY
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OCT 2 9 2004
) '-Cs"
land & RESOURCE
:4APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM
LAND & RESOURCE MANAGEMENT ^ f C
OTTER TAIL COUNTY COURT HOUSE
Phone:(218)739-2271 - FERGUS FALLS, MN 56537
WHITE — Office jYellow — Insqector’
Pink\— Owner '/-17//
\(o°l
rj-/)9^LEGAL
DESCRIPTION
Permit No.i
(X ) Yes ( ) NoAbatement;AND
LOCATION
LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER SECTION TWP. NO.RANGE TWP NAME
/CLASS^
uoU - - til oJ-^ (' Cl io
PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER
^ OSfdDOO
IDENTIFICATION; Please Print All Information
Last Name First.IrtItlal Mailing Address — No. Street, City and State Zip Code Telephone No.
dtllCCtcjl 39
ddiAlId/Tki' ddddd
i Cii ^Property
Owner Oi''y
t djyccy 61 /Sewage
System
Installer
Cy 14^ 7 INameJ.IT
A.M.
Ihis System will be ready for inspection on , 19.P.M.at
</This space for office use only
NUMBER OF BEDROOMS:
A.M.
19 P.M GARBAGE DISPOSAL: ( ) YES {JXj NODate Rec'd Time Rec'd Phone Call Rec’d By
SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM
( ) Holding tank (Alarm Required)
(^) Septic tank
( ) Lift station (Alarm required)
(yC.) Drain field
(yC) Trenches
( ) Bed
( ) Mound
( ) Outhouse
( ) Sewer line
TANK DRAIN FIELD
; GIs.C/i/K’Sq Ft.Capacity /i,_
SOly i ' Ft.Distance from nearest well 60 !=■■
Distance from lake or stream l6oFt.Ft.
Distance from building )D Ft.Ft.
IDDistance from property line Ft.
? Ft.Distance from bottom to Water Table Ft.'_^EFFLUENT DISTRIBUTION
(;/;) Gravity
( ) Pressure
All distances are shortest distance between nearest points
PERCOLATION TEST DATA:
WATER WELL DEPTH
cUrMJ
ocfl A 7- /-fft/f h
■/Perc Tester.Date of Perc Test.7
CAL'ill 033Rate 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.
A/1 ;oy]Ay-.{yy l' ' 3-'iDATE:
0: Signature
Permit: Permission is hereby granted to the above named applicant to perform the work described in the abti^e statement. This permit iSTgranted 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 Offer Tail County, Minnesota.
This permit may be revoked at any time upon violation of any said ordinances.
NOTE; Permit void if work is not commenced within six (6) months.
Issued Date:
Land & Resource Management Officeryi'il- ft y$o.36Fee $
Commentso(^^^ 'V7f\ (__________________________________________ __________
iAy6*y y.td yt aj/yu>oy cuyu /CA/y? 73/00) y fie Ay
Rec #.
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277.212 ■ Victor Lundeen Co . Printers • Fergus Falls. MinneostaBK 079B-003
A
INSPECTION RESULTS
Inspector must make all measurements
SEWAGE DISPOSAL SYSTEM STATISTICS f
DRAIN FIELDHOLDING
SEPTIC TANK LIFT TANKCATEGORY MinimumActuai
SF SFGLS. GLS.Capacity
FTFTFTFTDistance from Nearest Well
Distance from Buried
Water Suction Pipe FTFT50FTFT
Distance from Buried Pipe
Distributing Water Under Pressure FTFT10FT FT
FT FTDistance from Lake or River (OHWL)FT FT
10/20 FTFTFT FTDistance from Nearest Building
FTFTFTFT10Distance from Nearest Property Line
FTFT3FT FTDistance 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 Feel
FT = Linear Feet
Actual Minimum
FTX
FT 20 FT SF
Inspector’s Comments:
SKETCH:
Inspector’s Signature
Date of Inspectnn
Time of inspection
r
APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM
WHITE — dtfice
Yellow — Inspector
Pink — Owner
LAND & RESOURCE MANAGEMENT
OTTER TAIL COUNTY COURT HOUSE
Phone: (218) 739-2271 - FERGUS FALLS, MN 56537
Permit No.LEGAL
DESCRIPTION (^)Yes ( )Abatement:NoAND
LOCATION
LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER SECTION TWP. NO.RANGE TWP NAME
8 / 35"
PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER
^ 03f3^00
IDENTIFICATION: Please Print All Information
___________________________________ Mailing Address — No. Street, City and State
lU^tiuiJLoio J&d/y
Last Name First Initial Zip Code Telephone No.
Property
Owner
Sewage
System
Installer
Name
A.M. .
► This System will be ready for inspection on PM., 19-at
This space for office use only
NUMBER OF BEDROOMS:
A.M.
P.M (X) NO19GARBAGE DISPOSAL: ( ) YESDate Rec’d Phone Call Rec'd ByTime Rec’d
SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM
( ) Holding tank (Alarm Required)
(^) Septic tank
( ) Lift Station (Alarm required)
(^4) Drain field
( Trenches
( ) Bed
( ) Mound
( ) Outhouse
) Sewer line
TANK DRAIN FIELD
^<P^Sq
60 hop/ooOCapacity GIs.Ft.
60Distance from nearest well Ft.Ft.
l60Distance from lake or stream Ft. Ft.
(^d//0Distance from building )0 Ft.
)0 Ft.Distance from property line Ft.
3(Distance from bottom to Water Table Ft.
EFFLUENT DISTRIBUTION
(^^ Gravity
( ) Pressure
All distances are shortest distance between nearest points
PERCOLATION TEST DATA:
-WATER WELL DEPTH
Perc Tester Date of Perc Test
/■3/LM.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 Otficical 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.
r/7DATE:
Permit: Permission is hereby granted to the above named applicant to perform the work described in the abcwe stal
that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects
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.
snt. This permit is^ranted upon express condition
the Ordinance of Otter Tail County, Minnesota.
Issued Date:
Land & Resource Management Office56Fee $.Rec #
Comment^
loM
Falls. MinnoostaBK 0795-003
r
System de§%rt,must be to scale and must include the proposed location of the sewage system, all
existin^proposed buildings, property lines, the ordinary high water level of the water body and all water
weljs within 150' of the sewage system.
GRID PLOT PLAN
feet SKETCHING FORM/.inch(es) equalsgrid(s) equals feet, orScale:
/
FIRM NAME:J^:a>^
ADDRESS: _____________
b> Er(K)T W\.vVJ ^
SIGNATURE:SUBMITTED BY:
DATE:
ft'MPCA LICENSE #:
LICENSE
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SITE DATA i , ‘4
LAND AND RESOURCE MANAGEMENT
Otter Tail County
Fergus Falls, MN 56537
■ V t
OWNER:
ly ir-x
MIDDLE TELEPHONE NUMBERFIRSTLAST NAME
ADDRESS:
CITY STATE ZIP CODESTR./RT
SEC.RANGE TWP. NAMELAKE/RIVER NO.LAKE NAME TWP.
LEGAL DESCRIPTION:SOIL BORING LOG
COLOR &
MUNSELL NO.
DEPTH
(INCHES)STRUCTURETEXTURE
BLOCKY
PLATY
PRISMATIC
NONE
0“^
PARCEL NUMBER
BLOCKY
PLATY
PRISMATIC
NONE
loyy.FIRE NUMBER
5//
NUMBER OF BEDROOMS BLOCKY
PLATY
PRISMATIC
NONE
GARBAGE DISPOSAL: YES
WELL CASING DEPTH:ft.BLOCKY
PLATY
PRISMATIC
NONE
FLOODPLAIN: YES
VEGETATION: AQUATIC
BLOCKY
PLATY
PRISMATIC
NONE
SLOPE AT INSTALLATION SITE:
TYPE OF OBSERVATION: Probe Pit
PARENT MATERIAL:Outwash Loess Bedrock Alluvium COMMENTS:.
ORIGINAL SOIL:
COMPACTED SOIL:
DEPTH OF BORING:.ft.
PERC TEST # 1 PERC TEST #2- TWO TESTS ARE REQUIRED -
WATER DROP PERC RATEWATER DEPTHINTERVAL (MINUTESt WATER DEPTH PERC RATE TIME INTERVAL (MINUTES)TIME WATER DROP
msir ...MO-s.7-^STARTSTART
JO.PERC TIME DROP PERCTIMEDROP
PERC RATEWATER DEPTH WATER DROPPERC RATE TIME INTERVAL (MINUTES)TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP .L^ZET REFILLREFILLnS-lO10o TIMETIMEDROPPERC
PERC RATEWATER DEPTH WATER DROPPERC RATE INTERVAL (MINUTES)INTERVAL (MINUTES)WATER DEPTH WATER DROP TIME „TIME
YY2,REFILLREFILL fo ^ SJ ....LO...-Jo.£37 DROPTIME PERCPERCTIMEDROP
WATER DROP PERC RATEINTERVAL (MINUTES)WATER DEPTHINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIMETIME
REFILLREFia
TIME * DROP — __TIME DROP PERCPERC
PERC RATEWATER DROP/ATER DEPTH^WATER DROP PERC RATE VAL (MINUTES)TIME INTERVAL (MINUTES)WATER DEPTH REFILLREFILL
DROP PERCTIMETIMEDROPPERCWATE^^PTH
WATER DROP PERC RATEWATER DEPTHINTERVAL (MINUTES)TIME INTERVAL (MINUTES)WATER DROP PERC RATE TIME
REFILLREFILL
DROP PERCTIMEPERCTIMEDROP
PERC RATEWATER DEPTH WATER DROPINTERVAL (MINUTES)WATER DROP-PERC RATE TIMETIMEINTERVAL (MINUTES)WATER DEPTH REFILLREFILL
---- =DROP PERCTIMEPERCTIMEDROP
WATER PROP PERC RATEWATER DEPTHPERC RATE WTERVAL (MINUTES)TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP TIME
REFILLREFILL
DROP PERCTIMEPERCTIMEDROP
PROPOSED DESIGN:
4 A PRESSURE DIST.ATGRADE.MOUND.HOLDING TANK.GRAVITY DIST.TRENCH.BED.
SEWER LllsiE OUTHOUSE.OTHER.SPECIFY:______________
— SYSTEM DESIGN ON BACK —e
mmLwimim
m7<fIm sMi
CERTIFICATE OF APPROVAL
SEWAGE SYSTEMwm]
m
m
m mmmSThis Certificate has been issued this 1ST of FEBRUARY, 1999 , to certify
that the sewage system installed as per Sewage Treatment System Permit
N\imber 12022 A&B has been approved for use by Otter Tail County,
Minnesota.
S-i-
i*i
m SsS* ■illMimm-mm WMr>i The property served by this Sewage System is legally described as:
BORUP'S MAPLE BEACH
LOTS 6,1 & 8aIi <-Mi
Parcel Nvimber(s): 14000990314000,14000990315000 & 14000990316000
Section: 08 Township: 135 Range: 040 Township Name: DEAD LAKE TOWNSHIP
Lake Number: 56-383 Lake Name: DEAD m&m M
mRtiiKK
0H Current Property Owner:
Nvimber of Bedrooms : (A) -4 (B) -2
DONALD & MARY HOHENSTEIN
m 'PA (CABINS #1,2 & 3)
B (CABIN #4)
Land & Resource Management Official
''I
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284.709 • VtCJOf Lundeon Co. Printers • Fergus Falls, MN • 1 •800-346-4870
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
- ^1^ ) 0 Abatement: ( ) Yes ( ) No
Permit No.LEGAL
DESCRIPTION
AND
LOCATION
LAKE/RIVER
CLASS ,(^/E
SECTIONLAKE NUMBER LAKE/RIVER NAME ,
51^i)m
RANGE TWP.NAME r ^(Jko4 LWs-TWP. NO.
lir I
FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER(S)
n|-O00-Cf9-03((f-O®, 03IQ-000JIDENTIFICATION: Please Print All Information
FirsJ____Initial/ Mailing Address —ponai^' CL'Si — No. Styct, City and Stale____________________
•S
Zip Code Telephone No.Last Name
Property
Owner 1
Sewage
System
Installer
Name
A.M.
This System will be ready for inspection on , 19.P.M.at
This space for office use only 4NUMBER OF BEDROOMS:
A.M.
P.M19 GARBAGE DISPOSAL; ( ) YES NODate Rec'd Time Rec'd Phone Call Rec’d By
SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM
( ) Holding tank (Alarm Required)
Septic tank
( ) Lift station (Alarm required)
( ) Drain field
Trenches
( ) Bed
( ) Mound
) Outhouse
( ) Sewer line
TANK DRAIN FIELD
LOWCapacity GIs.Sq Ft.
So/cWsvDistance from nearest well Ft.Ft.
/W LDistance from lake or stream Ft. Ft.
/0/<^Distance from building Ft. Ft.
Ifl mDistance from property line Ft. Ft.(
>1Distance from fcottom to Water Table Ft.Ft.
EFFLUENT DISTRIBUTION
( LGravity
(^^Pressure
fences are shortest distance between nearest points
PERCOLATION TEST DATA:
WATER WELL DE
Perc Tester.Date of Perc Test
#3 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.
cASignature
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.
DATE:
/
Issued Date:
|>o>>-Land & Resource Management Office
Rec #.Fee $.
IComments:
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Systerrf 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
feet SKETCHING FORM<r/
Scale:grid(s) equals feet, or inch(es) equals
y
£SUBMITTED BY:SIGNATURE:
DATE:_____
MPCA LICENSE #:
LICENSE CATEGORY:
FIRM NAME: '}AlJ 1^4,'> y
ADDRESS: Y <7Z ^7
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SITE DATA
LAND AND RESOURCE MANAGEMENT
Otter Tail County
Fergus Falls. MN 56537
OWNER:
LAST NAME FIRST TELEPHONE NUMBERMIDDLE
ADDRESS:
? R&F i f f>tFKlr
CITYSTR./RT STATE ZIP CODE
TWP NAMELAKE/RIVER NO.LAKE NAME SEC.TWP.RANGE
LEGAL DESCRIPTION:
- Ooo
£>'^Y</'-06 o
______________________JO60
PARCEL NUMBER OOH
SOIL BORING LOG — Date
COLOR &
MUNSELL NO.
DEPTH
(INCHES)TEXTURE STRUCTURE
BLOCKY
PLATY
PRISMATIC
NONE
/oy/L-
BLOCKY
PLATY
PRISMATIC
NONE
/^y/^’^-^7FIRE NUMBER r/y
NUMBER OF BEDROOMS BLOCKY
PLATY
PRISMATIC
NONE
GARBAGE DISPOSAL:1^/9
WELL CASING DEPTH:ft.
BLOCKY
PLATY
PRISMATIC
NONE
FLOODPLAIN: YES
VEGETATION: AQUATIC TERRESTRIAL
BLOCKY
PLATY
PRISMATIC
NONE
SLOPE AT INSTALLATION SITE;%
TYPE OF OBSERVATION: Probe Pit
ty
No
COMPACTED SOIL: Yes
PARENT MATERIAL:Outwash Loess Bedrock Alluvium COMMENTS:,
ORIGINAL SOIL:
&
7 ifDEPTH OF BORING:ft.
PERC TEST #1 PERC TEST #2- r\A/0 TESTS ARE REQUIRED -
INTERVAL (MINUTES)
TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME WATER DEPTH WATER DROP PERC RATE2Z^I '1 rr^
iCyiTTf
TIME DROP PERCT .fSTARTST/VRT/o
TIME DROP PERCTIMEINTERVAL iMINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE
w <fREFILL 7l5
TIME DROP PERC
dL(2.:TIME DROP PERC
WATER DROPTIMEINTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES!WATER DEPTH PERC RATE
m REFILL REFILL
TIME DROP PERC
Yi)...AO--.-TIME DROP PERC
WATER DEPTH WATER DROPTIMEINTERVAL IMINUTES)PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEREFILLREFILL
---------r--------- =TIME DROP PERC TIME DROP PERC
INTERVAL (MINUTES!TIME WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEREFILLREFILL
drop"-----^------ ="perTTIMEPERCTIMEDROP
INTERVAL (MINUTES)TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME WATER DEPTH WATER DROP PERC RATEREFILLREFILL
TIME DROP PERC TIME DROP PERCTIMEINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEREFILLREFILL
TIME * DROPTIMEDROPPERC PERC
TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEREFILLREFILL
TIME DROP PERC
PROPOSED DESIGN:
TRENCH / BED,ATGRADE,MOUND,HOLDING TANK.GRAVITY DIST. PRESSURE DIST.
SEWER LINE,OUTHOUSE.OTHER.SPECIFY:
— SYSTEM DESIGN ON BACK —
APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM i
WHITE -^'Office
Yellow — Inspector
Pink — Owner
LAND &TtESOURCE MANAGEMENT
OTTER TAIL COUNTY COURT HOUSE
Phone: (218) 739-2271 - FERGUS FALLS, MN 56537
i■
0.) AnocLEGALPermk No.
DESCRIPTION
AbatemerTfr Yes ( ) NoAND
\,LOCATION
LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER
CLASS
SECTION TWP. NO.RANGE TWP NAME
Jje (I**>Uea c\I Ko; - ! , — ,Y
PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER
kI-OOO-99- 0^ji(i-0d0 , OilS-'^’> OJI(f-000 u;1iIDENTIFICATION: Please Print All Information
First!Last Name;Initial Mailing Address — No. Street, City and State Zip Code Telephone No.rl~ n i-C'l n 1
aOTTv'
Property
Owner
I
Sewage
System
Installer
Name
A.M.At <3'oo► This System will be ready for inspection on QjU ^&>. 19-
This space for office use only
NUMBER OF BEDROOMS:
^9_ol *9 ■
Date Rec d (X)P.M.GARBAGE DISPOSAL: ( ) YES NOTime Rec'd Phone Call Rec’d By
SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM
( ) Holding tank (Alarm Required)
Septic tank
( ) Lift Station (Alarm required)
( ) Drain field
Trenches
( ) Bed
( ) Mound
( ) Outhouse
( ) Sewer line
TANK DRAIN FIELD
5HCapacityGIs.Sq Ft.
(O’ R.Distance from nearest well Ft.
Mh ISDistance from lake or stream Ft.Ft.
inDistance from building Ft.
inLLlDistance from property line Ft.Ft.
Distance from/bottom to Water Table
jWip^i
Ft. Ft.
EFFLUENT DISTRIBUTION
( ) Gravity
(- ' ) Pressure
istances are shortest distance between nearest points\U
PERCOLATION TEST DATA:
WATER WELL DEPT 3*
;
f ' ^
^ 7 -4'irc Tester.L Date of Perc Test
I I'l / ’ ’ ./ I /I ISi
te of 1st Test7 Rate of 2nd TestV Average Rate__l:
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.
to install or extend Sewage Disposal System herein specified, agreeing to do all such work in strict
s.A.y^ -> o-isrl \DATE:
7/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.n
:>■ io '/ j
Issued Date:
b o >>Land & Resource Management OfficeAsFee $.Rec #.
IComments: L
m *Mi/i-wi
I ■1u \un(V
;
F«IU. MinnaosfU277.212 ■ Victor Lund««n Co.. PrmtorsBK 0796-003
i
5-'
INSPECTION RESULTS
Inspector must make all measuremdnts
SEWAGE DISPOSAL SYSTEM STATISTICS
i
j
DRAIN FIELDHOLDING
SEPTIC TANK LIFT TANKCATEGORY Actual Minimum
600 GLS./OOQ GLS.SF SFCapacity—jT
o
FT ft FTFTDistance from Nearest Well
Distance from Buried
Water Suction Pipe FTFT 50FTFT
Distance from Buried Pipe
Distributing Water Under Pressure FTFT10FTFT
ShJ-(o5 ft FTFTDistance from Lake or River (OHWL)
; ft 10/20 FTFTDistance from Nearest Building
II FT10FTFTDistance from Nearest Property Line II
Idi FT 3 FTFT FTDistance from Bottom to Water Table
T
V.YES NOHolding Tank/Lift Alarm
( ■NOOld System Pumped & Destroyed
DRAINFIELD CALCULATIONSewer Line to Well SeparationINTERPRETATION
OF ABBREVIATIONS
GLS. = Gallons
SF = Square Feet
FT = Linear Feet
Actual Minimum 7FTX
FT 20 FT SF
57K
Inspector’s Comments:
^SKETCH:
(Go'7q /f
uif3ofHouSK^
2M/Inspector's Signature
7-3-77
Date of inspection
)‘^Qq_____
' Time of inspection
Jk
AIB TEST CEftTIFICATTON
%S./fn (dote), an air test of the sewer line instciled
nop.
On
under Sewage Disposal System Permit Number
(owner), on _
(lake/rivcr) was made. At that time, the sewer line held
I inch for
for
jDnn X/a k^/7^/>/■/>
S'pounds per squore
minutes.
^ ?r
Installer's Si^ature License No.bate
PORMSsalrtst
PPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM
LAND & RESOURCE MANAGEMENTOTTER TAIL COUNTY COURT HOUSE
Phone: (218) 739-2271 - FERGUS FALLS, MN 56537
WHITE — Office
YELLOW -H Inspector
PINK — Owner
LEGAL Permit No.
Abatement: ( ^) YesDESCRIPTION
( )NoAND
LOCATION
LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER SECTION TWP. NO.RANGE
CLA^ ^he. ScOrteub /?S %)
PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER
Od\4oDO
IDENTIFICATION: Please Print All Information
Last Name FirstInitial Mailing Address — No. Street, City and State
Sjl/vhjJ
Zip Code Telephone No.
Property
Owner
Sewage
System
Installer
Name
State Lie. If
A.M.
> This System will be ready for inspection on.the year of P.M.at ^ - K,________
This space tor office use only NUMBER OF BEDROOM
A.M.
P.M.( X^NOGARBAGE DISPOSAL: ( ) YES
Date Rec'd Year of Time Rec’d Phone Call Rec'd By
TYPE OF SEWAGE SYSTEM
( ) Holding tank (Alarm Required)
( ^) Septic tank
( ) Lift station (Alarm Required)
(X) Drainfield
(^^) Trenches
( ) Bed
( ) Mound
( ) Outhouse
( ) Sewer line
SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTS
TANK DRAINFIELD
SAj/Ytf'
'760Capacity GIs.
6^Distance from nearest well Ft.
Pirhih loin 6>4?Distance from lake or stream Ft.Ft.
Ao//n
to^ss.
laDistance from dwelling Ft. Ft.
Distance from non-dwelling in Ft. Ft.
10inDistance from property line Ft. Ft.
EFFLUENT DISTRIBUTION
( Gravity
( ) Pressure
.5Distance from bottom to Water Table Ft.Ft.
All distances are shortest distance between nearest points
PERCOLATION TEST DATA:WATER WELL DEPTH
(p//o/<?eate of Perc Test
J-^6 06Rate 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 Official
shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the respon
sibility of the applicant for the permit to notify the County Shoreland ManMemeni that the job is ready for inspection.
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 con
dition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinance of Otter Tail County, Minnesota.
This permit may be revoked at any time upon violation of any said ordinances.
NOTE: Permit void if work is not commenced within six (6) months.
1-10-nIssued Date:
Land & Resource Management Office
- CA 5S50{■^) (laUdv P '4 __ ___^^Fee $
Comments:
BK 0795003 291.095 • Virifu iiuKii'i.'n (xj, Ptmii-rs • (••tijus r.-jii-, Minn.':
• ^APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM,■
fr‘_
LAND & RESOURCE MANAGEMENTOTTER TAIL COUNTY COURT HOUSE
Phone: (218) 739-2271 - FERGUS FALLS, MN 56537
WHITE — Oflice
YELLOW — Inspector
PINK — Owner
LEGAL Permit No.
-fNo
DESCRIPTION
4 C (o AbatemermJx^
sAND
LOCATION
LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER
CLASS
' }4~
SECTION TWP. NO.RANGE TWP NAMEi.CiL.'/O'\J Ck /'5Sr"5^- TK 6 r/i
PARCEL NUMBER(S)■JFIRE OR LAKE ASSOCIATION NUMBER 3OcjO'I^ cjdl^l ooO
IDENTIFICATION: Please Print All Information
Last Name First Initial Mailing Address — No. Street, City and State Zip Code Telephone No.
aJ_ 3
^ / )] ihuM
Property
Owner '7/
Sewage
System
Installer
2^Name
State Lie. If I
A.M.
>• This System will be ready for inspection on., the year of PM.
NUMBER OF BEDKOOlLiiT^^
This space for office use only
^ %i4 ( X^NOGARBAGE DISPOSAL: ( ) YESDate Rac'd Year of Time Rac'd Phone Call Rac’d By
TYPE OF SEWAGE SYSTEM
( ) Holding tank (Alarm Required)
( X) Septic tank
( ) Lift Station (Alarm Required)
(X) Drainfield
(X) Trenches
( ) Bed
( ) Mound
) Outhouse
) Sewer line
SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTS
TANK DRAINFIELD
Ft"
3oJ/OCf^-
330Capacity GIs.
SoDistance from nearest well Ft.
7lr>L LLDistance from lake or stream Ft.Ft.
A)//nlaDistance from dwelling Ft.Ft.
Distance from non-dwelling in.Ft. Ft.(
(10Distance from property line in Ft.Ft.
EFFLUENT DISTRIBUTION
( yO Gravity
( ) Pressure
1Distance from bottom to Water Table Ft.Ft.
All distances are shortest distance between nearest points ■1
PERCOLATION TEST DATA:WATER WELL DEPTH
duij3
•V
1
Perc Tester ate of Perc Test
/■33 1^6 /.36Rate 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 Official
shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the respon
sibility 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 statement. This permit is granted upon express con
dition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinance of Otter Tail County, Minnesota.
This permit may be revoked at any time upon violation of any said ordinances.
NOTE: Permit void if work is not commenced within six (6) months.7
z /OIssued Date:
Land & Resource Management Office 1■i5f50/n )Fee $.- Rec #
Ooion.iOrComments: \
TFlO iU/f To t 4'/-lO -Jr' -
77 7
BK 0795-003 291.095 • Viriof Luixlirtrrt Co, PniMers • f*-rgus Falls M>r>i»'sot;»
INSPECTION RESULTS
Inspector must make all measurements
SEWAGE DISPOSAL SYSTEM STATISTICS
•4
_ ■*
DRAINFIELDHOLDING
SEPTIC TANK LIFT TANKCATEGORY Actual Minimum
5~0 /■ FT
Capacity FT=’-FT2GLS.GLS.(
.S'O^PTDistance from Nearest Well FF FT
Distance from Buried
Water Suction Pipe FT FT FT 50 FT
Distance from Buried Pipe
Distributing Water Under Pressure FT FT FT FT10
Distance from Lake or River (OHWL)
^ O'f" FT
FT FT FT
Distance from Dwelling N FT FT 10/20 FT
Distance from Non-Dwelling FT FT FT FT
{^0Distance form Nearest Property Line FT FT FT 10 FT
Distance from Bottom to Water Table
FT FT FT FT3
Holding Tank/Lift Alarm YES NO
Old System Pumped & Destroyed YES NO
Sewer Line to Well Separation DRAINFIELD CALCULATIONINTERPRETATION
OF ABBREVIATIONS
GLS. = Gallons
FT^ = Square Feet
FT = Linear Feet
Actual Minimum 3FTX
FT 20
ROCK REDUCTION
Inspector’s Comments:
Rock trenches with inches
of rock under pipe for .%
DRreduction / equivalent to
SKETCH:I
Ftt-
.?
i
Inspector's Signature
Date of Inspection
Time of Inspection
*
SITE DATA ♦
LAND AND RESOURCE MANAGEMENT
Otter Tail County
Fergus Falls, MN 56537
C
OWNER:
/-/
LAST NAME5 7FIRST MIDDLE TELEPHONE NUMBER
ADDRESS:
STR./RT CITY STATE . ZIP CODE
OmJ Ca/Cc <r Z1ST_^I
LAKE/RIVER NO.LAKE NAME SEC.TWP.RANGE TWP. NAME
i
LEGAL DESCRIPTION:SOIL BORING LOG Date,
COLOR a
MUNSELL NO.
DEPTH
(INCHES)■I TEXTURE STRUCTURE
BLOCKY
PLATY
PRISMATIC
NONE
1
I'f
^ PARCEL NUMBER
BLOCKY
PLATY
PRISMATIC
NONE
^/,n/e/yFIRE NUMBERL■V
9-NUMBER OF BEDROOMS BLOCKY
PLATY
PRISMATIC
NONE
/GARBAGE DISPOSAL:
i WELL CASING DEPTH:BLOCKY
PLATY
PRISMATIC
NONE
[■
FLOODPLAIN: YES
TERRESTRIALVEGETATION: AQUATI
V BLOCKY
PLATY
PRISMATIC
NONE
SLOPE AT INSTALLATION SITE:%
j: TYPE OF OBSERVATION: Probe
PARENT MATERIAL:Outwash Loess Bedrock Alluvium COMMENTS:.
ft ORIGINAL SOIL:
COMPACTED SOIL:
■
• DEPTH OF BORING:-i r}
.{PERC TEST #1 PERC TEST #2- TWO TESTS ARC REQUIRED -
TIME
INTERVAL (MINUTES) WATER DEPTH WATER DROP PERC RATE
TIME
INTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATETJG..CjC
DROP PERC /
START
TIME DROP PERCTIME
TIME
INTERVAL (MINUTES) WATER DEPTH WATER DROP PERC RATE ,TIME .INTERVAL IMINUTES)WATER DEPTH PERC RATEWATER DROPn'TS
TIME DROP PERC.Z,REFILL REFILL
/i)....10—TIME DROP PERC
WATER DEPTH
TIME INTERVAL(MINUTES)
WATER DROP PERC RATE
TIME
INTERVAL (MINUTES)WATER DEPTH PERC RATEWATER DROPREFILLREFILLcT-J.O.JD.a TIME DROP PERCTIME
INTERVAL IMINUTES)
TIME
WATER DEPTH WATER DROP PERC RATE
TIME
INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEREFILLREFILL
TIME DROP DROPPERCTIME PERC
TIME
INTERVAL (MINUTESI WATER DEPTH WATER DROP PERC RATE
TIME
INTERVAL (MINUTES)WATER DEPTH PERC RATEWATER DROPREFILLREFILL
DROP ~PE^TIME DROPPERCTIME
INTERVAL (MINUTES) WATER DEPTH WATER DROP
TIME
WATER DEPTH PERC RATE
TIME
PERC RATE INTERVAL (MINUTES)WATER DROPREFILLREFILL
TIME DROP PERC TIME DROP PERC
TIME
INTERVAL (MINUTESI WATER DEPTH WATER DROP PERC RATE
TIME
WATER DEPTH PERC RATEINTERVAL (MINUTES)WATER DROPREFILLREFILL
DROPTIMEDROP PERCPERCTIME
TIME
INTERVAL [MINUTES)WATER DEPTH WATER DROP PERC RATE WATER DEPTH PERC RATE________
TIME
INTERVAL (MINUTES)WATER DROPREFILLREFILL
-tTmT • -5r7.T TmTTIMEDROPPERC
PROPOSED DESIGN:
TRENCH BED.GRAVITY PI ST. V'PRESSURE DIST.ATGRADE.MOUND.HOLDING TANK /I
OTHER, SPECIFY:.OUTHOUSE.. SEWER LINE.
— SYSTEM DESIGN ON BACK —