HomeMy WebLinkAboutLinden Park Resort & Campground_29000260180000_Septic System Permits_>
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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
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White — Office
Yellow — Inspector
Pink — Owner\.V
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pa r 4 (a M^Permit No.,
L iLEGAL
DESCRIPTION
AND
-9/~/:LOCATION - !' -?^ j.
Lake No.Lake Classif.Sec.Lake Name TWP Range TWP Name
IDENTIFICATION: Please Print All Information.
Mailing Address — No. Street, City and StateFirstLast Name Initial Zip No.Tel. No. %
;/OWNER
SEWAGE
SYSTEM
INSTALLER
Name.
'~fktir5 i^\30 h> nodThis System will be ready for Inspection , 19.on.
This space for office use only
a.32,19
Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signature
-NUMBER OF BEDROOMS:ESTIMATED COST:
V / ^
SEWAGE DISPOSAL SYSTEM DATA:
SEPTIC TANK SEEPAGE PIT DRAIN FIELD
GIs.Capacity Sq. Ft.Sq. Ft.
Ft.Ft.Distance from nearest well rIC /Ft.Distance from lake or stream Ft. Ft./
Distance from occupied building Ft.Ft.Ft.
Distance from property line Ft.Ft. Ft.
Ft.Distance from bottom to Water Table Ft.Ft.
All distances are shortest distance between nearest points
RECORD OF TESTS:
Inspection was made on 19 , Time M By
PERCOLATION TEST DATA:Date of First Test 19 , Rate/
Date of Second Test 19.........9 Rate
1st Test Taken By
First Test + 2nd Test 2 Rate2nd Test Taken By
The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work inAgreement;
strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn
esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi
cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the
responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection.
I understand that I have been granted a sewage system site permit in accordance with
the requirements of the Shoreiand Management Ordinance of Otter Tail County. I
understand I must contact my township in order to determine whether or not any addi
tional permits are required by the township for my proposed project.
i
■t
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
/o3^mFee $Rec #1
IVComments:•I
Form No. MKL-032085 237.443 — Victor Lundeen Co., Printers, Fergus Fails, Minnesota
T'
'•UK' r-
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INSPECTION RESULTS
.. 3 ^Inspector must make all measurements
H■i(ff ~ lOO^ ^
* O *' S 6
SEWAGE DISPOSAL SYSTEM STATISTICS
3t
SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORYActualShould Be Actual Should Be Actual Should Be
/5ooCapacityGIs.GIs.S F S F S F S F■e ■tsrI
FDistance from Nearest Well F F F FtvA 11
Distance from Lake or Stream F F F F F F
I
Distance from Occupied Building F F F F F F
/o'Distance from Property Line F F F F F F
f >^/ODistance from Bottom to Water Table 3 3FFFFF F
iInspector’s Comments: _____________
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T'r tncVvia^\ 30n V ■
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1-19 ^ XDate of Inspection
IX ' 0 0Time of Inspection M
) ^v»^ b^L>p
Signature of^nspector
INTERPRETATION
OF ABBREVIATIONS
GIs =: Gallons
SF = Square Feet
F = Linear Feet
Job We
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MKL • 032085 • Backer Agency
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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
Permit No.LEGAL Ll
DESCRIPTION
AND
I fh /T h) D9 ^/F^r/l/hTTAF A D is.131LOCATION
TWP NameLake Classif.Sec.RangeLake No.Lake Name TWP
IDENTIFICATION: Please Print All Information.
Mailing Address — No. Street, City and State Zip No.Tel. No.First InitialLast Name
-X- Hl?A//\l/h/6- yiA/AJAJMike:A P) D ^OWNER
L/n/DB/v EA-hE } /;f t
6'?3,><^‘'11SEWAGESYSTEMINSTALLER
B pa^/hPO Pao AaP ! n/B-b o B 3 /\/ r? ‘9'T A Ba/a//AZ/hV! J A/A>Name.
L ! O Mo ■ //T
. 9 \r> E A/b 9 V/
Q This System will be ready for inspection , 19.on.
This space for office use only
.19 .M
Owr\^r or Agent SignatureDate Rec'd Time Rec'd Phone Call Rec'd By
P)E Pr3 P A A/AY /^/Z?4z^^mberof BEDROOMS: / /ESTIMATED COST;
SEWAGE DISPOSAL SYSTEM DATA:
SEEPAGE PITSEPTIC TANK DRAIN FIELD
'y GIs./ r g aSq. Ft.Sq. Ft.Capacity
/goFt. Ft.t.Distance from nearest well
X
vx /
Ft.Ft. Ft.Distance from lake or stream
0- aFt.Ft.Distance from occupied building Ft.
7
Distance from property line Ft.Ft.Ft.
/ OFt. 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
.SUM.
9fr.L.A
3........., 19 9..P....... Rate.
, 19..^..^^........ Rate
PERCOLATION TEST DATA:Date of First Test
.3Date of Second Test
1st Test Taken
First Test + 2nd Jest 2 Rate2nd Test Taken
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.
I understand that I have been granted a sewage system site permit in accordance with
the requirements of the Shoreland Management Ordinance of Otter Tail County. I
understand I must contact my township in order to determine whether or not any addi
tional permits are required by the township for my proposed project.Signature
Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express
condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota.
This permit may be revoked at any time upon violation of any said ordinance.
NOTE: Permit void if work is not commenced within six (6) months.
Permit:
Issued Date:
Shoreland Management Office239/039MFee $Rec #
Comments:
Form No. MKL-032085 237.443 — Victor Lundeen Co., Printers. Fergus Falls, Minnesota
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215502®
VICTOR LUNOCEN CO.. PRINTERS, TERGUS PALLS. UINN.PERCOLATION TEST DATAMKL -0871 -028
LAND AND RESOURCE MANAGEMENT
Otter Tail County
Fergus Falls, Minnesota 56537T ■
Ph. No.
Mailing Address:Owner:
Ct//T\.~P .
Zip No.StateCitySt. & No.First Middleast Name
Legal
Description;TWP NAMERANGETWP.SEC.NAMELAKE OR RIVER NO.
TEST HOLE NO. 2TEST HOLE NO. 1
HO ‘ (3L.( <Depth to Bottom of Hole inches; Diameter of Hole jnchesDepth To Bottom of Hole inches;Diameter of Hole Inches
3 3 3 c:^Depth, Inches Soil Texture Soil Texture y
4/a igTT"Firm
--------------^ ---------4* - Name
Depth. InchesDate19 Date0^/^4a.^^^-^.j»i/^^ercolation
^ '‘Test By
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FirmName,
il' -Ml O
LUOC
LU
Address.AddressQC
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C/0
Otter Tail County License No..Otter Tail County License No..CO
LUMeasure
ment,inches
Percolation
rate minutes
per inch
Drop in
water level, inches
Percolation
rate minutes
per inch
Time
1 nterval, minutes
Measure
ment
inches
Drop in
water level, inches
Time
I ntervals minutes
Remarks:Remarks:TimeTimeo
I-279 /
6Vh
9' 3 3
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133::
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.a^See Booklet, "How to Run a Percojation
Test" by Agriculture Ext. Service, Un. of MNPercolation rate minutes per inchminutes per inch Percolation rate
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JJ’33’
V y60 30 1 SO o^(O‘Tii CM05
>O\SCALE IN FEET FjCO/y Lj-
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UjSCALE: 1 INCH = 60. FEET
BEARINGS ARE BASEO>ON AN ASSUMED DATUM.
• DENOTES IRON MONUMENT FOUND.
O DENOTES IRON MONUMENT SET MARKED ” RLS 13620”.
AREA = 11.63 ACRES -F/-
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ROADTOWNSHIP 14.35-
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S 00’ 33' 00" E T 330.02§A\'■S 00’33’00” E 373.80S 00-33'00"E 366.00 ■»
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S 00’33’no”E 366.00 !I/326.05h I CX.
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W’LY LINE OF COMSTOCK BEACH-
PROPOSED LEGAL DESCRIPTION
Lots 6 and 7, Block B, HURSH' S FIRST ADDITION TO LINDEN PARK, according to
the recorded plat thereof. Otter Tail County, Minnesota.!
Subject to a 53 foot ingress and egress easement over and across that part
of said Government Lot I, being 16.50 feet on each side of the following
described centerline:
AND
AH that part of Government Lots 1 and 2, Section 26, Township 133, Range
39. Otter Tail County, Minnesota, and that part of the vacated alley as
dedicated in HURSH’S FIRST ADDITION TO LINDEN PARK, according to the
recorded plat thereof described as follows:LAKE Commencing at the North Quarter corner of said Section 26; thence on an
assumed bearing of East along the north tine of said Section 26, a
distance of 495.00 feet; thence South 0 degrees 33 minutes 00 seconds
East a distance of 1169.82 feet to the point of beginning of the line to
be described; thence easterly to a point on the westerly line of Lot 4,
Block B, HURSH'S FIRST ADDITION TO LINDEN PARK, according to the recorded
plat thereof, distant 16.50 feet southerly of the northwest corner of Lot
4 and there terminating.
BATTLE IEASTICommencing at the North Quarter corner of said Section 26; thence on an
assumed bearing of East along the north line of said Section 26, a
distance of 495.00 feet; thence South 0 degrees 33 minutes 00 seconds
East a distance of 330.02 feet to the intersection with a line drawn
parallel with and 330.00 feet south of as measured at right angles to
said north line of Section 26, the point of beginning of the land to be
described; thence continuing South 0 degrees 33 minutes 00 seconds East a
distance of 373.80 feet; thence North 61 degrees 25 minutes 00 seconds
East a distance of 350.00 feet; thence South 0 degrees 33 minutes 00
seconds East a distance of 366.00 feet; thence South 61 degrees 25
minutes 00 seconds West a distance of 350.00 feet; thence South 0 degrees
33 minutes 00 seconds East a distance of 603.75 feet; thence on a bearing
of East a distance of 446.68 feet to the westerly line of the alley as
dedicated in said HURSH’S FIRST ADDITION TO LINDEN PARK; thence North 9
degrees 03 minutes 57 seconds West along said westerly line of the alley,
a distance of 166.54 feet to on angle point in said westerly line of the
alley; thence North 80 degrees 56 minutes 03 seconds East along the
boundary line of said alley a distance of 10.00 feet to an angle point
in said boundary line of the alley, thence North 9 degrees 03 minutes 57
seconds West along said westerly line of the alley a distance of 378.17
feet to an angle point in said westerly line of the alley, thence North
15 degrees 14 minutes 49 seconds West along said westerly line of the
alley a distance of 98.92 feet to the westerly extension of the
southerly line of Lot 6, Block B, said HURSH’S FIRST ADDITION TO LINDEN
PARK; thence North 74 degrees 44 minutes 43 seconds East along said
westerly extension of the southerly Hne of Lot 6 and along the southerly
line of said Lot 6, a distance of 155 feet more or less to the shoreline
of East Battle Lake; thence northeasterly along said shoreline to the
southwesterly line of COMSTOCK BEACH, according to the recorded plat
thereof; thence North 60 degrees 21 minutes 00 seconds along said
southwesterly Hne, a distance of 121 feet more or less to the westerly
line of said COMSTOCK BEACH; thence North 0 degrees 00 minutes 49 seconds
East along said westerly line of COMSTOCK BEACH, a distance of 35.84 to
the intersection with a line drawn parallel with and 330.00 feet south
of, as measured at right angles to said north line of Section 26; thence
on a bearing of West a distance of 510.54 feet to the point of beginning.
Except that part of the above described easement lying with in the alley as
dedicated in said HURSH’S FIRST ADDITION TO LINDEN PARK. Also subject to
and together with a 33 foot ingress and egress easement over and across
that part of said Government Lot 1, being 16.50 feet on each side of the
following described centerline:
Commencing at the North Quarter corner of said Section 26; thence on an
assumed bearing of East along the north line of said Section 26, a
distance of 495.00 feet; thence South 0 degrees 33 minutes 00 seconds
East a distance of 330.02 feet to the intersection with a Hne drawn
parallel with and 330.00 feet south of, as measured at right. angles to
said north Hne of Section 26; thence continuing South 0 degrees 33
minutes 00 seconds East a distance of 373.80 feet; thence North 61
degrees 25 minutes 00 seconds East a distance of 350.00 feet; thence
South 0 degrees 33 minutes 00 seconds East a distance of 366.00 feet to
the point of beginning of the Hne to be described; thence South 61
degrees 25 minutes 00 seconds West a distance of 350.00 feet and there
terminating.
11
1
CERTIFICATE OF SURVEY FOR:
MR. & MRS. JERRY LOOFE
SUR^YOR’S CERTIFICATE
I hereby certify that this is a true and correct representation of a survey
of the boundaries of the above described land, and that this survey was
prepared by me or under my direct supervision and that I am a duty
Registered Professional Land Surveyor under the lows of the State of
Minnesota. Dated this 29th day of May, 1998.
REVISED Dated this 12th day of AUGUST, 1998. /I ^ /J/D
FIELD BOOKCONTRACT NUMBER
NDERSON LAND SURVEYING, INC.
313 SOUTH MILL STREET
FERGUS FA1_US, MINNESOTA SeS3T
(21 S) T39—S26S
ALS-99/6288-98
DRAWING NUMBERCOMPUTER FILE
128-98David A. Anderson
Professional Land Surveyor
Minn. Reg. No. 13620 3982VDISK NUMBER 71V
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CERTIFICATE OF APPROVAL
SEWAGE SYSTEM
VmmELV AWN
NovmbeAlUh 92p;77i/5 certificate has been issued this
to certify that the sewage system installed as per sewage permit number indicated below has been approved for use
by Otter Tail County, Minnesota.
day of 19f.*'
fJliip •-iJ
uM:The premises covered by this certificate are legally described as:Wl.iMGyUuVidRangeTwp. ^ 33Lake No. 56-138 Sec. 26 Twp. Namem.
mM
m Lfnden Pank RfcAoAX and Campground
m
pi
MXfeg. {JJardloip/Lfndm Park Report 6 Compg/ioandS-Owner: NameWi
m2.RR<^2 HdnnXng. MMAddress
m 56551Zip No.
UaO^ ')Ldb^
Lund & Resource Management OITicial
Otter Tail County, Minnesota
9054Permit No. SP
Signed by:
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MKL-0987001
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253.617 1Vidor Lundecn Co . Prinlers. Pergus t-alls. Minncsoiu
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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
W :te — Office
V low — Inspector
Pii.. — Owner
Card — Owner
Permit No.,LEGAL
Date
DESCRIPTION
AND
V-LOCATION
TWP NameLake Classif.Sec.TWP RangeLake No.Lake Name
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.ZZon.
This space for office use only
Date RecM Time Rec'd Owner or Agent SignaturePhone Call Rec'd By
NUMBER OF BEDROOMS:ESTIMATED COST:
SEWAGE DISPOSAL SYSTEM DATA:
SEPTIC TANK SEEPAGE PIT DRAIN FIELD
Sq. Ft.GIs.Sq. Ft.Capacity
Ft.Ft.Ft.Distance from nearest well
Ft.Ft.Distance from lake or stream Ft.
Ft.Distance from occupied building Ft.Ft.
Distance from property line Ft.Ft.Ft.
Ft.Ft. Ft.Distance from bottom to Water Table
AH distances are shortest distance between nearest points
RECORD OF TESTS;
Inspection was made on ,, 19 , Time ,JVI By
PERCOLATION TEST DATA:Date of First Test 19
, 19
. Rate
Date of Second Test , 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
Issued Date:
Shoreland Management Office
Fee $Surcharge $
certificate TSRUFnComments:.
Form No. MKL-0771-003 vicTo* kuavccM « c«.. MtKTcaa. PCaau* P*ti.a. himh.158906
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
• * Capacity GIs.GIs.S F SF S F
V. /I
Distance from Nearest Well F 75F 50FFF F
Distance from Lake or Stream F F F F F
ZiDistance from Occupied Building 10 2020FF F F F F
yDistance from Property Line 10 10 10FF F F F F
Distance from Bottom to Water Table 4 4FFFF F
ut
?Inspector's Comments:,2_9.
/,W'r X 9d' l '
//Xj
Date of Inspection.19___
/Time of Inspection.M
/^^ature of InspectorINTERPRETATION
OF ABBREVIATIONS
GIs = Gallons
SF = Square Feet
F “ Linear Feet
\Job Title
AgencyMKL-077 i.003-Backe»
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
W :te - Office
V low — Inspector Pli..
Card — Owner
!
Owner
/= 3cx^S A /y ^
puvii^cf ^ Qjc trnrTS 0>^-7 cA
I ^ -jxi A.
Permit No.LEGAL
Date
DESCRIPTION
n<AND
■nLOCATION<L
Lake Name Lake Clatsif.TWP NameLake No.Sec.TWP Range
IDENTIFICATION: Please Print All Information.
Zip No.Tel. No.Last Name First Initial Mailling Address —No. Street, City and State
<r,OWNER f
SEWAGE
SYSTEM
INSTALLER
Name.
This System will be ready for inspection on., 19.
This space for office use only
19 M
Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signa^ture
/ Cj U ^NUMBER OF BEDROOMS:ESTIMATED COST:
SEWAGE DISPOSAL SYSTEM DATA:
SEEPAGE PIT/SEPTIC TANK DRAIN FIELD
(ySy Sq. Ft./y^OC) GIs.Capacity Sq. Ft.
Ft.Ft. Ft.Distance from nearest well
'zr'
ola Ft.
Ft.Ft.Distance from lake or stream Ft.
/oDistance from occupied building Ft.Ft.
Distance from property line 4QFt.Ft.Ft.
dFt.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
.... 19.Z..3?..r
..... 19..:7...:Z..., Rate
(PERCOLATION TEST DATA;Date of First Test Rate
(Date of Second Test
1st Test Taken By
u I 2_t.First Test -I- 2nd Test S
2 Rate2nd Test Taken By
The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work inAgreement:
strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn
esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi
cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the
responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. (Call qi: use attached mailer notice.)
'-.3 7^/77Dated ^^rwtCn XT
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 it not commenced within six (6) months.
Permit:
7?P/77Issued Date:
Shoreland Mana^ment Office
Fee $Surcharge $
Comments:.
V , ^7 rv
Form No. MKL-0771-003 vierea u/mdeim « co . aaiNua*. rf*«us r«LL» Mmn.158906
n\ /A T-' ' d
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PERCOLA TION TEST DA TA Price $ 1.00 per pad.
SHORELAND MANAGEMENT
OTTER TAIL COUNTY
Fergus Falls, Minnesota 56537
Ph. No.Owner:Mailing Address:
^ ' -<7'' Last Name First
Description: ~
LAKE OR RIVER NO. NAME SEC.
Middle St. & No.Zip No.
TWP NAMETWP.RANGE
■TEST HOLE NO. 2TEST HOLE NO. 1
6Depth To Bottom of Hole,Depth to Bottom of Hole inches; Diameter of Holeinches;Diameter of Hole inchesinches
Depth, Inches Soil Texture Depth. Inches Soil TextureDate.Date 19_____
eolation
est By___r//oUJlAFirm
Name,z/•QC Firm
Name7DoUJ
ir
UJAddress.OC Address
<
COOtter Tail County License No..Otter Tail County License No^HcoUJMeasurement,
Inches Depth In Water
Level, Inches
h-Measurement,
I nches
Depth in Water
Level, Inches
Time Remarks Time Remarks
oz to -zH
z4 L///9V
lH I L
i^-A.
/If L
4 -:5~Z L \
MKL-0871-028
See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn.
>;
s»»sfyfiff%yMm1#^
®l
mM.•e - * .T
^fivSi CERTIFICATE OF COMPLIANCE
SEWAGE SYSTEM
mmPI »■f€
&if
m
wk%
7 th 19 78day of_FebruaryThis certificate has been issued this
mmtel
to certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota.
The premises covered by this certificate are legally described as:
ii Twp. 133Lake No. 56-138 Sec. 26 Range__39 Twp. Name Girard
m
f4
E 30.55 A of Lots 1 & 2 ex pts. platted & ex tracts
Lots 6 & 7 of First Addition to Linden Park
€fl;
mmMM
John MagnusonOwner: Name.
Henning. MinnesotaAddress.
yyy.-56551Zip No.r
m^ TV
Ma/colm K. Lee, Shoreland Administrator
Otter Tail County, Minnesota
2621Permit No. SP_
Signed by:.A;5>;
V
MKL-087 1-009
iri m^0r
.si
ii
159035 tictOK Luaixci 4 C9. paiattAs. rcR2.* r*Lta. uisa
. f
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
W :te — Office
\ low Pi».. -
Card —
— InspectorOwnerOwner
d r ...-I
Permit No.,diacizLEGAL X r- (t Date
DESCRIPTION to • -r. 'i cn r: / K >'
AND
LOCATION
Lake No.Lake Name Lake Classif.Sec.TWP TWP NameRange
IDENTIFICATION: Please Print All Information.
Zip No.Tel. No.Last Name First Initial Mailling Address —No. Street, City and State
OWNER
SEWAGE
SYSTEM
INSTALLER
Name.
1"^This System will be ready for inspection on., 19
This space for office use only
OQ PPA
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.Capacity Sq. Ft.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
, 19
> Rate
Date of Second Test ., 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: Permission is hereby granted to the above named applicant to perform the w^V^cribed in the above statement. This permit is granted upon express
condition that the person to whom it is granted, and his agents, employees and wo^t&rt^^ conform in all respects to ordinances of Otter Tail County Minnesota.
This permit may be revoked at any time upon violation of any said ordinan^. ^ 3
NOTE: Permit void if work is not commenced within six (6) month ^
Issued Date:
Shoreland Management Office
Fee $Surcharge $
Comments:.
Form No. MKL-0771-003 VICTOK LUHOCCH 4 CO . PBiaTfaf rf*«u4 r*LL* aiilM 1S8906
INSPECTION RESULTS
Inspector must make all measurements
SEWAGE DISPOSAL SYSTEM STATISTICS
SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORYActualShould be Actual Should be Actual Should be
. Capacity GIs.GIs.S F S F SF«
Distance from Nearest Well l_z±F 75F 50FF F
Distance from Lake or Stream FFFFF F
fC‘0 /OO-f f:Distance from Occupied Building 10 2020FFF F F
Distance from Property Line 10 10 10FFFF F
Distance from Bottom to Water Table 4 4FFFF F
/ooInspector's Comments:
\ V \'Cl A' I
2:^,9:z6Date of Inspection
Time of Inspection M
o
7' signature of InspectorINTERPRETATION
OF ABBREVIATIONS
GIs - Gallons
SF = Square Feet
=* Linear Feet
Job TitleF
AgencyMKL-0771-003-Backer
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
W ;te — Office
V low — Inspector Pli..
Card
Owner
Owner
^ tTb 55" CLo
y
Permit No.,LEGAL ^-Po~r^Date
/P)d2d^ • '7x>DESCRIPTION S t-i
AND
JiS PO£l/)<X^ r-5L-/3P £. £dLt76i /? /\ <=? ^LOCATION
Lake Classif.Sec.TWP TWP NameLake No.Lake Name Range
IDENTIFICATION; Please Print All Information.
Zip No,Tel. No.Mailling Address —No. Street, City and StateFirstInitialLast Name
'3^Ajr\jy\^'r\SOLvo.Q^yS)OWNER 1P. I?SEWAGE
SYSTEM
INSTALLER
Name.1-
4
This System will be ready for inspection on.., 19.
This space for office use only
19
Date Rac'd Time Rec'd Owner or Agent Signa^ture _Phone Call Rec'd By
NUMBER OF BEDROOMS:ESTIMATED COST:
SEWAGE DISPOSAL SYSTEM DATA:
SEPTIC TANK SEEPAGE PIT J3RAIN FIELD7^i fSnn GIs.Sq. Ft.Capacity
Sb Ft.Ft.Ft.Distance from nearest well
Ft.Ft.Distance from lake or stream Ft.
in__ELDistance from occupied building Ft.Ft.
10 Ft.Distance from property line 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 ,M By
,/4./S /PERCOLATION TEST DATA:Date of First Test , 19 Rate
/
Date of Second Test 19 , Rate
1st Test Taken By
/./f?<L /.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
^-,so -y<yDated,
Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express
condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota.
This permit may be revoked at any time upon violation of any said ordinance.
NOTE; Permit void if work is not commenced within six (6) months.
Permit;
Issued Date;
Shorel Management Office
Fee $ O . 5'^Surcharge $
Comments:^! /aZk a?
)ri__/n - r<°£cr'f^ jtj.t r»C Zcli n ho-mr,
Form No. MKL-0771-0(f3
r ^Aa)7
vicToa uikocifi a m..
.158906
>. ,/yi “. / : y
■I0 ■- >Vr/ /''V'
S /.S:\ ■ ^
Iff: r
;■
•i'c’Cv
:iL'
i( ' ■li\ISflOPERATiNG PERMiT
for
fM
1fLinden Park Resort OTTEf; TA:L COURiTY
Fergos Falls, f'/Hnn.
SHORE LAND MANAGEMENT
Phone 218-739-2271
ij]
ft*
&(■
mi This Permit Issued To:
-'aj/4 ■:.;K?,li. 1 Address Route #2, Henning,__.Mi»ne_sx).tA 56551.John R. MagnusonOwner.'•-•'• .1 f.
■>
iAddressOperatorSame
\\■;
E. Battle Lake. Class_REL_Sec_lfw.Twp._i3.3_ Rg„_39.Lake Name.Lake No.__56.'. 1.58m:ft*,mmi ^
,/■
Twp. Name .Gi.r.axd
1 For:6 cabins with water and sewage
7 recreational travel campsites with water and sewage
13 recreational travel campsites vrithout vrater and sevrage
Boat rental units, live bait sales, Retail Store MM)M f ^'
ft II■ftv 1
♦“ ■ ; 'V- d
Date Issued 1 ^77May .5
■>P
f-xr-Malcolm K. Lee, Administra^^ii
<
G.Kermuth W. Hanson, Auditor
j0fm caiSs
i (Not transfer;i!il.^ v; to per.son or p!'ji O)— POST CO.N'SFICOOUSI Y-MKL-0473-036: L -
/.-^r
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i-'i^V.i^--Ll:i e
■pX
. . , „- . , _
Wb-Xti
Mr2'/
mmw
ms
CERTIFICATE OF COMPLIANCE
SEWAGE SYSTEM
13%
pm
§m
vA#3
mihA m
Ikth day n f Feb ru ary 19_TLThis certificate has been issued this
to certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota.
The premises eovered by this certificate are legally described as:
p4
14
w
Lake No. ‘?6-138 Sec. 26 Twp. _133 Range 3^
S 30«55 of Lots 1 & 2 ex pts platted & ex
tracts and Lots 6 & 7 of Hursch’s
Addr. to Linder Park
Twp. Name PrTnKrn
9M
majE<»fcsg
m#
A/^,r,f> Percy Lerfald, B.Owner:
g*‘&
tA
Adriress Hern in.s:. I-LT
m Zip No.
.}
1907Permit No. SP_Signed by:/^L^p
Si i " ~ ■ ^ ^ ^ 'Malcolm K. Lee, Shoreland Administrator
Otter Tail County, Minnesota■^ms
mmm MKL-087 1-009
IS ^jiX'/if
I
<X>-"
®159035
vieio* LU4BCC>< « CO. MiNTras. rE*«u« fiiLts.
PERCOLATION TEST DATA Price $ 1.00 per pad.
SHORELAND MANAGEMENT
OTTER TAIL COUNTY
Fergus Falls, Minnesota 56537
Ph. No.Owner:Mailing Address:
PfritLast Name Oh^Middle St. & No.
TWP.
State Zip No.Legal
Description:' j^e:JRA^GE►3
TWP NAMELAKE OR RIVER NO.SEC.NAME
TEST HOLE NO. 2TEST HOLE NO. 1
Depth To Bottom of Hole w ^ ^Depth to Bottom of Holeinches;inches; Diameter of Hole.Diameter of Hole inchesinches
Depth, Inches Soil Texture Depth. Inches Soil TextureDate Date 19_____
r>O-SO Percolation
Test By____
Percolation
Test By____aLLIFirm
Name.OC Firm
Name.DaUJ
cc
OiAddress.OC Address
<
C/5Otter Tail County License No..Otter Tail County License No^HCOUJMeasurement,
inches Depth in Water
Level. Inches
H Measurement,
Inches Depth in Water
Level. Inches
Time-Remarks Time Remarks
o5(=>Co\-7*1 6, ^
>!
r/
j_
f
MKL-0871-028
See Booklet, '*How to Run a Percolation Test" by Agriculture Ext Service, Un. of Minn.
Control Agency
i:>/28/07
Subsurface Sewage Treatment Systems
Completed form must be submitted to the local unit ofgovenmiciti withhi ■'.) days.aDate of this Report: Property Owner(s).
2.^754 (
772niA^n 6
S(eSSiZip CodeCitySite Address
I
Property Owner Phone #
_____ Reason for Inspection
__ County
:__Date system constructed
■■ -j-p Csy^^aA-c. 4o
4^'^__________________________
Fire No./ Parcel No.
Permitting Authority
(p ~ /CO'Brief System Description
3 -
Is the System: in Shoreland Area?^e^ll^o in Wellhead Protection Area? yes (^^n EPA Class V injection well? yeg^^
System serving a MDH licensed facility? yes*^^ Local Permit # (if any)# Bedrooms/Flow Rate
Compliance Status
Based on thejnfoimatioa-gattier^ and reported on attached forms, the compliance status of this system is (circle below): (Certificate of Compliance^ (valid until ^/lil______
^ ■*'D
For non-compliant systems:
The reason for non-compliance is:______________________
This non-compliant system is classified as (circle all that apply):
Notice of Non Compliance*^
* Based on state not local requirements
A. Imminent Threat to Pubic Health and Safety B. Failing to Protect Groundwater
C. Not in Compliance with Operating Permit
This system must be repaired, upgraded, monitored, maintained or operated or discontinued use by:_________
Required Attachments
1) Supporting information or documents that determined system status (soil descriptions, pumper tank verification, monitoring
results, etc)
2) System drawing /As-built drawing
3) An assessment of any local I'equirements that are different from what is required on this form. '
Certification
/ hereby certify as a state of Minnesota certified Inspector that I ensured that all necessary information has been gathered to
determine the compliance status of this system. No determination of future system performance has been nor can be made due to
unknown conditions during system construction, possit^/e abuse of the system, inadequate maintenance, or future water usage.
Inspector's name and Certification Number (print) I ______
Business Name and Number or LUG Name_____Address 5 5>5cT 7 Pk ^--cV ^ . ^VnO
Signature rlv--t
Z2iZ=
zd!~yji-imPhone.
Date
Upgrade Requirements (derived from Minnesota Statutes § 115.55)
An imminent threat to public health and safety (JTPH5) must be upgraded, replaced, or its use discontinued within ten months of receipt of this
notice or within a shorter period if required by local ordinance. If the system is failing to protect groundwater, the system must be upgraded,
replaced, or its use discontinued within the time required by 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 strict.. This provision does not apply to systems In
shoreland areas. Wellhead Protection Areas, or those used In connection with food, beverage, and lodging establishments as defined m law.
BECEWeD
1 stolid
resource
35
J13H
L^UULIUI riyuiiv.^;^yoSiic~Bc8i^c: o^cwo^'k
C.ompletud farm mii.i/ be submitted to the, local ti/iil of govern/iwiil wUhin J3 clays.
P P WWewBaawBnw
12/28/07
/Sk)
l'^l% CasH< T>^(
Property Owner(s)Date of Observation:
Zip Code__ City it
I
Site Address i237.36 TownshipCounty tFire No./ Parcel No,
Reason for Observation ScutX
6?li3ll2^Form Expires on (three years or whenever next inspection is requested)..
This form is to be completed and attached to page one of the MPCA's Compliance Inspection Form for Existing Suosurface Sewage Treatment Systems.
Observations, interpretations and conclusions to complete this form must be conducted by a certified linspector.
- HydrauOc Performance and Other Safety CompISance Form -
Compliance Issue #1 (of 4)
Verification Method*:Compliance Questions/Criteria:
Does the system discharge sewage to the
ground surface?
^ Searched for surface outlet
fQ Performed hydraulic test€)Yes
Does the system discharge sewage to
draintile or surface waters?
^ Searched for seeping in yard
□ Checked for back-up in home
Yes
Does the system cause sewage backup
into dwelling or establishment?<9 □ Excessive ppndirig in soil system/D-boxes
Nomeowner testimony
□ Examined fpr surging in tank
□ "Black soil" above soil treatment system
Yes
Do other situations exist that have the
potential to immediately and adversely
impact or threaten public health or safety
(electrical, unsafe covers, etc...)?
Yes
Q System required "emergency" pumpings
a Performed' dye test
□ Other:I Hri^iL fzv-Any "yes" answer indicates that the system is an imminent
threat to public health and safety.
UC-cJc Sen ( ,
*No standard protocol exists. This list is not exhaustive,
in sequential order, nor does it indicate which
combinations are necessary to make this determination)
I hereby certify that I personally made the observations, interpretations and conclusions reported on this form and
that they are corf^t.,
I S'fbllName
Certification #
Business Licens
DateSignature
36
Minnesota Pollution
^ ■ Control Agency
12128/07
CompSiance Inspection for Existing
Subsurface Sewage Treatment Systems
Completed form must be .'iiibniiUiid to the local unil of governmem u'ithin J5 day.s'.
2^736 TittuI nUT)Date of Observation Property Owner(s)
S(p^^ /Site Address Zip CodeCity
/^'VTTwr?Comi^23736Fire No./ Parcel No.Township
Reason for Observation
Form Expires on ('t/tree years)
This form is to be completed and attached to page one of the MPCA's Compliance Inspection Form for Existing Subsurface Sewage Treatment Systems.
Obseivations, interpretations and conclusions must be completed by an inspector, maintainer or service provider.
- Tank Integrity CompSiance -
Compliance Issue #2 (of 4)
Compliance Questions/Criteria;Verification Method*:
Does the system consist of a seepage
pit, cesspool, drywell, or leaching pit?
Q Probed tank bottom
□ Observed low liquid level.
Examined construction records
□ ^Examined empty (pumped) tank
tr Probed outside tank for "black soil"
a Pressure/vacuum check
□ Other;
Yes
Do any sewage tank(s) leak below their
designed operating depth?
If yes, which tank?
Yes No
Any “yes" answer indicates that the system is failing to
protect groundwater
■Wo standard protocol exists. This list is not exhaustive, in
sequential order, nor does it indicate which combinations
are necessary to make this determination)
I hereby certify that the observations, interpretations and conclusions reported on this form were personally
completed or completed under my supervision, and are correct.
1^:1 sUName
i ,Certification ft
)yjSBusiness Licens
DateSignature
37
V ■„ Control Agency
12/28/07
Subsurface Sewage Treatment Systems
Completed form muni be xiihmitlaci to the local iinil q/ govenwwni wilhiii J5 ckiyx.
Property Owner(s)Z373& r^ilcDate of Observation
Zip Code__ciy__LSite. Address
TownshipFire No./ Parcel No.
Reason for Observation
County
RwU P&tTn/fVViVvq
I2^Form Expires on ff/tree years)
This form is to be compieted and attached to page one of the MPCA's Cnmniiance Inspection Form for Existing Subsurface Sewage Treatment Systems.
Observations, interpretations and conciustons must be compieted by an inspector or designer.
- SoSI Separation Compliance and Other Compliance -
Compliance Issue #3 (of 4)
Compliance Questions/Criteria:
A. For systems built prior to April 1, 1996 and not
located in Shoreland or V\lellhead Protection Area or
Not Serving a Food, Beverage or Lodging
Establishment:
D. Is the system protective of groundwater for
any other conditions that may be present? (soil
system covered by an impermeable surface,
etc...) ■ . _____
Any "no"answer indicates that the system is failing to protec
groundwater.
No
Does the system have at least a two-foot vertical
separation distance from periodically saturated soil
or bedrock?Yes ■No
B. For non-performance systems built April 1, 1996
or later or for non-petformance systems located in
Shoreland or Wellhead Protection Areas or Serving a
Food, Beverage or Lodging Establishment:
Verification Method*’*':
^ Conducted soil borings/test pits
□ Limiting layer verification by Qualified employee ?
Q Two previous verifications
□ Other:
Observation does not expire. Previous verifications by two
independent parties is sufficient, unless site conditions
have changed
Does the system have a three-foot* vertical
separation distance from periodically saturated soil
or bedrock?No
C. For reduced separation distance systems (i.e.,
"performance"systems under old 7080.0179 or
Type IV or V system under new 7080. 2350 or
7080.2d00):
Does the system hove the designed vertical
separation distance* from periodically saturated soil
or bedrock?
Yes No **No standard protocol exists. This list is not exhaustive, or ir.
sequential order nor indicates which combinations may
necessar)' to make a determination)* niiiy be raiuced by 15% if allow be local ordinance.
I hereby certify that I personally made the observations, interpretations and conclusions reported on this form and
that they are correct.
Name
ZhSZ-Certification #
Business Licen:dlisjcriDateSignature
38
;Sire Sketch
•'
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:
. .
. • -i •
■■ ■> ■ • ■ i' ■
100'
N -
•• .T.■;Wd!100'0
[her iirablishmcnt, taxik(s). soil [rcatriicnt syscim,
NOT ioscallcd by the utilityj.
Please attach ai-flense indicate the location oT; Well, well setback to system, dtvelling reserved soil treatment area, cvnain drain, property lines, watenvays, and buried lines (those Include siscs tind length and approKimaie distances [romSixed reference points such as streets and buildings,
built drawings, inspection reports, Certit"icat(s) of Compliance and Noiice(s) DfNoncomplittnce, if aJvailablc.
: Locate each boring on t±ie mao above, indicate on the right of the column the soil
depth of each different soil type, evidence of mottling, bedrock and standing water.
or n
Soil Borings (EP.
te;dure, structure, color.Also indicate if the material is fill.
BR^
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• BR#
Y *'
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fy
iC^r
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THEMuS^^LL col
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ilECORD DEPTH OF MOTTLING,
AJOVE LINES
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nd not in compU^«---------into compliance if fouleted to bring the above system
What needs to be comp
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