HomeMy WebLinkAboutRush Lake Tent-Trailer Park_47000290200000_Septic System Permits_APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM
LAND & RESOURCE MANAGEMENTOTTER TAIL COUNTY COURT HOUSE
Phone: (218) 739-2271 - FERGUS FALLS, MN 56537
WHITtE — Office
YELLOW — L&R Inspector
PINK — Owner / Contractor
/33 5rP-h. ^ L HS- 4- SB
^ Pait
Permit No.LEGAL
DESCRIPTION ) Yes C)><P)NoAbatement: (AND
LOCATION
RANGE TWP NAMELAKE/RIVERCLASS SECTION TWP. NO.LAKE NUMBER LAKBRIVER NAME
isr oi-foSS/‘Yj dr 0
FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER(S)'
y 7-000- o S^OO- ooo
IDENTIFICATION: Please Print All Information
Zip Code Telephone No.Initial Mailing Address — No. Street, City and StateLast Name _______First y.
fi4-4- / rfr)L-g-Property
Owner Z/0>I f
fZS7/7*/Yj-e^L c (s> o aJ
'3_________
Sewage
System
Installer
Name
State Lie. If
A.M.
P.M.>■ This System will be ready for Inspection on_the year of .at.
This space for office use oniy NUMBER OF BEDROOMS:
AM.
.P.M.GARBAGE DISPOSAL; ( ) YES {^) NODate Rec'd Year of Time Rec’d Phone Call Rec’d By
TYPE OF SEWAGE SYSTEM
( ) Holding tank (Alarm Required)
( yC ) Septic tank
(^ ) Lift station (Alarm Required)
(^1 ) Drainfield
( ^) Trenches
( ) Bed
( ) Mound *
SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTS
DRAINFIELDTANK
/S30vs^go GIs.Capacity
^0 Ft.Ft.Distance from nearest well /C>Xj
■go Ft.Distance from lake, wetland or river (OHWL)Ft.
'/O Ft.Distance from dwelling Ft.
1 o Ft.Distance from non-dwelling Ft.() Outhouse
) Sewer line /o^0 Ft. Ft.Distance from property line
EFFLUENT DISTRIBUTION
( ) Gravity
(yC) Pressure
2Ft.Ft.Distance from bottom to Water Table
All distances are shortest distance between nearest points
PERCOLATION TEST DATA:WATER WELL DEPTH
* ABSORBTION AREA FOR MOUNDS y-,3-ooDate of Perc TestDesigner Lie. #
ft2
Highest RateRate of 1 St Test Rate 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 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 Management that the ji
DATE:_______OX)
js pady foi/inspection.d.
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.
y~ c ~o o /
Issued Date;
Land & Resource Management Office
$7>. -/3/76XFee S Rec it
Comments:
BK 1099-003 298.110 • Victor Lundecn Co., Printers • Fergus Falls, Minnesota
4^
APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTi
LAND & RESOURCE MANAGEMENTOTTER TAIL COUNTY COURT HOUSE
Phone; (218) 739-2271 - FERGUS FALLS. MN 56537
WHlt^ — Office
YELLOW — L&R Inspector
PINK — Owner / Contractor
14-2 Sf ji.
/? w j A /i? /^4- 7-"^ ^' ~T<lcc' Po/t ^
Permit No.LEGAL
DESCRIPTION )Yes NoAbatement: (AND
LOCATION
SECTION TWP NO.RANGE TWP NAMELAKE/RIVERCLASSLAKE NUMBER LAKE/RIVER NAME
Oi 4OS(cr /V/dr 0 \ 3^ \ ISC \^t
FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER(S)
^y-OOO-- 0 2 00 - OOO
IDENTIFICATION: Please Print All Information
Zip Code_______first /. Initial
/c^ g/
Mailing Address — No, Street, City and State Telephone No.Last Name
/?/ ^ / r YY-Or Ak)
0//p t Ay
-g i s-Property
Owner
fYj-e L Jftc do /J
Sic'I________
Sewage
System
Installer
Name
State Lie. ft
i-f-'?^-crxj
/SClO^^0-c)>■ This System will be ready for inspection on.the year of at
This space for office use oniy NUMBER OF BEDROOMS:
PM.GARBAGE DISPOSAL: ( ) YES ()<) NO
Date Rec'd Year of Time Rec'd Phone Call Rec'd By
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(
/5~30H<>(yo GIs.Capacity
50 Ft.Ft.Distance from nearest well
Ft.Distance from lake, wetland or river (OHWL)Ft.
'/oDistance from dwelling Ft.Ft.in.I OJAFt.Ft.Distance from non-dwelling
/oto Ft.Ft.Distance from property line
EFFLUENT DISTRIBUTION 2Ft.Ft.Distance from bottom to Water Table( ) Gravity
('yC) Pressure All distances are shortest distance between nearest points
PERCOLATION TEST DATA:WATER WELL DEPTH
* ABSORBTION AREA FOR MOUNDS y~30O743Date of Perc TestDesigner Lie. #
.ft2
5. 77Highest RateRate of 1 St Test Rate 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 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 Management that the joMsjeady for inspection.DATE:_______A ~ C - 00__________________ ^\
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.
V' Cn oIssued Date:
Land & Resource Management Office
/- CO5n. —/3/76XFee $.Rec #
Comments:
«BK 1099-003 -298.110 • Victor Lundeert Co. Printers • Fergus Falls. Minrtesofa
. TTT. ' ■■ I ,
INSPECTION RESULTS
Inspector must make all measurements
SEWAGE DISPOSAL SYSTEM STATISTICS
DRAINFIELDHOLDING
SEPTIC TANK LIFT TANKCATEGORY MinimumActual
f^dx>500Capacity
FT 2FT 2GLS. GLS.
-h./’■raf FT^S-6Distance from Nearest Well FT
Distance from Buried
Water Suction Pipe FT 50 FTFTFT
Distance from Buried Pipe
Distributing Water Linger Pressure FT 10 FTFTFT
cPOO+FT Pod-F ftDistance from Lake, Wetland or River (OHWL)ft FT
FTDistance from Dwelling 'iO-h ft
lao-hn
/^-^FT
•/" FT 10/20 FT
Distance from Non-Dwelling
ft iZ>4- FT FT
/(rf'hrtDistance form Nearest Property Line
10 FT
gP- FTDistance from Bottom to Water Table / Restrictive Layer FT3FT FT
Holding Tank/Lift Alarm NO
Old System Pumped & Destroyed YES NO
DRAINFIELD CALCULATIONSewer Line to Well SeparationINTERPRETATION
OF ABBREVIATIONS
FT«
MinimumActual
GLS. = Gallons
FT^ = Square Feet
FT = Linear Feet
FT
/5 V)fFFT20
MOUND CALCULATION ROCK REDUCTION
Inspector’s Comments:T(P^ ^ inches
ABSORBTION AREA
Rock trenches with
\Ft. X■G .%of rock under pipe for
,Ft2
■tr .ff2 DRreduction / equivalent to
I \SKETCH:
|1
)
rint Inspector's Name
5"^^^
tpector’s Signature
IScb 1‘r'iO I'iO/)
Date / Time of Inspection ’
CO \
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SITE DATA received
APR - 6
LAND AND RESOURCE MANAGEMENT
Otter Tail County
Fergus Falls, MN 56537
4
land & RESOURCE
I ^ ^ ct t- t*. k \*DOWNER:
l2:Lvs.s>v
LAST NAME FIRST MIDDLE TELEPHONE NUMBER
ADDRESS:
STR./RT.CITY STATE ZIP CODE
c^to
RANGELAKE/RIVER NO.LAKE NAME SEC.TWP.TWP. NAME
LEGAL DESCRIPTION:SOIL BORING LOG — Date
COLOR &
MUNSELL NO.
DEPTH
(INCHES)TEXTURE STRUCTURE
ditJ'j.
BLOCKY
PLATY
PRISMATIC
NONEPARCEL NUMBER
Z)BLOCKY
PLATY
PRISMATIC
NONE
/ f /
FIRE NUMBER
NUMBER OF BEDROOMS BLOCKY
PLATY
PRISMATIC
NONE
GARBAGE DISPOSAL: YES ;MO
ft.WELL CASING DEPTH:BLOCKY
PLATY
PRISMATIC
NONE
FLOODPLAIN: YES
^f^STRIAL:^VEGETATION: AQUATIC
BLOCKY
PLATY
PRISMATIC
NONE
/ %SLOPE AT INSTALLATION SITE:
TYPE OF OBSERVATION:Probe Pit Boring ■
Outwash Loess Bedrock AlluviumPARENT MATERIAL: Till COMMENTS:.
ORIGINAL SOIL:Yes No
COMPACTED SOIL: Yes No
DEPTH OF BORING:.ft.
PERC TEST #1 PERC TEST #2- TWO TESTS ARE REQUIRED -
TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE
/t .Z7W7ISTARTSTART6 ,1ti(s -4P"-5^TIME DROP PERC
WATER DEPTH
TIME INTERVAL IMINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DROP PERC RATETU7EFREFILL/O^ ^ -Z.00s:REFILL
....Ill—2TIMEDROPPERC TIME DROP PERC
TIME ^ INTERVAL (MINUTES)
mil.
WAT^R^EPTH WATER DROP PERC RATE TJME
'EM'INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEREFILLREFILL
liul;.u.TIME DROP PERC TIME DROP PERC
WATER DROPTIMEINTERVAL (MINUTES)WATER DEPTH PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE..j.i......4A...
---fs----
REFILL REFILL JO.3^ =115•7r-_*-.133.IQ....____iH3 TIME DROP PERC TIME DROP PERC
PERC RATE
TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROPREFILLREFILL
TIME ‘ DROP PERCPERCTIMEDROPTIMEINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEREFILLREFILL
TIME DROP PERC TIME DROP PERC
PERC RATE
TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROPREFILLREFILL
TIME ' DROP PERC
PERC RATE ___
TIME DROP PERCTIMEINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROPREFILLREFILL
-r_i_jTMr: :pm)P:_._.-wHr;,TIME DROP PERC
aPROPOSED DESIGN:
A'TRENCH BED ATGRADE MOUND.HOLDING TANK. GRAVITY DIST. PRESSURE DIST..
SEWER LINE.OUTHOUSE,OTHER.SPECIFY;.
— S YSTEM DESIGN ON BACK —
System design must be to scale and must include the proposed location of the sewage systemr, all
existing/proposed buildings, property lines, the ordinary high water level of the water body and all wat^
wells within 150' of the sewage system.
_feet SKETCHING FORMScale:grid(s) equals feet, or inch(es) equals
cSUBMITTED BY:SIGNATURE:
DATE:
MPCA LICENSE #:
LICENSE CATEGORY: /
"HPFIRM NAME:________________
ADDRESS: ^-1
r
;
;
BK — 0496 - 029
CERTIFICATE OF APPROVAL%
SEWAGE SYSTEM
Dec emb er15thThis 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.
mm The premises covered by this certificate are legally described as:
Twp. NameOTJORange 3856-141 Twp. 135Sec. 29Lake No.SSi.
29 135 38 54. 1
i)PT GL 1 2 & SEl/4
BG 2120.38' N FR SE CR SEC:
N 1306. 07WLY 1728.73',
m ELY ON LAKE TO E LINE SLY 1480'
HAGAMEISTER. DANIEL GENEOwner: Name
RR 1. OTTERTAIL. MNAddressi1W''56571Zip No.
Permit No. SP 10f)R6
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
^C>f-J- o-f GL U ^ ^Permit No.LEGAL
DESCRIPTION
AND
LOCATION
RANGE TWP NAMESECTIONLAKE/RIVER NAME LAKE/RIVER
CLASS TWP. NO.LAKE NUMBER
/ sr-/y /tO :5 7 7J-
FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER(S)
IDENTIFICATION: Please Print All Information
Zip CodeMailing Address — No. Street, City and Slate Telephone No.Last Name First Initial
!U ^ G <jO%Property
Owner
p/t 6.1- ^ c.Sewage
System
Instailer
Name
A.M.
^ This System will be ready for inspection on P.M., 19.at
This space for office use only _____f
GARBAGE DISPOSAL: ( ) YES ( NO
NUMBER OF BEDROOMS:
A.M.
P.M19
Phone Call Rac'd ByDale Rac’d Time Rac'd
SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM
( ) Holding tank (Alarm Required)
(■y ) Septic tank
(/^) Lift station
( ) Drain field
( ) Standard ( ) Bed ()^) Trench
( ) Modified
( ) Mound
( ) Outhouse
TANK DRAIN FIELD
37S" sqnH3GIs.Capacity Ft.
^o//cr6SOFt. Ft.Distance from nearest well
5*0 sroDistance from lake or stream Ft.Ft.
^o/^o/ f")Distance from building Ft.Ft.
/ 0Distance from property line JO Ft. Ft.
3Distance from bottom to Water Table Ft. Ft.
EFFLUENT DISTRIBUTION
(X) Gravity
( ) Pressure
All distances are shortest distance between nearest points
PERCOLATION TEST DATA:
WATER WELL DEPTH
(
OUL /luCPerc Tester.Date of Perc Test
/, J/^rRate 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.
6,^DATE:
/Signature
Permit: Permission is hereby granted to the above named applicant to perfdfm 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.
^ ^ p o - ^ rIssued Date:
Land & Resource Management OfficeIf.Fee $.Rec ft.
Comments:
272.858 • Victor Lundoen Co. Printers. Fergus Falls. MinnesotaFarm No. BK-0894-003
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
/of^Cf4 o -f GL Jii Permit No.LEGAL!I
DESCRIPTION
AND
LOCATION
TWP NAMERANGESECTIONTWP. NO.LAKE/RIVER
CLASSLAKE/RIVER NAMELAKE NUMBER
/'>!■
-/y/6 ^
FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER(S)
^ ooo- y ~ o ooc>
IDENTIFICATION: Please Print All Information
Zip Code Telephone No.Mailing Address — No. Street, City and StaleFirst InitialLast Name
14c,J GoO
6Jh^ L.
Property
Owner 7“
lOAM
|^U 6 L 4i CLSewage
System
Installer
Name
!
/A.M.
, 19.This System will be ready for inspection on at
• F,/V ►'i-
f grg?:
GARBAGE DISPOSAL: ( ) YES'^^' 'T^
This space for office use only - a)NUMBER OF BEDROOMS:
jS.52 A.M,
P.M19
Phone CalfRec'd ByTime Rec'dDate Rec'd
SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM
( ) Holding tank (Alarm Required)
(y ) Septic tank
(y) Lift station
( ) Drain field
( ) Standard ( ) Bed ()^) Trench
( ) Modified
( ) Mound
( ) Outhouse
DRAIN FIELDTANK
37S" s,GIs.Ft.Capacity
^ o/crOFt.Ft.Distance from nearest well
so Ft.Ft.Distance from lake or stream
/o/)o/nDistance from building Ft.Ft.
/O111Distance from property line Ft. Ft.
3 Ft.Distance from bottom to Water Table Ft.
EFFLUENT DISTRIBUTION
(X) Gravity
( ) Pressure
All distances are shortest distance between nearest points
PERCOLATION TEST DATA:
WATER WELL DEPTH
f
Oi^L /k.C C>-S- T\'%
Perc Tester.Date of Perc Test
1
A/ ^ r/, 7 >Rate 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.
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.
G -'0- "7 rDATE:
7
(o~ 0 O'issued Date:■tT
Lsr6 & Resource Management Office7 i .//q'7yj:' !\Fee $.Rec #.
Comments:
272.858 - Victor Lundeen Co.. Printors. Fergus Falls. MinnesotaForm No. BK^OSaseOS
•- f /f-V
INSPECTION RESULTS
Inspector must make all measurements
SEWAGE DISPOSAL SYSTEM STATISTICS
SEPTIC TANK DRAIN FIELD
CATEGORY Actual Minimum Actual Minimum
Capacity GLS. GLS.cy SF SF
FTftDistance from Nearest Well FT FT50
Distance from Buried
Water Suction Pipe R R R R5050
Distance from Buried Pipe
Distributing Water Under Pressure RRR R 1010
S 00 ft RDistance from Lake or River (OHWL)R R
/10/20 RR10 -r RDistance from Nearest Building R 10
/- ft RDistance from Nearest Property Line R R10 10
i-
A-Distance from Bottom to Water Table R R 3 RR
~7 7YES^NOHolding Tank/Lift Alarm
DRAINFIELD CALCULATIONSewer Line to Well SeparationINTERPRETATION
OF ABBREVIATIONS
GLS. = Gallons
SF = Square Feet
R = Linear Feet
Actual Minimum O'ooo RX
:'OOt R onR20 SF
Inspector’s Comments:
/I •OrV
SKETCH:
Inspector’s Signature
Date of Inspection
! o C)0
sa.'Time of Inspection
T*.
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* A •/ *
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5
5i
RUSH LAKE XENT-TRAILER PARK
Junior', Lil, Dan Ha^emeister
OTTERTAJL, MINN. 56571
Phone 218-385-3400
GRID PLOT PLAN SKETCHING FORM — (Must Be To Scale)
/
feet/inchesScale: Each grid equals
13L___19.^Dated: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.^
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PERCOLATION TEST DATA 4
LAND AND RESOURCE MANAGEMENT
Otter Tail County
Fergus Falls, MN 56537
OWNER:
01^} y 4^ /t-CuAj> ir
TELEPHONE NUMBERMIDDLEFIRSTLAST NAME
ADDRESS:
Sot^oo £1121My\J
.ta'te ZIP CODECITYSTR./RT.
m:0-^013SL
TWP.LAKE/RIVER NO.TWP. NAMERANGESEC.LAKE NAME
T^An / fc L >/LEGAL DESCRIPTION:
PARCEL NUMBER
NUMBER/BEDROOMSFIRE NUMBER
— TWO TESTS ARE REQUIRED —
TEST HOLE NO. 2
Depth To Bottom of Hole ^ inches; Diameter of Hole___^
TEST HOLE NO. I
Diameter of Hole ^Depth To Bottom of Hole inchesinchesinches;
—i_j^=—^- /s 19 9s-
“Th^/u
19DateSoil TextureDepth. Inches DateSoil TextureDepth. Inches
/V"Top S’c-it LPercolation
Test By _
Firm
Name
Percolation
Test By__
Firm
Name __
iJ€U\
^6>S7 /
2o 7 ^_________
r3A<irlcL'A mu £-<£?f
TZ-O 9 2._______
Address Address
Otter Tail County
License No.
Otter Tail County
License No.
PERC TEST # 2PERC TEST # 1
WATTODROP PERC RATE TIME WTBRVALfMlNin-BS^WATER DEPTH WATER t>ROPINTERVAL ff»CWirrBa WATER DEPTHTP--------------L-3-Cc?__
PERCRATnTIME
3^
'^suiS
3;s7
i/io7
STARTSTART
TIME * PROP PERC.r....u ....JO.....3_Cz...lO—...
PERC RATEWATER DROP PERC RATE TIME INTERVAL IMPUnro Water depth WATER DROPinterval IMTNI7TES)E^rgRDEPTHTIME
IfUO .^.1.F..1‘L.O l.lH REFILLREFILLU/.9.to ..3-7—-■fPBRC DROP P&RC4.
PERC RATE INTERVAL fMINtJTBa WAWATER DROP TIME WATER DROP PERC RATEINTERVAL IMINUTBa ■ WATER DEPTHTIME
' I I
V.Sl±REFILLREFILL r 8^ J-JhJ.P.4Pfirtc'rtME DROP PERC
PERC RATE TIME WATER DEPTHWATER DROP INTERVAL rMPOTTBS)WATER DRCT*PERC RATEINTERVAL fMPnnBS)W>aERTIME
REFILLREFILL
Zl *i
'lIMU" DROP PBRC 'rtWH” DROP PBRCTIMEINTERVAL fMTNUTBS)WATER PERC RATE WATER DEPTH WATER DROPINTERVAL tMlNUTBa WATER DEPTH PBRC RATETIMEi)'REFILLREFILLN.
'iTKfb *^DR~6^ "<»ERC X
TRffi“ 5kop i»kRC
» PERC RATE TIME INTERVAL (MINUTES)top
WATER DEPTH WATER DROP PERC RATSINTERVAL (MINUTES)WATER DEPTH W>TIME
\w REFILLREFILL
;+-A'
'HMk' DROP PERC1 \WATBl tCRATB TIME INTERVAL (MINUTES)Water depth PERC RATEWATER DROPINTERVAL (MINUTES)WATER DEPTHTIME
c REFILLREFILL
4
TIME DROP PBRC YIMH' droF ^BRCTIME
PERC RATE INTERVAL (MINUTES)WATER DEPTH WATER DROPWATER DROP PERC RATEINTERVAL (MINUTES)WATER DEPTHTIME
REFILLREFILL
f
TIME DROP PERC TIME DROP PEEC”
\-2COMMENTS/CALCULA TIONS:
MKL — 0390 - 005 250,815 — Victor Lundeen Co.. Primers. Fergus Falls, Minnesota
mmm
sSaiw»1'I'
py
CERTIFICATE OF APPROVAL
SEWAGE SYSTEM(i?3;fj
p%19TH DECEMBER 94This 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 19
s6z laM
: ''si
VThe premises covered by this certificate are legally described as:m<:sr"£
mTwp. ^ ^ 5 Range56-141 29 OTTOiiLxike No.Sec.Twp. Name
m 29 135 38 54.1
PT GL 18 2 & SE1/4
BG 2120.38' N FR SE CR SEC:
WLY 1728.73'/ N 1306.07'/ElY ON LAKE TO E LINE SLY 1 480*
Pi- -1
I
P-^>1mi
imIaHAGAKEISTEP/ DANIEL GENEWmOwner: Name
RR 1/ OTTERTAIL/ MNAddress
m 56571Zip No.5f
10339Permit No. SP
Signed by:
Lund & Resource Management Orficial
Otter Tail County, MinnesotaMKL-0987001
n[h
mmfT!;
JT-272472 Victor Lundecn Co., Piinlere. Fergus Falls. Mitmcsola
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
/0~^7 7Pf. C.L.Permit No.LEGAL
DESCRIPTION
AND
LOCATION
RANGE TWP NAMESECTIONLAKE/RIVER
CLASS TWP. NO.LAKE/RIVER NAMELAKE NUMBER
1O//OI^ CC S ^J ^ /3 y
FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER(S)
IDENTIFICATION: Please Print All Information
Zip Code Telephone No.Mailing Address — No. Street, City and SlateFirstInitialLast Name
14 Ck /y / iPovtPY'e. ,7Property
Owner C) P'f'&'E ^56 .r?/^Lc i l^<- CC3. JPeriPPs
/hcCSewage
System
Installer
Name
A.M.
^ This System will be ready for inspection on P.M., 19-at
This space for office use only NUMBER OF BEDROOMS: '4' 5 . ?4j
A.M.
P.M19 GARBAGE DISPOSAL: ( ) YES ( ) NOPhone Call Rec'd ByTime Rec’dDate Rec'd
SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM
( ) Holding tank (Alarm Required)
Oc') Septic tank ^
( ) Lift station
(;>C) Drain field
( ) Standard ( ) Bed (X) Trench
( ) Modified
( ) Mound
( ) Outhouse
DRAIN FIELDTANK
fc7X SiTnnoGIs.Ft.Capacity
S // CTO 1^1-Ft.Distance from nearest well
iTO Ft.Ft.Distance from lake or stream
Ft. Ft.Distance from building )0
Ft./O Ft.Distance from property line I O
3 Ft,Distance from bottom to Water Table Ft.
EFFLUENT DISTRIBUTION
(y) Gravity
( ) Pressure
All distances are shortest distance between nearest points
PERCOLATION TEST DATA:
WATER WELL DEPTH
Perc Tester.Date of Perc Test
/ 6 3 V rRate 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 r 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.
Issued Date:
Land & Resource Management Office3s-rFee $.Rec #.
Comments:
272,058 • Victor Lundoen Co.. Printers, Fergus Falls. MinnesotaForm Mo. BK-0894-003
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
/Q-^7 9fii. C.L.Permit No.LEGAL
DESCRIPTION
AND
LOCATION
RANGE TWP NAMELAKE/RIVER
CLASS
SECTION TWP. NO.LAKE NUMBER LAKE/RIVER NAME
yZus ^OY/O/ir5 (c'lH GO/
FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER(S)
^1-Ccxj' '^9 -
IDENTIFICATION: Please Print All Information
Zip CodeMailing Address — No. Street, City and Slate Telephone No.First InitialLast Name
//o
O't^
ey>ir,Property
Owner ^<1!\
fk^Sewage
System
Installer
Name
/jt«L A.M./r-^c5 P.M.This System will be ready for inspection on . 19.at
This space for office use oniy J «/- dUyffS. Jr ^NUMBER OF BEDROOMS:
Orf 30to GARBAGE DISPOSAL: ( ) YES ( ) NOPhone Call Rec’d ByDate Rec'd Time Rec’d
SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM
( ) Holding tank (Alarm Required)
(y) Septic tank
( ) Lift station
(y) Drain field
( ) Standard ( ) Bed (X) Trench
( ) Modified
( ) Mound
( ) Outhouse
DRAIN FIELDTANK
^7X sqFt.?r)(0O GIs.Capacity
S ^ /xrro FL50Distance from nearest well Ft.
50 5^0Ft.Ft.Distance from lake or stream
Distance from building Ft.Ft.)0
Distance from property line Ft.Ft.} O \
3Distance from bottom to Water Table Ft. Ft.
EFFLUENT DISTRIBUTION All distances are shortest distance between nearest points
(y^Pressu^PERCOLATION TEST DATA:
\SWTEFnAf£LL DEPTH
hfl/A /hcQ CCL-er^Perc Tester.Date of Perc Test
/ 63 Rate of 2nd Test ^D. rRate of 1 St 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.
3 ZjLDATE:
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.
/ 0 A ^ HIssued Date:
Land & Resource Management Office3s,Fee $.Rec it.
/6 yo~/9~7f- tOF uAdP A4sU' .Comments:L.r
272.858 • Victor Lundeen Co.. Primers. Fergus Fails. MinnesotaForm No. BK-0894-003
1
INSPECTION RESULTS
Inspector must make all measurements
SEWAGE DISPOSAL SYSTEM STATISTICS
1
4^
SEPTIC TANK DRAIN FIELDCATEGORYActualMinimumActualMinimum
‘T;ti SFCapacityGLS.SF4r
fO ftDistance from Nearest Well FTFT 50 FT
Distance from Buried
Water Suction Pipe R R R R50 50
Distance from Buried Pipe
Distributing Water Under Pressure RR10R R 10
Pco V ftf ftDistance from Lake or River (OHWL)RR
/<P 10/20 RR RDistance from Nearest Building R 10
FT R RRDistance from Nearest Property Line 10 10
3, y R RDistance from Bottom to Water Table R R 3
NOHolding Tank/Lift Alarm
Sewer Line to Well Separation DRAINFIELD CALCULATIONINTERPRETATION
OF ABBREVIATIONS
GLS. = Gallons
SF = Square Feet
R = Linear Feet
MinimumActual 7^7 J_RX _
20 RR SF
■
Inspector's Comments:
SKETCH:
(ytU %y^
3.
/Inspector's Signature
to
Date of Inspection
Time of Inspection
AIR TEST CERTIFICATIOH
(Date), an air teat of the sever line installed under Sewage
At that time, the ■'>ver
Dn 77
Disposal System Permit Number //^^} ^^ for
'Ay ■''f A
(Lake/River) vas made.Owner), on
£/ 6>pounc^ per square inch for
________
line held mlnutee.;•/
/
License Number jInstaller's Signature Date
042991
GRID PLOT PLAN SKETCHING FORM — (Must Be To Scale)
feet/InchesScale: Each grid equals
Dated:19 Signature
Please sketch your lot indicating setbacks from road right-of-way, lake and sideyard for each building currentiy
on iot and any proposed structures.
iI
1
i
-t
’
_!1
\f ;
I
;. ■ >i
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i; i:Li L.i ; i'Li :j i +
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vk
PERCOLATION TEST DATA
LAND AND RESOURCE MANAGEMENT
Otter Tail County
Fergus Falls, MN 56537
OWNER:
AME fTrst MIDDLE TELEPHONE NUMBERLAST N
ADDRESS:
;M «.c//
ZIP CODESTATECITYSTR./RT
A-g-fcri>
TWP. NAMETWP.RANGESEC.LAKE NAMELAKE/RIVER NO.
LEGAL DESCRIPTION:LtKi- 'Ter\T
PARCEL NUMBER
NUMBER/BEDROOMS
FIRE NUMBER
— TWO TESTS ARE REQUIRED —
TEST HOLE NO. 2TEST HOLE NO. 1
inches; Diameter of Hole, ^
I')
2. VDepth To Bottom of Hole inches; Diameter of Hole inchesDepth To Bottom of Holeinches
OiJ . I 7 1919DateSoil TextureDepth. Inches
Date
Soil TextureDepth. InchesJ3/aC k .iKtnd • /J /pUl f<J fir-/Percolation
Test By _
Firm
Name
Percolation
Test By____
Firm
Nam
2j£
\
Address Address
Oiler Tail County
. License No.
Otter Tail County
License No.
PERC TEST # 2PERC TEST # I
PERC RATO TIME INTERVAL rMmUTTOINTERVAL IMPn/TBSl WATER DEPTH WATER DROP WAim DEPTH
.3.2____
WATER DROP PERC RATETIME
...Q£T.*X b^l START 3h-.START
..lO.....
PBRCRATHreRC RATE TIME’i^ER DEPTH WATER DROP INTERVAL fMPn/TEft WATER DEPTH WATER DROPimINTERVAL rMlNtnEST W.
&L2«REFILL REFILL .1^./O
WATER DROP PERC RATE ■INTERVAL IMlNinE^}wate^d^to
INTERVAL IMINinESI WATER DEF^TIME WATER DROP PERC RATETIME
fiilSP 4 1
bROP raKC“
R^^LREFILL :ij../Ct
WATER drop reRC RATE TIME INTERVAL TMINinESl WltfBR DEPTHINTERVAL (MlNlfTEa W/OER DEPTH WATER DR<y PERC RATE■Has.
REFILLREFILL
«'llMU • DROP PERC I'lMM ' DROP PHRC”!PERC RATE TIME INTERVAL (MINUTSSI WATER DEPTHWATER DEPTH WAIERI»(y WATER DR<H»PERC RATEINTERVAL (MINUTESITIME
REFILLREFILL
4 -4
'nMH” DROP PERC 'llMti b>OP PERC
PERC RATE INTERVAL IMINUTBSlWATER DROP TIME WATER DEPTH WATER DROP PERC RATEINTERVAL (MINlfTEST Water depthTIME
REFILLREFILL
4 4
'nkut' DROP flSRC”*nMls, DROP PERC
PERC RATE INTERVAL (MINITTESITIME WATER DEPTHINTERVAL (MINinEST WATER 1»PTH WATER I»OP WATER MtOP ’ PERC RATETIME
REFILLREFILL
TIME * DROP PERC'I'lME DROP PERC
PERC RATE TIME INTERVAL rMINUTSSIWATER DROP WATER DEPTH WATER DROP PERC RATEINTERVAL IMINirTBST WATER DEPTHTTMB
REFILLREFILL
4
time" drop PERC TIME • bROP PERC
V^3 3, ^0
COMMENTS/CALCULA TIONS:
MKL — 0390 - 005 250,815 — Victor Lundeen Co., Printers, Fergus Falls, Minnesota
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PERCOLATION TEST DATA Price $ 1.00 per pad.
SHORELAND MAIMAGEMEIMT
OTTER TAIL COUNTY
Fergus Falls, Minnesota 56537
Ph. No.Owner:Mailing Address:
Last Name First Middle St. & No.City State Zip No.Legal
Description:
LAKE OR RIVER NO.NAME SEC. TWP.RANGE TWP NAME
TEST HOLE NO. 2TEST HOLE NO. 1
Depth to Bottom of HoleDepth To Bottom of Hole inches; Diameter of Hole.jnchesDiameter of Holeinches;inches
Depth, Inches Soil Texture Depth, Inches Soil TextureDate19 Date 19____
Percolation
Test By____
Percolation
Test By____Q
LUFirmName.GC Firm
Name.D
oLit
QC
LUAddress.QC Address
<
(/)Otter Tail County License No.Otter Tall County License No^I-COLUMeasurement,
Inches Depth In Water
Level, Inches
I-Measurement,
Inches Depth in Water
Level. Inches
Time Remarks Time Remarks
O
I-
MKL-0871-028
183-818 See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn.
[^EVItW SAItlt lAKE. MINNtSOIA
\
Unit // Ihok-0(f 1 lAr/
\
FIELD NOTES
7-/f'9yLAKE NO.: 56- 141 DATELAKE NAME: RUSH
FIRE NO.:LEGAL DESCRIPTION Parcel No.: 47000290200000
29 135 38: 54.1
PT GL 1 & 2 & SEl/4
BG 2120.38' N FR SE CR SEC:
WLY 1728.73', N 1306.07',
OWNERS NAME AND ADDRESS:
HAGAMEISTER, DANIEL GENE J-
/- “ho Lz.
56§ti^ - 73^-A1^8
- h'H Ce^ I
RR 1
OTTERTAIL, MN i.
Comments:
SetA^^r
SEPARATION DISTANCES(IN FEET)
OUTHOUSEABSORPTION AREATANKSEWER LINE
-^\QOWELL
• v"
-i-lOOOHWL
-hioLot. ^line
4-/0DWELLING-
4-XONON DWELLING
'^7GROUND ELEVATION @
REASON(S) FOR. ABATEMENT:
C) Oc.
is>
g) ^
i-Ly^
I ^ S' / 2y^—'Oui cJ~LyU^''^yr^
/
, SKETCH ON BACK...
Inspector's Signature(s)
I
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^---------------------■ ()/fd---------;
r/
//y
IV s
10 ^993
n fe.i.-^ >Sp»
OCT
Gi liBct. 19, 1993
Land & Resource
Fergus Falls, Mn.
Attn: Bill Kahler
Dear Sir,
We need septic tank sizing and drainfield sizing for Rush Lake Tent and Trailer
Park. Its an office building with bathroom facilities for campers to include
the following: 4 showers, 7 stools, 1 urinal, 5 lavs, 1 bathtub & 1 kitchen
sink. Also possibility of hooking up 2 bedroom trailer house to system.
Perk rate likely to be 1 to 5*
Thank you.•L
KooW^-^ ^r,‘ iAjM,€</juAr
Dan Wegscheid dfca!
Eluffton Hardware
P.O. Box 56
Bluffton, Mn. 565I8
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;
Z
/ ■
• SnORELAND MANAGEMENT — COUNTY OF OTTER TAIL
COUNTY COURT HOUSE
Phone 218-739-2271 • Fergus Falls, MN 56537
APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM
WNto — Office
Yellow — Inspector
Pink — Owrter
y3?yRus H ~TBrjT 4-Permit No.LEGAL
DESCRIPTION
AND
!3S 3^5L~ i HI IZ U.5 HLOCATION
TWP NameLake Classif.Sec.TWP RengeLake NameLake No.
IDENTIFICATION; Please Print All Information.
Mailing Address — No. Street, City and State Zip No.Tel. No.InitialFirstLast Name
i^T^I Lot)
_____rTrTeaT^iL mr\f
H-AG£ /viEI6‘TeigOWNER
SlSfl
SEWAGE
SYSTEM
INSTALLER
Name.
Tf}/s System will be ready for inspection on.., 19.
This space for office use only
19 .M
Date Rec'd Phone Call Rec'd By Owner or Agent SignatureTime Rec'd
NUMBER OF BEDROOMS:ESTIMATED COST:
SEWAGE DISPOSAL SYSTEM DATA:
SEEPAGE PITSEPTIC TANK DRAIN FIELD
A . 5S' O GIS.1,5 77 sqSq. Ft.. Ft.Capacity
Sv Ft.Ft.Ft.Distance from nearest well
Ft.Ft.Ft.Distance from lake or stream
Ft.Ft.Ft.Distance from occupied building
IVDistance from property line Ft.Ft.Ft.
3fVp,Ft.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
S'- f LM..
/. X5
, 19PERCOLATION TEST DATA: Date of First Test
Bp€.TX
Rate
‘SI.of Second Test , 19....Rate....
1st Test Taken ByM I I Hh - ...3.^^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 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.
ft /
Dated.
J (/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;
' ^ &iofeiandManagementOW^-MP r\/Issued Date:
*7 Rec #Fee
Comments:
Form No. MKL-032085 225239 — Victor Lundeen Co.. Printers, Fergus Falte, MN
*V'•t
ftiS’HORELAND MANAGEMENT - COUNTY OF OTTER TAIL
COUNTY COURT HOUSE
Phone 218-739-2271 • Fergus Falls, MN 56537
APPLICA TION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM
[
%\
llVMI* —
Y9M0W Intp^ctor
Pink — Omrm
l
AnPymit No. ^7 ^ _
I . n -t-/LEGAL
DESCRIPTION
&AND
'/O':7 I > t~f t. j
TWP
<2jIj02.r'.n- /LOCATION
Lak* Claulf.Sm.TWP Nam*Hanfl*Lak* Nam*Lak* No.
IDENTIFICATION: Plaaaa Print All Information.
Mailing Addrett - No. Street, City and State Zip No.Tel. No.InitialFiritLeft Name
;I r ,*OWNER f 54S7)I ^11 J...I
<^aXJUA 2 y:.
Art KLtJClu,%Ia4pJ
SEWAGE
SYSTEM
NSTALLER
Name.
C/Up
7/i/s S/srem will be ready for inspection on.19.
This space for office use only
- Sy /a',2op.
Phone Cell Rec'd By Owner or Agent^lgne^ureTime Rec'dDate Rec'd
/7 r.^-.■ /iUNUMBER OF BEDROOMS;ESTIMATED COST;A
SEWAGE DISPOSAL SYSTEM DATA:
SEPTIC TANK SEEPAGE PIT DRAIN FIELD
/ G 7 7 Sq. Ft.GIs.Sq. Ft.Capacity
\Ft.t Ft.Ft,Distance from nearest well
^ Ir*" r-Ft.Ft.FtDistance from lake or stream
m .xoFt.Ft.Distance from occupied building £L
/Ft.Distance from property line Ft.Ft.
/k 7 i SXFt.Ft.Distance from bottom to Water Table Ft.
All distances are shortest distance between nearest points
RECORD OF TESTS:
.....By .19 , TimeInspection was made on
Lll.
I X5
PERCOLATION TEST DATA: Date of First Test Rate
• aei*
,v ? Date of Second Testt' t)x, ■ i-yt Rate
Itt Taat Takan By H/>11 I 1 ...... I. XI.S:_ First Test + 2nd Test 2 Rat*2nd T**t Takan By
The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work inVgreement:
trict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn-
sota Depanment of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi-
ial 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
ssponsibility cf the applicant for the permit to notify the County Shoreland Management that the job it ready for inspection.
//</.‘ 7^
)ated.
Signature T
'ermit; Parmitaion it hereby granted to the above named applicant to perform the work de». tf in the above statement. This permit it (p'anted upon express
ondition that the person tc whom it is granted, artd his agents, employees and workmen shall conich in all respects to ordinartcet of Otter Tail County Minnesota,
'hit permit may be revoked at any time upon violation of any said ordinance.
lOTE; Permit void if wort is not commenced within six (61 months.
- f//.y/ 7 /•
■■ •
Steratand Managamant onto* '
ssued Date:.
C ■ C'
*r '^ /-ee 6 -— O / o Rec #
^mments:
orm No. MKL<032066 22S239 ~ Vldv UiMiii Gft.. PiWn. NiiHi hk. IM
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
Whits — Office
Ysilow — Inaps^or Pink — Owner
[
•7 V'Vl\U:> ht /-rtKiS (Permit No__-nLEGAL
DESCRIPTION
AND
:?1LOCATION
TWP NameLake Classif.Sec.TWP RangeLake No.Lake Name
IDENTIFICATION: Please Print All Information.
Mailing Address — No. Street, City and State Zip No.Tel. No.InitialFirstLast Name
OWNER
SEWAGE
SYSTEM
INSTALLER
Name.
/-.2^ - 7/7 3-yoThis System will be ready for inspection on.19.l^iThis space for office use only
ru Agent^igna^tureDate Rec'd Owner orTime Rec'd Phone Call Rec'd By
NUMBER OF BEDROOMS:ESTIMATED COST:
SEWAGE DISPOSAL SYSTEM DATA:
SEPTIC TANK SEEPAGE PIT DRAIN FIELD
GIs.Sq. Ft.Sq. Ft.Capacity
Ft.Ft.Ft.Distance from nearest well
Ft.Ft.Distance from lake or stream Ft.
Ft.Ft.Distance from occupied building Ft.
Distance from property line Ft.Ft.Ft.
Ft.Ft.Distance from bottom to Water Table Ft.
AH distances are shortest distance between nearest points
i
RECORD OF TESTS:
Inspection was made on ,, 19 , Time M By
!r I.PERCOLATION TEST DATA:Date of First Test 19 ....
, 19...:.
Rate •A
Date of Second Test , Rate
i1st Test Taken By 1
I
_ First Test + 2nd Test I■2'Rata2nd Test Takan 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.
The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in
Dated.
Signature
Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express
condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota.
This permit may be revoked at any time upon violation of any said ordinance.
NOTE: Permit void if work is not commenced within six (6) months.
Permit:
Issued Date:
Shoreland Management Office
Fee $Rec #
Comments:
i
Form No. MKL-032085 22S239 — Yidor Lundun Co.. Prtnurs. FtfBus Fab. MN
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10-^3-90 j ftvt I ' ' •
I
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■■ ' ■}
• •''.I.^7 *f-
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INSPECTION RESULTS
Inspector must make all measurements J.y\sftjtx"co /o- 7
“T<b .
3s'xM<1
SEWAGE DISPOSAL SYSTEM STATISTICS I
SEEPAGE PIT DRAIN FIELDSEPTIC TANKCATEGORY Should BeActualShould Be ActualActualShould Be
3t«3Q !MlCapacity s F s FGIs.S F S FGIs.
t50<r FDistance from Nearest Well F F FFF
"7cc>Distance from Lake or Stream FFFFFF
FDistance from Occupied Building FFF FF
I-f--TO FDistance from Property Line F FFFF
/2.33Distance from Bottom to Water Table F FF F FF
a-Inspector’s Comments:
'X
z
}
^ ~*t- LiJ— L. Ojt->c*^
SL Jitir^ uj ok<J^ JL, f=.p-c, —»
L,T7
0:l. \00a Ijir-
19Date of Inspection
MTime of Inspection
Signature of Inspector
INTERPRETATION
OF ABBREVIATIONS
GIs = Gallons
SF = Square Feet
F = Linear Feet
Job Title
1 Lp /
CoO i
MKL > 032085 • Backer Agency
:
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215502®
VICTOR UUNOEEM CO., PRIMTERS. EEflCUS FALLS,PERCOLATION TEST DATAMKL -0871 -028
LAND AND RESOURCE MANAGEMENT
Otter Tail County
Fergus Falls, Minnesota 56537 Ph. No.
Mailing Address:Owner:
/'J tJ-A-10
Zip No.StateSt. & No.L^st Name First Middle
Legal
Description:PSi / 3 3 853. -/
TWP NAMERANGETWP.SEC.NAMELAKE OR RIVER NO.
-A—
TEST HOLE NO. 2TEST HOLE NO. 1
5030Depth to Bottom of Hole inches; Diameter of Hole j nchesDepth To Bottom of Hole inches;Diameter of Hole inches
X ..Si
/3 >--<^7^
r ..nAA'Jif P^hJ^
5
Depth, Inches Soil Texture Soil TextureDepth. InchesDate Date
^1K diL/uf"o- Ig 6 - /7Percolation
Test By____
Percolation
Test By .t7Aya n - A5\(o ~
LU
5 a<;-3oFirmName_F irm Name.DIIJL /o S 0 .LUOC
/A3'}
LUAddress.CC Address
<33toOtter Tail County License No.Otter Tail County License No..HcnLUMeasure
ment,
inches
Drop in
water level, inches
Time
I nterval, minutes
Measure
ment
inches
Drop in
water level, inches
Percolation
rate minutes
per inch
Time
I ntervals minutes
Percolation
rate minutes
per inch
Remarks:Remarks:Time Timeo
53s/o5v^/yb
cf 0 0 /O
q fo
oj
10 /5 IIoZ5 0010^o
(0 lA A ooo
S35
7 5s
5cr ^0 ^5
iO30 I /o /•%2=1
im A (0/a $3/
wJfon ro /(>r<7 5(9 /(^A 5 A/
^2.5-510 oo 8ll
5
See Booklet, "How to Run a Percolation
Test" by Agriculture Ext. Service, Un. of MN,
5) /Percolation rate =,minutes per inchminutes per inch Percolation rat<
▼
Ai u iZ.I-7 3^-^ *
■ t SHORELAIMD MANAGEMENT - COUNTY OF OTTER TAIL
COUNTY COURT HOUSE
Phone 218-739-2271 - Fergus Falls, Mn. 56537
APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM
WWt»-Office
Ye(/ow — Inspector
Pink — Ovvner
Oird —Owner
(5 F S / 4 2- -fc S !=
'nI Permit No.f
iST /U Fiz. Sir
s>ic o y ‘ ^ I y o/v' L-*c
LEGAL
Ic iZ Sc-re w//
-To ho 5
A//DESCRIPTION
‘ ANDi 3? 0^0z:oT::2‘i /-?s-LOCATION ,SG^hf_L
TWP NameITWP RangeSec.Lake Classif.Lake NameLake No.
IDENTIFICATION; Please Print All Information.
Tet No.Zip No.Mailling Address —No, Street, City and StateInitialFirstLast Name
g 12 i R A {(^60_______
o rre^f\ (ujy]M
Ha ■‘L-rvyC^ ^r^-^rgL. -4 vM^iori.OWNER
iSEWAGE
SYSTEM
INSTALLER
\/rName.
This System will be ready for inspection ., 19.on.
This space for office use only
.M.19
Owner or Agent Signaturec-aiTiP siHs,
(jj (Uirntpsitfl.
Phone Call Rec'd ByDate Rec'd Time Rec'd w/o
"-^UMBER OF BEDROOMS:ESTIMATED COST:
SEWAGE DISPOSAL SYSTEM DATA:
SEEPAGE PIT DRAIN FIELDSEPTIC TANK
Solo GIs-Sq. Ft.Sq. Ft.Capacity
so//cc Ft.Ft.Ft.Distance from nearest well
s O Ft, Ft.Ft.Distance from lake or stream
i*3 oFt.Ft.Ft.Distance from occupied building
JO/a 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:
19,M, Time ByInspection was made on
.6^3
19.
q ^ 2.0-
Q ^ 20-, RatePERCOLATION TEST DATA:Date of First Test , 19
Date of Second Test , Rate
1st Test Taken By .sr"A 2-/
-I- 2nd TestFirst Test 1 Rate
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 specif icationssubmitted 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 r^ety for inspection. (Call or use attached mailer notice.)
~ Zj. ~"g3Dated
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.
J{ - - T3
Shoreland Management Office 'AIssued Date:
iJO-
(^ / D ig no p ^Comments; ^ 3 6^ H 0 'AJSEl__
Fee $
f4(i
ioir\ IQ S l^C-3 'W'
Form No. MKL 0771-003 [^CVliW BATTLI lAKE. MINNf&OTA
f---------—'
* V
♦ •
INSPECTION RESULTS
Inspector must make all measurements
SEWAGE DISPOSAL SYSTEM STATISTICS
SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORYActualShould be Actual Should be Actual Should be |
Capacity GIs. GIs.S F S F S F S F
*
Distance from Nearest Well 75 50FFFF FF
Distance from Lake or Stream F F F F F F
Distance from Occupied Building 2010 20FFFFF F
Distance from Property Line 10 10 10FFFF F F
Distance from Bottom to Water Table 33FFFFF F
Inspector's Comments:
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
/ i
^rr I'jLor^
"h
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
YeiJow — Inspector
Pink — Owfw
Cord — Owner
O' h <3- ‘ 3- % Skz 'y,
SC£C, w// 7-^9. 7 ' ^ A/
E: !) iQ f o' h
■y T"I Permit No.,
LEGAL /- A:
fV L <iZ
DESCRIPTION .{j
1-
AND ■J
LOCATION *
TWP NameRangeTWPLake Classif.Sec.Lake NameLake No.
IDENTIFICATION; Please Print All Information.
Tel. No.Zip No,Mailling Address —No, Street, City and StateInitialFirstLast Name
OWNER
SEWAGE
SYSTEM
INSTALLER
Name.
This System will be ready for inspection 19.on.
This space for office use only
.M19
Owner or Agent SignaturePhone Call Rec'd ByDate Rec'd Time Rec'd
NUMBER OF BEDROOMS; /ESTIMATED COST:
SEWAGE DISPOSAL SYSTEM DATA:
SEEPAGE PITSEPTIC TANK DRAIN FIELD
Sq. Ft.GIs.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:
,, 19., Time JVI ByInspection was made on
PERCOLATION TEST DATA:Date of First Test 19 , Rate
Date of Second Test 19 ..., Rate
1st Test Taken By
-I- 2nd TestFirst Test S
Rate2nd Test Taken By
The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work inAgreement:
strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn
esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi
cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the
responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. (Call or use attached mailer notice.)
Dated
Signature
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.
NDTE; Permit void if work is not commenced within six (6) months.
Issued Date:
Shoreland Management Office-r-^ CL C / ^2:-^Fee $SC-
< I r?Comments;.
(^IVIIW BA1UE LAKE. M!KNE$OtAForm No. MKL-0771-003
W-•>
,v
INSPECTION RESULTS
Inspector must make all measurements
SEWAGE DISPOSAL SYSTEM STATISTICS
SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORYActualShould 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 2010 20F F F F F F
Distance from Property Line 1010 10FFFFF F
Distance from Bottom to Water Table 33FFFF F F
Inspector's Comments:
Date of Inspection,.19___
Time of Inspection.M
Signature of InspectorINTERPRETATION
OF ABBREVIATIONS
GIs ■ Gallons
SF ■ Square Feet
F ■ Linear Feet
Job Title
Agency
M KL-0771.003- Backer
MINNESOTA DEPARTMENT OF HEALTH
Section of Hotels, Resorts and Restaurants
717 Delaware St. S.E., Minneapolis, Minnesota 55440
’ 'en:raj OHice
'_::9psee
siricT OHics
MOBILE HOME PARK AND/OR RECREATIONAL CAMPING AREA INSPECTION REPORT
?3r< or Camp ^
p. 0
PostedLie. No.
No. ind. R.C.Sites ^
No. M.H. Sites
LocationCo.
/Address
No. Dep. R.C. Sites
Li
No. OccupiedNo. Occupied
No. Occupied
l. Night Lighting ___
m. Community Kitchen
n. Bottled Gas______
0. Fuel Oil Systems___
p. Fire Protection____
Other____________
g. Sewage Disposal___
h. Toilet, Bathing and
Laundry Facilities
i. Incinerators______
j. Garbage and Refuse .
k. Vermin Control___
a. Location___
b. Caretaker___
c. Spacing ____
d. Animals____
e. Water Supply
f. Plumbing___
iVlHD 187
PARAGRAPH: __
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.19.Application for Building Permit Dated,
.19Application for Sewage System Permit Dated
Sewage System Permit Number.Building Permit Number.
Applicant agrees that this plot plan is a part of application (s) indicated above.
19.Dated Signature
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Price $1.00 per pad.PERCOLA nON TEST DA TA
SHORELAIMD MANAGEMENT
OTTER TAIL COUNTY
Fergus Falls, Minnesota 56537 Ph. No. 3S.^^
Owner:Mailing Address:
AR>J u-^\ I' C\r UJ
Last Name First Middle St. & No.City State Zip No.Legal
Description! ^/
('^AKE'OR RIVER NO.
R U$ ti Xa k'<T.
NAME
38
SEC.TWP.RANGE TWP NAME
TEST HOLE NO. 2TEST HOLE NO. 1
VS ^ "VI.Depth to Bottom of HoleDepth To Bottom of Hole, inches; Diameter of Hole.Jnchesinches; Diameter of Hole inches
V/c7C>
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Depth, Inches So^ Texture Depth, Inches Soil TextureDate.Date
Percolation
Test By____
Percolation
Test By____Q
LU >c?^eTz- H<1
/‘■ix 80
P'Cy- l\ A\tw f , pi /O
FirmName.CC Firm
Name.to c.DaLUDC
I AJ/0 LUAddress.QC Address<
SAl C/DOtter Tail County License No.,Otter Tail County License No.^COLUMeasurement,
Inches Depth in Water
Level, inches
I-Measurement,
Inches Depth in Water
Level. Inches
Time Remarks Time Remarks
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183-818
See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn.
[^fvifw eATHE lAKE MINNESOTA
Frc:^t
/fj^077e/sre^ u)
' ' '^ Last Name First
NAME
PERCOLATION TEST DATA Price $1.00 per pad.
SHORELAND MANAGEMENT
OTTER TAIL COUNTY
Fergus Falls, Minnesota 56537 Ph. No. 5 S _________
Zip No.
Owner:Mailing Address:
/O/TeyeTcLl/^OX /c£>0
Middle St. & No.City StateLegal
Description:C3^A1 oOT^ro
LAKE OR RIVER NO.SEC.TWP.RANGE TWP NAME
TEST HOLE NO. 2TEST HOLE NO. 1
/f//6. "Cf>MS-Depth to Bottom of HoleDepth To Bottom of Hole,inches; Diameter of Hole.inches;Diameter of Hole jnchesinches
Percolation^ LG^trT Q)
Z' -g Me/ c<~> <i_
/3^ /5~ S'tD
Depth, Inches 19 3^Soil Texture .19^Depth, Inches Soil TextureDate Date
Percolation
Test By___iT'Q
LUFirm
Name.GC Firm
Name.Do/?cg /ST~ 5/0
fx, > A
UJ
QC
'f^p' /»a)LU
yAddress.QC Address<
COOtter Tail County License No..Otter Tail County License No^HCOLUMeasurement,
Inches Depth in Water
Level, Inches
H Measurement,
Inches Depth in Water
Level, Inches
Time Remarks Time Remarks
0 —;---------------------^ /O.'OC A m
1 /O. /C^ry.
7' C ^ m
^ Am
^¥"
/Co \o ;L3i'
u C>
/ O >
n <rCm
I I
C4) ,f ///? I ^ o
/cif' 3 r
MKL-0871-028183-818
See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn.
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