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HomeMy WebLinkAboutPleasant Lake Resort_57000060041001_Septic System Permits_ABATEMENT FIELD NOTES MLAKE NAME:LAKE NO:LAKE CLASS: PARCEL NO:E911 PROPERTY ADDRESS: TOWNSHIP NAME:SECTION NO: LEGAL DESCRIPTION: OWNERS NAME(S): 4 i ^ MAILING ADDRESS: TYPE OF EXISTING SEWAGE SYSTEM: HOLDING TANK SEPTIC TANK/DRAINFIELD OTHER: SEPTAGE PIT, DRYWELL OR LEACHING PIT CESSPOOL COMMENTS: SEPARATION DISTANCES fIN FEETT SEWER LINE TANK ABSORPTION AREA OUTHOUSE WELL OHWL LOT LINE DWELLING NON DWELLING GROUND ELEVATION @ ___________ REASONfSl FOR ABATEMENT (SKETCH ON BACK...^ ' DATE IniL INSPECTOR'S SIGNATURE(S)i EXISTING FILE:YES NO ABATEMENT HELD NOTES R3RM 01/22/03 l\.a> J.(9 0^ n >■'•0 riP § r•*J| Ffrri .0 1/(4 1^1 JJr!i0^(L\\ oc^_6T)b>^p Ig ^ I") 0 U-Jj lsi4 ■illjll'i/ I'J Arri-Ci^ I /^}cH %J S>LhS^ si -t11> & FILE MEMO PARCEL #PROPERTY OWNER LAKE/RIVER/WETLAND NAME L&R OfficialDate it r r d ^ 9//3 Action / Com ments. Sc, J 7^^ L ^ ^A (Alci/v|) ^£xy\.J f <K J.,SCVN ) Date L&R Official Action/Comments. Date L&R Official Action/Comments. L&R OfficialDate Action/Comments. L&R OfficialDate Action/Comments. L&R OfficialDate Action/Comments. L&R OfficialDate Action/Comments. .4i-(T,- to - olt( CyH- v-4ot-^4 <N.V + \ C-4riJ&lh' \ 5, b\ «pyo3 ^)r\9\ \ Ir \;!■*-ll ?I to\fArrh Vv:?I5 l^rt\ M j f< \ pu--> 0) (!«- / ^ IS 4^ > . ^oUi11 0 ( i■' u-j lgM-\BK sjij'i'i_}©i/5ijt\I} oH(JA'Q iV^r / c i SHORELAND MANAGEMENT OTTER TAIL COUNTY FERGUS FALLS, MINN. 0871-0 > CLUSTER 19File Opening Date. f ftCitv Use Description. Last Name Name of Applicant:d.____dLAddress:First Middle St. & No.State Zip No.Phone No. do dydsLegal Description 4</r/’y Lake or River Name Twp NameMlClassif.Lai Sec.Twp.Range C — I - V / V -) Xa,_ i7-odo-oi»-oom-^i ■4' ^cjo . ^fcX 7R O BUILDING PEiiMITS VARIANCES ON BUILDING PFRMIT.S PurposeDate Date Inspected Results Appl. Date Hearing Date Date NotifiedHearing Judgerr:.ntNO, Ch/5?y -i.A. c; :L"' 0 SEWAGE SYSTEM PERMITS VARIANCES ON SEWAGE SYSTEM PERMITS PurposeDate Date Inspected Results Appl. Date Hearing Date Hearing JudgementNO.Date Notified Cj)nK. a Mm.) Th^iL A5 i>“"-e>ysimp 0 SPECIAL USE PERMITS Notice Mailed COMMENTS SECTION:Application Date • Hearing Date I Accompanying Documents Filed in Cabinet No.\ ® ««.. u,.„,....1B9093ANOTE: O and 0 See enclosed Inspectors Copy of Permit Application.© See enclosed Special Use Permit Application. ; CERTIFICATE OF APPROVAL SEWAGE SYSTEM HOLDING TANK mV. U This Certificate has been issued this 1ST of FEBRUARY, 1999 Mi certify that the sewage system installed as per Sewage Treatment System Permit Number 12438 has been approved for use by Otter Tail County,n1 1^1m Minnesota. The property served by this Sewage System is legally described as: (PLEASANT LAKE RESORT)UNPLATTED GLS 6 & 7 EX TRACTS Parcel Number(s): 57000060041001mSection: 06 Township:133 Range: 041 Township Name: SVERDRUP TOWNSHIP Lake/River Niimber: 56-1127/449 Lake/River Name: UNNAMED & PLEASANTm I^e;. JAwA Current Property Owner: BEVERLY J & ARLEN K JOHNSON Number of Bedrooms: SHOP 284.709 • Vicior Lundecr> Co, Printers ■ Fergus Falls. MN • 1-800-346-4870 APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 - FERGUS FALLS, MN 56537 WHITE — Office YELLOW —L&R Inspector PINK — Owner / Contractor LEGAL Permit No.f\jf: dpf CL 1 ^ Gl L DESCRIPTION ( ----fNoAbatement: ( ) YesAND LOCATION UKE NUMBER LAKE/RIVER NAME LAKE/RIVERCLASS SECTION TWP. NO.RANGE TWP NAME ^ • PLCfil$/^rf\GL-Dd-l G>V£<zO/7^P/33LnoPARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER G'l boo -6L •' ^v/ - Ob! IDENTIHCAT10N: Please Print All Information Last Name First Mailing Address — No. Street, City and StateInitial Zip Code Telephone No. /?) I 15-oy,na.LfrrJ l<LProperty Owner bH?L Sewage System installer Name State Lie. # A.M. ► This System wilt be ready for inspection on.the year of PM..at. This space lor office use only NUMBER OF BEDROOMS: /v/zw/5 - A.M. .PM.GARBAGE DISPOSAL: ( )YES (t^-TNO Phone Call Rec'd ByDate Rec'd Year of Time Rec'd TYPE OF SEWAGE SYSTEM ( j^^Holding tank (Alarm Required) ( ) Septic tank ( ) Lift Station (Alarm Required) ( ) Drainfield ( ) Trenches ( ) Bed ( ) Mound * ( ) Outhouse ( ) Sewer line SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTS TANK DRAINFIELD Ft"Capacity GIs./ qoo go Ft.Distance from nearest well Ft. Distance from lake, wetland or river (OHWL)Ft.Ft. 3 Ft.Distance from dwelling ID Ft. lb?Ft.Ft.Distance from non-dwelling Ft.Distance from property line Ft. EFFLUENT DISTRIBUTION ( ) Gravity ( ) Pressure Ft.Distance from bottom to Water Table Ft. All distances are shortest distance between nearest points PERCOLATION TEST DATA: kbr^Uiaco boa, WATER WELL DEPTH 15' * ABSORBTION AREA FOR MOUNDS Date of Perc TestPerc Tester m Average RateRate of 2nd TestRate of /st Test 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 Minnesota Department of Health. Applicant agrees that plot plan sketches and specifications submitted herewith and which are approved by Shoreland 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 accepted. It shall be the respon­ sibility of the applicant for the permit to notify the County Shoreland lagemen^at the job is ready for inspection. DATE: Signature n 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 con­ dition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of any said ordinances. NOTE: Permit void if work is not commenced within six (6) months. 3.Issued Date: Land & Resource Management Office ■4)Fee $.Rec # Comments: 291.095 * Victor Lurtdeen Co. Printers • Fergus Falls. MinnesotaBK 079&^3 r™”r APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 - FERGUS FALLS, MN 56537 WHITE — Office YELLOW — L & R Inspector PINK — Owner/Contractor LEGAL Permit No.V/f a 1 ^ L /fx DESCRIPTKHi Abatement: ( ) Yes (i—TNoAND LOCATION LAKE NUMBER LAKE/RIVER NAME LAKE/RIVERCLASS SECTION TWP. NO.RANGE TWP NAME S'/L /33r<oRARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER - OdO -OU - CO^] - 0^1/ IDENTIFtCATION: PiMsa Print All Information FiretLast Name Initial Mailing Address — No. Street, City and State Zip Code Telephone No. i'J J)iT- y'Je-Property Owner K I )71r^LH7LU/Joeii Sewage System Installer Lic^rcHName i1 State Lie. # -3a f/If)'on A.M. ► This System will be ready tor inspection on.the year of .PM..at. This apace for office uae only NUMBER OF BEDROOMS: H-9>6 Time Rec^ —GARBAGE DISPOSAL: ( ) YES (i^-TNO Phone Call Rec'd ByYear ofDate Rec'd TYPE OF SEWAGE SYSTEM ( Holding tank (Alarm Required) ( ) Septic tank ( ) Lift station (Alarm Required) ( ) Drainfield ( ) Trenches ( )Bed ( ) Mound * ( ) Outhouse ( ) Sewer line SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTS TANK DRAINFIELD FfCapacityGIs.loop Ft.Ft.Distance from nearest well IP Ft.Ft.Distance from lake, wetland or river (OHWL) Ft.Ft.Distance from dwelling Ft.Ft.Distance from non-dwelling IP> Ft.Ft.Distance from property line EFFLUENT DISTRIBUTION ( ) Gravity ( ) Pressure Ft.Ft.Distance from bottom to Water Table All distances are shortest distance between nearest points PERCOLATION TEST DATA: fl€6,uiaco inP}P fDate of Perc Test WATER WELL DEPTH *IS * ABSORBTION AREA FOR MOUNDS Perc Tester .ft* Rate of 1st Test Average RaiteRate of 2nd Test 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 Minnesota Department of Health. Applicant agrees that plot plan sketches and specifications submitted herewith and which are approved by Shoreland management Officieil 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 respon­ sibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. y__________________ ( -V? .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 con­ dition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of any said ordinances. NOTE: Permit void if work is not commenced within six (6) months. '1 ■j 3.1I 7)fIssued Date:■iLand & Resource Management Office Fee$_i^. ^Rec # Comments: 291.095 • Victor Lundeert Co. Prirttrs • Fergus Palls. MinnesotaBK 079&003 «paii IP INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS DRAINFIELDHOLDING SEPTIC TANK LIFT TANKCATEGORY Actual Minimum Capacity GLS.GLS.FT2 77Distance from Nearest Weil FT EL FT Distance from Buried Water Suction Pipe FT EL FT 50 Distance from Buried Pipe Distributing Water Under Pressure FT FT FT 10 FT Distance from Lake, Wetland or River (OHWL) FT FT /rDistance from Dwelling FT FT FT 10/20 /rDistance from Non-Dwelling FT FT FT FT,Distance form Nearest Property Line FT FT 10 Distance from Bottom to Water Table FT FT 3 Holding Tank/Lift Alarm NO Old System Pumped & Destroyed YES NO Sewer Line to Well Separation DRAINFIELD CALCULATIONINTERPRETATION OF ABBREVIATIONS GLS. = Gallons FT^ = Square Feet FT = Linear Feet Actual Minimum FTX .ft^FT 20 MOUND CALCULATION ROCK REDUCTION Inspector’s Comments: ABSORBTION AREA Rock trenches with inches Ft. X Ft of rock under pipe for .% Ft2 DF.reduction / equivalent to SKETCH: / L If*. -e-i' -50-----;■ / JJU^state License Category state License Number %.■ CERTIFICATE OF APPROVAL SEWAGE SYSTEM SEWAGE SYS TEW 17THm 19 9 3DE CETI? ERThis 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 m m The premises covered by this certificate are legally described as: mim Twp. 1 3 3 Range A ^Twp. Name 3 V E R PS UPiMke No.S fS -11 ? 7 Sec.msmi t 133 41 2?.11 GL3 6 3 7 EX TRACTS LIFE ESTATE TC ESTHER LEITCHm i J fe'iim {3. S-.Owner: Name X -c:THPP ;r~TTrHj ah-LisnN-x. E e:./.erl Y-. j 7. ..ari.=n__ tlAddressoai pny ^ V , IIM n - p,^ nn r; > r/rj S S KZip No.V: Permit No. SP Signed by: Lund & Resource Management Official Otter Tail County. MinnesotaMKL-098700I JT-263191 Victor Lundeen Co.. Primers, 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 LEGAL Permit No. DESCRIPTION AND LOCATION LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS - SECTION TWP RANGE TWP NAME S>{Je. r oLc \x. p FIRE OR LAKE ASSOCIATION NUMBER 4^//^S PARCEL NUMBER(S) S7-ooo ■ 06'00V/-0O/ IDENTIFICATION: Please Print All Information Last Name First Mailing Address — No. Street, City and StateInitial Zip Code Telephone No. Bjiverly / Ss>7x^ J^S9Property Owner ^ATa/-er ^ /^/Y'9r> fjs7-k^.r A.e/ -To^h /Scirrsy ^R+- I Bd~K JP3.7Sewage System Installer Name TTj'.st.i- A.M. This System will be ready for inspection on . 19.P.M.at 3This space for office use only NUMBER OF BEDROOMS: A.M. P.M..19 GARBAGE DISPOSAL: ( ) YES (^XCi.NODate Rec'd Time Rec’d Phone Call Rec'd By SEWAGE DISPOSAL SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM ( ) Holding tank (Septic tank ( ) Drain field ( ) Standard ( ) Bed ( X ) Trench ( ) Modified ( ) Mound TANK DRAIN FIELD CLOG'SCapacity Distance from nearest well Ft. Ft. 75'25Distance from lake or stream Ft. Ft. Distance from building Ft.Ft. Distance from property line Ft.Ft- EFFLUENT DISTRIBUTION (^) Gravity ( ) Pressure 3Distance from bottom to Water Table Ft. Ft. All distances are shortest distance between nearest points WATER WELL DEPTH: Djiep /4pr, / 2H 573PERCOLATION TEST DATA: Date of First Test . 19 Rate ?3 3Aj>rr' / ,7/Date of Second Test<2%. A?, 19 Rate 1st Test Taken By ss5 V5/First Test -I- 2nd Test 2nd Test Taken 2 Rate 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 Minnesota Department of Health. Applicant agrees that plot plan sketches and specifications submitted herewith and which are approved by Shoreland Management Officical 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 responsibilty of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspe6tion.i V 2^'f TDATE: /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 agent, employees and workmen shall conform in ail respects to the Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of any said ordinances. NOTE: Permit void if work is not commenced within six (6) months. Cl.t> pA-i' 6^ Land & Resourc/ Management Office Issued Date: 7 c/rst.7,''o7 c<j Fee $.Rec #. /2oComments: L Form No. BK — 0292-003 260.771 — Victor Lundeen Co., Printers. Fergus Felts. Minnesota m 0|'b 8> COUNTY OF OTTER TAILSHORELAND MANAGEMENT — 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 'JB Permit No. ^ ci\C O0 0( LEGAL DESCRIPTION ~tS^r^PAND ^ -2, O/ PARCEL NUMBER(S^ " ^ SL~f/^7 - cod - oom~0O/ ^c:^C)\ LAKE/RIVER NAME -LAKE/RIVER CLASS - SECTION -LAKE NU TWP RANGE TWP NAME S>0€- r ci\4^/Rd)73s 2'C vt FIRE OR LAKE ASSOCIATION NUMBER rIDENTIFICATION: Please Print AH tntormatlon I Mailing Address — No. Street, City and StateFirstLast Name Initial Zip Code Telephone No. itProperty Owner /?/• / ^d~x y____ 9o f.S / /verr I e/ 7f_i h 3>Sewage System Installer Name ctrr/ j- .19^Sf- 3 J;^£3^ KJLSThis Syst^ will be ready i^Sf^ection on.at O This space for office use onlfj ^ ^Od NUMBER OF BEDROOMS:8-‘T5 /gy- 3i GARBAGE DISPOS^AL: ( ) YES (^/<) NODate Rec’d Time Phone Call Rec’d B 7vT~^Tt5otCl "O -a: • SEWAGE DISPOSAL SYSTEM DATA: MINIMUM REQUIREMENTS o TYPE OF SEWAGE SYSTEM TANK DRAIN FIELD( ) Holding tank Septic tank ( ) Drain field ( ) Standard ( ) Bed ( ( ) Modified ( ) Mound 3 7^ Sq Ft.Capacity S'^■Distance fromTniearest yvftl r/A Ft.K V3Distance from lake or stream Z5Ft.Ft. Ft- FtDistance from building 1^ Distance from property line l-Ft.Ft. EFFLUENT DISTRIBUTION (^) Gravity ( ) Pressure Distance from bottom to Water Ft.Ft. !All distances are ,shortest distance between nearest points ¥WATER WELL DEPTH: 3j2e p> l /V ■-9 ^ Pvcj. c".-' Apr, / ■ 1P T'3 -F 2r\tfJesyl - XV 0L^j PERCOLATION TEST DATA: Date of First Test—------^ Date of Second TeSt ¥_: Rate j?.Rate 1st Test Taken By Sec rr 23^y 7^First Testif RateI T' ^2nd Test Taken Agreement: The undersigned hereby makes application for permit to install^extend SevFa^^ Disposal Systerrj herein specified, agreeing to'do all such work in strict accordance with Ordinances of the County of Otter Tail, Minnesota and Mirutesota Individual Sewage Disposal Code Minimum Standards set forth by Minnesota Department of Health. Applicant agrees that plot plan sketches and specifications submitted herewith and which are approved by Shoreland Management Officical shall become a part of the permit. Applicant further agrees that no part of the system shalLbe covered until it has beerr'inspected and(Mcepted. It shall be the responsibilty of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection^ ' ' ' ’ ' ’ 7? ' Signature ^ Permit: Perrhissioh,® tWreby granted to the above named applicant to perform the work describ^i?)^he Jbove 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 Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of any said ordinances. NOTE; Permit void If work is not commenced within six (6) months. DATE: /g ........ ' Land & Resource Management Office ?o e/^i.. Issued Date: Fe=$^^^ Comments: Rec If. 7^r ~f~ jJ ^ > XT'7» Form No. BK — 0292-003 260,771 — Victor Lundeen Co.. Printers. Fergus Falls. Minnesota I ..fPiP V INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS - . SEPTIC TANK DRAIN FIELDCATEGORYActualMinimumActual Minimum 37S SF[ OOw GLS./I 377 SFCapacityOon Qi-S- FTft 2:Distance from Nearest Well FT50 Distance from Buried Water Suction Pipe FT FT FT50 FT50 Distance from Buried Pipe Distributing Water Under Pressure FT FT FT10 FT10 47 FT 7^ ft7S ftDistance from Lake or River (OHWL)FT aDistance from Nearest Building FT 10 FT FT FT20 Distance from Nearest Property Line FT FT10 10 FT ft ftDistance from Bottom to Water Table FT FT3 Sewer Line to Well Separation DRAINFIELD CALCULATIONINTERPRETATION OF ABBREVIATIONS GLS. = Gallons SF = Square Feet FT = Linear Feet Actual Minimum 5/iS FTX FT So ft 32SFT20 SF 33 Cc'cre/' cufC I 'jrc-r^ci/^f4-4o 7Inspector’s Comments:o't-/ hTOEfvsftir M SKETCH:Sc^-JLLI \’^■=5 -- ~L3- V NZ Inspector's Signature g-3-~73 Date of Inspection Time of Inspection 1 I A V. ^,/ 7g/v^/OOP 2 jti^rt^yA <£\0 +ly ty^,A *v^n-f-/a Zn.fSkxij*i:t7S I \^l //tl6/^[^yy a >n 21SS02® VICTOH UlNOtCN CO.. PRINTEMS, FER6US PALLS. UINN.MfLL -0871.-028 PERCOLATION TEST DATA LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, Minnesota 56537 Ph. No. Mailing Address:Owner: -----First Mi.CX Last Name Zip No..^nn-StateCitySt. & No.Middle Legal Description:TWPCaLll uy RANGE ~ C/C/a LAKE OR RIVER NO.TWP.AMESEC.NAME ^ /SfJip d- 'H . jT'O - o<PC> ~ 0 G - on u! - 0<p / TEST HOLE NO. 1 TEST HOLE NO. 2 Cpo2£(p7r)Depth to Bottom of Hole inches; Diameter of Hole inchesDepth To Bottom of Hole Diameter of Holeinches;inches ^v-;/13Depth, Inches Soil Texture 19_^Soil TextureDepth, InchesDate Date 19 I ^ A.'// - 0Percolation Test Bv____ Percolation Test Bv .^Q tuOA /Ou f, ~//'a4c^Firm / > Name. /F irm Name_C(T DO LU tr LUAddress.CC Address < A’.?6C/5 Otter Tail County License No..Otter Tail County License No..H COLUMeasure­ ment. inches Drop in water level, inches Percolation rate minutes per Inch i-Tlme Intervals minutes Time I nterval, minutes Measure­ ment inches Percolation rate minutes per inch Drop in water level, inches Remarks:Remarks:Time Timeo§ I-r.//J~/ //^tl /J: <-/X-13U-EU } -</- lai ; / o!_j;o//'// t fUL1 3"£llj2-C>'^/0.3/nn / 's^/Q Ai-PifMM 04^oJ2£lOJl /£L 0 32^4"Orl G if a>d J^/A /A 6-’•- See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of MN. Percolation rate minutes per inch minutes per inchPercolation rate = i ll/ < N?? ■iWl .^3,’A '^i£ . A Sfi >ik».iBssc. a^sas/ r ^ ^fw^r-^jbJ miL mCS CERTIFICATE OF APPROVAL SEWAGE SYSTEM sHOLDING TANK 17thm,19 3Aday of DecemberThis 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. Pm m » ’ s.-. m The premises covered by this certificate are legally described as: Lake No. 5A-1127 r--' SVERDRUPRange 41Twp. 133h.Sec.Twp. Name mi iMb 133 41 29. 11 GLS 6 8< 7 EX TRACTS LIFE ESTATE TO ESTHER LEITCH i] w-^s. pmaBi [M my. ESTHER LEITCHvJnHNSHN. BEVRRLY J &/. ARLEN K.Owner: NamefA m L MAddress Rtti RnX PB9. UNDFRNOQn. MNIm1 Si^SSfeZip No. mmm Permit No. SP 9499B mSigned by: Land & Resource Management OITicial Oucr Tail County, MinnesotaMKL-098700I I®r* 4^ JT*263191 Victor l.undeen Co.. Primers. 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 rLEGAL DESCRIPTION AND LOCATION (g V' Z______g? V LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER SECTION TWP RANGE TWP NAME 3^ - m \3SCp y/t-FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER(S) iT7 - ~ I IDENTIFICATION: Please Print All Information Last Name First Mailing Address — No. Street. City and StateInitial Zip Code Telephone No. }y j.P4- 1 ^ a39 0 f Bc^ ca,2,> 1^1 M-hProperty Owner Sewage System Installer Name A.M. ► This System will be ready for inspection on , 19.P.M.at This space for office use oniy NUMBER OF BEDROOMS: A.M. P.M19 ( )(?NOGARBAGE DISPOSAL: ( ) YESDale Rec'd Time Rec’d Phone Call Rec'd By SEWAGE DISPOSAL SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM ( Holding tank_5 ) Septic tank ( ) Drain field ( ) Standard ( ) Bed { ) Trench ( ) Modified ( ) Mound TANK DRAIN FIELD GIs.Capacity Sq Ft.( Distance from nearest well Ft. Ft. /30Distance from lake or stream Ft. Ft.ate Distance from building Ft. Ft. Distance from property line Ft.Ft. EFFLUENT DISTRIBUTION Distance from bottom to Water Table Ft.Ft.) Gravity ) Pressure ( All distances are shortest distance between nearest points( WATER WELL DEPTH: ep PERCOLATION TEST DATA: Date of First Test Rate Date of Second Test Rate 1st Test Taken By First Test -F 2nd Test 2nd Test Taken By 2 Rate 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 Minnesota Department of Health. Applicant agrees that plot plan sketches and specifications submitted herewith and which are approved by Shoreland Management Officical 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 responsibilty of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection, i . 22 42^DATE. Signature Permit: Permission Is hereby granted to the above named applicant to perform the \^rk described in th^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 ^ll respects to the Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of any said ordinances. NOTE: Permit void if work is not commenced within six (6) months. Ji.r Bk,Issued Date:Land & Resource ^^nagement Office y fjL r B /< 7yh4y Form No. BK - 0292-003 ^ ^2 77 Fee $Rec #. S^P CcComments: y\Jef 260.771 — Victor Lundeen Co , Printers. Fergus FaUs. Minnesota \ /f'., 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 WhllTE — Office Yeitow — inspector Pink — Owner . - « )tLEGAL drDESCRIPTION AND LOCATION C 7_____gf '-/irct 9, // /?fi SceWm^J^ -Oq. Y LAKE NU lKJ LAKE/RIVER CLASS;r name SECTION"'TWP RANGE TWP NAME RD I3S 4^/fFIRE OR LAKE ASSOCIATION NUMBER ^7 - ^ f fIDENTIFICATION: Please Print All Information Last Name First Initial Mailing Address — No. Street, City and State Zip Code Telephone No. Ay i ^ Le'i'/-o,U P4 I ^ a59 Um Jf’/^Kyr.-SO k/ /i r jje.HProperty Owner y- Name ^ \/ R)CCja^ i/Ce'J^. \Rf / 0:^:2. >Sewage System Installer ''Ritirs. iRC'^^3► This System will be ready for inspection on., 19-at This space for office use only ¥r ( )0NO NUMBER OF BEDROOMS: 2 „ 9J.A.M. P.M GARBAGE DISPOSAL: ( ) YESDate Rec'd Time Rec’d Phone Call Rec’d By SEWAGE DISPOSAL SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM ( TC) Holding tank, ( ) Septic tank ( ) Drain field ( ) Standard ( ) Bed ( ) Trench ( ) Modified ) Mound TANK DRAIN FIELD G's-Capacity Sq Ft. Distance from nearest well Ft. Ft. .^ 30Distance from lake or stream Ft.Ft.pQ C !?an Distance from building Ft.Ft. ( Distance from property line Ft.Ft. EFFLUENT DISTRIBUTION ( ) Gravity ( ) Pressure Distance from bottom to Water Table Ft.Ft. All distances are shortest distance between nearest points WATER WELL DEPTH: 2^^ PERCOLATION TEST DATA: Date of First Test Rate Date of Second Test Rate 1st Test Taken By First Test + 2nd Test /2nd Test Taken By 2 Rate 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 Minnesota Department of Health. Applicant agrees that plot plan sketches and specifications submitted herewith and which are approved by Shoreland Management Officical 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 responsibilty of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection, y , rP~/^ /VJ ZiDATE: Signature Permit: Permission is hereby granted to the above named applicant to perform the that the person to whom it is granted, and his agent, employees and workmen shall conform in This permit may be revoked at any time upon violation of any said ordinances. NOTE: Permit void if work is not commenced within six (6) months. /// To^bove statement. This permit is granted upon express condition 4fll respects to the Ordinance of Otter Tail County, Minnesota. rk described in th Q r BkIssued Date:gLand & Resource ^nagement Office ^ c;^ r^ (3r^h>3 ! £kj/ ^ t '~fz. "p----^0 fRi) P (/o/ypf /r i.\'/ Fee $.Rec #. Comments: -r C , o,~r, Cyy.Form No. BK — 0292-003 260,771 — Victor Lundeon Co., Printers. Fergus Falls. Minnesota/c^' .y at / A •INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS mSEPTIC TAN DRAIN FCATEGORYActualMinimumActual Minimum ILrOtr rffQ !50't~ FT 'jrO "Ssr /IrsoCapacity GLS. GLS. FTftDistance from Nearest Well Distance from Buried Water Suction Pipe FT FT ,^T50 -------50 FT Distance from Buried Pipe Distributing Water Under Pressure 1 V- TO FTFT10FT ^3o FT 3o 3f§“Distance from Lake or River (OHWL)FT ft31 oJX20^Distance from Nearest Building FT FT 1- $0-h FT ^ FTftDistance from Nearest Property Line '^—3Distance from Bottom to Water Table FT FT FT’ Sewer Line to Well Separation DRAINFiELD CALCULATiONINTERPRETATION OF ABBREVIATIONS GLS. = Gallons SF = Square Feet FT = Linear Feet Actual Minimum FTX FT FT 20 FT SF Inspector’s Comments: ___________________________________________________ SKETCH: Inspector's Signature 5- >7-^^ Date of Inspection l~hCr^ Time of Inspection A 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 LEGAL DESCRIPTION AND LOCATION <^L. C> 'f'7 g?v "-h'cKS^^ ^9.// LAKE NUMBER LAKE/RIVER NAME SECTIONLAKE/RIVER CLAgS KD VHP RANGE TWP NAME P/^./ISS t-FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER(S) _5T 1 ! IDENTIFICATION: Please Print All Information Last Name First Initial Mailif>g Address — No Street. City and State Zip Cobe Talephona No. ^4- ; ^ A59 _______Um t/.t/'H/’oe >/ (?! ( «/ <■ Property Owner Sewage System Installer Name ■7XO€X. uCt A.M. ► This System will be ready for inspection on P.M.. 19.at This space for office use only GARBAGE DISPOSAL: ( ) YES ( )(5 NO NUMBER OF BEDROOMS:AM. 19 P.M., Dale Rec'd Time Rec'd Phone Cali Rac'd By SEWAGE DISPOSAL SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM ( Holding tank.^ ( ) Septic tank ( ) Drain field ( ) Standard ( ) Bed ( ) Trench ( ) Modified ( ) Mound TANK DRAIN FIELD /d>(^ GIs.Capacity Sq Ft. Distance from nearest well FI.FI. strearr^^ C ^ 30Distance from lake or Ft.Ft.an Distance from building Ft.Ft. Distance from property line Ft.Ft. EFFLUENT DISTRIBUTION ( ) Gravity ( ) Pressure Distance from bottom to Water Table FI.Ft. All distances are shortest distance between nearest points WATER WELL DEPTH: PERCOLATION TEST DATA: Date of First Test Rate Date of Second Test Rate 1st Test Taken By First Test + 2nd Test 2 Rale2nd Test Taken By Agreement: The undersigned hereby makes application (or permit to Install or extend Sewage Disposal Syslem herein specified, agreeing to do all such work in strlcf accordance with Ordinances ol Ihe County of Olter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minnesota Department of Health. Applicant agrees that plot plan sketches and specificalions submilted herewith and which are approved by Shoreland Management Officical 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 responsibilty ol the applicant for the permit to notify the County Shoreland Management lhat the job is ready for ins lion. 2^Q^cMkDATE;. Signaiur9 **' ’ Permit: Permission is hereby granted to the above named applicant to perform the vfbrk described in th^bove statement. This permit is granted upon express condition that the person to whom it is granted, and his agent, employees and workmen «hall conform in 4ll respects to the Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of any said ordinances. NOTE: Permit void If work Is not commenced within six (6) months. OL^ pAC Bk. Lend & Resource Management Office JIssued Date: Comments^P SIC 4-rt^lr /la'f- /m. ^ ii —■pa r fS Fofm No. BK — 0292-003 L 280.771 — vtclw Lund«n Co . Pclmot*. Fotgus FoHs. Minnoooti Fee $.Rec #. ~krf/er^ ca/ /6 U K-TSLik/MUUk^I y A 7^ [t^—/ oC> /I ,5 \/\I \\ r /■j. t/\^2CV?Z \ ^//7y ;^/i >/MM {> Z I \ > !1 4/IU.X i 1if>IIKX4/22(\ 7 % y +■ i1%]s£jSiJ!_L_5 \■i coiij Srj\t V:iIFT;oi t CERTIFICATE OF COMPLIANCE SEWAGE SYSTEM m day of_This certificate has been issued tfUs Jird ■TantmrySt m to certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota. I The premises covered by this certificate are legally described as: M.56-449 Sec._L Twp. 131 Range_JtL Twp. Name SvgrdrupLake No. N.E. COT. of G.L. 7 m r--. m I for Mrs. Agn»sChester LgltrhOwner: Name.g. Address.llnrfeTMnrxI, M^nnear>^^^ Zip No.56586 Permit No. SP..laa 1S903S >'='IMI L 4 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 /i)£ (1m. ^ - /I . 7/ 2^Permit No.,LEGAL Date DESCRIPTION AND esi 5vV/Location TWP Name^roJL/ Lake No.Lake Name Lake Classif.Sec.TWP Range IDENTIFICATION: Please Print All Information. Mailling Address —No. Street, City and StatefcInitial Zip No,Tel. No.Last Name ^ Ytu^ ■ Arj(%ji^ yj'mjCa //) o \ yName______/''y ^ nf ^ A o^^Kg '/7? ^ . OWNER SEWAGE SYSTEM INSTALLER 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 atk' c25 SEWAGE DISPOSAL SYSTEM DATA: DRAIN FIELDSEPTIC TANK SEEPAGE PIT \/cJ' '•n A „ /Tr GIs.Sq./t.Sq/Ft.Capacity 3 tTG ^ Ft.Ft. Ft.Distance from nearest well P Ft.Ft.Ft.Distance from lake or stream /O t Ft.Ft.Distance from occupied building Ft. /O ^ Ft.Distance from property line Ft.Ft. X 7Ft.Ft.Tt.Distance from bottom to Water Table AH distances are shortest distance between nearest'points RECORD OF TESTS:HoV Inspection was made on ,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 ~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 covergi responsibility of the applicant for the permit to notify the County Shoreland Management that the jotris re itil it has been inspected and accepted. It shall be the for inspection. (Call or use attached mailer notice.)■/ L/oDated a Signature Permission is hereby granted to the above named applicant to perform the work described in the above statement. This pemit 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 161 months. Permit: Issued Date; Shoreland Management Office Fee $Surcharge $/?o Comments:. Form No. MKL-0771-003 158906 vicToa LUNOCCH k CO.. 9oihT(8i. rcetus falli. .i 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., LEGAL Date DESCRIPTION AND LOCATION TWP NameLake Classif.Sec.TWP RangeLake No. Lake Name IDENTIFICATION: Please Print All Information. Zip No.Tel. No.Mailling Address —No. Street, City and StateInitialFirstLast Name OWNER SEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection on., 19. This space for office use only M.19 Phone Call Rec'd By Owner or Agent Signa.tureDate Rec'd Time Rec'd 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: M By,, 19 , TimeInspection was made on PERCOLATION TEST DATA:Date of First Test ,, 19 , Rate Date of Second Test 19 , Rate 1st Test Taken By First Test -F 2nd Test 2 Rato 2nd 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 expressPermit: 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. Issued Date: Shoreland Management Office Fee $Surcharge $ 4^- Comments:. 158906Form No. MKL 0771-003 i-. 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 S F 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 2020FFF F F F Distance from Property Line 10 10 10FFFFF F Distance from Bottom to Water Table 4 4FFFFF F Inspector's Comments: ____-jh fol j 0 »r~y~'> 11 I Date of Inspection 19. Time of Inspection M Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs Gallons SF * Square Feet F ■ Linear Feet Job Title AgencyMKL-0771-003-Backer >