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Home My WebLink AboutLake Region Recreational Center_46000990894000_Septic System Permits_-y . - -•• -R^ >;:■' R.; ,R- R:> -■•-.RR *x’y -iR:^-:-■\R,R -R- y.. CERTIFICATE OF COMPLIANCE SEWAGE SYSTEM omt iMym. WRR! mm 30th January 19 76This certificate has been issued this day of.V-^ to certify compliance with regulations of ShoreIa)id Management Ordinanee, Otter Tail County, Minnesota. tilillThe premises covered by this certificate are legally described as: Lake No ^6-2h2 Sec.2B___ Pt. of G.L. #1| I3h Range 3*^ Twp. Name Ottpr Tail Lake Region Recreation Center Twp.V ltllii iLf' ■<% i tei=3i mA P« Wisi)fw9mvM Lake Region Recreation CenterOwner: Name. Route #2. Battle Lake. MinnesotaAddress.PI®p*jlM m Zip No. Permit No. SP_ Signed by:.. 'Malcolm K. Lee, Shoieland A Otter Tail County, Minnesota dministrator MKL-0871-009 ®159035 Luastt* « CO. rtisvt r«u.*. •>» 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 Yeilow — Inspector Pink ’Owner Card — Owner G-J Permit No.,LEGAL DateG°<tA=v~DESCRIPTION AND 39 C)/^r~lQ ! /LOCATION Lake No.Lake Name Lake Classif.Sec.TWP Range TWP Name IDENTIFICATION: Please Print All Information. Last Name First Initial Mailling Address —No, Street, City and State Zip No.Tel. No. /fJe>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 Rec'd Phone Call Rec'd By Owner or Agent Signa^ture /^Ct ^ 5 g-NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD ^<3.5 Sq. Ft.Capacity GIs.Sq./Ft./nnr-s Ft.Ft.^ r>Ft.Distance from nearest well ^ Ft.Distance from lake or stream Ft.Ft. Ft.Distance from occupied building Ft.Ft. Distance from property line 7 0 Ft./OFt.Ft. i/Distance from bottom to Water Table Ft.Ft.Ft. AH distances are shortest distance between nearest/points T RECORD OF TESTS: Inspection was made on 19 , Time ..........M By........... ., 19....Rate , 19 /PERCOLATION TEST DATA:Date of First Test /Date of Second Test , Rate 1st Test Taken By //JFirst Test -I- 2nd Test 22nd Test Taken By Rate 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. (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 V /?. /IlAjLLAjDated. Sibnature 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 (j Issued Date: Fee Surcharge $_H IrJi/ jQ I/nComments:. Form No. MKL-0771-003 @ vieroa uni»C(h » co.. Mianat. ria«u» r«LLt...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 -----PWhite — Office Yellow — Inspector Pink Owner Card — Owner * //yG./r Permit No.. /LEGAL / Date/r TDESCRIPTION//' AND mh r")G /' ■ ) 9LOCATION Lake No, Lake Name Lake ClassIf.Sec.TWP Range TWP Name IDENTIFICATION: Please Print All Information. Mailling Address —No. Street, City and StateFirstInitialLast Name Zip No. Tel. No. OWNER ■-V, SEWAGE SYSTEM INSTALLER Name. 5 /K crcn^This System will be nady for inspection on.o ~~, 19. This space for office use only /n - 3 "S .19 -M Date Rac'd Time Rec'd Phone Call Rec'd By Owner or Agent Signature " NUMBER OF BEDROOMS:iESTIMATED COST;' A i; SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD GIs.Capacity Sq. Ft.Sq. Ft. Ft.Ft.Ft.Distance from nearest well A' • :5r>Ft.Ft.Distance from lake or stream Ft. Ft.Distance from occupied building Ft.Ft. Distance from property line Ft.Ft.Ft. /Ft.Distance from bottom to Water Table Ft.Ft. AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on ,, 19 , Time JVI By. ..>..G ,/ '' /»<r.'PERCOLATION TEST DATA:Date of First Test , 19 Rate /t Date of Second Test , 19 , Rate 1st Test Taken By j /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: 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: horeland Management Officef—- / \ - J ■- C'l >( ri / s Fee $Surcharge $ r ^ /"7 rComments:. Form No. MKL-0771-003 viero* uineiiH t ce.. aaiauiit. m*<u* h>«n.158906 , T- , «-t >4INSPECTION RESULTS •i Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORYActualShould be Actual Should be Actual Should be /OOPCapacity GIs.GIs.s F s F S F S F Distance from Nearest Well 75 50FF F F F /MT FDistance from Lake or Stream F F F F Lu.Distance from Occupied Building 201020FF F F F •1-Distance from Property Line 10 10 10FFF F F FDistance from Bottom to Water Table 4 4FF F F F Inspector's Comments:fis. ti( L> y-nCjpf . t A A ?P/i i ^T77 i Date of Inspection 19___ Time of Inspection,M '•V Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs “ Gallons SF * Square Feet = Linear Feet ;■ Job TitleF Agency MKL-0771-003-Backer ■1‘ ■ Lj/ild ‘ ‘ r-ICi 'V . S‘. n i : , >1 ■ il'C V .'ivii, 'qa ■ ■•'-'iH- s .■C! 'f ^ r ‘ y ' l-ii n-V: •I i > > « PERCOLATION TEST DATA Price $ 1.00 per pad. SHORELAND MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Mailing Address: Ph. No. Owner: A'"/- T/^' /> aL First NAME Iqea fJe %//A' Last Name Middle St. & No.Zip No.City State Legal Description: LAKE OR RIVER NO. r> r.tSEC.TWP.RANGE TWP NAME -3e<r K-f n^^p/3y - TEST HOLE NO. 2TEST HOLE NO. 1 ^2i i_kDepth to Bottom of Hole inches; Diameter of Hole inchesDepth To Bottom of Hole,inches; Diameter of Hole inches 19 19^Soil TextureDepth, I nches Depth. Inches Soil TextureDate.Date i C £> '¥ ‘v <17 A'Percolation Test By____rS O ■ t ^Percolation Test By .y^l& -7 ^ t t -rl7^- .^7 Q ntuFirm Name,Firm Name. QC DoUJ ocn Address ^ ^ ^^ LU QC Address < COOtter Tail County License No..Otter Tail County License No..I-coLUMeasurement, Inches Depth In Water Level, Inches I-Measurement, ____Inches Depth in Water Level. Inches Time Remarks Time Remarks oV z/5 g? 7/*/ II A ////zn 'g) 7 7 s:?y7 /-3/ / //■//T. - r i2^>4 7 3 7^7?7/.77 7r>/ > 7•?//3 '/S -? y X3 - /■jrC /r/L- s3 77C^-</T’ t t-■ip ^_________7T^ ' __________ /y r/Z , _ MKL-0871-028159179 ®VlCTD* LONDCCM t CO CDiNrc** FCIiauS FACCS HINN See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn.