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HomeMy WebLinkAboutPocahontas Resort_14000180149000_Septic System Permits_^^-C/yyJC^ (2W /^H A / - 4y/3 <^>*->->^d€^ /nhi. LmcJ llTWU. j .... /y 4** __JL:Ji_ y- // ^s'..........§ /^34^5' __ '/ .— )*■ ' „ J, \ij,-\«!! i/>i*'■As^ T 5>^ m IV''ii >f/j CERTIFICATE OF APPROVAL SEWAGE SYSTEMIpJ gr MR il » mm'iThis Certificate has been issued this 1ST of FEBRUARY, 1999 certify that the sewage system installed as per Sewage Treatment System Permit Number 11693 A,B&C has been approved for use by Otter Tail County, Minnesota. , to 7X is K'IThe property served by this Sewage System is legally described as:iW1UNPLATTED PT G L 1 S OF RD BG SW COR, E 240', NWLY 210' TO HWY, SW ON HWY TO W LN G L 1, S 130' TO ij W.BG ) Parcel Number(s): 14000080063001 rMmSection: 08 Township: 135 Range: 040 Township Name: DEAD LAKE TOWNSHIP Lake/River Number: 56-383 Lake/River Name: DEAD Current Property Owner: COLLENE C BARNICK Number of Bedrooms: * * (A)-5 CEfcans/ID bedcoans (1-5)0^5 CEisi^O bedmoDK (WD) (Q-ftme & Offic^todb)^ /• Land & Resource Management Official r/k^ i % Ti I :Xf 264.709 • Victor Lundeon Co.. Printers • Fergus Falls. MN • 1 •800-346-4670 APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM WHITE — Office Yellow — Inspector Pink — Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218)739-2271 - FERGUS FALLS, MN 56537 II APermit No.LEGAL DESCRIPTION Abatement: ( ^ ) Yes ( ) Nor \rAND LOCATION LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS SECTION RANGE TWP NAMETWP. NO. 5-63 ^0I3srn PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER IDENTIFICATION: Please Print All Information Initial Mailing Address — No. Street, City and State Zip CodeLast Name First Telephone No. Pc? 3C.Ct llZrt\^Property Owner iJ +Sewage System Installer Name cvv" \r AM. This System will be ready for inspection on., 19.P.M.at This space for office use only 10NUMBER OF BEDROOMS: A.M. P.M19 GARBAGE DISPOSAL: ( ) YES ( p<^) NOPhone Call Rec'd ByDate Rec’d Time Rec’d SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) ( vO Septic tank ( v"’^ift station (Alarm required) ( v/^rain field ) Trenches ( y/fBed ( ) Mound ( ) Outhouse ( ) Sewer line TANK DRAIN FIELD zasTf^Capacity GIs.Sq Ft. /tooDistance from nearest well Ft. Ft. Distance from lake or stream Ft.Ft.\ro /ra( / o'Distance from building Ft.Ft. f loDistance from property line Ft.Ft.\o 3Distance from bottom to Water Table Ft.Ft. EFFLUENT DISTRIBUTION ( ) Gravity ( v<Pr All distances are shortest distance between nearest points PERCOLATION TEST DATA:assure WATER WELL DEPTH W^\\. L q-xT-nC^;VY~<-X<Perc Tester.Date of Perc Test hU I S3Rate of 1 St Test Rate of 2nd Test Average 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 Flealth. 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. DATE: 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 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. la-s-'iQ tvla- ,s-qiIssued Date: Larrd & Resource Management Office Fee $.Rec #. Comments: 277,212 • Victof Luftdeen Co.. Printers » Fergus Falls, MinneostaBK 0795-003 APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM/ WHIl^ » Yellow Pink —’Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218)739-2271 - FERGUS FALLS, MN 56537 ♦ — tespeclor /I AS(S 4i SCLEGAL y DESCRIPTION : Permit No. O Abatement: ( ^ ) Yes ( ) No•SAND »LOCATION LAKE NUMBER LAKE/RIVER NAME -SECTIONLAKE/RIVER CLASS RANGETWP. NO.TWP NAME ^ -S_C\ c5i \VOIn PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER-\-0 ?\ T>i_ -107, . IDENTIFICATION: Please Print a(| information Last Name A -1 ■ J First Initial Mailing Address — No. Street, City and State Zip Code Telephone No. V Po Bt -1^---------------1Property Owner IX V>res'73yv^ fjj \'Ln irvN +)’ o>iV rSewage System Installer Name _TP13t£Z /^cOOThis System will be ready for inspection on , 19.at ^ImIer of 10 C 7This space for office use only ' \BEDROOMS:^3o 4^ ^19 GARBAGE DISPOSAL: ( ) YES ( X.)Date Rec'd Time Rec'd Phone Call Rec'd By SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) ( vO Septic tank (Lift Station (Alarm required)^ (\/)'*Drain field * ( ) Trenches ( v^ )'Bed ( ) Mound ( ) Outhouse ( ) Sewer line TANK DRAIN FIELD ^ 3^ Sq Ft.Capacity GIs. / foos-oDistance from nearest well Ft. Ft.“TTivlc ■ Distance from lake or stream Ft.Ft.O) )Distance from building Ft.Ft./ Z I foDistance from property line Ft. Ft.iO -0 3Distance from bottom to Water Table Ft. Ft. EFFLUENT DISTRIBUTION ( ) Gravity ( v^) Pressure All distances are shortest distance between nearest points PERCOLATION TEST DATA: WATER WELL DEPTH O VJ L 9-XI-11t-'v c^vrPerc Tester.Date of Perc Test. 2./•CO I.S^Rate of 1st Test Rate of 2nd Test Average 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. /DATE:■ r.-/Signature Permit: Permission is hereby granted to the above named applicant to perform the work described in ib'e 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 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 rr S' t.and & Resource Management Office ' JO- -s 1/Issued Date: 23> ~______Fee $. Commentsr^^ i 0 O 0 Rec #. _____________/1 ^ U.44 ____ » lAr W\Vt yvvJnA*4-WyvV *v 277.212 • Victor Lundeen Co . Pnrtters • Fergus Fells. MmneostaBK 0795-003 INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS 4- • i * DRAIN FIELDHOLDING ^ SEPTIC TANK^C~looo ^OOO gls. LIFT TANKCATEGORY Actual Minimum ’ SF ^ (T FT )dOO GLS.SFCapacity e 11^FTFTFTDistance from Nearest Well Distance from Buried Water Suction Pipe FT FTFT50FT Distance from Buried Pipe Distributing Water Under Pressure FTFTFT FT 10 FT>5 I FTFT FTDistance from Lake or River (OHWL) ^04- ft)o^10/20 FTFT FTDistance from Nearest Building t/, r- ft “i. 3 /“O <i c) t FTFTFTDistance from Nearest Property Line lO"^ FT FTDistance from Bottom to Water Table YES NOHolding Tank/Lift Alarm 7^NOOld System Pumped & Destroyed DRAINFIELD CALCULATIONSewer Line to Well SeparationINTERPRETATION OF ABBREVIATIONS GLS. = Gallons SF = Square Feet FT = Linear Feet Actual Minimum It /O .FTFTX S3.^ S<1FT20 FT SF Inspector’s Comments: u r n’SKETCH: iH' -svt) la IS lb Inspectors Signature\ CSFrt * 2>5 V Date of tnspecUon /1'4sa- Time of Inspection APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM WHITE — Office Yellow — Inspector Pink — Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218)739-2271 - FERGUS FALLS, MN 56537 pr gl "P o ^ V ^ LEGAL Permit No. DESCRIPTION Abatement; ( ) Yes { ) Noe W"AND LOCATION LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS SECTION TWP. NO.RANGE TWP NAME &/3S"tsfS PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER IDENTIFICATION: Please Print All Information Last Name First Irtitial Mailing Address — No. Street, City and State Zip Code Telephone No. k io*<p.O UC^sr(l®-W^Property Owner U Sewage System Installer U. >rName ¥ A.M. This System will be ready for inspection on , 19.P.M.at NUMBER OF BEDROOMS: This space for office use only i O A.M. 19 P.M GARBAGE DISPOSAL: ( ) YES ( )() NODate Rec’d Time Rec'd Phone Call Rec'd By SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM TANK DRAIN FIELD( ) Holding tank (Alarm Required) (yr^^eptic tank ( y'futt station (Alarm required) ( -^^-^iJrain field ( )Trenches✓f^d -LZSVCapacity GIs.Sq Ft. £TS>Distance from nearest well Ft. Ft. js~o 1^0Distance from lake or stream Ft.Ft. (lODistance from building 2^0Ft.Ft. ( ) Mound ( ) Outhouse ( ) Sewer line 1(2laDistance from property line Ft.Ft. 3Distance from bottom to Water Table Ft.Ft. EFFLUENT DISTRIBUTION ( ) Gjavity y) Pressure All distances are shortest distance between nearest points PERCOLATION TEST DATA:( WATER WELL DEPTH o^r VPerc Tester,Date of Perc Test /.S'3Rate of 1 St Test Rate of 2nd Test Average 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. DATE: Signature ^ // /f 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 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. Land & Resourcenfanagement Office Ljnl£>-Issued Date: IQjy)50,Fee $.Rec #. Comments: 277,212 • Victor Lundeen Co.. Printers • Fergus Falls. MinneostaBK 0795-003 APPtlCJ^TION.FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM ^ s y^ 'Yellow —JhSpector Pink —^Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218)739-2271 - FERGUS FALLS, MN 56537 -/ Permit NoT^pr Gl /,2.,3^ *LEGAL f\IDESCRIPTION VvLJ Vv 4 ^T Abatement: ( ) Yes ( ) Nor-cso H-anL 4 ILOCATION LAKE NUMBER LAKE/RIVER NAME SECTIONLAKE/RIVER CLASS RANGETWP. NO.TWP NAME 5^0&(-i< ./3S-NC PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER IDENTIFICATION: Please Print All Information Last Name First Initial Mailing Address — No. Street, City and State Zip Code Telephone No. B p.<:7 l3 ^ay F/ Ic^^Property Owner f>r>4 U O. .f V"Sewage System Installer Name (f A.M. y^PtMT► This System will be ready for inspection on //O " //]. 19 ^7 noat NUMBER OF BEDROOMS:'o iThis space for office use only /.T’A.M.^ So sM=i19 GARBAGE DISPOSAL: ( ) YES ( X) *^0Date Rec’d Time Rec’d Phone Call Rec’d By SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) (y^)TSeptic tank ( p-^rtift Station (Alarm required) ( y«')i5rain field ( ) Trenches ( x^'Bed ( ) Mound ( ) Outhouse ( ) Sewer line TANK DRAIN FIELD -L'LSO °l 37 Sq Ft.Capacity GIs. Distance from nearest well Ft.Ft. /^~o 1^0Distance from lake or stream Ft,Ft. toDistance from building 'ZoFt.Ft. \\o/<JDistance from property line Ft. Ft.\ 3Distance from bottom to Water Table Ft.Ft. EFFLUENT DISTRIBUTION ( ) (Jpavity ( x') Pressure All distances are shortest distance between nearest points PERCOLATION TEST DATA: WATER WELL DEPTH D rPerc Tester.Date of Perc Test. 1 1-42^j G G IS2>Rate of 1st Test Rate of 2nd Test Average 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. Signature J ^ / / () 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 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: Ilo- 3,-'i 'I Land & Resourcey^nagement Office Issued Date: •I ';5Fee $ Comments: ~ ^ ^ Rec # /coo t '* 277.212 • Victor Lundeen Co . Printers • Fergus Falls. MinneostaBK 0795-003 INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS m DRAIN FIELDHOLDING SEPTIC TANK LIFT TANK /6c/V FT CATEGORY Actual Minimum ‘f-ro SF4SP^ O cj.0OQ3LS.SFCapacity>------♦ (rn\ » FT lO)^ ^FTDistance from Nearest Well Distance from Buried Water Suction Pipe FTFTFTFT 50 Distance from Buried Pipe Distributing Water Under Pressure FTFTFT10FT /so FT/■^ 0 ft K O ^ ?-0 j-FT FTDistance from Lake or River (OHWL) 4 FTf ft 10/20 FTDistance from Nearest Building FT $■^5 4 ft FTFT10Distance from Nearest Property Line O )i (jU ^3 / (^ -/f®FT FTDistance from Bottom to Water Table AJb> /H^ YES NOHolding Tank/Lift Alarm NOOld System Pumped & Destroyed DRAINFIELD CALCULATIONSewer Line to Well SeparationINTERPRETATION OF ABBREVIATIONS GLS. = Gallons SF = Square Feel FT = Linear Feet Actual Minimum 7r FTlAFTX 5d+ ft FT20 SF Inspector’s Comments: i 1 SKETCH: T i---'Sk'—' ---- F f ']'o^Pf- Inspector's Signature A^3>6 /b-il-17 Date of Inspection /oif Time of Inspection APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM WHITE — Office Yellow — Inspector Pink — Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218)739-2271 - FERGUS FALLS, MN 56537 L U 0*=13pr GcLEGAL Permit No./ DESCRIPTION Vs Abatement: ( ) Yes (v»^ No <i VOs^.AND LOCATION LAKE NUMBER LAKE/RIVER NAME SECTIONLAKE/RIVER CLASS TWP. NO.RANGE TWP NAME 13>S'<40 PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER "b<-- ILZ_ IDENTIFICATION: Please Print All Information Last Name First Initial Mailing Address — No. Street, City and State Zip Code Telephone No. u I ok.'^O >c \2MProperty Owner "SoSewage System Installer fName A.M. ► This System will be ready for inspection on , 19.P.M.at OVhirnv Hpitv^ W O NUMBER OF BEDROOMS: ^This space for office use only A.M. 19 P.M GARBAGE DISPOSAL: ( ) YES ( ^ ) NODate Rec'd Time Rec'd Phone Call Rec'd By SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) ( v)^eptic tank ( V^ift station (Alarm required) ( ) Draimfield ( \yfTrenches ( ) Bed ) Mound ( ) Outhouse ( ) Sewer line TANK DRAIN FIELD Capacity GIs.Sq Ft. ff-c>o lsr:> Distance from nearest well Ft.Ft. Distance from lake or stream Ft.Ft. /oDistance from building 2^Ft.Ft. (!c?Distance from property line loFt.Ft. 3Distance from bottom to Water Table Ft.Ft. EFFLUENT DISTRIBUTION( "^Gravity ) Pressure All distances are shortest distance between nearest points PERCOLATION TEST DATA:( WATER WELL DEPTH WVTTPerc Tester.Date of Perc Test /.5C /.33Rate of 1 St Test Rate of 2nd Test Average Rate Agreement: The undersigned hereby makes application (or 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. IDATE: 7Permit: Permission is hereby granted to the above named applicant to perform the work described in th^above statement. This permit is granted upon express condition that the person to whom it is granted, and his agent, empioyees 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. Signature Lantf-’Sr-ft^source Marktgement Office l<0~ 3Issued Date: Fee $.Rec #. 4"IftOLcSl S__or-3c- W tt r^-Xy'Comments: N par IV ^ ^ 5T5 p ^ V.c,^Vs'e— A YC\i <i.0 rLO 277,212 • Victor Lundeen Co.. Printers * Fergus Falls, MirtneosiaBK 0795-003 r APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYS> WHIT€-f, em6i * Yellow — Inspector Pink — Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218)739-2271 - FERGUS FALLS, MN 56537 So ^M 0S3pr(.c /I.-3^ \ ^ Permit No.LEGAL NDESeRIPTlOSI — Abatement: ( ) Yes No'.'ll r- iAND >)VV Dc-LOCATION i- LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER ■ CLASS SECTION RANGE TWP NAMETWP. NO.E c\~ 5 V3 t)ISS"NSa- r • PARCEL NUMIBER(S)FIRE OR LAKE ASSOCIATION NUMBERro A ’oA\:•be.-■ fy—\IDENTIFICATION: Please Print All Information First Initial Mailing Address — No. Street, City and State Zip Code Telephone No.Last Name 4-9-0 \ZS\Y V4 \ okProperty Owner tV tJ ST,S'~?3yv>■L Sewage System Installer V \Name o- >rv. 9 J ( A.M. ) bf*rMY■/7This System will be ready for inspection on //) ^ /'J //nOO. 19.at Own's-v W O NUMBER OF BEDROOMS: t, ------------This space for office use only 3t/AM.ArJr—------ Phone Call Rec'd By ,U ^'P^M19 GARBAGE DISPOSAL: ( ) YES ( X ) NODate Rec'd Time Rec’d SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) ( '/fSeptic tank ( Lift station (Alarm required) ( ) Drain field ( \ATrenches ( ) Bed ( ) Mound ( ) Outhouse ( ) Sewer line TANK DRAIN, FIELD ' s\’ bapacity > --zy^7 Sq Ft.GIs. Distance from nearest well Ft.Ft. /^ODistance from lake or stream Ft.Ft. l<DDistance from building Ft.Ft. ' \!oistance from property line !0Ft.Ft. 3Distance from bottom to Water Table Ft.Ft.-^rrEFFLUENT DISTRIBUTION( '/Gravity ( ) Pressure All distances are shortest distance between nearest points PERCOLATION TEST DATA:,.-V- -.ri :4WATER WELL DEPTH /.33 Lk V Y' VPerc Tester.Date of Perc Test. f,3o /.3CRate of 1 St Test Rate of 2nd Test Average 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. '^t/1 iDATE:A -t LtSignature Permit: Permission is hereby granted to the above named applicant to perform the work described in the*"above statement. This permitTs 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. /o-3 1 >IIssued Date:\/V—JVLarktsource Management Office i \Fee $._______________ Rec If I o a 4 ^ /I liaoed-sComments: 6 ✓O f -h---S 4~~k4~ I 'V>C_ ^I IX- V'f'v Y-f A r o \i ^ c :: <-i rs i 277.212 • Victor Lundeen Co.. Printers • Fergus Falls. MinneosiaBK 0795-003 t INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS •»-1# .* DRAIN FIELDHOLDING SEPTIC TANK LIFT TANKCATEGORY Actual Minimum J'S'OO GLS.y SF SFICapacityGLS. FT FTDistance from Nearest Well FT Distance from Buried Water Suction Pipe FT FTFTFT 50 Distance from Buried Pipe Distributing Water Under Pressure FT FTFT10FT \/ 5^ FT / VO ft//o FTDistance from Lake or River (OHWL)FT So FT^~0 FT %10/20 FTDistance from Nearest Building FT l~0(f FT'$1^ FTFT FT10Distance from Nearest Property Line FT FTFT3Distance from Bottom to Water Table FT NOHolding Tank/Lift Alarm y'V’ ^ \ NOOld System Pumped & Destroyed DRAINFIELD CALCULATIONSewer Line to Well SeparationINTERPRETATION OF ABBREVIATIONS GLS. = Gallons SF = Square Feet FT = Linear Feet 19-^3MinimumActualFTX Cfy- ^ ^ FT 111FT20 SF )6Inspector’s Comments: cr^ SKETCH: V 7f6 Sis r inspector's Signature V'r Date of inspection Time of Inspection AIR TEST CERTIFICATION On Sewage Disposal System Permit Number C for __pounds per square inch for /-5" (date), an air test of the sewer line installed under (lake/river) was made. At that time, the sewer(owner), on minutes.line held DateInstaller's^ign^re License No. ^ 12/96 Date Resolved CHRONOLOGY REGARDING THE SEWAGE SYSTEM ABATEMEMT Gl i c Ig Property Owner; XD3S3_e,-coLake No. 56-Lake Name: /V- 060 ‘ c?S-00^ 3 -Parcel No.: 2/nl±y ja.X'GOwner's Initial Response (date): ry\ T-h 5 u XcQ. , t Cav\ /a-3~ 5-7 ? ff,3 5/e, lAdn-A-a \ I ( M >v I ukj^ abatement.chronology7-94 P bll 7Sb 3SS rus Postal Ser /lailm aReceipt f rXI No Insurance ( Do not use for rX to > oX X 2 'ee reverse) Sent to m O 2 ^ Street & Number toPost Office, State >Ul 2O'Postage Ul *—1 Ci 7:CJCertified Fee !O Special Delivery I wPJ Restricted Delivei10O)Return Receipt SI Whom & Date De OJ =c Return Receipt Show Date, 4 Addressee's, Q. < TOTAL Postage iO00COPostmarlr or Datego \A1U- -7^7C/)Q. stick pottage stamps to article to cover First-Class postage, certified mail fee, and charges for any selected optional services (See front) ' 1. If you want this receipt postmarked, stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service ^ window or hand it to your rural carrier (no extra charge). 2. If you do not want this receipt postmarked, stick the gummed stub to the right of the return address of the article, date, detach, and retain the receipt, and mail the article. 3. If you want a return receipt, write the certified mall number and your name and address on a return receipt card, Fomr 3811. and attach It to the front of the artide by means of the gummed ends if space pemrits Othenvise, affix to back of article. Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. 4. If you want delivery restricted to the addressee, or to an authorized agent of the addressee, endorse RESTRICTED DELIVERY on the front of the article. 5. Enter tees for the services requested in the appropriate spaces on the front of this receipt. It return receipt Is requested, check the applicable blocks In Kern 1 ol Fomt 3811. 6. Save this receipt and present It if you make an Inquiry. i250) inO)O) =S S; gCOCO iou.COCL SEWAGE SYSTEM ABATEMENT NOTICE LAND & RESOURCE MANAGEMENT COUNTY OF OTTER TAIL COURTHOUSE, FERGUS FALLS, MN 56537 (218) 739-2271 Lake Number: (56-383) Lake Name: DEAD rCOLLENE C BARNICK PO BOX 124 PERHAM, MN 56573 0124 You are hereby notified that the sewage system which you maintain on the following described property: UNPLATTED PT G L 1 S OF RD BG SW COR, E 240', NWLY 210' TO HWY, SW ON HWY TO WLN G L 1, S 130' TO BG Sec: 08 Twp: 135 Range: 040 DEAD LAKE TOWNSHIP Parcel Number: 14000080063001 Lake Assoc/Fire #: DL162 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 within 30 days. You should contact this office in order to determine what corrections and permits are required prior to complying with this notification. Land & Resource Management Official - Dated 7/28/97 / ■1 FIELD NOTES 4/3-vA 7LAKE NAME: DEAD LAKE NO.: 56- 383 DATE Parcel No.; 14000080063001LEGAL DESCRIPTION FIRE NO.: 8 135 40 PT G L 1 S OF RD BG SW COR, E 240', NWLY 210' TO HWY, SW ON HWY TO W LN G L 1,^ IZlO 4 /H 300a So rOWNERS NAME AND ADDRESS: BARNICK, COLLENE C Sys PO BOX 124 56573PERHAM, MN Coimnents;r^s<yr-^-hi (P>) s %r-O p (TL 5-he>r.c^ , SEPARATION DISTANCES(IN FEET) OUTHOUSEABSORPTION AREASEWER LINE TANK 1^WELL nsOHWL fir 7LOT LINE DWELLING NON DWELLING HLGROUND ELEVATION @ REASON(S) FOR ABATEMENT: pro UI prc>it: L'. h-ee(. iAyy\s^ci-(^S 1- 3D 'Tfiv^k <- >0 h(Jt < /60 S, HouS^ - »> “7-^fc S) '7''<v*a/c ! 5S y -T- -«L«u ) lA/i/x ^ ^ ^ s^z--e^ sh-TLc^ SKETCH ON BACK... o.u -«) OM’ < Srxs^ IkI — ScK^I-tS Sys-4^t^ Cf~, —' ^e^LcSL-O^ S-t-C^ lr C/lBXkIF- t') T^hIc s 2) it / C)' ■4^/' • 4) $6 l» A ^ iS-C^ .f <C no Sra-yt^ I «_/«_c /■ 2. f - 4- Z.dyis4yt» 6^^ C-t-sh- eS SyS'h*.-'^ ^jLuCi^yz^ S' t-e.^ sS/^ci-4^i./ ri~ ^ • ri^x^Us) Inspector's Signature(s) V* I I n ^ ^a a-g n lJ i:j OD d n- ?'''.^-T-,--- : <> i vc^@ i. \vO'^\XcUt'^\ \J0>6v^» 5.-;v .\w> Ce> 3 s «l •- ^ ^ = ?i: i “ a ? ^ 'A Ai —r. i r.f,'>) SITE DATA LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, MN 56537 O gWNPB; LAST NAME FIRST TELEPHONE NUMBERMIDDLE ADDRESS: STR./RT CITY STATE l.?S^ ZIP CODE /Oz U ^ 'K.LhOi4 RANGE \ A LAKE/RIVER NO.LAKE NAME SEC.TWP.TWP. NAME LEGAL DESCRIPTION:SOIL BORING LOG COLOR & MUNSELL NO. DEPTH (INCHES)TEXTURE STRUCTURE BLOCKY PLATY PRISMATIC NONEPARCEL NUMBER /)/_BLOCKY PLATY PRISMATIC NONE s;-K ^ fFIRE NUMBER ZPNUMBER OF BEDROOMS BLOCKY PLATY PRISMATIC NONE' im. > GARBAGE DISPOSAL; YES '/■ ' WELL CASING DEPTH:ft.BLOCKY PLATY PRISMATIC NONE /N^ FLOODPLAIN: YES VEGETATION: AQUATIC ^^'TERRESTRIAL^ />y^ j/2.BLOCKY PLATY PRISMATIC NONE SLOPE AT INSTALLATION SITE:%j? TYPE OF OBSERVATION: Probe Pit y 'Til/PARENT MATERIAL; 'Til ORIGINAL SOIL: Yes No COMPACTED SOIL: Outwash Loess Bedrock Alluvium COMMENTS: / ,N^ Yes DEPTH OF BORING;.ft. PERC TEST # 1 PERC TEST #2- TWO TESTS ARE REQUIRED - watcr DEpreT'INTERVAL IMINUTESITIME WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE«■ rT5 -grjr rSTA^c—-0-—TIME DROP PERC TIME PERCDROP INTERVAL (MINUTES!TIME WATER DEPTH WATER DROP PERC RATE TIME INTERVAL IMINUTESI WATER DEPTH WATER DROP PERC RATEYJ7W-'rREFILLREFILL z ^6?^ 7 . TIME * DROP ~ PERC I /oJOTIMEDROPPERC INTERVAL (MINUTES!WATER DROPTIMEWATER DEPTH PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE—L-—67REFILLREFILLId/c?Tux <2.a.TIME DROP TIME DROP PERCPERC INTERVAL (MINUTES)WATER DROPTIMEWATER DEPTH PERC RATE TIME INTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATEREFILLREFILL Tf»lE*^-DROB^ ~TIME PERCPERCDROP WATER DROPTIMEINTERVAL (MINUTES)WATER DEPTH PERC RATE TIME INTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATEREFILLREFIU TIME DROP PERCPERCTIMEDROP INTERVAL (MINUTES) C WATER DEPTH*PERC RATETIMEWATER DROP WATER DEPTH WATER DROPTIMEINTERVAL (MINUTES)PERC RATEREFILLREFILL ---------r--------- =TIME PERCDROPPERCTIMEDROP INTERVAL (MINUTES)WATER DROP-INTERVAL (MINUTES)WATER DEPTH WATER DROPTIMEWATER DEPTH PERC RATE TIME PERC RATEREFILLREFILL DROP TIME DROP PERCTIMEPERC WATER DROP PERC RATE TIME INTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATETIME INTERVAL(MINUTES!WATER DEPTHREFILL REFILL TIME PERCTIMEDROPPERCDROP PROPOSED DESIGN: MOUND.HOLDING TANK. GRAVITY DIST..PRESSURE DIST..J.TRENCH.BED.ATGRADE. SEWER LINE.OUTHOUSE.OTHER.SPECIFY:______________ — SYSTEM DEStam ON BACK — I System design must be to scale and must include the proposed location of the sewageNi^f^m, all existing/proposed buildings, property lines, the ordinary high water level of the water body and all water wells within 150' of the sewage system. GRID PLOT PLAN feet SKETCHING FORM.grid(s) equals feet, or Jnch(es) equalsScale: > SIGNATURE:SUBMITTED BY: FIRM NAME:~I3*i^ s DATE: MPCA LICENSE #: ^ LICENSE CATEGORY: ADDRESS: ^2 OClC-. Orv-r Qa. cr i ! 43t 43 t _ -v( s,-h; - /rej.±5v- I ■ I __f-sc 1 i 1:\HD\ V i 5 i“1 11; s ‘'• 4 r f 3»,.. av4 >>, • . J S ^1 * i a\\I.ij BK — 0496 » 029 281.183 • Victor Lundoan Co.. Printars • Fargus Falls, MN • 1-800*346-4870 SITE DATA LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, MN 56537 OWNER: LAST NAME FIRST MIDDl TELEPHONE NUMBER ADDRESS: STR./RT.CITY STATE ZIP CODE LAKE/RIVER NO.LAKE NAME SEC.TWP.RANGE TWP. NAME LEGAL DESCRIPTION:SOIL BORING LOG COLOR & MUNSELL NO. DEPTH (INCHES)TEXTURE STRUCTURE BLOCKY PLATY PRISMATIC NONE I ^/3 PARCEL NUMBER €l BLOCKY PLATY PRISMATIC NONE^/yFIRE NUMBER NUMBER OF BEDROOMS BLOCKY PLATY PRISMATIC NONE &>GARBAGE DISPOSAL; YES WELL CASING DEPTH: Ufffi /^4c//oMt. BLOCKY PLATY PRISMATIC NONE FLOODPLAIN: YES VEGETATION: AQUATIC \ TERRESTRL BLOCKY PLATY PRISMATIC NONE 5“SLOPE AT INSTALLATION SITE:% TYPE OF OBSERVATION: Probe Pit PARENT MATERIAL:Outwash Loess Bedrock Alluvium COMMENTS;. ORIGINAL SOIL: COMPACTED SOIL: 7 <DEPTH OF BORING:.ft. PERC TEST # 1 PERC TEST #2- WO TESTS ARE REQUIRED - WATgR DEPTHTTIMEINTERVAL (MINUTES!WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE77^9'Z/START 7 5"/O TIME DROP PERC TIME DROP PERC TIME INTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATE INTERVAL (MINUTES)WATER DROPTIMEWATER DEPTH PERC RATEwwfjw 7/l.■7'y*- V.Va-VS.75"REFILL REFILL //.n?TIME DROP PERC TIME DROP PERC TIME INTERVAL (MINUTES!PERC RATEWATER DEPTH WATER DROP TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE..nxu.77-^JrTy7^REFILL 7/2> PERC TIMETIMEDROP DROP PERC TIME INTERVAL (MINUTES!PERC RATE INTERVAL (MINUTES)WATER DROP PERC RATEWATER DEPTH WATER DROP TIME WATER DEPTH hUREFILL REFILL TIME DROP PERCTIMEORQ1C ..PCTC RATETIMEINTERVAL (MINUTES)WATER DROP INTERVAL (MINUTES)WATER DROP PERC RATEWATER DEPTH TIME WATER DEPTHREFiaREFII ^---- =[fi^DROP PERC TIME DROP PERC TIME INTERVAL (MINUTES!WATER DROP PERC RATE INTERVAL (MINUTES)WATER DROP PERC RATEWATER DEPTH riME WATER DEPTHREFILLREFILL TIME DROP PERC TIME DROP PERC PERC RATE INTERVAL (MINUTES) WATER DROPTIMEINTERVAL (MINUTES) WATER DEPTH WATER DROP-TIME WATER DEPTH PERC RATEREFILLREFILL TIMETIMEDROPPERC DROP PERC WATER DROPTIMEINTERVAL (MINUTES)WATER DROP PERC RATE INTERVAL (MINUTES!WATER DEPTH PERC RATEWATER DEPTH TIME REFILL REFILL DROP PERC TIME DROP PERCTIME PROPOSED DESIGN: 7 GRAVITY PI ST. X"PRESSURE DIST..TRENCH ATGRADE.HOLDING TANK.BED.MOUND. SEWER LINE.OUTHOUSE.OTHER.SPECIFY:______________ — SYSTEM DESIGN ON BACK — FIELD NOTES DATELAKE NO.: 56- 383LAKE NAME: DEAD FIRE NO.:Parcel No.: 14000080063001LEGAL DESCRIPTION 8 135 40 PT G L 1 S OF RD BG SW COR, E 240', NWLY 210' TO HWY, SW ON HWY TO W LN G L 1,^ 737^ '^OOO /So rOWNERS NAME AND ADDRESS: BARNICK, COLLENE C Sy^r PO BOX 124 J^OO 5 r^sa-r-i- 56573PERHAM, MN Comments:■htf'-O McmyyiC/\^ej p 0~L SEPARATION DISTANCES(IN FEET) OUTHOUSEABSORPTION AREATANKSEWER LINE 1^WELL nsOHWL 7LOT LINE DWELLING NON DWELLING iGROUND ELEVATION @ REASON(S) FOR ABATEMENT: prc ii.' U* Prc-h '. t>', tL 3>) 'Spv*A, U <- S, S) 5rM<<- ct US ^ - I J0 “T'^v-i.fc: jLu e S'1-c- ^ sS/^u-a^ S) 'T~c»^tc. aV>/5’s/X^ ^ 3^ cLt'C^ S^Z. ^ <^d>t s'h'u, ^ SKETCH ON BACK... dm -0 0M‘ < 'fnts^ IkI.tSi ---■/</*-> D. — Fc^ 3^.S^vO,IjtSl/Ui\S4.ct to -f'i- I^IJIa - C/i&Zk\S- 0 7“A~t\lc s 3*^ FiL^C. f t</>, • V) S<5 ^ < tA S ? ^ /^C? Sf'a-yy^ I tiJc-C, dj0id S'ly !•Sr 2^ t- 4- >r-€S'f~ oS syy/~-I Inspector's Signature(s) LJ Vo K if S' 30 on D D OP i*7^n s> i tyfcS ^1 %• 0 oi>V u K/~^ \/i^II s N vO^\\\\^Ll!\ \j f .\le>\, Co S S o'S- rs\ —> >s r- - ^'>1^0 CERTIFICATE OF APPROVAL u: SEWAGE SYSTEM 3 16 th Fe.bmioAy ]9_JlThis certificate has been issued this day of - ^to certify that the sewage system installed as per sewage permit number indicated below has been approved for use by Otter Tail County, Minnesota. M The premises covered by this certificate are legally described as:iM Vzad Ldfee56-3S3 Twp. ^IS 40Lake No.Sec.Range Twp. Name M 1/Pocahontoi Ruoht iM iM BtlZ Eafintc-kOwner: Name. i7 307 2nd Auenue South. MooAh&.ad, MSIAddress 56560Zip No. 37370Permit No. SP Signed by:. K,Malcolm K. Lee, Land & Resource Management Administrator Oner Tail County, MinnesotaMKL-0987001 Si 237,987 — Victor Lundeen Co.. Printers, Fergus Falls. Minnesota OTTER TAIL COUNTY Sewage Permit No. SP I-iQC3.tl011! LakeI*? Twpf.1^Range_^£ATwp.Namp Uc , K(7<^Ov l4or^T^S ^ S 0 g.T~_________________________ Ns Dej^oOwner's NampBjci- 6>lake 19^, Tn 19 n Work Aiif-lir>ri7:«=>H-T»s7~accT'^fe ^■loo ^K.X )0*7*7 Valid O f NOTE; This card must be placed in a conspicuous place not more than 12 feet above grade on the premises on which work is to be done, and must be maintained there until completion of such work. No part of system shall be covered until it has been inspected or approved. Notify Shoreland Management office when job is ready for inspection. Shoreland Man^ement Official OTTER TAIL COUNTY, MINNESOTA Board of County Commissioners FORM MKL-0871-006 VICTOR LUNOEEN & CO.. PRINTERS. FERGUS FALLS. MINN. 22S, 1 03 t 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 — ornce YbIIow — Inspector Pink — Owner 73 70Permit No.,LEGAL DESCRIPTION AND lie iMg/ Ikih/E.LOCATION Lake No. Lake Clasalf.Lake Name Sec.TWP TWP NameRange IDENTIFICATION: Please Print All Information. Mailing Address — No. Street, City and State Zip No.Tel. No.Last Name First Initial n! o K JAo / -c^S/ //£ALOWNER. > y71nnr\\t‘a <7 . ) ?^V7 -^?>3 0?G3.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 i Owner or Agent Signature NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD /Capacity T7 7S3>! 1^0 ISO se.Ft.Ft.Ft.Distance from nearest well ISO Ft.Ft.Distance from lake or stream Ft. 5 2?!0 Ft.Distance from occupied building Ft.Ft. 10 ioDistance from property line Ft.Ft.Ft. 3Ft.Distance from bottom to Water Table Ft.'t. AH distances are shortest distance between nearest points *—< .-Jl i* ^ RECORD OF TESTS:13j7 Inspection was made on 19 , Time ,M By "'^1 n...Ji.fz.. ... PERCOLATION TEST DATA:Date of First Test 19 Rate o t>i 17...Date of Second Test 19 Rate i\l*t Test TakenII■ i First Test...'...^..^..........+ 2nd Test..f. 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 OffF 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 jof>,is ready for inspection. C.l/hl -IJL ^/ y /ff7.Dated 7iSignature 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 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. Q-)C - S'?Issued Date: aO SNoreienO Management OtSce Fee $Rec # Comments: uiForm No. MKL-032065 — Victor Lundeen Co.. PiMan. Frgui Fall. MN 9 1 V0'^SHORELAND MANAGEMENT — COUNTY OF OTTER TAILyC COUNTY COURT HOUSE Phone 218-739-2271 • Fergus Falls, MN 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM i(t Whito — Omcs Yeltow — Inspector Pink — Owner 3 7oPermit No..LEGAL /J^ISO~00° i^-ooa -1%-nnl-ow DESCRIPTION AND I ...LOCATION TWP NameLake Clattif.Sac.TWP RangeLake No.Lake Name IDENTIFICATION: Please Print All Information. Mailing Address — No. Street, City and State Zip No,Tel. No.InitialFirstLast Name OWNER K. /' SEWAGE SYSTEM INSTALLER Name, This System will be ready for inspection on., 19. This space for office use only 19 M Date Rac'd Owner or Agent SignaturePhone Call Rec'd ByTime Rec'd I<- kV* ■NUMBER OF BEDROOMS;ESTIMATED COST;-w' ■ -- SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD ~ Oq. F4.WiSSf■OtsrCapacity oq. ri. Ft.Ft. Ft.Distance from nearest well Ft.Ft.Ft.Distance from lake or stream V Ft.Ft.Ft.Distance from occupied building Distance from property line / Ft.\^Ft. Ft.Ft.Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS: Inspiection was made on 19,, Time ,M By PERCOLATION TEST DATA;Date of First Test . 19 . Rate 19...L2:..zDate of Second Test , Rate 1st Test Taken By ,.-52^.First Test + 2nd Test....1..../.2 Rata2nd 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. Dated Signature Permit: Permission is hereby granted to the above named applicant to perforrnthe work described in the above statement. This permit is granted upon express condition that the pwrson 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:Shorelend \ Fee $_i Rec #1 Comments: 7 rf-I ij / Form No. MKL-032065 I 225239 — Victor Lundnn Co., PrMm. Firgu* Ftfi, MNL •■'V t V -: tpvar.--' ' -'■ INSPECTION RESULTS Inspector must make all measurements \)SEWAGE DISPOSAL SYSTEM STATISTICS I 2.-X (Qo DRAIN FIELDSEEPAGE PITSEPTIC TANKCATEGORY Should BeActualShould BeShould Be ActualActual I'^OO3000 S FCapacitys FS FGIs.S FGIs. I fHo 13^FDistance from Nearest Well F FFFF /^6 FDistance from Lake or Stream FF FFF f 7f FFDistance from Occupied Building FF FF /O^ FFFDistance from Property Line F FF ^ Jl ■VST33F''Distance from Bottom to Water Table FFF F F jJnspector’s Comments: ■■ ______________________ h v.»»- 3I.Yoc^S rv>cj>,\\ s( crc)< S N/^" tY. ^ — Sudv S Cn S-ci T- A X Cj ' ^LciVfj '0*0 \txyw‘ k SVo.V>-V Y ‘ ■ f w 1931n-t-Date of Inspection / <00 MTime of Inspection <.-) Y t -g-p signature^ln^ec^4-\ INTERPRETATION OF ABBREVIATIONS GIs = Gallons SF = Square Feet F = Linear Feet t_ i Job Title MKL • 032085 • Backer Agency .... V'. V -;.VWv?'■VV<V-;"v„ f' Li^KC. </A 1 ‘j> 7T €ki if^ou^cr *iou%C. !♦ . —Hr=-yf' r-‘ ■■ ;</ _» -—y- -:V I 33 /VI i>N /O'N. i ]!...H ■ ' P .TCI n u ■ ■ o TI , /fr f^ih. il izyzzMzzill f ■©Ucll 10 ll H 13 i *f t I- v>< c i-' ■j_ '^nlCin i^Kfci i'. I■ ^ Ii^'h.l4ooli M II 1 A If- 10.nu^. K \I f/ L 4'^ K rh c:C .0-<vc/_i3 <a.A-<>~>-^-^_ (3. __ Qo—wyg-Q.^^______ ___3 <a^Leg^-e^ ^________________ y____ ? ■1^^___£j2^ _ il ^ 7 / 3 0 /<^^/3g<g ^ T) /3^^ ^___________ ^ ^ ~~~ ____/^_ 7_5 yCT ^ ■ V^) _____/3^?o ___________________ 57£ /I ;J3' Jui^-Qi.Ql DZ> ^ SP^ 737^ <a>-/(g-<zr7 6'1I-8'7 /M A Itt c yAl^uit^ A .93 ll(o2 f=T^ i-12-87 — ■ cAe.■*-«/^ ^-«rr<«•*»> I __HOO e^yjiM^ X .7S .„. _! 0€AiWf/eu»lose ■+-ILAS ( I SJ 7 S fcQ CTfl>^»i) I Pa^ f-!13 /do 13^^ ^ Jio^(3^0 . IS. 5*3 —i.‘fS/ <5 7 f Pt'^ JUeJ^ju) V /'};// _j I xy ^1 h ^ <^ T^cZAK 'r2. \ i^oi-|- rV'^ 3-t- • ! - 4- / ;i r hV,! f /./J (3 ^ (Pt^SLS />v-^ _ 5) ^ '■ J ' ........ <-©-‘^^4^ '^*''' @ ^ -V^ XI4. ^ C^yUZiSk. / rt)</ r/ y^tj^ (i I iI ! i 21SS02® VtCTOK LUNOECM CO., PRINTED*. FERGUS FALLS. UINN.PERCOLATION TEST DATAMKL -0871 -028 LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, Minnesota 56537 r,U'-3 )).jJPh. No. ■ 'ib* Mailing Address:Owner: f)r?. TY) >'c.\< Zip No.TSt. & No.StateCityFirstMiddleLast Name Legal Description:,Z£Hllj^u TWP. I X. 'j TWP NAMERANGESEC.NAMELAKE OR RIVER NO. TEST HOLE NO. 2TEST HOLE NO. 1 A Depth to Bottom of Hole inches; Diameter of Hole.inchesDepth To Bottom of Hole.inches;Diameter of Hole inches 7 1919 S' 7- ~7Depth, Inches Soil Texture Depth. Inches Soil TextureDate Date alien SLmXjAj P))lkL/ ISiy^ £:^£ ercolation Test By___nw ,/ Test ByX' /o•I aUJFirmName.F irm Name.GC DOLii cr g**-! P..I.V i^^fVf-5 /T7 /77^'?ALUAAJdJ, cr \CfilVAddress. Address < CO Otter Tail County License No..Otter Tail County License No.,CO LUMeasure­ ment, inches Drop in water level, inches Percolation rate minutes per Inch F-Time I nterval. minutes Measure­ ment Inches Drop in water level, inches Percolation rate minutes per inch Time Intervals minutes Remarks:Remarks:Time Timeo5 3^'3 -.6L El11_ Szuuu- 3^/•^ . A& 4!3-tiw S^/n,'nJ cq- M 30 ULH : m n^3(2.3fruijL ul LIO .4:llH.H . !?>3t22z/V3 am'Nj LlV: H: H '-HO O mJJ33>B0iiKt.3minj LL LEClo LIH: hb 3/Y\iIu UL LIH ;33aH3 CL il , -1V See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of MN. Percolation rate minutes per inch minutes per inchPercolation rate =