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Home My WebLink AboutKohler_17000110144001_Septic System Permits_APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095) GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 www.co.otter-tail.mn.usWHITE - Office YELLOW -L&R Inspector PINK - Owner/ Contractor (after issue) APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED Permit No. NUMBER PARC^UMBER (S) OE PROPERTY BEINCJ SER^ LAKE/RIVER NAME TWP NO.;/RIVER SECTION TWP NAMERANGE ;ss DRESS OR DIRECTIONS FROM NEAREST PUBLIC ROAD LEGAL DESCRIPTION Last Name First Initial Mailing Address laytli me No. ,'^o9y. ,________/C'dA/p*^Property Owner ontractor Lie.# THIS SPACE FOR OFFICE USE ONLY A.M. >- This System wilt be ready for inspection on , the year of P.M.at. A.M. P.M. Date Received Time Received L&R Officiai TYPE OF NSTALLATION (circle one)SEWAGE TREATMENT SYSTEM DESIGN DATA AS SHOWN ON DRAWINGtestcteiMi al Collector Other Est. (E) New (F) Replacement (B) Replacement (C) New (D) Replacement Soil Treatment Area Tank Lift ,J3esiyiTFIow-(Gj ( (G) 1 -2,499 J alions/Day)Effiuent Distribution ( ) Gravity ( ) Pressure GIs _____Ft.(H) 2,500 — 4,999 (I) 5,000 — 10,000 Size Setback To Nearest WellType I Type II Ft.____ Ft. (20) Trench, Rock (27) Rapidly Permeable Ft.Ft.Setback To OHWL __ Ft.(21) Trench, Gravelless (28) Flood Plain f-/c/y (22) Trench, Chamber (29) Privies 30 — -------Ft.Ft.Setback To Bluff(23) Bed (30) Holding Tank ^) Monitoring/Disposal Contract(24) Mound Ft.Setback To Dwelling (25) At Grade Type III Setback To Non-Dwelling(26) Greywater (31) Other/Problem Soils/<12" Soil 05JS,''Ft.___ Ft. Type IV Setback To Nearest Lot Line Ft. Ft.TODept (32) Public Domain & Proprietary Technologies Setback To Road Right-Of-Way Ft.Ft.,^ypeVTotal # Bedrooms (33) Performance Elevation Above Restrictive Layerm Ft.Ft. Ft.Abatement Y /Garbage Disposal Y / PERC TEST DATA miDesigner Agreement: The undersigned hereby makes application for permit to install, alter, repair or extend Sewage Treatment System herein specified, agreeing to do all such work in strict accor dance with Sanitation Code of Otter Tail County, Minnesota. Applicant agrees that the Site Data Worksheet submitted herewith and which is approved by a Land & Resource Management Official shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and approved for use. It shall be the responsibility of the applicant for the permit to notify Land & Resource Management that the installation is ready for inspection. Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Sanitation Code of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of the Sanitation Code. NOTE: I.This permit Is valid for a period of six (6) mon^s. 2.This permit does not include the building sewer (sewer line). License #Date of Test Highest Rate Date;Permit Fee $ SignatJjre Pyr^/Yrty Owne^gertt for Own^r-\^Y^ t Land & Resource Management Official • ---------------------^^-----\mi ir/n-rY Date:Rec. No.. Dale StampComme mB[#igra L&R InitialForm No. BK — 07-2011-06 345,197 • Victor Lundsen Co.. Printers • Fergus Felts, Minnesota APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095) GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 yyvvw.co.otter-tail.mn.usWHITE - Office YELLOW-L & R Inspector PINK - Owner / Contractor (after issue) APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED Permit No.L- ^>AKE NUMBER LAKE/RIVER NAME LAKE/RIVER ' CLASS SECTION TWP NO.RANGE TWP NAME IrijiLLRARCEOjUMBER(S)OFPROPERTYB£IN&siRViCED / Y OdO d'A A O yu W-'YpY / y /AY ADDRESS OR DIRECTIONS FROM NEAREST PObLIC ROAD ^7C7- :^y'0/0y / :> -cc /t !(1.- —•• c" LEGAL DESCRIPTION ^/ftz 'y^y^o oC '''' py' ~ '’'^iPiA/'/^^'i/o/ Ph6rie N«!'Last Name First Initial Mailing Address /7) ''^ou \Property Owner <n9y>j yV j 1 yOr^uyyjK^ n yOt^ yO ,y ■ /y>_ 9 "^yy^-zyA k-v^4/y' K"- ’AyContractor Lie. It !rr- ^y ,'^A —> A y THIS SPACE FOR OFFICE USE ONLY __ii-A o __atJDum)\M/U>• This System will be ready for inspection on , the year of P.M. U7S)'\^ Date Rede Time Received P.M. ived L & R Officiai TYPE OF NSTALLATION (circle ONE)SEWAGE TREATMENT SYSTEM DESIGN DATA AS SHOWN ON DRAWINGlesiilentialCollectorOther Est. (E) New (F) Replacement (C) New ' (B]^eplacement (D) Replacement ^^Sesign Flow (Gallons/Day) Effluent Distribution { ) Gravity { ) Pressure iw Soil Tank Lift Treatment Area jG) J —2,499 (H) 2,500 — 4,999 (i) 5,000 — 10,000 >GIS — GIs Ft.y/OSize } i Setback To Nearest WeiiType i Type ii Ft.Ft.Ft.1 (20) Trench, Rock 4^(27) Rapidiy Permeable Ft.Setback To OHWL Ft.Ft.(21) Trench, Gravelless (28) Flood Plain /.4 / (22) Trench, Chamber (29) Privies 1 /.4-.Ft.Ft.----Ft.Setback To Bluff(23) Bed (30) Holding Tank (A) Monitoring/Disposal Contract(24) Mound Ft.^ Ft.£t.Setback To Dwelling L(25) At Grade Type iii Setback To Non-Dwelling(26) Greywater (31) Other/Problem Soils/<12" Soil < Ft.^^-,, Ft.Ft. Type iV Setback To Nearest Lot Line 7 Ft.2 Ft. Ft.Depth of Well '(32) Public Domain & Proprietary Technologies L- Setback To Road Wght-Of-Way n ■) Ft. / ■ “ Ft.Type VTotal It Bedrooms A3) Performance Elevation Above Restrictive Layer7----V Ft.Ft.Ft.Abatement Y / , N Y Garbage Disposal Y / N ;PERC TEST DATA ■ 1 '' ; / Designer :■ zC- iJ/iA-z.License #Date of Test Highest Rate Agreement: The undersigned hereby makes application for permit to install, alter, repair or extend Sewage Treatment System herein specified, agreeing to do all such work in strict accor dance with Sanitation Code of Otter Tail County, Minnesota. Applicant agrees that the Site Data Worksheet submitted herewith and which is approved by a Land & Resource Management Official shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and approved for use. It shall be the responsibility of the applicant for the permit to notify Land & Resource Management that the installation is ready for inspection. Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Sanitation Code of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of the Sanitation Code. NOTE: I.This permit is vaiid for a period of six (6) months. 2.This permit does not inciude the building sewer (sewer ilne). I Date:Permit Fee $7 Signature of Property Owner/Ager)t for Owner ~y ) // 7Date:Rec. No.. Land & Resource Management Official Comment^/yA 77^ 1 SCANNEDII lifeaForm No. BK — 07-2011-06 345,197 • Victor Lundoon Co.. Prinlors • Fergus Falls, Minnesota 9- SEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTS Inspector must make all measurements SOIL TREATMENT AREA HOLDING SEPTIC TANK OUTHOUSELIFT TANKCATEGORY /Sdo FT2FT2CapacityGLS.GLS. I FTFTFTFTSetback from Nearest Well Setback from Buried Water Suction Pipe FTFTFTFT Setback from Buried Pipe Distributing Water Under Pressure FTFTFTFT 100‘FT FTFTSetback from OHWL (lake &/or river)FT FTFTFTSetback from Bluff FT FTFTFTSetback from Dwelling FT •K%FTFTFTFTSetback from Non-Dwelling FTFTFTFTSetback from Nearest Property Line FTFTFTFTSetback from Right-of-Way FTFTFT FTElevation above Restrictive Layer 7"NOHolding Tank/Lift Alarm 1 Old System Pumped & Destroyed NOYES TRENCH REDUCTIONSOIL TREATMENT AREA CALCULATION MOUND / AT-GRADESEPTIC TANK(S) # Tanks installed FILTER ROCK B/inchesRock trenches wi) of side\%^ Manuf.\Ft.Ft.Ft.z\ft*reduction / equivalent toModel#Ft*Ft*Soil Treatment Area./ Inspector's Comments: Sketch: 'A I ! o ) j 101 \ \. H CO Igfltial / L a R OfficialTimeate the above described sewage system installation was found to be compliant with the provisions of the SanitationAs of__V Code of Otrer Tail County. ZLertd a Resource Management OfR^ Form No. BK — 07-2011-06 t345,197 • Victor Lundeen Co.. Printers • Fergus Falls, Minnesota OTTER TAIL COUNTY LAND & RESOURCE MANAGEMENT PUBLIC WORKS DIVISION WWW.CO.OTTER-TAIL.MN.US9irriRTiiH GOVERNMENT SERVICES CENTER 540 WEST RR AVENUE FERGUS FALLS, MN 56537 218-998-8095 FAX 218-998-8112 06/19/2014 Todd C & Larry J Kohler 50913 County Highway 31 Detroit Lakes MN 56501 9455 RE: Primary Owner; Todd C & Larry J Kohler Inspection on Sewage Treatment System Servicing Permit Nbr: 22823 Lake; 56-786 Pelican Tax Parcel Number: 17000020022000 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 approve the system for use, for the following reasons: □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 The non-comforming sewage system had not been destroyed No Township Letter □There was not a well onsite The installer had not completed the air test Miscellaneous Our office has not received the Well Abandonment Certification □□ □ □□ □ Please contact our office when the dwelling is on site. At that time we will reinspect your holding tank for certification. Sincerely, ^ Denise Gubrud Inspector SITE DATA WORKSHEET Super Septic Excavation 38992 183rd Ave, Pelican Rapids, MN 56572 218-863-3373 www.seDticandexcavation.com SEWAGE SYSTEM PERMIT #:OWNER Larry or ToddKohler PhoneFirstnameLast name Cell 5650150913 Co Hwy31 Addres Detroit Lakes MN state ZipCity 137N 42W Dunn Township Name: Pelican Lake Name 0256-786 Lake/River #Section TWP Range LEGAL DESCRIPTION: 1.10 AC - PT GL 8 E OF HWY & S OF RIVER #22 & #144-001 NOT TO BE SPLIT 17-000-11-0144-001 Tax Parcel # 51010 Co Hwy31 911 Address NUMBER OF BEDRROMS:I__ tfiojGARBAGE DISPOSAL: YES ft:WELL CASING DEPTH: SEWER LINE SEPERATION: FLOOD PLAIN: YE^^^^^^ BLUFF: YES NO VEGETATION: AQUATIC^^X^ER^TRIaP^ SLOPE AT INSTALLATION SITE: ORIGINAL SOIL: YES NO COMPACTED SOIL: YES NO DEPTH TO RESTRICTIVE LAYER:INCHES SEPTIC TANK MANUFACTURER: Brown Wilbert PROPOSED DESIGN: BED ATGRADE MOUND HOLDING TANKTRENCH GRAVITY DIST PRESSURE DIST.OTHER SPECIFY: DESIGNED BY: MPCA LICENSE #: 901 LICENSE CATAGORIES: Intermediate designer, installer, maintainer, basic inspector DESIGNER:38992 183rd Ave Pelican Rapids, MN 56572 PHONE: 218-863-3373 DATE: /y2SIGNATURE: Site map on b SCANNED iCr"::. <!:■:.■ J: North ■ .-■ tt<2=^^Larry or Todd Kohler 51010 Co Hwy 31 east end of pelican lake ((V/m.!/old tank^i^ abandon\v 1500 gallon 2 compartment holding tank§ -CO -0 O •-CTS hydranf72.68'.....- Setbadi Line • ■ — Lot Line,C Sewer Line & Drain Field Structuresa Wfeyne Johnson Super Septic & Excavation 38992 183tdAve Pelican Rapids, MN 56572 License #901 218-863-3373 Scale: 1" = 30' ^— 30.00' —^ Holding Tank Management Plan OWNER Larrv or Todd Firstname Kohler Last name Phone Cell 565Q1MN50913 Co Hvcr31 Addres Detroit Lakes City State Zip 51010 Co Hwv31 911 Address 17-000-11-0144-001 Tax Parcel # This management plan will identify the operation and maintenance activities necessary to ensure long-term performance of your septic system. Some of these activities must be performed by you, the homeowner. Other tasks must be performed by a licensed septic service provider. Homeowner Management Tasks and Responsibilities: __Monitor alarm daily - make sure the alarm is functioning properly. __Surfacing sewage - Regularly check for wet or spongy soil around your tank. __Leaks - Check (look,listen) for leaks in toilets and dripping faucets, repari leaks proptly. __Maintain the access road so that the holding tank(s) can be serviced with the pumping equipment. Professional Management Tasks: __Check to make sure tank is not leaking __Check inspection pipes, replace broken or damaged parts __Verify that the alarm works and that there is at least 25% reserve capacity. __Pump tank and follow all applicable local, state, and federal regulations regarding holding tank waste. Mechanical indicator starts to rise when the tank is 75% full Daily homeowner should test mechanical indicator to make sure it is free and functioning properly. “I understand it is my responsibility to notify the maintainer in a timely fashon to assure that the holding tank on this property is emptied before overflowing to the ground or backing up into the structure it serves. It is also my responsibility to perform the tasks listed in Homeowner Management Tasks and Responsibilities listed above. HOME OWNER SIGNATURE:,'DATE; / DESIGNER:MPCA LICENSE #: 901 LICENSE CATAGORIES: Intermediate designer, installer, maintainer, basic inspector SIGNATURE:DATE: / 38992 183rd Ave Pelican Rapids, MN 56572 PHONE: 218-863-3373^ & EXBAVAT10N SCANNED Page 1 of2Interactive Land Viewer - Otter Tail County, MN - Bigger - Better - FASTER m0'm X \z &Otter Tail County, MN - Interactive Land Map (Parcels)AboutiiFlex Viewer V2.5H 7_ 2012 Fergus Falls 2007 Fergus Falls2008200319922009More...Topo 2010 PhotoBasemap A ?:o i. \,^inTLEPFJJCAN L4KE S-6-76}X /i\ V yL '~~lj (VX *IrEUCAXUEEII ://17( %IViI I I /i y’ ^ ;traottguEBMtiaa111 f 17<»QQ2(X119000xfudussiiama□iaurij? IIj <I ■xtm'tmuimf 17COQ1iaU20CO /17<170a3110U100Q I Not to bo used as a legal descript 1700Q-' nnr«aaK4 I sno N'O "f il5# titiS UfOCIild 6/10/2014http://www.ottertailcounty.neEflexviewers/land/index.html?search=l 7000020022000 i r" ABATEMENT NOTICE Shoreland Management COUNTY OF OTTER TAIL Court House Fergus Falls, Minn. 56537 2Sth .day of Mat/ 19 85Dated this. K^n ConnoATo. 1623 Topping RoadAddress. City and State.St. LouJj, f Zip Code_h31M. the. APL{}a.gp. AustemYou are hereby notified that. Which you maintain at (Legal Deseription and Location) - Plus Fire No.5004 G.L. 8 60uth oi fiivoA Lfttle, Peltcan56-761 1W 137 Vann242 Range Twp. NanneLake No.Lake Name Class. Sec.Twp. con^tnucitzd andjoA locattdis not. in accordance with minimum standards of the Otter Tail County, Minnesota Shoreland Management Ordinance. You are hereby ordered to abate the above described condition within 30_^ays from this date. If you fail to correct the above defect you may be subject to a fine, imprisonment or injunction proceedings. Shoreland Management Official PROOF OF SERVICE State of Minnesota County of Otter Tail Fergus Falls, Minnesota 56537 The above notice and order was served by me on._______________ 19___, by handing a copy thereof _*the (owner-occupant-agent) of the above describedto premises. *By posting a copy thereof upon the above described premises. Otter Tail County Sheriff Department *Strike out words that do not apply. CC: Otter Tail County Attorney MKL-0372-03501 220522 Victor Lundeen Cr Co., Printers, Fertfue Falls, Minn. ; ;• I . r/FIELD NOTES eUHB HAHB DATE•• : LAKE NO.FIRE NO. LEGAL DECRIPTION OF LOT; S ou OWNERS NAME (q.OWNERS ADDRESS TYPE OF SEWAGE SYSTEM (Inspector’s Conunents) 0(^/\,6iT~ /Sd)d/t45''7 ■C(?iJ(^^'( fCacA SEPARATION DISTANCES - FEET Septic TankCategory Soil Disposal Area Well - A/aLake - Lot Line - Occupied Building - . fElevation of Area REASON SYSTEM WAS ABATED; [)\/^K<Aouj<n ) d^i tOi^/Id neco^>V3V \ SKETCH OF LOT ON BACK hi ! / ) !<a ,(S-\J Ie±_LLMlc5£|l \jy Lt^ I * SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 — Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM White — Office Yellow — Inspector Pink — Owner Card — Owner /j Permit No.! “ LEGAL sDESCRIPTION AND <Z-I~ J 3'7 -LOCATION TWP NameLake No.TWP RangeSec.Lake Classif.Lake Name IDENTIFICATION: Please Print All Information. Tel. No.Zip No.Mailling Address —No. Street, City and StateInitial, First(1St Name OWNER X<a< :>S/3l r?JSEWAGE SYSTEM INSTALLER, Nam This System will be ready for inspection on.. 19. This space for office use only 19 Owner or Agent SignaturePhone Call Rec'd ByDate Rec'd Time Rec'd NUMBER OF BEDROOMS:ESTIMATED COST; SEWAGE DISPOSAL SYSTEM DATA: t SEEPAGE Pl/SEPTIC TANK DRAIN FIELD as752:»Sq. Ft.GIs.Sq. Ft.Capacity 7 Ft.Ft.Ft.Distance from nearest well 7 SiDSZJ Ft.Ft. Ft.Distance from lake or stream a?Ft.Ft. Ft.Distance from occupied building Ft.Ft.Distance from property line Ft. _33 Ft.Ft.Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS: , 19 , Time M ByInspection was made on .S~L% PERCQLATUDN TEST I3GX iM.ATA: Date of First Test 19 Rate IIIW..Date of Second Test 19 Rate a,'.,./2 33/.S:,First Test -I- 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 applicarit for the permit to notify the County Shoreland Management that the job is ready for inspection. (Call or use attached mailer notice.) A’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 nof commenced within six (6) months. Issued Date: Shoreland Management Of Fee $ Comments:. Form No. MKL-0771-003 [^tVIEW BATTLE LAKE, MINNESOTA \(4 INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS : SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORY Actual Should be Actual Actual'Should be Should be Capacity S FGIs.GIs.S F S F S F Distance from Nearest Well .■ 75 50FFFFF F Distance from Lake or Stream F F F F F-F 20Distance from Occupied Building 10 20,F F F F F F Distance from Property Line 1010 10FFFF F F Distance from Bottom to Water Table 33FFFFF 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 Agency* MKL-0771-003-BackCT .: 0 «\ 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 whii»-omc» ' Ymilow — Imptefor Fink — Owner Cord —Owner Permit No., . LEGAL aI-V ■DESCRIPTION AND LOCATION TWP NameTWPRangeLake Classlf.Sec.Lake 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, < - I - R'00fl|This System will be ready for inspection on. This space for office use only Time Rac'd t^hone Cyi-R^ d/gv^V Owner or Agent SignatureDate Rac'd MBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD GIs.Sq. Ft.Sq. Ft.Capacity Ft. Ft.Ft.Distance from nearest well Ft.Ft. Ft.Distance from lake or stream Ft.Ft.Ft.Distance from occupied building Ft.Ft.Ft.Distance from property line 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 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 $A -^ ! /certificate issuedComments:. Form No. MKL-0771-003 ^(^fVliW KATTIE LAKI, V.INNiSOTA ‘vy , ▼r*^ "‘ii 'V ■ t ■ \ r INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORY Actual Should be Actual Should be Actual Should be Capacity Distance from Nearest Well H T SP o SFGIs.GIs.S F S F %t./oOfp75 50FFFF F Distance from Lake or Stream /obypFFFF F ^(/1Distance from Occupied Building 10 20 20f<0Qf FFFFF F 8-rO ^ 10Distance from Property Line n-i 10 10FFF F F fDistance from Bottom to Water Table 33FFFFF F ^ Sr 1Inspector's Comments: M„rU-C:^9 yt/ tl U /vP U)/ L.'f-I 7 Date of Inspection Time of Inspection M Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs ~ Gallons SF ■ Square Feet F “ Linear Feet f Job Title AgencyMKL-0771-003> Backer ■i ■ ■ ■ ) / CERTIFICATE OF COMPLIANCE SEWAGE SYSTEM 1 26th V&cmbeA ]9_S±This certificate has been issued this day of.m to certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota.S..T The premises covered by this certificate are legally described as: t.S6-U6 1 Twp. ^37 VannRange 42Lake No.Sec. Twp. Name. I l-Udland Bexich Lot C that pt. S. RtveA. h-Sf' Ken ConnotiOwner:Name. 7623 Topptng Road, St. Loufi, MOAddress. m 63131Zip No. -7775977/ ryyPermit No. SP_ Malcolm K. Lee, Shoreland Administrator Signed bv^y Otter Tail County, Minnesota MKL-0871-009 r/.5 1S903S PERCOLATION TEST DATAMKL-0871 -028 LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, Minnesota 56537 .a f /•I'd 6T/J/ Ph. No. > ■Mailing Address:Owner:ttAJ i-Sae St. & No.'’^ ' V aJjl'6 Li/S Zip No.StateCityFirstMiddleLast Name y P^// a4^ J?/ Ue/[ NAME Legal Description:TWP NAMERANGETWP.SEC.LAKE OR RIVER NO. cP - J c ^ d 7^, S d 6 /pf 0 C ^ /P ^TEST HOLE NO. 2TEST HOLE NO. 1 ijt ■ /’X'/Z1Depth to Bottom of Hole inches; Diameter of Hole JnchesDepth To Bottom of Hole,inches; Diameter of Hole inches Depth, Inches Soil Texture Soil TextureDepth, Inches Date 19____ O ' !Percolation Test By____ Percolation Test Bv_^QLUFirm Name.FirmName,CC DaUlQC LU Address.CC Address <IC/3Otter Tail County License No..Otter Tail County License No..HCOUJMeasure ment, inches Percolation rate minutes per inch Drop in water level. Inches Time I ntervals minutes Percolation rate minutes per inch l-TimeInterval, minutes Measure ment inches Drop in water level, inches Remarks:Re*»farks:_Time TimeO§ 7^I-Ay?')'__ mr- s J-i j.:ao IP Ik-zOii4^^\0 0 AcPy/.O A'xa B.lA64^u qhla.JO_5 33I M4^ ... !■ Jjb n/JoOS 2^I V./ See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of MN Percolation rate “.minutes per Inchminutes per inch Percolation rate ® «4* 1 SHORELAISID MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 - Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM V' ite — Office V low — Inspector Ph.. — Owner Card — Owner Permit No., LEGAL Date DESCRIPTION •?- gz- A cji // rs>7 V?- AND MLOCATION TWP NameLake Classif.TWPLake No.Lake Name Sec.Range IDENTIFICATION: Please Print All Information. Tel. No.Zip No.Mailling Address —No. Street, City and StateFirstInitialLast Name &)J -?3 /^pOWNER SEWAGE SYSTEM INSTALLER Name , 19?'5:oc>This System will be ready for inspection on. This space for office use only 19 Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signature NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD GIs.Sq. Ft.Capacity zFt.Ft.Distance from nearest well v5 6 Ft.Ft.Distance from lake or stream /n Ft.Ft.Ft.Distance from occupied building inDistance 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 PERCOLATION TEST DATA:Date of First Test'v. Date of Second Test... , 19 iRa 19 late 1st Test Taken By First Tesi -I- 2nd Te^ 2 Rate2nd Test Taken By The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work inAgreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. (Call or use attached mailer notice.) Dated Signature Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six (6) months. Permit: Shoreland Management Office Issued Date: Fee $Surcharge $ 7^Comments:, Form No. MKL-0771-003 VICTOe LUNeCtH 4 CO.. PRlHTCao. PCK6US '4LL4. MlM. 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 te - Office V low — Inspector Pii.. Card — Owner Owner Permit No.,LEGAL -■ Date//■/: DESCRIPTION <■, /AND y- -''7 LOCATION i- ■ Lake Classif.TWP NameLake No.Lake Name Sec.TWP Range IDENTIFICATION: Please Print All Information. Zip No.Tel. No.First Initial Mailling Address —No. Street, City and StateLast Name //OWNER // SEWAGE SYSTEM INSTALLER Name This System will be ready for inspection on.I—. 19: This space for office use only I ,19 ,M 1Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signature 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 buildinq 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 ,JVI By PERCOLATION TEST DATA:Date of First Test,.19 , Rate Date of Second Test 19 , Rate 1st Test Taken By First Test -I- 2nd Test s: 2 Rate2nd Test Taken By The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work inAgreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. (Call or use attached mailer notice.) 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 $ rTIFICATE imspectep tcc UED -| Q ^ w ------- Comments:. HO ------HO^Form No. MKL-0771-003 veto* LuNociM a ce.. peiarcMl. riMdpg r»i.La. mimh.158906 INSPECTION RESULTS Inspector must make all measurements 4 SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORYActualShould be Actual Should be Actual Should be /Capacity I! O GIs.GIs.S F S F S F S F Oo S_oDistance from Nearest Well 50FFFF F / n.oo /f■foeDistance from Lake or Stream iFF F F /IDistance from Occupied Building / 201020FFF Fir>%D \Distance from Property Line 10 10 10FFFF F Distance from Bottom to Water Table 4 4FFFFF F Inspector's Comments; Date of Inspection !. Time of Inspection.M i Stature of InspectorINTERPRETATION OF ABBREVIATIONS GIs — Gallons SF “ Square Feet “ Linear Feet Job TitleF AgencyMKL-0771-003-Backer - .. 'J * ^ i i rj : J >