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Home My WebLink AboutJulie Koski Et Al_56000080045000_Septic System Permits_CERTIFICATE OF APPROVAL SEWAGE SYSTEM m 97February21stThis 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 ofmi 19 mS-. m iM m The premises covered by this certificate are legally described as:Wl.iMSTAR LAKERange ^^Sec._®13556-395Lake No.Twp.Twp. NamemMmi iSe 135 41 25 LOT 1 EX 1. 25 AC IN SE CR iM mM M mKOSKI, THONAS CM, ET AL Mi Owner: Name i j16004 DAWN DR, MINNETONKA, MMAddress%mi 55345 iMZip No. 9986Permit No. SP Signed by: Land & Resource Management OfTicial Otter Tail County, Minnesota 9 MKL-0987001 JT 279005 Victor Lundeen Co., Printers, FeigmFtlh.Miiiiiesoti APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM WHITE — Office Yellow — Inspector Pink — Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218)739-2271 - FERGUS FALLS, MN 56537 S /WifSl^oT I AC Cu LEGAL Permit No. DESCRIPTION AND LPCATION LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER SECTION RANGETWP. NO.TWP NAME Gb OS /S5 SrrtftLAKt'54-SS5 St-aJJ, PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER Si^~ ooo~o8' ~ooo IDENTIFICATION: Please Print All Information Last Name First Initial Mailing Address — No. Street, City and State Zip Code Telephone No. AA'tiOk) (!?ToaJi<(A waaJ 5^'^>V_5 •SoHi^SoaJ^ ^TAL Kosxi Property Owner 1Sewage System Installer Name A.M. This System will be ready for inspection on.P.M., 19.at This space lor office use oniy NUMBER OF BEDROOMS* A.M. {^) NO19P.M GARBAGE DISPOSAL: ( ) YESDate Rec'd Time Rec'd Phone Call Rec'd By SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM TANK DRAIN FIELD( ) Holding tank (Alarm Required) (^ ) Septic tank (^)TinXcaoCapacityGIs.Sq Ft. ^o/looSoDistance from nearest well Ft. Ft.Drain field ( ) Standard ( ) Bed ( Trench ( ) Modified ( ) Mound 50Distance from lake or stream 50 Ft. Ft. Distance from building Ft. Ft.J O iO lODistance from property line IO Ft. Ft. EFFLUENT DISTRIBUTION (^^) Gravity ( ) Pressure Distance from bottom to Water Table Ft. Ft. All distances are shortest distance between nearest points WATER WELL DEPTH: 9u/5PERCOLATION TEST DATA: Date of First Test , 19 Rate 5^^7Date of Second Test , 19 Rate 1st Test Taken By 5 5 5/oFirst Test + 2nd Test Rate22nd Test Taken By Agreement: The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in strict accordance with Ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minnesota Department of Health. Applicant agrees that plot plan sketches and specifications submitted herewith and which are approved by Shoreland Management Officical shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibilty of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. DATE: Signature Permit: Permission is hereby granted to the above named applicant to perform the work described in the that the person to whom it is granted, and his agent, employees and workmen shall corih 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. ^ Jbove statement. This permit is granted upon express condition resjjfects to the Ordinance of Otter Tail County, Minnesota.in 6 -vv-7Issued Date:7a 7QC Land & Resoua magement OfficeS5Fee $.Rec # ^ b ^ 'ft' S(Ze^ CSr k ^9 i uy -r5Comments: iBk J S Form No. BK-0993-003 266.559 • VictorLundeen Co., Printers * Fergus Falls, MN • 800-346-4870 ' ««p -1^ APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATM wri..- — 0 „e ’ Y$U6w — Inspector Pink — Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 - FERGUS FALLS, MJSL58 SI^OT ILEGAL 'ermit No. DESCRIPTION tK 1.3 5 cAND . LOCATION - . -s* SECTIONLAKE NUMBER LAKE/RIVER NAME LAKE/RIVER TWP. NO.RANGE TWP NAME c'b 09. /2>5 Hi Srr^kLpKt'S ~rflHSi,-IBS PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER Sdo' aoo~o8-<yoVS -ooo IDENTIFICATION: Please Print All Information Mailing Address — No. Street. City and StaleLast Name First Initial Zip Code Telephone No. )T>/^y<OAilb ^T/jLProperty Owner Mf iOMC TcjaJKA waaJ SSSH51 Sewage System Installer Name /a OO A.M. This System will be ready for inspection on , 19-P.M.at This space for office use oniy NUMBER OF BEDROOMS* /S<SiO A.M. ) YES (<^) NOP.M.19 GARBAGE DISPOSAL: (Time Rec’d Phone Call Rec'd ByDate Rec’d SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) ) Septic tank ) Drain field ( ) Standard ( ) Bed (Trench ( ) Modified ( ) Mound DRAIN FIELDTANK //c^/9^QDcyCapacity GIs.Sq Ft. ^o/too5oFt. Ft.Distance from nearest well 50Distance from lake or stream Ft.50 Ft. /^QDistance from building Ft. Ft.) O iO Distance from property line Ft.Ft.IO lOEFFLUENT DISTRIBUTION ) Gravity ( ) Pressure 3>Distance from bottom to Water Table Ft.Ft. All distances are shortest distance between nearest points WATER WELL DEPTH: 9.-/5PERCOLATION TEST DATA: Date of First Test ^cUZ-AnJ . 19.Rate 5(s> " fDate of Second Test . 19 Rate 1st Test Taken By ,McLTS-ANJ 5 5 5/oFirst Test + 2nd Test Rate22nd Test Taken By Agreement: The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in strict accordance with Ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minnesota Department of Health. Applicant agrees that plot plan sketches and specifications submitted herewith and which are approved by Shoreland Management Officical shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibilty of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. DATE:. Signature Permit: Permission is hereby granted to the above named applicant to perform the work described in the eibove statement. This permit is granted upon express condition , that the person to whom it is granted, and his agent, employees and workmen shall confgtoq in ^resprcts 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. 6 -/V-Issued Date: Land & Resou^ftMahagement OfficeOO55Rec #.Fee $.- i)G ( M.ok/l VComments: Ar- Form No. BK-0993^26BAS» ■ Victor LundMn Co., Prinlars - Fergus FaRs. MN - aOO-346^70 'v? INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS i SEPTIC TANK DRAIN FIELD CATEGORY Actual , Actual MinimumMinimum hts sfQLS.SFCapacityGLS. ^0 PO FTFT FTDistance from Nearest Well FT50 Distance from Buried Water Suction Pipe FTFTFT FT 5050 Distance from Buried Pipe Distributing Water Under Pressure FT FTFT FT 1010 FT! (iOfh FTDistance from Lake or River (OHWL)FTFT FT(qO 10/20 FTFT FTDistance from Nearest Building 10 nFT FT FTFT10Distance from Nearest Property Line 10 lof FTFTFTDistance from Bottom to Water Table 3 YES NOHolding Tank/Lift Alarm DRAINFIELD CALCULATIONSewer Line to Well SeparationINTERPRETATiON OF ABBREVIATIONS GLS. = Gallons SF = Square Feet FT = Linear Feet Actual Minimum 3FTX FT FT20 SF Inspector’s Comments: r / ETCH: 1 ■f Inspector's Signatur^/' Date ol Inspection '' Time of Inspection Minnesota Well and Boring Sealing No H 64637MINNESOTA DEPARTMENT OF HEALTHWELL OR BORING LOCATION WELL AND BORING SEALING RECORD W nnesota Umque noCountv-Nameuouniv Name Towrgpip Name Township No Range NcSir/r/akr\ I V/m/ or W-series No (Leave blank i1 noi knowni Minnesota Statutes. Chapter 1031 Approximate Date Wetl or Boring Constructed Date SealedSection NoTownship No Range No Fraction (sm • Ig )June. Numerical Street Address or Fire Number and City ot^eli or Boring Location'Sd r ot^eli orhjLks^ I 36'36ofb^fr>g Original DepthDepth Before Sealing ft ft.rh ni Static Water Level CD Accurate Approximate Sketch map of well or boring location, showing property lines. roads, and buildings Show exact location of wefl or m section grid with X N XSingle Aquifer Q Multiaquiler below above land surfaceft CASING TYPE4 Ew-.KT-- r- 1 Steel CD Plastic CD Tile D Other 1 33 ,o ^ftft Open Hole fromScreen from tosK1 mile OBSTRUCTION/DEBRIS/FILL D Obstruction IH Debris CD Fill PR^ERTY OWNER'S NAMESfiiuM_____ or lo No Dio6 hru c in ons Type of debris/obstruction ObstructiofVDebris/Fill removed'’ O Yes CD No£led above PUMP Removed D Not Present Q Other CASING HARDNESS OF FORMATION TOFROMCOLORGEOLOGICAL MATERIAL Set in oversize hole?Annular space initially grouted'’Diameter Depth It not known, indicate estimated formation log from nearby well or boring 3 3 ,o 3 3 (I CD No D Unknown□ Yes □ No □ Yesin from CD No CD UnknownQ Yes CD No D Yesft.in from to □ Yes □ No Q Yes D No CD Unknownftin from to METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS. OR CASING AND BORE HOLE; D No Annular Space Exists lU Annular space grouted with tremie pipe CD Casing Perforation/Removal D Perforated Q Removedin. from ft.to D Perforated n Removedftin. from to Type of perforator CD Other GROUTING MATERIAL ^gnhini 36 HOfrom yards bagsGrouting material to ft.from yards bagsto REMARKS. SOURCE OF DATA. DIFFICULTIES IN SEALING tt-from yards bagsto ft.from yards bagsto UNSEALED WELLS AND BORINGS [YnoC YesOther unsealed well or boring on property'’ "JUN 1 LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules, Chapter 4725 The intormation contained in this report is true to the best of my knowledge4 1996 ffPA) n '5 en Jfful 7)n I /mg tor bus,ness // V— Representame Signature )3/^ i ^2. Contu Ueense oc Registr^iqa No AutI me of Person Seaj/ng Well or Boring IMPORTANT-FILE WITH PROPERTY PAPERS-WELL OWNER COPY H 64637 A/a HE-01434 01 ;From the Desk of GLEN SHAW ■\■ * •I ■ ■■■,>•\i . '<Vi•i\ ) \\ \• . T’Syt,-' ' .-»■■■. “A f. 3 ■', •, ;- —.-..vr.,^>, '.rr.--’- ■ %- X' .' .'■ I ■>*AX : \ '^ '. ! “.: : a {:*'i •*. ■'■ 'V-•I , •- -i -'• , • •.•*.- -j iKa-. ;» !=irr ■ 1a ;■'»•. t\/¥/■ / /\i \ .'•//■, \ ■/\/ T \ \ \// f dSWS®®* -oec; >. 1 IS ■ t :. 4<Sw ■ :\ V» i ,'■; V-,■>'■ •X -’, Y- •\-' \ . * H Department of LAND & RESOURCE MANAGEMENT COUNTY OF OTTER TAIL Phone 218-739-2271 Court House Fergus Falls, Minnesota 56537 0 -l(y ^7 /t, ci-' 'i-c ( ^JO lx ^ (o OC i0(\ (I: /'b' ^ /yjAJijj p fri ^ ^ 5 S 3V\’ iC /Lake * i?- 5Ci Inspection on Sewage System PermitRE: This is to inform you that an inspection was made on the above mentioned Permit. At that time we could not complete the inspection and certify the sewage system for the following reason(s): There was not a visual alarm on the lift station. There was not an alarm on the holding tank. There was not a dwelling onsite. /M mus i-X There was nail a well onsite The Installer had not completed the air test. Our office has not received a letter from the Township allowing feet from the right-of-way.the sewage system to be Our office has not received a letter from the neighbor allowing feet from the lotline.the sewage sytem to be Certification of the sewage system can not occur until this matter is resolved. Inspector SHORELAND MANAGEMENT ORDINANCE — SUBDIVISION CONTROL ORDINANCE RIGHT-OF-WAY SETBACK ORDINANCE — SEWAGE SYSTEM CLEANERS ORDINANCE RECORDER, OTTER TAIL COUNTY PLANNING COMMISSION LTR.SEWAGE.SYSTEM.INSPECTION051294 GRID PLOT PLAN SKETCHING FORM — (Must Be To Scale) feet/inchesScale: Each grid equals ^ 9* rff- 9 I*Dated: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. so \ I ^ 4- I / i; /6 !! i ; i ! f ■ 1 ■: ■ ! r ( 6O0 aaJL ^ t A- I PERCOLATION TEST DATA LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, MN 56537 OWNER: 'Vvt FIRST ^LAS^NAME TELEPHONE NUMBERMIDDLE ADDRESS: u.5LL5Li2 ZIP CODECITY ^ STAT^ STR./RT. LAKE NAME ILL TWP. NAMERANGESEC.TWP.LAKE/RIVER NO. LEGAL DESCRIPTION: -w I :r PARCEL NUMBER Do^t 9-SL- /sNUMBEKfBEDROOMS FIRE NUMBER — TWO TESTS ARE REQUIRED — TEST HOLE NO. 2TEST HOLE NO.c 3/Diameter of Hole inchesinches; Diameter of Hole. inches Depth To Bottom of HoleE>epth To Bottom of Hole inches; ;3 5^19DateDepth, Inches Soil Texture Date 19 Depth, Inches Soil Texture Name Percolation Test By____ Firm Name __^ Address Address TT Otter Tail County License No. Otter Tail County License No. PERC TEST # 2PERC TEST # I INTERVAL OnQNUTM)WA^BR PgPTH WATER PROP PERC RATE TIME INTERVAL IMINtrrBR^WATER DEPTH WATER DROPTIME PERC RATE m:START2i^.23:T3T f 'IIMIT DROP PBRC TDHH” DROP AURC PERC RATEPERC RATE TIME WATER DEPTH WATER DROP PrrBRVAI-fMINlJTM^TIME INTERVAL fMPWTESI WATER DEPTH WATER DROP REFILLREFILL :x^:.(2^T T '11MB' DROP PBRC 'HMU DROPPERORATEWATER DROP TIME WATER DEPTHINTERVAL nrfINtJTEft REFILL WATER DEPTH INTERVAL IMINIHEH WATER DROP PERC RATE REFILL 5*. 3-:? *nMB DROP PBRC :2’xz.XTg~75'4 '11MU PK5P" ^BRC WATER DROP rate RATE TIME PHERVAL/MlNmES^WATER DEPTHINTERVAL (MINUTEST WATER DEPTH WATER DROPTIME PERC RATE R^^LLRB^^L XX- JUS.PERC RATE INTERVAL (MINUTEDINTERVAL (MDIUrBSI WATER DEPTH WAITODROP WATER DEPTH WATER DROPTIME PBRC RATE REFILLREFILL 3X.. 33 'HMB DROP PBRCXX-CJ^ PERORATE TIME INTERVAL (MINUTESTINTERVAL (MINUTED WATER DEPTH WATER DROP WATTO DEPTH WATER DROP PERORATETIME REFILL 3REFILL5-1/0 X 3 .3 3 'nME ^ DROP PERCxx:::.rxi.iJL?*TOME" FOtCRATBINTBRVAL(MDnnED TIME INTERVAL (MINUTEDWATER DEPTH WATER MtOP WATER DEPTH WATER DROPTH«rate RATE 2REFILLREFILLX.7^x:x::.:jx7./2IZ TORE" DROP PERC INTERVAL (MIMUTEII REFILL WATER PROP FERCRATE TIME INTERVAL (MINUTED WATER PEPTHWATER nepTH WATER DR<TIME PERORATE 2.1.REFILL /O TOMB" ^ DROP ^bRd TIME * bROP ^hIc 7IS xx::. 6-XCOMMENTS/CALCVLA TIONS: X MKL — 0390 - 005 250,815 — Victor Lundeen Co., Printers. Fergus Falls. Minnesota