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Home My WebLink AboutInspiration Point Bible Camp_36000170122002_Septic System Permits_(•r'SEWABE SYSTEM ABATEMENT NOTICE OTTER TAIL COUNTY LAND & RESOURCE MANAGEMENT 121 W; Junius, Suite 130, Fergus Falls, MN 56537 218-739-2271 JULY 31, 2002 CURRENT PROPERTY OWNER: Joe Keep RE: Parcel Number: 36000170122000 Section:17 Township Name: Leaf Mountain Ef911 Property Address: 41581 Spitzer Lake Road Lake Name: Spitzer Lake You are hereby notified that the sewage system which you maintain on the above identified parcel, is not constructed and/or located in accordance with minimum standards of the Shoreiand Management Ordinance of otter Tail County. Lake Number: 56-160 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 notificatiori. C)€0^f (J>dt-Land & Resource Management Offi^l. r w ■ STATE OF MINNESOTA ) )ss. AFFIDAVIT OF SERVICE BY MAIL COUNTY OF OTTER TAIL) Amy J. Mark, of the City of Fergus Falls, County of Otter Tail, in the State of Minnesota, being duly sworn, says that on the 31®'^ day of July, 2002, she served the annexed: SEWAGE SYSTEM 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: JOSEPH A & EILEEN KOEP 41581 SPITZER LAKE RD CLITHERALL, MN 56524-9555 Land & Resource Management Official Subscribed and sworn to>€fore me this ^_____day3L in the year of My Commission Expires JOYCEL.THOMPSON “I NOTARY PUBLIC-MINNESOTA My Cormssiofi Expires JAN, 31.2005 I••f FormLtrs->CertifiedMailingMS CHRONOLOGY REGARDING THE SEWAGE SYSTEM ABATEMENT Property Owner: Lake Name:Lake No. 56- Parcel No.: GiS Address: Date Issued: Date Initial Response (owner): ^ 11C'/ Date Resolved L-i 7»* cli>f< ;r /e> TJo* ^'J Phof^eJ <Toe. -p.. lU f^U ^ Cro4n/ /{as Onta/^fu/Of" IS i»o -tk,es~(. . Th- fi's^'xsse. /s twf /(, use . /"^Aiss us-e oiri ^OH-^ Abatement. chronology5-02 'J r X.C.X.AJ xMU'raa LAKE NO. 56~DATE:7f Parcel No . 3^CCoO FIEE/LAKE NO.M(S’g(LEGAL DESCRIPTION: IOWNERS NAME AND ADDRESS: . f, TYPE OF SEWAGE SYSTEM: Septic . Tanlc V Drainfield: ___Cesspool: ___Holding Tank:^ .___ » • Septage Pit, Dryvell, or Leaching Pit: ___Other: COMMENTS: SEPARATION DISTANCES (IN FEET) ABSORPTION AREA OUTHOUSETANKSEWER LINE . , WELL Z' 10OHWL V LOT LINE DWELLING NON DWELLING ; GROUND ELEVATION 0 EEASON(S) FOR ABATEMENT: on Too cloiC To UK< ^ on Too chc to it NoH II’ it 6/f fHP Inspector’s Signature(s)SKETCH ON BACK.• • \ 'C? o Pji-tlp S P I T Z E Rlake :e)(NATURAL ENVIRONMENT LAKE AS PER DEPT. OF SHORELAND MNG’NT.) Se^iAC^f- T«»/€mmmmrn * • • * f~0 0&(n3> u)J»p/< K/fct(^ t>/»^/ffs S P I T Z E R A K E fUATURAL ENVIRONMENT LAKE _ ' -r \ aCERTIFICATE OF APPROVAL mmSEWAGE SYSTEM mSEPTIC TANKS (2) (K’ ' This Certificate has been issued this 1ST of FEBRUARY, 1999 , to certify that the sewage system installed as per Sewage Treatment System Permit Number 0 has been approved for use by Otter Tail County, Minnesota.K- WM■y The property served by this Sewage System is legally described as: UNPLATTED 20 AC TR IN GL 5 Parcel Number(s): 36000170122002 Section: 17 Township: 131 Range: 039 Township Name: LEAF MOUNTAIN TWP PSLake/River Number: 56-160 Lake/River Name: SPITZER PMaCurrent Property Owner: LUTHERAN BRETHREN BIBLE CAMP Number of Bedrooms: RETREAT CENTER p V 284.709 • Victoi Lundeen Co., Ptinters • Fergus Falls. MN • 1 •800-346-4B70 APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 - FERGUS FALLS, MN 56537 ffice L & R Inspector /ner / Contractor LEGAL Permit No.^ he 4yDESCRIPTION Abatement: (AND LOCATION LAKE NUMBER LAKE/RIVER NAME LAKE/RIVERCLASS SECTION TWP. NO.RANGE TWP NAME Lf-H f //fnSAfSV-/(«0 /3/11KJE PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER IDENTIFICATION: Please Print All Information Last NamerFirstInitial Mailing Address — No. Stryt, City and Stale Zip Code Telephone No. Property Owner Sewage System Installer Name noState Lie. # A.M. ► This System will be ready for inspection on.the year of PM..at. This space tor office use only NUMBER OF BEDROOMS: A.M. P.M.GARBAGE DISPOSAL: ( ) YES ( )NODate Rec'd Year of Time Rec’d Phone Call Rec’d By TYPE OF SEWAGE SYSTEM ) Holding tank (Alarm Required) 0 Septic tank UOO 0 ) Lift station (Alarm Required) ( ) Drainfield ( ) Trenches ( ) Bed ( ) Mound * ( ) Outhouse ( ) Sewer line SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTS TANK RAINFIELD( L ooo Ft"(Capacity GIs. ('P. Ft.SV Ft.Distance from nearest well ISODistance from lake, wetland or river (OHWL)Ft. Ft. Id Ft. Ft.Distance from dwelling Id Ft. Ft.Distance from non-dwelling oOza Ft.Distance from property line Ft. TEFFLUENT DISTRIBUTION ( ) Gravity ( ) Pressure Ft.Distance from bottom to Water Table All distances are shortest distance between nearest points PERCOLATION TEST DATA:WATER WELL DEPTH * ABSORBTION AREA FOR MOUNDS Date oiPerc Tester .ft2 Rate of 1 St Test Average RateRate of 2nd Test 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 sgecifications submitted herewith and which are approved by Shoreland management Official shall become a part of the permit. Applicant further agrees that no Mrffofttae system shall be coVefed until it has been inspected and accepted. It shall be the respon sibility of the applicant for the permit to notify the County Shorelai/d Management ttet the job is^j^dy for inspection. cuxilDATE: 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. Issued Date:( Land S Resource Management Office Fee $.Rec # Comments: -fet/ygcs \mOX C<yr\i^ 291,095 • Victor Lundeen Co., Printers • Fergus Falls. MinnesotaBK 079&^3 APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENTOTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 - FERGUS FALLS, MN 56537 — Office V — L& R Inspector - Owner / Contracfor L£GAL Permit No.2o A ^ 4y I G s!!7DESCRIPTXM ( X)NoAbatement: ( ) YesAND LOCATION LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS SECTION TWP. NO.RANGE TWP NAME C f / (f r\7 < ^I 1 I yi PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER ;y- ()/>.)-O0> lOENTIHCATION: PleSM Print All Information Mailing Address — No. Street, City and StateFirstinKiai Zip Code Teiephone No.Last Name % f s yyii v, /> {^ 1 (Property Owner ■Vj-I TW(7 <1cj I i >■c \r-ISewage System Installer iName)i >10 ^ Qfnstate Lie. # LK the year of>- This System will be ready for inspection on..at. This space for office use only NUMBER OF BEDROOMS: / II'2.1 ^7 f- Date Rec'd'^ Year of Time Rac'd A.M. P.M.GARBAGE DISPOSAL: ( )YES ( )NO7Phone Call Rac'd By TYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) ( X) Septic tank , I ) Lift station (Alarm Required) ( ) Drainfield ( ) Trenches ( ) Bed ( ) Mound * ( ) Outhouse ( ) Sewer line SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTS TANK DRAINFIELD i Ft*GIs.CapacityI 1 ■7^ V Ft.Ft.Distance from nearest well CI Ft.Ft.Distance from lake, wetland or river (OHWL) Id Ft.Ft.Distance from dwelling 10 Ft.Ft.Distance from non-dwelling A \■'Ft.Ft.zaDistance from property line ■> EFFLUENT DISTRIBUTION ( ) Gravity ( ) Pressure ■v-j iFtr-Distance from bottom to Water Table All distances are shortest distance between nearest points PERCOLATION TEST DATA:WATER WELL DEPTH * ABSORBTION AREA FOR MOUNDS Date of Perc Test.Perc Tester .ft* Average Ra)Rate of 2nd TestRate of 1st Test Agreement: The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeifig 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. DATE: _____________________________________________________________________________________ Signature Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express 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. ■ Issued Date: Land & Resource Management OfficeV "I y~'Fee $.Rec if■d yrComments: I H ’ -7'7.I /!\I I 291.095 • Victor Lundeen Co. Printers • Fergus Fells. MinnesotaBK 079&003 INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS DRAINFIELOHOLDING SEPTIC TANK LIFT TANKCATEGORY Actual Minimum looojrhcroa^gl3:~~Capacity FT2 FT2GLS. Distance from Nearest Well /^f FT FT FT Distance from Buried Water Suction Pipe FT FT FT FT50 Distance from Buried Pipe Distributing Water Under Pressure FT FT FT 10 -h FTDistance from Lake, Wetland or River (OHWL) FT FT FT Distance from Dwelling ^3 EL FT 10/20 FTFT Distance from Non-Dwelling ^ FT FT FT FT Distance form Nearest Property Line FT FT FT 10 FT Distance from Bottom to Water Table FT FT FT 3 FT Holding Tank/Lift Alarm 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 .FIX .ft^FT FT20 MOUND CALCULATION ROCK REDUCTIONector’s Comments:n ABSORBTION AREA 7u4 Rock trenches with inches u Ft. X Ft of rock under pipe for .% Ft2 r DF.reduction / equivalent to * II- State License Category state License Number design must be to scale and must include the proposed location of the sewage system, all ''proposed buildings, property lines, the ordinary high water level of the water body and all water yithin 150' of the sewage system. GRID PLOT PLAN feet SKETCHING FORMinch(es) equalsScale:.grid(s) equals feet, or \.SUBMITTED BY: FIRM Jyl SIGNATURE: DATE: (f. f^/ru /X>ADDRESS:MPCA LICENSE #: LICENSE CATEGORY: r BK — 0496 — 029 SITE DATA : LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, MN 56537 I 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 — Date. COLOR & MUNSELL NO. DEPTH (INCHES)TEXTURE STRUCTURE BLOCKY PLATY PRISMATIC NONEPARCEL NUMBER BLOCKY PLATY PRISMATIC NONE FIRE NUMBER NUMBER OF BEDROOMS BLOCKY PLATY PRISMATIC NONE GARBAGE DISPOSAL: YES NO WELL CASING DEPTH:ft. BLOCKY PLATY PRISMATIC NONE FLOODPLAIN. YES NO VEGETATION: AQUATIC TERRESTRIAL BLOCKY PLATY PRISMATIC NONE SLOPE AT INSTALLATION SITE:% TYPE OF OBSERVATION:Probe Pit Boring PARENT MATERIAL: Till Outwash Loess Bedrock Alluvium COMMENTS: ORIGINAL SOIL: Yes No COMPACTED SOIL: Yes No DEPTH OF BORING:.ft. PERC TEST # 1 PERC TEST #2- TWO TESTS ARE REQUIRED - INTERVAL (MfNUTES)TIME WATER DEPTHINTERVAL (MINUTES)WATER DROP PERC RATE TIME PERC RATEWATER DEPTH WATER DROP START START TIME DROP PERC TIME DROP PERC TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME PERC RATEINTERVAL (MINUTES)WATER DEPTH WATER DROP REFILL REFILL TIME DROP PERC TIME DROP PERC TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE PERC RATETIMEINTERVAL (MINUTES)WATER DEPTH WATER DROPREFILLREFILL DROP PERC TIME DROP PERCTIME TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE PERC RATETIMEINTERVAL (MINUTES)WATER DEPTH WATER DROP REFILL REFILL -----=' DROPDROPPERCTIME PERCTIME INTERVAL (MINUTES)TIME .■ 'WATER DEPTH WATER DROP PERC RATE PERC RATETIMEINTERVAL (MINUTES)WATER DEPTH WATER DROP \REFILL REFILL ______-r * drop'TerTPERCTIME TIME DROP INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE PERC RATETIMETIMEINTERVAL (MINUTES)WATER DEPTH WATER DROPREFILL REFILL DROP PERC PERCTIMEDROPTIME INTERVAL (MINUTES)WATER DEPTH PERC RATETIMEWATER DROP TIME PERC RATEINTERVAL (MINUTES!WATER DEPTH WATER DROPREFILL REFILL TIME DROP PERC PERCPROPTIMETIMEWATER DEPTH WATER DROP PERC RATE PERC RATEINTERVAL (MINUTES)TIME INTERVAL (MINUTES)WATER DEPTH WATER DROPREFILLREFILL -r_[ML..:,_DRUL___PiHC;.,DROP PERCTIME PROPOSED DESIGN: TRENCH BED.ATGRADE.MOUND HOLDING TANK PRESSURE DIST..GRAVITY DIST. OUTHOUSE.SEWER LINE.OTHER. SPECIFY:. — S YSTEM DESIGN ON BACK — — S ' ”72. - di sX<\- \V( C-Ww\7Z r ^ 4 uy j\^ ^ ptrf iryy\F F ly ltff ltd.F I'S'F (S’ i3ai_J>F\\C_v 4-/U X7 '<r \ rFFlc Fc '^ r’l.f'-M'V i.^&ja <r yj V CERTIFICATE OF APPROVAL SEWAGE SYSTEM s 19 95Decemb er15thThis certificate has been issued this to certify that the sewage system installed as per sewage permit number indicated below has been approved for use by Otter Tail County, Minnesota. day of uM mIThe premises covered by this certificate are legally described as: Twp. Namet-EAF MOUNTAINTwp. 131 Range 39Lake No. 56-160 Sec. 17mdW‘ I 17 131 39 20 20 AC TR IN GL 5 ♦ ^ •iJ tUTHFRAN BRETHREN BIBLE CAMPOwner: NameWi mj. RR 1 nnx 156. r.L ITHFRAi 1 . MNAddress 11ri;56524Zip No. Permit No. SP 1057fl___________ (Day Camp Building)Signed by: Lund & Resource Management OfTicia) Otter Tail County. MinnesotaMKL-0987001 JT 279005 Victor Undeeo Co.. Primal. Fergus FaUs. Mtnnesou APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM ■K WHITE — Office Yellow — Inspector Pink — Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218)739-2271 - FERGUS FALLS, MN 56537 los-iyPermit No.LEGAL DESCRIPTION AND PTO vnLOCATION RANGE TWP NAMESECTIONLAKE/RIVER NAME LAKE/RIVER CLASS TWP. NO.LAKE NUMBER L-eri F- frrr,c 13/( h2^ t, r I 7 FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER(S) A/OO 3 ~n -o I IDENTIFICATION: Please Print All Information Zip Code Telephone No.Mailing Address — No. Street. City and StaleFirst InitialLast Name 1 (S-QH<1 ^Property Owner i r «• CJv-Pv n« V h rSewage System Installer ^ VName A.M. ^ This System will be ready for inspection on P.M., 19-at This space for office use only NUMBER OF BEDROOMS: A.M. P.M19 GARBAGE DISPOSAL: ( ) YES (^) NO Phone Call Rec'd 8yTime Rec’dDate Rec’d SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) (^) Septic tank ( ) Lift station ( ) Drain field ( ) Standard ( ) Bed ^) Trench ( ) Modified ( ) Mound ( ) Outhouse DRAIN FIELD GIs.Capacity 6 looFt.Ft.Distance from nearest well Ft.Ft.Distance from lake or stream ICC / o Ft. Ft.Distance from building 2^0 (0<6 Ft.Ft.Distance from property line 3 Ft.Distance from bottom to Water Table Ft. EFFLUENT DISTRIBUTION (X) Gravity ( ) Pressure All distances are shortest distance between nearest points PERCOLATION TEST DATA: WATER WELL DEPTH V TN t;-X) -‘fS'T V\«LJLPerc Tester,Date of Perc Test T.5J=(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 in iction. 0 '' 4 u.DATE: ignalure Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of any said ordinances. NOTE: Permit void if work is not commenced within six (6) months. L.-UIssued Date:Vyv—> & Resource Management Office1/9 7 2-03^Fee $.Rec # •vy Vtr p<urS0/\^(jC/1 ADCS ZjiZZZZZZZ c? Cl.g.O ^tt-0 ^V.y CComments:X-x. 4? 3^0 s<t tncKt3 * rc. c- /-X- A Uy lOOrT)1 272.856 • Victor Lundeen Co.. Printers. Fergus Falls, MinnesotaForm No. BK-08944M3 APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM%■* * WHITE — Omce Yellow — Inspector Pink — Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 - FERGUS FALLS, MN 56537 jos?yPermit No.LEGAL 0^\o?d:DESCRIPTION AND LOCATION RANGE TWP NAMELAKE/RIVER CLASS SECTIONLAKE/RIVER NAME,,^^^^^LAKE NUMBER Lc n F ryrr.0 - oo / 7 \T J3/[ FIRE OR LAKE ASSOCIATKWJJUMSERPARCEL NUMBER(S) 1-O \ -0 0"^ / t-----------TiiS--------------- Mailing Address — No. Street, City and Slate IDENTIFICATION: Please Print All Intonation Zip Code Telephone No/InitialFirstLast Name 41.jr> spry* P^'\I 5^ O£Property Owner CJi\4-W 9 /> Tr’i.y ^Sewage System Installer Name 1 rii A.M.'\fSirId —C'F'r'This System will be ready tor inspection on . 19.at This space for office use only '^;^UMBER OF BEDROOMS: f GARBAGE DISPOSAL: ( ) YESPhone Call Rec'd ByTime Rec'dDate Rec'd ■ ■ ■ i SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) (^) Septic tank ( ) Lift Station ( ) Drain field ( ) Standard (^ ) Bed Trench ( ) Modified ( ) Mound ' ----------------- “ ( ) Outhouse DRAIN FIELDTANK SliT sqFt.GIs.Capacity \<^oo S-Q/fcon Ft.Ft.Distance from nearest well )ra Ft.Ft.Distance from lake or stream KO lo Ft.Ft.Distance from building 2-0 10 Ft.Ft.Distance from property line >0 3 Ft.Ft.Dists^nce from bottom to Water Table ------d/sfances are shortest distance between nearest pointsEFFLUENT DISTRIBUTION (^ Gravity ( ) Pressure /PERCOLATION TEST DATA:xr.!1 ii> I ':a:IWATER WELL DEPTH Ci i ' ^ ^ j I-1Pefc>.Tl9ster T |Ljl , ^ ^ ■ o C., \Cf?T r\ Date of Perc Test Ch-—r !‘T Rate of 2nd Test I ^ -^1 Rate of 1 st 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 Tall, 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. t' T{!U,Vo - I')c. 4DATE: ignature J 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. ^~Lana & Resource Man^ement OfficeV . ) (;jV • ""Issued Date:Vyw^ t. cc?t(9 7^03^Rec ft.Fee $.i r^-Q ^ a. o *C <A Yv> r}'J 272,858 - Victor Lundeen Co.. Printers. Fergus Falls. MinrtesotaForm No. BK-0894-003 SIP S}t INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS ** SEPTIC TANK DRAIN FIELDCATEGORYActualMinimumActual Minimum 375 SFlOOO GLS.57'0 SFCapacityGLS. f (Od' ftDistance from Nearest Well FT FT FT50 Distance from Buried Water Suction Pipe FT FT FT FT5050 Distance from Buried Pipe Distributing Water Under Pressure /100 FTFT10FTFT10 ]50' FTDistance from Lake or River (OHWL)FTFT FT FT Tk'S' FT 10/20 FTDistance from Nearest Building FT10 FT)Distance from Nearest Property Line FTFT10FT10 FT3'f'3 FTDistance from Bottom to Water Table FT FT 3 YES NOHolding Tank/Lift Alarm Sewer Line to Weil Separation DRAINFIELD CALCULATIONINTERPRETATION OF ABBREVIATIONS GLS. = Gallons SF = Square Feet FT = Linear Feet Actual Minimum0^,313c?FTX 50 FT 20 FTT''SF li£J._pf[bOo'f'A-ti Y Kip ^ c/os ^ Inspector’s Comments: U/ell^ < SKETCH: /+n$Sir<r ■> IFL O o oA K V. 5| v'o/T/F'l' CO'^ 6 T ftspector’s Signature Date of Inspection Time of Inspection GRID PLOT PLAN SKETCHING FORM — (Must Be To Scale) 1 feet/inchesScale: Each grid equais ! S-21 .19$:Dated:Signature Please sketch your lot indicating setbacks from road right-of-way, iake and sideyard for each buiiding currently on lot and any proposed structures. l! ;l ;;lli'i! II li I li V^054. Hi Oi SepT/c.:TAkiiLIs? 5)M sMi e:\1 \ 1 !I :I WO VjOBLLS VOHHiW \oo' Of ?^£0?QS£]i ^ S£Uli£e.SVSTe/'1 ! ; V // i r PERCOLATION TEST DATA LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, MN 56537; OWNER; 90iNT C-jA M p FIRST TELEPHONE NUMBERLAST NAME MIDDLE ADDRESS: STR./RT.CITY STATE ZIP CODE S0lT7,PgL LAKE/RIVER NO.LAKE NAME SEC. TWP.RANGE TWP. NAME LEGAL DESCRIPTION: PARCEL NUMBER NUMBER/BEDROOMSFIRE NUMBER — TWO TESTS ARE REQUIRED — TEST HOLE NO. 1 ^_inches; TEST HOLE NO. 2 12Diameter of Hole.Depth To Bottom of Hole inches Depth To Bottom of Hole inches; Diameter of Hole inches 5~-Z~7 19 S^271 ,9 5^ PnZUCP. ■ UPSS \'Soil Texture DateDepth. Inches DaleSoil TextureDepth. Inches IIfelApUL.Percolation Test By _ ! Firm Name ___ 6LA)BL.r-ia-Percolation Test By___laZ2X BiA5k_btii3" Firm Namei Address Address Otter Tail County License No. Otter Tail County License No. PERC TEST # I PERC TEST # 2 INTERVAL fMDWTBn WATBR DEPTH WATER DROP PERC Rate Tl>^TIME IWTBRVALrMtNUTBS)WATER DEPTH WATER DROP PERC RATEi^?o START START a.oi'OwiS * ^BACB..75T.3Q--\Z^42.^-----isr-t TIME INTERVAL rMlNUTBn WATER DROP reRCRATB PERC RATEWATER DEPTH TIME INTERVAL fMlHUTTO Water depth WATER PROP __ ...h.ji's:.IZ!$C REFILL REFILL So .3.?. 8.y ‘ilKib * t)ft6p P6AC S_..JDS...3Q--30-- PERC RATETIMEINTERVAL rMlWUTEa WATER DOTH WATER DROP TIME INTERVAL (MINUTEST WATER DEPTH WATER DROP PERC RATE132 —S.CX-— REFILL REFILLgo ^.2-s: snTP^ DROP PERC 3lZT....5-.25T-..30.3a-2^ PERC RATETIMEINTERVAL (MINUTES)WATER DEPTH WATER DROP TTME INTERVAL (MIWUTBS) WATER DEPTH WATER PROP PERC RATE-U^REFILL REFILL ^ ^.“S.I3:C ^'6> 'nMri bROP PERC 3l.12S..—3a—«YIMU DROP PERC INTERVAL (MPnnES)WATER DEPTH WATER I»OP reRCRATB TTME INTERVAL (MINUTBS)TIME water DEPTH WATER PROP • PERC RATEREFILLREFILL30^.3,^-4 TTME DROP WfeftC .3..IL5-•3a-•p 'llMM DROP PERC INTERVAL (MINITTBS)WATER DEPTH WATER PROP PERC RATETIME TIME INTERVAL (MINVTBS)WATER DEPTH WATER DROP PERC RATE REFILL REFILL *'HME ' DROP PERC *nWE“ DROP PERC PERC RATETTMEINTERVAL (MINUrBS)WATER DEPTH WATER PROP TIME INTERVAL IMlNIffES)WATER DEPTH WATER PROP PERC RATE REFILL REFILL YlMii DROP PERC TGvlE™ DROP PERC INTERVAL (MINUTES)PERC RATETTMEWATER DEPTH WATER DROP TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE REFILL REFILL T TIME ^DROPTlMfi” DROP ffeRC \ COMMENTS/CALCULA TIONS:/^ MKL — 0390 - 005 250,815 — Victor Lundeen Co.. Printers, Fergus Falls. Minnesota A CERTIFICATE OF APPROVAL SEWAGE SYSTEMmV This Certificate has been issued this 21st , to certifyof April, 1999 m that the sewage system installed as per Sewage Treatment System Permit Number 10317 has been approved for use by Otter Tail County, Minnesota. The property served by this Sewage System is legally described as: UNPLATTED 20 AC TR IN GL 5 Parcel Number(s): 36000170122002 Section: 17 Township: 131 Range: 039 Township Name: LEAF MOUNTAIN TWP‘‘I Lake/River Number: 56-160 Lake/River Name: SPITZER Current Property Owner: LUTH BRETHREN BIBLE CAMP INC Number of Bedrooms: 6 (Sleeping Rooms) 284.709 • Victor Lundeen Co. Pnniets • Fergus Falls. MN » 1-800-346-4870 APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM ' oifice Yelfow — Inspector Pink — Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218)739-2271 - FERGUS FALLS, MN 56537 lO'btl-fv'o.c Permit No.LEGAL 2oDESCRIPTION AND LOCATION TWP NAMERANGESECTIONLAKE/RIVER CLASS TWP. NO.LAKE/RIVER NAMELAKE NUMBER OXf -oxt; - / 7 - c- ' Z7^-O0 n|7E (7 /3^ FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER(S) IDENTIFICATION: Please Print All Information Zip Code Telephone No.[dress — No. Street, City and StateFiiInitialMailingLast Name /.s'rp-<1 ( AJ ‘O^S JaiS^ ^01 g-fProperty Owner / Sewage System Installer Name A.M. . 19.atTh/s System will be ready for inspection on This space for office use only NUMBER OF BEDROOMS: AM. y\) NOP.M19 GARBAGE DISPOSAL: ( ) YES (Phone Call Rec'd ByTime Rec'dDate Rec'd SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) (■pxi Septic tank ( ) Lift Station ^ Drain field ' ( ) Standard ( ) Bed (V) Trench ( ) Modified I ( ) Mound ( ) Outhouse TANK DRAIN FIELD 777 sqt.ooo GIs.Ft.Capacity 60(100 Ft.Ft.Distance from nearest well isn Ft.Ft.Distance from lake or stream l0/>oI 0 Ft.Distance from building Ft. TO lO Ft.Distance from property line Ft. 3-Ft.Ft.Distance from bottom to Water Table EFFLUENT DISTRIBUTION Gravity ( ) Pressure All distances are shortest distance between nearest points PERCOLATION TEST DATA: WATER WELL DEPTH ^>rU(X Tl-^ S3 fo'-7-7/Perc Tester.Date of Perc Test /.L’7 LkRate 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 rea$ly...for inspection.) /ykDATE: Sign i»erfoHTHfTe>^prk 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 cominenced within six (6) months. an I-'. Permit: Permission is hereby granted to the above named applicant to Issued Date: Land & Resource Management Office Rec #.Fee $. Comments: 272.858 • Victor Lundeen Co. Printers. Fergus Falls. MinnesotaForm No. BK-0894-003 ii-ZA-^'^ i_•■l- ' 4 - ’ , APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM WHITE — Offfce Yellow — Inspector Pink — Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218)739-2271 - FERGUS FALLS, MN 56537 lO 'bi 7V Permit No.LEGAL 2oDESCRIPTION AND LOCATION RANGE TWP NAMESECTIONLAKE/RIVER CLASS TWP. NO.LAKE/RIVER NAMELAKE NUMBER L-^« f j^ -uuu- /y-oiz-L-aoz- Mt l7 alit FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER(S) IDENTIFICATION: Please Print All Information Zip CodeMailing /^dress — No. S^et, City and State£g/ C ( M a; 'ji^s Telephone No.InitialFirstLast Name Xl! ^ I ^^artr{y)^ j^o i n-iProperty Owner I Sewage System Installer 3Name .M. ► This System will be ready for inspection on , 19.at V'; u JThis space for office use only p,H\NUMBER OF BEDROOMS:Id-st)/l(M A.M. NOP.M.,19 GARBAGE DISPOSAL: ( ) YES (BHone Call Rec’d ByTime Rac’dDate Rec'i SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) (p^Septic tank ( ) Lift Station Drain field ( ) Standard ( ) Bed (V) Trench ( ) Modified I ( ) Mound ( ) Outhouse TANK DRAIN FIELD 7 "/7LOOPGIs.Capacity ■S'O 60/100 Ft.Ft.Distance from nearest well /Sro\o/^ Ft. Ft.Distance from lake or stream / 0 Ft. Ft.Distance from building TO 10Ft. Ft.Distance from property line 2-Distance from bottom to Water Table Ft. Ft. EFFLUENT DISTRIBUTION C'^) Gravity ( ) Pressure All distances are shortest distance between nearest points PERCOLATION TEST DATA: WATER WELL DEPTH /(J-7-9</Perc Tester.Date of Perc Test 1-61 LiRate 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. y U4.DATE: Permit: Permission Is hereby granted to the above named applicant to perfornr thl^|>f^d^ribed Inl^abov/^fement. This permit is granted upon express condition that the person to whom it is granted, and his.agent, employees and workmemshall conform in all respects to the Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upoiT Violation of any said ordinances. NOTE: Permit void if work is not commenced within six (6) months. Signature Issued Date; Land & Resource Management Office Oj Rec #.Fee $. Comments: ior Lurtdeen Cr» 'IP •'I!;''V;. ■ * ■» INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS ■i SEPTIC TANK DRAIN FIELD CATEGORY Actual Minimum Actual Minimum 7SFL•737 SF 7V FT I&6Q} S&O GLS.Capacity GLS.PI 5£‘//ae> FT nDistance from Nearest Weli FT FT50 Distance from Buried Water Suction Pipe FTFTFT FT 5050 Distance from Buried Pipe Distributing Water Under Pressure 1 FT FT FT FT1010 ISO ft150 fti IA7 ftDistance from Lake or River (OHWL)//7' Ul FT Distance from Nearest Buiiding '\T-> ___________________________________________________V'J' Distance from Nearest Property Line 10/20 FT10FT FTFTFTFT1010 I ftDistance from Bottom to Water Table ftFT FT3 YES NOHolding Tank/Lift Alarm DRAINFIELD CALCULATIONSewer Line to Well SeparationINTERPRETATION OF ABBREVIATIONS GLS. = Gallons SF = Square Feet FT = Linear Feet FTXActualMinimum 5^ FT 7.5 7FT 20 FT SF 'f' V,2.Z —LInspector’s Comments:ft s. ^,s^S 5L11. 5— CM. (-vyvW io j>Lf i^ill , ISL/kvftK^^Vx- 46 p-i^' /// s4i//La^C cV S'^0^1 . fi/'v SKETCH: rTJ^ I /a?' LJ^ 'V, pfcr AJe i>Je^lls /50 ' •S m3-i /t f. Inspector’s Signaturet. Date of Inspection;l 3^0iryi. r.1 Time of Inspection S iPERCOLATION TEST DATA LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, MN 56537 OWNER: TELEPHONE NUMBERMIDDLELAST NAME FIRST ADDRESS: ZIP CODESTATESTR./RT.CITY TWP.RANGE TWP. NAMESEC.LAKE/RIVER NO.LAKE NAME LEGAL DESCRIPTION: PARCEL NUMBER b N UMBER/BEDROOMSFIRE NUMBER — TWO TESTS ARE REQUIRED — TEST HOLE NO. 2TEST HOLE NO. 1 7Depth To Bottom of Hole aDepth To Bottom of Hole inches; Diameter of Hole inches inches; Diameter of Hole.inches tn~q IQ 14 '0-6 tvg-S*^ DateDepth. Inches Soil Texture Date 19Soil TextureDepth. Inches RIyv bi.-r-7 Percolation Test By _ Firm Name _____ 4 6lAf>r ti( r Percolation Test By____ Firm Name ____ XAui\1*^- Address Address Otter Tail County License No. Otter Tail County License No. PERC TEST # 2PERC TEST # 1 PERC RATSINTERVAL rKOKinTO WATER PgPTH WATER DROP TIME INTERVAL fMINUTBSjTIME WATER PgPTH WATER DROP PERC Rate...£JZS- ___2.7S- ti'pyiLi'T START STARTLi,....10.__PBRC INTERVAL <MINVrBS>WATER DEPTH WiCTBRDROP fERCRATE TTMBTIME INTERVAL IMINUTHm Water dropWATER DEPTH PERC RATEiris' .....a.S - REFILL REFILLh....LO..........VQ__W-40 PERC RATEINTERVAL fMlWtlTEn REFILL .....to.... WATER DEPTH WATER DROPTIMB TIME INTERVAL IMINUTERI Water depth WATER DROP PERC RATEWAS-iLiS'.s.S7?r.-6rO REFILL10 ^ fe . I.ts7 TIMB DROP PERC 4 S ./''Sio.----------if INTERVAL (MINUTHSI WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTBSITtME WATER DEPTH WATER DROT PERC RATH REFILL REFILL l.-jT 'llMU DROP INTERVAL (MTNUTB5I WATER roOP PERC RATH TIME INTERVAL (MINUTES)TIME WATER DEPTH WATER DEPTH WATER DROP PERC RATE REFILL REFILL ■f 4 'iTWH Crop perc nRUT bROP INTERVAL (MINUTES)PERC RATEWATER DEPTH WATER DROP TIME INTERVAL (MINUTES)TIME WATER DEPTH WATER DROP PERC RATE REFILL REFILL 4 4 'flMM DROP PERC 'llMk DROP P^CreRCRATHINTERVAL (MINUTES)INTERVAL (MINUTES)TIME WATER DEPTH WATER DROP TIME WATER DEPTH WATER DROP PERC RATH REFILL REFILL TlMti DROP PERC IIMU DROP PERCTIMEINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATBRDROP PERC RATEREFILLREFILL f TIME DROP PERC TIME DROP PERC COMMENTS/CALCULA TIONS: MKL - 0390 - 005 250,815 — Victor Lundeen Co., Printers, Fergus Falls, Minnesota GRID PLOT PLAN SKETCHING FORM — (Must Be To Scale)\i /¥ Scale: Each grid equals f Ir - s feet/inches r 19_if£XMSJl.Dated: Signature and sideyard for each building currentlyPlease sketch your lot indicating setbacks from road right-o1-w. on lot and any proposed structures.ea, lake i. N tkS-'a 9 h~1 0/*J I4 ! I 1i i !/1I P 1 I ; (1 ■ 1t ♦(I 1 r J J.i-i \4- iJ-LWi -------1'tT:;4-CV'A9^,L r ti ■t—I—1— t ■ -I I + --t i-;: i-r;y I -4 I , I III 1-i;"1 ;; i 1 1 M 1 ,^1 1 t ■ I i t| [-4-4 i 1i: ri j n:Jp-1- :1--p--f r ■i t! V t t!.!. : ' T \ I t • i-'tli- A1 I ti1 i!VnA f I -J;4^!44 :i i P-A' :i i i p iii I I Ilii^1 I : I I >S) A- l i-orpvte e^M5 I4dhl>I-t I-1 -i-4 > -i I I I I III!':1 ; : ; Li::a.1 M: i !i —i I ’ i r I 11- ;-1 _i ' L! ! i i : |Li i :IJL--I I it:1 t t -i 7 \ Hi$y-m ?te ^rte •'LjLUl CERTIFICATE OF APPROVAL SEWAGE SYSTEM m 199A31 ST day of DECEMBERThis certificate has been issued this to certify that the sewage system installed as per sewage permit number indicated below has been approved for use m by Otter Tail County, Minnesota.m ■ ■M The premises covered by this certificate are legally described as: s- Range 3_9Sec. 1 7 Twp. 131 Twp. NnnieLE^F MOUNTAIN56-160Lake No. 17 131 39 20 20 AC TR IN GL 5 ii im fST- IllTHFRAN BRETHREN BIBLE CAMPOwner: Name &£Address Zip No. <?n?nPermit No. SP Signed by: Liind & Resource Managemenl OfficiulMinncsola 253.617 Victor l.undecii Co . I’limcf., ) crgiis, 1 alK. 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 Wh/te — Office Yekow — Inspector Pink — Owner Q/)mPermit No.GL^LEGAL DESCRIPTION Parcel Number AND Name_____ /7 /3/ 39'JlILOCATION Lak6^ameLake No. Lake Classif.Sec.TWP Range IDENTIFICATION: Please Print All Information. Last Name___________________ First Initial jyiailing Address — No. Street, City and State Tel. No.Zip No. OWNER SEWAGE SYSTEM INSTALLER Name. 9/ ‘X' Ay ^ Z/2£ /Q-' ^This System will be ready for inspection on., 19 This space for office use only ^ Phone Call Rec*d ByDate Rac'd Time Rec'd iNUMBEROF BEDROOMS;ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: DRAIN FIELDSEPTIC TANK SEEPAGE PIT /MP 3o//r0f)f^. GIs.Sq. Ft Sq. Ft,Capacity SyO Ft.Distance from nearest well /.6^Ft.Ft.Distance from lake or stream Ft, zo Ft.Distance from occupied building Ft.Ft. i /6zn.Distance from property line Ft.Ft.Ft. S> Ft.Ft.Ft.Distance from bottom to Water Table AH distances are shortest distSnce between nearest points /O-Zi 7i> - ^7 ti...PERCC^TION TEST DATA: Date of First Test ~rZd<x ^19 ...Rate a.«<L 2 Date of Second Test Rate 1st Test llBken By O/t First Test + 2nd Test Rate2nd Test Taken By The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work inAgreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is/eady'forJnspection. /// / I understand that I have been granted a sewage system site permit in accordance with the requirements of the Shoreland Management Ordinance of Otter Tall 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: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. ““ NOTE: Permit void if work is not commenced within six (6) months. L Signature /O-TIY-- f/Issued Date:Tand&RB^yf^ManagemenTdtnce ioGi9jFee $Rec # Comments: Form No. MKL 082090 253,056 — 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 mn0 — otiica Yellow — Inspector Pink — Owner CERT Permit No.LEGAL DESCRIPTION Parcel Number AND /7 39 .93,^ 99/r..//tO ■V\ '-D/ 'tjJ' 9iJ_LOCATION TWP NameLake Clattif.Sec.TWP RangeLake NameLake No. IDENTIFICATION: Please Print All Information. Mailing Address — No. Street, City and State /vx Tel. No.Zip No.First InitialLast Name I L.OWNER C V.//j .( .P / 7 < ijP- U' SEWAGE SYSTEM INSTALLER Name, /n~ ^9This System will be ready for inspection on.. 19 / /^/$6/9/ 4-snP This space for office use only /0-29 ,J/ /P/6 „ Date Rec'd Time Rec'd Phone Call Rec'd By NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD /6//0 9 C/9 Sq. Ft.GIs.Sq. Ft.Capacity '^,<:^/..-Ft.) Ft.Ft.Distance from nearest well >1 /722/'6<0 Ft.Ft.Distance from lake or stream 29 Ft.Ft.Distance from occupied building Ft. /2//J Ft.Distance from property line Ft.Ft. (Ft.Ft.Ft.Distance from bottom to Water Table All distances are shortest distance between nearest points 7?p' T/................ 19 ........... 19..£.x.., pp. ..P, PERCOLATION TEST DATA:Date of First Test Rate /''tUJ’f P.LDate of Second Test Rate let Teet Tieken By. 4 P7?yT/ /A /y First Test -I- 2nd Test 2 Rata2nd Teat 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 end 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 Tall 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 pro|ect. , 'Signature Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six (6) months. f /Issued Date:. Land t Resource Management Office rpy) ■/) OFee $Rec # %J!Comments:fT ,< u 7* I J ) >•>fForm No MKL 062090 253,066 — Vidor LunOoon Co., Printon. Forgot Folio. Minnioolo 9^ \ INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORYActualShould Be Actual Should Be Actual Should Be /ooO 2^7Capacity/OOOGIs. Gis.S F S F S F S F Distance from Nearest Well F SO F F F F F ¥¥Distance from Lake or Stream /S' OF/s~o F F F F F/ii"" /JS toDistance from Occupied Building F F F F F F / o/oDistance from Property Line /OF F F F F F Distance from Bottom to Water Table 3 3FF F F F F 3 ^, - 3 rf ' Inspector’s Comments: 0<s^19^Date of Inspection. 4' '^o ^ MTime of Inspection /t!^ t.e~- S/0narure oi M^pecforINTERPRETATION OF ABBREVIATIONS GIs > Gallons SF > Square Feet F « Linear Feet Z.O Job We MKL - 0320SS - Baciwr Agency 3 3 GRID PLOT PLAN SKETCHING FORM — (Must Be To Scale)* Scale: Each grid equals feet/inchesi Dated:19 Signature Please sketch your lot Indicating setbacks from road right-of-way, lake and sideyard for each building currently on lot and any proposed structures. r 1 '-I 1 t / V\'i 4y Pi/T(/£jy , CffrCtiUorrSc, Opb'P Uj$'^ L-4 : . ,i I. na r 1-1. ,i I . .. I.. -f1 mu 1'-; 1 I I LiTxi. Li i: ;i j -T : i I~!I I t- ■ - -4-H- ±hl j I I PERCOLATION TEST DATA LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, MN 56537 OWNER: ZLl'JpQ/fuT" C' P TELEPHONE NUMBERFIRSTMIDDLELAST NAME ADDRESS: /^'7ypi//V STATE ZIP CODECITYSTR./RT. S PI czd^fo L SEC.RANGE TWP. NAMELAKE/RIVER NO.LAKE NAME TWP. LEGAL DESCRIPTION: PARCEL NUMBER NUMBER/BEDROOMSFIRE NUMBER — TWO TESTS ARE REQUIRED — TEST HOLE NO.TEST HOLE NO. 2 Lq Diameier of Hole Depth To Botlom of Hole inches;Diameter of Hole inchesDepth To Botlom of Hole inches;inches 9/9/________ - :Z!y d ~ ^ i19DateDepth, Inches Soil Texture DaleSoil Texture 19 Depth. Inches 4'^/f1 Percolation Test By Firm Name / /0 a 76,Firm Name / .J ''7}d/Jc/../i^cr'-% '6'y ) LzyiA^4 Address Address / Otter Tail County License No. Otter Tail County License No. PERC TEST # 1 PERC TEST # 2 INTERVAL rMPATTEg)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL rVINUTBS^TIME WATER DB!mi WATER DROP PERC RATE ffylLO //:> ‘.gc.k.START STARTy'o z. 60 .K b- 'I'iMM * DROP PfaRC Jdz. b. } do ‘ bROP PERC ^ Lars —..a„. WATER DEPTH WATER DROP PERC RATH TIMETTMBINTERVAL fMTNITTBS^INTERVAL rMINlfTBS)WATER DEPTH WATER DROP PERC RATH7UUU/Ov/Szii^s/'0 /o sX/REFILL b REFILL /CJ 60 h 9 TIME • a ^‘Ai WATER DEPTH WATER DROP PERC RATEINTERVAL n>1!NUTBn TIMETIME INTERVAL fMINtfTES)WATER, DEPTH WATER DROP PERC RATEu/dliS 1000 1030 LP.REFILL REFILL5 PftOP PERC TIME DROP PBRC jr.JOI J PERC RATHINTERVAL IMINinTO WATER DEPTH WATER DROP TIMETIME INTERVAL IMINUTES^WATER DEPTH WATER DROP PERC RATEJr)jJHf) muF)Join in: 4?. JJ>v/i.VREFILLREFILL 'fij^ DROP PEgg~ JO iD :62. PERC RATEINTERVAL (MTNUTESy WATTO DEPTH WATER DROP TIME INTERVAL n>HNUrBS)TIME WATER DEPTH WATER DROP PERC RATEitr.iij, ifr-jg JF> :-J(j in; St ? ^REFILL 'lltMti PRbP I^ERC REFILL s:.'Aim: PERC RATEINTERVAL (Mtmmasi WATER DEPTH WATER DROP TIME INTERVAL IMINtrreS)TIME water DEPTH WATER PROP PERC RATEjom U-.fl....di jaiAj jim> Ttl^S~ PROP PERC REFILL REFILL Jjy t _ DR6p PERC /O PERC RATEINTERVAL (MINUTES)WATER DEPTHTIME WATER DROP TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE REFILL REFILL 4 4TistSL " DR6p PERC TIME DROP PERC PERC RATE TIMEINTERVAL (MINUTES)WATER DEPTH WATER PROP INTERVAL (MINUTES)TIME WATER DEPTH WATER DROP PERC RATE REFILL REFILL TUaE~^DR6P "pERC 4TIME bROP PERC COMMENTS/CALCULA TIOIMS: MKL — 0390 - 005 250,815 — Victor Lundeen Co., Printers, Fergus Falls, Minnesota V r I. P, CE S/)VJ' OUvA^^ fxs^^ 5’2>7 -^V ’> y 3>T ■^^/c'-cO '^hcy~vt^ /^~r>’5''7^ ^ <L./<5^ Sfyu. ■P^^Tc'/ fp^^Sl ’~~~~ > (K kjLa^ c/;^ ^ ^ 0C<^ /f 11 ove^^^'3^ V ^3 y(<, J) /'J - f(p *>^ C/JI4C\ c r'/P /~~l,,-'C^ J lxt3^ft/'O'-^ ■i!?. :. ■ PERCOLATION TEST ^/>ap c>^ 7^4//f- xV A A/CkJ^ ,V ^//r:ry^ /<Cj£p No,Lake ! I 0^/f//\ZOwner I 7/9 J. /f9N* Test hole #1 Test hole #;r/- min/in /Aza/P^ min/in //Perc, rate:Perc. rate: Depth to bottom of hole inches Depth to bottom of hole 3^ Inches inchesinches Diameter of holeDiameter of hole c.r~ Soil textureDepth,inches Soil texture Depth,inches O- ,^4/ I jPerc, testPerc, test by 'y/ 9- - ysDate of test (Date of test V/a ter level drop inches Remarks Water level drop inches Water depth Time inches V/a ter depthRemarks ;Time inches I fi<42.J'Vsr 9o'■ 3.'Sh 6-'‘ ! ^ CO3^s:t'£>rjp^y i £/T7/:>A/ ■! r—7~ )t 39'y9’C€>S's'r /ik/VxV !.i c-I\9‘^P^rr>£)Jy*/ OS'£Mp/jL 1! t39\y/o 9- 2o Vos'! /P^O'JLO/P/ry^cO 6"nV/S^0^rm3/y \ V/ VV/s~^39'2- ;✓/A 930 V-j.s' IVd''z.Vas'V3 (J !//•IV 30 W 3o V: S3 I i I '/eO/920933"V/^i !//4A\V so !IX&[ min/in )Perc. rate min/inPerc. rate z \ >I \ minutes/inch/-••-A wTTCftnT? p-PRnnT.ATTON RATE i'JOw.. 215S02® VICTOR LUNDEEH CO., PRINTERS. FERGUS FALLS. MINN.PERCOLATION TEST DATAMKL -0871 -028 LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, Minnesota 56537 Mailing Address: \ Ph. No. Owner. -J State Zip No.CityFirst Middle St. & No.Last Name Legal Description:spiT2ej^_ TWP nameRANGESEC. TWP.LAKE OR RIVER NO.NAME TEST HOLE NO. 2TEST HOLE NO. 1 -?• Depth to Bottom of Hole inches; Diameter of HoleDepth To Bottom of Hole,inchesInches;Diameter of Hole inches ZS^ C?0 SoilTDepth, inches Soil Texture Depth. Inches extureDate Date A? "ft Percolation Test Bv . Percolation Test By____I.— i -n" _ E /7^'-38 13 ^ 7r-jp^\^rFirm Name.Firm Name. aLU . OCf" 'LU,Address.•QC Address , -■< C/DOtter Tall County License No..Otter Tail County License No..h-i/iLUMeasure ment,inches Time Intervals minutes Drop in water level, inches Percolation rate minutes per inch I-Percolatlon rate minutes per inch Time Interval, minutes Measure ment inches Drop in water level, Inches Remarks:Time Remarks;TimeO I-3Vv’^■'V7 ‘f: -f S' 9 EZ//// 7 TN 7WA2ii k:.7^ Milk. /M !J, 0 / 7 7/7^■h 3, S'S:3V 5,r/ “f >/Refi/t Ze;il61tt wIVLZ '//mil ML LILI, 60 VM 9WirnmtUU: iwJO ''~~r u\j¥ IUM-.UM>: I miL^:S'3 5, 03'Q LI . 00 EM/I..99'll 9''9:^I 6il/3.b11LMiLiy ■(O'.OO fo L i S'/'R /1/I 111.00 - = hot 3. 0 See Booklet, "How to Run a Percolation Test" by Agriculture’Ext. Service, Un. of MN. PercolationPercolation rate minutes per inch minutes per inchrate S \ f vxS'- o ( ”l I\ ?5^ %U id WM2-t« CERTIFICATE OF CX)MPL1ANCE li?SEWAGE SYSTEM K% I fcl79iZ]^tW day n f JanuOAdThis certificate has been issued thisIfii hMto certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota.- M6 jI-The premises covered by this certificate are legally described as: Range^^ mI■ MiK-.T Twp. Name Mountci^yi13156-160 17Lake No.Twp.Sec. LM MR'lwl 'I'M-H[Motcth SLdg]Jn6pCtLOtion Point m-3%S.T Jn^spikotion Point Bible. Campm.m Owner: Name. / mClttk2tiatl, Hinn&iotaPR Box 156Address.S ■:W56524Zip No. 6U1Permit No. SP_ M^olnn^/Lee, Shoreland^dministraforSigned by:. Otter Ta^ County, Minnesota k MKL-087I-009 .' 1 ^35W' X ®159035 ™ t (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 I •low — Inapedor — Owner Permit No.. LEGAL DESCRIPTION AND n. _/ii ^LOCATION TWP NameLake Clatsif.Sec.TWP RangeLake NameLake No. IDENTIFICATION: Please Print All Information. Mailing Address — No. Street, City and State Zip No.Tel. No.First InitialLast Name 7'TVv) . OWNER f SEWAGE SYSTEM NSTALLER Name. This System will be ready for inspection on... 19. This space for office use only .19 .M Date Rac'd Time Rac'd Phone Call Rec'd By Owner or Agent Signature NUMBER OF BEDROOMS: Gk^ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD (^OOO Sq. Ft. IbP 10O GIs.Sq. Ft.Capacity £0 Ft.Ft.Ft.Distance from nearest well ISO Ft.Ft.Ft.Distance from lake or stream OoWFt.Ft.Ft.Distance from occupied building lOlo.Distance from property line Ft.Ft.Ft. 3Ft.Ft.Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on „ 19,, Time ,M By 1~12....S.L.,PERCOLATION TEST DATA:Date of First Test 19 Rate , 19..STk..,Rate...LA±..0...u£..Date of Second Test 0-C —9-5-^TTSS O, C hr^ 1ft Test Taken By\ »iI 1 . s-=i^ = -hFirst Test + 2nd Test 2 Rate2nd Test Taken By Agreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered responsibility of the applicant for the permit to notify the County Shoreland Management that the job i/reMy for inspection/^ ) The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in until it has been inspected and accepted. It shall be the 'y.yDated Signature Permission Is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six (61 months. Permit: /3.Issued Date:. Shoreland Management Officeg/7r?Fee $Rec # f)!^. 5^ 7^ I ^ Form No. MKL-0320eS Comments: 22S239 — vugf Unkm Co. PrMn. Fvgu F*. MN 1 4 • 1 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 0 Whit9 — 0mc9 Yeflow — /njpacfor Pink ~ Ownnr %1 1CPermit No.. LEGAL s S]3slS(^ ^I DESCRIPTION AND ' ^LOCATION / TWP NameLake Name Lake Ctassif.Sec.TWP RangeLake No. IDENTIFICATION; Please Print All Information. Mailing Address — No, Street, City and State Tel. No.Zip No.InitialFirstLast Name OWNER SEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection on... 19. This space for office use only 19 .M Date Rec'd Time Rac'd Phone Call Rec'd By Owner or Agent SIgna.ture NUMBER OF BEDROOMS:ESTIMATED COST: 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 Ft.Ft.Distance from occupied building Ft. 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 ,M By ‘V iPERCOLATION TEST DATA:Date of First Test 19 . i9....:...i..... RatelU. Date of Second Test ...■.Rate 4 1ft Test Taken By + 2nd Test....i:::!:t:±'7First Test s ■2‘Rate2nd Test Taken By Agreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in Dated. Signature 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 agenu, 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.c 3\} eo T "4 Issued Date: ^ ShofBiand ManagMwnt Office J.Fee $Rec #J K ,N .-.VComments: '/ o'*.1 - ■(,1 2^6239 — YtoofXvndm Co.. PriniBrs, Fergus FUs, MN Form No. MKL-032065 I 1I,-., I JiAT «=»'^tO ^Twyoc -. OJ^A J3ffOHis, :jsi;K>r- j Y'n4uc>j te€t?e Vlli? ?5;CT!9~} ■' V,iS .«!>/;-.3{•fi Sf’O!?’-! % _ Ti^iSi.'TrT’.' ■• -•■ ;’=?Sr-~: XSJT :^‘S‘Jgr:zaazzA.^~_ ..•"<a •■ INSPECTION RESULTS__t.-.^-C'A li*T) ■■: Inspector must make all measurements '•'OM'^;^ . - .'O .^•>T- SEWAGE DISPOSAL SYSTEM STATISTICS SEPTIC TANK SEEPAGE PIT !.<lDRAIN FIELDCATEGORYActualShould Be Actual Should Be Actual Should Be C>0(X>Capacity GIs.GIs.S F S F S F S F 5^ScoDistance from Nearest Well F F F F F F aiL '3C'/i”0Distance from Lake or Stream F F F F F F -h-t ?001010Distance from Occupied Building F F F F F F rhrr(0W\oDistance from Property Line F F F F F F / Distance from Bottom to Water Table 3 3FFFFF Inspector’s Comments:■^3 .«^vw<^Ck>0Zt^____________________/<37 2Ll ^ ^ I I C4yeL.<*^ *~ 30 Alt. .0e> a^.eisL^ ^ /OOP faZ/oA^. _______Ijc// 5<^f ?n ->er 'A >0: ■>.r Date of Inspection 19 1^ 'TLoV^'C Time of Inspection M (@ (t S^nafure of fnspecforINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF = Square Feet F = Linear Feet r 7^ VO. UV-V OJi-lO ‘V? C.‘ - iwlT' . • ■ j-h i-Ts H-jiv-.-i-erf ■ ‘»i - . ■ T" ■ * <-i‘ -'<f 1 ■t «>£> Title V .f?' ■ MKL - 032085 - Backer A /</>o '— iMiy pf* O 6 /unk C -,y WV ■ 2ISS02® VICT6K UlHBEEN CO.. PRINTEDE, rCOauS ru.Lt. HIKM.PERCOLATION TEST DATAMKL -0871 -028 LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, Minnesota 56537 Ph. Nn 218-864-5379 Mailing Address:Owner: Box 156, RR Clltherall,MNInspiration Point Bible Gamp Zip No.StateCityMiddleSt. & No.FirstLast Name Legal Description:131 N.39 W.56-160 Leaf MountainIZSpltzer TWP NAMERANGETWP.SEC.NAMELAKE OR RIVER NO. North Base House and Gafetorium Talfpn in Flnf+hall Ft p1 d . - Right Field TEST HOLE NO. 2 Taken In Softba.n Diamond near 2ri(i Base TEST HOLE NO. 1 6"24"6"24"Depth to Bottom oi Hole inches; Diameter of Hole JnchesDepth To Bottom of Hole Diameter of Hole inchesInches; 864-17-19864-17-Depth, I nches Soil TextureDepth. Inches Soil Texture 19 DateDate 24"Medium to2"Sandy Clay Medium to Percolation Test Sv ■ Percolation Test By____Dennis DelzerDennis Delzer Coarse Sand22"Q Ul Delzer Construction, Inc.F irm Name.QCFirm Name.or GravelCoarse Sand Delzer Construction, Inc. Dor Gravel amw/small rocks tr P.O. Box 735» RR 1, Dalton, MNP.O. Box 735. RR 1, Dalton, MN 56324 <AddressAddress.5632.4 1236 1236Otter Tail County License No^Otter Tail County License No..H coLUMeasure ment, inches H TlmeInterval, minutes Measure ment inches Drop in water level, inches Percofatlon rate minutes per Inch Drop in water level. Inches Percolation rate minutes per inch Time I ntervals minutes Remarks:Remarks:TimeTimeO§ K ll!25 19"18"n !20 6"24"0 Water Gone 24"11:30 11:35 5"0 Water Gone1010 19?"11:30 Refilled 18"11:35 Refilled 6"11:45 24"0 Water Gone101051-"Hi 4a 24"Wa t PI- Gnrifi 11:4511:40 Refilled19"Refilled 10 1024" 24"11: 50 51 0 Water Gone n ! 55 £l Water Gone Refilled18"11:55l6kL‘ n ! 50 Refilled 10 7i"1024" 24"6"Water Gone 12:05 12:05 12:15 012; 00 0 Water Gone 17"Refilled.I8f Refilled.^ Water Gone 22_lQQ, 12:10 0 ^6"1024"24"7"Water Gone10 i6i:i16^-"12:15 Refilled• 12:10 1012:20 24"7j"12:25' Water Gone_____ r— ' Percolation rate -*^ minutes per InchPerco‘«tion rate =___sTV minutes per Inch See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of MN. 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 te — Office ow — Inspector i( — Owner / Permit No. LEGAL ESCRIPTION AND / I LakB^ Name LOCATION TWP NameRangeLake Classif.Sec.TWPLake No. IDENTIFICATION: Please Print All Information. Tel. No.Mailing Address — No. Street, City and State Zip No.InitialFirstLast Name OWNER SEWAGE SYSTEM ISTALLER Name. r/7/s System will be ready for inspection on.19. This space for office use only 19 M Owner or Agent SignaturePhone Call Rec'd ByDate Rec'd Time Rec'd NUMBER OF BEDROOMS:ESTIMATED COST; SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD /^3 i ^ Sq. Ft. ISO GIs.Sq. ft.Capacity Ft. Ft.Ft.Distance from nearest well Ft. Ft. Ft.Distance from lake or stream \0 aoFt.Ft.Ft.Distance from occupied building ir>It?Distance from property line Ft.Ft.Ft. 3 Ft.Ft. Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on 19 , Time M By .B.z.n .^.-..1.2. S^L.PERL ii.ATION TEST DATA:Date of First Test 19 Rate 1st Test Taken By ^ . . Date of Second Test 19 Rate ■ ••r KI I 3.3 . ^,3/I1 (£•IFFirst 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^'B is ready for inspection. /ASignature Dated C'CA-Jr. _Z/wC. Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon expressPermit: condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minor jota. 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. /3.issued Date: Shoreland Management Office snoFee $Rec # Comments: Form No. MKL-032085 225239 — Victor Lundeen Co.. Prmtsrs, Fergus Fals, MN 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 * yi/hitB — Office Yellow — Inspector Pink — Owner [■ 1Permit No.__J ) •/'LEGAL I/'''1.1 y0£^DESCRIPTION ^ / AND ! LOCATION TWP NameLake Name Sec.TWP RangeLake Classif.Lake No. IDENTIFICATION: Please Print All Information. Mailing Address — No. Street, City and State Zip No.Tel. No.InitialFirstLast Name OWNER TSEWAGE SYSTEM INSTALLER Name -h. This System will be ready for inspection on.19. TTThis space for office use only (\(^1 19 Owner or Agent SignatureDate Rec'd Phone Call Rec'd ByTime Rec'd NUMBER OF BEDROOMS;ESTIMATED COST; SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD (3 GIs.'j ^ j /C(' Sq.^t.. Ft.Capacity ' Ft:Ftl Ft.Distance from nearest well 4 Ft.Ft. Ft.Distance from lake or stream Ft.Ft. Ft.Distance from occupied building /t \lO/Distance from property line EL Ft. 3Ft;Ft.Ft.Distance from bottom to Water Table V j.AH distances are shortest distance between nearest points Ii RECORD OF TESTS: Inspection was made on „ 19 , Time ,JM By )..;:....i.2.. C . 19...134..., = PERCOLATION TEST DATA; 1st Test Taken By' Date of First Test Rate C-Date of Second Test Rate / I I 7t t« I /57. ^_7First+ 2nd Test 5'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, sketchesand 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)ob is ready for inspection. / / .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 Minne:tota. This permit may be revoked at any time upon violation of any said ordinance. i \ W NOTE: Permit void if work is not commenced within six (6) months. l ^ Permit; \ fij. \Issued Date: Shoreland Management Office ;Fee $_____ Reg # 4 /3 ^r- \ T ' ' ' Comments: c'7 k/' Form No. MKL-032065 225239 — Victor Lundeen Co., Printers, Fergus Fans. MN 4 i v; INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORYActualShould Be Actual Should Be Should BeActual St-miCapacityGIs.GIs.S F S F S F S F .i"rr SO^0Distance from Nearest Well F F F F F F x5o tSf:>Distance from Lake or Stream F F F F F F t\i>wDistance from Occupied Building F F F F F F (/c^/oIPDistance from Property Line F F F F F F (fl3Distance from Bottom to Water Table 3FFFF FF Inspector’s p 'T I /S' omments: f I ^ DSS-t-1 \fJ?. CI <1^0 S- P2 19 ^ Date of Inspection Time of Inspection M 6k. Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF = Squarg. f Job TitletFirtear Feet c.IKL • 032085 • Backer P Agency o (t "9oc.J C5?-^ cPj^ A' } n/sI'’,/ \no ''W 0 O 3l -> 215S02® ViCTOfi IUnOEEN CO., PH1STE“S. fEBGUS f*LLS, umh,PERCOLATION TEST DATAMKL - 0871 - 028 LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, Minnesota 56537 18-864-5379Ph. No. Mailing Address:Owner: ^6S24Box 156, RR MNGlitherall,Inspiration Point Bible Cajnp Zip No.StateCitySt. & No.MiddieFirstLast Name i_egal Description:56-160 39W Leaf MountainI3IN17Spltzer TWP NAMERANGETWP.SEC.NAMELAKE OR RIVER NO. South Bath House Area Tpqt, Tairpn l6S' from Lake in Natural. Crnnnr^Test Taken l60' from Tjakn in Trill Arpa 41TEST HOLE NO. XTEST HOLE NO. 16"16"6-inches; Diameter of Hole j nchosDepth to Bottom of HoleDepth To Bottom of Hole _ inches;Diameter of Hole inches 864-17-864-17-Soil Texture Soil TextureDepth, Inches Depth, I nches 19DateDate19 1616 Medium Ranr^Medium Rand Percolation Test By . Percolation Test By____Dennis DelzerDennis Delzer 3/8-i" Rockwith Traces QLU Firm Name.F irm Name.CC Delzer Construction, Inc.Delzer Construction, Inc. Z)aLLI cn P.O. 735, RR 1, Dalton, MN 563-P.O. 735. RR 1. Dalton, MN 563S^AddressAddress. <12361236CO Otter Tail County License No..Otter Tail County License No.H00LLI Measu re-ment,inches Percolation rate minutes per inch Measure mentinches Drop in water level, inches Drop in water level, inches Time I nterval, minutes Time I ntervals minutes Percolation rate minutes per inch Remarks:Remarks;Time Timeo H 1:3^1:30 ID. 6161:45 101:40 10 025 Water Gone10 9i1:45lli:: 12ir- 8 Refilled1:50___W r, 2:00 10 101 2.91^5 1:55 13 9iS'?Refilled2:00 Refilled 6.62:10 10 10 li 2.92; 0 5 10 119 3/4 Refilled2:052:20 10 5111 12 3/ij- 310 3.31-13. 2a 15. 2:25 2 : 3C___^12 51 Refilled9i 10 12|3.33 li2:25 Refilled 3.3___LO.1 3. 3.31 See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of MNminutes per inchPercolation r&te =minutes per inch Percolation rate - 'TLJh. 2.^ >3 {/>v'««^Y 3 ■7,5 >c 33-7^ T^l^ .^3 \SSC> PT^ C. 2I<7- ^ji_ cz-^J' 13 lU X \2S y, 12^ I lo 2G / 34? Q.00a ji^ , IS \Soo +11 . I I 3 k ^S\S^L 13^:;^6 2S^ g^fDOO^ros ^oJ*^\ tm, 7-+^ 1613 \2S t2S U2^ r^ I Q.CO o X , 15^ 11 ^3 SHORELAND MANAGEMENT OTTER TAIL COUNTY . Fergus Falls, Minnesota 56537 NOTICE OF HEARING FOR SPECIAL USE PERMIT NOTICE OF HEARING ON APPLICATION FOR DEVIATION FROM THE REQUIREMENTS OF THE- SHORELAND MANAGEMENT ORDINANCE, OTTER TAIL COUNTY, MINNESOTA. TO WHOM IT MAY CONCERN:Dale"F. Tibbetts Route #3, Box 38A Pelican Rapids, Minnesota 56572 has made application to the Otter Tail County Planning Advisory Commission for a Deviation from the requirements of the Otter Tail County Shoreland Management Ordinance. The Otter Tail County Plan ning Advisary Commission will assemble for this hearing on I9_13.Aprt1 4 Fergus Falls, Minnesota,Time ft«nn P. M. Place.County-Court House The property concerned in the application is legally described as: Lake No 56.747 Sec. 9 Range 42W Twp. Name LidaTwp. 136N Dale's Bait Shop located on a parcel of land lying between County State Aid Road and Lida Lake, a general development lake, near County State Aid Road ^31. The lot has approximately 300 feet of lake frontage and is approximately 100 feet deep at deepest point narrowing down to approximately 80 feet deep. A complete legal description was not furnished by applicant. Application was made by mail. THE PURPOSE OF THE APPLICATION IS: Construct and operate a boat landing facility to accommodate twenty (20) rental boats. Install a concrete slab 10* by 24* near the edge of the water. Otter Tail County Planing Advisory Commission Dated Vahr’Tm'ry ?7 ^ 1Q7^ iC MKL-0871-011 , ■0'Y'<^ 3 y- ^y 5 li.®7.g COyyy-^'Ui. I /3 f /Ko-/>*'-*'®^) /4pa^ N^- C^iftL. ^ Ol‘SO 0>^, iL^- i^S" - V'^r- •r^ ■v'i CONSULTING ENGINEERS PHONE 701-237-3211 ULTEIG ENGINEERS.INC. P,0. BOX 1569 1401 OAK MANOR AVENUE FARGO. NO 56107 May 2, 1985 Mr. Tom Mirichinton GRAND FORKS ND 58201 Wastewater Treatment (Preliminary) inspiration Point Bible Camp Otter Tail County, Minnesota SUBJECT: We have reviewed the wastewater treatment needs considering on-site treatment using septic tanks and drainfields. current needs of approximately 180 campers per day and the future needs of 250 campers per day. We looked at both the To handle the current and future wastewater, we need to expand the present south bathhouse and cafetorium systems plus add a new north bathhouse.Using current standards, significant expansion of the present systems is necessary. South Bathhouse System This system should have two septic tanks in series (one 1500 gallon and one 1000 gallon) together with approximately 500 feet of draintile. Cafetorium System This system should have five 1500 gallon septic tanks in series together with approximately 1100 feet of draintile. The need for several septic tanks in series is for two primary reasons, (1) to cool the hot water from the automatic dishwasher, and (2) to cool and collect the grease from the kitchen. The grease can severely shorten the life of the drainfield if it is not trapped and removed from the septic tanks. North Bathhouse System ()/^^ClLiXi This new system is needed to handle additional campers and provide growth to 250 campers per day. The same size septic tanks and drain- field are needed for this system as the south bathhouse. A trailer/ motorhome dump station could be provided at this location. '/ CONTOUR MAP OF i PART OP GOVERNMENT LOT 5 IN SECTION 17 TOWNSHIP I3IN. RANGE 39W. .OTTER TAIL COUNTY, MINNESOTA. DATE: 11/12/SO scale: r- 2oO SPtTZCR lake: ! SPnZER LAKE /s^> ^ T k. e^€:;yL/ sysTaMs gt/tiuoAtSUa 4'^'^ C ^06 PT sar'^^k') I K>OOOaAI5UWCI> •kTCff CtEV IO/t4/«0 “lrCONTOUR MAP OF i ' ' '1 PART OF GOVERNMENT LOT 5 IN SECTION 17 TOWNSHIP 131N. RANGE 39 W. , OTTER TAIL COUNTYjMINNESOTA. i V. date; 11/12/60 scale: r« 2oo‘ //<^0 7/ '' " i I { ■'•{ t04SPITZCR — .OA• v'VLAKE .. (M)I ,lO•%/ \ sSu>e.^ /(>//^i^ 5PITZER LAKE ^0^(2-11 ^fF'7' s-r>f^-rta K ^ ^-/S'bo &aL. • ✓ Z--</ i<frC.^FS k>^L ( t ’^■<(0'rrNcS^' / ^y; urif^Q ) /; c-r :7A'r.'fi' /;?$'<? /S9 /='T' <?^ s^o /'/</ ' /? c; oLyf-~r(.o fj -7^.5 7^ k>fC,s>U(UtF -r-i^ST^ ? / I tOOGOiAltUVCO «AT(« tuv lO/t4/VO/ / '•i.' t- 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 Y0HOW — ln$p0Cfor Pink — Owner Card — Owner Permit No.. LEGAL DESCRIPTION AND 3/ Range ^TWP Namen Lk ^^ake ^nime LOCATION TWPSec.Lake Classif.Lake No. IDENTIFICATION: Please Print All Information. Tel. No.Zip No.Mailling^ddresM—No. Street, City and StateInitialFirstLast l^me_______________ OWNER SEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection ., 19.on. This space for office use only .19 .M Owner or Agent SignaturePhone Call Rac'd ByDate Rac’d Time Rec'd fNUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PIT DRAIN FIELDSEPTIC TANK Ja So. Ft.Sq. Ft.GIs.Capacity Ft.Ft.Distance from nearest well Ft.Ft.t.Distance from lake or stream / o Ft.Ft. Ft.Distance from occupied building / ®Ft.Ft.Ft.Distance from property line 3 Ft.Ft.Ft.— </Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS; ., 19,, Time JVI ByInspection was made on , RatePERCOLATION TEST DATA:Date of First Test ., 19 First Test....................2nd Test 19 , Rate 1st Test Taken By 2..n.'5'Rata2nd 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.) 7- / j-' S3Dated. Signature Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon expressPermit: condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six (6) months. 7-yr- nIssued Date: Shoreland Management Office ,Fee S /(/ f (fo o-^ c '^^rss~Comments:. Kes' Vi No. MKL-0771-003Fo [^fVIfW lAmi LAKI, MINNiSOTA T ’-f ^ ‘wr"« w INSPECTION RESULTS Inspector must make all measurements !■♦, ■!V i% SEWAGE DISPOSAL SYSTEM STATISTICS SEPTIC TANK SEEPAGE PIT DRAIN FIELDiCATEGORY Aetual Should be Actual Should be Actual Should be Capacity GIs.GIs.S F S F S F S F Distance from Nearest Well 75 ' 50VvFFFFF F Distance from Lake or Stream F F F F F F Distance from Occupied Building 2010 20FFFFF F Distance from Property Line 10 10 10FFFFF F Distance from Bottom to Water Table 33FFFFF F Inspector's Comments;_1 ■ i ' > i -1 j ■> l\-e \ '3 \ - \ Date of Inspection 19. •Time of Inspection.M '' \* A r■'i' j Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs ~ Gallons SF ■ Square Feet F ■ Linear Feet Job Title AgencyMKL-0771-003-Backer /3o * - V-J \ 'V'^V a. ^ « /"(> S.''v •t ri I rS' - A■ VX 1 \r\ ?< I \V V.(■ ■ i?-; ; f II >• 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 Cord —Owner c. 77 :/-•10Permit No..f -LEGAL DESCRIPTION AND LOCATION TWP NameSec.RangeTWPLake Classif.Lake NameLake No. IDENTIFICATION: Please Print All Information. Tel. No.Zip No.Mailling Address —No. Street, City and StateInitialFirstLast Name OWNER SEWAGE SYSTEM INSTALLER Name, 4; ^ ^Th/s System will be ready for inspection on.. 19 •4*** V.ooThis space for office use only Owner or Agent SignaturePhone Call Rec'd ByDate Rec'd Time Rec'd NUMBER OF BEDROOMS;ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PIT DRAIN FIELDSEPTIC TANK Sq. Ft.Sq. Ft.GIs.Capacity FtFt.Ft.Distance from nearest well 7 Ft.Ft.Ft.Distance from lake or stream Ft.Ft.Ft.Distance from occupied building Ft. Ft.Ft.Distance from property line a Ft.Ft.Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS: 19 M By, TimeInspection was made on PERCOLATION TEST DATA:Date of First Test 19 Rate 19 RateDat-3 of Second Test 1st Test Taken By First Test -I- 2nd Test 2 Rate2nd Test Taken 6v The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work inAgreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. (Call or use attached mailer notice.) Dated Signature Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon expressPermit: condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE; Permit void if work is not commenced within six (6) months. Issued Date: Shoreland Management Office Fee $ ^l^dERTlF IC AT£ ISSUED ^ mM ,C 1Comments:. okcp(or\ Form No. MKL-0771-003 [^IVIfW ftATTli LAKE. MINNISOTA I f •• V,% INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORYActualShould be Actual Should be Actual Should be m77Tsf1^00Capacity GIs.GIs.S F S F S F isS rxf F5"^Distance from Nearest Well 75 50FFFF F f CO F/S<^Distance from Lake or Stream F F F F ss (HJ FDistance from Occupied Building 2010 20FFFF F 'i-I 06 F/ooDistance from Property Line 10 10 10FF F F F Distance from Bottom to Water Table 33FF F F F I/ Inspector's Comments: At- ^ c. c ^ q- i q ccrf'y#^) gk c oke.p j?e.C-avtsro kv\ ^0 r s > sf I -L<iyyy -^o c c --f~ti) ^ tp ^ f QY\"f-r , AA / Av- S'f G?o -P rom he.v\r^%ri' Wt^jf jZnt? uv<L^U ' ^ n c T CS k\ s •/ A / r>L) o y JD I ^ y I *W . / .19_Date of Inspection Time of Inspection.M Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs ■ Gallons SF “ Square Feet F * Linear Feet Job Title AgencyMKL>0771-003-Backer \ PERCOLATION TEST DATA SHORELAND MANAGEMENT^ OTTER TAIL COUNTY /XCS, Fergus Falls, Minnesota 56537 Owner:Mailing Address: ¥cnLaName Fir Middle St. & No.Legal Description;Sh/ * NAME SEC.LAKE OR RIVER NO.TWP.RANGE TWP NAME TEST HOLE NO. 2TEST HOLE NO. 1 * Depth to Bottom of Hole inches; Diameter of Hole JnchesDepth To Bottom of Hole,Diameter of Holeinches;inches 19222iz2_i9_Z2 T- ycDepth, inches Soil Texture Depth. Inches Soil TextureDate Date aV</Percolation Test By____ Percolation Test Bv .Pa '/(h Q LU/o/ih^ysFirmName.q:FirmName.7 - sk-’ OUJDC LUAddress.T CC Address < inOtter Tail County License No..Otter Tail County License No^h-mUJ Drop In Water ■Level. ItKhes Measurement, Inches Drop In Water Level. Inches Measurement, Inches HTimeRemarks Time Remarks o I -' ! /S' V/ J.V22 -#5 SI ■ /Q ■//<? 2 /^«<// 2Ji*/'WJt zo </3 -V 7/22 /Pc^ //J?;■ /.S'vU V yy <2.J ■ 30 a ■yy 2//3f^ //0,pc-- ^~T 39 J '^sr-? -?/0 V-i" V y2<3- vr^ y^>yj’toW j) ^S'/P(S///Z V/^ 9n 2V25’V V-TJ : SrSP:S7> ^JO "'9 ^sAJ/39 ^ - 5-:^^ y VyyV3 -or-Vifc? MKL-0871-028183818 ®VICT88 UJflIfla • M 88iaTl*8. f«.t.t. Mian 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 V' te - Office* V low — Inspector Pii.. Card Owner Owner (JV-^ Permit No.. LEGAL Date DESCRIPTION AND fV -l(tO ‘y'p it7.tr Lake No. ' Lake Name LZ JJl '3f L ^ Range ^WP Name LOCATION Lake Classif.Sec.TWP IDENTIFICATION: Please Print All Information. Tel. No.Zip No.Mailling Adctre^ —No. Str.get, City and StateInitialFirstLast Name Ip/-£>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 Owner or Agent Signa.tureTime Rec'd Phone Call Rec'd By 3NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD ^7gtsq. Ft.(QOO GIs. ^ QFt. Sq. Ft.Capacity ■ 7<0 Ft.Ft.Distance from nearest well /b (9 Ft.Ft.Ft.Distance from lake or stream d-OtoFt.Ft.Ft.Distance from occupied buildinq (O Ft.ua.Distance from property line Ft.Ft. Ft.Ft.Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS: By ......... 19.7.;^.- Inspection was made on PERCOLATION TEST DATA:Date of First Test Rate ■ Test 2.Z..Date of Second Test 19 Rate 1st 5 = H - S'^First Test -I- 2nd Test 2 Rate2nd Test Taken By Agreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job Is ready for inspectjofr (Call or use attached mailer notice.) The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in K It [117J.Dated Signature Permit:Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six (6) months. Shoreland Management Office If77Issued Date:t Fee $Surcharge $. Comments:. Form No. MKL-0771-003 VICTM WHVtfll • «•.. PC*«Ut FM.L*. MIMM 158906 SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 - Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM W te — Office V low — Inspector Pi».. — Owner Card — Owner Permit No.,LEGAL Date DESCRIPTION / '5^AND LOCATION TWP NameLake Classif.Sec.TWP RangeLake No.Lake Name IDENTIFICATION: Please Print All Information. Zip No.Tel. No.Mailling Address —No. Street, City and StateInitialFirstLast Name OWNER SEWAGE SYSTEM INSTALLER Name, This System will be ready for inspection on.. 19. This space for office use only 19 ,M Date Rec'd Owner or Agent SignatureTime Rec'd Phone Call Rec'd By NUMBER OF BEDROOMS:ESTIMATED COST: 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 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: 19.../Time...„.Inspection was made on ;.....JVl By Rate, 19.....^.........., Rate PERCOLATION TEST DATA;Date of First Test 19 Date of Second Test i 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 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 16) 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 Issued Date: Shoreland Management Office Fee $Surcharge $ Comments:. orm No. MKL-0771-003 wiCTon kuaecCN * ee . MiNTtM. rcaeus r*ki.a ,158906 INSPECTION RESULTS s, Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORYActualShould be Actual Should beActualShould be Capacity GIs.GIs.S F S F S FS F Distance from Nearest Well 75 50FFF F F F Distance from Lake or Stream F F F F F F 20Distance from Occupied Building 10 20FF F FFF 10Distance from Property Line 10 10F FF F F F 4 4Distance from Bottom to Water Table F F F FF F Inspector's Comments: Date of Inspection 19___ Time of Inspection M Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs " Gallons SF •• Square Feet F * Linear Feet Job Title AgencyMKL-0771-003-Backer \ 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 V*' ■ te — 0#ffce V law — lupector > Owner Owner Pii.. Card Permit No..LEGAL Date DESCRIPTION AND 39 > Range ' TWP Namei2- -mh(. .. \(jO Vflf-2/’ll Lake No. LOCATION Lake Classif.TWPLake Name Sec. IDENTIFICATION: Please Print All Information. Tel. No.Zip No.Mailling Adclr^ss —No. Street, City and StateF£:Ari.7/ InitialFirstLast Name Joe9OWNER SEWAGE SYSTEM INSTALLER 4Name. This System will be ready for inspection on., 19. This space for office use only .19 M Date Rec'd Owner or Agent Signa:tureTime Rec'd Phone Call Rec'd By ^ f 3 - (y'NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD / ^OO GIs.7oQO Sq. Ft.Iq. Ft.Capacity 5 0 Ft.Ft.Ft.Distance from nearest well ] h 0 DFt.Ft.Ft.Distance from lake or stream lilJOFt. Ft.Distance from occupied building Ft. ininDistance from property line Ft.Ft.Ft. aFt. Ft.Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS: 19.2.7,By .zz. Inspection was made on Time ■Z. -7PERCOLATION TEST DATA: ---------------------------------------1st Test Tfikj^ By 2nd Test raken By Date of First Test , 19 Rate Date of Second Test........19 Rate i.a..Rate ^ First Test -I- 2nd Test 2 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. AppI leant 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.) /f, /f7 7Dated 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 (61 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 /?. /f7 7 < Issued Date: Shoreland Management Office \^o£Fee $Surcharge $ X Comments:. Form No. MKL-0771-003 ^ v>er*» uwKiii « M.. PfliaTiai. riatus tw.Lt. 158906 SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 — Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM l^ispector , Owner Owner , w ,^-s - > low — Card Pii.. Permit No.LEGAL -•>/Date DESCRIPTION AND LOCATION TWP NameLake Classif.Sec.TWP RangeLake No.Lake Name IDENTIFICATION: Please Print All Information. Tel. No.Mailling Address —No. Street, City and State Zip No.First InitialLast Name OWNER SEWAGE SYSTEM INSTALLER Name. //)-. 19J2?This System will be ready for inspection on. This space for office use only &lO-Jr A. M,192:2 Date Rec'd Owner or Agent Signa;tureTime Rec'd Phone Call Rec'd By NUMBER OF BEDROOMS;ESTIMATED COST: 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 Ft.Ft.Ft.Distance from occupied building 4- 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: /19./....Z , Time ...... .....uiu........... Inspection was made on JVl By PERCOLATION TEST DATA:Date of First Test ,, 19 , 19 .....> Rate Date of Second Test Rate 1st Test Taken By First Test + 2nd Test 2'Rate2nd Test Taken By The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work inAgreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. (Call or use attached mailer notice.) Dated Signature Permit:Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six (6) months./1 u ./ VIssued Date: Shoreland Management Office Fee $L-'Surcharge $ Cl f L'Comments:. NO C2 ri213AT2 iSSUf1 k =orm No. MKL-0771-003 ,158906 viCTOt Lw*»ccM • c«.. paiam J \ i-i INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORYActualShould be Actual Should be Actual Should beT71:Capacity GIs.GIs.SF S FS F S F<4 J.rt h o \ FDistance from Nearest Well 75 50FFFF F F/ ^i6oi-Distance from Lake or Stream I±oF.F F F F Ai_E16 20Distance from Occupied Building 10 20F F F F F iec FDistance from Property Line 10 10 10FFF F F7^T J 30'^ F, 4 4Distance from Bottom to Water Table F F F F FI\ \ •if » 7 cr\A [^D . ji/< * l / '■ !j^ ./}J ~.L\^ Inspector's Comments; ■J V'/"4 /Vl f itin.Q/iXr ( I f Ci^? iHH___ iO > 30 A .19^22Date of Inspection Time of Inspection.M Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs » Gallons SF ■ Square Feet * Linear Feet Job TitleF Agency MKL-0771-003-Backer i’i i . I -t'• '■ PERCOLATION TEST DATA SHORELAND MANAGEMENT:r^/;v3*' OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Ph. No. Owner:Mailing Address: ^___ v NameLas Fir Middle St. & No.City State Zip No. Legal Description:.Shj SEC. TWP.LAKE OR RIVER NO.RANGENAME TWP NAME TEST HOLE NO. 2TEST HOLE NO. 1 3Z Depth to Bottom of Hole inches; Diameter of Hole.JnchesDepth To Bottom of Hole,Inches;Diameter of Hole inches 19JZ7Depth, Inches Soil Texture Soil TextureDepth, InchesDate.Date 19_____ B/. pjtzf z?/Percolation Test By____ Percolation Test By .r -S'-Ja Q 111Firm Name.Firm Name. CC SimD o111QC /hhhi LUAddress.GC Address < CO Otter Tail County License No..Otter Tail County License No^H coUJ Drop In Water Level. Inches Measurement, Inches Drop In Water Level, Utches Measurement, Inches HTimeRemarks Time Remarks O5 V/✓i; • */r/Z: » \ -------- I- /Z~< /Pc^iX/J/2.!SD WL■XV"ZIOT/ ■ oo //U'J -OS'/ .'OO v-ywV7 V// /o ^2-Bc-Xy/Vi: V APeJf///t /sr'/; //?\V VV^7v'j~V 3 'z./ zs~/ ' zn a //V/V3 / '7«' 3^'S zjur. / z r V/A^ciX//ZlBn.V./■3 'i:-/• MKL-0871-028183818 ®VICTO* LUHaCfa 8 U 8*IBTt88. rOfUf r«.C8.See Booklet/'How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn. I CERTIFICATE OF COMPLIANCE SEWAGE SYSTEM m 3Lst day of_JanuaryThis certificate has been issued this i r to certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota.;1mThe premises covered by this certificate are legally described as:91 Twp. Name__Leaf MtRangeTwp. 131Sec.56-160 12 3QLake No. W-Pt. of G.L. 7, 8 and 2 in Sec. 17 m f- *I I Owner:Name.■ Too Ifnop I Clltherall. MinnesotaAddress. I 56524Zip No.t- i3457Permit No. SP_I Signed by:. Malcolm K. Lee, Shoreland Administratork i?Otter Tail County, Minnesota5 IMKL-0871-009 I I ;159035 >■"’%1 r SHORELAIVID MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 - Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM ;ffrce ^nspiecl-orV'' :te V low Pii.. — -Ownerr. : Card - Ovviner s.4s7 - 7 r Permit No.___PtLEGAL Date DESCRIPTION n n /.4/ T? a?AND Lake Nami nfL//ryf)LOCATION ^ TWP NameSec.TWP RangeLake Classif.Lake No. IDENTIFICATION: Please Print All Information. Tel. No.Zip No.Mailling Address —No. Street, City and StateFirstInitialLast Name 0 'ihJjiAn JO yy\.Ar\OWNER J SEWAGE SYSTEM INSTALLER '5'Name, This System will be ready for inspection on., 19. This space for office use only 19 M Date Rec'd Owner or Agent Signa;CureTime Rec'd Phone Call Rec'd By NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT y DRAIN FIELD I OQdT cQOa Sq. Ft.GIs.SCapacity '/Oo Ft.Ft.Ft.Distance from nearest well /Ft.Ft.Ft.-Distance from lake or stream Zji.Ft.Ft.Ft.Distance from occupied building /6/dDistance from property line Ft. Ft.Ft. Ft.Ft.Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on ..., 19,, Time M By 71.....IPERCOLATION TEST DATA:Date of First Test , 19 Rate /Date of Second Test:s- 1st Test Takenj E^J^ 19 , Rate /!1-I- 2nd TestFirst Test 2 Rate2nd Test Taken By The undersigned hereby makes application for permit to install dr 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.) /^5 '/bDated 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 Issued Date: Shoreland Management Office ^ ■. 3T>Fee $Surcharge $ Comments:. Form No. MKL-0771-003 VICTOa kUMOetk 4 CO.. vaiNttiO. ftacus riiLl. 158906 -/; <■ \i timm»ii»'r^-. ^i. miV‘ CERTIFICATE OF COMPLIANCE rSEWAGE SYSTEM mi s •J ,i^: ■ - -.r.Jrd Decembe p /9_iaday n f_This certificate has been issued thisSt w^nm-rifto certify compliance with regulations of Shoreland Managetnent Ordinance, Otter Tail County, Minnesota.f■■S MThe premises covered by this certificate are legally described as:It &■;r.: ‘•■A '.Lake Mo ^6-l60 Sfe'Sec. 17 Twp. Name Leaf Mountain131Range.Twp. nmiLutheran Brethren Bible Camp1;/, m Robert LindatromOwner: Name. \mEAddress Box PeJican Rapids. MinnesotaP .^6^7?Zip No.t>^ WMtr5BJPermit No. SP_'I- Signed by:. Malcolm K. Lee, Shoreland Administrator Otter Tail County, Minnesota MKL-087 1-009Wi I II*-' m mm ®159035 IwiDttN « ec. P«I>|TM«, ft»eui f»LLI. Hiiao> r 1SHORELAND 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 — pffice Yellow — Inspector Pink — Owner Card — Owner4 rs7Permit No.,LEGAL Date DESCRIPTION AND f' TWP Namejf Lake ^ame /!/£ /7 iV HE^ 0LOCATION Sec.TWP RangeLake Classif.Lake No. IDENTIFICATION; Please Print All Information. Tel. No.Mailling Address —No. Street, City and State Zip No.InitialFirstLast Name H-t/^ T Prt*^L^JLnOWNER SEWAGE SYSTEM INSTALLER Name, This System will be ready for inspection , 19.on. This space for office use only .M.19 Phone Call Rec'd By Owner or Agent SignatureTime Rec'dDate Rec'd OOAI = ^ SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD /^OO GIs.Sq. Ft.Sq. Ft.Capacity 510 Ft. Ft.Ft.Distance from nearest well Y-/ rrj Ft.Ft. Ft.Distance from lake or stream y•TL f)/ a Ft.Ft.Ft.Distance from occupied building / 0^Ft.It Ft.Distance from property line Ft. 7^Ft. Ft.Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS: 19 , Time ,jVl ByInspection was made on , 19 .7..1....£...'..>....1..PEBCOL^^N TEST DATA: Date of First Test Rate / 0of Second Test 19 , RateSL 1st Test Taken By L.P..First Test -I- 2nd Test ZZ 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.) 7/73f ’.l-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 (61 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 < h 7 > Issued Date: Shoreland Managenn^t Office 0 0 , ^ 0Fee $Surcharge $ /37 ip Comments:. Form No. MKL-0771-003 VICTC* LUMfiCtM k M.. PitHTfHt, roius rsLLa. wihh.158906 SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 - Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM White 4lf)ffice Yellow — Inspector Pink — Owner Carri — Owner Permit No., LEGAL Date DESCRIPTION AND LOCATION TWP NameSec.TWPLake Classif.RangeLake NameLake No. IDENTIFICATION: Please Print All Information. Zip No. Tel. No.Mailling Address —No. Street, City and StateInitialFirstLast Name OWNER SEWAGE SYSTEM INSTALLER Name, This System will be ready for inspection on., 19. This space for office use only ,M,19 Phone Call Rec'd By Owner or Agent SignatureDate Rec'd Time Rec'd SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PIT DRAIN FIELDSEPTIC TANK Sq. Ft.Sq. Ft.GIs.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: , 19 , Time ,jVI ByInspection was made on 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 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 Issued Date: Shoreland Management Office Fee $Surcharge $,, Comments:, Form No. MKL-0771-003 158906 viCTOii LUMecfH 4 ce.. aamuai, rtagus falli. i INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORYActualShould be Actual Should be Actual Should be Capacity GIs.GIs.S F S F S F S F Distance from Nearest Well F 75FF F 50F F Distance from Lake or Stream F F F F F F Distance from Occupied Building 10 20 20 F F F F F F Distance from Property Line 10 10F 10FFFF F Distance from Bottom to Water Table 4 4FFFFF F Inspector's Comments; Date of Inspection 19___ Time of Inspection.M Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF * Square Feet F ■ Linear Feet Job Title AgencyMKL-0771.003-Backer >L PERCOLATION TEST DATA Price $ 1.00 per pad. ' SHORELAND MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Ph. No. Owner:Mailing Address: Last Name First ^ME Middle St. & No.City State TWP NAME Zip No. Legal Description:^ /^O SEC.LAKE OR RIVER NO.TWP.RANGE TEST HOLE NO. 2TEST HOLE NO. 1 3^"’ i* Depth to Bottom of Hole inches; Diameter of Hole inchesDepth To Bottom of Hole,inches; Diameter of Hole inches ^-2.J ..73 19 ^3Depth, Inches Soil Texture Depth. Inches Soil TextureDate.Date C7^/F“o - /O.*•Percolation Test By____ Percolation Test By .o /<y '‘/rt 3o'‘ S)mFirm Name. Firm Name.DaLU IT LUAddress.CC Address </?l./9ilCO Otter Tail County License No..Otter Tall County License No.H in Water Level, Inches X2*4^CO LU Deiatk* in Water Level, Inches Measurement, Inches h-Measurement, InchesTimeRemarksTime Remarks 0 ---------------1 /-vo' I zu^.r^JT/"/: ^s' llZLys'\/ / j /:y<i WW'YW / <f yjr3‘v5"‘^ ! a S' Yj-‘‘/<^ y9Z^''yAi ^ : ye; ^: yoSs'ysV'yp''^ZKL0-: s3"3 </ c TJZ_jrVA 3:/C3 ZZ5y3"'3 ■ 3J'3:y<y 3 W' aAi VIW yp '■'/y.‘ o>y y^o p£ ^ MKL-0871-028 'I 53 17^ VICT9* LUNDItN t CO . PttIMTflf. fEKOUS FALL*. See Booklet, "How to Run a Percolation Test” by Agriculture Ext. Service, Un. of Minn. ',y /i^^asuizb\ jmoPA?SA5(fi^^' M £."T fi^Sj^AKIC-S //y'T/A1£^ /\J2./^S"~r'y/^£ ^7^''<5*/^'’ ^«pi'‘ rss- <£"'. <^s'y./o £^-i>t*^£££*Ar^ £y%Zi ' <^vC^ i"' / c '~Pyt£*'yu^u -V £7v4^— ,