HomeMy WebLinkAboutMaple Beach Resort_37000320180000_Septic System Permits_CERTIFICATE OF APPROVAL
SEWAGE SYSTEM
r Si 8SVzcmbzn.22ndThis 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 19
J
The premises covered by this certificate are legally described as:
m;i:ifda42Twp.3256-747ILake No.Sec.Range Twp. Name!
Map£e Beach RuoaX
.1 Thomas HuttcnOwner: Name
R^3, Petfcan RapfdU>, MMAddress
56572Zip No.
Macolm K. Lee, Land & Resource Management Administrator
Otter Tail County, Minnesota
7642Permit No. SP •h
Signed by:.
MKL-0987001
r/
mhi
243,984 ~ 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
While — Office
Yellow — Inspector
Pink — Owner
2^Permit No.,LEGAL
DESCRIPTION ■j
AND
uoR LiO/^3a i3LQD.LOCATION
Lake No.Lake Name Lake Classif.Sec.TWP NameTWP Range
IDENTIFICATION: Please Print All Information.
Mailing Address — No. Street, City and StateInitial Zip No,Tel. No.Last Name First
Pf£L 1C /;) tvilT 3'TUcvmsOWNER
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
SC /fOO6)0 Ft.Ft. Ft.Distance from nearest well
SCsoFt.Ft.Distance from lake or stream Ft.
10 aoFt.Ft.Distance from occupied buildinq Ft.
lO lODistance from property line Ft.Ft. Ft.
Ft.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 ,JV1 By
PERCOLATION TEST DATA:Date of First Test , 19 . Rate
Date of Second Test 19 ,, Rate
1st Test Taken By
First Test + 2nd Test S
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.
-rI 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.1 y
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
c»' ^ Shoreland Management Office
Issued Date:
Fee $Rec #
k jfk ^*~X>c~Comments:
CjlQ.
Form No. MKL-032085 237,443 — 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
White — Office
Yellow — Inspector
Pink — Owner
4;^ Permit No.f^fiPLSLEGAL
DESCRIPTION
AND
u L\pfiL\ QjqLOCATION
Lake No.Lake Name Lake Classif.Sec.TWP Range TWP Name
IDENTIFICATION:Please Print All Information.
Mailing Address — No. Street, City and StateLast Name First Initial Zip No.Tel. No.
/Zr 5'THoiVm,OWNER ifr\fZ
SEWAGE
SYSTEM
INSTALLER
Name,
h //ss V- iJ;3oThis System will be ready for irtspection on.. 19
This space for office use only
ThS3 /
Date Rec'd Time Rec'Phone Call Rec'd By Owner or Agent Signature
NUMBER OF BEDROOMS:ESTIMATED COST:
SEWAGE DISPOSAL SYSTEM DATA:
SEPTIC TANK SEEPAGE PIT DRAIN FIELD
00 GIs.Capacity Sq. Ft.Sq. Ft.
SO hooSOFt.Ft.Ft.Distance from nearest well
SOsoFt.Distance from lake or stream Ft.Ft.
10 SioFt.Distance from occupied building Ft.Ft.
lO 10Distance from property line Ft.Ft.Ft.
3Ft.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 + 2nd Test 2 Rate2nd Test Taken By
The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work inAgreement:
strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn
esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi
cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the
responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection.
I understand that I have been granted a sewage system site permit in accordance with
the requirements of the Shoreland Management Ordinance of Otter Tail County. I
understand I must contact my township in order to determine whether or not any addi
tional permits are required by the township for my proposed project.Signature^ _
/
Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express
condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota.
This permit may be revoked at any time upon violation of any said ordinance.
NOTE: Permit void if work is not commenced within six (6) months.
Permit:
Issued Date:
Shoreland Management Office
Fee $Rec #
Comments:f_#
5/^Cl'i t
Form No. MKL-032085 237,443 — Victor Lundeen Co., Printers, Fergus Falls, Minnesota
■I
'i4INSPECTION RESULTS
*2.^
?M,. . Inspector must make all measurements
I ^1
ISEWAGE DISPOSAL SYSTEM STATISTICS 7^^1
SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORYShould BeActual Should BeActual Actual Should Be
\o^1/^/-(^oCapacity /adiC GIs.GIs.S F S F S F S F
• r^i-^istance from Nearest Well F F F F FF
A-(iod/ odDistance from Lake or Stream F F F F FF
uLDistance from Occupied Building lOOFFFF F F
f-rt-/dDistance from Property Line >6 F F F F F F
2P-^0f3Distance from Bottom to Water Table 3FFFF F
Inspector’s Comments:_________________________________________
Q'A-f \ s^^\\ so' O
2 y /Qi <■ gcK
H I'I
Quo S ^\p>
T
y
6.-19^Date of Inspection
Time of Inspection M
Signature of InspectorINTERPRETATION
OF ABBREVIATIONS
GIs = Gallons
SF = Square Feet
F = Linear Feet
Job Tide
MKL - 032065 • Backer Agertcy
X
n**
V
f
mPROJECT
ELK RIVER CONCRETE PRODUCTS • 7575 GOLDEN VALLEY ROAD • MINNEAPOLIS, MN. 55427
(612) 546-8972 • INWARD WATS - 800 + 552-1158
mPlF RFArH RF^nRT DATE
biOE =PROPOSEP SySlSN\
KBD ^wmR a^tslWEii)^pnss
^loTE - WAITER apE OUToP
Of (>Rouyo 1 TOrixvdwfs
Oow^.
:W7
9
d?
s
Q
llet""
SJATIQMM/OU^F /
F®1 /\
r-iLiJ•i
............iO.:2i.___
Lcxte.
•■ \
Soo4^ L('J^ ^
Scale: Each grid4^uals GRID PLOT PLAN SKETCHING FORM.feet/inches.
Application for Bijilding Permit Dated_____
Application for Sdwage System Permit Dated
.19.
19
Sewage System Permit Number
Applicant agrees tlhat this plot plan is a part of application (s) indicated above.
Building Permit Number
19.Dated,SignatureI
^CO
K m. ^\Q
T-f’s-b
15^
.J_
I
X
d2.4bi«nIC
1
"1^i
y K'
j* Q
\
rn 7 y Tw-v-vkl\\
^ID
r
-X“^
lO^}4/lU'
'‘7
L- O\
159104 ®MKL-0871-029
VICTOR LUKOCIM 4 CO.. HIINTCRt. rCROUR FALL*.
- ^'1^3
* -jr
I
M-
’■-y
k
i
t•:
Vf ''JL1\%Mm 1
Va t/J
Kfi
CERTIFICATE OF COMPLIANCE M ';
SEWAGE SYSTEMf^«|
i
'^J
19 S4lOtkJamoALf "i Iday of_This certificate has been issued thism
to certify compliance '“■ith regulations of Shoreland Management Ordinance, Otter Tail County. Minnesota.
W&i
!
I-
The premises covered by this certificate are legally described as:W>MV%L-idaTwp. 136 Range_42_Lake No. 56-747 Sec. 32 Twp. Name.mn £
Maple Beac-h R&60At
iMIm i
1)l:“
tThomoA MullenOwner: Name.m r!Rt. Pelf can Rap-tcU. UinneiotaAddress.!■-
VK ^w:56572 :Zip No.
''k5i9RPermit No. SP_
Signed by:.LMalcolm K. Lee, Shoreland Administrator
Otter Tail County, Minnesota i;.
Sl
MKL-0871-009
%
awrA‘3W*g «=s
tJi ■
\yiS7
®I5903S *Kto« uiaecCB « M. vaiatTM. *EaHa «4UJ.
■V.
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
Whitt-Offin
Yellow — Inspector
Pink — OiA/ner
Card — Ovrw
Permit No.,LEGAL People ReSoeiDESCRIPTION
AND
3a. /3C, va5U'7if7 Lirif^L ILOCATION
Lake No.Lake Name Lake Classif.TWP NameSec.TWP Range
IDENTtFICATION: Please Print All Information.
Last Name First Initial Maifling Address —No. Street, City and State Zip No.Tel. No.
/ Tw I CArrtQ «; .OWNER
7 gT6c 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 Signature
NUMBER OF BEDROOMS: / 3 S^S-ESTIMATED COST:
SEWAGE DISPOSAL SYSTEM DATA:
SEPTIC TANK SEEPAGE PIT DRAIN FIELD
9i(cOO Qmi Sq. Ft.GIs.Capacity Sq. Ft.
SO 5^0Ft.Ft. Ft.Distance from nearest well
S<DFt.Distance from lake or stream Ft.Ft.
/ o ZerDistance from occupied building Ft.Ft.Ft.
I o laDistance from property line Ft.Ft.Ft.
3Distance 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 ,M By
LQ-II.::...(o -- i H -PERCOLATION TEST DATA:Date of First Test 19 Rate
Date of Second Test 19 Rate
l8t Test Taken By 'JloCA'orh //.6532::^I 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.
The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in
ICi -___Dated.
Signature
Permit:Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express
condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota.
This permit may be revoked at any time upon violation of any said ordinance.
NOTE: Permit void if work is not commenced within six (6) months.
^ ^4- ^3
Issued Date:
Shoreland Management OfficejO^^1Fee $!
Comments:.
Form No. MKL-0771-003 (^VKW lATIlt LAKi, MINNiSOTA
INSPECTION RESULTS
Inspector must make all measurements
SEWAGE DISPOSAL SYSTEM STATISTICS
SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORYActualShould be Should beShould be ActualActual
Capacity GIs.GIs.S F S F S FS F
Distance from Nearest Well 5075FFF-F ^ F F
Distance from Lake or Stream F F F F FF
20 2010Distance from Occupied Building F F F F F F
10 10Distance from Property Line 10F F F F FF
33Distance from Bottom to Water Table F F F F F F
Inspector's Comments:
Date of Inspection 19___
Time of Inspection
Signature of InspectorINTERPRETATION
OF ABBREVIATIONS
GIs = Gallons
SF «« Square Feet
F «■ Linear Feet
Job Title
AgencyMKL-0771-003-Backer
SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL
COUNTY COURT HOUSE
Phone 218-739-2271 - Fergus Falls, Mn. 56537
APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM
Whif9 — Office
YbIIow — Inspector
Pink — Owffier
Cord —Owner
Permit No.,LEGAL rv^Q p\s_ '^bpc-H QesoeiDESCRIPTION
AND
3 I3C V,'VuyLOCATION / : rI n n oL.
Lake No.Lake Name Lake Classif.Sac.TWP Range TWP Name
IDENTIFICATION: Please Print All Information.
Zip No.Tel. No.Mailling Address —No. Street, City and StateLast Name First Initial
j3// /-. f ^ {-■ r i 1 iOWNER
SEWAGE
SYSTEM
INSTALLER
Name,
ILzjJ.This System will be ready for inspection on., 19.
This space for office use only
BkiW - n .19
Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signature
3 . :>NUMBER OF BEDROOMS:ESTIMATED COST:
SEWAGE DISPOSAL SYSTEM DATA:
SEPTIC TANK SEEPAGE PIT DRAIN FIELD
cV M 7 7 Sq. Ft.GIs.Sq. Ft.Capacity a--
Ft.Ft.Ft.Distance from nearest well
,'7' r;Ft.Ft.Distance from lake or stream Ft.
f Ft.Distance from occupied building Ft.Ft.
/C7Distance 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 'J1.0-12..:...
{o ~~ f -
: IPERCOLATION TEST DATA:Date of First Test 19 Rate
f ,75>.Date of Second Test 19 Rate
1st Test Taken By (1I^ V\V ’//.65312^..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.
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
Id - B3Issued Date:,3 Shoreland Management Office0JOCLFee $
Comments:.
CE-RTIFICATC is<tU
[Review ftAIHI LAKf. MINNESOTAForm No. MKL-0771-003
•' • •• • o(-r
!?
-1
1
INSPECTION RESULTS
Inspector must make all measurements
SEWAGE DISPOSAL SYSTEM STATISTICS
SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORYActualShould be Actual Should beActualShould be
4:^0 <3H77c2C}Q0CapacityGIs.S FGIs.SFS F
c3C50 fm 50Distance from Nearest Well 75 FF F F F
360 F/OoDistance from Lake or Stream F F F FF
tIQl*^ ("5^ F
/O F
20 2010Distance from Occupied Building F FF F F
//<?10 1010Distance from Property Line FFFFF
33Distance from Bottom to Water Table F FFFF
i I> (r;0 VTVInspector's Comments:
■s
L^\ ^ V <^V‘u4‘iov\
P-TIYK t!^tL.-Vy o'vV- U^s I- >
______^ 4-^ i rAa yS' ^ ^ \ S. ?q;c
£> V "Ao OO
r
^ iso
\wVqY tv
.191?//-
Date of Inspection.
I 6 ■'■^<5Time of Inspection.M
)
Signature of InspectorINTERPRETATION
OF ABBREVIATIONS
GIs - Gallons
SF ■ Square Feet
■ Linear Feet
Job TitleF
AgencyMKL-0771*003-Back«
acco TDr'\V^ s V^UtiC cv\\ ® CD
V ^ Vr ojl^
tcrvvOYCO
O T
^ / *^a / / 3 6roo»w5. s4"l I^
cxAV>\>f>s 'VV>uV- Wcxvc >1X04"
I h 'iS S ^It s o
<c(osts't- Vo ‘jra*'*
^QtX^ \3Xltw tAl’
21SS02®
ViCTOt LUNeeCN CO.. PRIHTENS. FCRGUS PAULS. yiNN.MKt PERCOLATION TEST DATA71 -028
LAND AND RESOURCE MANAGEMENT
Otter Tail County
Fergus Falls, Minnesota 56537 Ph. No.
Mailing Address:Owner:
7^77 u ///91fy/p5
Zip No.StateCitySt. & No.First MiddleLast Name
i \chn /Legal
Description:/3L>/ ________
LAKE OR RIVER NO.TWP NAMERANGESEC. TWP.NAME
TEST HOLE NO. 2TEST HOLE NO. 1
K lA3dlId.Depth to Bottom of Hole inches; Diameter of Hole.JnchesDepth To Bottom of Hole,inches;Diameter of Hole inches
45JLiJO/19Depth, Inches Soil Texture Soil TextureDepth, InchesDate19 19DatePiii^cK l),i. AA- iD ' ^ ^rcolation
BIacIaIlU ct/
/o i o /y f/n Ao /Percolation
Test By .It, " Jc X'CA aQ ti CLUto.FirmName /\ h Firm
Name.CC
oLU
QC
,.o f/TEIi'') f\Tipjj3 OM-i P } O h J icl/gy)^)iAfriAp:>iAi LU
Address.CC Address
<
CO
Otter Tail County License No.Otter Tail County License No..CO
LUMeasure
ment,
inches
Drop in
water level, inches
Percolation
rate minutes
per inch
Percolation
rate minutes
per inch
Time
I ntervais minutes
Time
Interval,
minutes
Measure
ment
inches
Drop in
water level, inches
Remarks:Remarks:Time Timeo
I-
/ c/ jX
Pl ”
^__
JS3 y)/M./2
St/
-L. IS..
r OS'
it
kJLtf //r,oP
LJj_
rpy
/. .^0-
!/\ n ifi
rt
17/A'.'n, A
■zM 'f kljy_
r-n (jlIhJL
utl
LTy./Onxtn
-J-' fiS
I
! <>r
3tlMl177aJ7iIIP-/D. ^7, tAy.'>4^Itijfiii .hx
r.hJ
■/
• If4-/CiVjy
X "LMl ((n 5A
17^ao See Booklet, "How to Run a Percolation
Test" by Agriculture Ext. Service, Un. of MN.
Percolation rate minutes per inchminutes per inch Percolation rate =