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Home My WebLink AboutPelican Beach Resort_17000100134000_Septic System Permits_CERTIFICATE OF COMPLIANCE SEWAGE SYSTEM PM%5tk F2.bA.a0Ay ]9_1Aday 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:Sr, m56-7B6 10 Vann137r, 42Range____Twp. Name.Twp.Sec.Lake No. mPelfcan Beach R2g>oAt li J; Ken Ff6 cheAOwner: Name Lim301 19th Aue. W., Foaqo, hIVAddress. 58102Zip No. (_e,^ 6208Permit No. SP./f'//y : Cff ^/ y ■/ /' ‘ Malcolm K. Lee, Shoielahd Administrator Otter Tail County, Minnesota Signed by:. MKL-0871-009 Vi 535 ■< 159035 VlCTOtl LUROEEM i CO. fRlRTEftS, EttCUl r«LLa. 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.,V.LEGAL DESCRIPTION AND 4;i A\r)LOCATION Lake NameLake No.TWP NameLake. Classif..Sec. TWP Range IDENTIFICATION: Please Print All Information. Zip No.Tel. No.Last Name First Initial Mailling Address —No. Street, City and State OWNER ra-C 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 1 fc>act-VA_o to rv-~ ^NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: - SEPTIC -TANK SEEPAGE PIT DRAIN FIELD Sq. Ft.GIs.S<Tt.Capacity Ft.Ft.Ft.Distance from nearest well 5o Ft.Ft.Distance from lake or stream Ft. \ o Ft.Distance from occupied building Ft.Ft. ID Ft.Distance from property line Ft.Ft. VFt.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 , Rate Dat-e of Second Test 19 , Rate 1st Test Taken By 1 First Test •I- 2nd Test 2 . Rate2nd Test Taken By Agreement: The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in 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./^/ ^rA La' signature ^ VjIDated 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 mojk is not commenced within six (6) months. Vo Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express r ShV^land Management Office Issued Date: Fee is 0-^Comments:.*• Form No. MKL-0771-003 [^EVlfW BAMIE LAKE. MINNESOTA »»■' 7-iT. ~ - ~>1 -; • V ■ V <1 •"s. ? ».:.AT «r -t: -n / ns ? '•c ’•'> ’INSPECTION RESULTS <■>' r^‘ Inspector must make all measurements ..tffh. I'-'.-v/- i :r-'i-™ -•: •-; t-, - .,'k'" ^ 7 r w - & '.. ASEWAGE DISPOSAL SYSTEM STATISTICS•f SEEPAGE PIT DRAIN FIELDSEPTIC TANKCATEGORYJ(Actual Should be Actual Should be Actual Should be Capacity S FGIs.GIs.S F SF S F 50Distance from Nearest Well 75F F FFF F f Distance from Lake or Stream F F F FFF 20 2010Distance from Occupied Building F F F F FF 10 10Distance from Property Line 10F F FFFF 3Distance from Bottom to Water Table 3F F FF F F Inspector's Comments: IV ■> . %-'•i>T t , /Wn.n>-4' /. ■ ■ - 'i A - f ii, (i 1 ^ '!':,T- V. ■'■3 •Date of Inspection .19____■S- ■/JTime of Inspection..M .i / signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs - Gallons SF “ Square Feet “ Linear Feet : .1 . It Job Title - ’.Tar --■ f -si:*-.tt-.-F ■:<* y-.- ... I'.’ t.V -i ‘if- Kl- :<1' • - ■ V ' ..ir-:- 1,:^ •. ■-'..vni-. - ' n g 'f.i : vj '> > O 5‘>> * ^ 1' V ,Agency . MKL-0771-003>Backer ’• PK- if'. •f \ ' t A _v.'--1 ■ • '• /■ ■f'.■3 . .vh f ;; '^.1 r.f^ '5 '5- - ■ vtC 'I'i. ' f" f 75 rn»C4, it I ' :‘ '-.t .■» T . • >i’t ■riifi,St r-i ;■>; ,, .. > Aft---iJ t<',. .K ■ t'" . .L ', , ' u> f' V, - '"Iv/, , , » I . ' '..X ■ - .ft.•T-r-■: tc '4J -s ' I . ?n.t■ .>• > !•• ■ '7- .♦•■yb:'ft' er^tt /it f« v • nn is.n; c • * "I.*r /J.V r V-'7t </ / / •'''.•L r"7 A'. iTCTIf V - 4..-•- -r-' h' ........■ 7- Vfi.-v. ,?v-r p .hK*.' ••A ; 4. SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 - Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SFWAGF DISPOSAL SYSTEM WhJf* — Office Yellow — Inspector Pink — Owner Card —Owner '. ji A 5Permit No.,S LEGAL XLa DESCRIPTION AND LOCATION - Lake No.Lake Name Lake Clastif.TWP TWP NameSec.Range IDENTIFICATION: Please Print All Information. Mailling Address —No. Street, City and State Zip No.Tel. No.Last Name First Initial OWNER -X V \ SEWAGE SYSTEM INSTALLER Name. vgQ 'Vx> H-O Q This System will be ready for inspection on.. 19 This space for office use only 19 Date Rac'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.Capacity Sq. Ft. Ft.Ft.Ft.Distance from nearest well Ft.Distance from lake or stream Ft.Ft. Distance from occupied building Ft.Ft.Ft. Distance from property line Ft.Ft.Ft. Ft.Distance from bottom to Water Table Ft.Ft. AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on ,, 19,, Time By PERCOLATION TEST DATA:Date of First Test . Rate A,\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. 7 -IjDatedN, 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 (61 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 $ o- \ \0\Comments:. LM Form No. MKL-0771-003 @fVI{W BAIUf UKE. MINNESOTA a*, ^ a .K . ..a .... rL . .la... —\ '.. a I .' ,1. 1 ^ T - r * '» r - INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PIT DRAIN FIELDSEPTIC TANKCATEGORY Should beActualShould be Actual Should be Actual w |g«c.S»Capacity s F s FGIs.S F X'56 50Distance from Nearest Well </75 FFFF F SfL 56Distance from Lake or Stream F F Fj FF X* 20 2010Distance from Occupied Building F FFF F X. r 10 10 Distance from Property Line 10F X-. F FFF F 33Distance from Bottom to Water Table F FF F F,F dL—Inspector's Comments: g rgA. VeU jga. ,tJXsr,A»UcTiU. :ta—4 3r/a Date of Inspection.19 Time of Inspection. (SJLSignature of InspectorINTERPRETATION OF ABBREVIATIONS Git * Gallons SF “ Square Feet ■ Linear Feet Job TitleF AgencyMKL>0771*003-Backer tX - 1—GRID PLOT PLAN SKETCHING FORMfeet/inchesScale: Each grid equals t t- r'19Dated:Signature Please sketch your lot indicating setbacks from road right-of-way, lake and sideyard for each building currently on lot and any proposed structures.\ A i o O KA I I i . S ^OA. Ka \y r I 0^ <r 1 /?*5 / /f /"e A, /?e^c 4 /j>^ ^VlCTOK LUNOEEM CO.. PRrMTEttS. ECRGUS FALLS. UINM.MKL-0871-029 wm 12 'S'n '^7L CERTIFICATE OF COMPLIANCE m SEWAGE SYSTEM PI m9th19 7f>Ant»ilr/n’5 certificate has been issued this day of. m Wsi'M li m ^c€8 to certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota. mUm The premises covered by this certificate are legally described as: Range__l^2L Par. in G.L. #3 cont, 19 Acres known as Pelican Beach Resort 56-786 s^r 10 Twp. 137 Twp. Name.DnrrnLake No. mr r.u-mfuflwmmSI3iPIft#iimFrank MiosekOwner: Name. #•1Route #5. Box IilO. Detroit Lakes. MinnaRotaA ddress. a & W'^Zip No. wMalcolm K. Lee, Shoreland Administrator 1337%Permit No. SP_ Signed by:. Otter Tail County, Minnesota m MKL-087 1-009 ®159035 viEtB* LUMfiEia 4 ee f»iatr»t. fercui r<ui. 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 /V-X n ^7(y Lt Permit No..LEGAL fe. f I CA-.Cl JDESCRIPTION //to /:^(„ AND <0.-1^ PJIZI GO ih /37LOCATION ATWPLake No. Lake Name Lake Classif.Sec.Range TWP Name IDENTIFICATION; Please Print All Information. First Initial Mailling Address —No, Street, City and StateLast Name Zip No.Tel. No. FT r 3c)c ^J/DK^)y 0 3e/x ,02^yOWNER [) J Cl j Y Tbl /H^ ■/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 TT Ft. $~3 .^3^ GIs.Capacity Sq. Ft. Ft.Ft.Distance from nearest well >Ft.Ft.Distance from lake or stream Ft.<TJ 2TTLtLFt.Distance from occupied buildinq Ft.Ft. //oDistance from property line ZFFt./ (j Ft.Ft. 7Ft.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 JVI By 2.1,.4---(X^L£:..ifPERCOLATION TEST DATA:Date of First Test 19 , 19 Rate I f 7/7c...^.... ..2...S.S Date of Second Test , Rate 1st Test Taken By bIiFirst 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.) ( - '>0 - 75~.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; IIssued Date: m^id Management OfficeShor y-icnS'- ooFee $Surcharge $ 'fXHi'—^ ~ I ~i- COComments:. ^ 5 'jSqa.F 6^^ (/ PC f Cr. y { ^£,'24!/ // ^ viergt uiMeicn a m.. f.'t'"ic i, oc\Form No. MKL-0771-003 .... 1S8906/■ 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 Tr TO n/?/y^ I'M /'''-d '" "'j Permit No..LEGAL 7r/I /Date/{ ' /•DESCRIPTION AND %- yj-c,r.n / 'J-7/ ^/ uLOCATION U-'y. r \ TWP Narne ;/L Lake No.Lake Name Lake Classif.Sec.TWP Range IDENTIFICATION: Please Print All Information. First Initial Mailling Address —No. Street, City and StateLast Name Zip No.Tel. No. • r XOWNER 'i I ry; ■; o , SEWAGE SYSTEM INSTALLER Name, This System will be ready for , ,9^2-/ This space for office use only /O'' %-a yr'.19 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.Capacity Sq.-Ft./' !.:y. * 'v Ft.Ft.Ft.Distance from nearest well t■£0 Ft.Ft.Distance from lake or stream Ft. Ft.Distance from occupied building Ft.Ft. / (;Distance from property line Ft.Ft.Ft. ; ■ 7 7Ft.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 ...C.rrfPERCOLATION TEST DATA:Date of First Test , 19 , 19.... Rate7 V'fIf 7-^Date of Second Test , Rate 9'JCo1st 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 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 «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 respe^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. ^ —Vj Issued Date:<"7 '^horelan^Management Office i- ;' ) Fee $_^Surcharge $___mo ,/ i:>'K>ro!r— -!i I,> £( I 'i i• ■hip yComments: ^•T ■7 ■+^ 3 7--T, ;/ . I i I - f-r 0 'f i-7 Form No. MKL-0771-003 viCTOB LUkeccN 1 ee.. aaiaTEai. fiasus r«kkt. hihm 158906 • 'k. INSPECTION RESULTS i \Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORY Should beActual Actual Should be Actual Should be s F <? /<■Capacity GIs.GIs.S F S F S F FDistance from Nearest Well 75 50FFFF F ^ FDistance from Lake or Stream F F F F F Distance from Occupied Building 201020FFFF F ' /VDistance from Property Line 'V F1010 10FF F F F Distance from Bottom to Water Table 4 4FFFFF F .4 c.// Inspector's Comments:^ ■ . A. A '/'*-if / / Date of Inspection Time of Inspection i/Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF = Square Feet F » Linear Feet / Job Title Agency MKL-0771-00 3-Backer I . c. >y PERCOLATION TEST DATA Price $ 1.00 per pad. SHORELAND MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Ph. No..Owner:Mailing Address: p.j di--rJe First D^n^ofT M j Last Name Middle St. & No.City State Zip No.Legal Description:/3 7/o DUiLJ A>/ LAKE OR RIVER NO.NAME SEC.TWP.RANGE (I ^sc/z r TWP NAME Pbl • cn nd 75^ p^£>pc.f TEST HOLE NO. 2TEST HOLE NO. 1 /Z C/Depth To Bottom of Hole.Depth to Bottom of Holeinches; Diameter of Hole inches; Diameter of Hole.inches jnches Depth, Inches Soil Texture Depth. Inches Soil TextureDate.19 Date 19_____V_£l Percolation t Test By < / Percolation Test By___/ A 'L ■'C (' A I - 'IQ ti "7jo 6 ^ a / /'■ LU )/i FirmNaroo_l QC Firm Nanoe.DoUJ QC r • ILUX ■ y*Address CC Address<./ ^ COOtter Tail County License No..Otter Tail County License No..h-COUJMeasurement, Inches Depth in Water Level, Inches h-Measurement, Inches Depth in Water Level, Inches Time Remarks Time Remarks o/7.'</7 § I- '1 c J6?O '/o JT^! : O O 4*^X/ : /7 . .J o—^ ‘ )/ ■'1 ( c i 7/JOQu / 7c-: ...//£7 f/ : 4^5^57 'L /yc/ 7C7 /. o a if*1 O o ■rcP la -i-'1 \MKL-0871-028 <3 See Booklet, "How to Run a Percolation Test" by Agriculture Ext Serwce, Un. of Minn.r PERCOLATION TEST DATA Price $ 1.00 per pad. SHORELAND MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Ph. No,Owner;Ma^ftg Address: ^I Last Name First Middle St. & No.City State Zip No. /.3rLegal Description:m'L'<,^^.yyU \ LAKE OR RIVER NO.NAME SEC.TWP.RANGE TWP NAME 5"7^ D 1/i'TEST HOLE NO. 2TEST HOLE NO. 1 '/y yDepth to Bottom of HoleDepth To Bottom of Hole,inches; Diameter of Holeinches;Diameter of Hole inchesinches aGWq. . IS ^^~7<L . DateC^tZf i d I S 13~7 ^Depth, Inches Soil Texture Depth. Inches Soil TextureDate Percolatioi Test By__ Percolatio Test By___ UJFirm Name ^-^<9 E ^ B FirmNami // // LU QC /6U^'A. ,UJAddress.OC Address//<y COOtter Tail County License No.,Otter Tail County License No_HcoLUMeasurement, Inches Depth in Water Level, Inches H Measurement,Depth in Water Level. Inches Time Remarks Time RemarksInches% I vVs's'/ASA 2W /?2 ~STq^£< ZZZtjzJl3': OS’ 2 'J)S: /S X7 <Z AS" ' /S'z:/sH^9^z5 .£ . .7 tSoaSaJP3oS;<^S zi Sf3S 7oZ:3 r 7^22^ j A39%sss S7S',3S iX /3SirDsss Lr5~;77 /^ MKL-0871-028 \S^3^<s-3JU-.i/yL A<S(Z<l^See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn.