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Home My WebLink AboutLutheran Island Camp_29000260175001_Septic System Permits_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 1 08/22/2013 Minn N Dist Of Lutheran Church Attn Lutheran Island Camp 45011 230th St Henning MN 56551 9449 RE: Primary Owner; Minn N Dist Of Lutheran Church Sewage Treatment System Servicing Tax Parcel Number: 29000250174000 Sec 25 Twp Girard Township Sect-25 Twp-133 Range-039 GL3&4 Described as: Lake: 56-138 E Battle As of 08/19/2013 the sewage treatment system (Sewage Treatment Installation Permit # 22423 servicing your property was determined to be in compliance with the provisions of the Sanitation Code of Otter Tail County for a 4 bedroom home. If you have any questions regarding this matter, please contact our office. Sincerely Scott Ellingson Inspector SCANNED APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095) GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 www.co.otter-tail.mn.usWHITE - Office YELLOW-L & R Inspector PINK - Owner / Contractor (after issue) A9.<4MAPPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED Permit No. LAKE/RIVER NAME LAKE/RIVER SECTION TWP NO. RANGE TWP NAME £a,r To /33 39 —t ^'Y!L —' PARCEL NUMBER (S) OF PROPERTY BEING SERVICEDy^gi‘^-e>oc , 0( 1 h ~6t>o y - poo 3.(g) - 7 ( LEGAL DESCRIPTION lor^ E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROAD ’Sr ^ S' S£ Ycf SUy ^ U Tecr/ FirstLast Name Mailing AddressInitial Daytime Phone No. lc.ri.^^0/1/S ^Property Owner t •*tiX He /y A/ / , z -yf A o 3 Oo V/~7J<>- TtfContractor Lie.#7^He I /£77^ 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 TYPE OF NSTALLATION (circle one)SEWAGE TREATMENT SYSTEM DESIGN DATA AS SHOWN ON DRAWINGCollectorResidential New(jBjVl Design Fiow (Gaiions^ay)^pl—2,499 (H) 2 Other Est. (E) New (F) Replacement /t)New eplacement ^ (D) Replacement Soil Treatment Area t II Tank /<: V /nr'^ ^ Lift Effiuent Distribution (Vl) Gravity { ) Pressure /So^_GIs2,500 — 4,999 (I) 5,000 — 10,000 Size Setback To Nearest WellType I Type II Ft.ifoo F^* (20) Trench, Rock (27) Rapidly Permeable Ft.Setback To OHWL Ft.(21) Trench, Gravelless T(^)Trench, Chamber ^28) Flood Plain (29) Privies Ft.Ft.-— Ft.Setback To Bluff(23) Bed (30) Holding Tank ( ) Monitoring/Disposal Contract(24) Mound Ft.Ft.Setback To Dwelling (25) At Grade Type III Setback To Non-Dweiling(26) Greywater (31) Other/Problem Soils/<12" Soil Ft.Ft.■— Ft. Type IV Setback To Nearest Lot Line /Ft.Ft.Depth of Well (32) Public Domain & Proprietary Technologies /Setback To Road Right-Of-WayTotal # Bedrooni^/^ T^_ Ft.Ft.Type V id.Wl. (^) Performance Elevation Above Restrictive Layer yL( FVFt.Ft.Abatement Garbage Disposal Y / PERC TEST DATA ^ License # ^ 0idini 4t- —Designer Agreement; The undersigned hereby makes application for permit to install, alter, repair or extend Sewage Treatment System herein specified, agreeing to do all such worklrrsIrTcTaccor- dance with Sanitation Code of Otter Tail County, Minnesota. Applicant agrees that the Site Data Worksheet submitted herewith and which is approved by a Land & Resource Management Official shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and approved for use. It shall be the responsibility of the applicant for the permit to notify Land & Resource Management that the installation is ready for inspection. Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Sanitation Code of Otter Tail County, Minnesota, This permit may be revoked at any time upon violation of the Sanitation Code. NOTE: I.This permit is valid tor a period of six (6) months. 2.This permit does not Include the building sewer (sewer line). Date of Test Highest Ral ^I3d3 Signature of Property Owner/A^^t for Owner Date:Permit Fee $ Date:Rec. No., Land & Resource Management Official Date StampComments: 345,197 • Victor Lundean Co.. Primers * Fergus Fells. Minnesota L&R InitialForm No. BK — 07-2011-06 APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095) GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 www.co.otter-tail.mn.us hTe-rWHITE - Office YELLOW-L & R Inspector PINK - Owner/Contractor (after issue) APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED Permit No. Z E NUMBER LAKE/RIVER NAME LAKE/RIVER SECTION TWP NO.RANGE TWP NAME r Id 0 < ,3";j-^nLa Z A v' PARpa.NUMBER (S) OF PROPERTY BEING SERVICEDO OO Z ^ - O: 1 - 0i>O - O0\J - O/ 1 ~ oo < E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROAD i !i *■J ST i.* "1LEGAL DESCRIPTION loTc, - $CC cP S" -S <£V.5^ '/cy ^ (^L U Set ? Q:,\■3 Last Name First Initial Mailing Address Daytime Phone No. ^<ro/1 <DProperty Owner e ^ •V'] He<U K\/ /L/ /*5 nPo /<d>{<■Contractor Lie.# a >/'-7 ^7L /i3X /-/a n~7o- THIS SPACE FOR OFFICE USE ONLY '20\^ „ I'.oo. AxaJ3 A.M. > This System will be ready for inspection on , the year of P.M. ’.M. Date Received Time Received L & R Official TYPE OF NSTALLATION (circle one)SEWAGE TREATMENT SYSTEM DESIGN DATA AS SHOWN ON DRAWINGResidential (A)^ New i' (B) Replacement Collector Other Est. (E) New (F) Replacement /<C) New (D) Replacement Soil Treatment Area V Tank Lift Design Flow (Gallons/Day) UG)Z — 2,499 (H) 2,500 — 4,999 (I) 5,000— 10,000 Effluent Distribution ( V. ) Gravity ( ) Pressure /zGIsSize Setback To Nearest WellType I Type II Ft.Ft.Ft.zV(20) Trench, Rock (27) Rapidly Permeable Ft.Setback To OHWL Ft. Ft.(21) Trench, Gravelless (28) Flood Plain ^ (22) Trench, Chamber .(29) Privies Ft.Ft.Ft.Setback To Bluff(23) Bed (30) Holding Tank ( ) Monitoring/Disposal Contract(24) Mound Ft.Setback To Dwelling Ft., 4=t. (25) At Grade Type III Setback To Non-Dwelling(26) Greywater (31) Other/Problem Soils/<12“ Soil Ft. Ft.Ft. Type IV Setback To Nearest Lot Line Ft.Ft.Ft.Depth of Well (32) Public Domain & Proprietary Technologies zSetback To Road Right-Of-Way Ft.Ft.Type V ..FtTotal # Bedrooms V (33) Performance Elevation Above Restrictive Layer zFt.Ft.Abatement Y / N Garbage Disposal Y / N PERC TEST DATA N uuAgreement: 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 strrefaccor dance with Sanitation Code of Otter Tail County, Minnesota. Applicant agrees that the Site Data Worksheet submitted herewith and which is approved by a Land & Resource Management Official shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and approved for use. It shall be the responsibility of the applicant for the permit to notify Land & Resource Management that the installation is ready for inspection. Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Sanitation Code of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of the Sanitation Code. NOTE: I.This permit is vaiid for a period of six (6) months. 2.This permit does not include the building sewer (sewer line). Z/2. -ADesigner _' '.1 License #Date of Test Highest Rate/ ^ i 1 ' ( .-/■ Date:Permit Fee $i I-I6-IZDate:Rec. No.. Land & Resource Management Official 'JF ir HIA U I/, fi tj.. / A /)1 jy iComments: /,/z r.v /j TU'-7 ) J .SCANNED Form No. BK — 07-2011-06 345,197 • Victor Lundeon Co.. Printers • Fergus Falls, Minnesota SEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTS Inspector must make all measurements SOIL TREATMENT AREA HOLDING SEPTIC TANK OUTHOUSELIFT TANKCATEGORY 5¥0 ft 2Capacity ! ft 2GLS.GLS. T FTFT FTFTSetback from Nearest Well Setback from Buried Water Suction Pipe Is FTFTFT FT Setback from Buried Pipe Distributing Water Under Pressure lo^FTFTFTFTI f "y- ftSetback from OHWL (lake &/or river)FTFT FT i. \FTSetback from Bluff FT FTFT I5qSetback from Dwelling FTFT FTFT \ &Setback from Non-Dwelling FTFTFT FT FTSetback from Nearest Property Line FT FTFT/ FTSetback from Right-of-Way FT FTFT 1:FTElevation above Restrictive Layer FT FTFT (5^Holding Tank/Lift Alarm YES ^SOld System Pumped & Destroyed TRENCH REDUCTIONMOUND / AT-GRADE SOIL TREATMENT AREA CALCULATION FILTERSEPTIC TANK(s) # Tanks Installed\ROCK BED 'Rock trencftes with inches □ YESManuf.of sidewall for.%22-Ft.Ft.Ft. X ____ 12J_Ft* ___ft*\reduction / equivalent to Soil Treatment Area. NOModel #Ft*\ i Inspector's Comments: 'x 7^Sketch: SniUal/L SR OfficialTimeDate As ----------- Code of Otter Tail County. the above described sewage system installation was found to be compliant with the provisions of the Sanitation tr Land & Resource Management Official Form No. BK — 07-2011-06 345,197 • Victor Lundoen Co.. Printors • Fergus Palls. Minnesota r i 1 1 I SimE !H- i : .r ].■; LAND & RESOURCE management; county OF OTTER lAlli ^ iGOVERNMENTSERVlJcEStGENTER, 540 WEST FIR,-FERGUS FALLS,]MN 56537 , -----;---_ ^.i..‘. i;;; .L_' r www.cb:otteMail.mrilus I ^ ^ i i i ^.|..I...'..|-i.!' i.I-I M..ff-Lj.,.).*.| J.J.i ' Sewage TreatmentiSvstem Permiti#. ............................rP-f:. I I !I ^^H.4 I »r .■ i •. ^I I OWMER:I !I....!... y ;.... Li...;..... I • 1 1 IU_4-^4^.457-A/>4/Wf--»~ t ; -.,i : ' [.:■I ADDRESS: f :x-i6j{i"yr_ ffe ~ ■ .....'.....'■■■'■^......... - -CIT\ , , -fMippLE^-^^^r-TELEPHdNE-NlJMBER uj;'r'|:T; rj,,, 11":r;;"■■M..I'j'-i-i ; ■'..'.....I..h-r-f'! I p-'-i' Wh. !•4 4-I I : j I 1 ;1 ■ 7T;:\ STR./RT i I 1 ■ STATE ZIP CODE, ,1I- - i 4^-r ^ \SEC. \\llAKE/PilVER NO. ' '! 'I..........r ^ i"I ' ' LAKpNAME 1 \TWP. ' RANGE' ! I ■ TWP.\nAME... i !.i.,L,..L +H" 1 f :f-I: llEGALcD^SCJBIPTION: ! [ j j SOILtBORINGj LOG ! !PT!'1 I OQLor ■& MIDNSELU NO. . -4 DEPTH (INCHES) ,Of 7r~'op\\ texture STRUCTUREs I r -1.'. ..-;"BL0CKY.PuJ i 1, ' ?i'4 s>;it I PLjATY PRISMATIC , I none , I iI PApCEpNUdlBER\iI 4-i :]h [BLOCKY? ! ! pUADf ■ [ PRISMATIC :‘--“—none------- !■ i J.iI r{- .44-344' 4^ ^: E-911 "Address or Directidns From Nearest Public Road ' rT“fi“^".......................................;■ I..■.....................^ 4-1..1-------- i GARBAGE] DISPOSAL. YESyj^(^^^ :] ; WELL: CASING I DEPTH Ziift.' S^ER LINE SEPARATION: 44ft. yEs^-@^>:v4S L ;-kzJlI -4- NUMBER OF BEDROOMS :l4i:[j;tLiPLj:j,::|p:^:' iti:: :L [blockV, ' PLATY [ 1 ly^lSMATIC- P-NONE L■I ....i iI /O V;/—' : ■ \ ■I I 1(• —i i IBpCKYi 4|~PLjAT-Y--| ' PRisMATIC j ; :-N0K|E I!...Irt-:..j..1 iPjFi^fQPPEWI NjXY ES rNo-fyrBLUFFii- I VEGETATION:! AQUATIC <4TERRESTR'iAr''-^^^4 iIppjI'pj”'4j.iPi.|jp'"- ;pi i ‘ Ft ' ' ^ SLOPE AT INSTALLATION ISITE __ / % ' ' ,4.rTTTti f-!-tT 1 "T!1 BLOGKY' i ; JEATY : ! ! PRISMATIC; 1 i i NONE ' t't r I"i"I ! 7" ■ RA^ MkrERIAL:4fe^i'a4' 4^ B^ck ; Alluvium P] ..i-i-vP-p-; :-j..I.p *. - - ORIGINAL SOIL: YesY^No X \ yp ■ :n::: tj'iriTpLi ""' "" ........ COMPACTED SOIL: ' Yes i :jJ_L±±L4i±41.:.-i,„Lc4j._........ DEPTH OF-SBORINGClb 7' or restrictive layer):.-- ..-J E.I i 1 i I r I I!Date of Soil iBoring [I,i 1.!i t 1f i-i m S'4-37-3 f r f-r pate of Perc TeSTTT - TWO TESTS ARE REQUIRED -j I 4 44 "i" r■f.•L—•--I.PER<^ TEST # i PERC TEST #2..J.rf : .■:----------F I } i TIME I INTERVAL* (MINUTES)! WATER DEPTH 1 WATER DROP!PERC RATE! I I TIME 1 INTERVAL (MINUTES)i WATER DEPTH.WATER DROP I iPERC RATE i ! I'WTo mtb®'■ ^.‘S'fFlP. CFy <r START : (TIMEl.- j DROP-J 1 PERC- _ ' I4fi-r:i ■Y""*"*:, i I TIME INTERVAL»(MINUTES)I WATER'DEPTH i WATER DROPS i PERC RATEi : I ? > TIME I WATEaPEPTHlJNTERVAL (MINUTES)WATER DROP i IPERC RATE I 3 4 -| "i 4.43, TIME I -i- DROP 4 : PERC - i ^3?4].:;-r'er^ ,ir i.i l-TIME>--V- DROP ! - UpeRC -{ | I .j3-4v-;"T 1 F-TIME INTERVAL (MINUTES)WATER DEPTH i WATER DROP'PERC RATE J_TIME INTERVAL (MINUTES)WATER DEPTH!WATER DROP [ ! IPERC RATE..;!,3wyyc~»-T .!.■-j...i—Irehll- ;24^4 mI. I I—r I' REFI^ipi^' '...f ' t /l^i:§.b^4cl/4: -■•r-“i TIME - ^-INTERVALMMINUTES) i WATER DEPTH - WATER drop: - -i 4 -- PERC RATE TIME 4-INTERVAL (MINUTES)4 WATER DEPTH!WATER drop I 4—V—: - IPERC RM-H..:r^l4 "izzfiozdrryrl TIME ' ! DROP 1 ' ( PERC 1 I-,:444S8II 4 -nzril—jTTjzri" 4 TIME I DROP ! 1 PERC 1!-t-TIME-INTERVAL(MINUTES)i - r WATER DEPTH-WATER DROP -r-PERC RATE r . ■ r •:—TIME r INTERVAL-(MINUTES) WATER DEPTHf -rWATER DROP r t--f r ‘PERC RATE -i—r-t-f -i...;:R^'LLV:;i-; ; •-•-1-4 ■|.....i-tREFiLrr ■■|-f --rti3j;;:i- TIME 4' I DROP 4 PERC 1 i I4.I f TIME DROP PERCI I TIME INTERVAL'(MINUTES) I 'WATER DEPTH !WATER DROP ' 1 PERC RATE TIME i INTERVAL (MINUTES)I WATER DEPTH! WATER DROP i iPERC RATE I 4 r.:.: refE :...i- r ' 4' \ " i ' ! i •!1 SI I TIME I 4 DROP I ; PERCDROP i ! PERC i......i mME TIME ;INTERVAL (MINUTES) i j WATER DEPTH WATER DROP \ '■ I PERC RATE I TIME :INTERVAL (MINUTES)! WATER DEPTHI i WATER DROP ? i i PERC RATE I I I i .LL.!REFILL . ' I !; _ I i REFILL J ..i.l::j.u-Mbi I TIME' 4 DROP I 44:::■r-rf-i:T:r41 iTIME ~ i DROP i i PERC. I___u PERC 1 TIME INTERVAL (MINUTES) i WATER DEPTH :WATER DROP I PERC RATEi j__) i TIME INTERVAL (MINUTES)WATER DEPTHI j WATER DROP i i PERC RATE I L. .1... I REFILL _■ ,. -fTIME 1 4; DROP ..,, j PERC...F (iREFILL i ^...i - DR0P4 - :-PERC .1 t -) TIME f"- |" ' I ' fL|vi .■.■j ^ ...-I i TRENCHL J<^: 4 BED ..I.!. X.4tii 4+:43. ......' ‘:'"v ■ : ^ ■..; ' I...I.........' ' i ATGRADE i ) I I i : ! : „L.LJ _..l..'.................GRAVITY PISTiTTV-'' HOLdlNG TANK i ...i. , SPECIFY: MOUND PRESSURE DIST...L ih4 OUTHOUSE_-I: OTHErTj T rSEWER LINE i !!- ! • 'j !■S YSTEM DESIGN ON BACK. 4,:.r;:ru4i'| 4.a 4 ■ '; 44:': I ..j..4...:1 ■ I•tT .I---r i......i...1 System design must be to scale and must include the proposed location of the sewage system, all existing/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. l_inch(es) equals ^ feetI____grid(s) equals Oi ■feet, orScale: MPCA LICENSE #: DESIGNED BY:LICENSE CATEGORY: FIRM NAME:DATE: ADDRESS:SIGNATURE: Jr^rr/ye ^ H I'' V 1 i i ; I ! 6/ V I—Tf 3Iu» 4 L f 1/ i I A'/ I J ; \t f SCANNED BK — 1003 — 029 315.904 • Victor Lundeen Co.. Printers •. Fergus Falls, MN • 1-800-346-4870 APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE 121 W. JUNIUS AVE. • SUITE 130 Phone:(218)739-2271 • FERGUS FALLS, MN 56537 WHITE - Office 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 SECTION TWP NO.RANGE TW NAME I fO I ¥1 E-911 ADDRESS ^PARCEL NUMBER (S) OF PROPERTY BEING SERVICED Z^-coo-Jy-onM-ero , fSi^yxhzL- o| LEGAlf DESCRIPTION I , uj-h 5 , H SEH ^uJHa PT F-r-f , Last Name '■ First Initial Mailing Address Daytime Phone No. WTlLuVWiAProperty Owner CoHp / SoS’/o i £y<f F- /^ , Pi T-t'crK ^AJL ^ y / 9/P'-Contractor Lie.# s rs S9J~^rS'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 Officiai SEWAGE TREATMENT SYSTEM DESIGN DATATYPE OF INSTALLATION (CIRCLE ONE) TANK DRAINFIELD ^ 0 (9 Ft^ .Jc, r^ 0 O yksUF^ Size GIs./ 6 g gAdd-On/ Replacement (32) Tank, Septic (33) Tank, Lift (34) Trench, Rock (35) Trench, Graveliess (36) Trench, Chamber (37) Bed (38) Mound (39) At Grade (40) Combination New System (20) Trench, Rock (2U Trench, Graveiless n?2)^i§nch, ChamterVsfSed Setback to nearest well Ft.S ^ Setback to OHWL (lake &/or river)Ft. Ft.7S7 S (24) Mound (25) At Grade Setback to wetland Ft.Ft.SSo Setback to dwelling Ft.Ft.l±Collector System (26) Trench, Rock (27) Trench, Gravelless (28) Trench, Chamber (29) Bed (30) Mound (30) At Grade Setback to non-dwelling Ft.Ft.C fl Setback to nearest property line /OFt.Ft.Other / 0 (41) Tank, Holding (42) Outhouse (43) Sewer Line (44) Performance (45) Warranted (46) Miscelianeous Setback to road right-of-way / 0 Ft.Ft. 3/\fa rtf Ft.Elevation above restrictive layer Ft. ALL DISTANCES ARE SHORTEST DISTANCE BETWEEN NEAREST POINTS. # BEDROOMS H GARBAGE DISP. Y ABATEMENT Y / DEPTH OF WATER WELL ABSORPTION AREA FOR MOUNDS W Ft^EFFLUENTDISTRIBUTION (>J^ Gravity ( ) Pressure HOLDING TANK MONITOR/ DISPOSAL CONTRACT ( )Yes ( ) No-L&R Can Not Process rjp S'____________ DesignerPERCOLATION TEST DATA Designer Lie. #, fc 7 3T- orDate of Test Highest Rate Agreement; The undersigned hereby makes application for permit to instali, aiter, repair or extend Sewage Treatment System herein specified, agreeing to do ail 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 Officiai shall become a part of the permit. Applicant further agrees that no part of the system shali be covered until it has been inspected and approved for use. it shail be the responsibility of the applicant tor the permit to notify Land & Resource Management that the instaliation 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. A copy of the final Inspection Report will serve as the Certificate of Compliance for approved installations. 0 %-Date:Permit Fee $ Signatim of Property Owner/Agent for Owner 13 7Date:Rec. No. Land & Resource Management Office Comments: SeVVKL Form No. BK — 0201-003 306.475 • Victor Lundeen Co., Printers « Fergus Falls. Minnesota'n • * * * APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM s/isfox. LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE 121 W. JUNIUS AVE. • SUITE 130 Phone:(218) 739-2271 • FERGUS FALLS, MN 56537 WHITE-Office YELLOW^ L&R Inspector PINK - Owner / Contractor (after issue) ’ IH JAPPLICATION MUST BE COMPLETE IN ORDER TO BE PROCESSED Permit No. LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS SECTION TWP NO.RANGE TWP NAME V / c\-f 4 fri!^4y:U•i--f /i- E-911 ADDRESSPARCEL NUMBER (S) OF PROPERTY BEING SERVICED Z'-]~oo(7- ? 5 - on 4 -OX) )0(J~7L- oi -7\^ I DESCRIPTION ' ; ^H, 2,5" iHi1/IA4^ ■4' P \ * First I A LEGA n\"7J wj ^ & I- ^Oir■Lv Last Name Initial Mailing Address Daytime Phone No. '<301! 3 lo~*-AProperty Owner OqKp Mu r I f A'f n. ■ rf A3Jof ' ^Contractor Lie.#rr/zr\ frjJL Ayf/fJM r ? / ./ C S k Z 5y 3- trj- T THIS SPACE FOR OFFICE USE ONLY SzJSL ,, q-'3c> This System wilt be ready for inspection on.the year of j:/S-A.M. Date Received Time Received L&R Official SEWAGE TREATMENT SYSTEM DESIGN DATATYPE OF INSTALLATION (CIRCLE ONE) TANK DRAINFIELD 3 a <0 Ft^Size GIs.Add-On/’ 0 0New System (20) Trench, Rock g1). Trench, Gravelless ^2) Trench, Cham^r p3) 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.f J ' c C' Setback to OHWL (lake &/or river)Ft.Ft.7 /lA Setback to wetland Ft.Ft.Ijp Setback to dwelling Ft.Ft.0Collector System (26) Trench, Rock (27) Trench, Gravelless (28) Trench, Chamber (29) Bed (30) Mound (30) 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) Warrantied (46) Miscellaneous / 0 Setback to road right-of-way /<»/ 0 Ft.Ft. 3Elevation above restrictive layer Ft.Ft.n- .■ ALL DISTANCES ARE SHORTEST DISTANCE BETWEEN NEAREST POINTS. DEPTH OF WATER WELL ft BEDROOMS GARBAGE DISP. Y ABATEMENT Y ABSORPTION AREA FOR MOUNDS Ft^EFFLUENT DISTRIBUTION (^) Gravity ( ) Pressure HOLDING TANK MONITOR/ DISPOSAL CONTRACT ( )Ves ( ) No-L&R Can Not Process Designer____ Designer Lie. #. .. 1PERCOLATION JEST DATA Date of Test___X 7 3sHighest 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. A copy of the final Inspection Report will serve as the Certificate of Compliance for approved installations. X oj0Date:Permit Fee $ Signature of Property Owner/Agent tor Owner MM 0^/3iT6;i7Date:Rec. No. Land & Resource Management Office Comments: jevVKmft t )g>r/ Hy/f!(I __ Siff rmj Form No. BK — 0201-003 306.475 • Victor Lundeen Co., Printers • Fergus Falls, Minnesota V » ..SEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTS Inspector must make all measurements HOLDING SEPTIC TANK OUTHOUSEDRAINFIELDLIFT TANKCATEGORY GLS.Capacity FT2GLS. Setback from Nearest Well FT FT + 6/ ft FT4-C s Setback from Buried Water Suction Pipe FTFTFTFT Setback from Buried Pipe Distributing Water Under Pressure FT FT FT FT + ‘7^Setback from OHWL (lake &/or river)FT FTFTFT?r Setback from Setback from Wetland FTFTftFT Setback from Dwelling FT FTFTFT 4~tO FTSetback from Non-Dweliing FT FT4-3 0 ft Setback from Nearest Property Line 4/D FT FTFTFT Setback from Right-of-Way -iso ft FT4 5" O ft FT FTElevation above Restrictive Layer FT FT ^3 -S' ft 4^/fHolding Tank/Lift Alarm NOYES 4AOld System Pumped & Destroyed YES NO FILTERSEPTIC TANK I JO DRAINFIELD CALCULATIONSewer Line to Well Separation MinimumActualXvi.e/3MimJ1+12ftx__^□ YESManuf. foao/sTooModel #□ NO FT 20 MOUND CALCULATION MOUND /AT-GRADE ROCK REDUCTION Inspector’s Comments: /A.ABSORBTION AREA inchesRock trenches with fiUji U of rock-undo r pipe for %Ft. X DF.reduction / equivaient to,Ft2 SKETCH: t '>1 <J•>*7 ~7t *^•7/1 ( 1 L ifi' fO>Hi Initial/L & R OfficialTime CERTIFICATION OF COMPLIANCE As of Code of Otter Tail County. , the above described sewage system installation was found to be compliant with the provisions of the Sanitation Copy of inspection Report Mailed to Applicant L & R Official / DateLand & Resource Management Official SITE DATA WORKSHEET LAND AND RESOURCE MANAGEMENT Otter Tail County 121 W. Junius Ave., Suite 130 Fergus Falls, MN 56537 OWNER; TELEPHONE NUMBERMIDDLEFIRSTLAST NAME ADDRESS: CITY £ , ^ hB LAKE NAME tu sr.STR./RT. S6 S /M/ AJ Af STATE ZIP CODE 3 I f ! H fi A it-) RANGE TWP. NAMESEC.TWP.LAKE/RIVER NO. LEGAL DESCRIPTION:SOIL BORING LOG - Date DEPTH (INCHES! COLOR & MUNSELL NO.STRUCTURETEXTURE ^ y ~ a> t o ^ i ~ J 7 S' - 6 0 I y ~/7V' PARCEL NUMBER Usd// FIRE.NUMBER BLOCKY PLATY PRISMATIC Y3 6 /x 7.S l.sj/ bo D BLOCKY PLATY PRISMATIC7/ syis V//d I 'YSJUJ .NUMBER OF BEDROOMS ^ , ; GARBAGE DISPOSAL: YES <^N^ 1*1 ^ WELL CASING DEPTH: ft. BLOCKY PLATY PRISMATICs yn S/cj}(tjk BLOCKY PLATY PRISMATIC NONE FLOODPLAIN: YES VEGETATION: AQUATIC TERRESTRIAL SLOPE AT INSTALLATION SITE: A).'tr /O %BLOCKY PLATY PRISMATIC NONETYPE OF OBSERVATION: Probe Pit PARENT MATERIAL: RU.__Outwash Loess ORIGINAL SOIL: No Bedrock Alluvium COMMENTS; ©COMPACTED SOIL: Yes XDEPTH OF BORING:ft. - TWO TESTS ARE REQUIRED -PERC TEST #2PERC TEST PERC RATEWATER DROPWATER DEPTHINTERVAL (MINUTES)PERC RATE TIMEINTERVAL (MINUTES!WATER DEPTH WATER DROPTIME .......... .....Lk..In i « %■ l/>’ B?Ih../o'.oro START ,START ./.P.I.S.P..S ^ 3/XT-//i5 TIME DROP PERC PERC RATEWATER DROPWATER DEPTHTIMEINTERVAL IMINUTES)WATER DROP PERC RATETIMEINTERVAL IMINUTES)WATER DEPTH ........... /X-liS-REFILLREFILL .j.sj.ps.TIME DROP PERC S.(4^--------hTIME PERC RATEWATER DROPWATER DEPTHINTERVAL (MINUTES)INTERVAL (MINUTES)WATER DROP PERC RATE TIMETIMEWATER DEPTH ......C.k....... ....../"3...... 'p,'/4 ..... foils: TIME ' DROP PERC REFILL ft’, I ^ REFILL 33^..S / S3 TIME DROP PERC PERC RATEWATER DROPWATER DEPTHINTERVAL (MINUTES)WATER DROP PERC RATE TIMETIMEINTERVAL (MINUTES)WATER DEPTH /e: %(> to', 1/ ....ck...... jo; REFILL it.L>± .......././r........ ....1^...3 3,S^Ji7.Z TIME * DROP PERC REFILLJL,3l3jr^....(S.L.T.f. DROPTIME PERC WATER DROP PERC RATEWATER DEPTHWATER DEPTH INTERVAL (MINUTES!WATER DROP PERC RATE TIMETIMEINTERVAL {MINUTES!/o: 3i75lb! 33 (bS/y ,Tfi^REFILL 3..±..(S.I.Ir..DROP PERCTIMEDROPPERCTIME PERC RATEWATER DROPINTERVAL (MINUTES)WATER DEPTHPERC RATE TIMEINTERVAL (MINUTES)WATER DEPTH WATER DROPTIME ....(1...^. .....lk.i.kn WO iaImS. fp: tj % 'bin:/ REFILLS 3.13 ------ "drop PERC REFILL U'.n 0 lOfU'i- TIME DROP PERCTIME PERC RATEWATER DROPINTERVAL (MINUTES)WATER DEPTHWATER DROP PERC RATE TIMETIMEINTERVAL (MINUTES)WATER DEPTH >>REFILLREFILL DROP PERCTIMEDROPTIMEPERC V- PERC RATEWATER DROPWATER DEPTHPERC RATE TIME INTERVAL (MINUTES)INTERVAL (MINUTESI WATER DEPTH WATER DROPTIME REFILLREFILL PERCTIMEDROPTIME DROP PERC PROPOSED DESIGN: GRAVITY DIST. 6->--^RESSURE DIST.HOLDING TANKMOUNDTRENCHBEDATGRADE SPECIFY: — SYSTEM DESIGN ON BACK — OUTHOUSE OTHERSEWER LINE System design rnust be to scale and must include the proposed location of the sewage system, all existing/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. /^ feet, orScale:grid(s) equals feetinch(es) equals SUBMITTED BY:SIGNATURE: FIRM NAME:DATE:-S - /3 - ‘If— ADDRESS:MPCA LICENSE #:.r' LICENSE CATEGORY: ^AS r Batn B <1^ o ' A A Vf4 a se t ." yv ^ BK - 0599 - 029 300.817 • Vicior Lu^deef^ Co. Pftniefs • Fergus Falls. MN • 1-800-346-4870 r V ■■■if Department of LAND AND RESOURCE MANAGEMENT! OTTER TAIL COUNTY 121 W. Junius Ave., Suite 130 Fergus Falls, MN 56537 Ph; 218-739-2271 ; May 21, 2002 MINN N DIST OF LUTHERAN CHURCH 45011 230TH ST HENNING MN 56551-9449r V RE; Inspeetibn on Sewage Treatment System Perrnit # 14982 Lake # 56-138 This is to inform you that an inspection was made on the above mentioned Permit. At that time, we could not complete the inspection and approve the system for use, for the following reason(s); There was not a visual alarm on the lift station. There was not an alarm on the holding tank. There was not a dwelling onsite. The non-conforming sewage system had not been destroyed. There was not a well onsite. The Installer had not completed the air test. Our Office has not received the Well Abandonment Geftification. A variance is required for non-complying setbacks: ______ Ordinary High Water Level ______ Lotline Road Right-Of-Way Structure CC/INSTALLER: ' _____ Wetland Miscellaneous Be aware that failure of obtaining the variance will result in removal of the non-complying portion of the system. Please contact our pffice for a reinspecfion of your sewage system when the problem is corrected. Approval of the system cannot occur until this matter is resolved. /o<<.f- 'at Eckert/Inspector I** P' t' CERTIFICATE OF APPROVAL SEWAGE SYSTEM DRAIN FIELD IQth ;V i^i TTtis 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 Apri 1 9519 iMS' ”1 }*S'' vni »J m The premises covered by this certificate are legally described as:iS 5hiLL3B Sec____2^JJ33 Range 39 Twp. Name GIRARDLake No.Twp.’AaK mj iS25 133 39 62. 15 GL 3 & 4mifv; m !E MTNM N niPiT HF I HTHFRAN r.HURrHOwner: Name WMAddressMTCjt^nURT CiVMnn. MFIMMIMn. MMi [MZip No.56551 Permit No. SP 1 0377 Signed by:2 Lund & Resource Management Official Oner Tail County. Minnesotaly MKL-0987001 h m JT-272472 Victor Lundeen Co.. Printers, Fergus Falls, Minnesota APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM WHITE — Office Yellow — Inspector Pink — Owner LAND & RESOURCE MANAGEMENT O OTTER TAIL COUNTY COURT HOUSE Phone:(218)739-2271 - FERGUS FALLS, MN 56537 Permit No.LEGAL DESCRIPTION AND LPCATION RANGE TWP NAMESECTIONLAKE/RIVER CLASS TWP. NO.LAKE/RIVER NAMELAKE NUMBER cZ^7- - J? S" - (9 / -CRJO P-/3A P?DhO-\ AY ! i ^ FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER(S) IDENTIFICATION: Please Print All Information Mailing Address — No. Street, City and Stale Zip Code Telephone No.InitialFirstLast Name ' ^ IflAProperty Owner ___ (o 0 ? A/ P S>TName^ (') /'^ P Y f A (/— P 1C / P P _______ Sewage System Installer // /g~ /?//!/ /A/t^~ A/1 /A/A A.M. P.M.Ihis System will be ready for inspection on.19.at This space for office use oniy NUMBER OF BEDROOMS: A.M. P.M19 ( ) NOGARBAGE DISPOSAL:Phone Call Rac’d ByTime Rac’dDate Rac’d SEWAGE TREATMENT SYSTEM DATA: MjHHW^frfiggUIREMENTSTYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) ( ^’f^ptic tank--------- lX^x^\r\ field ( ) Standard ( ) Bed ( ’ench ( ) Modified ( ) Mound TANK )DRAIN FIELD GIs.Sq Ft.Capacity -fO ^h 0 Ft.Ft.Distance from nearest well /o 0 rh/ 0 0( Ft.loo j-Ft.Distance from lake or stream foo T- Ft. Ft.Distance from building nso Ft.Ft.Distance from property line /(J IPEFFLUENT DISTRIBUTION ( F-f^rTvity ( ) Pressure Ft.Ft.Distance from bottom to Water Table All distances are shortest distance between nearest points /rPP ^ ^ i^A/u N p PPWATER WELL DEPTH: /go RatePERCOLATION TEST DATA: Date of First Test , 19 RateDate of Second Test , 19 1st Test Taken By + 2nd TestFirst Test 22nd 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 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. 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 s/x (6) months. Issued Date: Land & Resource Management Office3^Rec #.Fee $. Comments:^ LC. 268.559 • Victor Lundeen Co.. Printers • Fergus FalisTt^Form No. BK-0993-003 - 800-34&4670 1 APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM ^^yA/i/ T 'Vo u 3. tiO WHITE — Office Yellow — Inspector Pink — Owner !LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218)739-2271 - FERGUS FALLS, MN 56537 IO377 Lurnn/^ J^i-^fipc- i 3 7 mdicci.'kcl H(£d: id- u/u/ ^(pcijiz. Permit No.LEGAL DESCRIPTION AND LOCATION SECTIONLAKE/RIVER CLASS RANGE TWP NAME yio-f-LAKE/RIVER NAME TWP. NO.LAKE NUMBER hr? hh( (h^\? ~ h h - onLj^a?yO />/3 FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER(S) IDENTIFICATION; Please Print All Information Zip Code Telephone No.Mailing Address — No. Street, City and StaleFirst InitialLast Name 7 - 3-/rProperty Owner /±j_ h 'y >- j,'-Sewage System Installer '■■7Name -y ' ^^ ^7 .7 / -/7 A / ,/> 7-c- 4 n h 7 A/A/ /yt/7/ 7 7^y, )c <-■!'6 A.M..197K3 P.M.This System will be ready for inspection on.at This space for office use only NUMBER OF BEDROOMS: lO-L)A.M. P.M19 GARBAGE DISPOSAL: ( ) YES ( ) NOPtje^ie Cair Rec’d ByTime Rec’dDate I lec'd SEWAGE TREATMENT SYSTEM DATA: MJtjlfMOMhR^gUIREMENTSTYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) ( ' ) Septic tank ( ) Drain field ( ) Standard ( ) Bed ( ffrench ( ) Modified ( ) Mound 775 DRAIN FIELDTANK GIs.Sq Ft.Capacityf-■7 Ft.Ft.Distance from nearest well 4-/• ^ t jFt.Ft.Distance from lake or stream r!Ft.Ft.Distance from building Ft.Ft.Distance from property line EFFLUENT DISTRIBUTION ( ) Gravity ( ) Pressure Ft.Ft.Distance from bottom to Water Table .V Alt.distances are shortest distance betweennearest points o/Q /■V']'nWATER WELL DEPT il RatePERCOLATION TEST DATA: Date of First Test . 19 V RateDate of Second Test . 19 1st Test Taken By + 2nd TestFirst Test Rate22nd 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 piot plan sketches and specifications submitted herewith and which are approved by Shoreland Management Officicai shail become a part of the permit. Appiicant 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. 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.;Ni1Issued Date: Land & Resource Management Office S-Pvl/Ic I i-Vj 'TT- Rec it.Fee $. ST7 bif/nComments:5/Haii-^ \V 7m7 Form No. BK-0993-003 268,558 • Victor LundMn Co., Printers - Fergus FaRt, MN > 800-346-4870 INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEPTIC TANK DRAIN FIELDCATEGORYActualMinimumActualMinimum /0OO SFCapacityGLS. GLS. SF /VO ftDistance from Nearest Well FT FT50FT Distance from Buried Water Suction Pipe bo* FT FTFTFT 500“Distance from Buried Pipe Distributing Water Under Pressure )o* ftFT 10 FT10 lOO^ ftDistance from Lake or River (OHWL)FTFT 4 So* ftDistance from Nearest Building 10/20 FT10FT( /Distance from Nearest Property Line FT FT A)oi0e Ct-our FT FT10 10 5^ ftDistance from Bottom to Water Table FT FT FT3 YESHolding Tank/Lift Alarm NO Sewer Line to Well Separation DRAINFIELD CALCULATIONINTERPRETATION OF ABBREVIATIONS GLS. = Gallons SF = Square Feet FT = Linear Feet Actual Minimum ^OO 3,__FTX __£ i2ootoo"' ^20 FT SF Inspector’s Comments: (L ^ /Qo' L> 1 i)c*YO \ i40o a %;sy Kloo Q(IQ.Q> H Inspector's Signature y-/-95 Date of Inspection c Time of Inspection GRID PLOT PLAN SKETCHING FORM — (Must Be To Scale) f Scale: Each grid equals feet/inches 19 ___//? > >Dated:Signature Please sketch your lot Indicating setbacks front road right-of-way, lake and sideyard for each building currently on lot and any proposed structures. I I t -.0 . 0 \ <6. f h PERCOLATION TEST DATA V LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, MN 56537 OWNER: MIDDLE TELEPHONE NUMBERFIRST 'LAST NAME ADDRESS: ZIP CODECITY STATESTR./RT. TWP. NAMESEC.TWP.RANGELAKE/RIVER NO.LAKE NAME LEGAL DESCRIPTION: 1; PARCEL NUMBER NUMBER/BEDROOMSFIRE NUMBER — TWO TESTS ARE REQUIRED — TEST HOLE NO. 2TEST HOLE NO. 1 inches; Diameter of Hole inchesinches; Diameter of Hole inches Depth To Bottom of HoleDepth To Bottom of Hole 19DaleSoil TextureDepth, Inches Dale 19Soil TextureDepth, Inches Percolation Test By _ Firm Name ___ Percolation Test By___ Firm Name ___ Address Address Otter Tail County License No. Otter Tail County License No. PERC TEST # 2PERC TEST # 1 PERCRATCIKTBRVAL<MPIlfrBS>WAIBRPBFTH WATER DROP TIME INTERVAL (MPn/TES>WATER DROPTl)>g PERC RATE STARTSTART r TIMB "frBftCYIMK" DROP PERC PERORATEPERC RATHWater depth WATER DROP time INTERVAL IMINUTEnINTERVAL (M1WUTBS>WATER E«PT«WATER DROPTIME RBPILLR6PILL ■f T * DROP PBRC * DROP l^bRC WATER PROP PERORATE INTERVAL fMINlHEft WATER DEPTHINTERVAL IMINUTBO WATER DEPTH TIME WATER PROPTIME PERC RATE RBPILLREFILL 4 4'rtMtf' PBRC DROP PBRC WATER DROP reRCRATB TIME INTERVAL fMINUTBS)WATER DEPTHINTERVAL IMINUTBO WATER DEPTH WATER DROP PERORATETIME RBPILLREFILL 4 *?TCgr^pg5P~~rege~TIMU DROP PBRCPERORATE TIME INTERVAL (MlNUTBSlINTERVAL fMTNUTBa WATER DEPTH WATER PROP WATER DEPTH WATER DROPTIME PERORATE REFILLRBPILL 4 4 'TTKffi" DROP PERC DROP PbRCPERORATEINTERVAL (MTNUTES>INTERVAL (MIWUTBS>WATER DROP TIME Water depthWATER DEPTH WATER DROP PERORATETIME RBPILLRBPILL 4 4 WHB” DROP PERC~'HME DROP PBRCPERORATEINTERVAL fMINUTES>INTERVAL (MINUTEST TIME WATER DEPTHWATER DEPTH WATER DROP WATER DROP PERORATETIME RBPILLREFILL r TIME DROP PBRC TIMM DROP PERC PERC RATE TIMBWATER DROP WATER DEPTHINTERVAL IMTNUTBn WATER DEPTH WATER DROP PERORATETIME REFILLREFILL T time” drop PErC"ITOB" ' drop PERC COMMENTS/CALCVLA TIONS: MKL — 0390 - 005 250,815 — Victor Lundeen Co., Printers, Fergus Falls, Minnesota 'f. \'/hn.>‘0; CERTIFICATE OF APPROVAL SEWAGE SYSTEM s ^5)7 19TH 94 vk: -M ¥« DECEMBERmThis 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. faiday of 19 i m m Ii The premises covered by this certificate are legally described as:B'KT, %56-138 Twp. ^ ^ ^25 Range GIRARDMLake No.Sec.Twp. Name m 21 133 39 62.15 GL 3 8 40-\ um at'.’ ST'/ PI mi MINN N DIET OF LUTHERAN CHURCH H Owner: Name MISSCURI SYNODiT HENNING/ MNAddress 56551 L,#Zip No. 9988Permit No. SP mmSigned by: Land & Resource Managemeni Official Ouer Tail County, Minnesotali; MKL-0987001 i V/ EW JT-272472 Vidor Uindeen Co., Primers, Fergus Falls, Minnesota 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 > ----------- ^<^-000— o I'i'~l 'uub Permit No.LEGAL DESCRIPTION AND n? R tyLOCATION Lake No.Lake Name Lake Classif.Sec.TWP Range TWP Name IDENTIFICATION: Please Print All Information. I rLast NameOWNEli^ L U TE- /^/y Mailing Address — No, Street, City and StateFirstInitial Zip No.Tel. No. ^37h /yIS3^/9A/D C/3A/Jh (p 0 ^ P~ A/ 0^7'SEWAGE SYSTEM INSTALLER Name, /E /P A//] Y/V r,~ />'1 A A' This System will be ready for inspection , 19.on. This space for office use only 19 M Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signature 1Q^3NUMBER OF BEDROOMS: /ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DAT^X SEPTIC TANK SEEPAGE PIT DRAIN FIELD J a- /GIs.Capacity Sq. Ft.Sq. Ft. / (PC Ft.Ft./Ft.Distance from nearest well Ft.trvDistance from lake or stream Ft.Ft. iP(JFt.Distance from occupied buif Ft.Ft. / ^Distance from property line Ft.Ft./ ^6^Ft. Ft.Distance from bottom to Water Table Ft.Ft. An distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on......... PERCOLATION TEST DATA: fhf^/ //AT /3/'?g> Date of Second Test ,.U.T:....L3.. ., 19 , Time ByM k../..I / ^3 „ 19 zk..... , .... Date of First Test Rate Rate 1st Test Taken By 5 A-n/U fT First Tesx .//...£!+ 2nd Test 2 Rate2nd Test Taken Bv 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.Signature Permission Is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon expressPermit: condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six (6) months. mE>Issued Date: :3XL-Shoreland Management Office ^ /A \Af\ nJ Dis-V 'it)Fee $Rec # Comments: Form No. MKL-032085 237,443 — Victor Lundeen Co.. Printers, Fergus Falls, Minnesota r r« 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 I ■ .j 23.■ yL/y ^ ^ p Permit No.,LEGAL i '(JuC)DESCRIPTION 4(3O 7 AND LOCATION / Lake No.Lake Name Lake Classif.Sec.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. This System will be ready for inspection , 19.on. This space for office use only 72A Phone dall Rec'd ByDate Rec'd Time Rec'd Owner or Agent Signature A/:NUMBER OF BEDROOMS: /ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA:; i r~ f 1 DRAIN FIELDSEPTIC TANK SEEPAGE PITV ^ /,a GIs.Capacity l/'V i.^ ■'Sq. Ft.Sq. Ft. /V ‘I Ft.Ft.Ft.Distance from nearest well /I I Ic.'-L.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. AH distances are shortest distance between nearest points RECORD OF TESTS: ■1 Inspection was made on -.119, Time ,JVI By 15/. >- y-PERCOLATION TEST DATA:Date of First Test 19 , Rate II i i/ ^Date of Second Test , 19...1:, Rate .-I1st Test Taken By i1First Test......+ 2nd Test 2'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 Minn esota Department of Health. Applicant agrees that plot plan, sketches and specificationssubmitted 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. 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 16) months. Signature 1 Permit: i 1 Ayi %Issued Date;u i?Shoreland Management OfficeiM-42/'H Fee $Rec # M\A\'\ k) 13|s4'ij's - lComments: L 5 !Form No. MKL-032065 237,443 — Victor Lundeen Co., Printers, Fergus Falls, Minnesotau T ■'.r 1 Ii INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORYActualShould Be Actual Should Be Actual Should Be Capacity Qls.GIs.S F S F /<r0Distance from Nearest Well F F F F F F Pm-Distance from Lake or Stream F F F F F F IXDistance from Occupied Building F F F F F F ^004^Distance from Property Line F F F F F F 5^Distance from Bottom to Water Table 3 3FFFFF Ji 9J4©oi>*< Comments:tNAffhz /OOM Jflirts .2L- 4 . p'i -04/' tJixii) Date of Inspection 19 Time of Inspection M /( Si^ature of InspectorINTERPRETATION OF ABBREVIATIONS Qls = Gallons SF = Square Feet F = Linear Feet Job Title f0MKL - 03208S • Backeri AgerKyf i iII •i GRp Rl/QT PLAN SKETCHING FORM . 1/ / ~ ^cVgiid equals } ^ 1.yScale:-feet/inchesA ►■V ^■Qsf y,A Dated:19 Signature ketctryour lot Indicating setbacks from road right-of-way, lake^nd sideyard for each buttdtn^ carrentlf^ on lot i id any proposed structures. ■-------Please- !i -I 4 J- , ...I. ^t ^:J)s^.^LCu^.*• 1: ♦;1 T CO 01. ' -tft V ' TPu.e i--, T T Is//VA I ’ 1 T- Sv^ -..... -i-Li: ■■I .u* i.. H'"]‘-'t- \/go o f 1 : 4 -r A. 1 —h-t-7 : ; : ' .. '- 4- r iI; I- i PERCOLATION TEST DATA LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, MN 56537 OWNER: /• ^ T (U/S A/,^ ,VP 1 MIDDLE TELEPHONE NUMBERLAST NAME FIRST ADDRESS: CITY STATE ZIP CODESTR./RT. RANGE TWP. NAMESEC. TWP.LAKE/RIVER NO.LAKE NAME LEGAL DESCRIPTION: PARCEL NUMBER NUMBER/BEDROOMSFIRE NUMBER — TWO TESTS ARE REQUIRED — TEST HOLE NO. 2TEST HOLE NO. I O’(J U-uiy inches; Diameter of Holeinches;Diameter of Hole inches Depth To Bottom of Hole inchesDepth To Bottom of Hole. 0 'TA0 y S19 ^ &/ /3 MoO 0-A /? P FPM ^ i-f’ ,____________ Date ri /fJpPercolation ----^^------- Test By Firm Name Depth, Inches Soil Texture Date 19Depth. Inches Soil Texture ^ O f Percolation ---------------------- Test By___ Firm Name A . , ()0 ^ 7 AZP "S- 7 }■/ y /O/A QJY f-AO! //PV' ■Address Address Otter Tail County License No. Otter Tail County License No./ ^ Oo / o/ & n PERC TEST # 2PERC TEST # 1 WAJBRDBFfH WATHRDROP PERC RATETIMEIWTCRVaL (MlHUTBSl TIME tWTBRVALfMim/TBS^WATER DEPTH WATER DROP PERC RATE Cfjf/ZyPl. '/ 0 ! HAS'i' i’ /sSTARTSTART.A f-IQ / //&'Ti/r) af rYlMir * bkop' PERC TIMB * DROP PERC PERC RATH TIME Water depth Water drop PERC RATE TIME IKTERVALfMIWUTHS^ INTERVAL fMINUrHa WATHR DEPTH WATER DROP»/■»10 SO f'-’-OO)2.7r/A-REFILL REFILL 4 ^4-J,f J>416/ /A-if!i //‘N.T Tmffi • OTSF ‘DROP PBRCTIMB WATER DEPTH WATER MIOP PERC RATETIMEINTERVAL OtIINUTBn INTERVAL (MINI/TBS)WATER DEPTHTIME WATER l»OP PERC RATEt/ / Oio S-7 7.pipREFILL REFILLTip/o'A/A 4 4 'ilMM DROP PERC TIME BROP inSLRd WlOTR DEPTH WATER DROP PERCI^TH TIMETIMEINTERVAL (MINVTEg)INTERVAL IMWUTEm WATER DEPTH WATER DROP PERC RATEqijj' Cf // f ^ REFILLREFILL i r-J-47/07 60 * .h7^p PRgP~ PBRg~ /a/A/g i 'lIMU DROP PaR£ WATER DEPTH WATER DROP PERC RATE INTERVAL IMINIHES^TIME INTERVAL (MINIJTES^TIME WATER DEPTH WATER DROP PBRC RATEtf !A liS± REFILL Jf REFILL /fi Y?-//r. / <407/A/ 3//t 7/fI'iAS 4 4 TOBE" BROP PERC TIME CROP PBRC TCRC RATEIHTERVAHMimrrBS>WATER DEPTH WATER DROP TIME INTERVAL IMTNUTBS2TIME WATER DEPTH WATER DROP PERC RATEREFILLREFILL 4 4 bRbP PERC •rtME DRCP" PERCTTMB INTERVAL IM1NUTB5T WATER DEPTH WATER DROP PBRC RATE INTERVAL fMTNUTBS)TIME WATER DEPTH WATHR DROP PERC RATEREFILLREFILL Tiwn brcop PERC TIME BROP" PERC WATER DEPTH WATER PROP PERC RATE TIME INTERVAL IMINUTHSITTMBINTERVAL fMIWl/rBS> REFILL WATER DEPTH WATER PROP PERORATE REFILL ▼ TlMfi” BROP PERC TIME BRbP PERC h^7 /; COMMENTS/CALCULA TIONS: MKL — 0390 - 005 250,815 — Victor Lundeen Co., Printers, Fergus Falls, Minnesota ;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 .A' :te — Office Y low — inspector , Pi».. — 'Owner Card — Owner Permit No. LEGAL Date DESCRIPTION AND LOCATION TWP NameLake Name Lake Cla&sif.Sec.TWP RangeLake No. IDENTIFICATION: Please Print AM Information. Tel. No.Zip No.Last Narne FirstInitial Maijlipg Address —No. Street City and State OWNER SEWAGE SYSTEM INSTALLER Name, / I'/ This System will be ready for inspection on.. 19. This space for office use only 19 Date Rec'd Phone Call Rec'd By Owner or Agent SignatureTime Rec'd NUMBER OF BEDROOMS;ESTIMATED COST; SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD 3~d O—ci GIs.Sq. Ft.Sq. Ft.Capacity / f-Ft./ -j- Ft.Ft.Distance from nearest well yr7 j Ft.Ft.Ft.Distance from lake or stream Ft.Ft.Distance from occupied building Distance from property line Ft. / o / g-Ft.Ft.Ft. c- —Ft.Ft.Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on , 19 , Time M By PERCOLATION TEST DATA;Date of First Test 19 Rate Date of Second Test 19 , Rate 1st Test Taken By First Test -I- 2nd Test 2 Rate2nd Test Taken By The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work inAgreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. (Call or use attached mailer notice.) Dated 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: / cr r.Six-—(ye'd/Issued Date: 'Shoreland Management Office Fee $Surcharge $ VComments:. Form No. MKL-0771'003 vicTo* LUNOceh « CO.. pkinUm. roeus rxcLi. hinn.158906 ilc^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 V te — Office V low — inspector Pii.. — Owner Card — Owner az ‘^'^3 y ^Permit No.,LEGAL Date/DESCRIPTION AND / !r y r / 7 ?LOCATION Sec.TWP NameLake No.Lake Name Lake Classif,TWP Range IDENTIFICATION: Please Print All Information. Tel. No.Mailling Address —No, Street, City and State Zip No.Last Name First Initial .• f'-:yOWNER-<r SEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection on.i This space for office use only //- 3-19 Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signature NUMBER OF BEDROOMS;ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD GIs.Sq. Ft.Capacity 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.Ft.Distance from bottom to Water Table 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 + 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 th^^e job is ready for inspection. (Call or use attached mailer notice ) Dated Signature Permission is hereby granted to the above named applican^^rform the work described in the above statement. This permit is granted upon express p|an\^and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. \Vinance. Permit: condition that the person to whom it is granted, and his agents, emp This permit may be revoked at any time upon violation of any NOTE: Permit void if work is not commenced within six (6)>hs./'I-5.o '' rrIssued Date:o Shoreland Mana^/nent Office Fee $Surcharge $]■3 -r P--I., 7 - -f .■VComments:. 7J... 7Form No. MKL-0771-003 VICTOH UlMbCCM « CO.. OBIMTCaO. fttout fALLI. NfMM 158906 - ^ '33. INSPECTION RESULTS H- Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORY Actual Should be Actual Should be Actual Should be s FCapacityGIs.GIs.S F S F ncmilDistance from Nearest Well 75F 5£lFFF F FDistance from Lake or Stream F F F F F Distance from Occupied Building 10 2020FFFFF F Distance from Property Line 10 10 10FFFFF F (ODistance from Bottom to Water Table 4 4FFFF F if ii'S-fo saJ tx"Inspector's Comments:cu*. xjj-___3«-yg yg'xggO Tp }/I A Jr ^-/oo) wJ5^-// 7'lap ■ Ij' f ^u/f thI if Date of Inspection i Time of Inspection. //■r Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF « Square Feet * Linear Feet (jM Job TitleFA/O AgencyMKL-0771-003-Backer A ! / -/ tf■i -it-■J 1 '7r o- i I'<'V 4!0 ■' ///.f-y C/ ( ■'I - ;/f /^ 'y' I V Ol>~~xrVv. -5/t <■ 1o /■ !>■ V s »t’^ tL /-n-/i ..I A-/:? fe>^";! > 4-1_c?c 'ier~ / '^'■■)./C'^ ' -Pi _.,L2 \?'? \+++4-t TT+TT r ; '*’ / /■"1 ; :■I 3 L>C.3 ^' t,U“ } 3 ^'' ■ 3 /;5 (-'):j 7 7\\I cX ! I i I » 'cIi:I 1 I ! t I I !I: I : BROGARD PLUMBING CO. ■ HtNNING. «W S6351 ^■'^0 <7 i <Lj-U 0 ' / o.jt (>' i' (/ L> , p ^ ^ ,}><^o (P ^ir__;r o S3 - />' -*t' C :' «r* /y'J.>"' f b /•/ ■' •( ■'. s { . {.■ >' 1■ 0 V>J,a.;'e>~- ff 1V ■ 3E,: ‘1^ ' >A i-------^++t r T -----r0!xL-i j 0 / f o! y t3t !t iL>UL3 O'l ilt’ j (.i;i; > (/■ 3 t' ■> 4/"' i • ^; i 1 : : I-.• ; r*i ii-"P,uS D^\}>'iri-'yA/^ ____ !'o! >! •J!^ d (|> ;■i> 'i»? / ■ * \. ! I i PERCOLATION TEST DATA SHORELAND MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 IPh. No. Owner:Ming Address: A L- 4 ^ Zip No.Last ^^#ame First Middle St. & No.Legal Description: (i'// j TWP NAMESEC.LAKE OR RIVER NO.NAME TWP.RANGE ^ O PC/oo 0 TEST HOLE NO. 2 ^5’,!L tTEST HOLE NO. 1 0>Lf;VPDiameter of Hole_^.Depth to Bottom of Hole.inches; Diameter of Hofe.jnchesDepth To Bottom of Hole.inches;inches Depth, Inches Soil Texture }Soil TextureDate /Depth, Inches /C7 S>DateX.'T ----- -*^W. Test By yt.Test By> AQ✓UJ XFirm Name / OC FirmName.CpID OLU CC lU—«-4Address.CC Address. < 7^ ^ /7^M Otter Tail County License No.,Otter Tail County License No..K UJ Drop In Water ■Levai. ItKhes Drop In Water Level. Inches Measurement, Inches Measurement, Inches V—Time Remarks Time Remarks oLl('7 I /"LI.ffLJ J(/__/r-/zU1y/ii—y <2.:^I f- / z MKL-0871-028183818 ®*<eT»8 LWMtCIM 4 M KBTII See Booklet/'How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn. CERTIFICATE OF COMPLIANCE SEWAGE SYSTEM w. i-' iT This certificate has been issued this 3rd day of MarchI to certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota. M The premises covered by this certificate are legally described as: Si'Sec.Twp.Range GirardTwp. Name.I.nke No. Sfi-1 3ft J_33 3qWm Lutheran Island Camp G.L. 3 & 4 & j 1^* I Lutheran Island CampOwner: Name. ft A Henning ^ MNAddress.g. 56551Zip No. Permit No. SP_Aoiq Signed by:,^/rolm K. Lee, Shoreland Administratorer Tail County, Minnesota MKL-0871-009 159035 uwettM « eo tua. MW 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 - Office — Ir^spector 'Owner Owner W :te • V low Pli.. - Card — Vo/ fPermit No.___ LEGAL .‘TTp i>yDate//DESCRIPTION AND y i ,b L^ke Name ■P r ! 3 3s^~/j rLOCATION Lake Classif.TWP TWP NameSec.RangeLake No. IDENTIFICATION: Please Print All Information. Tel. No.Zip No.Mailling Address —No. Street, City and StateInitial■ast JMame _________________________First Vis-r/fOWNER 7^ 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 NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: DRAIN FIELDSEEPAGE PITSEPTIC TANK y /f /f Gis.y? C7 Sq. Ft.Sq. Ft.Capacity /> 7•f~a Ft.Ft. Ft.Distance from nearest well r ? r Ft.2)Ft.Ft.Distance from lake or stream / o Ft.Ft.>-~p Ft.Distance from occupied building Distance from property line Ft.Ft.Ft./ <J r- Ft.Ft.Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on , 19 , Time M By PERCOLATION TEST DATA:Date of First Test , 19 .., Rate Date of Second Test 19 , Rate 1st Test Taken By First + 2nd Test 22nd 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 7 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 Office Fee $Surcharge $ Comments:. ^21 Form No. MKL-0771-003 ViCrO* LUHOCCN t CO.. PIIMTCM. rt*6U$ rxLL*. 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 OfficeV'' te V Jow — Igspertor Pli.. —‘Owner Card — Owner Permit No.. GL 3 f y .■'tLEGAL ■L/ Date/DESCRIPTION AND LOCATION / i Lake Name Lake Classif.Sec.TWP Range TWP NameLake No. IDENTIFICATION;Please Print All Information. Mailling Address —No. Street, City and State Zip No.Tei. No.Last Name First Initial OWNER SEWAGE SYSTEM INSTALLER Name, V This System will be ready for inspection on This 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•T 1st Test Taken By 1 First Test -I- 2nd Test Rate2nd Test Taken By The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work inAgreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the 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 (j^irform 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, empl^e^ 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 NOTE: Permit void if work is not commenced within six (6) monn^ ance. Issued Date:\Shoreland Management Office Fee $Surcharge $ 7' o ; /J/ i'r ///Comments:. / Form No. MKL-0771-003 yiCTOt UfHOCCH « C9.. FtMut FALLI «iH« 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 X 17©Capacity GIs.GIs.S F S F S F S F Si>Sfi pDistance from Nearest Well F 75FF 50F F 300 FDistance from Lake or Stream F F F F Tlt>Distance from Occupied Building 10 2020FFF'F F Distance from Property Line 10 10 10FFFF F Distance from Bottom to Water Table A 4FFFF F Inspector's Comments: * # QIC. 0 top - /2s ^ ^ -w«je^ s 19_gSDate of Inspection iro» /»MTime of Inspection. Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs » Gallons SF * Square Feet * Linear Feet Job TitleF Agency MKL-0771-00 3-Backer ■; '■r / ■ PERCOLATION TEST DATA SHORELAND MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 3 7 r 7 Owner:Mailing Address: %4. U tH £/f/Z / SJ-y^A/D C. /tA/lP AA / A/ A/ AA 0 StateLast Name First Middle St. &Zip No.City Legal Description; ~ j _______ LAKE OR RIVER NO. B/hTTL-P /$-//? aA /O NAME SEC.TWP.RANGE TWP NAME s pop, C B0'P> o/P/f/vp> p TEST HOLE NO. 2TEST HOLE NO. 1 Soot///Vo hr 11 u >"ULDepth to Bottom of Hole .2-inches; Diameter of Hole.Depth To Bottom of Hole,Jnchesinches;Diameter of Hole inches Depth, Inches Soil Texture P__ 19/ iV 19^£L Depth. Inches Soil TextureDate Date 4 ^AHm 'f UocAA AA/D ir lc/e/V1 A Ah A/ DA7 Percolation Test By____ Percolation Test Bv .O i r p /3 Pi c 6~^A Pi______ Pi A (T~ A- O P U AaR/ /v6r- rLU.Q /?IllFirm Name.CC Firm Name.DoLUQC UJAddress.OC Address < to PS/Otter Tail County License No..Otter Tail County License No^.H coUJMeasurement. Inches Drop In Water •Lewi. Inches Drop In Water Level. Inchas Measurement, InchesTimeRemarksTime Remarks O IB %kB /7 / 1 0^Ik 0-kkIkIk if/ "ikJk b •b"/ ■J— ff/ I--S5 MKL-0871-028183818 ®vicre* uiMOtta • Co natli See Booklet/'How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn. 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 V'' te Office V low — Inspector' Pl»..Card Owner Owner Permit No.. LEGAL xrzDate DESCRIPTION AND /Pi>(3jjs^s^££_3n.LOCATION TWP NameLake Name Lake Classif.Sec,TWP RangeLake No. IDENTIFICATION: Please Print All Information. Zip No.Tel. No.Initial Mailling Address —No. Street, City and StateLast Name ._________________^ Fir^t /tk r OWNER SEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection .. 19.on. This space for office use only -19 Date Rec'd Owner or Agent Signa.tureTime Rec'd Phone Call Rec'd By NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD GIs..q. Ft.Sq. Ft.Capacity :£cFt.Ft.Ft.Distance from nearest well 7-^Ft. Ft.Ft.Distance from lake or stream amFt.Ft.Ft.Distance from occupied building /Q £0Distance from property line Ft.Ft. Ft. 4Ft.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 7 7Dated lign^uri 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. V7 Shoreland Managen^ent Office Issued Date: Fee $Surcharge $ ^4I ___7^77 c <rComments: 7y Form No. MKL-0771-003 158906 vitran ummch t c*.. paianoa. reti«u« u SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 — Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM ,« te — Ot;^e V lliw — Inspector' Pii.. Card — Owner Owner Permit No.,LEGAL Date DESCRIPTION A-4^'AND 4- LOCATION Lake No.Lake Name Lake Classif.Sec.TWP TWP NameRange 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. X This System will be ready for inspection on.. I This space for office use only .19 M Ag^Date Rac'd Time Rac'd Phone Call Rac'd By SignatureOwneNor 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.Ft.Distance from iake or stream Ft. Ft.Distance from occupied buiidinq Ft.Ft. Distance from property line Ft.Ft.Ft. Ft.Ft.Distance from bottom to Water Table Ft. AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on ., 19,, Time .M By PERCOLATION TEST DATA:Date of First Test ,, 19 , Rate Date of Second Test 19 , Rate 1st Test Taken By First Test -t- 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 $ I S'1'7Comments:.I r //' T r?r:-: ■ /, .-L-f i Form No. MKL-0771-003 viCTOn Lu»eet» 4 CO . pniHtta*. pc«sua rM.Li mih* 158906 rr I INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PIT DRAIN FIELDSEPTIC TANKCATEGORY Should beShould be Should be ActualActual Actual Capa,city S F S FGIs. GIs.S F SF Distance from Nearest Well 75 50 FF F F F F Distance from Lake or Stream F F F FFF 20Distance from Occupied Building 10 20F F F F F F 10 10 10Distance from Property Line F F F F F F 4 4Distance from Bottom to Water Table F F F F F F Inspector's Comments: / V. o' Date of Inspection .19___ Time of Inspection,M signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs “ Gallons SF “ Square Feet F « Linear Feet Job Title AgencyMKL-0771<003-Backer 1 *■ ' ' r tr<'■ my ; ■ '• ........yym i ■ \ -y.<■ ' •'V ■; r-\» ' - . 4 '■ -fS 'i ‘ . ., • . • •j).'B\*.V J ■I ; r ,:l • V'It '• I?'-'-.a ■ 7 ' --r ? ----------h-* T i i■ i ^ T B /^‘TTL^ L/^K£ (Referc’/?crC ^/<tk — S-Zi- 7?)\ I : Is I '• !: /3f=br. /! ■ ^5 ; ' /0 Rar./SOO (^ol Rr.e-cas/i /'■ :Cor7C/~‘ S<TpJ^^c- T^/tA:II I '* ■i 1 ,v- - i. --■ }' rI-a---S J 'i^co. MI1C21!jc-'V'tr.aI ;(5!C-Q.ifcf. ^■:jaRsr. j “|-A !I ; /8 Per.v5'//«? Refer. £/er. ^joC.oo(5MS ff/S.£. Corner p/rcp/ac<0>• .±!5 ! /3R?r.iV !/CrifP JDrcf/J? JScra C9 7 Sa. PtS fSoc^!-'ir---)C-P r-.r /Z Ftn ;:Sl/i T s 1 Pfjfsr^X. 7S1 .-U./•500 «yc?/. c<ryi^ Concr. ^ejor/c Tan/c 1 ..^-. iRpprOp. PL.PZ’O i p, - JOOO Pr^~c:a>.sf Co/7cr. P5'eorR PpproX. £L 9S-P \ P L.P \\‘i' ESc<rf Pbeoer Pa/e Ifafrr Wc// \ ' \//, / '7//III / !//// $'•■■■ I ' 7 ! /=>l^O'T puyiN ^ccric» f" B/iST V/LUi^QE 30*- O".!! 1 !i i •i BBEC/P/Cfn^/OA/Bl f)// /T? a T^er'/a/.s fS cj o rA:/r? ar/?sf?7/? ySfa// J>e /n a c c Of da nee" oj/t/z tde reazy/rer^CRra /fhe P7 / of a De^p or^m p A/7d Offer TaJ/ Co^.rpz/^ ^/?ara>/cf/7<f P/arzaf^d- rzTorzf Bd^u/af/aPd- i } Le.G-S.ND :i 4 t:ir ------- ff P\fC ySdujcrr * LrrzdyS . V/-— }* (7a/v. IVafer' *Ser\r/cc> ------ U. Gf E/crc^/^/s:—-~ ^ — i4. Q. Copp L.f? (^ds f.//7dd SI !I \£ s !'i ff f/OTBV PI/ ^fra/cf’p^r"crd are I !<r drary /cere /Rcf/aafiTtf /r> p/acre - EXCEPT /a3/careif dr^cd- //yyejT <f ^zdrpoa-a/ dr^a^ferrfd. T^c /pfcR Bap/aae pred’d/yf r?a/? - corrorm-- /r?p dydrerrpSy I i LUTHERAN ISLAND Cf^MP H£.NNtNif,Mlf^NESOTi^ djf/~SJ TE DISPOSAL SYSTEMS ;CT <;i I f j i- 1 . -iLfiYOifr ^ Inst A u. by ' Stbc/^pt a>. S-3P7?' p/i£. I s Pe/7/7/r?jr, ///rzr?<ssofa 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 ite — Office V low — •Inspector. Pli.. Card — Owner Owner ^^37/ Permit No.,# 3LEGAL ItoDate DESCRIPTION AND jT.sL3^ C»)Vci-A'/3yLOCATION Lake No.Lake Name Lake Clauif.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. Au /Ai?rcvvw_-7^ /AC r\ iTvOWNER SEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection on.., 19, This space for office use only 19 Date Rac'd Time Rec'd Phone Call Rec'd By Owner or Agent Signa^ture NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD '9- \U2lC^^ - /Son /GIs.Capacity Sq. Ft. Ft.Ft.Ft.Distance from nearest well .'ST^ Ft.251Distance from lake or stream Ft.Ft. Ft.Distance from occupied building Ft.Ft./to Distance from property line /nFt.Ft.Ft./n Ft.Distance from bottom to Water Table Ft.Ft. An distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on „ 19,, Time ..........jVI By ., 19 ..3.6... . 19............. PERCOLATION TEST DATA:Date of First Test Rate Si Date of Second Test ., Rate L lit Te*t 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 u^ 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 10 Dated ■tSignature^ 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. Shoreland Management Office (y A/..Issued Date: 50 Fee $^ ^5^ P OSurcharge $ Comments:. Form No. MKL-0771-003 158906 vicToa LuaeccH t c«.. eniHTtai. rin«u* rscLi 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 W :te — Office V low 1- Inspectpr Pii.. Card I y 1-f;Owner Owner Permit No.,LEGAL Date DESCRIPTION AND LOCATION Lake No.Lake Name Lake Classif.Sec.TWP Range TWP Name IDENTIFICATION; Please Print All Information. Tel. No.Last Name First Initial Mailling Address —No, Street, City and State Zip No. OWNER SEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection on., 19. This space for office use only 19 M Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signature /c -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. Ft.Distance from lake or stream Ft. Distance from occupied building Ft. Ft.Ft. Distance from property line Ft.Ft.Ft. Ft. Ft.Distance from bottom to Water Table Ft. AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on „ 19,, Time ,M By PERCOLATION TEST DATA:Date of First Test 19 , 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 $ NG 1 ii J -**T_ISSUE!Comments:. Form No. MKL-0771-003 viereii u«aBCl« « c«., p(««us r*t.L«. MiHa.l58906 \ INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORYActualShould be Actual Should be Actual Should be Capacity GIs.GIs.s F SFSF S F Distance from Nearest Well F 75F 50FF F F Distance from Lake or Stream F F F F F F Distance from Occupied Building 10 2020FFFFF F Distance from Property Line 10 10 10FFFFF F Distance from Bottom to Water Table 4 4FFFF F F ^ f( cjj Jn ^Inspector's Comments:4- 7/J!a ^ C'-A/GO •v -e/C ,/L^ //0 L' • (C ~ 3-g,192:7Date of Inspection. Time of Inspection.M 71/Signatur^/6f Inspe9<brINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF * Square Feet F » Linear Feet Job Title Agency MKL-077 l-OOS-Backer IT' •• r'i'- .■•v ■ ‘. PERCOLATION TEST DATA Price $ 1.00 per pad. SHORELAISID MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Ph. No. " y^'/A’' Mickfle Owner:Mailing Address: yLast Name First State%St. & No.Zip No.Legal Description: TWP.RANGE TWP NAMELAKE OR RIVER NO.SEC.NAME TEST HOLE NO. 2TEST HOLE NO. 1 CpDepth To Bottom of Hole,Depth to Bottom of Hole inches; Diameter of Holeinches; Diameter of Hole JnchesInches Depth, Inches Soil Texture Depth. Inches Soil Texture "7 —Date.Date Percolation Test By___/y> /V /n Firm Name QC UJAddress.GC Address < COOtter Tail County License No.,Otter Tail County License No^HcoLUMeasurement, Inches Depth in Water Level, Inches I-Measurement, I nches Depth in Water Level. Inches Time Remarks Time Remarks o / /I j J :p^o J J5^ L///n //./!LnL/Z/n/(J 'L1 ' }U / "ZZ- ^a ^ y />Z> JZ rlZpA V «r MKL-0871-028 See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn. PERCOLATION TEST DATA Price $ 1.00 per pad. SHORELAIMD MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537f Ph. No.Owner:Mailing Address: ^------First “ NAME _yu y JiU. TWP NAME /Last Name Zip No.StateSt. & No.City Legal Description:^3L SEC.RANGELAKE OR RIVER NO.TWP. TEST HOLE NO. 2TEST HOLE NO. 1 66Depth to Bottom of HoleDepth To Bottom of Hole inches; Diameter of Holeinches; JnchesDiameter of Hole inches Depth, Inches Soil Texture 197^Depth, I nches Soil TextureDate Date 19_____ /srPercolation Test By____ i Percolation Test By____// Trr //Firm Name,FirmName, aLU cc LU Address.CC Address< C/)Otter Tail County License No.,Otter Tail County License No..1-cnLUMeasurement, Inches Depth in Water Level, Inches H Measurement, Inches Depth in Water Level. Inches Time Remarks Time Remarks o ^ '■^75/\IH " 0 /n: /f'l (n ft/l f!/ft I rrz///// /adL Sti X ■ 4>7 ^7/ A' ■ C7 ^7/ >- /xT:^ S'y/y - C97^.^/ MKL-0871-028 See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Serwce, Un. of Minn. \ I /// / ; i PERCOLATION TEST DATA Price $ 1.00 per pad. SHORELAIMD MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Ph. No.Owner:Mailing Address: Last Name First I NAME / Cit^^/Middlg=^StateSt. & No.Zip No.Legal . ^ Description; ~ ______ LAKE OR RIVER NO. '^y7-^:7 SEC.TWP.RANGE TWP NAME TEST HOLE NO. 2 fZTEST HOLE NO. 1 Depth to Bottom of HoleDepth To Bottom of Hole,inches; Diameter of Holeinches;JnchesDiameter of Hole inches / ^ “ Depth, Inches Soil Texture Depth, Inches Soil TextureDate Date 19_____ Percolation Test By____ Percolation Test By____ZS.Q UJFirm Name CC FirmName/=5 oLU ir LUAddress.QC Address< COOtter Tail County License No.Otter Tail County License No,.HCOLUMeasurement, ___Inches Depth in Water Level, Inches H Measurement, Inches Depth in Water Level, Inches Time Remarks Time Remarks o z». / ' :s;2> z /I-f //nJX. /L n /L 'f/( /(y x^o X ■ — ■ (7_z // ^7/X/. MKL-0871-028 See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn. PERCOLATION TEST DATA Price $1.00 per pad. SHORELAIMD MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Ph. No.Owner:Mailinq Address; (2p. Last Name /Middle “VFirst St. & No.Legal Description: RANGELAKE OR RIVER NO.NAME SEC. TWP.TWP NAME / TEST HOLE NO. 2TEST HOLE NO. 1 Depth to Bottom of Hole inches; Diameter of HoleDepth To Bottom of Hole,Diameter of Hole Jnchesinches;inches 7 -IQ 7 7 19^7Depth,Inches Soil Texture Depth, Inches Soil TextureDate Date7^ I U f -• •4Percolation Test By____ Percolation Test By___//OUJ Ii:L /)Firm Name.QC //Firm Name.W3 o \ ^LUQC LUAddress.QC Address < COOtter Tail County License No.,Otter Tall County License No..7 COLUMeasurement, Inches Depth in Water Level, Inches H Measurement, Inches Depth in Water Level, Inches Time Remarks Time Remarks o /O''< Or- S'//H !(/(I(!<2 1 D:frO' "7^ ** K -=s f p 7 Z/// LT 6^ V ’ _____________________________ u MKL-0871.-028 See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn./ 1 I : < ! ;battle: Lake (R(sfcr<r/?<EC 8^^^ — S-Zi~'?7') \t i!} ! ' i: f C 5. ■ /3f=lTr. it3\/& /3c:r./Soo /=^r<r- c£7s/ CoT?A/- ^<Tp//c- To'/zJe \ j :~T~S 'FCO." C.D.r ■■ 'C.O-E-- j3Par: GC-O.'1-**f £'>i\a\ /3Ftr. c -1C.D.-\ r./$ Fcr.>S/fe /ee/er £/ek ■=./o6,06 iS/(7h a/ S.£.Cor/7e^r £y'rcp/ac^. I f-4 V-i L : Sr S£, F/-. CrL/j/?Bc/ Focjc JOra//? i 67/S !/3/=br. JDko///? ^<r<7 __r- :t \u. d"ao/>(',/2 f=tr.li t2Vty r:T i rZ:’----1:s:FppK^X- F/.S9. 7f \ /)pp,-o7-. Cl. 92’O '■ J2. - /OOO 6a/. Fee~Co.S7^ Co/?cr. ^epr/c Jo'/z^ts- /:SOO (ra/. F/-e~ Cp.r 7K . -G ..- Tc *- t' \\C-a /^oaJe/' /^0/"cV /PppraX. £1. ^S. £ j-'-f f / /OOO (Sra/. Fre-coed'— J Cb/?CT: ^Sep£/C7dr?k _J £E / } p L.F 6<zs £/0rezp(TtaV// --- E/aerj/ FboJrr Fa/0/J jH '7/ /Waj/cre y/c///02S S^, F£, drE^epea/ FoeP jDr~a/r7 JBc’d ! r~-7/// / /32.2 .3a. py. CTE/sX/zeed Facp Ora/'/? Oad ! / i OT F* U N escape E/^ST /" — 30‘-0" EPE CJFJ C/^ F/O/VE I p// rr? a yer-/a/O’ ^ ojor/err? a/? s.6/p 3'^a//he /n a c c of-da nc<r cj/r/? E/ra rta pe//E'eTha7?/ci e>P 7h7e /^//7a>e>aoi/a Dep oaF Pea///!? p /Pe Ofper Ta// Caa/7/Er 3/?a/^e/atzP /da/aa^e-- r??e/?r Fea'/a/a//aFd- Leo ENo: _------ p3)/(p Oeujer L/r?ea^W— /" (ra/y. IVar^e/^ 3rpy'/ae u,(jr. E/ec^x/c Fery/fccE/. Q, Capps’/- L./6 (pas /.//?es s- i~E ‘ /VOFFl PI/ 3h/-E/epEa/ss s s~er-y/aes J/?c//aa^ea/ az-e //? p/aee - EXCCPT //7 c//earea' s'eu)- CF ///?es p c//sp osar 3Fsferr?s. Tr/e /apTF Fap/aae p/-ese/?r FO/?~ Car/Por-m^ /r?p ■i \LUTHERP/N ISL/^ND Ch/MP /-iENNINd J F J N/V £S OT6 ON'-SITE DISPOSAL s3rST£M5 Lfiyodr ^ In3T/^cl. by : /Oe >5“TTc/nFr (3>. //(a/p/7//7^, /^/rp/aesoha S-3/-77 F/^. 1 ; i e/T?s.t 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 OfficeW :te V Jow — Inspector Ph.. Card Owner Owner 10hit? iaQl3 / & A-Permit No.LEGAL Date DESCRIPTION AND I 6 cDM.3_l_LOCATION Lake No, Lake Name Lake Classif.Sac.TWP TWP NameRange IDENTIFICATION: Please Print All Information. Last Name InitialFirst Mailling Address —No. Street, City and State Zip No.Tel. No.' /C[ *7 ^ ^ P StOj ■3Vt JV^OWNER ■f ( c I r.g. ST e uoL^-rSEWAGE 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 NUMBER OF BEDROOMS: JESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK EEPAGE PIT DRAIN FIELD 7oo / O Sq. Ft.GIs.Capacity iq. Ft. m:SIFt.Ft.Ft.Distance from nearest well -r -'y7.TFt.Distance from lake or stream Ft.Ft. /oDistance from occupied building Ft.Ft.Ft. /o'"Distance from property line Ft.Ft.Ft. Distance from bottom to Water Table Ft.Ft.Ft. AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on 19 , Time ,JVI By .....IPERCOLATION TEST DATA:Date of First Test 19 , 19 Rate r L z.k..Date of Second Test Rate 1st Tost Taken Bv IrI I II First Test -t- 2nd Test 22nd Tost Taken By Rate Agreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. (Call or use attached mailer notice.) The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in /I'S /C yy ibed 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 shal/conf^m in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. ( \ A~\ NOTE: Permit void if work is not commenced within six (6) months. \ 1 11// ! 0/nh\,Dated. Permit:Permission is hereby granted to the above named applicant to perform the work [1 ___Issued Date: loreland Management Office Fee $Surcharge $+L r/ 7 f Comments:. Form No. MKL-0771-003 vierea mutcta • co.. eautTtaa. ftnaut r*LL*. «imm 158906 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 ;te — Office > low Inspector Ph.. Card Owner Owner Permit No.LEGAL Date DESCRIPTION AND LOCATION Lake No.Lake Name Lake Classif.TWPSec.TWP NameRange IDENTIFICATION; Please Print All Information. Last Name Initial Mailling Address —No, Street, City and State Zip No,Tel. No.First OWNER SEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection on.., 19. This space for office use only 19 .M Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signature NUMBER OF BEDROOMS;ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD GIs.Sq. Ft.Sq. Ft.Capacity Ft.Ft.Ft.Distance from nearest well Ft.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 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 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 (61 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 $ NOT called FOR INSPECTComments:. Form No. MKL-0771-003 ,158906 viCTO* kUHBten 4 c».. PKiHUNe. rceeus r4i.L«. INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORY Actual Should be Actual Should be Actual Should be Capacity GIs.GIs.S F SF S F S F Distance from Nearest Well 75FF 50FFF F Distance from Lake or Stream F F F F F F Distance from Occupied Building 10 2020FFFFF F Distance from Property Line 10 10 10F F F F F F Distance from Bottom to Water Table 4 4FFFFF F Inspector's Comments: Date of Inspection .19___ Time of Inspection,.M signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs ^ Gallons SF » Square Feet * Linear Feet Job TitleF Agency M KL-07 71-00 3- Backer -J-p. 1V[ ,1i =1 ii. ■ '1'i3 jI*1‘I 1i 51•i' i £-.AST battle lake 8l. 6>8 /d-h?^) \ ■i i% "i{■'* (• i i i I ycrra' i.I -i s/¥<^ ^cs^eea: a/ct/.-E/oacy ^/Ya/Z Abeek Cf /y.-S*£< iS/aipj !.Tl:: X i t •- -- ^'xX X.J .1X\£i Xs I m-j L^'><II/8A&r.A)!//5/2VTi>)}■h . :'/3 ,■'.-\X?■...'/a/^X-E/xad da/: A>r<A C-eis 7^ Co/tc/^ >Sc‘/7>^/a 7dr/?A; -c3-' W-w~■4k I. Q"' - - <5(---------•“ft- *■*, i-s£\£>/sZrt /■■■ j 0f-f QI ■> / ' / 7 !//1 /\. //oooAot. fy~c- ' casr^(TjdZ/c TJfc /SO() PrB~paJrj^ Ca/rtEK •Seys//<7 7a A} Wf:^70 AZ CAA/y3Z> ’^^acAf ^AI?av7/7 8<ra(fC.O.\r~ a-¥''/ZAcr SJ/ / ‘\A)fX.dZ<rY97o V/'^/k Sa-x\S\!-----;i 4 ^X'■3“£\I '1A/(fcZ. 7?-a/7s- Aoi^b i 4/f^<5' ^/oA-a^<E'(!1/!•7 ,■4.1/;•VZO >3a. a/. OALL^r /?ocAz Gao/a? Sac/;u'/:j'Z/O -3o, AZ. CrL/SA<Tc/ - - ■ Secf 1■ ] / C^PAir/AA Wb// -i ] 1 ■i '.:!S /=>LOT PL a^ N wasT viLL/isa/" ~ 30~o” : iI , ^ caZc i >^F^ac/r/ca^TfONs \A)/i /rroZ^A/ff/^ ^ ryoAJk:m>&A?atA/p J/7 £7CCOAC/crAC<E CO/Z/t ZAb AC’a^/AO^rr?E>/^Za cp ZAcr A7/'r7A?c^oZeA Z7c‘^aAfAr?G'rrr //BaZZA. a. fAe C>ZZ<rA 7a 7Z C'aAAzZy ^S^AaAcr Za/7</ />7aA?ap^, Z7BA7A J^S^ZaZZo/xs, ICaG a/sZV : Z" Al/C 3'cuac’a V Bp''f" (ra/y, y/aZar JS'c-rx/Zco / 6/^ (fT aicaZrZc -^^eAy/cc C/.Q, CopA&A <?«r TD/aZA C7r?es. •s ; ■ j-£J-“'G\■ .1- I JJ i ^-iNOTE:I 'ZiZZ ^ZAi/cZiAAcrs Z ^iTAy/ciTa /Wc/7caZ^ ere/ aAA /A p/ace - £xce/^T /Ac/ZEa/era escra/e-A V/Acrs ^ c/ZySp caaZ v5^*y7A<r . ZaZer .j^fi/ace c&Ar^rvA7U^...^^Lryyms.. \ •V i ■1 5ili/rZ^£P/^/i IJLi^ND ezipp . p£NN/N(9 , /^/AA£80ri^ Ozz~S/7'8: Disposal SySr^Ais 1 i I 1■■ Zay087 z Sa/tall, jsy : PaSreuAKTCo. F/^’S£<rAA?ZA^j /f/Af/rc’LroZa ■]/0-S0-7C,\ -JI 1-. PERCOLATION TEST DATA Price $1.00 per pad. SHORELAND MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Ph. No.Owner:Mailing Address: Vt/, /J 1 Zip No.Last Name >i/lidci1e/First St. & No.State -dT; ~ /.s^ Legal Description:.Z13 3 TWP ISTAMELAKE OR RIVER NO.SEC.NAME TWP. 'S,.TEST HOLE NO. 2TEST HOLE NO. 1 Lz.Depth To Bottom of Hole ^Depth to Bottom of Hole inches; Diameter of Holeinches;Diameter of Hole Jnchesinches ^~/6r- in t, ^ Depth, Inches Soil Texture Depth. Inches Soil TextureDate Date I Z7 Percolation Test By____ Percolation Test By___aLUf I r f-FirmName.QC Firm Name,DoLUQC LUAddress.QC Address < CO Otter Tall County License No..Otter Tail County License No..F-coLUMeasurement, Inches Depth in Water Level, Inches H Measurement, I nches Depth in Water Level, inches Time Remarks Time Remarks o6>.z/H / ^ //Z/^3 i'1r i MKL-0871-028 See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service. Un. of Minn. 3PERCOLATION TEST DATA Price $1.00 per pad. SHORELAIMD MAIMAGEMEIMT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Ph. No.Owner:Mailing Address: MiddleLast Name St. & No. TWP. City State Zip No.Legal Description: Ct^ LAKE OR RIVER NO. 3s^NAME SEC.RANGE TWP NAME TEST HOLE NO. 1 ^TEST HOLE NO. 2t 6.Depth To Bottom of Hole,Depth to Bottom of Holeinches;Inches; Diameter of HoleDiameter of Hole inches Jnches Depth, inches / da 19 7 <oSoil Texture /Depth, I nches Soil Texture yDate.Date /f. fiO (oPercolation Test By___ Percolation Test By____u Q LU lH / (/V,Firm Name.//OC Firm Name./DaLU OC lUAddress.GC Address < COOtter Tail County License No.Otter Tail County License No..HCOLUMeasurement, Inches Depth in Water Level, Inches H Measurement, Inches Depth in Water Level, Inches Time Remarks Time Remarks o Z 'T J/ L 5 AX 4/I- //—i =7/AS V/7 MKL-0871-028 See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn. •-it misf 9thh ipmihJenuapyThis certificate has been issued this day of_•i-1:■???'■%< Mto certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County,Minnesota. ‘ifV'- m The premises covered by this certificate are legally described as: Lake No. $6-138 2$m 39.Twp. Name GlpapdRange.Twp.Sec. m Lutheran Island Camp -¥ 1- !% •A Lutheran Island Camps2tOwner:Name. Address Henning. Minnesota& • S':m $6$$1Zip No..•••i. -V ■ i *r Malcolm K. Lee, Shoreland Administrator Otter Tail County, Minnesota $96Permit No. SP_ ''kSigned by:.-1 MKL-0871-009 % f// IS Jig,■ <sr 159035 leiocfi 4 ee. Miirtii. riaout riu.4, mn SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 - Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGF DISPOSAL SYSTEM White — Office Yellow — Inspector Pink — 6wner Card — Owner Permit No., LEGAL Date DESCRIPTION AND /?? Cy f f-Q*- c!~~/ 3^ P-- BcuCCJLaLOCATION Lake Classif.Sec.TWP Range TWP NameLake No.Lake Name IDENTIFICATION: Please Print All Information. Mailling Address —No. Street, City and State Zip No.Tel. No.First initialLast Name OWNER 7*- F-/.SEWAGE SYSTEM INSTALLER Name This System will be ready for inspection , 19.on. This space for office use only 19 ,M Date Rec'd Phone Call Rec'd By Owner or Agent SignatureTime Rec'd SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD 7^9do Sq. Ft.GIs.Sq. Ft.Capacity 7^Y-yvFt.Ft. Ft.Distance from nearest well 7 yFt.Ft.Ft.Distance from lake or stream 7^T-/O Ft.Ft.Ft.Distance from occupied building / 0^/ 0Distance 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 By !71......PERCOLATION TEST DATA:Date of First Test , 19 Rate 7.2....../7 05T..-Date of Second Test 19 Rate 1st Test Taken By /...First Test -I- 2nd Test zz2 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 specificationssubmitted 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 Sign: 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: £- /- 7^ Issued Date:7 Shoreland Mammement OfficelU^'Nb. 13 9^5 - 0 0Fee $Surcharge $ cQdLComments; Form No. MKL-0771-003 . 7 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., LEGAL Date DESCRIPTION AND 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 OWNER SEWAGE SYSTEM INSTALLER Name. (o ''7^This System will be ready for inspection on., 19. This space for office use only 6 '^o_c>i '■ 6 Pm7A.19 Phone Call Rec'd By Owner or Agent SignatureTime Rec'dDate Rec'd SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD ( / U 0 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 buildinq 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,MInspection was made on , Time 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 Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon expressPermit: condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six (6) months. Issued Date: Shoreland Management Office Fee $Surcharge $ SljSComments:. victoi Luaecia 4 ce . e*i«tce«. rt*cu» rm.L*. mimn 158906Form No. MKL-0771-003 INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORY Actual Should be Actual Should be Actual Should be Capacity GIs.GIs.S F S F S F S F Distance from Nearest Well F 75F F 50 F 20 F F Distance from Lake or Stream F F F F Distance from Occupied Building 10 20FFF F F Distance from Property Line 10 10F 10FFFF F Distance from Bottom to Water Table 4 4FFFFF F Inspector's Comments: •j j h--:2. 0Date of Inspection__1 ^ .0 0Time of Inspection Slpnature^f/fnspectorINTERPRETATION OF ABBREVIATIONS GIs » Gallons SF B Square Feet F • Linear Feet Job Title AgencyMKL-0771-003-Backer -A