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Home My WebLink AboutMadsen's Resort Inc._25000990564001_Septic System Permits_• V > :;pfzri_ZZ3S3Ei 1329 ' ------1328------if ;: 7‘ (I ;J CERTIFICATE OF COMPLIANCE SEWAGE SYSTEMH S >.-•73January3 rd of_This certificate has been issued this 19.s. to certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota. s; m The premises covered by this certificate are legally described as: Twp. Range 5^ * ,.r* Everts56-2UO 5ec._i Twp. Name.Lake No. iM Madsen Resort m4 , -<3U' i mCharles MalmstromOwner: Name.wiilBattle lake, MinnoAddress. m s56515Zip No. id m UiUPermit No. SP..'p Signed by:. Malcolm K. Lee, Shoreland Administrator Otter Tail County, Minnesota ONE SYSTEM ONLYMKL-0871-009 y iK-.-lM pm 159035 iMMia 4 ««. fiiKTiM. natvt raua, ch ; 3 /i-juSHORELAND 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 (3 AND M./ TWP LOCATION Sec.TWP NameLake Classif.RangeLake No,Lake Name IDENTIFICATION; Please Print All Information. Tel. No.Mailling Address —No. Street, City and State Zip No.Last Name_________ __---_______First Initial OWNER SEWAGE SYSTEM INSTALLER Name, This System will be ready for inspection ., 19,on. This space for office use only ,M,19 Phone Call Rec'd By Owner or Agent SignatureDate Rec'd Time Rec'd ✓SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD ^ ^ GIs.2/0C> Sq. Ft.Sq. Ft.Capacity 3'^Ft.o Ft.Ft.Distance from nearest well O 7r> Ft.7 ^ f-Ft.Ft.Distance from lake or stream a 7^ ■/- Ft.Ft.Ft.Distance from occupied building //6Distance from property line Ft.Ft. Ft. €>YdFt.Ft.Ft.Distance from bottom to Water Table All distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on ,, 19,, Time ,JW By .<C.,, 19^. , 19.> PERCOLATION TEST DATA:Date of First Test , Rate 1st Tesr Taken By Date of Second Test , Rate (^aieFirst Test -I- 2nd Test 2nd Test Taken By The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work inAgreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn esota Department of Health, Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi- until it has been inspected and accepted. It shall be the V for inspection. (Call or use attached mailer notice.) cial shall become a part of the permit. Applicant further agrees that no part of the system shall be cgyweeLu responsibility of the applicant for the permit to notify the County Shoreland Management that th^'f^b is rem Signature r7Datedr7 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 Surcharge S . 3"**Fee $ jCll Comments:, Form No. MKL-0771-003 VICTOt LU»Ot(N « C9.. PKI«T(a«. M««US MIMN.158906 SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 — Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM White — Office Yellow — Inspector Pink — Owner Card — Owner Permit No.,LEGAL Date DESCRIPTION AND LOCATION Lake Name Lake Classtf.Sec.Lake No.TWP Range TWP Name IDENTIFICATION: Please Print All Information. Mailling Address —Np. jtreet. City and StateFirstInitialLast Name Zip No.Tel. 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 SIgna.ture 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. Ft.Distance from occupied building Ft.Ft. Distance from property line Ft.Ft.Ft. Ft.Ft.Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on ,, 19,, Time 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 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 shail 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 ail 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 $ Comments:. certificate LR.qfrrn Form No. MKL-0771-003 VieTO* LUNOECH I CO.. PRINTEM. rCROuS FAULI. 158906 INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORYActualShould be Actual Should be Actual Should be QOO SFCapacity tO-l 0GIs.GIs.S F S F S F Distance from Nearest Well 75FFF 50FF F Distance from Lake or Stream F F F F F F Distance from Occupied Building 10 2020F F F F F F Distance from Property Line 10 10 10FFFFF F Distance from Bottom to Water Table 4 4FFFFF F Inspector's Comments: Tr./J oJ,f'T'o <Zc>t)c.y~ -yp ' Date of Inspection 19___ Time of Inspection M Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF Square Feet Linear Feet Job TitleF AgencyMKL-0771-003-Backer PERCOLATION TEST DATA Price $ 1.00 per pad. ^ SHORELAND MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Ph. No. Mailing Address:Owner: ChFirst /P(A//fAS'fp<f/h ' ^ Last Name Middle St. & No.City State Zip No. Legal Description;v..- SEC.LAKE OR RIVER NO.NAME TWP.RANGE TWP NAME V' TEST HOLE NO. 2TEST HOLE NO. 1 L ADepth to Bottom of HoJe inches; Diameter of Hole,JnchesDepth To Bottom of Hofe,Inches; Diameter of Hole Inches A Mji y o Aty A 6 a P^/s e 19 T.cSoil TextureDepth, Inches Depth, Inches Soil TextureDate Date^^^^V=r=o,a.ion .T4 ^ cl S A 4^ cL Z A / .9Percolation Test By___AQ IXI I A{^ P -lyo ^yyTe. pS'X Firm Name.F irm Name.ju a XLU oc X y A / A /<y A h'/^’ L A k r="LU Address.DC Address < cnOtter Tail County License No..Otter Tail County License No^h-coLUMeasurement, I nches Depth in Water Level, Inches Measurement, Inches h-Depth in Water Level, Inches Time Remarks Time Remarks O TT3-/7 g-r/9-7gI- A-froP-S3. // A///Re A///77^ - J nA>Pa A> /xZX S' A7 i MKL-0871-O'’T See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. qf Minn.i- SOIL ABSORPTION SYSTEM WORKSHEET Otmer Name: Average Percolation Rate Number Bedrooms 7,Critical Slope Vsq. ft.Bedroom Absorption Area: -JX Number of Bedrooms r= Sq. feet required T'/ a Septic Tank Requirements in Gallon Capacity 750 Gals.2 Bedrooms or less 900 Gals.3 Bedrooms 1,000 Gals.4 Bedrooms For each additional bedroom add 250 Gals. Percolation Rate Per BedroomPercolation Rate Per Bedroom 19817701 20285182 206191003 210115204 214211255 218226135 222237140 24 2261508 230251609 2341652610 2382711170 2422817512 2461801329a2501853014300f4515190b3306016194 a Unsuitable for seepage pits b Unsuitable for absorption system :-mr « ‘ jse^a 4'-’&iflu ^17' W/&7M1' CERTIFICATE OF COMPLIANCE !< SEWAGE SYSTEM w;% W- 3rd 19 73i/aj of_JanuaryThis certificate has been issued thism•■ im to certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota. The premises covered by this certificate are legally described as: aCliM Si a 56-2A0 5ec.__L Twp. 133W:Twp. Name EvertsRangeLake No.rf kMLl iS Blanche Lake Beach M E 80' on lake x 204.8* on Hwy. of Outlot Am--m Anna MadsenOwner: Name. 1Route #2. Battle Lake. MinnesotaAddress. W"■w56515Zip No..n- V 1 178Permit No. SP.. mSigned by:. ./Malcolm K. Lee, Shoreland Administrator Otter Tail County, Minnesota m MKL-0871-009 1" A1 159035 tuaMla 4 CO. aoiBTfio. naout f*LkO. h>» L »ft. 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 /7^Permit No.,LEGAL ) /xa(r ^ o' (yvs zA. K G H ■ f ^ A Date DESCRIPTION AND 2d ]_ /33S/. 0^0LOCATION Sec.TWP TWP NameLake Classif.RangeLake No.Lake Name IDENTIFICATION; Please Print All Information. Zip No.Tel. No.Maillingp^ddress —No. Street, Cky arid StateFirstInitialLast Name____________________________, , _ OWNER ASEWAGE SYSTEM INSTALLER r-rfName. 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- /VO Sq. Ft.A Gis. Sq. Ft.Capacity SQ i- Ft.Ft.5~Q -h___^Distance from nearest well 73 i- Ft.7^ r Ft. Ft.Distance from lake or stream <1.0 7^ Ft.cOO V-Ft./O Ft.Distance from occupied building Distance from property line ir:> ^ Ft./O 7»- Ft.jn r Ft. y -h Ft.^ j- Ft.Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS: Time±r.Inspection was made on ..........JVI By 19 .....7^. , 19 L/..L./..ZXPERCOLATION TEST DATA:Date of First Test Rate / ^rirr-y Taken By ^ G /Date of Second Test , Rate££!Q Test1st Crri'Ci a.//rt'\/First Test + 2nd Test 2nd Test Taken By 2 Rate 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.) V/ J?:2.a>Dated Signatur/ 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 Shoreland Management Office 1^/ / Issued Date: . 3^0ooS',Fee $Surcharge $no Comments:. iForm No. MKL-0771-003 victe* uiaetCH • CO.. prihUO*. rt*«us rw.Lt. wma 158906i ■ 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 — InspectorPink — Owner Card — Owner ;i Permit No.,LEGAL Date DESCRIPTION AND LOCATION 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.InitialFirstLast Name OWNER SEWAGE SYSTEM INSTALLER Name This System will be ready for inspection on., 19. This space for office use only .19 ,M Phone Call Rec'd ByDate Rec'd Time Rec'd Owner or Agent Signature SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD GIs.Sq. Ft.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 Distance from property line Ft.Ft.Ft. Ft.Ft.Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS: ,, 19Inspection was made on , Time JW By PERCOLATION TEST DATA:Date of First Test , 19 , 19 , Rate Date of Second Test , Rate 1st Test Taken By First Test + 2nd Test 2 Rate2nd Test Taken By The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work inAgreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection, (Call or use attached mailer notice.) Dated Signature Permit; condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six (6) months. Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express Issued Date: Shoreland Management Office Fee $Surcharge $ Comments:. r.FRTlFlCATE ISSUEP VICTeH LUHOCCH 4 CO . *tlHTC«a. Fe««U9 rkcL*.Form No. MKL-0771-003 158906 r INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORYActualShould be Actual Should be Actual Should be Capacity GIs.GIs.S F S F S F S F Distance from Nearest Well 75FF 50F F Distance from Lake or Stream 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: Ip I ^1^Date of Inspection ‘■’-fb PTime of Inspection M Signature of InspectedINTERPRETATION OF ABBREVIATIONS GIs » Gallons SF ■ Square Feet Linear Feet y Job TitleF AgencyMKL-0771-003-Backer .K k y * iX .. ^ "'-S’ • PERCOLATION TEST DATA Price $1.00 per pad. SHORELAND MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Ph. No. Owner:/ , , Mailing Address: //A. ^First Middle ^t! &' .ast Name Zip No.No. Legal Descriptiork.■/rrJo X /A>o SEC.TWP.LAKE OR RIVER NO.NAME RANGE TWP NAME S'/ (Uc TEST HOLE NO. 2TEST HOLE NO. 1 L.LaDepth to Bottom of Hole inches; Diameter of Hole JnchesDepth To Bottom of Hole,Diameter of Holeinches;inches Depth, inches Soil Texture Depth, Inches Soil TextureDate.Date 19_____ 2' if/vS^rv/o S ih rArnl • f ^tJJ /Ar^AAa/doJ~ s 7 ^ < Q - ^Ii /Kv.3S- //Percolation /Z/, t>% ^ Test By . Percolation Test By___:AAa^<So"-Y r¥'^TjLAAjl^jFirmName^Firm _ Name^ / // JOtt/Address.Address u$OOOtter Tail County License No..Otter Tail County License No..I-COLUMeasurement, Inches Depth In Water Level, Inches Measurement, Inches I-Depth In Water Level. InchesTimeRemarksTime Remarks I ic>-.(sAf[ I ‘ iO M>S 7777 r1 \ u±m¥-1 ■>7) .Jo Pj^V.-WAp^',1 )y/~> ■ A, Ay jQ : 3o /n: do /c> .Yo /n ' y/7 jg :^r) C'ir>k Zr -T .• /1 )o : 2><r<A?%} ykoto : /<0 i // /?(f. 1 (frr,n fO ■ S-g/G/ ' u / / ;g<T4^/O ^/ \Or^ I I ^V- T; 11n •// ■■ /rO 43 // .■ 7.^4/ 4 t//: /g4 /44 MKL-0871 -028159179 ®vicro* L.UN0CCM t ce pnHuat rosua rALLt See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn.