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Home My WebLink AboutNorthshore Resort_37000990225000_Septic System Permits_s.^ ». CERTIFICATE OF COMPLIANCE SEWAGE SYSTEM S'-t. 19_ilVccmbeAUtThis certificate has been issued this day ofS-. 5* to certify compliance with regulations of Shoreland Management Ordinance, Of ter Tail County, Minnesota.Mk’.. The premises covered by this certificate are legally described as: Range 42 r &LidaTwp. ^ 36Lake !9o. S6-747 Sec. ^ 4Wd Twp. Name. m Lr Rz^stand UohXh^kotLO, Rzi>otvt.f m AadelZ Rz^iZand____________________ Arlrlrpt.s Roiit£ 3. PzLitan RapicU. UinneAota Owner: Name. wm msb^nZip No. Permit No. SP 4751 Signed by:. Malcy61m K. Lee, Shoreland Administrator Otter Tail County, Miimesota MKL-087 1-009 Vlt'] 159035 LVIBIIa 4 40. BOiRTItt. rtttwa ran*. 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 Whi» - C0!cm YeHow — Inspector Pink — Owner Card — Owner V7S/Permit No., LEGAL DESCRIPTION AND r/- 7y?/JA.LOCATION TWP NameRangeSec.TWPLake Classif.Lake NameLake No. IDENTIFICATION: Please Print All Information. Tel. No.Zip No.Mailling Address —No. Street, City and StateInitialFirstLast ..Name OWNER ^3 fJ.. . KUJL,.-eP SEWAGE SYSTEM INSTALLER Name,w»*r\ This System will be ready for inspection on.19. This space for office use only ,19 ,M Owner or Agent SignatureDate Rec'd Phone Call Rec'd ByTime Rec'd NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD ^ 3 / O Sq. Ft.(7' GIs.Sq. Ft.Capacity S~^ Ft.12:/ Vo 'Ft.Ft.Distance from nearest well S^O Ft.Ft.Ft.Distance from lake or stream / c' Ft.Ft.Ft.Distance from occupied building / Ft.Ft.Ft.Distance from property line 3 0— a Ft.Ft.Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS: 19,, Time JVl ByInspection was made on O'PERCOLATION TEST DATA: Date of First Test 19 , 19 , Rate Date of Second Test , Rate 1st Test Taken By First Test -H 2nd Test 5'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.) //- r <F/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: Issued Date: Shoreland Management Office^ 7/ Z-Fee 3L r<LsijL.Comments:./ 1 [^VKW lAIUf LAKI. MiNNISOTAForm No. MKL 0771-003 T~ ‘ INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORYActualShould be Actual Should be Should beActual Capacity S FGIs. GIs.S F S FS F Distance from Nearest Well 5075FFFF- v^F F Distance from Lake or Stream F F F F F F Distance from Occupied Building 2010 20FFFF F F Distance from Property Line 1010 10FFF F F F Distance from Bottom to Water Table 33FFF F F 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 . MKL-0771-003-Backer ISHORELAND 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 Yefiow — inspector Pink — Owner Cord—Oiwner Permit No., LEGAL DESCRIPTION AND LOCATION TWP NameSec.TWP RangeLake Classif.Lake No.Lake Name IDENTIFICATION: Please Print All Information. Tel. No.Zip No.Mailling Address —No. Street, City and StateFirstInitialLast Name OWNER SEWAGE SYSTEM INSTALLER Name. /^/y]S'- L s-xThis S/stem will be ready for inspection on., 19. This space for office use only V- SKS’- ^ Owner or Agent SignatureDate Rec'd Phone Call Rec'd ByTime Rec'd 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.Distance from property line Ft. Ft.Ft.Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS: 19,, Time ,JVI ByInspection was made on Date of First TestPERCOLATION TEST DATA:, Rate., 19 , 19 .L, Dat-3 of Second Test ,, Rate 1st Test Taken By First Test -f 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: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit Is granted upon express conditiop 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 CEl?TlFir/trFee $ Comments:. [^VKW lATM LAKI, M3NNISOTAForm 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 /tlooCapacityGIs.GIs.S F S F S FtDistance from Nearest Well 75 50FFFF F ^0sro\50Distance from Lake or Stream F F F F F10Distance from Occupied Building 10 20 20FFF F 10 fO FDistance from Property Line iS10 10FF F F 3'v",Distance from Bottom to Water Table 3FFF F Inspector's Comments: A 1 fv/ :j. o _x-.,eiZi2o. " I IZJLl > tj2rv^gri^yys r ___^ gT^v-v 19.^^Date of Inspection / ' Time of Inspection. K3IC signature of InspectorINTERPRETATION OF ABBREVIATIONS Gif “ Gallon! SF “ Square Feet F ■ Linear Feet Job Title AgencyMKL-0771.003-Backer \3<^^V Ho y\<rcJk. ' ^^00 rr^II <<1^ PERCOLA TION TEST DATA SHORELAND MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 - ^0^3Ph. No. Owner:Mailing Address: First £5Middle St. & No.City State Zip No.Legal Description: TWP NAMESEC.LAKE OR RIVER NO.TWP.NAME RANGE TEST HOLE NO. 2TEST HOLE NO. 1 I Depth to Bottom of Hole inches; Diameter of Hole JnchesDepth To Bottom of Hole,inches; Diameter of Hole inches Depth, Inches Soil Texture Soil TextureDepth. InchesDate.Date 19_____ Percolation Test Bv .^2^oLUFirm Name.OC FirmName.c.DOmOC lU Address.QC Address < COOtter Tail County License No..Otter Tail County License No^I-COU4 Drop In Water Level.. Indies Drop In Water Level. Irtches Measurement, Inches K Measurement, InchesTimeRemarksTime Remarks o \:x \ 13 /^);r/3 I )7 \ M Ui- /PilPA A,d /P-« / 6r /9:/I /P’30 Z /r 3Mh^-I 3L2Ztj.= 3EL \j^- 3^w MKL-0871-028183818 ®vierea luaecia • M.. aaiam '*LI See Booklet/'How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn. ;, l' f . f- ^3— V/ J J ' r'.- MINNESOTA DEPARTMENT OF HEALTH Section of Hotels, Resorts and Restaurants 717 Delaware S.E., Minneapolis, Minn. 55440 PUBLIC HEALTH and SAFETY INSPECTION RECORD DATE P.O.CO.OWNER '/r LICENSEE ADDRESS ADDRESSr -5 __ RO. ____ /^^I^*^S^MPLOYE£S T<C 3 ~/BUSINESS NAME_____^ ~27Lie. NO. / -:y< posted ' ^ ^ r ^ , cabins CUNITS, SLEEPING ROOMSNO. OF: BEDSt'- TYPE OF BUSINESS Mobile Home Park and/or Recreational Camping Area Sites ORDERS WRITTEN BELOW MUST BE COMPLIED WITH BY DATE INDICATED y '■ y\^ * 1 I 1 ■ ■ H • pH MMiia - 2. y fi ^ i-' V -yy ys?o£>■o / ' y-^.‘-j^'-. - -J-^a y✓ <^cyc?■eJ ,- >» ■/’^ r r7777yy^-^-4 ....-y.-^y^ir,ejc^ r------<3^- /y^y ^PZ'C^yr f / 7 tr <sv _ WELL - SEWER DIAGRAM Received oy COMPLIANCE PREVIOUS ORDERS DISTRICT OFFICES: Bemidji (755-3820). 2. Mar (285-7289). 4. Duluth (723A642). 5. MarshaU (5 7. Fergus Falls (736-6922). 8. St. Cloud (255A216 5 NO i9-2501). 3. Rochester . 6.,Mpls. (296-5335). Putrrtc ?1 eaTtti Sanita^'tinCOPIES - Central Office, Licensee, District Office /Pyy^z/S-I IE-00874-01