Loading...
HomeMy WebLinkAboutMaple Shores Assoc_16000991114000_Septic System Permits_Department of LAND AND RESOURCE MANAGEMENT OTTER TAIL COUNTY Government Services Center - 540 West Fir Fergus Fai_ls, MN 56537 PH; 218-998-8095 Otter Tail County’s Website: www.co.otter-tail.mn.us October 5, 2007 Charles Lillibridge 31026 County Highway 4 Vergas, MN 56587 Sewage Treatment System Servicing Tax Parcel Number 16000030013001 Described as BEG S 54 45' E 809.5' FROM NW COR GL 2.... Section 3 of Dora Township, West Loon Lake (56-523) RE: As of October 2, 2007, the sewage treatment system (Sewage Treatment Installation Permit #19332) servicing your property was determined to be in compliance with the provisions of the Sanitation Code of Otter Tail County for holding tanks. If you have any questions regarding this matter, please contact our office. Sincerely, Scott Ellingson Inspector 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) APPLICATION MUST BE COMPLETE IN ORDER TO BE PROCESSED Permit No. LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS SECTION TWP NO.RANGE TWP NAME 3 I's.Q, ‘Yf!^0 PARCEL NUMBER (S) OF PROPERTY BEING SERVICED E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROAD jo >|o C 'fy LEGAL DESCRIPTION ■ (o 6^. S ,9*/ -vr' Last Name ' *:> First Initial Mailing Address Daytime Phone No. Lt HProperty Owner ^ ZZ x.<~ ^ Contractor Lie.#•a 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 SEWAGE TREATMENT SYSTEM DESIGN DATA - AS SHOWN ON DRAWINGTYPE OF INSTALLATION (CIRCLE ONE)TANK DRAINFIELD (^/SOD ,2SizeGIs.Add-On/New System (20) Trench, Rock (21) Trench, Gravelless (22) Trench, Chamber (23) 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 CoSetback to nearest well Ft.Ft. Setback to OHWL (lake &/or river)Ft.Ft.Z/_0. Setback to wetland Ft.Ft. Setback to dwelling Ft.Ft.Collector System (26) Trench, Rock (27) Trench, Gravelless (28) Trench, Chamber (29) Bed (30) Mound (31) At Grade Setback to non-dwelling Ft. Ft. Setback to nearest property line Ft. Ft._.^-Qtber Tank, Holding^ (4Z) uuthouSe (43) Sewer Line (44) Performance (45) Miscellaneous Setback to road right-of-way Ft. Ft. Elevation above restrictive layer Ft.■t. ALL DISTANCES ARE SHORTEST DISTANCE BETWEEN NEAREST POINTS. DEPTH OF WATER WELL # BEDROOMS.ABSORPTION AREA FOR MOUNDS GARBAGE DISR Y / N ABATEMENT Y / N Ft^EFFLUENT DISTRIBUTION ( ) Gravity ( ) Pressure HOLDING TANK MONITOR/ DISPOSAL CONTRACT (^Yes { ) No-L&R Can Not Process Designer____ Designer Lie. #, PERCOLATION TEST DATA Date of Test Highest 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 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: This permit is vaiid for a period of six (6) months. Signature Owner Date:Permit Fee $ m¥6Rec. No., Land & Resource Management Office Comments: Form No. BK — 0906-003 327,315 • Victor Lundoon Co., Printers • Fergus Falls, Minnesota APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM qlzlhLAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095) GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 'o1 'f Permit No. WHITE - Office YELLOW- L&R Inspector PINK - Owner/ Contractor (after issue) www.co.otter-tail.mn.us APPLICATION MUST BE COMPLETE IN ORDER TO BE PROCESSED LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS SECTION -TWP NO.RANGE TWP NAME i<J. i-1 r ■ '•1^0 /^ 'C PARCEL NUMBER (S) OF PROPERTY BEING SERVICED E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROAD / Qc3 O ^ ^ 0 O ^/n > (p 0 -fw _________ Sh ' freoM /U(aS c&t • - LEGAL DESCRIPTION C_J_<r•7d- / Last Name First Initial Mailing Address Daytime Phone No. /t n < (o rA<r,r:____.. .. _______ % 5^ ^102> Property Owner 'Mi - —______ 7§y Yd dContractor Lie.#/-g/ J ' C fdiJtn ‘i/yi »/era * T7^arry^.THIS SPACE FOR OFFICE USE ONLY ta^7>■ This System will be ready for inspection on at, the year of RM. Time Received '-------^Date Receiv L&R Offici; SEWAGE TREATMENT SYSTEM DESIGN DATA - AS SHOWN 01 lWINGTYPE OF installation (CIRCLE ONE)TANK DRAINFIELD Ft"Size GIs.Add-On/New System (20) Trench, Rock (21) Trench, Graveliess (22) Trench, Chamber (23) Bed (24) Mound (25) At Grade 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 4oSetback to nearest well Ft.Ft. Setback to OHWL {lake &/or river)Ft. Ft.( ( 0 Setback to wetland Ft. Ft. 3d)Setback to dwelling Ft.Ft.Collector System (26) Trench, Rock (27) Trench, Graveliess (28) Trench, Chamber (29) Bed (30) Mound (31) At Grade 4^0 C o_ Setback to non-dwelling Ft.Ft. Setback to nearest property line Ft.Ft.Other Holding rase-'"^ (43) Sewer Line (44) Performance (45) Miscellaneous Setback to road right-of-way Ft.Ft.\ Elevation above restrictive layer Ft.Ft. ALL DISTANCES ARE SHORTEST DISTANCE BETWEEN NEAREST POINTS. DEPTH OF WATER WELL # BEDROOMS. GARBAGE DIS ABSORPTION AREA FOR MOUNDS / N Ft^EFFLUENT DISTRIBUTION ( ) Gravity ( ) Pressure HOLDING TANK MONITOR/ DISPOSAL CONTRACT M) Yes ( ) No-L&R Can Not Process abatemen:7 N Designer____ Designer Lie. #. PERCOLATION TEST DATA Date of Test Highest 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 tor 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: This permit is vaiid for a period of six (6) months. oo■^1 Date:Permit Fee $ Signature of Property Owner/Agent for Owner Date:Rec. No.. Land & Hesourve Management Office Comments: Form No. BK — 0906-003 327,315 • Victor Lundeen Co.. Printers • Fergus Falls, Minnesota SEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTS Inspector must make all measurements HOLDING SEPTIC TANK DRAINFIELD OUTHOUSELIFT TANKCATEGORY liOO-Capacity GLS.2GLS.FT2C/’yiyl^< ft l5oo Setback from Nearest Well FT FT ' FT XSetback from Buried Water Suction Pipe FT FT FT FT Setback from Buried Pipe Distributing Water Under Pressure /o"FT FT FT FT Setback from OHWL (lake &/or river)FT FT FT FT ^5(9Setback from Setback from Wetland FT FT FT FT 3b'/Setback from Dwelling FT FT FT Setback from Non-Dwelling FT FT FTSetback from Nearest Property Line FT,FT FT T10^'^ ftSetback from Right-of-Way FT FT FT Elevation above Restrictive Layer FT FT FT FTX Holding Tank/Lift Alarm NO ifOld System Pumped & Destroyed L>YES NO Sewer Line^irWell SeparatioriSEPTIC TANKfSt FILTER DRAINFIELD CALCULATION # Tanks Installed I- 2 ____ - /fioo Actual Minimum □ YES NO FTX FT^S'Matjuf. .ft^FT 20Model # MOUND CALCULATION MOUND /AT-GRADE R)CK REDUCTIONInspector’s Comments: .•fcw Vg ABSORBTION AREA Rock trenche 3 v\ ith inches f rock under pip = for %Ft. X ft^DF.V ilent toFt2 —SKEigH: fOa't- * 8k Initial/L & RQmci4l/Date Time As of /^/^y/b^ Code of Otter Tail County. the above described sewage system installation was found to be compliant with the provisions of the Sanitation Land & ResouyS Management Official SITE DATA WORKSHEET LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 218-998-8095 www.co.otter-tail.mn.us Lj l(i _____ LAST NAME l\0 ^ Sewage Treatment System Permit #OWNER: FIRST MIDDLE TELEPHONE NUMBER ADDRESS: ' T CITY Q FTc3 10 3-v o STR./RT STATE ZIP CODE ri4'A NAME 60. ^ LAKE/RIVER NO.LAKE NAME SEC.TWP RANGE LEGAL DESCRIPTION:SOIL BORING LOGf 3, /a 4c. Q<)SS4 zee / ^on'( PARCEL NUMBER ______ % LATY E-911 Address or Directions From Nearest Public Road NUMBER OF BEDROO GARBAGE DISPOSAIT YES NO WELL: CAs'lj^G DE^H/)^t. SEWER LINE SEPARATION: 1: yL :2ft. FLOODPLAI S NO BLUFF: YES NO/j VEGETATIOM; AQUATIC TERRESTRIAL SLOPE AT IN$TALLATION SITE:y TYPE OF OB^ErVaTION: % NONEProbe Pit Boring PARENT MATERIA Outwash Loess Bedrock AlluviumTill ^0 /^ORIGINAL SOIL: Y^ COMPAOTED SOIL: Yes No No Date of Soil Boring. DEPTFI OF BORING (To T or restrictive layer):.ft.Date of Perc Test PERC TEST #1 PERC TEST #2- TWO TESTS ARE REQUIRED - TIME INTERVAL (MINUTESI WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTESI WATER DEPTH WATER DROP PERC RATESTARTSTART TIME DROP PERC TIME DROP PERCTIMEINTERVAL (MINUTESI WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTESI WATER DEPTH WATER DROP PERC RATEREFILLREFILL TIME DROP PERC TIME DROP PERCTIMEINTERVAL (MINUTESI WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTESI WATER DEPTH WATER DROP PERC RATEREFILLREFILL TIME DROP PERC TIME DROP PERC WATER DROP/TIME INTERVAL (MINUTESI WATER DEPTH PERC RATE TIME INTERVAL (MINUTESI WATER DEPTH y^ATER DR^PERC RATE/REFILL REFILL TIME DROP PERC TIME DROP PERC^TER~bEPT?r~^WATE^ DR(5FTIMEINTERVAL (MINUTES)PERC RATE TIME INTERVAL (MINUTES)WATEVt)EPTH' WATER DROP PERC RATEREFiaREFIU /TIME DROP PERC TIME DROP PERCTIMEINTERVAL (MINUTES)/ WATER DROFWATER DEPTH PERC RATE INTERVAL (MINUTES/TIME WATER DEPTI WATER DROP PERC RATEX7/REFILL REFILL TIME DROP PERC TIME DROP PERCDEPfHTIMEINTERVAL [MINUTES)WATER WATER DROP PERC RATE TIME INTERVAL (MINUTESI WATER DEPTH WATER DROP PERC RATEREFILLREFILL -/-TIME DROP PERC TIME DROP PERC WATERTIMEINTERVAL (MINUTES)DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTESI WATER DEPTH WATER DROP PERC RATEREFILLREFILL TIME DROP PERC TIME DROP PERC PROPOSED DESIGN: TRENCH,BED.ATGRADE.MOUND.HOLDING TANK GRAVITY DIST.PRESSURE DIST. SEWER LINE.OUTHOUSE.OTHER,SPECIFY:. — SYSTEM DESIGIM ON BACK — 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. ____grid(s) equals /O feetinch(es) equalsfeet, orScale: MPCA LICENSE LICENSE CATEGORY: ?V_DESIGNED BY: ! FIRM NAME: ADDRESS: 9 / Jc)-[DATE: SIGNATURE: aJ 15'cJ<£3^ (y / o (c^ d, X- l'SA>0^ BK — 1003 — 029 315.904 • Victor Lundeen Co., Printers •. Fergus Falls. MN • 1-800-346-4870 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.ottertail.mn.us July 2, 2007 Maple Beach Resort Charles Lillihridge 910 5*AveS Fargo, ND 58103 Re: Sewage System Abatement, Loon Lake (56-523) Dear Mr. Lillihridge, It has over 1 year since you received the Abatement Notice on your Loon Lake property. To date, this matter remains unresolved. Please be advised that your septic system must be brought into compliance with the Sanitation Code of Otter Tail County. For your information, individual property owners on Loon Lake have been given 1 year to bring their septic systems into compliance and Resort owners are given 3 years to bring then- septic system(s) into compliance. If you have any problems, please contact me so we may work out a solution to your Sewage System Abatement, otherwise please have this situation taken care of by August 18, 2009. Failure to do the above will result in us turning this matter over to the County Attorney. Sincerely, Michael J. Douglas Inspector MD/dag CHRONOLOGY REGARDING THE SEWAGE SYSTEM ABATEMENT f i/DO/) Property Owner; S^3Lake No. 56-Lake Name: l(eOCOo^a>>30DIParcel No.: 3\0^(P ^ti/y fGIS Address; Date Issued: ______ Date Initial Response (owner): Date Resolved loouj 4o r<.S«lv^-e^XpIcu/vvU^ 4o K^avs. Kt ^ow>€ 0’Vva4 “io dLa 4r-j *it5 5or^ v\ofi^r.OA <<X . wor 1C wou . Abatement. chronology5-02 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.ottertail.mn.us SEWAGE SYSTEM ABATEMENT NOTICE August 18, 2006 CURRENT PROPERTY OWNER:Maple Beach Resort - Charles Lillibridge 910 5th Ave S Fargo, ND 58103-1722 Parcel Number: 16000030013001 Section:03 Township Name: Dora Lake Name: Loon Lake (56-523) Property Address: 31026 Co Hwy 4 You are hereby notified that the sewage system which you maintain on the above identified parcel, is not constructed and/or located in accordance with minimum standards of the Shoreland Management Ordinance of Otter Tail County. Please be advised that you must correct this situation by September 18, 2006. You should contact this office in order to determine what corrections and permits are required prior to complying with this notification. VScott M. Ellingson Land & Resource Management Inspector Michael J. Dodglg^^ Land & Resource Managementlnspector STATE OF MINNESOTA ) )ss. AFFIDAVIT OF SERVICE BY MAIL COUNTY OF OTTER TAIL) Denise Gubrud, of the City of Fergus Falls, County of Otter Tail, in the State of Minnesota, being duly sworn, says that on the 18th day of August, 2006, she served the annexed: SEWAGE SYSTEM ABATEMENT NOTICE On the following person, by mailing a copy thereof, enclosed in an envelope, postage prepaid, and by depositing same in the post office at Fergus Falls, Minnesota, directed to said person at the following address: MAPLE BEACH RESORT - CHARLES LILLIBRIDGE 910 5TH AVE S FARGO, ND 58103-1722 Land 86 Resource Management Official Subscribed and sworn to before me this 18th day of August in the year of 2006 % Notary Fubnc My Commission Expires January 31,2010 AMY X> ANDERSON Nolaiy PuMc ____ MinoMOU 5^5^ My C«nm. Expires Jan 3t 20^0 Area FormLtrs~CertifiedMailingM S f ABATErv^E»VT FIELD NO^'ES Loo A LAKE NO: ^<53 E911 PROPERTY ADDRESS: LAKE CLASS: A M V SECTION NO: ^ 3 LAKE NAME: PARCEL NO: llj) QQQ 0:?(.X:>R CO[ TOWNSHIP NAME: LEGAL DESCRIPTION: ^CflQ ^ fAM^n <00 5^103-11^0- AOWNERS NAME(S):. MAILING ADDRESS: TYPE OF EXISTING SEWAGE SYSTEM: HOLDING TANK SEPTIC TANK/DRAINFIELD OTHER: SEPTAGE PIT, DRYWELL OR LEACHING PIT CESSPOOL \YT COMMENTS: -kr SEPARATION DISTANCES fIN FEET^ ABSORPTION AREA ^ ^OfXj / 1 OUTHOUSESEWER LINE TANK WELL OHWL LOT LINE DWELLING NON DWELLING GROUND ELEVATION @ ___________ REASONfS^ FOR ABATEMENT fSKETCH ON BACK...^ 3 Thiret!'Rof/onil^^S /q C^Ou^// Aug /nrn INSPECTOR'S SIGNATURE(S)DATE i<EXISTING FILE:YES NO ABATEMENT HELD NOTES FORM 01/22/03 Cab V r'■ V Old\(o j 5 Wa/‘KhN? r T'A/jt:V) :Xn OTItH TAIL COUNTY FERGUS FALLS, MINN.^ \W^!^File Opening Date. Subdivision Name.Individual File { ) Name of Applicant: Subdivision File ( )Special Use ( ) 9 I n Aoe ’ ^ St. & No. /6?C ^ Use Description. 0( AjUiok^lLdilt First tbmLAAAddress:MiddleLast Name City Zip No.Phone No.dLegal Description of Land 6TC 3 (j 0 A r IL-Ooo-o3-OG/3~OG 1Oassif.Lake or River Name Twp.Lake No.Sec.Range Twp NameIggn £r\j^ Gz, a s^l 7f. \jb\ IjS*- H g ^/^ ny Ly^ 7n-PPf^. /^(oO (3 9^-(3,\0NL^ V T3- O BUILDING PEBfyilTS VARIANCES ON BUILniNn PFRMITc; Purpose Date Inspected . Results i/oi~ ChTVf-Appl. Date Hearing Date Date NotifiedDateHearing JudgementNO. <JUl 2K.I0~2JZ~27 T\ © SEWAGE SYSTEM PERMITS VARIANCES ON SEWAGE SYSTEM PERMITS Purpose Date Inspected ResultsDate Appl. Date Hearing Date Hearing JudgementNO.Date Notified 6 [b Ce>^f''h\IW0s-iCu-he © SPECIAL USE PERMITS Application Date Hearing Date Notice Mailed COMMENTS SECTION: » Accompanying Documents Filed in Cabinet No. gig CERTIFICATE OF COMPLIANCE SEWAGE SYSTEM m;I u 1Sth VecmbeA J9_Mday of_This certificate has been issued this to certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota. The premises covered by this certificate are legally described as: Range_H r-j Twp. ^ 36 VotLCi56-523 Sec.__i Twp. Name.Lake No. Haplo, Beach Re^otU Sf' W-m s- >.ChaAlu LAJULibfvidqzW.Owner: Name. g910 5th Auenue South, Foaqo, MoNth DakotaAddress. 5S102Zip No.Tv] #5453Permit No. SP_ Signed by:.P^colm K. Lee, Shoreland Administrator Otter Tail County, Minnesota MKL-0871-009 ff r. W ./i. 159035 ««i ILLS. MM 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 Whilm — Office Yeltow — inspector Pir)k —Owner Cord— Owner Permit No., so/z~r'LEGAL /Y\/^ p LB H DESCRIPTION AND 3 /3fe U/ l^ceAUoo y\LOCATION TWP NameTWPRangeLake Classif.Sec.Lake NameLake No. IDENTIFICATION: Please Print All Information. Zip No.Tel. No.Mailling Address —No. Street, City and StateFirstInitialLast Name ST7/ Prtf so ■cK«rU.il,tl 1/0OWNER ecoo NX> SEWAGE SYSTEM INSTALLER Name, Th/S System \iill be ready for inspection on.19. This space for office use only ,M19 Owner or ^9®'’^^'9n^ur^ ^ ^ ">Phone Call Rec'd ByDate Rec'd Time Rec'd ?LNUMBER OF BEDROOMS;ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD '/Si Sq. Ft.GIs.Sq/Ft.Capacity /6 0a Ft.Ft.Ft.Distance from nearest well 75~*7<T Ft.Ft.Ft.Distance from lake or stream 'Z^<yfaFt. Ft.Ft.Distance from occupied building !0 f C7Ft. Ft.Ft.Distance from property line 3 Ft.Ft.Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS: , 19 , Time )VI ByInspection was made on......... PERCOLATION TEST DATA; Cf\U^ hl oFr m(a\r\ Date of First Test 19 Rate ^-30 jTDate of Second Test 19 , Rate 1st Test Taken By11 I 0nFirst 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 stftached mailer notice.) jg - f -Dated Signature Permission is hereby granted to the above named applicant to perform the wocfc-<fescribed 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 smil confoiim in all respects to^acdinances of Otter Tall County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. \ j \ NOTE; Permit void if work is not commenced within six (6) months. \. / Permit; S'-Issued Date: Shoreland Management Office cFee $ Comments:. (^VKW kATTLI LAKI. MiNNCSOTAForm 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 SF S F S F Distance from Nearest Well 75 50FFFFF F Distance from Lake or Stream F F F F F F Distance from Occupied Building 10 20 20FFF F FF Distance from Property Line 10 10 10FFF F F F Distance from Bottom to Water Table 33FFFFF F Inspector's Comments: r e Date of Inspection 19____ V"♦Time of Inspection..M Signature of InspectorINTERPRETATION OF ABBREVIATIONS Git « Gallons SF ■ Square Feet F “ Linear Feet Job Title AgencyMKL-0771*003-Backer 1 V J.-. . r W^(Xajv>X\ « 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 Whif-OHic* Y0UOW — Inspector Pink — Owner Card—Owner Permit No., LEGAL DESCRIPTION AND LOCATION TWP NameSec.TWP RangeLake Classif.Lake NameLake No. IDENTIFICATION; Please Print All Information. Tel. No.Zip No.Mailling Address —No. Street, City and StateInitialFirstLast Name OWNER SEWAGE SYSTEM INSTALLER Name. 3. SoThis System will be ready for inspection on., 19 This space for office use only 9"^.M Owner or Agent SignatureDate Rec'd Time Rec'd Phone Call Rec'd By NUMBER OF BEDROOMS;ESTIMATED COST: 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 building 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 , Time M ByInspection was made on 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 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 $ certificate issuedComments:. 0{VIEW SATTLE LAKE. MINNESOTAForm No. MKL-0771-003 -.r * !■ ^ ^ f wm.. \W'>fvm■«*<: ' f .V7f • - W’ f f INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS tSo y9o SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORY Actual Should be Actual Should be Actual Should be 2_ocoZsoO If^lCapacitys FGIs.GIs.S F SF S F I ‘^(^0 F^GODistance from Nearest Well 75 50FFFF F 7^75 75Distance from Lake or Stream F F F F F f !I~2 3o' FDistance from Occupied Building ,.10 20 20FFFF F w rfo'!Distance from Property Line 10 10 10FFFF F So'Distance from Bottom to Water Table 33FFFFF F CoQ -/-7S’p^cH~'i(7f\ 5o Inspector's Comments:7^ / ^ ^ I 0 S "V"O \csUpD -TMt!4 0Q \jt a i 5^VJ 0 Vv \1Corti£\') ,’e/C 'JG/.(,D 3Qr\C«iV\ ^ -.qDate of Inspection 19___ S'I COTime of Inspection.M /r Signature of InspectorINTERPRETATION OF ABBREVIATIONS Gif * Gallons SF * Square Feet F “ Linear Feet Job Title i AgencyM KL-0771-003-Backer TO BE COMPLETED BY PERSON INSTALLING SYSTEM received may 1 iand&besou'"^' I hereby attest that I am familiar with the minimum standards required by the OTTER TAIL COUNTY SHORELAND MANAGEMENT ORDIANCE regar­ ding sewage systems and that I have install­ ed the below system in accordance with those standards. Please complete and return within 10 days to Land & Resource Management Office, Court House, Fergus Falls, Minnesota 56537. Lake No.Classif.Lake Name Twp. Name Permit No. Sec.Twp.Range Legal Description; w Owners Name f/-3oLicense No.Date of Installation Fill in below:Septic Tank Drainfield Capacity Distance from Nearest Well Distance from Lake or Stream Distance for Occupied Building Distance from Property Line Distance from Bottom to Water Table n! /-fi .4;Vyyz<vvvy\^zs /fSign^ure Date! (CLOM'n O Wi o A -Y -y\ ^ \ S!_\ i\j w doenee_ o 21SS02© VICTOtt LUNOCCN CO.. PRiMTEflt, FCflQUS FALLS. UINN.PERCOLATION TEST DATAMKL -0871 -028 LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, Minnesota 56537 Ph. No. Mailinq Address:Owner: FirstLast Name / ^ S^S’/o Zip No.StateCityMiddleSt. & No. Legal Description:5 LAKE OR RIVER NO. ■iL- TWP NAMERANGETWP.SEC.NAME tfjL—•yyc— TEST HOLE NO. 2TEST HOLE NO. 1 A.Depth to Bottom of Hole inches; Diameter of Hole JnchesDepth To Bottom of Hole inches;Diameter of Hole inches ^/30Depth, Inches Soil Texture Soil TextureDepth. InchesDate.Date Sc\r^^ ciy Z /- clay Percolation Test By____ Percolation Test By ^Q LU Firm • Name_QC FirmName.DoLU(T LUAddress.CC.Address < COOtter Tail County License No.Otter Tail County License No..coLUMeasure­ ment,inches Drop in water level, inches Time I ntervals minutes Percolation rate minutes per inch I-Percolation rate minutes per Inch Time Interval, minutes Measure­ ment inches Drop in water level, inches Remarks:Remarks:Time Time o§ TIM. H 7'.£^9 X. 13 2 £5 m20W-20W1X17:iii±Ta5:s(XlUk.2.r ■rf 22. T E niPlz571^m £2.224 22? \JL 22 2 TS.Z 2Z71^7ta See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of MN Percolation rate minutes per inch minutes per inchPercolation rate - \ \ \50\(ly&^'-'^p- \ r^4<A XA'fi-Tn^/U>-~0-'l>7i^ W ‘/■OXS/X/ <^ /?-// dM^ i I K I I CERTIFICATE OF COMPLIANCE SEWAGE SYSTEM a 2 i 20 th day nf FebruaryThis certificate has been issued thiss.: 4 to certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota. m The premises covered by this certificate are legally described as: 56-523 136 41 Twp. Name DoraSec__3 RangeTwp.Lake No. Bvg S 54’ E 809.5’ from NW Cor G.L. 2 SEly 143.5' SWly Approx. 660* on lake/> Wly 152.6' Nly & NEly mim- :v Charles LilllbridgeName.Owner: 910 5th Ave. S., Fargo, North DakotaAddress. ^11 58102Zip No. ^latcpim K. Lee, Shoreland Administrator Otter Tail County, Minnesota Permit No. SP_ Signed by:. MKL-0871-009 V? 159035 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 Pii.. - Card — — InspectorOwner Owner S ^ A/^ C^L ^3hv7Permit No./LEGAL ScJ lS OtO uc A//.y iN'L'i 4-h/BLy ^hy/ s^oDate DESCRIPTION 3 /ifgyS^ToAND jp 3 /IL V/0^C>0 TSi-5-^3 O^IXLOCATION Lake No.Lake Name Lake Ciassif.Sec.TWP Range TWP Name IDENTIFICATION: Please Print All Information. Last Name Fi^t_____Initial CA 0t!es Mailling Address —No. Street, City and State Zip No,Tel. No. WdL, !!/Lr I Vo-^SoOWNER Fci-r /U.D, 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 /0C)0 i (f ^ Sq. Ft.GIs.Capacity Sq. Ft. / ■ 5P/ioo-hSV Ft.Ft.Distance from nearest well 7J^Ft.Distance from lake or stream Ft.Ft. ml ^0Distance from occupied building Ft.Ft.Ft. 10Distance from property line Ft.Ft.Ft. yDistance 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 HiPERCOLATION TEST DATA; / Date of First Test 19 Rate r /E.Date of Second Test , 19 Rate 1st Test Taken By 6' (p6>n P 3IFirst Test + 2nd Test 22nd Test 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- 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 esota oDated 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 pw^inances 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. /PIssued Date:SlO Managemer)*OfficeIreland Fee $Surcharge $ Comments:. Form No. MKL-0771-003 vicTot LunftEiM t ca.. aiianaa. rcasus r«t.Lt. 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 W te — Office V low — Inspector Pii.. — Owner Card — Owner -Permit No.,!./■ LEGAL L V“ ^ V !Date DESCRIPTION /AND /I ■ LOCATION Lake No.Lake Name Lake Classif.TWPSec.Range TWP Name IDENTIFICATION: Please Print All Information. Last Name First Mailling Address —No, Street, City and State Zip No,Tel. No.Initial 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 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.Ft.Distance from lake or stream 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 .M By PERCOLATION TEST DATA:Date of First Test , 19 , Rate Date of Second Test 19 ., Rate 1st Test Taken By First Test -H 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 express condition that the person to whom it is granted, and his agents, employees atj^vSfrkmen 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 ordinan^ NOTE: Permit void if work is not commenced within six (6) months. * O Permit: Issued Date: Shoreland Management Office CFee $Surcharge $ Comments:. Form No. MKL-0771-003 vicToa i eo.. rineus rM.L«. mimm 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 / oi)oCapacity GIs.GIs.s F SF SF /OO FDistance from Nearest Well F 75 50FFF F 01 /Od FDistance from Lake or Stream F F F F F F(0Distance from Occupied Building 10 2020FFFF F fO F10Distance from Property Line 10 10 10FFFF F Distance from Bottom to Water Table 4 4FFF F F /rx .03' ! ' n iSr jInspector's Comments: 4f I f ^ ^ 0 hL ( BOO__kjl-'-n-ti. Date of Inspection 7 Time of Inspection.M Signature InspectorINTERPRETATION OF ABBREVIATIONS Gl» = Gallons SF * Square Feet F » Linear Feet Job Title AgencyM KL-0771-003- Backer PERCOLATION TEST DATA SHORELAND MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Mailing Address: ph. No. 7or- ^3Ji- 6.7/7 Oi cdL s-^/oi State Zip No. Owner; First Middle St. & No.Legal Description:, LAKE OR RIVER NO.SEC.NAME TWP.RANGE TWP NAME TEST HOLE NO. 2TEST HOLE NO. 1 0 Depth to Bottom of HoleDepth To Bottom of Hole,inches; Diameter of Hole.inches; Diameter of Hole Jnchesinches Depth, Inches Soil Texture Depth, Inches Soil TextureDate.Date 19____* --r* V JPercolation? Test By____; Percolation Test Bv ,O/LUFirm Name.OC Firm Name.DaUJ cc .?! )UJAddress.GC Address < WOtter Tail County License No..Otter Tail County License No.^I- LUMeasurement, Inches Drop In Water ■Level. iTKhes Drop In Water Level. Inches I-Measurement,Time Remarks Time Remarks yro 7 f J> ~ 7- 1 ' V 35I-/7- / /-f1^ S ^Lliy_¥- 7 J 'l7 3 /V 7L A'ZlZZ Q' a?! ^-/7A V-1. m7ZsiUlIlUL/V /m ZAZAi.? r > // 7'! V. A- L- 'i- __</cc- It .7 :> - -ft Lc-- iijc ■ !tt ~ ^ 1..at.r7^/f 01' ' ^1<? pC~-11838iv’® 4 ey 4 MKL-0871-028 v>CT«4 Luaecia •laTtM. fcaau* 844k(. Miaa.See Booklet/'How to Rune Percolation Test" by Agriculture Ext. Service, Un. of Minn.