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HomeMy WebLinkAboutMaplewood State Park_39000100077000_Septic System Permits_% 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 » — Office Yellow — Inspector Pink — Owner 7/ggPermit No..LEGAL DESCRIPTION AND // - I3Sgms5LOCATION TWP NameTWPLake Classif.Sec.RangeLake No.Lake Name IDENTIFICATION: Please Print All Information. Mailing Address — No. Street, City and State Zip No.Tel. No.First InitialLast Name S'^40/•SLiK ~OWNER Qp '^^rsc>oQjC£f.T SEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection on.19. This space for office use only 19 M Date Rec'd Owner or Agent SignatureTime Rec'd Phone Call Rec'd By NUMBER OF BEDROOMS:ESTIMATED COST; SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD /oeo Gis.Sq. Ft.Sq. Ft.Capacity A Ftr Ft. Ft.Distance from nearest well Bf>0 Ft.Ft.Ft.Distance from lake or stream Kue Ftr Ft.Ft.Distance from occupied building 'h.Distance from property line yittc Ft. Ft. 7 Ft.Ft.Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points VAULT T-’iLeiRECORD OF TESTS:‘■■'i ^ 'w y I.'?. ......................y....u o /J!wvil / Inspection was rnade on ...7T.19 , Time ,JVI By PERCOLATION TEST DATA: /Date of First Test , 19 , Rate 1 \ Date of Second Tei . 19 ., Ra- 1st Test Taken By First Test + 2nd Test Test 1 Rate2ndTaken 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 re^y for inspection'C:_.C_,-' t 1 t \7- V' n X-£.Dated_5C. ^gnature IPermit; 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. BIssued Date: Shoreland Management Office Fee $Rec # Comments: ------ Form No. MKL-03208S 225239 — Vksn Unkan Co.. PtMara. Fngus Fils. MN 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 miu — ofHct Yeltow — Inspector Pink — Owner 7I 2 73 6^9^Permit No.,LEGAL DESCRIPTION AND /' ( t .,'o O*7 ■;U ■LOCATION Lake No,Lake Name Lake Classif.TWP NameSec.TWP Range IDENTIFICATION: Please Print All Information. Mailing Address — No. Street, City and StateFirst Zip No.Tel. No.Last Name Initial /'■r ■OWNER y 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.Capacity Sq. Ft.Sq. Ft. Ft.Ft.Ft.Distance from nearest well Ft.Distance from lake or stream Ft.Ft. Ft.Distance from occupied building Ft.Ft. Distance from property line Ft.Ft.Ft. 7 Ft.Distance from bottom to Water Table Ft.Ft. All distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on 19 , Time /,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 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 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 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 Otte' 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; ^xtreland Management Office ' 'Fee $Rec # hComments:I ! 4 Form No. MKL'032065 225^39 — Victor Lundeon Co . Printors, Forgus FaNs. MN •i i INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS V SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORYShould BeActual Actual Should Be Actual Should Be %i //V /Capacity Qls. GIs.S F S F S F S Fl /fJeviC-Distance from Nearest Well F F F F F F 4 V)o LDistance from Lake or Stream F F F F F F \DDistance from Occupied Building F F F Fi F Distance from Property Line F F F F F F Distance from Bottom to Water Table 3 3FFFFF F / hInspector’s Comments: CLO^^:/xCl ^ i<L- !Date of Inspection 19 fL__ MTime of Inspection signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF = Square Feet F = Linear Feet ‘i 1' h. ''X^ ' Job Title "i MKL • 032085 • Backer Agency 1 •1\^t>' //^ >' ^1:; ' ■- rlT a I -r jJar-I'20^\ • ¥2>j '. Department of LAND & RESOURCE MANAGEMENT COUNTY OF OTTER TAIL Phone 218-739-2271 Court House Fergus Falls, Minnesota 56537 MALCOLM K. LEE, Administrator kpnAI 19,1988 Bob Hamon Maplewood State PoAk Pelican RapldU,, MW RE; OuAhoiue^ In Skoaeland an.ea6 o£ OtteA Tall County VeoA. Ma. Han^on, Enclosed please ilnd a copy Ojj OtteA Tall County’^ minimum ^tandoAcUt {)0A outhou^e-d 04 peA oua conveA&ation o^ 4- 18- 1988. AIao enclosed l& a copy oi the Shoaeland Management Oadlnance and the Sanitation code o(i OtteA Tall County ^oa youA uie. Ai I mentioned, ive cuAAently do not AequlAe a Sewage Syitejm PeAnUt loA the Installation o^ outhouses. An outhouse must howeveA be Installed such that It compiles with all sepoAotlon distances and the above gAound stAuctuAe must be less than 100 sq. it. In size ( li oveA 100 sq. it. then a Site I building] PeAmlt may be AequlAed ). li you have any iuAtheA questions AegoAdlng this matteA, please contact ouA oUlce. SlnceAely, Bill KaloA Asst. AdmlnlstAatoA mis SHORELAND MANAGEMENT ORDINANCE - DIVISION OF EMERGENCY SERVICE - SUBDIVISION CONTROL ORDINANCE SOLID WASTE ORDINANCE SEWAGE SYSTEM CLEANERS ORDINANCE - RECORDER, OTTER TAIL COUNTY PLANNING ADVISORY COMMISSION RIGHT-OF-WAY SETBACK ORDINANCE FUEL AND ENERGY COORDINATION ' f i t h,j/^ fVl*»to <v J ,__1 ! 71'? 12-5 k9'4 ^"'ISW-F^-® iT T c r ■TV''pUi/fVl V>>^' '•* **4 ' srr IK\¥h»i,9f f f> \9r^ f)-!’ ^i-[g ^ c-t OMi-jq) i Lt )‘3iTe KV ApLeUtiPP 0-> W I___I ! 7i'7 12.3 K9'4 a'^'5 I ©nTT p r^ -TV'-puUrfH V>^*'fK2^,-■ ^ W .'. : ,I srr 1 ■ h*^ n r*' 4l]g ^ c< Okii-w) STATEMENT Frazee, Minn. 56544,_,19 •‘v'wOTO IN ACCOUNT WITH FELDT’S Plumbing and Heating LeRoy Feldt, Master Plumber—Phone 334-2441 Furnacs Installation Gas, Oil, Wood & Eloctric Trenching Excavating Kohler & Crane Bathroom Fixtures Septic Tank Pumping Septic Tank Installation Well Drilling Sewer Routing & Cleaning All Types of Sheet Metal Work Dirt Hauling & Cat Work /Ad. Mnut ^-B'6 3: / ^^ /id \\¥-4 /hJ<c i' ^ TktJf /^(fAciXu^ / nJi ^ ^ I r (£cSlu^ ____________^ A ~Wa /%/ i_■/ ___jo yn ________ FInan :e Ch ifqe is computed by a “Periodic Rate” ot 1 % pa i 12 % i pplie I to the previous balance without deducting currer month, wh ch is payments ind/or n Annual Ra n nf (redits appes ring on thi; i stati ment.