HomeMy WebLinkAboutLeisure Lane Resort_50000990275000_Septic System Permits_APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM
WHITE — Office
Yellow — Inspector
Pink — Owner
LAND & RESOURCE MANAGEMENT
OTTER TAIL COUNTY COURT HOUSE
Phone:(218)739-2271 - FERGUS FALLS, MN 56537
J_o'h 3', V, 5, 4 ^7
Permit No. j/“Z3 ^________
Abatement: ( ) Yes (X ) No
LEGAL
DESCRIPTION
AND
LOCATION
LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER
CLASS
SECTION RANGE TWP NAMETWP. NO.
PJL5Q- ^i5 Pi ^1/3J/J3(o
PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER
50-0GO'99 - 02.72^ ^ OJLIL-OOO /111
IDENTIFICATION: Please Print All Information
Last Name First Mailing Address — No. Street, City and StateInitial Zip Code Telephone No.
jK'u Piki./
//'ll Ol^
R-l' 2. 3>o'~pc. 12.0Property
Owner -Y-
_ /)^A/PJL C-cut^
LLofS'f' c
IIU9_____________
Sewage
System
instalier
Name
\PJ-rg rj~ J~Jcjc^ ^A/
A.M.
This System will be ready for inspection on P.M., 19.at
This space for office use oniy 3NUMBER OF BEDROOMS:
A.M.
P.M19 GARBAGE DiSPOSAL: ( ) YES { ^ ) NO
Date Rec'd Time Rec'd Phone Call Rec'd By
SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM
( ) Holding tank (Alarm Required)
( ) Septic tank
( ) Lift station (Alarm required)
( X^) Drain field
(^ Trenches <X
( ) Bed
( ) Mound
( ) Outhouse
( ) Sewer line
TANK DRAIN FIELD
Capacity GIs.Sq Ft.7V
S oL/ crODistance from nearest well Ft. Ft.
Distance from lake or stream Ft.7T Ft.I
S /^/^oDistance from building Ft. Ft.
iDistance from property line Ft.Ft./
Distance from bottom to Water Table Ft.Ft.J
EFFLUENT DISTRIBUTION
( ) Gravity
( ) Pressure
All distances are shortest distance between nearest points
PERCOLATION TEST DATA:
WATER WELL DEPTH
Perc Tester.Date of Perc Test.
1.02 /l£1Rate of 1 St Test Rate of 2nd Test Average Rate
Agreement: The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in strict
accordance with Ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minnesota Department
of Health. Applicant agrees that plot plan sketches and specifications submitted herewith and which are approved by Shoreland Management Officical shall become a part
of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibllty of the applicant for
the permit to notify the County Shoreland Management that the job is ready for inspection.
/('/s.'y/ 1 c.
DATE:
Signature
Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition
that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinance of Otter Tail County, Minnesota.
This permit may be revoked at any time upon violation of any said ordinances.
NOTE: Permit void if work is not commenced within six (6) months.
9C.Issued Date;
Land & Resource Management Office3S^Fee $.vV oJoL,
___________
3 7/±7.Comments:
7^ 3" JJr'yyr- S f
277.212 • Victor Lundeen Co.. Printers • Fergus Falls, MinnoosiaBK 0795-003
.1APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM
•;
WHITE — Office
Yellow — Inspector
Pink — Owner
LAND & RESOURCE MANAGEMENT ^OTTER TAIL COUNTY COURT HOUSE 3--
Phone: (218) 739-2271 - FERGUS FALLS, MN 56537
J-, V, 5-, 4 * 7
LEGAL Permit No.
DESCRIPTION
Abatement: ( ) Yes (X ) NoAND
LOCATION
LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER
CLASS
SECTION TWP. NO.RANGE TWP NAME
PJL.■7/ 5 KDPro. I f/3//J3&<■-c
PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER
OJi'7C - COOr W- 99 - 0212^ ^ OOO VA-ill
IDENTIFICATION: Please Print All Information
Last Name First Initial Mailing Address — No, Street, City and State Zip Code Telephone No.
I'R-^ 2 120Property
Owner / I 4^-Y-
V Ccc-P,
9Sewage
System
Installer
Name
4 x: ■■'>>'c.7 P^Rr 0 / ■/ l~o^ I CyIa/UL 9 <.JL.S
This System will be ready for inspection on , 19.P.M.at
This space for office use only
NUMBER OF BEDROOMS:
'PUo t ^Czy^P.M GARBAGE DISPOSAL: ( ) YES ( ) NODate Rec'd Time Rec’d Phone Call Rec’d By
SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM
( ) Holding tank (Alarm Required)
( ) Septic tank
( ) Lift station (Alarm required)
(^) Drain field
( ) Trenches
( ) Bed
( ) Mound
( ) Outhouse
( ) Sewer line
TANK DRAIN FIELD
Capacity Gis.Sq Ft.7V
S 6>// O ODistance from nearest well Ft.
Distance from lake or stream Ft.Ft.7T
Distance from building Ft.Ft.o
'Distance from property line Ft.Ft./ OA
Distance from bottom to Water Table Ft.Ft.
EFFLUENT DISTRIBUTION
( ) Gravity
( ) Pressure
All distances are shortest distance between nearest points
PERCOLATION TEST DATA:
WATER WELL DEPTH
c p
Perc Tester.Date of Perc Test.1
h03Rate of 1st Test Rate of 2nd Test /_ Average Rate
Agreement: The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in strict
accordance with Ordinances of the County of Otter Tall, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minnesota Department
of Health. Applicant agrees that plot plan sketches and specifications submitted herewith and which are approved by Shoreland Management Officical shall become a part
of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibilty of the applicant for
the permit to notify the County Shoreland Management that the job is ready for inspection.
V Z .-ZkDATE:
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 agent, employees and workmen shall conform in all respects to the Ordinance of Otter Tail County, Minnesota.
This permit may be revoked at any time upon violation of any said ordinances.
NOTE: Permit void if work is not commenced within six (6) months.
V RIssued Date:
Land & Resource Management Office- yO Rec # //S’ ^Fee $.
^ .je^S ■// ^ 9
S' (/ T
3 7ZComments:
7
277.212 • Victor Lundeen Co.. Prinisrs • Fergus Falls. MinneostaBK 0795-003
INSPECTION RESULTS
Inspector must make all measurements
SEWAGE DISPOSAL SYSTEM STATISTICS
HOLDING SEPTIC TANK DRAIN FIELDLIFT TANKCATEGORY Actual Minimum
^0 SFCapacityGLS.GLS.SF
50^ FTDistance from Nearest Well FT FT FT
Distance from Buried
Water Suction Pipe >2^FT FT 50 FT
Distance from Buried Pipe
Distributing Water Under Pressure rtFTlO FT FT10
47 S FTDistance from Lake or River (OHWL)FT FT
FTDistance from Nearest Building 10/20 FTFT
n ftDistance from Nearest Property Line FT FT10
/O^ FTDistance from Bottom to Water Table FT FT 3 FT
YESHolding Tank/Lift Alarm NO
YES NOOld System Pumped & Destroyed
Sewer Line to Well Separation DRAINFIELD CALCULATIONINTERPRETATION
OF ABBREVIATIONS
GLS. = Gallons
SF = Square Feet
FT = Linear Feet
Actual Minimum 5 soFTX
90FT20 FT SF
r'
/aInspector’s Comments:
SKETCH:
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V':
/nspector's Signature
/o-n-%
Date o1 Inspection
Time of Inspection
i
M&^.m. M^jSf.. .4
Mitou
CERTIFICATE OF APPROVAL
SEWAGE SYSTEM
£
DRAINFIELD21st February 19 HThis certificate has been issued this day of
to certify that the sewage system installed as per sewage permit number indicated below has been approved for use
by Otter Tail County. Minnesota.
■>.
1?^The premises covered by this certificate are legally described as:
mLake No. 56-915 Sec. 11 Twp. 136 Range 43 Pel lean •ki Twp. Name
Li
11LEISURE LANE RESORT
Subrosa Beach
Lots 3,4,5,6 & 7
(50000990272000 - 50000990276000)
mm iMHy:.i 'i- i 4!
.'Owner: Name Allan & Jane KunkGl
L MRR#2 Box 120 Pelican Rapids. MNAddress))&■
5657?4Zip No.
K-
lr^Permit No. SP _1122Z
Land & Resource Management Official
Signed by:
Otter Tail County. Minnesota
MKI. 0987001
284.909 • Victor Lundeert Co.. PiirMeis • Fergus rails. MN • 1-8OO-346-407O
, ^ GRID PLOT PLANinch(es) equals 33^ feet SKETCHING FORM//IScale:.grid(s) equals feet, or
i :I'I I r
19 9^ _________________
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Please sketch your lot indicating setbacks from road right-of-way, lake,\sldeyard arid septic ta
field fpf, each building currently on lot and any proposed structures.
pated:11i i 1
nk and drain-
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CERTIFICATE OF APPROVAL
SEWAGE SYSTEM
92NOVEMBER19THThis certificate has been issued this day of 19 LM§ZMto certify that the sewage system installed as per sewage permit number indicated below has been approved for use
by Otter Tail County, Minnesota.
The premises covered by this certificate are legally described as:
PELICANRangeSec. Twp. ^ ^ ^5 6-91 5Lake No.Twp. Name mlitsaSUBRCSA BEACHSUBROSA 9EACH
LOT 7LOT 6
KRACHT/ DANIEL R CYNTHIAOwner: Name
BOX 121/ PELICAN RAPIDS/ MNRR 2Address
56572Zip No.
9087Permit No. SP
Signed by:
Land & Resource Management OfTicial
Otter Tail County. MinnesotaMKL-098700I
/gu..\r m
JT‘263191 Victor Lundeen Co., Primers, Fergus Falls, Minnesota
WHITE — OfficeYelfovi — frispector
Pink — Owner
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
Permit No.LEGAL SubuGAa Be^aah
LotA 6 and 7DESCRIPTION
AND
LOCATION
LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER
CLASS
SECTION TWP RANGE TWP NAME
fn.aLn.ie.fD k3\d fe.L Leantk/36N
PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER
f-l!!7
IDENTIFICATION: Please Print All Information
Last Name First Initial Mailing Address — No. Street, City and State Zip Code Telephone No.
KMCHJ 863-^^86Danff2 Box 120 fe.Lic.an fapLdA MN 218Property
Owner
Ohm ^Kcavating.f.O.BoK 2^3 Audubon,56511 D39-6D28Sewage
System
Installer
Name
► This System will be ready for inspection on , 19-at
nnsSvz:
Time Rpr'rt ----- --------'
This space for office use only
NUMBER OF BEDROOMS:2
19 GARBAGE DISPOSAL: ( ) YES ( X ) NODate Rec’d PTOne Call Rec'd By
SEWAGE DISPOSAL SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM
( ) Holding tank
( L^)^eptic tank
( j^^^^J^ain field
( ) Standard (
( ) Modified
( ) Mound
TANK DRAIN FIELD
7bt)Capacity GIs.Sq Ft.
$0(0050Distance from nearest well Ft.Ft.
7^-7T)Bed () Trench Distance from lake or stream Ft.Ft.
laDistance from building Ft. Ft.
/OIQDistance from property line Ft.Ft.
EFFLUENT DISTRIBUTION
\y) Gravity
) Pressure
Distance from bottom to Water Table Ft. Ft.(V
All distances are shortest distance between nearest points(
WATER WELL DEPTH:,
14-30
^^f30
y,c?'2.PERCOLATION TEST DATA: Date of First Test , 19 Rate
(J vcmaIiSSrTBy
Cx/VvY------
f sDate of Second Test . 19 Rate
1sl Test /
=hoa.First Test -F 2nd Test
Rate2nd Test Taken By
Agreement: The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in strict
accordance with Ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minnesota Department
of Health. Applicant agrees that plot plan sketches and specifications submitted herewith and whiefnare approved by Shoreland Management Officical shall become a part
of the permit. Applicant further agrees that no part of the system shall be covered until it has beery irlspected and accepted. It shall be the responsibilty of the applicant for
the permit to notify the County Shoreland Management that the job is read/fSjr inspectii
31
DATE:
Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition
that the person to whom it is granted, and his agent, employees and wot
This permit may be revoked at any time upon violation of any said ordinances.
NOTE: Permit void if work is not commenced within six (6) months.
len shall conform in all respects to the Ordinance of Otter Tail County, Minnesota.
-5)-'7TIssued Date:
Land & Resource Management Office
Fee $.Rec #.
Comments:
Form No. BK — 0292-003 260.771 — Victor Lundeen Co., Printers, Fergus Falls, Minnesota
#1 u
i
SHORELAND MANAGEMENT — COUNTY OF OTTER TAIL
COUNTY COURT HOUSE
Phone: (218) 739-2271 • FERGUS FALLS. MN 56537
APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM
WHITE -^Office
Yellow — Inspector
Pink — Owner
LEGAL Permit No.Sub/ioAa Be.acA
LotA. 6 and 7DESCRIPTION
AND
LOCATION
LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER
CLASS
SECTION
/1
TWP RANGE TWP NAME
T'aaUU no b3\flIk/36N fe.Lic.an
PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER
21ff-aX) ^^uuo-f-t 117
IDENTIFICATION: Please Print All Information
Last Name First Mailing Address — No. Street, City and StateInitiai Zip Code Telephone No.
Kum f.f.2 Box 120 fciican fapidA (hHDan 2lS S63-klS6Property
Owner
Ohm Excavating,Sewage
System
Installer
f.O.Box 293 Audubon, (hhi k37-6k2836511Name
c .M.
a,This System will be ready for inspection on . 19.
This space for office use only 1
NUMBER OF BEDROOMS:2
____Pl)6ne Call Rec'd By GARBAGE DISPOSAL: ( ) YES ( ) NODate Rec'd Time Rec'd
4. - •'!SEWAGE DISPOSAL SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM
( ) Holding tank
( tank
( field
( ) Standard (
( ) Modified
( ) Mound
DRAIN FIELDTANK
TOTCapacity Gls.Sq Ft.
5T>Il<50Distance from nearest well Ft.Ft.
l/^Viench 15(Distance from lake or stream Ft.Ft.
laDistance from building Ft.Ft.
loloDistance from property line Ft.Ft.■j
EFFLUENT DISTRIBUTION
( \y) Gravity
( ) Pressure
Distance from bottom to Water Table Ft.Ft.
All distances are shortest distance between nearest points
WATER WELL DEPTH:,;0 4
I
II- JOPERCOLATION TEST DATA: Date of First Test . 19.Rate
2Z/.-/ JDate of Second Test , 19 Rate •T
S)1st Test n By /
./.OT)Vv v|First Test + 2nd Test
Rate2nd Test Taken By
Agreement: The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in strict
accordance with Ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minnesota Department
of Health. Applicant agrees that plot plan sketches and specifications submitted herewith and which are approved by Shoreland Management Officical shall become a part
of the permit. Applicant further agrees that no part of the system shall be covered until it has beery inspected and accepted. It shall be the responsibilty of the applicant for
the permit to notify the County Shoreland Management that the job is ready f(^ inspectim '''iI
ih'inv-.'o<
DATE:
SignatufS ^
Permit: Permission is hereby granted to the above named applicant to perform tl)e work described in the above statement. This permit is granted upon express condition
that the person to whom it is granted, and his agent, employees and wot
This permit may be revoked at any time upon violation of any said ordinances.
NOTE: Permit void if work is not commenced within six (6) months.
■ilen shall conform in all respects to the Ordinance of Otter Tail County, Minnesota.
1
Issued Date:
Land & Resource Management Office104^80Fee $.Rec #.i
Comments:
Form No. BK — 0292-003 260.771 — Victor Lundeen Co.. Printers, Fergus Falls, Minnesota
I
INSPECTION RESULTS
Inspector must make all measurements
SEWAGE DISPOSAL SYSTEM STATISTICS
SEPTIC TANK DRAIN FIELD
CATEGORY Actual Minimum Actual Minimum
SFSBC/&to
FT
7^0 GLS.SFGLS.Capacity
^/Ob FT
Distance from Nearest Well FT50
Distance from Buried
Water Suction Pipe FTFT5050
Distance from Buried Pipe
Distributing Water Under Pressure FT FT FT FT1010
IS ft 757S-7j. ft 74 •'77ft FTDistance from Lake or River (OHWL)
H! ftftDistance from Nearest Building FT FT1020
FT .5/-;?? ftDistance from Nearest Property Line 10 FT 10 FT
FTDistance from Bottom to Water Table FT FT 3 FT
Sewer Line to Well Separation DRAINFIELD CALCULATIONINTERPRETATION
OF ABBREVIATIONS
GLS. = Gallons
SF = Square Feet
FT = Linear Feet
Actual Minimum -3* ft/CrC FTX
FT20 SF
Inspector’s Comments:
t
SKETCH:
4 •I f
/l<7
Inspector's Signature
S-!I
Date o1 Inspection
/;a7
Time of Inspection
GRID PLOT PLAN SKETCHING FORM — (Must Be To Scale)
«
Scale: Each grid equals feet/inches
«
Dated:19
Signature
Please sketch your lot indicating setbacks from road right-of-way, lake and sideyard for each building currently
on lot and any proposed structures.
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PERCOLATION TEST DATA r
LAND AND RESOURCE MANAGEMENT
Otter Tail County
Fergus Falls, MN 56537
%
OWNER:
VAST NAME FIRST MIDDLE TELEPHONE NUMBER
ADDRESS:
KR ^ /AO
STR./RT. V
AJU^n Vi. NO. LAKE NAME
CITY STATE ZIP CODE
IZ nvP. NAMESEC. TWP.RANGE
LEGAL DESCRIPTION:
PARCEL NUMBER
FIRE NUMBER N UMBER/BEDROOMS
— TWO TESTS ARE REQUIRED —
TEST HOLE NO. 1 TEST HOLE NO. 2
lADepth To Bottom of Hole inches; Diameter of Hole. inches Depth To Bottom of Hole inchesinches; Diameter of Hole.9^DateDepth, inches Soil Texture Depth. Inches Soil Texture Date 19
S/A^^i^^rcolation
—“ Test By.
Firm
Name ,
Firm
Name
AAzX-
Address Address
Otter Tail County
License No.Otter Tail County License No.
PERC TEST # 1 PERC TEST # 2
WTOVAL n^IHlTTBP WTT"WATBR CHOP PERC RATE
Til TIME IWTBRVALn>iflNllTBS\W/WATHRDKOP
PERC RATE
y.A.START START
TIME Sr6P PERC<r...Tlfcg iKTERVAL/wiwtrran PERC RATE Tliig IWTBRWU-fltflWUTTO Water 1 WAIBRDROPDEPTH PERC RATE7^REFILL REFILL
.s....X/...PBRC
INTERVAL rMIMUTBR^WAItttDROP PERC RATETlliigPER DEPTH TIME
INTERVAL fMIMUTBSl WA,TERDEDEPTH WATER DROP PERC RATEREFILLREFILL3.3./
'i'lMM PBRC
-3......
TIME PITERVALIMINUTBST Wi WATER DROP PERC RATH TTME IWTBRVAL(MiNUTEl>W.DEPTH WATER DROP PERC RATE
y ^Ar.
’nRB“ DROP ABAC
REFILL REFILL-/
'HMH <^BRCA 33.___
Tlfcg DnERVAL(MIHUTES>WA*
W--
WiPERDROP rate RATH TIME
INTERVAL <MIWUTBF^
WA1 Mm WATER DROP PERC RATE
tj
'fTMli t>k<5p ^ERC
3 4^.-3?
'IIMM tSW5p abac
REFILL REFILL
-J......—^___
INTERVAL tMlWOTEH WATER WATER DROP rate RATE
TIME ________DEPTH...aW..
-yyY--
TIME
INTERVAL fMINUTBR^WATER DEPTH WATER DROP PERC RATE^ ^ iz\U
BrOP PERC
REFILL £$r.REFILL
...j:....-.3-__J'IIML
INTERVAL (MINVTBft WATER DEPTH rate RATEWATER DROP
TIME
INTERVAL (MlNUTEa WATER DEPTH WATER DROP PERC RATEREFILLREFILL
TIMB BASIF BEAC 'ITMti bA6A BerC
INTERVAL IMIHUTBEITll>«
WATER DEPTH WATER DROP rate RATE
TIME
INTERVAL OtflNUTESI WATER DEPTH WATER DROP PERC RATEREFILLREFILL
TIME DROP AKAt TTMe drop abac
3T/,PJ^COMMENTS/CA L CULA TIONS:/
MKL — 0390 - 005 250,815 — Victor Lundeen Co., Printers, Fergus Falls, Minnesota