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Home My WebLink AboutLake Side Camp_20000310190001_Septic System Permits_OTTER TAIL COUNTY LAND & RESOURCE MANAGEMENT PUBLIC WORKS DIVISION WVWV.CQ OTTER-TAIL MN USpmiiTiiit GOVERNMENT SERVICES CENTER 540 WEST RR AVENUE FERGUS FALLS, MN 56537 218-998-8095 FAX: 218-998-8112 seraClick here to enter a date. Richard H & Marcia Wieler 40225 Purlieu Rd DentMN 56528 9108 RE: Primary Owner: Richard H & Marcia Wieler Sewage Treatment System Servicing Tax Parcel Number: 20000310190001 Described as:Sec 31 Twp Edna Township Sect-31 Twp-136 Range-040 17.99 AC PT GLS 6 & 7 COM NW COR GL 6, Lake: 56-384 Pine As of 09/08/2017 the holding tanks (Sewage Treatment Installation Permit # 24836 servicing your property was determined to be in compliance with the provisions of the Sanitation Code of Otter Tail County. Please be advised that this certification is only valid for five years from the date of this inspection 9/11/2022. If you have any questions regarding this matter, please contact our office. Sincerely Alexander Kvidt Inspector 8/23/2017 https://onegov.co.ot1ertail.mn.us/admst/viewcard.php?card=2&app=1160 OTTER TAIL COUNTY Land & Resource Management * Phone (218) 998-8095 O PERMIT TYPE Sewer Permit PERMIT NUMBER See Work Authorized PROPERTY OWNER Richard H & Marcia Wieler LAKE INFORMATION Pine DNR ID(S)384 LOCATION Parcel(s): 20000310190001 Township Name: Edna Township Section/Township/Range: Sect-31 Twp-136 Range-040 Legal: 17.99 AC PT GLS 6 & 7 COM NW COR GL 6, S 719.6', E 436.7', S 840' TO WORK AUTHORIZED Sewer Permit # 24836. Install 3 1500 gallon Holding Tanks. Kyle Westergard 08/23/2017 07:36 AM b930828512817aef9ce11942577d0d72 3c8f36d70acc3930c51 a568c9d7ffb35 08/23/2017 08/23/2018 ISSUE DATE DATE EXPIRESLand and Resource Management Official/Date NOTE: • This permit must be placed in a conspicuous place not more than 6 feet above grade on the premises on which work is to be done, and must be maintained there until completion of such work. • If the terms of this permit are violated, the entire permit maybe revoked and the owner/contractor maybe subject to legal prosecution. • Property Owner is legally reponsible for all surface water drainage which may occur. • Topographical Alteration projects shall be stabilized within 10 days of the completion unless otherwise stated. • No part of the Septic System shall be covered until it has been inspected or approved. • Notify Land & Resource Management when job is ready for inspection (218) 998-8095. 1/1https://onegov.co.ottertail.mn.us/admst/viewcard.php?card=2&app=1160 SEWAGE TREATMENPSYSTEM^PERMITINSPECTIQN^ESULTS ■r nA/: fiMf 'i ' : *fZ/i 1^ < fV; - Sm^^o// Itestment Area) OUmOUSE TRENCH REDUCTIONHOLDING I SEPTIC TANK ^yrfTANK ;2CATEGORY Rock trenchK^JiHs.l^dO GLS.inchesCapacityGLS. Ma/of sidewall for %Setback from Nearest Well FT FT i^i^qd^lentto ' reductiotiSetback from Buried Water Suction Pipe f|255^FT FT FT Setback from Buried Pipe Distributing Water Under Pressure 16^STA CALCULATIOJhh10FTFTFT16lent ml■pSetback from OHWL (lake &/or river)FT FT FT Ft, Setback from Bjuff FT FT FT Ft* i-Mi j‘^r-^UND/AT-GRADESetback from Dwelling FT FT T 6-61(/<■- Setback from Non-Dwelling FT FT FT Setback from Nearest Property Line FT FT FT C5^4-Setback from Right-of-Way FT FT FT XElevation above Restrictive Layer FT FT FT «3ANn IN —r FtINSTALLERS COMMENTS SEPTIC TANK(s)YES □ NOHolding Tank / Lift Alarm ■?# Tanks InstalledYES □ NOOld System Purnped & Destroyed Weep Holes.<2-f-}n [ih Hiihr d- 3-Kda »nManuf. Mnmhcrof I atetato-*Lateral Pipe Size IN Model #Perforation Diameter SizePerforation ^pacing-INFT X'FILTERS OYES NOFeet of Total HeadPUMP^.Gallon&.Pof-Minntg' $7)'/. rul^Inspector's Comments: »r lojl.rUC/ p/^ Sketch: 1^0 HT \(;b0 itr ■the above described sewage system installationAs of was found to be compliant with the provisions of the Sanitation Code of Otter Tail Countv.Initial/LSROf/idalTimeDate i. QMlt Lane & Resource Management Ondal 357,243 • Victor Lundosn Co., Printers * Fergus Falls, MinnesotaForm No. BK — 04-2014-06 8/9/2017 OneGov Land & Resource Management Government Services Center 540 Fir Avenue West Fergus Falls MN 56537 Phone: 218-998-8095OTTER TflllOOOriTT-IBIIIIIfOTA Sewer Permit Permit #______ Applicant Information Applicant Information:; Name: i Wayne D Johnson!; Phone: I Email Address: i gdigger@loretel.net i ^ Mailing Address: i! 38992 183rd Ave :j Pelican Rapjds Mi 56572 i Agent/Designer ! ( I am the: Is this Sewer Permit Application for a No Collector System? Work Performed By Work to be performed by:Contractor Contractor's Contact Information Contractor Information:: Name; I Wayne D Johnson I Company or Business Name: Super Septic & Excavation l I Contractor License Number. i L901 1 Additional Phone:: Phone:1 U215 )863 -jm ijn(?18 >863 -3373 ; Email: gdigger@loretel.net ' Address: i 38992 183rd Aye I Pelican Rapids Mi 56572 I i Property Owner*s Contact Information Property Owner Contact Information: Name:I Rick & Marcia Wieter I Phone:i ;-(2ie )758 -2777 Email Address: ; mjcayley@9mail.com Mailing Address:i ::«40225 Purlieu Rd ;I i I Dent MN 56528 ! Property Information Property Please search by one of following: Parcel U, name of Physical Address. Click the blue "Select" to select Selected: Property Attributes Legal DescriptionProperty Address Primary Name/Address Parcel U Property Address City Section/TownshIp/Range Legal Description Legal Description Legal Description Name Primary Address Line 1 City 20000310190001 PT GLS 6 & 7 COM NW COR GL Sect-31 Twp-136 Range-17.99 AC S 719.6'. E 436.7’. S 840* TO RICHARD 40225 PURLIEU RD DENT 040 H& 6.MARCIA WIELER Is the property Developed Developed or Undeveloped? Is the property foreland located in the Shoreland or Non- Shoreland area? Shoreland Information Associated Lakes:Selected: Lake Name DNR ID Lake Class LRCD 56-384Pine384NE Bluff:No https://onegov.co.ottertail.mn.us/view.php?id=1160&viewOnly=1&p=1/2 8/9/2017 OneGov Project Information Type Of Installation:Other Establishment - Replacement Design Flow: System Type: 1 (0^,499 Gallons Per Mill System Components Type II Components:Holding Tank (Contract Required) 25 FeetDepth of Well; Number of Bedrooms:5 Abatement:Yes Garbage Disposal: Ejector: Number of Tanks: No 3!' Number of Lifts: Number of Soil Treatment Areas: 0 9 Septic/Holdinq Tank(s) Total Capacity of Septic/Hoiding Tank(s):4^00 Gallons Setback to Nearest Well:60 Feet Setback to Ordinary High Water Level: 50 Feet na Feet 5 Feet »50 Feet •t-50 Feet +100 Feet Setback to Bluff: Setback to Dwelling: Setback to Non*Owelling: Setback to Nearest Lot Line: Setback to Road Right-of-Way: Documentation r'Attach Supporting Documentation:File 1: Management_Plan_01.pdf File 2: weiier_site_data.pdf File 3: Wielers__Resort_cabins_map.pdfL . JApplicant Approval Applicant Signature: Date Signed: Please check to approve: 08/09/2017 I understand that checking this box constitutes a legal signature Terms 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 accordance with Sanitation Code of Otter Tail County, Minnesota. Applicant agrees that the Attached Documentation 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. Note Once a permit is approved it is valid for a period of twelve (12) months from the date of approval unless otherwise indicated on permit. A sower permit does not include the building sower (sower lino).i Invoice 08/09/2017 QuantityCharge Cost Total Grand Total $0.00Total (Unpaid) Approvals SignatureApproval #1 Received and Assigned Andrea Skogen - 08/09/2017 3:18 PM 5e3cfe8cff3baa0ca22ec844b6822b34 Ie9237879ef3a239flf5c8986084f576 #2 /Application Review #3 Application Approval ( https;//onegov.co.ottertail.mn.us/vtew.php?id=1160&viewOnly=1&p=2/2 Subsurface Sewage Treatment System Management Plan Sewage Treatment System Permit Number: Property Owner Rick & Marcia Wieler Parcel Number 20-000-31-0190-001 Lake Name / Numbe Pine 56-384 NE Section 31 Township Name Edna E-911 Address: 40225 Purlieu Rd 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: __Leaks - Check (look, listen) for leaks in toilets and dripping faucets. Repair leaks promptly. __Surfacing sewage - Regularly check for wet or spongy soil around your soil treatment area. __Alarms - Alarm signals when there is a problem. Contact a service provider any time an alarm signals. __Vegitative cover - Establish and maintain a vegitative cover over your treatment system. Professional Management Tasks: every 24 months or less if needed. __Check to make sure tank is not leaking __Check and clean the in-tank effluent filter __Check the sludge/scum layer levels in all septic tanks __Recommend if tank should be pumped __Check inlet and outlet baffles __Check the drainfield effluent levels in the rock layer __Check the pump and alarm system functions __Check wiring for corrosion and function __Check manhole covers (accessibility, security, damage) and inspection pipe caps (broken or missing) __Provide homeowner with list of results and any action to be taken __Flush and clean laterals if cleanouts exist (pressure distribution only) __Record event counter reading “I understand it is my responsibility to properly operate and maintain the sewage treatment system on this property, utilizing the Management Plan. If requirements in the Management Plan are not met, I will promptly notify the permitting authority and take necessary corrective actions. If I have a new system, I agree to adequately protect the reserve area for future use as a soil treatment system.” Property Owner Signature:Date: Received by:Date: For more informantion go to www.septicandexcavation.com or search for "MN septic system owners guide" Plan prepared by; Wayne Johnson, Super Septic and Excavation, Phone; 218-863-3373 MPCA License # 901 Land & Resource ManagementOtter Tail County Government Services Center, 540 W Fir Fergus Falls, MN 56537 218-998-8095 www.co.otter-tail.mn.us FAX: 218-998-8112 SITE DATA WORKSHEET Property Information: Lake / River Number Lake / River Class SectionLake / River Name Township Name 56-384 NEPine 56-384 NE 31 Edna Parcel Numbeits)Property's E-911 Address . 20-000-31-0190-001 40225 Purlieu Rd Property Owner Information: Name(s): Mailing Address: 40??s PtjriiP.u Rd Rick & Marcia Wieler £>ent MN Designer Information: Name:MPCA License Number:Wavne Johnson I gni Firm Name:License Category:Super Septic & Excavation Mvanced Designer Mailing Address:38992 183rd Ave, Pelican Rapids, MN 56572 Wayne@septicandexcavation.comE-Mail Address: Phone Number:218-863-3373 Cell: 218-863-7500 Sewage Treatment System Design Information: Number of Bedrooms: Garbage Disposal: Yes jXl No Well: Casing Depth: I Sewer Line Separation: Ft. Floodplain: __Yes No Vegetation: Aquatic [“^Terrestrial Slope at Installation Site: I i% Type of Observation: I j Probe j I Pit __Boring Parent Material: ^Till | | Outwash Original Soil: Yes | | No Compacted Soil: Q] Yes No Depth of Boring (to 7’ or restrictive layer):![Ft. □ Yes I^NoBluff: I [Bedrock | [AlluviumLoess In. 7 ^^/Signature of Licens^l4}esigner LR: Oriline Permitting Fcxma 2016: Site Data Vitorksheet Fillabla 03-09-2016 9Date North t I i#I I Rick & Marcia Wieler 40225 Purlieu Rd Dent, MN 56528 Pine Lake 56-384 NE Parcel: 20000310190001 ____€)O O / Replace existing cesspools with holding tanks y /Well #2 #3 #5 I T \\\ - o o o Pine Lake 56-^84 camper #4 Wetland, not lake //Super Septic & Excavation Wayne Johnson, Advanced Designer/ Inspector 38992183rd Ave Pelican Rapids, MN 56572 License #901 218-863-3373 — Setback Line — Lot Line -----Sewer Lines Drain Field -----Structures /Scale: 1" = 30'/ I — 30.00' —^; I I I I Scott Ellingson Scott Ellingson Wednesday, March 15, 2017 8:11 AM 'Wayne@septicandexcavation.com' Wieler's Resort From: Sent: To: Subject: Good morning Wayne, yesterday I had a chance to go over the flows you provided to our office. Upon reviewing them they all look good. Otter Tail County will agree that 4500 gals of septic tank would be the correct sizing for the boys dorm rooms. Thanks Land & Resource Management Inspector Otter Tail County 218-998-8100 sellinqs@co.ottertail.mn.us seraii. 1 ms ifoj 4^^ ■bpo _in'%tt-J!i if-tl'llf i^-'Z^' /^ U'ZH'L^ i)- 'bb'Ilf 1' \^He l-Z-K^ ,. 7' 3 '4 7 'H-/C 7'S'y^ I'k'llf. 1'l'l(f l'lb-l(e 7'I\-Iif> 7' /^'/^^ 7' 7'/V"/^ n'i6-.l(f I'Kf'Kf'i-Vl-'io 4 4,^‘ZS n, tld //, /7, //O /■4/. 4Z(2 ; <76 ! /1, Hib %ia4A il, If 7Xb>MiC> "‘>•4H i’-p* 7 - / 'i-'ijf 7' /7 I'-lOrKf 7' z-Z'/iJ' 7'Z5'llf 7' 7^ 7.4','^ oMo/ MIOUtU«U5 $VP2T T tt rl_(p^ 7-_J/-yA.^ t- 2-/A ir« ' loZJi,- 7'-lh 2^' %Hk. &lJ6'/k^. S'' ildJn '^-11'Ho 2Ajj-eo ..30,6()0_ __ ^'2y_21<5 14/ 0>4_ . %T,AOi__ 357ZZ4 HO. 5^0 -. -.-■ ( ~D7V/A?(S~Wj^KX: /,3Hl> 0:-tO'IQ, ^ (i, '■Zi '-/(f, (f'tZ'll) (m y'-'Z-^'/lf, IflO'tif if "2^'/7^'29'"/^ 4»'35'/i7 7- / '/<5!’ _____7'V"/(i 7 7“^ Z(fi "" 7-7'/^. 1-9-11, I'JO'K^ l-l[-l(f l-(^■'L!f rii-Kf "7^/ y l-lS'l{f l-f&'llf — 7-/7-/^ ■ 3/7^<^ ■5"V2J 7^ 7-Z-O =7/ “770 III 5" 70 / .. ^6>0 / 7, /T;X//4'fe2> 2-^y 19 4 / .Uei l-24 . _* -- R7 ?7, <74)/ 7'-/9'-/^ 7-'24'-/>; 7 •'2/'-/^ I'll-'lb l-pl-Kf /"^5V<7 1^9,:29().i 5_Q^^ .-gJTo. 5 ?/ !M0. 5^7 190 )7Z- MiQUTlAMS 3JKSV aSAiOruJ ■7 rso'/o _ t-l -/^ g'' ,Z-/<^ Ti' S) /L> g" - ^'3'/L 2'" I'lZf'2rj^" / (e_ Ql, 1 It) h^t ,V/@ i/<r, f'S'o H, t 70 1 5 , 74, ■?(#£■ 'I?, 70 777/ 700 erz-/ 4/g> ?v,?70 ‘9''=f/(>7ay 5-=d/>Ar'9a, ?m ■.-I- U)£JL-Kt>% Sie ^CLC^ MO'Admus &IZLA s,/ /,- 2/) - /^ h-H' /^ tf- 1:i,' !(« k'lH'I (/_ I l^'iS'lip Id'lie' t <a ki-k /L> -^->^>10 7 7a,T7-d-. Wi_i_7’ku /■Li.k-kQ- / 'h, 6 i^ kP>Ci'lif l-'I'lb 2rS'/7,_ 7-V7f _7'5'/A I'JrJk I't'IU 1' 9-/L I /'i/w*lu/JaA oOe/tt(\flu) CU^\>i/v- i vvd 1■v^. /jsy 7-20-/// 7-//-/(i 7- /7-/6 ^17-/2 7(^ I'lb'/i, I'/O'/O ■•'■;?.■ jnjV eW-.i 7-/ 7-/2 7'Z!'/6> JU' aH, 6 *-< 30/ 4<£ D ^7, ^10 1TZZ-/I. I'li'/l,^ b ! ^■2. IrJLTzlL 7'7, h /(, Vi. m 1^ , Q.ZQ iV/,.3 3_(3. S,-z2rlL Ti' 5'tiff /4 %7jfLUJfL g'- / 3:Acik- ^'lO-it. 3fl.l'iii> ^'f‘7-n. ^ 10 _y_5,_2_Sl m7. i'f ' MKKJBJWJS Wieler's Resort Boy's Dormitory A B C D E F G H gallons useddaydatemeter reading1 % capacity max flow 7 day average 2 1 20-Jun 1360 760 81.8%J28.89 886.98 953.333 2 21-Jun 2120 780 81.8%874.76 3 35^.054 22-Jun 2900 780 81.8%953.33 According to Wielers, 45 boys staying, 55 is maximum capacity 5 4 23-Jun 3680 653 81.8%798.11 756.90 81.8%6 5 24-Jun 4333 653 798.11 676.94 6 25-Jun 49867 654 81.8%799,33 672.05 8 7 26-Jun 5640 800 81.8%977.78 666.98 645;!^9 8 27-Jun 6440 690 81.8%843.33 10 9 28-Jun 7130 690 81.8%843.33 642.54 Yellow boxes are averaged or estimated flows 11 10 29-Jun 7820 195 81.8%238.33 632.94 12 11 30-Jun 8015 195 81.8%238.33 744.25 1-Jul13 12 8210 625 81.8%763.89 855.56 2-Jul1413 8835 625 81.8%763.89 1018.81 3-Jul15 14 9460 675 81.8%825.00 1029.29 4-Jul1615 10135 675 81.8%825.00 1031.03 5-Jul1716 10810 635 81.8%776.11 1032.78 ^Maximum 7 day average flow, 1041.51 gallons per day. Design flow 1042 / 0.70 = 1490 gallons per day. Design flow * 3 = tank sizing, = 4500 gallons. 1041.51186-Jul17 11445 832.5 81.8%1017.50 m 1017.5d7-Jul19 18 12277.5 832.5 81.8%1035.83 8-Jul2019 13110 1560 81.8%1906.67 1016.19 9-Jul2120 14670 685 81.8%837.22 869.52 22 21 10-Jul 15355 685 81.8%i 837.22 882.62 11-Jul23 22 16040 685 81.8%S 837.22 856.08 12-Jul2423 16725 685 81.8% 837.22 977.78 817.01 13-Jul2524 17410 800 81.8%784.14 25 14-Jul26 18210 720 81.8%880.00 751.74 15-Jul2726 18930 720 81.8%880.00 734.81 16-Jul2827 19650 760 81.8%928.89 726.96 17-Jul2928 20410 533 81.8%651.44 712.12♦According to Wielers, 52 boys were staying, 55 is maximum capacity18-Jul3029 20943 533 94.5%563.75 712.73 19-Jul3130 21476 94.5%574 607.12 725.88 32 31 20-Jul 22050 710 94.5%750.96 693.54 Signed:Date; Wieler's Resort Boy's Dormitory A B C D E F G H 21-Jul33 32 22760 720 94.5%761.54 719.23 22-Jul3433 23480 780 94.5%825.00 743.41 23-Jul3534 24260 780 94.5%825.00 758.52 24-Jul36 35 25040 620 94.5%655.77 732.83 25-Jul3736 25660 620 94.5%655.77 731.32 26-Jul38 37 26280 360 94.5%380.77 750.96 27-Jul3938 26640 880 94.5%930.77 929.26 28-Jul4039 27520 880 94.5%930.77 894.20 29-Jul4140 28400 94.5%880 930.77 859.15 42 30-Jul41 29280 610 94.5%645.19 824.09 31-Jul 298904342 610 94.5%645.19 829.84 44 43 1-Aug 30500 750 94.5%793.27 835.58 2-Aug45 44 31250 1540 94.5%1628.85 868.82 46 45 3-Aug 32790 648 94.5%685.38 754.74 4647 4-Aug 33438 648 94.5%685.38 775.44 48 47 5-Aug 34086 648 94.5%685.38 753.83 49 48 6-Aug 34734 648 94.5%685.38 732.23 4950 7-Aug 35382 648 94.5%685.38 710.62 5051 8-Aug 36030 970 94.5%1025.96 689.01 52 51 9-Aug 37000 785 94.5%830.29 632.85 53 52 10-Aug 37785 785 94.5%830.29 593.37 5354 11-Aug 38570 505 94.5%534.13 534.13 39075555412-Aug 505 94.5%534.13 534.13 56 55 13-Aug 39580 505 94.5%534.13 534.13 57 56 14-Aug 40085 505 94.5%534.13 534.13 58 57 15-Aug 40590 59 60 According to a conversation with Wielers on February 23, 2017 The boys dorm maximum capacity is 55 persons, the girls dorm is 55 persons but they have an overflow bunkhouse for the girls that holds an additional 25 girls, that facility uses the restroom facility in the girls dorm. 61 62 63 64 65 Signed:Date: Denise Gubrud Denise Gubrud Wednesday, June 06, 2018 10:24 AM 'jthomaso@co.ottertail.mn.us' RE: Wieler, Richard: Failure to Comply with Abatement Notice; Crt FN: 56-CR-18-516 From: Sent: To: Subject: Jake, I have no record of an extension for this case. I do not have a Permit Issued or Pending for this property. Even if the contractor is behind, we would require some communication from Mr. Wieler prior to dismissing this case. L&R considers this an active case at this time. Denise ----Original Message----- From: jthomaso@co.ottertail.mn.us <jthomaso@co.ottertail.mn.us> Sent: Thursday, May 31, 2018 2:17 PM To: Denise Gubrud <DGubrud@co.ottertail.mn.us> Subject: Wieler, Richard: Failure to Comply with Abatement Notice; Crt FN: 56-CR-18-516 Hi Denise, Any updates on this case? I received word that the contractor was taking responsibility for the lack of progress. Is L&R need to keep this open? Thanks, Jake ^1^ &>fS ddvwv t\iuj 4x> 1 OTTER TAIL COUNTY LAND & RESOURCE MANAGEMENT PUBLIC WORKS DIVISION 'AWW.CO OTTER-TAIL MN US GOVERNMENT SERVICES CENTER 540 WEST RR AVENUE FERGUS FALLS, MN 56537 218-998-8095 FAX: 218-998-8112 February 1, 2018 Richard H & Marcia Wieler 40225 Purlieu Rd DentMN 56528 9108 RE: PIN: 20000310190002 Described as:Sec 31 Sect-31 Twp-136 Range-040 2.05 AC PT GL 7 COM NW COR SW1/4, S Twp Edna Township Lake: 56-384 Pine You are hereby notified that you have violated the Shoreland Management Ordinance of Otter Tail County, Minnesota pursuant to MINN. STATUTES CHAPT. 394 AND SEC. 103F.201 THROUGH 103F.221. The nature of the violation is as follows: Failure to comply with an abatement notice This violation referred to the Otter Tail County Attorney’s Office for legal action. Alexander Kvidt Land & Resource Management Official ^ 111>■«<d - ’ • f. STATE OF MINNESOTA ) )ss. AFFIDAVIT OF SERVICE BY MAIL COUNTY OF OTTER TAIL) Alexander Kvidt Minnesota, being duly sworn, says that on February 1, 2018 she/he served the annexed: in the City of Fergus Falls, County of Otter Tail, in the State of VIOLATION On the following person(s), 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(s) at the following address; Richard H & Marcia Wieler 40225 Purlieu Rd DentMN 56528 9108 rander KvidtAle Land & Resource Management Official Subscribed and sworn to before me on February 1, 2018 BRITTANY ANNE WALTERS NOTARY PUBLIC ' MINNESOTA | My Commlssian Explnes Jan. 31,2021 Nfet^ry Pub ic My Commission Expires January 31, 2021 6..:^ Original - Owner Yellow - Oounty Atty. Pir\k - LRO VIOLATION ^ O'hiCigName •Ku V!, < u.Address City/State/Zip ^ Lake No. 56- AW ^?/py SH Lake Name_LliitL oc>Jt33/cO/^-/Parcel No.V. Legal Description You are hereby notified that you have violated the Shoreland Management Ordinance of Otter Tail County, Minnesota pur suant to MINN. STATUTES CHAPT. 394 AND SEC. 103F.201 THROUGH 103F.221.The nature of the violation is as follows: iic''jJ__W i W! M Ji -i-iil ic: nr .,r:H You MUST CONTACT the Land & Resource Management Office, Government Services Center, West Fir Ave., Fergus Falls, Minnesota on or before_______ Attorney’s Office for legal action. This violation mayiae referred to the Otter Tail County ;DATED: UPhone: 218-998-8095 Land & Resource-Management OfficialBK 0706-001 326.779 • Victor Lundeen Co., Printers. Fergus Falls. MN ^ ,<> f I»f ^ ----J STATE OF MINNESOTA) )ss. AFFIDAVIT OF SERVICE BY MAIL COUNTY OF OTTER TAIL) Michelle Jevne, of the City of Fergus Falls, County of Otter Tail, in the State of Minnesota, being duly sworn, says that on the of January 2017, she served the annexed: VIOLATION no. 3590 On the following person(s), 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(s) at the following address: Richard & Marcia Wieler (Lakeside Camp) 40225 Purlieu Rd Dent, MN 56528-9108 Micl^elle Jevne ’ ^ Land & Resource Management A k ^a Subscribed and sworn to before me this 10‘^ of January in the year of 2017. AlU.\ It Notary Public My Commission Expires January 31, 2020 LR FontiLtrs-Affidavit of Mail-Violations 02/2016 CHRONOLOGY REGARDING THE SEWAGE SYSTEM INSPECTION PROGRAM Primary Owner Richard H & Marcia Wieler Alternate Owner Richard H & Marcia Wieler Lake Parcel No 20000310190002 GIS Address 40225 PURLIEU RD ^777 Date of Compliant Letter Date of Non-Compliant Letter Date Initial Response (owner) Date Sewer Permit Issued Date Abatement Notice Date Violation Issued Date to County Attorney Date Resolved No Further Action f-ld-e.'t €>c4^r hf To jot, doiyy . U) C/tr]Ui lOC. M«)cf TV Comments: // -/i?f Chronology Sewage System Inspection Program 1-2014 / flyi 7~'^ <f-4-^ I A> O^/fer^P'l^i XjO ^ oOtAy 'ef Alft'^C'CL U}c\<A. aW£y.c. a^l dtc<‘oCc H >*T' 'Sc|?-f-tf^iv\S)t ISo ijpcJ^ Z.oab\*^S OKIC 5 cab'iyy^ bISO Cjpd K 5 - J750 <3P0^ yaj<c^ feo r-N 1l__\ t*<*)«Oi>^ €<acu dcx rv\ Wi U be, 5b /f Y3 P‘^^c>»\ €si/5b <yp<3( uv^iiv ,^o/ , l^r ^ W/ 11|4rr'i tOUV fejz^ -C,'x€jeJl (4- cfcvf "Hii'j <S.|| iAMf^ 4o 'P/jt- io\,|T cJo<»v\ , Oiy^ft<'o^cC ^>^SpiCJ-iO^ <5*^ bc^k-^ . mI(in -fix-eit O'^’ l/fv Op ^.F. ^\( FvV» I * OTTER TAIL COUNTY LAND & RESOURCE MANAGEMENT PUBLIC WORKS DIVISION WWW CO.OTTER-TAIL MN US GOVERNMENT SERVICES CENTER 540 WEST FIR AVENUE FERGUS FALLS. MN 56537 218-998-8095 FAX: 218-998-8112 01/11/2016 SEWAGE SYSTEM ABATEMENT NOTICE Richard H & Marcia Wieler 40225 Puriieu Rd DentMN 56528 9108 CURRENT PROPERTY OWNER: Parcel Number:20000310190002 Section:31 Town/City:Edna Township Lake Name:Pine Property Address:40225 PURLIEU RD 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 Sanitation Code of Otter Tail County. Please be advised that you must correct this situation by 02/11/2016. You should contact this office in order to determine what corrections and permits are required prior to complying with this notification. Inspector U.S. Postal Service TM CERTIFIED MAIL.,, RECEIPT (Domestic Mail Only; No Insurance Coverage Provided)□□For delivery Intormatlon visit our website at www.usps.com.□ i:1-^ $Postageru Certified Fee ^ Return Receipt Fee Q (Endorsement Required) Restricted Delivery Fee I—I (Endorsement Required) Postmartt Here □ ^ Total Postage & Feesm ^entfo yA^lt....£u.r\.ku...^....... ru 'Sireei'ApiWo.': or PO Box No.civsiatirzipir' a 1 PS Form 3800. August e'Uuu See Reverse for Inslructions OTTER TAIL COUNTY LAND & RESOURCE MANAGEMENT PUBLIC WORKS DIVISION WVWV.CO OTTER-TAIL MN USOTTfRTIIIl • •••*• •••••!•»■ GOVERNMENT SERVICES CENTER 540'WEST FIR AVENUE FERGUS FALLS, MN 56537 218-998-8095 FAX: 218-998-8112 08/11/2014 Richard H & Marcia Wieler 40225 Purlieu Rd DentMN 56528 9108 RE: Primary Owner Richard H & Marcia Wieler Result of Onsite Sewage System Inspection, Non-Compliant Parcel(s) 20000310190002 Lake Name Pine Lake No 56-384 Class NE Dear Richard H & Marcia Wieler: As part of Otter Tail County’s ongoing Sewage System Inspection Program, our Office inspected your sewer system located at 40225 PURLIEU RD on 7/11/2014. At that time, we found your sewage system to be non-compliant for the following reason(s): Cesspool * Failed drainfield w/surface discharge No riser - no access Unknown final treatment Unsealed tank Private compliance inspection required Please contact our Office by 09/12/2014, at 218-998-8095, so that this matter can hopefully be resolved. Sincerely, George Hausske Inspector Michael Douglas Inspector SCAHNED SEWAGE SYSTEM INSPECTION PROGRAM FIELD NOTES LAKE NO.: E-911 ADDRESS: LAKE CLASS:LAKE NAME: PARCEL NO.: SECTION NO.: TOWNSHIP: RANGE:TOWNSHIP NAME: PROPERTY OWNER(S): MAILING ADDRESS CITY, STATE Zip: ONSITE INSPECTION FINDINGS - SKETCH ON BACK: Drywell Straight Pipe Primitive Dwelling Septic Tank/Drainfieid Cesspooi Porta Potty Seepage Pit Surface Discharge Outhouse Hoiding Tank Leaching Pit Sink Drain SEPARATION / SETBACK DISTANCES (in feet): TANK OUTHOUSEABSORPTION AREA OHWL RESTRICTIVE LAYER WELL ONSITE INSPECTION RESULTS: IMMINENT THREAT TO PUBLIC SAFETY OR HEALTH (Send 10 Day Abatement Notice) COMPLIANT (Send Compliant Letter) NO FURTHER ACTION NECESSARY^ NON-COMPLIANT (Send Non-Compllant Letter) REVISIT COMMENTS: ^ . All i>4sfecr-J) *'•’ Boys *- J Inspector’s Sigffature(s) SCMlHtO Sewage System Inspection Program - FiSra Notes Form 07-19-2011NoExisting File:Yes ■ ^ (4d7nT?'o.\i'15ii ©DM o ]pofip H 3LAK« 5i d < CAH jp 'M SEWAGE SYSTEM INSPECTION PROGRAM FIELD NOTES LAKE CLASS NELAKE NOLAKE NAME Pine 56-384 40225 PURLIEU RDPARCEL NO PHY ADDR20000310190002 7, IX,SECTION NO 31Edna TownshipTOWNSHIP PROPERTY OWNER Richard H & Marcia Wieler TAXPAYER Richard H & Marcia Wieler 40225 Purlieu Rd DentMN 56528 9108 - 15^ - :iT77 ONSITE INSPECTION FINDINGS - SKETCH ON BACK: Drywell Straight Pipe Primitive Dweliing Seepage Pit Surface Discharge Outhouse Septic Tank/Drainfield Cesspooi Porta Potty Hoiding Tank Leaching Pit Sink Drain SEPARATION / SETBACK DISTANCES (in feet): TANK OUTHOUSEABSORPTION AREA OHWL RESTRICTIVE LAYER WELL ONSITE INSPECTION RESULTS: IMMINENT THREAT TO PUBLIC SAFETY OR HEALTH (Send 10 Day Abatement Notice) COMPLIANT (Send Compliant Letter) NO FURTHER ACTION NECESSARYREVISITNON-COMPLIANT ^Send Non-Compliant Letter) COMMENTS: Art ou i/tjji A-kL4 T7Inspector’s Signature(s)Date NoExisting File:Yes Sewage System Inspection Progra 4 x\ V Department of LAND AND RESOURCE MANAGEMENT OTTER TAIL COUNTY Government Services Center - 540 West Fir Fergus Falls, MN 56537 PH: 218-998-8095 OTTER Tail County’s Website: www.co.otter-tail.mn.us 5/6/2014 Richard H & Marcia Wieler 40225 Purlieu Rd DentMN 56528 9108 RE: Primary Owner: Richard H & Marcia Wieler Onsite Sewage System Inspections Parcel: 20000310190002 Lake: Dear Richard H & Marcia Wieler: As part of Otter Tail County’s ongoing effort to preserve and enhance water quality, the County Board of Commissioners has directed our Office to conduct onsite inspections of existing septic systems for compliance with the Sanitation Code of Otter Tail County. In order to complete this process, a map was created (July 10, 2008) which identifies the year in which an area of the County would be inspected. It appears your property is included in the area that will be inspected in 2014. Since this is the case, please be informed that starting in early June 2014 Inspectors from our Office will be checking existing septic systems in your area. Should a non-compliant septic system be discovered, our Office will contact the property owner and inform them of the need for their septic system to be brought into compliance with the provisions of our Sanitation Code. If you have any questions regarding this matter, please contact our Office (218-998-8095). Sincerely, Scott Ellingson Inspector i ? ',i- is<ilyf '> I F »1 it “4 4' ,H'" ^ ‘v i, jnn ‘ a ,‘ii' Jijjirt’ , ‘ihf ^ I I ' f " 'h „ ;ij i.! ^ } ’ ^tv 'I t' ‘itiiI ' .f«'9i'' '■, it i M 'i H:■»K1 i '■}'i i-ifiti■iip i i,4I !l I 1 S J i ,“■( »E vl>S f 1 < 1 I !M»sesoe®ssi^'^«vI'‘#4. I < •> ■ f'l, •■,;' I'l M‘t t,].;t-jlF'- ’fi> ,, ■,'s .,, if .‘-ifV-'t*'.,.'-» I sUi'i „ ifeliSsfcAw':.- Stiiiiii ■| iiiltIS v'V i IIift , ’ ‘ ' ? '( > r A,I "|1 , ^ ‘ ',, ' 5i| 'I ‘ f f| 'vli' ’“T ! Mt'vif , A,, p' ji j{-f^ ,t ’ ‘ ; / .-4 It: 'i ‘l i *i', * i ! >(F ' ll ,‘| •* ■«' 'i'^ ’ 1 f ' c' <si‘ ? 'i ‘ I ;„ «.f ti ',(,|o>« i> t .iftS-T >i ,U|^| f/J it. -■ » 4 ■; -fw '» If-I,ftiiiii ii;i. i\-\, ■'1 k4 ^iji 1.4- ^CERTIFICATE OF SURVEY* f }■4- iiaii If I' • ,‘B , ’ .- , 4 i" ’H " ‘ v44fi, .. '4 Ilii®I ifiji‘"t;fh ' ‘■f /4i i i<. !^ ^ ’ ’11tiiiPf4? r J. r i'!i4'< >! *,t ■*< 414 Sffift.ilffiIw.' !sifte®* i,f 4 ,i f; ‘[>- • ,1 ■* 'SHiiwx*.I 1 'f f BWIf’;i;1“. * • r >i,ft , i' . < ,!;-f'A‘:a'15'' mRT OF GOVERNMENT LOTS 6 87 SECTION 31, TOWNSHIP 136 NORTH, RANGE 40 WEST OTTER TAIL CCUNTY, MINNESOTA iPliiSIfl' ' lii« if :. 'i .f.|II4j(I1 iiPiliiff, , LJ (•?.r ■(• V !Jr 1 i .'1; *1 t : •i - .* ■- ;4 ^-;•J' NW COR,GOV'T, lots, ' SEC.3M36-40 i f r-}, I-I4J II Ir,^;1 %:■ ■f i.t k^4%';i iiff' ftT :iMIf:ml''(■t :1-i’ Ai\ iif;ii 4^ -•AA=55®I9'00"I- 'R~ 15752 ifiiiL= 152.08'ti T •‘s«K ft;f r-„~ t:, t-™,—■ ,,L, •' ••!■' ■■ ::„4 \!!r ”'‘®'T“4~4QAQ .r Iii 'V ‘!i4; I|L i W.LINE gov't. LOT 6 LLuPOSED ...LEGAL ,.:0ESC,R 1PTION.I h' ' >0 k'L MV- .-3Q7.Q'7‘i /Thnl. part of Govei-nment Lots B and 7, Section 31, ToWnahip 136 Noi'th 40 West,. Otter Tail Coupty, Minnesota described as followH;tPUSnr ROAD I I ‘o ■Slic(D iommenc ing at the iron monument a t the . nor thwea t <;orner. of said „ lioN'ernment, Lot 6; t hence South 00 degrees 11 rmnut.es 00: seconda East, asBumed bearing along the \west line of said Government Lot 6, a distance of 719. BO feet to an iron raonuraent: on the ;, south line of the DEDICATED PUBLIC ROAD in the, Subdivi.sion Plat <if PURI/fEU BEACH, scoording to t.he plat on fi le in t,he office . of t.he County Recorder, Otter Tail County, Minnesota; thence South.-87 degrees 50 minutes 15 seconds East 43B.70 feet said DEDICATED PUBLIC ROAD, thence South 00 degrees 13 minutes 00 seconds feet, along the monumented line to an iron monument designated as Point A, the point of beginning of t.he tract to be described;, thence reversing North 00 degrees 13 iftinutes 00 seconds East 840.00 feet, along the monumented' line Oi t EXISTING .T.M vShiCH-- IS 1543.69 NE'LY \\!!/f4 i4 PUBLIC ROAD 5along £ aj|p^0 = 1546.00')al ong toi an 1 ron West l Stft. C the south line of monumen t; 840.00 l',e re inaf ter ■? .QV“'^i iMI Q:>4“* / h?ru j>.dJI PUPLIC ^ EXISTING FENCE LINERO^Qf—4iij. /a OCCUPATION LINE 4;\I N lo an iron monument on the south line of said DEDICATED PUBLIC iiOAD; thence South 87 degrees 50 minutes 15 seconds. Eas t 327,70 leet along the south line of said DEDICATED PUBLIC ROAD; thence tiasterly 144.07 feet along the south line of said DEDICATED iH/BLIC ROAD and along a tangential curve concave to the north having a central angle of 15 degrees 56 minutes 00 seconds and a radius of 518.08 feet.; . thence North .76 degrees 13 minutes 45 <st,;conda East, tangent to last described curve and along the Louth line of said DEDICATED PUBLIC ROAD, a distance of 101.00 Letil to an iron pipe monument; thence South 29 degrees 32 ftcOnules 05 seconda East 299.2*3 feet to an iron pipe monument; ihence North 80 degrees 11 minutes 58 seconds East 95.5 1 feet minutes 55 tS.LINE DED. PUB. ROAD (PURLIEU BEACH) '»t "id ^ L 01N ^ /N\nB!ilS51F’i4dj!,*POINT BVJ,i!iir!i5**4 J rft 4ro'• 436,70’--.4ro>%3C2*"'32770':-f !■ I i4»t <t-3IBtlft'!''L((It PUBLIC RpAD'EASEMENT-M ft!i an iron monument; thence Norl,h 205.28 degrees feet to an iron monument; thence Nc.rth 2.3 Wes t ./: 218.26 feat: to an i rpn,,pipt' thence Soul It 88 degrees 11 minutes 58 seootnls pipps' pnL ‘-Le, som U^er 1 'Ij L/ie RS)Aii;i :iieiir-i* Wurijh 8r greh ‘i I 3l an t I'lni mij/HiHitUi! , liuui a Nort.fi .seconds West 17 5.0C) feet to .an iron 12!'seconds 3 4 37LIf li a a 1. i>;.‘reen 27 muiutes 05 .ie<3orida ii; ,i(;umen t.; ■ft.jtjmlH.(t- 4,5 •IF, a w tIi I ii S-LMattSt Oi t V- '8» .J. 'an J |-qp *H4.lU'tiH VI ED !4IH! IfI I .! tulh r, ain I ^Zb . oH I »,! e 1 t .,(.>,T < ■ IIft > .00UU degrees 1 1 mlnu tes p 1 pt; monument; thence North 89 degrees 50 minutes l-.aHt 307.07 feet, along the aopth line of said DEDICATED PUBLIC ROAD 19 seconds East t -tIJrfrli,»!1 jSi'S 5 t »rfF fjr.%rt ^ ’■-CoMaji4■*T iron monument; thence South 12 degrees 03 minutes ' 450.00 to anUJf :8 feet along the iron pipe monument hereinafter designated as Point B; continuing monumented line "to an ;L thence South 12 degrees 03 minutes 19 seconds East 10 feet ii;}W.LIMEGOV’t.LOT 6 , ffl0 O i less the shoreline of Honer Lake;to t h e n o e southwesterly, southerly and southeasterly, along the shoreli of Honer Lake approximately more orin n e» 4 i@ifeet to the i n ter sec t,i on w i th line which bears North 48 degrees, 00 minutes 00 seconds iron pipe monument hereinafter designated as I Point degrees 44 minutes 39Lseconds Point Blft thence 00 minutes 00 seconds West 13 feet less, to the iron pipe monument hereinbefore Point C; thence continuing South seconds West 50,00 feet 671 t hftftI East from an C (Point C is located South ;3B West 573.72 feet from hereinbefore designated .South 48 degrees 5UFr*/EY B\ ■ !! 11 V C{>I more or designated as 48 degrees 00 minutes 00 to an iron pipe monument hereinafter designated as Point D (Point -D is located North 73 de'gree.s 25 |i i outes detiignated Point 1 37 seconds East 1126.93 A); thence minutes 00 seconds West 10 fept, more or less, to the of Pine Lake; thence northwesterly, westerly and southwesterly, along the shoreline of Pine Lake, to:the intersection with the line which bears South 00 degrees 13' minutes 00 seconds East from the point of beginning (hereinbefore designated as Point A); thence North 00 degrees 13 minutes 00 seconds West 20 feet more or leas to the point of beginning containing 17.99 acres feet from continuing South 48 degrees 00 shere1ine herf? i nbe f ore ■"i I I more or ess . Together with and subject to an easement for Pub 1 ic Road ‘purposes adjoining said DEDICATED PUBLIC itOAD as shown hereon.The Line from Point C to Point D wos determined Using on Existing 20‘’Ash Tree with oldPOIN'^ *Subject to other easements, restrictions record, if any. or reservations of,/t Barbed wire embedded ond oL1:/Beoring which is Approxirnotely ai Ir-'Right Angles :to the Appurerui- "Sond BoitL .1 \ I: \ REVISED! MARCH 5,1993 i hereby certify that this Survey, Plan or Report was prepared by me or under my .direct supervision and that I am a duly Registered Land Surveyor under the laws of the State of RLVUI:!i: U S) ■; Anderson / Me^en/Peorsoa M.innesota . -DRAWNBY, RRW tRECtiW BY- dWF Wb'^NO.' ' »Ot .uJ...L Pt.of Govt.Lot's.£and7' ■ L Sea31,1Wft^.6N„R,40W. , ■ ‘ V • ■ . , . ■' , 1 ’ Otter Tail County,Minnesota r' James wT ^'owlds ;— • 3a, it, rai 18164Reg. No.Date;T7-¥ ' H i / 'J - ^ r)I ;tJ ^BJORGUM. , ; •736-59B6,.-" . t v-------------------------U------.)----’■ 107 1/2 N. Mil I St ' I Rt3, Box 2Ln ; 8. Assoc., Inc. ’ ^ Ferovis. Falls, MNl Detroit LAk'?"'.,' SURVEYORS ^>Y'*'k.S38 -56".. ••1 1 t : i ■f>LI ■I'!i s APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENTOTTER TAIL COUNTY COURT HOUSE 121 W. JUNIUS AVE. • SUITE 130 Phone: (218) 739-2271 • FERGUS FALLS, MN 56537 www.co.ottertail.mn.us APPLICATION MUST BE COMPLETE IN ORDER TO BE PROCESSED WHiTE - Office YELLOW -L&R Inspector PINK - Owner / Contractor (after issue) nnsPermit No. LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS SECTION TWP NO.RANGE TWPNAME 5j>'5d\'-00 T. PARCEL NUMBER (S) OF PROPERTY BEING SERVICED E-911 ADDRESS 9^<j' ooo -01'=)0 - oci LEGAL DESCRIPTION Pf dc G4-1 Last Name First Initial Mailing Address Daytime Phone No. LOie-le.r~{LAProperty Owner AAU IH Ic •?/-iLu /<A- 43bcy‘^A~ I yg Aaf Contractor Lie.#tL S'! ^ THIS SPACE FOR OFFICE USE ONLY A.M. ► This System will be ready for inspection on.the year of P.M..at. A.M. P.M. Date Received Time Received L&R Official SEWAGE TREATMENT SYSTEM DESIGN DATATYPE OF INSTALLATION (CIRCLE ONE) TANK DRAINFIELD V7cPSizeAdd-On/ Replacement (32) Tank, Septic (33) Tank, Lift (34) Trench, Rock (35) Trench, Gravelless (36) Trench, Chamber (37) Bed (38) Mound (39) At Grade (40) Combination ^.j—sNew System (j[20j^rench. Rock (?T) Trench, Gravelless TiuiilIi, OlititnibiBT g'5'9^Setback to nearest well Ft. Ft. 152.'Setback to OHWL (lake &/or river)Ft.Ft.(23) Bed (24) Mound (25) At Grade SoSetback to wetland Ft.Ft. 7 Setback to dwelling Ft.Ft.Collector System (26) Trench, Rock (27) Trench, Gravelless (28) Trench, Chamber (29) Bed (30) Mound (31) At Grade (o^Setback to non-dwelling Ft.Ft. /Oco ^ -hSetback to nearest property line Ft./ Ft.Other (41) Tank, Holding (42) Outhouse (43) Sewer Line (44) Performance (45) Miscellaneous /g>o JOO V Ft.Setback to road right-of-way Ft. -3-A Ft.Elevation above restrictive layer Ft. ALL DISTANCES ARE SHORTEST DISTANCE BETWEEN NEAREST POINTS.# BEDROOMS H GARBAGE DISP. Y /(^ ABATEMENT Y / N DEPTH OF WATER WELL ABSORPTION AREA FOR MOUNDS 12^HOLDING TANK MONITOR/ DISPOSAL CONTRACT ( )Yes ( ) No-L&R Can Not Process EFFLUENT DISTRIBUTION (.^C^ravity ( ) Pressure Designer Designer Lie. # PERCOLATION TEST DATA . 3 7LDate 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 accordance 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 con dition 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: This permit is valid for a period of six (6) months. / CC/nn-io- I H Permit Fee $Date: Signature Omt^r/Ag^ tor Own^ Date:Rec. No. Lan<Y& fiisource Management Offici Comments: Form No. BK — 0208-003 311,054 • Victor Lundeen Co., Printers • Fergus Falls. Minnesota APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENTOTTER TAIL COUNTY COURT HOUSE 121 W. JUNIUS AVE. • SUITE 130 Phone: (218) 739-2271 • FERGUS FALLS, MN 56537 www.co.ottertail.mn.us APPLICATION MUST BE COMPLETE IN ORDER TO BE PROCESSED PINK - Owner / Contractor (after issue) / /Permit No. 0 LAKE/RIVER NAME LAKE/RIVER CLASS SECTION TWPNO.RANGE TWPNAME \r-/V' £-t- c-' 0_ PARCEL NUMBER (S) OF PROPERTY BEING SERVICED E-911 ADDRESS ' I LEGAL DESCRIPTION Last Name First Initial Mailing Address Daytime Phone No. ^.r 7 7=, \1Property Owner LOic.Je. 1 " Da t'^A-. A^\k.7 'L^^S£l L 7/<- Contractor Lie.# -f THIS SPACE FOff OFFICE USEpNUf cl A.M. ► This mstem will be readyTor inspBcSon on P.M..at./ M dh^f /hi' / \ Date Received ’ Time Fteceived L & R Official SEWAGE TREAXMCNrSVSTEM DESIGN DATATYPE OfTFJSTAU-AIIQN (CIRCLE ONE) TANK DRAINFIELD Ft"Size GIs.TAdd-On/New System (20) Trench, Rock (21) Trench, Gravelless (22) Trench, JChaoiiter (23) Bed (24) Mound (25) At Grade Replacement (32) Tank, Septic (33) Tank, Lift (34) Trench, Rock (35) Trench, Gravelless (36) Trench, Chamber (37) Bed (38) Mound (39) At Grade (40) Combination Setback to nearest well Ft. Ft. Setback to OHWL (lake &/or river)Ft. Ft. ISetback to wetland Ft.Ft.O Setback to dwelling Ft, Ft.21Collector System (26) Trench, Rock (27) Trench, Gravelless (28) Trench, Chamber (29) Bed (30) Mound (31) At Grade Setback to non-dwelling Ft.Ft. Setback to nearest property line Ft.Ft.Other (41) Tank, Holding (42) Outhouse (43) Sewer Line (44) Performance (45) Miscellaneous Setback to road right-of-way Ft.Ft. Elevation above restrictive layer Ft.Ft. ALL DISTANCES ARE SHORTEST DISTANCE BETWEEN NEAREST POINTS. DEPTH OF WATER WELL # BEDROOMS GARBAGE DISP. Y / N ABSORPTION AREA FOR MOUNDS .Ft"HOLDING TANK MONITOR/ DISPOSAL CONTRACT ( )Yes ( ) No-L&R Can Not Process EFFLUENT DISTRIBUTION ) Gravity ( ) Pressure ABATEMENT Y / N C/-Designer____ Designer Lie. # PERCOLATION TEST DATA 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 accordance 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 con dition 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: This permit is vaiid for a period of six (6) months. Cc /oo-Permit Fee $Date: Signature of Property Owner/Agent for Owner / j 2= ‘ 7rDate:Rec. No. Land & Resource Management Office Comments: IForm No. BK — 0208-003 311,054 • Victor Lundeen Co., Printers • Fergus Falls. Minnesota SEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTS Inspector must make all measurements r ■ W . HOLDING SEPTIC TANK OUTHOUSEDRAINFIELDLIFT TANKCATEGORY Capacity FT2 FT2GLS.GLS. FT FT FT FTSetback from Nearest Well Setback from Buried Water Suction Pipe FT FT FT FT Setback from Buried Pipe Distributing Water Under Pressure FT FT FT FT Setback from OHWL (lake &/or river)FT FT FT FT Setback from Setback from Wetland FT FT FT FT Setback from Dwelling FT FT FT FT Setback from Non-Dwelling FT FT FT FT Setback from Nearest Property Line FT FT FT FT Setback from Right-of-Way FT FT FT FT Elevation above Restrictive Layer FT FT FT FT Holding Tank/Lift Alarm YES NO Old System Pumped & Destroyed YES NO SEPTIC TANK FILTER Sewer Line to Well Separation DRAINFIELD CALCULATION Actual Minimum Manuf..□ YES FTX FT Model #.ft^□ NO FT 20 MOUND CALCULATION MOUND /AT-GRADE ROCK REDUCTIONInspector’s Comments: ABSORBTION AREA Rock trenches with inches of rock under pipe for %Ft. X DF.reduction / equivalent to,Ft2 SKETCH: Date Time Initial / L & R Official As of Code of Otter Tail County. the above described sewage system installation was found to be compliant with the provisions of the Sanitation Land & Resource Management Official System design must be to scale and must include the proposed location of the sewage system, all ekisting/proposed buildings, property lines, the ordinary high water level of the water body, wetlands, bluff and all water wells within 150' of the sewage system. If there are any questions, see the University of Minnesota Site Evaluation worksheets. (.grid(s) equals feet, or .inch(es) equals feetScale: 5^ ‘MPCA LICENSE #: DESIGNED BY:LICENSE CATEGORY: FIRM NAME:DATE: ^ /£>0 f 5^ADDRESS:SIGNATURE: \ I 0 4 ■4-ij X lO •4- LfU<;.i I- r 315.904 • Victor Lundeen Co.. Printers • Fergus Falls. MN • 1-800-346-4870BK — 1003 — 029 Ti r SITE DATA WORKSHEET LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 218-998-8095 www.co.otter-tail.mn.us i[...*L„ T r ■f Sewage Treatment System Permit #OWNER: TLAST NAME FIRST MIDDLE TELEPHONE NUMBER 4. ADDRESS:i i Ho R V jr\X STR./RT.CITY STATE ZIP CODE P;\cxkjL TWP. 1 f\.i> LAKE NAMELAKE/RIVER NO.SEC.RANGE TWP. NAME LEGAL DESCRIPTION:SOIL BORING LOG COLOR & MUNSELL NO. DEPTH (INCHES)TEXTURE STRUCTURE ‘So~T\^^Iz.BLOCKY PLATY PRISMATIC NONE (^-1 S. \oQJN\- PARCEL NUMBER \3'3H BLOCKY PLATY PRISMATIC NONE \OCMY\ lov^r S((^E-911 Address or Directions From Nearest Public Road 5H'4c>S.dL.'S^ 1NUMBER OF BEDROOMS BLOCKY PLATY PRISMATIC NONE ^b'Loo GARBAGE DISPOSAL; YES f CASING DEPTH 130 ft. SEWER LINE SEPARATION:WELL:BLOCKY PLATY PRISMATIC NONE FLOODPLAIN: YES BLUFF: YES NO Cd6-Bo AQUATIC /^ERRESTRIAlT!I>VEGETATION: BLOCKY PLATY PRISMATIC NONE zs:SLOPE AT INSTALLATION SITE:%SojTvI8c-BH TYPE OF OBSERVATION; Probe Pit (butwa~si^PARENT MATERIAL: Till Loess Bedrock Alluvium 4- (L\- OH(Ve5~^ NoORIGINAL SOIL:Date of Soil Boring. COMPACTED SOIL:Yes / H- g»HDEPTH OF BORING (To T or restrictive layer):ft.Date of Perc Test PERC TEST # 1 PERC TEST #2- TWO TESTS ARE REQUIRED - TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES}WATER DEPTH WATER DROP PERC RATEI€>START START lli.dl DROP PERC 1 ISI -rTIMEDROPPERCTIME TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE8..3‘Af.REFILL REFILL DROP PERC S5H fI\3.%TIME TIME DROP PERCTIMEINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATE%REFILL REFILL DROP PERC 1 TIME TIME DROP PERC TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATE%8REFILLREFILL TIME DROP PERC V 1 TIME DROP PERC TIME INTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEREFILLREFILL TIME DROP PERC TIME DROP PERC TIME INTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATEREFILLREFia TIME PERCDROP TIME DROP PERCTIMEINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEREFILLREFILL TIME DROP PERC TIME DROP PERCTIMEINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATEREFiaREFILL TIME DROP PERC TIME DROP PERC PROPOSED DESIGN: TRENCH.BED.ATGRADE.MOUND.HOLDING TANK GRAVITY DIST.PRESSURE DIST. SEWER LINE.OUTHOUSE.OTHER.SPECIFY;. — SYSTEM DESIGN ON BACK — Trench and Bed Worksheet All boxed rectangles must be entered, the rest will be calculated. 1. AVERAGE DESIGN FLOW A. Estimated or measured ____ B. Septic tank capacity gpd (see figure A-1) x_K5fsafe^acforJ = 600 0 gpd gorl gallons iDDD 1000 existin if neededreplace with A-1 Estimated Sewage Flows in GPD Number of Bedrooms Class II Class III Class IVClass I 225 180 60% of3002 218300 the3450 375 256 values in the Class I, II or II columns 6004 450 2947505 525 3329006 600 37010507 675 4088 1200 2. SOILS (Site evaluation data) C. Depth to restricting layer = D. Maximum depth of system Item C - 3 ft = E. Texture F. SSF G. % Land slope 7 feet 4 feet 0.32Percolation rate mpisand ft^/gpd (see figure D-15)0.83 15 % C-1 Septic Tank Capacity in GallonsD-15 Soil Characterisitcs & SSF SSF Number of Minimum Capacity with Garb. Disp. Perc Rate Soil Tecture Capacity with Disp. and Liftsq ft/gpd Bedrooms Capacitympi 0.83 2 or less 3or4 5 or 6 7,8or9 750<0.1 *Coarse sand Medium sand Loamy sand Fine sand Sandy loam Loam Silt loam, silt Clay loam, sandy clay or silty clay Clay, sandy or silty clay 1125 1500 0.830.1-5 1000 1500 2000 1500 2250 3000 1.670.1- 5"2000 3000 4000 6-15 1.27 D-9: Soil Characteristics aud Soil sizing factors (SSF) forCravcIless Pipe16-30 31 -45 46-60 1.67 2.00 ixa-cdaticm mtc <nvmitcs/(iKh)lincsil feet/ galioi/dayseal toxlmc2.20 VVcstcrlhanO I * 01 to5 Cctti'sc Sand Medium Smd Loanw Sand Fine ^d Sandy Lccjm Lcnm Silt Lofim 028 01 (05 6 to15 16to30 31 1045 06 04261-120***4.20 0 560.67 Sill46IO60Qay LccinKCU Sandy Cl, Silly CLQfiy Sandy Qay Silly Qay 074 >120’ slow^'cr lhan 60*“* No trench >25% of total system ** Soil with >50% fine sand particles *** A mound must be used An other or performance system • Soil loo coarse for stsv. Use sy^ems for rapidly per '*Scil havinc 50% or man? fine sand -» vtry '**Sal wilhToo high a pereaxtage cf icr installation cf a standard inground trcatTnmt.mcablesdls. l ine sand Page 1 of 2 3. TRENCH OR BED BOTTOM AREA. H. For trenches with 6 inches of rock below the pipe: AxF =0.0 ft^0.83 ft/gpd =gpdx I. For trenches with 12 inches of rock below the pipe: gpdx ft'0.83 ft/gpd X 0.8 =0.0A X F X 0.8= J. For trenches with 18 inches of rock below the pipe: A X F X 0.66=ft'0.00.83 ft/gpd X 0.66 =gpdx K. For trenches with 24 inches of rock below the pipe: A X F X 0.6=298.8 ft'0.83 ft/gpd X 0.6 =gpdx600 L. For gravity beds with 6 or 12 inches of rock below the pipe; 1.5xAxF = 1.5x M. For pressure beds with 6 or 12 inches of rock below the pipe; gpdx ft'0.83 ft/gpd =0.0gpdx 0.0 ft'0.83 ft/gpd =AxF= ____________ 4. DISTRIBUTION (Check all that apply) Bed (<6% slope) Trenches Pressure 5. SYSTEM WIDTH, LENGTH AND VOLUME M. Select width = __ N. If using rock, divide bottom area by width: (H, I, J or K) divided by P = lineal feet 298^8 Ift' / X__Drop Boxes (any slope) ___Distribution Box (<3%) X Gravity Rock Chamber Gravelless X X 3.0 ft 99.6 lineal feet3.0 ft = Rock depth below distribution pipe plus 0.5 foot times bottom area: (Rock depth + 0.5 foot) x Area (H, I, J, K, L) ft + 0.5ft)x [2 Volume in cubic yards = volume in cubic feet divided by 27 ft' =fP298.8 747.02 27.7 yd'/ 27=747.0 Weight of rock in tons = cubic yards times 1.4 X 1.4=38.7 tons27.7 0. If using 10" Gravelless Pipe, length = Flow (A) x Gravelless SSF (see figure D-9) ____________ gpd X ft/gpd =0.0 lineal feet P. If using a Chamber (H, I, J, K [based on height of chamber slats] divided by width of chamber in ft) #DIV/0! lineal feetft' /ft = 7. LAWN AREA Q. Select trench spacing, center to center = R. Multiply trench spacing by lineal feet R x Q = sq. ft. of lawn area 8 Ifeet 797 ft'8 99.6X 8. LAYOUT Select an appropriate scale; one inch = Show pertinent property boundaries, rights-of-way, easements. Show location of house, garage, driveway, and all other improvements, existing or proposed. Show location and layout of sewage treatment system, well and dimensions of all elevations feet I hereby certify that I have completed this work in accordance with all applicable ordinances, rules and la\^ (signature) V (license #)(date) Page 2 of 2 Department of LAND AND RESOURCE MANAGEMENT OTTER TAIL COUNTY 121 W. Junius Ave., Suite 130 Fergus Falls, MN 56537 Ph: 218-998-8095 Otter Tail County’s Website: www.co.ottertail.mn.us July 3, 2003 Richard & Marcia Wieler 40225 Purlieu Rd Dent, MN 56528 RE: Sewage Treatment System Servicing Tax Parcel Number 20000310190001 Described as Pt GL 6 & 7 Com NW Cor..., Section 31 of Edna Township, Pine Lake (56-384) As of June 27, 2003, the sewage treatment system (Sewage Treatment Installation Permit #15884) servicing your property was determined to be in compliance with the provisions of the Sanitation Code of Otter Tail County for a dining hall serving 150 meals 3 times daily. If you have any questions regarding this matter, please contact our office. Sinci ly. Pat Eckert Inspector f APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095) 121 W. JUNIUS AVE. SUITE 130, FERGUS FALLS, MN 56537 www.co.otter-tail.mn.us WHITE- Of fice YELLOW\L & R Inspector PINK - Owner / Contractor (after issue) APPLICATION MUST BE COMPLETE IN ORDER TO BE PROCESSED Permit No. LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS SECTION TWP NO.RANGE TWP NAME 31 )34/Jt Ho PARCEL NUMBER (S) OF PROPERTY BEING SERVICED E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROAD Purheud~o 'ooo o \ ^o- oo] LEGAL DESCRIPTION f c;c ^^7 Daytime Phone No.First Initial Mailing AddressLast Name . s! St ; ^ AJ d C^- "i** Property Owner %V3c3 //Contractor Lie.# A/73 THIS SPACE FOR OFFICE USE ONLY A.M. P.M.the year of> This System will be ready for inspection on_.at. A.M. P.M. L & R OfficialTime ReceivedDate Received SEWAGE TREATMENT SYSTEM DESIGN DATA - AS SHOWN ON DRAWINGTYPE OF INSTALLATION (CIRCLE ONE) TANK DRAINFIELD 3,000 , Ft"GIs.SizeAdd-On/New System (20) Trench, Rock (21) Trench, Gravelless (22) Trench, Chamber (23) Bed (24) Mound (25) At Grade ^—Replacement^(32)Jfenk, Septic ^33fTank, Lift (34) Trench, Rock (35) Trench, Gravelless (36) Trench, Chamber (37) Bed (38) Mound (39) At Grade (40) Combination 5o Ft.Ft.Setback to nearest well /SOSetback to OHWL (lake &/or river)Ft. Ft. -50 Ft.Setback to wetland Ft. Ft.Setback to dwelling 10Collector System (26) Trench, Rock (27) Trench, Gravelless (28) Trench, Chamber (29) Bed (30) Mound (31) At Grade to Ft.Setback to non-dwelling Ft. I o Ft.Setback to nearest property line Ft.Other (41) Tank, Holding (42) Outhouse (43) Sewer Line (44) Performance (45) Miscellaneous / oSetback to road right-of-way Ft.Ft. Ft.Ft.Elevation above restrictive layer ALL DISTANCES ARE SHORTEST DISTANCE BETWEEN NEAREST POINTS. #BEDROOMS a GARBAGE DISr7?n) ABATEMENT Y /(^) ABSORPTION AREA FOR MOUNDSDEPTH OF WATER WELL b g’ep Ft^HOLDING TANK MONITOR/ DISPOSAL CONTRACT ( )Yes ( ) No-L&R Can Not Process EFFLUENT DISTRIBUTION Gravity ( ) Pressure Designer____ Designer Lie. PERCOLATION TEST DATA Highest RateDate of Test 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 accordance 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 con dition 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. six (6) months.NOTE: This permit is valid for a perioi c_CO A-S'-. a 3 7S—Permit Fee $Date: 6 'S-cO / 3(^ !Rec. No.Date: iesource Managd^nt OfficeLand Sc-ahe 70 'S^Ooa ^Comments: /So ¥ 3 Form No. BK — 0203-003 313,017 • Victor Lundeen Co., Printers • Fergus Falls, Minnesota •APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095) > 121 W. JUNIUS AVE. SUITE 130, FERGUS FALLS, MN 56537 q[ WHtT^ - Office YELLOW - L & R Inspector PINK - Owner / Contractor (after issue) www.co.otter-tail.mn.us / SffyPermit No.APPLICATION MUST BE COMPLETE IN ORDER TO BE PROCESSED RANGE TWP NAMETWP NO.LAKE/RIV^ NAME LAKE/RIVER CLASS SECTIONLAKE NUMBER 54-2><PV I O <o/Jt Ho E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROADPARCEL NUMBER (S) OF PROPERTY BEING SERVICED /I /! Ho -oco II' c 1^0 ool r'ur/<c- p4 aLu-^1 cLEGAL DESCRIPTION MuO Co-r,,,O Iry^f Cl Daytime Phone No.First Initial Mailing AddressLast Name uj^ia^JClA ZZ2Property Owner ■I 2 ^W3c3 O /fl vContractor Lic.«LUlaj ,4>/73 THIS SPACE FOR OFFICE USE ONLY <^003 at ^'^0^ the year of>■ This System will be ready for inspection on. m//L &/h < (/I I 00 A.M. OfficialTime ReceivedDate Received SEWAGE TREATMENT SYSTEM DESIGN DATA - AS SHOWN ON DRAWINGTYPE OF INSTALLATION (CIRCLE ONE) DRAINFIELDTANK Ft"Size GIs.Add-On/New System (20) Trench, Rock (21) Trench, Gravelless (22) Trench, Chamber (23) Bed (24) Mound (25) At Grade T-Replacement (f (32) Tank, Septic ■T(33) Tank, Lift (34) Trench, Rock (35) Trench, Gravelless (36) Trench, Chamber (37) Bed (38) Mound (39) At Grade (40) Combination -A Ft.Setback to nearest well Ft. 3Af/Ft.Setback to OHWL (lake &/or river)/SO Ft. 50 Ft.Setback to wetland Ft.r Setback to dwelling Ft. Ft.LOCollector System (26) Trench, Rock (27) Trench, Gravelless (28) Trench, Chamber (29) Bed (30) Mound (31) At Grade Setback to non-dwelling Ft. Ft./a Setback to nearest property line Ft. Ft.lOOther (41) Tank, Holding (42) Outhouse (43) Sewer Line (44) Performance (45) Miscellaneous I oSetback to road right-of-way Ft. Ft. Elevation above restrictive layer Ft. Ft. ALL DISTANCES ARE SHORTEST DISTANCE BETWEEN NEAREST POINTS. DEPTH OF WATER WELL # BEDR00MS_____ GARBAGE DISP. Y / N ABATEMENT Y I W]' ABSORPTION AREA FOR MOUNDS I Ft®HOLDING TANK MONITOR/ DISPOSAL CONTRACT ( ) Yes ( ) No-L&R Can Not Process EFFLUENT DISTRIBUTION Gravity ( ) Pressure t Designer____ Designer Lie. # K)h/\PERCOLATION TEST DATA Highest RateDate of Test 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 accordance 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 appiicant 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 con dition 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: This permit is vaiid for a period of six (6) months. oo75—-----Permit Fee $Date; 4^ Signature of Property Owner/Agent tor Owtfer 5 i jRec. No.Date: Land & Resource Management Office Comments: 7 V / Form No. BK — 0203-003 313,017 • Victor Lundeen Co., Printers • Fergus Falls, Minnesota SEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTS Inspector must make all measurements 0 HOLDING SEPTIC TANK DRAINFIELD OUTHOUSELIFT TANKCATEGORY Capacity FT2FT2GLS.GLS. FT FT/ 0^0 FT FTSetback from Nearest Well Setback from Buried Water Suction Pipe FT FTFTFT Setback from Buried Pipe Disfributing Water Under Pressure FTFTFT FT 4 Zoo ft FT FTSetback from OHWL (lake &/or river)FT FT FTSetback from Setback from Wetland I oo FT FT Setback from Dwelling FT4- So ft FT ^ FT 1^- FTSetback from Non-Dwelling 4- SO FT FT FT FTSetback from Nearest Property Line •f fO FT FT FT FTSetback from Right-of-Way FT FT4<0 FT FT FTElevation above Restrictive Layer FT Holding Tank/Lift Alarm YES NO Old System Pumped & Destroyed NO FILTERSEPTIC TANK DRAINFIELD CALCULATIONSewer Line to Well Separation MinimumActualWCi'a'>^ES □ NO y" <r .FTXManuf.. lOOO 4^sV ft"Model #FT 20 MOUND CALCULATION MOUND /AT-GRADE ROCK REDUCTION Inspector’s Comments: Oh JX. -3 l^lA,ABSORBTION AREA Rock trenches with inches y t* • •of rock under pipe for %Ft. X - i'DRreduction / equivalent toFt2 SKETCH: - OT 330 YV6 Initial/L S R OfficialTime , the above described sewage system installation was found to be compliant with the provisions of the SanitationAs of Code of Otter Tail County. Land & Resource Management Official System design must be to scale and must include the proposed location of the sewage system, all existing/p^oposed buildings, property lines, the ordinary high water level of the water body, wetlands, bluff and all water wells within 150' of the sewage system. feet, orT___grid(s) equals feetScale:inch(es) equals SUBMITTED BY: FIRM NAME: ________ ADDRESS: lOO \ SIGNATURE:KVNt DATE: MPCA LICENSE #: LICENSE CATEGORY: O X* \J oV/0 ^ - I (s>aL~ .V' - ^ > ■o' 'te' ^ jr Sot L 2 - u li.< >0 ’* pUJ ' / ' V (2 V -----—y • Fergus Falls. MN • 1-800-346-4870300.817 • Victor Lundeen Co . PrmiarsBK - 0599 - 029 SITE DATA WORKSHEET LAND AND RESOURCE MANAGEMENT Otter Tail County 121 W. Junius Ave., Suite 130 Fergus Falls, MN 56537 cic ^ & ^A/( '^nO 7^'?-^,3 7/ hsn;QOWNER: TELEPHONE NUMBERMIDDLEFIRSTLAST NAME ADDRESS: PluViulI^- STR./RT. /t?A^ ZIP CODESTATECITY 15^ n1 Hdu) Bdmju3\Pi >\p I j^ lcp TWP. NAMERANGESEC.TWP.LAKE NAMELAKE/RIVER NO. LEGAL DESCRIPTION:Tui P-1'5, 4 \<Hr^^.-0L(0 SOIL BORING LOG - Date COLOR & MUNSELL NO. DEPTH(INCHES)STRUCTURETEXTURErr 7 Co/^ 6 dI&, 4^.« ro.JTfe CblockyJ^ PLATY PRISMATIC NONE f/'^6c-V 30c 0-1 ^fi a 1 lJ{ 'r.-:PARCEL NUMBER Teroc^ PCATY|Cc-32L/7/?f NUMBER PRISMATIC NONE NUMBER OF BEDROOMS BLOCKY PLATY PRISMATIC//^bGARBAGE DISPOSAL: YES WELL CASING DEPTH:BLOCKY PLATY5a>'^-77FLOODPLAIN: YES PRIS;«1AT.ICOo V______■^VVv-O-VEGETATION: AQUATIC lESTRIA BLOCKY PLATY PRISMATIC NONE SLOPE AT INSTALLATION SITE: I % TYPE OF OBSERVATION; Probe Pit (tlutwas^PARENT MATERIAL: Till Loess Bedrock Alluvium COMMENTS: ORIGINAL SOIL:No COMPACTED SOIL: Yes 4t70<f' PERC TEST #2 to'ft.DEPTH OF BORING:2\:<5iri*^) d)* FT - TWO TESTS ARE REQUIRED - V PERC TEST #1 PERC RATEWATER DROPINTERVAL tMINUTES)WATER DEPTHPERC RATE TIMEWATER DROPTIMEINTERVAL (MINUTES)WATER DEPTH STARTSTART TIME DROP PERC PERC RATEWATER DROPINTERVAL IMINLITES)WATER DEPTHTIMEPERC RATEWATER DEPTH WATER DROPTIMEINTERVAL (MINUTES)REFILLREFILL PERCDROPTIMETIME DROP PERC PERC RATEWATER DROPINTERVAL (MINUTES)WATER DEPTHTIMEWATER DROP PERC RATEINTERVAL (MINUTES)WATER DEPTHTIME REFILLREFILL TIME DROP PERCTIME DROP PERC PERC RATEWATER DROPWATER DEPTHINTERVAL (MINUTES)PERC RATE TIMEWATER DEPTH WATER DROPINTERVAL tMINUTES)TIME REFILLREFILL PERCDROPTIMEDROPPERCTIME PERC RATEWATER DROPINTERVAL (MINUTES)WATER DEPTHTIMEPERC RATEWATER DEPTH WATER DROPTIMEINTERVAL (MINUTES!REFILLREFILL PERCDROPTIMEDROPPERCTIME WATER DROP PERC RATEWATER DEPTHPERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER PROPINTERVAL (MINUTES)TIME REFILLREFILL PERCTIME DROPTIME DROP PERC PERC RATEWATER DROPINTERVAL (MINUTES)WATER DEPTHPERC RATE TIMEWATER DROPWATER DEPTHTIMEINTERVAL (MINUTES!REFILLREFILL PERCDROPTIMETIME DROP PERC WATER DROP PERC RATEWATER DEPTHTIMEINTERVAL (MINUTES!PERC RATEWATER DEPTH WATER DROPINTERVAL (MINUTESITIME REFILLREFILL = __PERCDROPTIMEDROPPERCTIME PROPOSED DESIGN: x:GRAVITY DIST. PRESSURE DIST.HOLDING TANKATGRADE MOUNDTRENCHBED SPECIFY: — SVSrfAf DESIGN ON BACK — OTHEROUTHOUSESEWER LINE f-f /-A /l^-^ Tf 1%-Q- Ar^.f , r<^ 5’^3^ ^f¥' Compiianci^ Inspection Form for Existing Individual Sewage Treatment Systems ✓t -c / Water/Wastewater-I5TS4.31 Minnesota Poitiitibn Control Agency Completion of this form fulfills the minimal requirements of Minn. Slat. § 115.55 (2001) and Minnesota R. ch. 7080 (1999). Please refer jo local ordinances for other requirements or information, especially for compliance requir.effients for bedroom additions._______ ■ General: /Ar<^ S'^ Date of Inspection: ^Reason for inspection: Property Ownerf s) /rf^hot ('cl /7)lX (lOflfCQf f / cjoc OU)f\ /citr/eci. ^c/ yfaJl \ / f 1^7 ^ *7 ' '^r/)7/ Telephone::i^^ TlS^'W 7 / Person requesting inspect) Site Address ^^ 'Z ZS> Jelephone ( ) _ Zip Code.b <^ ^City 9/^^ ■Fire No./ Parcel No. CdOCi^ /019OC0 j County (DTi~<Z\! t(Xi I •.'t- Township Legal Description Local Regulatory Authority Date system constructed _ O ^^f/' TX'V (O'g^.oi System in Shoreland Area:(y^ no System in Wellhead Protection Area: yes (T^ System serving a MDH licensed facility: no Local Permit # (if any)_______ Systems built prior to April 1, 1996 and not located in Shoreland or Wellhead Protection Area or Serving a Food, Beverage or Lodging Establishment Systems located in Shoreland or Wellhead Protection Areas or Serving a Food, Beverage or Lodging Establishment, or systems Built after/' ________________March 31, 1996 ___________ Is the system an Imminent threat to public health or safety? (a ves answer is an JTPHS system) - Discharge of sewage to the ground surface? - Discharge of sewage to draintile or surface waters? YES NO YES NO Is the system an imminent threat to public health or safety? 7a yes answer is an UPHS system) - Discharge of sewage to the ground surface? - Discharge of sewage to draintile or surface waters? YES ' YF.S YESYES NO - Sewage backup into dwelling? - Situation with the potential to immediately and adversely impact or threaten public health or safety? - Sewage backup into dwelling? - Situatiori with the potential to immediately and adversely impact or threaten public health or safety?YESYES NO i Is the system failing? ('a yes answer is a faiiing system) - Less than THREE feet of vertical separab’ori between system bottom and saturated soil or bedrock? - A seepage pit, cesspool, drywell, or leaching pit? Is the system failing? fa yes answer is a failing system) - Less than TWO feet of vertical separation between system bottom and saturated soil or bedrock? - A seepage pit, cesspool, drywell, or leaching pit?© YES, YES NO YES NO YES Is the system non-comoliant? - Is the system regulated under a monitoring plan or operating permit? (if no, go to page 2) If yes, - Has the required monitoring taken place? (if no, the system is non-complying) Is the system non-compliant? - Is the system regulated under a monitoring plan or operating permit? (if no, go to page 2) YES If yes, - Has the required monitoring taken place? (If no, the system is non-complying) - Does the monitoring indicate that the system meets performance expectations? (If no, the system is non-complying). YES NO YES NOYES NO - Does the monitoring indicate that the system meets performance expectations? (If no,- the system is non-complying) YES NOYES NO wq-wwists4.31Page 1 of 2 .> Fire No./ Parcel No./?Z<3* *VVn3Vg?/ 9rj On( Property Owner(s) System Components fPlease describe the system components and attach site sketch showing systenri location): / . c /^ /^s s:^.<>,^PCa.j-P ni?c(O i/ ✓ What methods were used to make the determinations for the compliance inspection? (Note: No standard protocol exists. Tne following list is not exhaustive, or in sequential order nor indicates which combinations may necessary to make a determination) Vertical Separation Distance Conducted soil borings Depth to limiting layer Depth to system bottom □ Examined records Q Probed outside tank for "black soil" □ Excessive ponding in soil system/D-boxes □ LGU Limiting Layer Verification ^ Homeowmer testimony /□ Examined for surging in tank □ "Black soil" above soil system □ Other -______ Hydraulic Functioning ^^.ET^Searched for surface outlet □ Performed hydraulic test ^ Searched for seeping in yard □ Checked for back-up in home Watertight tank(s) ' Probed tank \^,ar"^Observed low liquid level □ Examined const, records □ Examined empty (pumped) tank ■ bottom cil~7d^ • // □ other□ Pressure/vacuum check □ Other_____________ f . ■/, -Status of the system Based on the compliance criteria, the system status is: (check one) □ failing (to protect groundwater) □ an imminent threat to public health or safety (ITPHS), □ non-compliant (monitoring issue) □ compliant (none of the 3 previous conditions). Therefore, this document is a:^Certificate of Compliance □ Notice of Ndncompliance Is this system an EPA Class V Injection Weli? □ yes no Certification I hereby certify as a state of Minnesota licensed Inspector and/or Designer I or Qualified Employee Inspector and/or Qualified Employee Designer I that I conducted an investigation that accurately determined the compliance status of this system and that my recorded observations are accurate as of this date. No determination of future hydraulic performance has been nor can be made due to ■ ' unknown conditions during system construction, abuse of the system, inadequate maintenance, or future water usage. __ Phone C Address.^^'^^^^ /'Asr Inspector's name (print) License and/or Registration Number ______ Employed by >• . Signature Upgrade Requirements, fderived from Minnesota statutes ^ 115.55) • '; iAn ITPHS must be upgraded, replaced, or its use discontinued within ten months of receipt of this notice or within a shorter penod if required by local ordinance. If the system fails to provide sufficient groundwater protection, then the system must be upgraded, replaced, or its use discontinued within the time required by rule or the local ordinance. If an existing system is not failing as defined in . law, and has at least two feet of design soil separation, then the system need not be upgraded, repaired, replaced, or its use discontinued, notwithstanding any local ordinance that is more stn'ct This does not apply to systems in shoreland areas, wellhead protection areas, or those used in connection with food, beverage, and lodging establishments as defined in law. Address Date ^ '.2 - ^^ V.■1 Suggested Attachments 1) Site sketch'could also include: well, well setback to system, dwelling or other buildings, tank(s),reserved soil treatment area, surface water and soil boring locations. Include as-built drawing if available. 2) Soil boring logs, showing each horizon. Indicate the texture, color, redoximorphic features depth to bedrock, standing water and whether the material is fill. 3) A list of any and all requirements of the local ordinance that are different from the state requirements referred to on this form. 4) A homeowner survey of system performance, signed by the homeowner as bang factual. :5) Monitoring data as appropriate. Page 2 of 2 Inspection Form for Existing Septic Systems i <i a a<a(ircel ___________. IDENTIFICATION I /// / ■Property 0\vner(s) At Cl)dCQ /'^T Telephona^^) ~?S9i- ^ 7 7 7 Site Address City /P^en _______ Zip Code^/^ County _________ DATE OF INSPECTION: 6 ‘O?TIME; //' CO WEATHER CONDITIONS: REASON FOR INSPECTION () Bedroom addition () Variance 0 Complaint () Property Transfer (bj^r or seller^ pother 0/d^>. jT^ r^' ' ^rea^ithjocal^rdinance^^^ Township Name 0~^_____ Full Partial Contractor/Installer name: Fire No. Is system opened up? N Township J3(s Range dCi Section ■S / Quarters SYSTEM : :Year.Svstem Built: ./ ^ ^ ^ For what reason: »^routinely : 0 basement backup □ sluggish plumbing □ other Any repair done pn system? Y What____- ' - When: __________ By whom Usage: pother estabiishmentOdwellingG seasonal Qotheri ■ ' ^ ^ ; ■, No. Bedrooms _____ No.. of occupants:. ■"' : ■: Water using appliances:.'0Clothes washerl0bishwasher;Q;Oarbage disposal OWWrlpooI bath.□ Water conditiphing unit DSelf-cIeaning humidifier in furnace Nearest Surface Water: = ft from which tvpe of surface water : □ river jS;iakeO stream □ other Has tank(s) ever.b^^^umped? !:■ (Check appropriate sewer system component and indicate location on site sketch on back of form). Tankfsl Material:Soil Treatment System:Tank (si:Other: __alternative system (identify type) _ / __experimental system (identify type) __other (identify type)____________ ^^eptic tank Aerobic tank __Fiberglass __Plastic __Metal ^Concrete Other___ __rock trench __gravelless trench __chamber trench ^'seepage bed __mound __at-grade __Pump tank __Holding tank Other_____ Tanl;(^ze; ^0(DCD gals Soil treatment area size(s):sq. ft. COMPLIANCE INSPECTION* I.s there or has there ever been any evidence of: Discharge of sewage to -the ground surface? • • • Discharge of sewage to a surface water?........... A seepage pit, drywelj, cesspool or leaching pit?............................. Less than three feet of vertical separation between the soil treatment system bottom and saturated soil or bedrock?..................................................... Sewage backup into dwelling or other establishment presently occurring? Situations with the potential to immediately and adversely impact or threaten public health or safety?................................................................................... Re.spon.se •...........YES ..............YES■ • • • •. YES /Q^ Explain YES YES <@>YES * if YES was answered for any of the above questions, the system is failing according to Minn. R. ch. 7080.0060. (if well setbacks are violated, a potential imminent threat to public health or safety may exist) STATUS OF THE SYSTEM %r><20.Based on the compliance inspection conducted above the system; status is ____ /_ ~C _£lr (Choo’se:;ia.compliani'pj-rC'OT^CP (Choose; Certificate of Compliance OR Notice ofNoncoInpliance ) . ___________________________, thereforej le ’OR failing’ OR' failing/imminent: threat) this document is a CERTIFICATION I hereby certify as a state of Minnesota licensed Inspector, Designer I or Qualified Employee that my observations recorded on this form are accurate as of the date at the top of this form for the site stated above. I hereby certify that all inspection work was completed according to applicable requirements. No determination of future hydraulic performance can be made due to unknown conditions during system construction, future water usage over the life of the system, abuse of the system , and/or inadequate maintenance all of which will adversely affect the life of the system. Inspector’s name^^»l.S5 (print) Phone )^C?-.<i/g/^ALicense aml/or Registration Number Address JSignature Date Site Sketch: ■ ^^ v • .\i■ -V .............^■ ■ • ■ ■ ^ .............^• .... ..... , . .■ .. .. ■ ■ -X j . r. f. :: Im ■ y 7 ..Jp.;. . . i:----•:----i-----•;----------V ..• V- •••»••• V- . . . • • J . . ^---- 4 - ••;• 100’---;;----------•;----.% • ........'.... i-, i'. . N Well 100’0 Please indicate the location of: Well, well setback to system, dwelling or other establishment, tank(s). soil treatment system, reserved soil treatment area, curtain drain, property lines, waterways, and buried lines (those NOT installed by the utility). Include sizes and length and approximate distances from fixed reference points such as streets and buildings. Please attach as- built drawings, inspection reports, Certificat(s) of Compliance and Notice(s) ofNoncompiiance, if alvailable. Soil Borings (BR #): Locate each boring on the map above, indicate on the right of the column the soil texture, structure, color, depth of each different soil type, evidence of mottling, bedrock and standing water. Also indicate if the material is fill. BR#BR# BR#BR#BR# BR# 10Q-^o fa///6 I(CXSA"' cl^rloy^ 3/V -7/h ; ey/?Q\COl /o WV/y_ /> /oy^t!I ^z" lOH^/ '' /c7 //7^.3 7^ /\/oe>r //'fz /l/o'^CL RECORD DEPTH OF MOTTLING. SEASONAL HIGH WATER (AS DETERMINED USING THE MUNSELL COLOR BOOK) OR BEDROCK ON ABOVE LINES c/ra/fsComments: a.r<? exy'^,70 -ihan<::<r___________________________ .Oto/)ers oji// /'/}s7aLff c^osi^r What Meds to bfe 9omi^ted to bring the above system into confpliance if found not in compliance? / S ^ O/ci cpfnrn9 n^fl \Te fi!cL . r\J^ame iX i\\ocurh peof>U - _l lJ gy'^r’-— ng r s' Yi.\p>dL/Q£ ^' Vvt> <7 -f'ac .S'/fi'iy J>^ /t JV p<0 rf nZir/rLfi^ // 7- r~<3> nba^ h/c / /a rno- r— <2» A- c/es^fzn -f^r r^f>/ac 'tfr t I CERTIFICATE OF COMPLIANCE SEWAGE SYSTEM Vsr 26th 79_79This certificate has been issued this Januaryday of_ to certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota. The premises covered by this certificate are legally described as: tt I Lake No. 56-384 Sec__li Twp. 136 Range 40 Twp. Name Edna G.L. 7m t4-Owner: Name.DoTin^ g ATiHprgnn Address.npnt-^ M'tnnpgnfa L W.Zip No. Permit No. SP_3027 'p Signed byj. Ucolm K. Lee, Shoreland Administrator ;ter Tail County, Minnesota k;5 tIMKL-087!-009 IA1 I 159035 vcT<l«MIV i 4 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 y W ;te — Office V low — Inspector Ph.. — Owner Card -• Owner Permit No.LEGAL ■ I- n Date DESCRIPTION AND 77 n(, 7d <LUL^h/FLOCATION Lake No.Sec.Lake Name Lake Classif.TWP Range TWP Name IDENTIFICATION; Please Print All Information. Last Name First Initial no Address —No. Street, City and StateMailli Zip No.Tel. No. Ux> ISOWNER SEWAGE SYSTEM INSTALLER Name. This System will be ready for infection on.., 19. This space for office use only 19 M Date Rec'd Time Rec'd Phone Call Rac'd By Owner or Agent Signature NUMBER OF BEDROOMS: JESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD 90 0 GIs.'Sq. Ft.Capacity Sq. Ft. r»Ft.Ft.Ft.Distance from nearest well mlAFt.Distance from lake or stream Ft.Ft. Lol Ft.Distance from occupied building Ft.Ft. Distance from property line Ft.Ft.Ft. yFt.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 TvS-'2-7 .22PERCOLATION TEST DATA:Date of First Test ., 19 Rate T~1I-Date of Second Test 19 , Rate ts^ Test Taken By \''1First Test -I- 2nd Test 1 Rate2nd Test Taken By The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work inAgreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. (Call or use attached mailer notice.) Sigr/atureDated 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 corifprm 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 Fh/p 7Issued Date: loreland ManagemeqvOffice3;^3Fee $Surcharge $ (Comments:. Form No. MKL-0771-003 1S8906 viCTot urNDECM 4 CO . ptmnai. rf*«u4 salli ■»!«■ SHORELAIMD MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 - Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM W to - Office, V .low — Inspector Pii.. Card —* Owner Owner Permit No.,LEGAL Date DESCRIPTION 1^I AND 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. OWNER SEWAGE SYSTEM INSTALLER Name. mir2 N 2This System will be ready for inspection on. VThis space for office use only ,19 ,M 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 Sq. Ft. Ft.Ft.Ft.Distance from nearest well Ft.Distance from lake or stream Ft.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 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:. ISsO'eD VICTOII LUMCCH 4 C«.. PlltNTE4l. rittuS fALLl. «■■■ 158906Form No. MKL 0771-003 r %M INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORY Actual Should be Actual Should be Actual Should be jfiis:Capacity GIs.S F S F S F S F 75 FDistance from Nearest Well F 75FF 50F F Distance from Lake or Stream / FFFFF F Distance from Occupied Building 10 2020FFFFF F Distance from Property Line 10 10 10F/at FFFF Ft /5/- FDistance from Bottom to Water Table 4 4FFFF F Inspector's Comments: C ' 1‘iDate of Inspection Time of Inspection M K ^ Signature c^lnspec^r/INTERPRETATION OF ABBREVIATIONS GIs = Gallons SF * Square Feet F • Linear Feet Job Title AgencyMKL-0771-003-Backer PERCOLATION TEST DATA Price $1.00 per pad. SHORELAND MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 79^z//z.Ph. No.Owner:Mailing Address: O PMM.r /h ! rttt Last Name First Middle St. & No.City State Zip No.Legal Description; ^ ^nc 77^ D/)^71LAKE OR RIVER NO.SEC.NAME TWP.RANGE TWP NAME TEST HOLE NO. 2TEST HOLE NO. 1 CL4-Depth To Bottom of Hole,Depth to Bottom of Holeinches; Diameter of Hole inches; Diameter of Holeinches Jnches -T 7 TL.Depth, Inches Soil Texture Depth, Inches Soil TextureDate19 Date 19_____^lie.Percolation Test By____ Percolation Test By____Z. ^Q LUFirm Name.GC Firm Name. alUcc LUAddress.GC Address < COOtter Tail County License No.Otter Tail County License No^HCOLUMeasurement, Inches Depth in Water Level, Inches H Measurement, I nches Depth in Water Level. Inches Time Remarks Time Remarks o¥6 I 1^3^Z5 6 O -V/0 V/^3 r ( MKL-0871-028 See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn. i ................................................................................... CS7>'as^ : ( te^1 CERTIFICATE OF COMPLIANCE SEWAGE SYSTEM m i iti mm t'ik6 th Jenua ry 19 7)|This certificate has been issued this day of PiBeto certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota. m ^‘1The premises covered by this certificate are legally described as: fl WM Lake No. 5fe~36U Sec.^1 136 Range UP Twp. Name EdnaTwp. m.\W/ WmOtter Basketball Camp, Inc. formerly Lone Pine Resort ml€ M m V omiotter Basketball Camp, Inc.Owner: Name, Address Box UlU, Fergus Falls, Minnesota &I1 Zip No.0. •mw I 783Permit No. SP_ Signed by:.;Malcolm K. Lee, Shoreland Administrator Otter Tail County, Minnesota mm. MKL-0871-009 . I•(Ti I ■ " ■ m> s ®1S9035 >'•' i1 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 — Ow^er -m 7 tJPermit No.,/LEGAL JDate DESCRIPTION AND cz- uy 3/ /3^LOCATION TWP NameSec.TWP RangeLake Classif.Lake NameLake No. IDENTIFICATION; Please Print All Information. Zip No. Tel. No.Mailling Address —No. Street, City and StateInitialFirstLast Name 7^ 2v/ ■jr<iQ7OWNERy Lit £SIC ATtSEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection on. This space for office use only .M.19 Phone Call Rec'd ByDate Rec'd Time Rec'd Owner or Agent Signature Cr ^ SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD ^SLSt J-?^ oSq. Ft.Sq. Ft.GIs.Capacity y-Ft.7 ry-Ft.Distance from nearest well 4^ y- Ft.ys~^ y- Ft.Ft.Distance from lake or stream ■><h^y~ Ft.J U A- Ft.Ft.Distance from occupied building / o y~ Ft./u y~~ Ft.Distance from property line Ft. Y Ft.Ft.Ft.Distance from bottom to Water Table All distances are shortest distance between nearest points RECORD OF TESTS: , 19 ........JVI By.......... 19 ?„3 , Rate. , 19?..I....... Rate Inspection was made on , Time PERCOLATION TEST DATA:Date of First Test /P.Date of Second Test 1st Test Taken By + 2nd Test....y^.r.....^..^,First 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 rea^ for inspection. (Call or use attached mailer notice.) 3 y?7 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 (6) months. Permission is hereby granted to the above named applicant to perform the work descrmed in the above statement. This lit is granted upon express Issued Date:f r/Shoreland Management Office Surcharge S 3-Fee S .iT^.Hio . 3Comments:. / >e X 0/ 7 / f ^ ^f Form No. MKL-0771-003 V>CTO* UINBKN t CO . VaiNTCM. FEKtU* FACLB. HiMM 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 —^Office Yellow — Inspector ^ink Card Owner Owner Permit No., LEGAL Date DESCRIPTION AND LOCATION TWP NameSec.TWP RangeLake Name Lake Classif.Lake No. IDENTIFICATION: Please Print All Information. Tel. No.Zip No.Mailling Address —No. Street, City and StateFirstInitialLast Name OWNER SEWAGE SYSTEM INSTALLER Name, This System will be ready for inspection , 19.on. This space for office use only \ .19 M Phone Call Rec'd By Owner or Agent Signa.tureDate Rec'd Time Rec'd SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD Sq. Ft.GIs.Sq. Ft.Capacity Ft.Ft.Ft.Distance from nearest well Ft. Ft.Ft.Distance from lake or stream Ft. Ft.Ft.Distance from occupied building Distance from property line Ft. Ft. Ft. Ft.Ft. Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on 19 , Time JVl By PERCOLATION TEST DATA:Date of First Test 19 , Rate Date of Second Test 19 , Rate 1st Test Taken By First Test -I- 2nd Test 2 Rate2nd Test Taken By 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 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 LIssued Date: rShoreland Management Office Fee $Surcharge $00 ISSVJtPComments:. Form No. MKL-0771-003 viCTot uiMsccH « e».. rexsus ratk* mimm 158906 5" f INSPECTION RESULTS CG Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORY Actual Should be Actual Should be Actual Should be Capacity GIs.GIs.S F S F S F SF Distance from Nearest Well 75F 50FFFF F Distance from Lake or Stream F F F F F F Distance from Occupied Building 10 2020FFFF F F Distance from Property Line 10 10 10FFFFF F Distance from Bottom to Water Table 4 4FF F F F F / r Inspector's Comments: "s-.OLi. / f~0fe t/oT n1 /V /Lt /J V /do " ^if J■f Date of Inspection 19___ Time of Inspection,M Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs - Gallons SF “ Square Feet F * Linear Feet Job Title Agency M KL-07 71 -003- Backet . ....» ■ r PERCOLATION TEST DATA Price $ 1.00 per pad. SHORELAND MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Mailing Address: Ph. No. Owner: A2 C sBo\ ^ ^ ^(OV'Vc.h Last Name First Middle St. & No.City State Zip No. ' _£_ Legal Description:r SEC.TWP.LAKE OR RIVER NO.NAME RANGE TWP NAME . r TEST HOLE NO. 2TEST HOLE NO. 1 U-1/ V Depth to Bottom of Hole inches; Diameter of HoleDepth To Bottom of Hole,inches;Diameter of Hole inches Tciy z?Depth, Inches Soil Texture Depth. Inches Soil Texture Date 19/ u y Percolation Test By____ Percolation Test Bv ^OliiFirmName.o:Firm Name. aLU CC UAddress.OC Address < (/)Otter Tail County License No..Otter Tail County License No^,HC/D UJMeasurement, I nches ^ Depth in Water Level, Inches H Measurement, Inches Depth in Water Level, Inches Time Remarks Time Remarks o I >I jCK !Cs.h' 'I SirJ ‘ 4 ' V"✓/-W 7-5I'i.f 5^ -j! >i.. ?: I Y h ^3./ ')K > / /: /:Sl A ^ 'T'“S Z3?! H> 3 '■ ll-n )f ■uI■.-5 +' I) it s U322A-1 f I MKL-0871-028159179 ®VICTOR LUNOCCn t CO »«iHT(|ta. rCROuS T*I.L(. WINN See Booklet, "How to Run a Percolation Test" by Agriculture Ext Service, Un. of Minn. . i , •i. 7^-^e j^ryr w t;/\ ^ - MlfriPi^l CERTIFICATE OF COMPLIANCE SEWAGE SYSTEM m •U:-—••>. ; •-• V8 th . ?:19 7hJanuaryThis certificate has been issued this day of.mt0am pH •‘v:t:n';to certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota. ,.'^- The premises covered by this certificate are legally described as: Twp. 13^ Range ilO ■ ■ ' 7.'-'Pf WM Wm56-3811 w 31 ITwp. Name EdnaLake No. PS|SI Iotter Basketball Camp, Inc. Parcel In G.L. #6 ,vj; mmWm i*r■‘ T'\I ■ iL.Otter Basketball Camp, Inc.tfJi Mm m Owner: Name. pm ■" pi) " I*''® m Address Box U3U» Ferffljs Fella, Minnesota ..-.it )k 56537Zip No. T: 708 Malcolm K. Lee, Shoreland Administrator Otter -Tail County, Minnesota Permit No. SP_ Signed by:.m MKL-087 1-009 Ir-v ;v":' : sw,s' .i,''..-. -:Sv;t \.-yf .*®i’;ri'v. ,’/■ ■159035 ■"->•: SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 — Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM White — Office ^Yellow — Inspector 'Pink — Owner Card — Owner Permit No., O-.L. -Z. c_LEGAL V/7Date DESCRIPTION I AND Q.3/ 6MB VOLOCATION TWP NameLake Ciassif.Sec.TWP RangeLake NameLake No. IDENTIFICATION: Please Print All Information. Tel. No.Zip No.Mailling Address —No. Street, City and StateInitialFirstLast Name Auo f~ fog///^r\X V3Y />orau s5OWNER 0 SEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection on., 19. This space for office use only ,M.19 Owner or Agent SignaturePhone Call Rec'd ByDate Rec'd Time Rec'd SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PIT DRAIN FIELDSEPTIC TANK Sq. Ft./^SO GIs-Sq. Ft.Capacity Ft.Ft.Ft.Distance from nearest well Ft.Ft.Ft./snDistance from lake or stream za Ft. Ft. Ft.Distance from occupied building Distance from property line zo ZD.Ft. Ft.Ft. Ft. Ft.Ft.Distance from bottom to Water Table 1AH distances are shortest distance between nearest points RECORD OF TESTS: 19 , Time .........JVI By........... ,, 19 Rate- , 19.....?.3...., Rate Inspection was made on A.S'...Z./...LO.PERCOLATION TEST DATA:Date of First Test fcriJ--Date of Second Test 1st Test Taken By A..K.,Z...5r.-1 First Test......-I- 2nd Test 2 Rate 2nd 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. Issued Date: Shoreland Management Office A)oFee $Surcharge $ <arSnn ptpf<or\^js ■C, riL4 Comments:.o» hci.M tr\ c / t5~ Ir.RTr) y/ n/r.//ACXXpCiSLt iyr ctuXA vicTo* * CO . r>iHt(»a. riaeus rk^Li 158906' No. MKL-0771-003 SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 - Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM White — Office •Yellow — Inspector Tink — Owner Card — Owner Permit No., LEGAL Date DESCRIPTION AND LOCATION TWP NameTWPRangeLake Classif.Sec.Lake 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 .. 19.on. This space for office use only .M19 Owner or Agent SignaturePhone Call Rec'd ByDate 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 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: 19,, Time ,jVl 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: 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. Issued Date: Shoreland Management Office \Fee $Surcharge $ Comments:. ..158906Form No. MKL-0771-003 vicroa uiiieccH t co . p«inum. riatua fall*. INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORYActualShould be Actual Should be Actual Should be SF f/ilo SFICapacityGIs. GIs.S F S FI Distance from Nearest Well 75FFF F F F Distance from Lake or Stream F F F F F F r Distance from Occupied Building 201020FFFF F / Distance from Property Line 10 10 10FFFF F ■r )Distance from Bottom to Water Table 4 4FFFFF F Inspector's Comments:" . //\ yfl't 7V. f Lf >■ a.4 7'cu X- C''sr\ ■? -i Date of Inspection 19___ r'\Time of Inspection \V Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs - Gallons SF * Square Feet F ■ Linear Feet /1y Job Title Agency MKL-0771-003-Backer > < PERCOLATION TEST DATA \«Price $ 1.00 per pad. SHORELAND MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Ph. No. Owner:Mailing Address: 00XO.Xtcf- 0H/reZ C X/iOc ^ ^ h/9LlS Last Name First Middle St. & No.Zip No.City State Legal Description;I LAKE OR RIVER NO.NAME SEC.TWP.RANGE TWP NAME nhou*. e TEST HOLE NO. 2TEST HOLE NO. 1 ■j. i 7 Depth to Bottom of Hole,^ inches: Diameter of Hole JnchesDepth To Bottom of Hole,inches; Diameter of Hole inches 19>3Depth, Inches Soil Texture Depth. Inches Soil Texture / [A i. .-%■ ■ Percolation Test By____ Percolation Test By .3l1 Q LUFirmName.>QC Firm Name.D aLUfDC LUAddress.DC Address < (/)Otter Tail County License No.,Otter Tail County License No.H- LUMeasurement, Inche^Depth in Water Level, Inches h-Measurement, Inche^^Depth in Water Level, Inches Time Remarks Time Remarks o ^2^j i/5H U3.-f ;9-3 mL- — ^ ii’im—^—*,—2■? A ->>m ^ 'Xi'i -v I HIfe-f r-M ; a I :U' . ■ f: PA ¥-Jt-e 4 f //!njii• >.1 >'■ I .'/«>•Jrt+r 1 M ■' S J CO- //.O c-|:^ / MKL-0871-028159179 ®vicToi i.uHoef« i CO rcRsua rkLct./See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn.