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Hovey's on Star_56000030010003_Septic System Permits_
Department of LAND & RESOURCE MANAGEMENT COUNTY OF OTTER TAIL Phone: (218) 739-2271 Court House FERGUS FALLS, MINNESOTA 56537 August 11, 2000 Shirley Dunham 413 41«t Ave S St Cloud MN 56301 RE: Septic System Abatement - . 19 Acre Tract in GL 2 Sec 3 Star Lake Twp Star Lake (56-385) Dear Ms. Dunham, I am writing this letter to confirm our telephone conversation of this date. As I told you, a search of our records does not conclusively prove that you are connected to the septic system of Hovey’s Resort. Our basic concerns about your system are these: Are you in fact connected? Is the tank we located on your lot solid and up to code? 1. 2. To satisfy these concerns you must remove the lid and call us to inspect the exposed tank and install two cleanout openings over the inlet and outlet pipe. r Please have this work done by August 11, 2001 and give us a call at that time to verify the situation. Thank you for your prompt attention to this matter. Sincerely, George Hausske Inspector GH/jlt Date Resolved CHRONOLOGY REGARDING THE SEWAGE SYSTEM ABATEMENT Property Owner; se- 3S'S Lake Name;Lake No. OOOO ?>001Parcel No.; ^[nj_2pOwner's Initial Response (date); I iy S4iV/^/ InA-H JuJrfh a^'^'h^U^o ^ H(^rliN {Ua-oL, C - ________ / U/Or-d^eN A/^ ^ Id - ^<AcX I i/trf tl( D(/IS.A/}-^ tt^i7/ liA^M'dU A-LA^'CtieN't SkirU'j folj ^Y^-i-eri ^ hl-ove'fS> (RiiQOrT A p-crH-'i' /iSt^€c7 /,v/( Fi/-c rc: ^^^-y-Ccr OUJi-i-cr- f^vvi- Q.eH^ve /i'd? an t!> \/CrJ4-') FIELD NOTES S77K LAKE NO. : 56-^^^ OOOO '^OO/ooi— Parcel No. : / LAKE NAME:DATE LEGAL DESCRIPTION FIRE NO.: . H Ac tv 6,Li~ OWNERS NAME AND ADDRESS: ^ vA NWa5t5T5Commen SEPARATION DISTANCES(IN FEET) SEWER LINE TANK ABSORPTION AREA OUTHOUSE WELL SI'OHWL LOT LINE DWELLING NON DWELLING GROUND ELEVATION @ REASON(S) FOR ABATEMENT: 0 Tank to 0 Sjo A^<-^5-5 Tc 0 iHsoW^t^'h ^'I hU>Or\,’\-io*^Sot f' . ♦ « • Page 15:50:43 Print Key Output 06/30/005769SS1 V4R4M0 990521 OTTER Display Device User ....QPADEV0070LAND Inquiry Taxpayer/Legal InfoTC906D 10 T56 ACS Tax System Bill No. Parcel No.10074 R 16000340189002 2000 Name LORARINE WARDENR L Tax CodesTwn/Sch 0016 0549 Spec Dist User Codes TIE DistrictAddress PAS RECORD District Code 1602 12595DOUGLAS 0 & NANCY A HOVEY RR 2 BOX 203 DENT MN Taxpayer 229 56528-9635 Property Legal Description Sect/Twn/Range PlatLot/Block !Zl\ X'*' fits k A-r) ^ 4 S Alternate 34 136 041 EscrowDeededPT SWl/4 SWl/4 & PT GL 5 COM NW COR LOT 14 1ST ADDN PEACHS BCH E ,122.94 ' S 173 ' E 419.92' TO BG ELY 544.19' S TO S LN SEC 34 W TO PT S OF BG A=CSM B=ASM C=DQ D=NAL E=TR F=SP P=PA S=GS U=CAMA .38 AC ! Other NANCY A HOVEY54466 OWNER More Addresses? Y Mod? Action?More Legal? Y J. V •-r A STATE OF MINNESOTA ) )ss. AFFIDAVIT OF SERVICE BY MAIL COUNTY OF OTTER TAIL) Mavis Samuelson, of the City of Fergus Falls, County of Otter Tail, in the State of Minnesota, being duly sworn, says that on the July 25, 2000 she served the annexed: i ABATEMENT On the following person, by mailing a copy thereof, enclosed in an envelope, postage ; j prepaid, and by depositing same in the post office at Fergus Falls, Minnesota, directed to% said person at the following address: •: • DOUGLAS & NANCY HOVEY RR#2 Box 203 DENT MN 56528-9635 j Mavis Samuelson Land 86 Resource Management Official Subscribed and sworn to before me this QolLia in the year of ^OOOday of NotaiwTublm yy?. ^COSMy Commission Expires JOYCE L THOMPSON a NOTARY PUBUC-MINNESOTA f My Commission Expires JAN. 31.2005 | i FormLtrs-CertifiedMailingMS r SEWAGE SYSTEM ABATEMENT NOTICE LAND & RESOURCE MANAGEMENT COUNTY OF OTTER TAIL COURTHOUSE, FERGUS FALLS, MN 56537 (218) 739-2271 Lake Niomber: (56- 385) Lake Name: star DOUGLAS 0 Sc NANCY A HOVEY RR 2 BOX 203 DENT, MN 56528 9635 You are hereby notified that the sewage system which you maintain on the following described property: UNPLATTED PT SWl/4 SWl/4 & PT GL 5 COM NW COR LOT 14 1ST ADDN PEACHS BCH E 122.94' S 173' E 419.92' TO BG ELY 544.19' S TO S LN SEC 34 W TO PT S OF BG Twp:Sec:Range:34 136 Parcel Number;16000340189002 l. is not constructed and/or located in accordance with minimum standards of the Shoreland Management Ordinance of Otter Tail County. Please be advised that you must correct this situation within 30 days, should contact this office in order to determine what corrections and permits are required prior to complying with this notification. You ^________jQcOLWi ' Lan^ Resource Management Official - Dated 7/25/Odi/ ;■ STATE OF MINNESOTA )ii; )ss. AFFIDAVIT OF SERVICE BY MAIL ‘ COUNTY OF OTTER TAIL) Mavis Samuelson, of the City of Fergus Falls, County of Otter Tail, in the State of Minnesota, being duly sworn, says that on the July 28, 2000 she seiwed the annexed: ABATEMENT NOTICE ■•I ' ; On the following person, by mailing a copy thereof, enclosed in an envelope, postage prepaid, and by depositing same in the post office at Fergus Falls, Minnesota, directed to said person at the following address: JUDITH CATALENO 211 2“^ AVE SE A^ 204 PERHAM MN 56573 Mavis Samuelson Land 85 Resource Management Official Subscribed and sworn to before me this day of in the year of Notarwub]•;* My Commission Expires \ -WCEl THOMPSON p WTARypUBUC-^INNESOW Wy Carniisson Expires JAN. 31,2005 FormLtrs-CertifiedMailingMS SEWAGE SYSTEM ABATEMENT NOTICE OTTER TAIL COUNTY LAND & RESOURCE MANAGEMENT 56537121 W. JUNIUS, FERGUS FALLS, MN (218)739-2271 RECEIVED AUG - 1 ZOOO Lake N\amber: 56-3 85 Lake Name:STAR land & RESOURCE JUDITH CATALENO 211 2ND aVE SE apt #204 PERHAM MN 56573 You are hereby notified that the sewage system which you maintain on the following described property: .19 AC TR IN GL2 Sec; 3 Twp: 135 Range: 4i Lake Assoc/Flre #: NAParcel Number: 56000030001002 is not constructed and/or located in accordance with minimum standards of the Shoreland Management Ordinance of Otter Tail County. Please be advised that you must correct this situation within 30 days. You should contact this office in order to determine what corrections and permits are required prior to complying with this notification. (^co^(^e ^ Mr h Cand & Resource Management Official 07/2^00 / » 4 ■ STATE OF MINNESOTA ) )ss. AFFIDAVIT OF SERVICE BY MAIL COUNTY OF OTTER TAIL) Mavis Samuelson, of the City of Fergus Falls, County of Otter Tail, in the State of Minnesota, being duly sworn, says that on the August 1, 2000 she served the annexed: ABATEMENT NOTICE On the following person, by mailing a copy thereof, enclosed in an envelope, postage prepaid, and by depositing same in the post office at Fergus Falls, Minnesota, directed to said person at the following address: LORRAINE E WORDEN LAKELAND APTS 2112^ AVE SE #204 PERHAM MN 56573-1785 ■ c mMavis Samuelson Land 8& Resource Management Official Subscribed and sworn to before me this U-. ■ day of in the year of Notai 1C My Commission Expires j-— ■ -r ................................................. JOYCE L THOMPSON notary PUBUC-MINNESOW My Cotitmssion Expires JAN. 31,2005 FormLtrs-CertifiedMailingMS SEWAGE SYSTEM ABATEMENT NOTICE.V r OTTER TAIL COUNTY LAND & RESOURCE MANAGEMENT 56537121 W. JUNIUS, FERGUS FALLS, MN (218)739-2271 • i;Lake Niimber: 56-3 85 LakeiName:STAR LORRAINE E WORDEN LAKELAND APTS 211 2ND aVE se #204 PERHAM MN 56573 You are hereby notified that the sewage system which you maintain on the ' following described property: PT GL 2 COM NW COR LOT 14 l®’^ ADDN PEACH'S BCH (.19 AC) Sec: 03 Twp: 135 Range: 4i Lake Assoc/Fire #: NA. Parcel Number: 56000030010002 is not constructed and/or located in accordance with minimum standards of the Shoreland Management Ordinance of Otter Tail County. Please be advised that you must correct this situation within 30 days. You should contact this office in order to determine what corrections and permits are required prior to complying with this notification. // ___ __________________________ ^nd^Resource Management Official 08/01/00 \ 't 7. Print Key Output Page 1 08/01/00 10:30:345.769SS1 V4R4M0 990521 OTTER Display Device User ....QPADEV0018JTHOMPSO TC906D 20 T56 ACS Tax System Bill No. Parcel No. R 5G000030010002 Inquiry Other NamesNameJUDITH CATALANO ET ALR 02001 PRIMARY TAXPAYERJUDITH CATATANO KT _AT. ATTN fLORRAINE E WORDEN ^211 "2ND AVE SE APT 2 04 f PERHAM MN 56573-1785 21273 OWNER 47328MARLIN J PEACH. J///^ S//OWNER 47329 SHIRLEY K DUNHAM % LORRAINE E WORDEN 211 2ND AVE SE APT 204 PERHAM MN 56573-1785 'T*; i y ' STATE OF MINNESOTA ) )ss. AFFIDAVIT OF SERVICE BY MAIL COUNTY OF OTTER TAIL) Mavis Samuelson, of the City of Fergus Falls, County of Otter Tail, in the State of Minnesota, being duly sworn, says that on the August 1, 2000 she served the annexed: V- ;• ABATEMENT NOTICE On the following person, by mailing a copy thereof, enclosed in an envelope, postage ’ prepaid, and by depositing same in the post office at Fergus Falls, Minnesota, directed to said person at the following address: ■ LORRAINE E WORDEN 31268 TRAILER PARK LOOP DENT MN 56528 .VV-: Mavis Samuelson Land 86 Resource Management Official Subscribed and sworn to before me this (2a ^_in the year ofday of My Commission Expires JOYCE L THOMPSON ^ NOTARY PUBLIC-MINNESOIA MyCommissJon'Expir8SJAN.31,2006 K FormLtrs-CertifiedMailingMS M SEWAGE SYSTEM ABATEMENT NOTICE : OTTER TAIL COUNTY LAND & RESOURCE MANAGEMENT 56537121 W. JTJNIUS, FERGUS FALLS, MN (218): 739-2271 Lake Number: 56-385 Lake Name:STAR LORRAINE E WORDEN 31268 TRAILER PARK LOOP DENT MN 56528 r You are hereby notified that the sewage system which you maintain on the following described property: PT GL 2 COM NW COR LOT 14 1®'' ADDN PEACH'S BCH (.19 AC)i. Twp: 135Sec: 03 Range: 4i Lake Assoc/Fire #: NAParcel Number: 56000030010002 ; •is not constructed and/or located in accordance with minimum standards of the Shoreland Management Ordinance of Otter Tail County. ■-/ Please be advised that you must correct this situation within 30 days. You should contact this office in order to determine what corrections and permits are required prior to complying with this notification. ! ‘^nd & Resource Management Official08/01/00 4~f OH ff\j€A-U /"i^_____4H iNi^^C __lit>oLe<^ (Nio I7t^ ‘^y^'hrn /li>\)(*y% ___ J/'cAf-^^ 'XUA'^ 5/5/ U/A-i 7^5 ~fh‘9 ho\;i,< . Hr lh>Off iv^’^ fi^ -jz^N k. %jf /!>/V c-t^Spoo! 'J%{ cthiN ^ uJitH VoC H-eS>oH Syc,^ Lj/4^ lfvO('/S. Stcu^^n‘^>T^ IH Co^ '^'■'7 5‘/sV ieS>oh€(^ ONiJire^ Cf$<^^pc>o} is -klkLl. \}i>ri^i cf).H i/-?/o I Ip^Cetfclj}p\A^ - ^'if O'!7, - ,J -t-At^'C f ry-5(\it}4i’o'^' c^Jt rct\ -—\JTHtV7 1^//. ri' S' m ..^ v>v^>^ _ (^ p-^)fZt. r )f ^ , <'&£■.^a*jj’9-^^J2X^4, 'JP^fhT -SZUiQ /'ve-s /?t \wS^ ^ ^,.w*-<--<' V«^ St P.CL-W^5^ /<»? (" 7V^yp^',yQ^SJ^] C-’"^■\>R.i-"’^vi -w«0-7 ^ 7"^ ■ iCcry^ SKjt^^J^^ y2%t^ -A/'C. ^ ^ 5/^^ im^-'^^'-'''>V4» / m A^ 7^u \. /^'x'C^ » / ^ .-tf-Ui. /O0J2-P /To*-^ ^r\ vvj 7^ l<3UNi2L -*^ </>1 ^ .0-^?<fw«/i y J<y^ cf^ )-k^Ai^0^ }0t .■^-V <r\;icl^'^ ^E©“ / ^ t yy.) CERTIFICATE OF APPROVAL SEWAGE SYSTEM 19 thThis certificate has been issued this day of Umj 19 M.mto certify that the sewage system installed as per sewage permit number indicated below has been approved for usei ■by Otter Tail County, Minnesota. The premises covered by this certificate are legally described as: Lake No.Sec.Twp.Range 41 Twp. Name VcHaM ‘135 acA^ tAact, pt SWi 6 GL5 \ ofihnJvto WofirlomOwner: Name T)o\nt ^ MMAddress Zip No. Permit No. SP 7QT0 Signed by:—^ Malcolm K. Lee, Land & Resource Management Administrator Otter Tail County, MinnesotaMKL-0987001 243,984 » Victor Lundeen Co., Printers, Fergus Falls, Minnesota 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 ^hile — Office Yeltow — Inspector Pink — Owner Tno5ffc. Tfi. Pr Permit No.,LEGAL DESCRIPTION AND <30 3V !2L 4!g.- 3gs srmLOCATION Tl^ Narni>Lake No.Lake Classif.Lake Name Sec.TWP Range IDENTIFICATION: Please Print All Information. Mailing Address — No. Street, City and State Tel. No.Last Name First Initial Zip No. (h- IUj0fij3£rJ DbyJT nnrVOWNER 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 aNUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD "yso Gis.Sq. Ft.Sq. Ft.Capacity ju>j-eJLQ GO Ft.Ft.Ft.Distance from nearest well GO Ft.Ft.Distance from lake or stream Ft. 10 Ft.Distance from occupied building Ft.Ft. loJODistance from property line Ft.Ft.Ft. 3Ft.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 M By S- 3 3LPERCOLATION TEST DATA:Date of First Test 19 Rate S- 3 . i9.^iDate of Second Test Rate 1st Test Taken By V...... Itn A aFirst Test + 2nd Test zz Rate2nd Test Taken By Agreement: Strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspectiox»0 I understand that I have been granted a sewage system site permit in accordance with the requirements of the Shoreland Management Ordinance of Otter Tail County. I understand I must contact my township in order to determine whether or not any addi tional permits are required by the township for my proposed project. Permit: condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to Ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six (6) months. The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in APermission is hereby granted to the above named applicant to perform the work described in the abov^taWr :ure ent. This permit is granted upon express S'-‘I- 5-fIssued Date: Shoreland Management Office2.0. oo_QO/ATFee $Rec It aComments: Form No. MKL-0320S5 237,443 — Victor Lundeen Co., Printers. Fergus Falls. Minnesota i , ■ ' Ir i •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 5 Ft df Permit No.Su % ^ cslSLEGAL DESCRIPTION AND QO 3V !3L 4! . D»Rn3H5 S7flHLOCATION Lake No.Lake Name Lake Classil.Sec.TWP TWP NameRange IDENTIFICATION; Please Print All Information. Mailing Address — No. Street, City and StateLast Name First Initial Zip No.Tel. No. /h- (l^OfiOFrsJ.OEp/i mrVOWNER 7£«-S«lS tSEWAGE SYSTEM INSTALLER Name, 1 WoO TipOK/loThis System will be ready for inspection on., 19. This space for office use only Time Rec'd / Phone Cl CiI19 Date Rec'd Call Rec'd By Owner or Agent Signature 7 aNUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FI^LD Sq. Ft.750 GIs.Sq. Ft.Capacity ^o/m50Ft.Ft.Ft.Distance from nearest well 50 Ft.Ft.Distance from lake or stream Ft. oo10Ft.Ft.Distance from occupied building Ft. i!010 iDistance from property line Ft.Ft.Ft. Ft.Ft. Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on 19 , Time JM By S- 3 m.PERCOLATION TEST DATA: 1st Test Taken By Date of First Test 19 Rate S- 3 i9..^.i IDate of Second Test Rate VMf I\ First Test + 2nd Test 2 Rate2nd Test Taken By The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work inAgreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. I understand that I have been granted a sewage system site permit in accordance with the requirements of the Shoreland Management Ordinance of Otter Tail County. I understand I must contact my township in order to determine whether or not any addi tional permits are required by the township for my proposed project.Of Permission is hereby granted to the above named applicant to perform the work described in the above statehient. 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. Signature Permit: Issued Date: Shoreland Management Office QO/ gj-P20,00Fee $Rec #i 4/■i Comments:i77 Form No. MKL-032085t 237.443 — Victor Lundeen Co,. Printers, Fergus Falls, Minnesota - -— V '.JV -‘ -i 4 I t,-r >, i ♦ : k. INSPECTION RESULTS 2?Inspector must make all measurements V j'l SEWAGE DISPOSAL SYSTEM STATISTICS // X 37 SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORYShould BeActual Should Be Should BeActualActual Zf7Capacity ^GIs.GIs.s F S F S F S F Distance from Nearest Weil F F F F F F -f-320Distance from Lake or Stream F F F FF F 1yDistance from Occupied Building F F F F F F / ^(0Distance from Property Line F F F F F F 4- 3 3Distance from Bottom to Water Table F F F F F F Inspector’s Comments: "p? o (J ^ f ^ s ^(!)-W K C■tj / za «r--. I ■ 7 7 ^i/\ l< Aj 0 A'oD rCk 'rr ®/SS 0-^-^ vjj W\A p < •/ 4 / ^ k y X <r V ^ c/S / 3 V /u] Z y fps y" ocj:^o Date of Inspection 19 Time of Inspection M S^nafure oi InspectorINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF = Square Feet F = Linear Feet Job me MKL - 032M5 - Backer Agency \4.x-N. j ; ^ le?rrfli'tK. ^oKc/e/7 3V 7^reu T^Ul <? M/ >Y ^ i)<r *5*'“ Ac.ri^ y^frctcJ^ ;1^ \To ylCee/ € S //Z( jhlovv' (^ic-lf ifrc^ 4-A UJo/-^fyt ’ S ^ -'x ^ 15/<•/ eto <x - -i ■7^ iic<*‘'^* \jQC,ll/•/'I-------- 1 L^|i ^O M t< i *7 ,til Cpra/>1 .f /■ _-f H ir~^ }^(^U M li (I ItII 4'' . A^L j; «< '■/ „'.f 'A II V ^ 6-M>')' >/ ^If k (f 'iDofMr,*II! « kjc// — • ■P. f^te. I i (^ t ^ » JP. z^«// — i^ror^ /.a K^ i Ks> Lf tt f ~f ^ /fo^tfir ffc>t^r 5 I ri^ J^<f^\te) h Xd mfn j)If; IIli : <1t|l li Iti nfi (I II! ! IIW U\' i_lZll T T^ec'/ Ci» if - V, ■ A.---^'"i!.,------V„ '•V._ -.•■-‘• »-—'X4 '^^cejveo 0 4 ^O&RESO "f^ /' i~«- Ki 1S89 ^Rce I C^fifi'fr«.eu- MKL -0871 -028 215S02@ VICTOt LUNOfEN CO.. fRIHTEPtS. EERCUS FALLS. MINN.PERCOLATION TEST DATA LAND AND RESOURCE MANAGEM^ ^ Otter Tail County ^ ^ Fergus Falls, Minnesota 5653;^ ^ Mailinq Address: -V ^ i'v.j Ph. No. Owner:I/O i>r JeA/ Zip No.Last Name First Middle St. & No.StateCity•^/o y /•^ ^Legal Description:y/ I—=-5r—\ SEC. ^ TWR. RANGE ^To^i§\ ^ TWP NAME. LAKE OR RIVER NO. Jr^Cr 6 ^ NAME \AJ t 7p,/='t^rJ ^ /V . - 3 3'(5 'n<=>‘'< / a *^r -C/<?. A.-'ai y f TEST HOLE NO. 2TEST HOLE NO. 1 /« /TeI r A,/’•7*9. Depth to Bottom of HoleDepth To Bottom of Hole,inches; Diameter of Holeinches; Diameter of Hole Jnchesinches :/t 9Depth, Inches Soil Texture Depth, Inches Soil TextureDate19 Date 19. O - iQ o ^d(.o - / •z-/Percolation Test By____ Percolation Test Bv^ i'( ■y 4^*^ » ''f 'h / yfor S/^ 'f V/✓ c.7rX//f/' ^‘r'a' L.‘^A I 1------?0/t> ~ 2-0 Qf LU17i c/Firm Name.QC Firm Name. £(S d D^o '' io or -/LU QC LUAddress.QC Address < C/3Otter Tail County License No.,Otter Tail County License No^C/) LUMeasure ment, inches Time Intervals minutes Drop in water level, inches Percolation rate minutes per inch Time Interval, minutes Measure ment inches Drop in water level, inches Percolation rate minutes per inch Remarks:Time Remarks:Timeo5I-hnMil L3-6 Z ^1 dill A. 2/2a LieaV J Jr / '3t.(0: , 7C5.3 3 rOT35izlA, 6333.C?■ go ’1 24/^41..7^^ I 9 u 7'gZ.O f /. 5"3 ?'V/. ^/, o A3a.i t 2^3r.a A1L /, 0yLoh /, OV /,oU-P-23^./!iJ /- O /.C>dPA I /./ ' f^o LAii,o no no7z/• 4uc *«-/ r __< 1 T-y C_. ^/rrr See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of MN Percolation rate minutes per inch minutes per inchPercolation rate = "^^^^mSMSSSXSlSSMSiSSSSMi^^^ '"rt^^p » i^/( W'-mpi V,'!'' \Qr CERTIFICATE OF COMPLIANCE SEWAGE SYSTEM ii9^4 teil mp;«pafepatepi 3rd January 19 75day of.This certificate has been issued this sI#If to certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota. The premises covered by this certificate are legally described as: Lake No. 56-385 Sec. 34 Range__41 Twp. Name.Twp. 136 Uxjxa fet, Sip wmimiI'M V^M 3*« Parcel in G.L. #5 & SMk of SW^ Peach's Trailer Park iSl m Lorraine Peach WordenOwner: Name. K Route 41f Dent. MinnesotaAddress. tel 56528Zip No. Permit No. SP_QRQ^.3 Signed by:. afef Malcolm K. Lee, Shoreland Administrator Otter Tail County, Minnesota »MKL-087 1-009 / ®159035 v'CToa (.uaficex 4 co. piiircAt, rtisut r*LLi, PERCOLATION TEST DATA Price $ 1.00 per pad. SHORELAND MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 76~<?~ F/ r ~Ph. No. Owner:Mailing Address: LAMAjM£-JL First I P/TfUT- Si - 3 f j ^ Zip No.Middle St.StateCity Legal Description;H}Po/lA3U.D6AA LAKE OR RIVER NO.NAME SEC.TWP.RANGE TWP NAME TEST HOLE NO. 2TEST HOLE NO. 1 63ADepth to Bottom of Hole ^inches; Diameter of Hole inchesDepth To Bottom of Hole__;Diameter of Holeinches; inches i /L lADepth. Inches Soil Texture Depth. Inches Soil TextureDate Date LHIStc^Percolation Test By____; Percolation Test By___zxuolUFirm Name. QC Firm Name.3oliJ cr 'ZJ-'Zz.UJ Address.CL Address <7 (oOtter Tail County License No..Otter Tail County License No^H(/)LUMeasurement. Inches Depth in Water Level, Inches H Measurement, Inches Depth in Water Level. Inches Time Remarks Time Remarks o / “} T ^ - ■■ C ’—7-5L- 9 J Sit:../ y./X_ ^-------^C I MKL-0871-028 See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn. 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 Or ^ <¥• Permit No.yLEGAL ^ /^q /7-yDate/ ■ra i }^rDESCRIPTION AND cn nLOCATION Lake No. ■ c ---- TWP NameSec.Lake Name Lake Ctassif.TWP Range IDENTIFICATION; Please Print All Information. Lailling Address —No. Street, City and StateFirstInitialLast Name Zip No.Tel. No./f^L ^ hdr In rrtf tOWNER X^ t fi/t M LLSEWAGE SYSTEM INSTALLER > C J Ir'^Name,5■A-3 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 ^g^wner or Agent Signajure /?rXESTIMATED COST: i^/jQn NUMBER OF BEDROOMS: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT ,DRAIN FIELDcJ2rif. , ;5'c3t-S" ^9- Pi-7k:'0>r,GIs.; Capacity . Ft. -S-g ~l- Ft.Ft.Ft.Distance from nearest well O -f 7y Ft.Distance from lake or stream Ft.^ a i Ft. Q O ''f Ft.Distance from occupied building Ft.Ft. Distance from property line /rs< Ft.Ft./Cy - Ft. zFt.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............ , 19 Rate. , 19....??;j. Rate MPERCOLATION TEST DATA:Date of First Test .A...?.Date of Second Test 1st Test Taken By i z..^..r.First Test + 2nd Test 2 Rate2nd Test Taken By The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work inAgreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job Is ready for inspection. ICall or use attached mailer notice.) Dated Signature Permit: condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six (6) months. Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express " ^-9-. />-vIssued Date: horeland Management Office5 AJ q ro. <s raFee $Surcharge $O ■ a /Mo JIId.A 4kComments:r‘f=‘ c rr\ io r. ih //■'clr'rt, i_____ds.u m L3 ncij J dForm No. MKL-0771-003 I,.... 158906vima uiaMtu ■ e«.. Mianaa. SHORELAISID 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 CkI. ^<1;. V *Permit No.,LEGAL ra->'/aifrr Date/ K.DESCRIPTION AND m--■j /LOCATION /~ nr Lake No. Lake Name Lake Classif.Sec.TWP Range TWP Name IDENTIFICATION: Please Print All Information. First Initial (\A^illing Address —No. Street, City and StateLast Name Zip No.Tel. No./II Vr- C.r /or(r.i ■r_OWNER 4 SEWAGE SYSTEM INSTALLER I ' I- i 1!'Name / r\ f~T A 9!. :r>DThis System will be ready for inspection on., 192^ This space for office use only tY fL19 iDate Rec'd Time Rec'd Phone Call Rec'd By Ow^fic—Ior Agent Signajture )J//v»^e I'd f0 /^Vh ,‘eNUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD r' ^O(-'0 GIs.Sq. Ft.Capacity ' Sq. Ft. Ft.Ft.Ft.Distance from nearest well O • O ^Ft.Ft.Distance from lake or stream Ft. -5- oDistance from occupied building Ft.Ft.Ft. Distance from property line Ft.''O 'Ft.Ft. A /__Ft.Distance from bottom to Water Table Ft.Ft. AH distances are shortest distance between nearest points : RECORD OF TESTS: Inspection was made on , 19 ...... , Time ..../o t( JVI By /.PERCOLATION TEST DATA:Date of First Test 19 , 19 Rate r I > v-Date of Second Test , (Rate.;. 1st Test Taken By /J / ■/ / :'i '*First Test + 2nd Test f 1 Rate2nd Test Taken By The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work inAgreement; strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for Inspection. (Call or use attached mailer notice.) Dated Signature Permit; condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE; Permit void if work is not commenced within six (6) months. Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express 1/ ' Issued Date; Shoreland Management Officedo/-W f\j^, r ■ c\ M T r- ■■ ^ I n r~i o oFee $Surcharge $ r ct-irr; ^ J C A T* S'i-scCk)mments:. /?,/-^7d.//r /-Q ic-'i li7/■ cVdr b, Form No. MKL-0771-003 1S8906--L VICTOa LuaBICN • CO.. PlINtCMB. rEABuS FAi.Lt. HIHM INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORY Should be Actual Should be Actual Should beAct! ~^ / SsFCapacityS F fGIs. GIs.S F S F 2^:Distance from Nearest Well 75 50FFF F I mDistance from Lake or Stream F F F F FIi-Distance from Occupied Building 10 2020' F F F F F Distance from Property Line 10 10 10FFF F 1-CJlDistance from Bottom to Water Table 4 4FFFFF F \ CTK ^ - f _ Inspector's Comments: 2-~?A ;r; Date of Inspection -off; .'c-'-. Time of Inspection.M 'Ignature of InspectorINTERPRETATION OF ABBREVIATIONS GIs Gallons SF = Square Feet * Linear Feet Job TitleF f= Agency } if i MKL-0771-003-Backer H. 1. : • tiy. • ;?•.f . -8 V.JO e,‘ ■'Vn !(>i w -"fO *nr -ft 1 :■"1 ■i'' f r •s.I i SHORELAND MANAGEI^'EIMT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 PERCOLATION TEST DATA Price $1.00 per pad. Ph. No.Owner:Mailing Address: r 'L-T-.r^L Last Name irst Middle St. & No.City State Zip No. 214Legal Description: LAKE OR RIVER NO.SEC.NAME TWP.RANGE TWP NAME• -^1 U UA,x.’~c^riy _r’—'Lt d 1TJ/TEST HOLE NO. 2TEST HOLE NO. 1 CDepth to Bottom of HoleDepth To Bottom of Hole,inches; Diameter of Hole inchesDiameter of Holeinches;inches £19^19^7Depth, Inches Soil Texture Depth, Inches Soil TextureDate.Date y 'o - ^■A rfCPercolation Test By____ Percolation Test By____/A>,r Q V - o 4^2^ .¥f d^aAM.//Firm Name.Firm Name.ry'fy S(cTTLf-r <r 7/ TiC. 'r^ •j cc%LUAddress.CC Address < </)Otter Tail County License No.,Otter Tail County License No..HcoLUMeasurement, Inches Depth in Water Level, Inches H Measurement, Inches Depth in Water Level, Inches Time Remarks Time Remarks O I 7474'//7 7-^/A AjlaLXIi /2L/7 v-r 7 O! /s'&“Aj>a:aa'd:iA /2 ~^T7^Tza!A.16: A^O \I /a :a>6//. >- /i ///lAJJL/T?r C . TS O 7T7 7W 77 /ic^AdX--- Li^ ■^x. 477.' x;V A iiiiJ?I ■ ■.cr:OCi. /j 7.=7 tf A ivH MKL-0871-028 See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn. >•,S •*i'UjJ/-<v f{f^.' 1 'V^ ■4-r^/A ^Ja %mfeltfikI9lAiiS?Its* ^. \ « CERTIFICATE OF COMPLIANCE SEWAGE SYSTEM I® mu •la If19^17. th day of JanuaryThis certificate has been issued this .:■■ I,f -§M mM to certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota. ^ The premises covered by this certificate are legally described as: Range Ul it 'i. Lake No. 5fe~385 Sec___3 Twp. 135 Peaches Trailer Court Twp. Name Star Lake 1^1m ■ s m. r.- ■ m wM m iLS1 ■ i.5 -'V' Lorraine Peach .■FOwner: Name. « Address Dent, Minnesota ■ --V'i'; m f liSl ^6^28Zip No.'••o m Malcolm K. Lee, Shoreland Administrator m7h6Permit No. SP_ Signed by:. Otter-Tail County, Minnesota "IP . ^MKL-0871-009ff'i:!.- |M0-^■}j \M r.^‘ ■r^.- ■® 1 159035 v'CTsi tnocci ft ce. Murcti, rti*min fftixa. ion :'is' ; -J. 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 Permit No___7V4^7^0^* )c'TLEGAL Date DESCRIPTION AND SC>-38S'^ V/r^nLOCATION TWP NameLake Classif.Sec.TWP RangeLake NameLake No. IDENTIFICATION: Please Print All Information. Zip No.Tel. No.Mailling Address —No. Street, City and StateFirstInitialastj^a me L /T)f3 //n^ ^ T'ri /OWNER ■f SEWAGE SYSTEM INSTALLER Name This System will be ready for inspection r 19.on. This space for office use only M19 Phone Call Rec'd By Owner or Agent Signa.tureDate Rec'd Time Rec'd SEWAGE DISPOSAL SYSTEM DATA: nn n4 SEEPAGE PITSEPTIC TANK DRAIN FIELD sq. Ft. 5~<D GIs.S^. Ft.Capacity Ft.Ft.Ft.Distance from nearest well Ft.Ft. Ft.g~r)Distance from lake or stream Ft.Ft. Ft./nDistance from occupied building /ODistance from property line /O Ft.Ft. Ft. Ft.Ft. Ft.Distance from bottom to Water Table AH distances are shortest distance between near^ points RECORD OF TESTS: ,, 19,, Time .MInspection was made on By /.................. 19 , 19.....?..r;?L., Rate PERCOLATION TEST DATA:Date of First Test Rate ^........^/Date of Second Test,p r- 1st Test Taken 2./jFirst Test -I- 2nd Test 2'Rate2nd Test Taken By The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work inAgreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been Inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. (Call or use attached mailer notice.) Dated Signature Permit: condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six (6) months. Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express ■ xjJ) Sh Management Office Cf ^ 2y Issued Date: ^loo /Jo / 7S' oOFee $ .0 Surcharge $ /on' Comments:. f.. ,A.i iOr/'i I r\ CAj^pp>.e. ^Pr^ t, i rp d, T:,V 158906 VICTOB LUHBEIH 4 CO.. PBiaURO. rtaOuS rstLO. HIMMForm No. MKL-0771-003 SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 — Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM White — Office Yellow — Inspector Pink — Owner Card — Owner Permit No..LEGAL Date DESCRIPTION AND LOCATION Lake No. Lake Classif.Sec.Lake Name TWP TWP NameRange IDENTIFICATION: Please Print All Information. Mailling Address —No. Street, City and StateInitial Zip No.Tel. No.Last Name First OWNER SEWAGE SYSTEM INSTALLER Name 11This System will be ready for inspection on.. 19 This space for office use only .M Date Rec'd Phone Call Rec'd ByTime Rec'd Owner or Agent Signature SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD GIs.Sq. Ft.Sq, Ft.Capacity Ft.Ft. Ft.Distance from nearest well Ft.Ft.«« Ft.Distance from lake or stream Ft.Ft.Ft.Distance from occupied building Distance from property line Ft. Ft.Ft. Ft.Ft.Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS; Inspection was made on 19 , Time JVl By PERCOLATION TEST DATA;Date of First Test 19 , Rate Date of Second Test 19 , Rate 1st Test Taken By First Test -I- 2nd Test 2 Rate2nd Test Taken By The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work inAgreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. (Call or use attached mailer notice.) Dated Signature Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon 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-fc/)innesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six (6) months. Permit: Issued Date; Shoreland Management Office Fee $Surcharge $ Comments:. CERTIFICATE VICT»R LUNBIlM • C».. RKIHURa. PCiRUS FN.L*. HI«H 158906Form No. MKL-0771-003 INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORYActualShould be Actual ActualShould be Should be Capacity GIs.GIs.S F SF S F Distance from Nearest Well 75 50FFFF F Distance from Lake or Stream F F F F F F Distance from Occupied Building 201020FFFFF F Distance from Property Line 10 10 10FFFF F F Distance from Bottom to Water Table 4 4FFFFF F Inspector's Comments:« ( ^ y Cr //rM 7^3I Of/h fj It-v r^' ^ C/-i 1 Date of Inspection 19___ Time of Inspection.M 1r / Si^ature of Inspector7INTERPRETATION OF ABBREVIATIONS GIs = Gallons SF = Square Feet =■ Linear Feet Job TitleF AgencyMKL-0771-003-Backer MllNNISSDTA DEPARTMENT OE liPEALTiA L’.’ciion of .V'iclelfi, Rraorss and Rfsicr.rrr.ri;; 717 Deiavvore S.E., Minneopoli:;, Minn. 55440 A ■_r j'^UirAJlC IhOSALTH SAFETY ENSFEGTitCN RECORDAND/.T ?■ £t.v y/ DATE co.aC^.|^;7Ai. 7 AeeaaP-0.... ,7. j:AA_ LICENSEE OWNER /■ ///)MET.ADDRESS •AL-ADDRESS P.O.AT-7";;,7 -f 7A25AE;:iL_iL_^,.sA7AALMJ42^^AMMo. of employeesBUS’.NE-:SS NAME , SLEEPING ROOMS,POSTEDLie. NO.NO. OF; BEDS , UNITS CABINS _ Mloblle Hoi’.ig Park nnoTYPE OF BUSINESS 0;\0:.;i;s ViRl'iTEN BELC31V HU3T BE COMPLIED VflTS-i BY DA11; iMClCATED AAtjO;'!Pr 0-'\E cPAATAsP'.'A'T-^.7//.7',7 .OaSVAAA... f-iTAA 77 TaA/i: A__ A. ■-1.-A*7’A7.A 17-,L, I '7 j'I/'' A-a7--7_AA TA4;A4A.A2A, 3 • -»'ll'A/ /■fOP/y^Ato__A:lA-:.7i_A2l_t.4 ap .7"' u!- . vRt a -3'~'r / i','R A_ ,P■"’■AT /£ A'07 T,T”Aa£R ■/ ,A’,-:Ca€Lu"AN;7"cS'Su--:Ac-=<t■'PP A-''yA a;,?“' .07 A-' .. 'AAl n'A A A/£ ...JAAA:A““;py 7"«;AA. A'£Aa' _.^5 3,A' A p- .y..•A ti'' y TAl:li3.CAfAAyw;/u; r T7'*.Ip-i fK 1y■T =/C'"7 X? !'■■ ,PA’7-O-7*' < -4-''. . A^7r :l.YC-O, 1, 4' .■p /7 __A.'- '''I•£'. ./;! >1, i L,.§ S7ELL - SH\7ER DIAGRAM ■; n:ocompl;/l:ce previous orders YES 3 _/LISTS T,:' OFFICES - 1. BemHji (755-2‘TSS: 2. ManSaro (589-60’5) i. Rochester f2!P-5sSs.) 4. '72V-7204) S, 'Vorrliingtoi) (?76-6543) 6, Hd's., STB-Il^O 7. Ferjus F-aik (736-6922) 8. Little Falls (632-8626) COPIES ■ Ceniral Ojlt.ee, Licensee, District Office V RlooIv.’cI by Dic^.'ict ScnilviMci y". p: •-i j /-•-P s SHORELAIMD MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 — Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM Office — inspector Owner Owner White Yellow Pink - Card — Permit No..LEGAL /-r Date DESCRIPTION AND 3 /3ryv/LOCATION TWPLake Classif.Sec.TWP NameLake No.Lake Name Range IDENTIFICATION: Please Print All Information. Mailling Address —No, Street, City and State Zip No.Tel. No.First InitialLast Name 2a aOWNER SEWAGE SYSTEM INSTALLER Name, This System will be ready for inspection , 19.on This space for office use only .19 Phone Call Rec'd ByDate Rec'd Time Rec'd Owner or Agent Signature . ^ O'SEWAGE DISPOSAL SYSTEM DATA:t SEPTIC TANK SEEPAGE PIT DRAIN FIELD '3 f Sq. Ft.GIs.Sq. Ft,Capacity 5"^Ft.Ft. Ft.Distance from nearest well Ft.£}L Ft.Ft.Distance from lake or stream 2ulZjlFt.Ft.Ft.Distance from occupied building Distance from property line Ft.Ft.Ft. Ft.Ft.Ft.Distance from bottom to Water Table dis^nces ar^^orte^ distan^J)etwee^ nearest^pmnts^ tECORD OF TESTS: Inspection was made on 19 , Time ...........JVI By............. ., 19 Rate. , 19..^.......... Rate zr.PERCOLATION TEST DATA:Date of First Test rIfrDate of Second Test 1st Test Taken By r/(■ First Test -I- 2nd Test S 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.) Permission is hereby granted to the above named applicant to perform the work described in the above statement. Thi^pfermit ^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 orOtter 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. / Dated Permit: u.Issued Date: Shoreland Management Office/ Fee Surcharge $ /• ?r7/ prP'9 ^ ^Comments:. 'f //i^.2j3 3c7c ■2J021 Form No. MKL-0771-003 vicToa xumttim t eo.. eaiNTcat. FCaau* iiiMe.lS8906 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 ■x'-a Permit No..LEGAL / / ■ /Date DESCRIPTION AND '.r*A V ) A''/LOCATION Lake Classif.Sec.TWP TWP NameLake No.Lake Name Range Please Print All Information.IDENTIFICATION: Initial IVIailling Address —No. Street, City and State Zip No.Tel. No.FirstLast Name > . < X'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 Phone Call Rec'd ByTime Rec'd Owner or Agent Signa^ture SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD GIs.Sq. Ft.Sq. Ft.Capacity Ft. Ft. Ft.Distance from nearest well Ft. Ft.Ft.Distance from lake or stream ^t.Ft. Ft.Distance from occupied building Distance from property line Ft.Ft. Ft. Ft.Ft. Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on 19,, Time .....JVI By 19 ..'..r.....,PERCOLATION TEST DATA:Date of First Test Rate;...x Date of Second Test 19 , Rate 1st Test Taken By First Test + 2nd Test 2 Rate2nd Test Taken By The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work inAgreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi cial shall become a p>art of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. (Call or use attached mailer notice.) Dated Signature Permit: condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six (6) months. Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express -fIssued Date: Shoreland Management Office Fee $Surcharge $ I J fComments:. .158906 VICT«* LUNBCCN t eo.. PIIHTEIU. FCRSUS FACLI.Form No. MKL-0771-003 INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORYActualShould be Actual Should be Actual Should be Capacity GIs.GIs.S F SF S F S F Distance from Nearest Well 75FF 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 10FF F F F F Distance from Bottom to Water Table 4 4FFFF F F Inspector's Comments: T Date of Inspection.19___ Time of Inspection M Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs » Gallons SF " Square Feet “ Linear Feet Job TitleF AgencyMKL-0771-003-Backer * ■- V 1 Pv i I □ID ( r 7 I f-r; - ^ PERCOLATION TEST DATA SHORELAND MANAGEMENT ---------------------— OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Price $1.00 per pad. Ph. No. Owner:Mailing Address: Middle CitySt. & No.State Zip No.ame Legal Description: LAKE OR RIVER NO.NAME SEC.TWP.RANGE TWP NAME TEST HOLE NO. 2TEST HOLE NO. 1 (/(o1010LDepth to Bottom of Hole inches; Diameter of Hole JnchesDepth To Bottom of Hole.inches; Diameter of Hole inches 7ru^ i19_L>12- .rDepth, Inches Soil Texture Depth. I nches Soil TexturetDate.Date 19 ^Vc. •---i3 0 l-ll Y . n' \ M W ->V ^ .J Percolation Test By____ Percolation Test Sv . .xv-u o Ccfw-LUPirm Name.QC Firm Name.DaLU cc LUAddress.GC Address < Otter Tail County License No.,Otter Tail County License No^I-COLUMeasurement, Inches Depth in Water Level, Inches I-Measurement, Inches Depth in Water Level, Inches Time Remarks Time Remarks OllAl L? _JUUA 1-^Vs -4iL^< 1C,jL TTUTCp1 3!T.k. ZlC_^ .j,111-. V-' 7 777■4=^f 159179 ®MKL-0871-028 yidO* LJNCXCM *l>R<kTC*|. rc*sus rALLi See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn. 1 i y *■ t FL.Ul\e-lSl& rCfMl.b rcf.!j ■a^;iEoTTO ecxr~ri 1 !\' ! .i e5\iv\cm3 B-m ra2. t. ' ■ ■ pacpttsof^v-pe. \-siH rUvi|L j-X wajksti re;c>(!I 1 ! !; t .1I11 ‘i ;:0^ atasK I 5SZXCU K h £^^r/,!aFK.LD 0®:“;-f 'V...T y-—----- —;i ;SCTuOM^TAxtiK,}r::drr.-,:rc:'i i=rXVj:^ —r.XI 5 t 'i i i-trr.r ii____—•■ i ;i5nj i i•■ ..i==r^.-=r•TTT-.1 !ifiirrI,1 u^T6T/.rr^'!:r",..je.aacsl■'r:(•V)rI__i..tco^-o'*I r i(^eri£5!i ! PL&M VIEW l |fi SC !' ‘ pfSTEirDim ecKWMi nap[MSfeOlCU M/^4HDUE Gf\L- SEFTlCmklt;;?//•iwFSSSS^SsasisaseiWKsw»??rfrs 14”^-r S"t‘if *' prpp (*vi lOD-o" !;Tiir-.'^7 war>Eia.^, Lexer, HlMJ u\5T mt cc^ir,(ki;qGD h arc"i «4Ze,055 5GJ10H\; 1". l0‘-0‘’j mg:*uMiaroD euiuDif^ rmreii All wa7t; 5-H/\u r\m t.xceix> MiJCK^EecTA Hooivi a,rAC7rHt:w?> 6xAKimr,v>sof Y4-*' OEAiMiiie '3^" v^s^ED Ki\£v/ oAmutr T f V#6fLt> 03^!C A0CXlr TlE'!9 'J .r-'■o:. :0^ i -‘aXiaOl.rv^'-lit 3'<X 3^-0"3k>» !'7 '^ SV 3X>'i 4I-p.■fi eeoicra-A-£^i< / k um»E FEtm imLz wi: .EmTlUQ.PUKir. 4\QI 4^ COPIES: Central Office Licensee District Office MINNESOTA DEPARTMENT OF HEALTH Section of Hotels, Resorts and Restaurants 717 Delaware St. S.E., Minneapolis, Minnesota 55440 MOBILE HOME PARK AISID/OR RECREATIONAL CAMPING AREA INSPECTION REPORT c K V, i- Camp Namfi jra" L f 'Jfl. Co. '"t'A i Lie. No. /V V ? PosIrH / /o r, <7 ri a J- Park or r'i i Z r')y-/1 -<■-LocationP.O.hi.J-77•7 n r h AddressLicenseeV ) No. Occupied____No. Occupied______ ____ No. Occupied S’ /lu\jr-.Z.^ h. No. Dep. R.C. SitesNo. Ind. R.C.Sites No. M.H. Sites ■J T) iZ - ' 7Sewage Disposal AoA " Toilet, Bathing and Laundry Facilities_ Incinerators________ Garbage and Refuse_ Vermin Control yl. Night Lighting ___ m. Community Kitchen n. Bottled Gas______ o. Fuel Oil Systems__ p. Fire Protection____ Other____________ a. Location b. Caretaker c. Spacing d. Animals _ g-A/n I- I. Water Supply Plumbingk je. lf. MHD 152 PARAGRAPH: _ -....-7.7...£!/■/ ■■ •"/ A T?*/.// b^-r MsL/i J>n ■U rp 4 aT /'V 7" 'L-'I /? ■;i -y QZZLi-^. /£L \1 y/I/"/ -/_/.T' /7r J!"5 1.74-//7/ j-ui-j - /‘5'y/ "77 /I JD>/ A Joe roe -T- / //?5 7A 7L-77//..^ / >i7 A7-t4) Ari n- U f 77 /z -/7 ^t7(9 l-r^ B A£L /ILJ ^ 7 ^ J^r-' ft /y s >s JJ J..\a/i^ -i-c 1^4s rt\j JdiiK)n. (J nJ r~ /O ra_1J77 7 /r? J p/l ^ 7 9- 7/ c=S7-/ 7. /^rt-r!l /La_ fv o Ay rt> li, rK- n n nrV /] c rL-a si -,Sf-f'LyiLI 1 /7.yf 7°Jr^tX /T) J TV d 4.;^ A I' Y r'i 'j /1 ^7T 7 ■ V7-s; /’ n/ 1 -C L4yl-£J_ /2 L y-/..'i Received ByDist. Inspector^.■ ..r' T" f j y ; •77 7 - 7-'- g^ Dist. Office and Phone No. fMINNESOTA DEPARTMENT OF HEALTH Section of Hotels, Resorts "and Restaurants H35 State Office Bldg-, St. Paul, Minn. 55101 Central Office Licensee District Office : TRAILER COACH PARK INSPECTION REPORT 2&m.jDIST. NO. __^ c£2^x. ■'.v POSTEDLie. NO— DATEPARK (4/?■ Xs i J VfT. C.P. LOCATION_________________P. 0. - to^/z f-dzMz’hCO.■i LICENSEE _ ADDRESS .i.4 r.:M.7-L,C.fl.:>NO. SITES ATTENDANTNO. TRAILERS ,!Sir: (X) Indicates NO COMPLIANCE. COtlPLIiVNCE MUST BE MADE ON OR BEFORE DATE INDICATED.'V ICENTRAL BUILDING 1-FLOORS—Impervious,><mooth, good repair, sloped to drain, clean 2-WALLS & CEILING—Smooth, washable,, good repair, clean ar-DOORS & W'INDOWS--Effeclively screened, doors open outward, self-closing 4-tJOIITIMG—Adequate 5-VENTIUS*TI0N—Adequate, no odors or condensation, heaters properly vented 0-PIAJM3ING—Compiles State Code (t.ip. 7-^-0ILETS--Adequate, convenient location, separate foiv,;9«ch sox, nra.rksd, good repair, clean, enclosed t-fj. 8-LAVATORIES—Adequate, convenient to tc^^ts 9-SHOWERS-;-' Adequate, oatlsfactory dressing area or compartment; no absorbent floor cover^g 10-LAUNDRY—Adequate, - . 11-ADEQUATE HOT WATER FACILITIES GENERAL REQUIREMENTS ' 3separate from toilet and showers ;.l 13-WATEIR—A.dequate; under pressure; accessible; complies State Standards 13a-^?fvFRAGE SYSTEM--Publie or other aejlroved; sewers, water lines, stop and y/ap^te valves properly separated <y)j^-T.C. properly con- ' neoted (Z), c-Sewers on unoccupied sites closed , d-No slop creating practices 14-(?ARBAGE DISPOSAL- • . -I'eial, .f.t’.squate, good repair, fly-tight covers, covered clean container, wash^lck, frequent collection ( )'* 1 .’^rrXTiSIC.M DIDFOSAL—Adequate; satlsfac^py containers, frequent collection (I Q . 16-piSECTS AND RODENTS— ('■4. 17-ANIMALS—In utility bldg., at large . I8a-ELECTRICAL— duty rubber cover, 14 gauge ( ), adequate. -y 'NO-evidence on. premise, under control ' . OutletG Fc7 cac'.i site, extenslgiTs not on ground or ,crossing sites, heav^' "•/•' j'r - Iv. No, cbv lcus safety hazards 19-ytGHTING—Adequate Park Lights {C'f- 20a-FIRE. SAFETYjaftCV ,'^fTagprOTed ■33rt:lngi3lshers; convenient pf’, V'In encl'i T. Cznfr^j c-No obvious fire hazards d-Bottle gas i cyilncSTa prcner.U^ located, connected 2la-PARK LAYOUT—Drained, sites abut ^^r'lveway, access to hlgh-' VJay or alloy X' i , b-Sites proper size . c-T.C. and/vehicles properly parki'il V'). 22a-SUPEK^*t^^JTlTr-’. ids kept I-'), b-Park conducted with stricf regardjf<jS^Jall;h,'^ . Attandont at all times, registnrf'tioii ' y-’.'Qafoty and comfort of guest if).rec Cl * • • Jr. ■ . RE7.1ARSS; ‘--V _________________ j___________«_______ _____________________________ • I________ ■; -y7i■i.//4y2' / y4 A^) k-e / 7^ t3 -fQI\A Xj? /wJt<L i A) 4',Cf <2. h e) c k.tt 0-' 1I i~V <^\/TINfftf r 4 Le 791 1y^ ^ (4^/^ c) /t, 7~ I j I K> eou tA' % i?I ■i iy. \ / IJDIST. INSPECTOR’U'i fiClilVED. BY -L 3 0