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Scenic Point Resort_10000130089012_Septic System Permits_
Minnesota Pollution Control Agency 520 Lafayette Road North St. Paul, MN 55155-4194 Compliance Inspection Form Existing Subsurface Sewage Treatment Systems (SSTS) Doc Type: Compliance and Enforcement For local tracking purposes:Inspection results based on Minnesota Pollution Control Agency (MPCA) requirements and attached forms - additional local requirements may also apply. Submit completed form to Local Unit of Government (LUG) and system owner within 15 days os > I ^Gy(h\y\S -7- Bg-^/3 ' %System Status System status on date (mm/dd/yyyy): 13 Compliant - Certificate of Compliance (Valid for 3 years from report date, unless shorter time frame outlined in Local Ordinance.) nn Noncompliant- Notice of Noncompliance (See Upgrade Requirements on page 3.) Reason(s) for noncompliance (check all applicable) Q Impact on Public Health (Compliance Component #1) - Imminent threat to public health and safety □ Other Compliance Conditions (Compliance Component #3) - Imminent threat to public health and safety Q Tank Integrity (Compliance Component #2) — Failing to protect groundwater □ Other Compliance Conditions (Compliance Component #3) - Failing to protect groundwater D Soil Separation (Compliance Component #4) - Failing to protect groundwater □ Operating permit/monitoring plan requirements (Compliance Component #5) - Noncompliant 5-/3 Ti^pJ33L Property Information Property address; Parcel ID#orSeoTwp/Range: ^ \06Or)\Zt)OS‘^0/^ ^9^*7^ I S'h I jy-h'fiFdf 1/ Reason for inspection; S /Vig - Sc -e in/(I T/{V-^^blmer's phone: 9'bProperty owner: 'Tt-Ce/V-, or ' Owner’s representative; Local regulatory authority; Brief system description; Comments or recommendations: Representative phone: Lothc(l Regulatory authority phone; Ctl 7- (Cyso sy}M ~ Si L) g o/yuDr/y^-f^ixlfo{ r' Certification / hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. f^olo 1^0 /'T-t’5 Certification number: (2 $ 7__________ License number: f 9' X) /________ Phone number: ^V Inspector name: Business name: 0o b"s S-‘Lpj'i c V'\/iC^ Inspector signature: Necessary or Locally Required Attachments - 0 System/As-built drawing 0 Forms per local ordinance^'^^j:' v wV u ti0 Soil boring logs O Other information (list): www.pca.state.mn.us • 651-296-6300 • 800-657-3864 TTY 651-282-5332 or 800-657-3864 • Available in alternative formats SY;. CInspectorinitials/Date; iS^Rl Q•"^^ 3 ' ^ (mm/dd/yyyy)Property address: 1. Impact on Public Health - Compliance component #1 of 5 Verification method(s): [3 Searched for surface outlet B Searched for seeping in yard/backup in home □ Excessive ponding in soil system/D-boxes 0 Homeowner testimony (See Comments/Explanation) □ “Black soil” above soil dispersal system Q System requires “emergency” pumping □ Performed dye test □ Unable to verify (See Comments/Explanation) Q Other methods not listed (See Comments/Explanation) Compliance criteria: System discharges sewage to the ground surface. _________ D Yes 0 No n Yes @ NoSystem discharges sewage to drain tile or surface waters.________ O Yes 0 NoSystem causes sewage backup into dwelling or establishment. Any “yes” answer above indicates the system is an imminent threat to public health and safety. Comments/Explanation: 2. Tank Integrity - Compliance'component #2 of 5 Verification method(s): 0 Probed tank(s) bottom B Examined construction records Q Examined Tank Integrity Form Y-Aftac/jj □ Observed liquid level below operating depth B Examined empty (pumped) tanks(s) □ Probed outside tank(s) for “black soil” Q Unable to verify (See Comments/Explanation) □ Other methods not listed (See Comments/Explanation) Compliance criteria: □ Yes,, 0 NoSystem consists of a seepage pit, cesspool, drywell, or leaching pit. Seepage pits meeting 7080.2550 may be compliant if allowed in local ordinance. □ Yes 0,NoSewage tank(s) leak below their designed operating depth. If yes, which sewage tank(s) leaks; Any “yes” answer above indicates the system is failing to protect groundwater. Comments/Explanation: 3. Other Compliance Conditions - Compliance component #3 of 5 a. Maintenance hole covers are damaged, cracked, unsecured, or appear to be structurally unsound. □ Yes* * 0 No □ Unknown b. Other issues (electrical hazards, etc.) to immediately and adversely impact public health or safety. □ Yes* 0 No □ Unknown *System is an imminent threat to public health and safety. Explain: c. System is non-protecfive of ground wafer for other conditions as determined by inspector. □ Yes* S No *System is failing to protect groundwater. Explain: TTY 651 -282-5332 or 800-657-3864 • Available in alternative formats Pnop ? nf .1 www.pca.state.mn.us • 651-296-6300 • 800-657-3864 a r ! ^^~i ^^]/t Inspector initials/Date: ^AR\ ^ ~^0~ ^ 0$!^ ' ' (mm/dd/yyyy) .Property address; 4. Soil Separation — Compliance component #4 of 5 Q'' 3(9" ^ 3 Q UnknownDate of installation:Verification method(s): Soil observation does not expire. Previous soil observations by two independent parties are sufficient, unless site conditions have been altered or local requirements differ. □ Conducted soil observation(s) (Attach boring logs) □ Two previous verifications (Attach boring logs) □ Not applicable (Holding tank(s), no drainfield) C] Unable to verify (See Comments/Explanation) □ Other (See Comments/Explanation) (mm/dd/yyyy) Shoreland/Wellhead protection/Food beverage lodging?S Yes □ No Compliance criteria: Q Yes □ NoFor systems built prior to April 1, 1996, and not located in Shoreland or Wellhead Protection Area or not serving a food, beverage or lodging establishment: Drainfield has at least a two-foot vertical separation distance from periodically saturated soil or bedroclc__ S Yes □ NoNon-performance systems built April 1, 1996, or later or for non-performance systems located in Shoreland or Wellhead Protection Areas or serving a food, beverage, or lodging establishment: Drainfield has a three-foot vertical separation distance from periodically saturated soil or bedrock.* Comments/Explanation: □ Yes O No“Experimentar, “Other”, or “Performance" systems built under pre-2008 Rules; Type IV or V systems built under 2008 Rules (7080. 2350 or 7080.2400 (Advanced Inspector License required) Drainfield meets the designed vertical separation distance from periodically saturated soil or bedrock. Indicate depths or elevations >6"A. Bottom of distribution media ifAp y\ e.B. Periodically saturated soil/bedrock 3,'-hC. System separation D. Required compliance separation* Any “no” answer above indicates the system is faiiing to protect groundwater. ‘May be reduced up to 15 percent if allowed by Local Ordinance. -i^Not applicable5. Operating Permit and Nitrogen BMP* - Compliance component #5 of 5 □ Yes □ No If “yes”, A below is required D Yes D No If “yes”, B below is required Is the system operated under an Operating Permit? Is the system required to employ a Nitrogen BMP? BMP = Best Management Practice(s) specified in the system design if the answer to both questions is “no”, this section does not need to be compieted. Compliance criteria a. Operating Permit number: _____________________ Have the Operating Permit requirements been met? □ Yes □ No □ Yes □ Nob. Is the required nitrogen BMP in place and properly functioning? cf M’vjrnAny “no” answer indicates Noncompliance. Upgrade Requirements (Minn. Stat §115.55) An imminent threat to public health and safety (ITPHS) must be upgraded, replaced, or its use discontinued within ten months of receipt of this notice or within a shorter period if required by local ordinance. If the system is failing to protect ground water, the system must be upgraded, replaced, or its use discontinued within the time required by local ordinance. If an existing system is not failing as defined in law, and has at least two feet of design soil separation, then the system need not be upgraded, repaired, replaced, or its use discontinued, notwithstanding any local ordinance that is more strict This provision does not apply to systems in shoreland areas. Wellhead Protection Areas, or those used in connection with food, beverage, and lodging establishments as defined in law. www.pca.state.mn.us • 651-296-6300 • 800-657-3864 A. ^ H A ! TTY 651 -282-5332 or 800-657-3864 • Available in alternative formats n— ^ ^ Department of LAND AND RESOURCE MANAGEMENT OTTER TAIL COUNTY Government Services center - 540 West Fir Fergus Falls, MN 56537 PH: 218-998-8095 Otter Tail County’s Website: www.co.otter-tail.mn.us Otter Tail County Compliance Inspection Form Addendum This form is a required attachment to MPCA Compliance Inspection Form for all Existing Subsurface Sewage Treatment Systems in Otter Tail County as of June 1,2011. Property Information Parcel Number: Q lf)OOOl'^602^C) 1"^ Township: H Property Owner Name(s): Property Address: ^ ClUh€v'a/) Reason for Inspection: bu.]fJ ^ Number of Bedrooms: Ct,h\^s --/■/ou^^'3 No Section: /3 In Shoreland Area? Lake/River Name, Number, & Class (if applicable):S~5-^i3g C.l'ih^vtLDUkt System Compliance Status; (circle one) Compliant Non-Compliant Yes Yes l(^> Yes Does the soil treatment area have less than 3 feet of vertical separation? Is the septic tank located less than 50 feet from any well? Is the soil treatment area located less than 50 feet from any deep well? Is the soil treatment area located less than 100 feet from any shallow well? Yes / Does any part of the septic system fail ,to meet the minimum OHWL setback requirements for the public water classification?Yes I "Yes" indicates that the system is failing to protect ground water and is noncompliant. If "Yes", describe the condition noted: Required A ttachments: System drawing to scale on next page. Completed MPCA Compliance Inspection form,1/24/12 I hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. Name: Bhk Certification Number: Business License Name & Number: Solbk Se - ) ^39 OI Signature:Date: ^7-^0/'^ Excel/Compliance Form for OTC 2/29/2012 Page 1 of 2 otter Tall County Compliance Inspection Form Addendum (cont.) Date & Initial: 9-^7~^o^3Parcel Number: P System Drawing The system drawing must be to scale and include all septic/holding/lift tanks, drainfields, wells within 100 feet of system (indicate depth of wells), dwelling and non-dwelling structures, lot lines, road right-of-ways, easements, OHWLs, wetlands, and topographic features (i.e. bluffs). (\5 13 Additional Comments: Page 2 of 2Excel/Compliance Form for OTC 2/29/2012 P. 02FAX NO. 020021SEP-23-.96 MON 10:24 > . -fr ■ . /■ A V|! 7I r: \. r^^l>0 -fi3 ^<j-Vo 9V 7* 7\rv >k.«^ ^ -?0~ ^ 1? I •\ t\ i \ 7'~^303<i C 3c5’jy' p ffZA - .S ^ vt ,•/■' ' f r -r=i iM-—\ " <Pz^’O' / . ■ (T^ O/'^U.L ' I'l ' li/c.L'O I (j^ p (3-^ / • •;, • c^-3o-'5»3 '?T/l-i^Ul*<l|7jl^ /-onl< /j ■ ^ ~t- ^ V\ W V.# \ IN W ^ ^ ''^ ^'• ^Cjony^ top .«. d . Tl^ OvjrN»y»^ W\»N bt. C / /V<^r3<rA-'j^vwsv'VjVx v-<j A<.vV<«»xi ol <0 X.y.C \f\ h uit-HA NU. u^:uiidinuN W-!M .. , . v' ■«z>S";« INSPECTION RESULTS'" .. Inspector must make all measurements ' ■ SEWAGE DISPOSAL SYSTEM STATISTICS ;/ / !■ SEPTIC TANK DRAIN FIELDCATEGORYTActualMinimumActualMinimum P-OSF ----------------r X ■ FT I Capacity QLS.GLS SF <5B|-FTDistance from Nearest Welt FT FT50 Distance from. Buried Water Suction Pipe FTFn50 50 FT IDistance from Buried Pipe Distributing Water Under Pressure ^6 rrFTFT FTto10 J FTDistance from Lake or River (OHWL)ft:FJ FT f'=>ft!FT10FTDistance from Nearest Building FT 20Ii 6,^/- ft I p. <L> f— FT i FTi FTDistance, from Nearest Property Line FT1010 1 FTDistance from Bottom to Water Table FT I FT 3 DRAINFIELD CALCULATIONSewer Line to Well SeparationV INTERPRETATION : OF ABBREVIATIONS GLS. = Gallons SF = Square Feet FT.'» Linear Feet I ^ FT XMinimumActual ‘3 : FTtFTi20 _SF I Inspector's Comments: _ Posi^it^ Fax Note 7671 Date TofTT Paget^Tto -^~r^Ti77 from \Co./Oept,II Co.Oil A.A,Phone $■ JcIS-€-JFaxOL. SKETCH:.. \ i •>L;/I?:•'V ___YiT--. ✓ . V t. I, 'v^^. \i \i h.I ~~-e // h!■ !;I ^ Sf‘ I'r-\■r<< V/•r >A i r''J ■ rr-,v’''Tn ■•J \ i Lli ’ # *’ Ari * % __^ hsptoior 'i Sigr»»fu(» fl /O- TOtic oi Insocction'• 1 I ) I (.rojI r/r?ie L>/11 r^ i' Minnesota Pollution Control Agency 520 Lafayette Road North St. Paul, MN 55155-4194 Compliance Inspection Form Existing Subsurface Sewage Treatment Systems (SSTS) Doc Type: Compliance and Enforcement For local tracking purposes:Inspection results based on Minnesota Pollution Control Agency (MPCA) requirements and attached forms - additional local requirements may also apply. Submit completed form to Local Unit of Government (LUG) and system owner within 15 days ...S'ephc ■ t;, System Status System status on date (mm/dd/yyyy): /-5 •-/ ^ Compliant - Certificate of Compliance (Valid for 3 years from report date, unless shorter time frame outlined in Local Ordinance.) n Noncompliant - Notice of Noncompliance (See Upgrade Requirements on page 3.) Reason(s) for noncompliance (check all applicable) Q Impact on Public Health (Compliance Component #1) - Imminent threat to public health and safety □ Other Compliance Conditions (Compliance Component #3) - Imminent threat to public health and safety □ Tank Integrity (Compliance Component #2) - Failing to protect groundwater □ Other Compliance Conditions (Compliance Component #3) - Failing to protect groundwater Q Soil Separation (Compliance Component #4) - Failing to protect groundwater □ Operating permit/monitoring plan requirements (Compliance Component #5) - Noncompliant Property Information Parcel id# or SecA^wp/Range: R /(90(^01 ^0S90IX Property address: I9S~^ for inspection. lo( Property owner: Go •'Sin>c ■Poi'^'tf^esovT^hSS'/ Owner’s phone: S J3 yor Owner's representative:Representative phone: Local regulatory authority: Lfi hn( 4 Po <.o l/ /'c cl rnn Regulatory authority phone: “Sl/ 9 9S'- Certification I hereby certify that ail the necessary information has been gathered to determine the compliance status of this system. No determination of future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. Inspector name: Business name: Inspector signature: 6^2 b ^nk'es C3S97Certification number: ___________ License number: 3 9^ ^ / Phone number: I 8 ~ S? V V Bch's Sep'hc 5g r W e Necessary or Locally Required Attachments 0 System/As-built drawing 0 Forms per local ordinanceISSoil boring logs n Other information (list): www.pca.state.mn.us • 651-296-6300 • 800-657-3864 TTY 651-282-5332 or 800-657-3864 • Available in alternative formats JL19S^ C/A/j?P)^«?//yyAiispectorinilials/Date:^^^^^[ ^ (mm/dd/yyyy) • Property address; 1. Impact on Public Health - Compliance component #1 of 5 Verification method(s): □ Searched for surface outlet □ Searched for seeping in yard/backup in home □ Excessive ponding in soil system/D-boxes □ Homeowner testimony (See Comments/Explanation) □ “Black soil” above soil dispersal system Q System requires “emergency” pumping □ Performed dye test Q Unabie to verify (See iSomments/Explanation) Q Other methods not listed (See Comments/Explanation) Compliance criteria: System discharges sewage to the ground surface. _________ □ Yes 0 No Q Yes ^ NoSystem discharges sewage to drain tile or surface waters.___________ D Yes 0 NoSystem causes sewage backup into dwelling or establishment. Any “yes” answer above indicates the system is ah imminent threat to pubiic health and safety. Comments/Explanation: 2. Tank Integrity - Compliance component #2 of 5 Verification method(s): □ Probed tank(s) bottom □ Examined construction records □ Examined Tank Integrity Form (Attach) □ Observed liquid level below operating depth □ Examined empty (pumped) tanks(s) □ Probed outside tank(s) for “black soil” □ Unable to verify (See Comments/Exp/anation) Q Other methods not listed (See Comments/Explanation) Compliance criteria: □ Yes . H'NoSystem consists of a seepage pit, cesspool, drywell, or leaching pit. Seepage pits meeting 7080.2550 may be compliant if allowed in local ordinance. □ Yes 0 NoSewage tank(s) leak below their designed operating depth. If yes, which sewage tank(s) leaks: Any “yes” answer above indicates the system is failing to protect groundwater. Comments/Explanation; 3. Other Compliance Conditions — Compliance component #3 of 5 a. Maintenance hole covers are damaged, cracked, unsecured, or appear to be structurally unsound. □ Yes* * 0 No □ Unknown b. Other issues (electrical hazards, etc.) to immediately and adversely impact public health or safety. □ Yes* 0 No □ Unknown ‘System is an imminent threat to pubiic heaith and safety. Explain: c. System is non-protective of ground water for other conditions as determined by inspector. DYes* H[No *System is faiiing to protect groundwater. Explain: TTY 651 -282-5332 or 800-657-3864 • Available in alternative formats Pave 2 of 3 www.pca.state.mn.us • 651-296-6300 • 800-657-3864tHAH-} • A m A Mi • dn hem/insc^donmteisma^: B4r ^-SO-13 ^ ' (mm/dd/yyyy) ■Property address; 4. Soil Separation - Compliance component #4 of 5 }'^?i Q UnknownDate of installation:Verification method(s): Soil observation does not expire. Previous soil observations by two independent parties are sufficient, unless site conditions have been altered or local requirements differ. □ Conducted soil observation(s) (Attach boring logs) □ Two previous verifications (Attach boring logs) n Not applicable (Holding tank(s), no drainfield) EH Unable to verify (See Comments/Explanation) EH Other (See Comments/Explanation) (mm/dd/yyyy) Shoreland/Wellhead protection/Food beverage lodging?□ Yes □ No Compliance criteria: Q Yes EH NoFor systems built prior to April 1, 1996, and not located in Shoreiand or Wellhead Protection Area or not serving a food, beverage or lodging establishment: Drainfield has at least a two-foot vertical separation distance from periodically saturated soil or bedrock.________ S Yes EH NoNon-performance systems built April 1, 1996, or later or for non-performance systems located in Shoreiand or Wellhead Protection Areas or serving a food, beverage, or lodging establishment: Drainfield has a three-foot vertical separation distance from periodically saturated soil or bedrock.* Comments/Explanation: □ Yes □ No“Experimental", “Other", or “Performance" systems built under pre-2008 Rules; Type IV or V systems built under 2008 Rules (7080. 2350 or 7080.2400 (Advanced Inspector License required) Drainfield meets the designed vertical separation distance from periodically saturated soil or bedrock. indicate depths or elevations A. Bottom of distribution media B. Periodically saturated soil/bedrock 7^ 4 Pt vx(j3^C. System separation 3'D. Required compliance separation* ‘May be reduced up to 15 percent if allowed by Local Ordinance. Any “no” answer above indicates the system is faiiing to protect groundwater. 5. Operating Permit and Nitrogen BMP* - Compliance component #5 of 5 Not applicable □ Yes EH No If “yes”, A below is required EH Yes EH No If “yes”, B below is required Is the system operated under an Operating Permit? Is the system required to employ a Nitrogen BMP? BMP = Best Management Practice(s) specified in the system design If the answer to both questions is “no”, this section does not need to be completed. Compliance criteria a. Operating Permit number: _____________________ Have the Operating Permit requirements been met? □ Yes D No D Yes D Nob. Is the required nitrogen BMP in place and properly functioning? Any “no” answer indicates Noncompliance.vvru'i' Upgrade Requirements (Minn. Stat § 115.55) An imminent threat to public health and safety (ITPHS) must be upgraded, replaced, or its use discontinued within ten months of receipt of this notice or within a shorter period If required by local ordinance. If the system is failing to protect ground water, the system must be upgraded, replaced, or its use discontinued within the time required by local ordinance. If an existing system is not failing as defined in law. and has at least two feet of design soil separation, then the system need not be upgraded, repaired, replaced, or its use discontinued, notwithstanding any local ordinance that is more strict. This provision does not apply to systems in shoreiand areas. Wellhead Protection Areas, or those used in connection with food, beverage, and lodging establishments as defined in law. www.pca.state.mn.us • 651-296-6300 • 800-657-3864 iA/n-\AAA/i<hcA-‘Ti • 7I1A/17 TTY 651-282-5332 or 800-657-3864 • Available in alternative formats Department of LAND AND RESOURCE MANAGEMENT OTTER TAIL COUNTY Government Services Center - 540 West Fir Fergus Falls, MN 56537 PH: 218-998-8095 Otter Tail County’s Website: www.co.otter-tail.mn.us Otter Tail County Compliance Inspection Form Addendum This form is a required attachment to MPCA Compliance Inspection Form for all Existing Subsurface Sewage Treatment Systems in Otter Tail County as of June 1,2011. Property Information Parcel Number: 50 S'90fX Township: /> Property Owner Name(s): Property Address: d~ Reason for Inspection:__________ Number of Bedrooms: ^3 cc^ In Shoreland Area? No Lake/River Name, Number, & Class (if applicable): Oh'hn'^v^/I LciA^. Section: C <n ! ^ __________ oi S " S So^ <x ///up eu n System Compliance Status: (circle one) Compliant Non-Compliant Yes Yes Yes /(^D^ Does the soil treatment area have less than 3 feet of vertical separation? Is the septic tank located less than 50 feet from any well? Is the soil treatment area located less than 50 feet from any deep well? Is the soil treatment area located less than 100 feet from any shallow well? Yes / Does any part of the septic system fail to meet the minimum OHWL setback requirements for the public water classification?Yes "Yes" indicates that the system is failing to protect ground water and is noncompliant. If 'Yes", describe the condition noted; Required Attachments: System drawing to scale on next page. Completed MPCA Compliance Inspection form, 1/24/12 I hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of future system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate maintenance, or future water usage. Name: (B^ Certification Number: Q Business License Name & Number: Signature: 7^1 S^ri/icP J9S9DI Date: Excel/Compliance Form for OTC 2/29/2012 Page 1 of 2 otter Tail County Compliance Inspection Form Addendum (cont.) Date & Initial:Parcel Number: l^/0^OC>/ 30 9^9o System Drawing Tha system drawing must be to scale and include all septic/holding/lift tanks, drainfields, wells within 100 feet of system /p (indicate depth of wells), dwelling and non-dwelling structures, lot lines, road right-of-ways, easements, OHWLs, wetlands, and to ographic features (i.e. bluffs). Cc.yy'P A Excel/Compliance Form for OTC 2/29/2012 Page 2 of 2 c gg^</ 'cairSusc. <i CERTIFICATE OF APPROVAL SEWAGE SYSTEM oS' 5S ifH 0 I9_91This 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. 7 th day of October a mIr The premises covered by this certificate are legally described as:m ‘ ..ii u Clltherall401325cc.56-238mLake No.Twp.Range Twp. Name m.ijfM■aScenic Point Resort Pt GL 2ml ■rl- M Elmer Colton, Et A1--Owner: Name \\ it mm RR//1 Box 205 Battle Lake, MNAddress 56515Zip No.? 9747Permit No. SP I ■> aASigned by:1-yY\ Land &. Resource Managcmenl OHIcial Oner Tail Couniy. MinncsoiaMKL-0987001 vM 3\§ •V5^™ mm JT-263191 Victor Lundetn Co.. Printers, Fergus Falls. Minnesota SHORELAND MANAGEMENT — COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 • FERGUS FALLS, MN 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM niniTE — Office ^ Yellow — Inspector Pink — Owner IT Id ^0 m4 Permit No.LEGAL DESCRIPTION AND LOCATION LAKE/RIVER NAME SECTION TWP RANGE TWP NAMELAKE NUMBER LAKE/RIVER (3 PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER lO- bCO- Ib-OC'gOf-oiZ-^ IDENTIFICATION: Please Print All Information Zip CodeLast Name MailinO^ddress — No. Street, City and Slate^1 zds-Telephone No.First Initial C.nIrOfi, / I K-^Property Owner JbioJl b 1^5^-h^Sewage System Installer Name A.M. ► This System will be ready for inspection on.P.M., 19-at This space for office use only 31NUMBER OF BEDROOMS; A.M. P.M19 GARBAGE DISPOSAL: ( ) YES () NODate Rec'd Time Rec'd Phone Call Rec’d By SEWAGE DISPOSAL SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM ( ) Holding tank {p/C) Septic tank ) Drain field TANK DRAIN FIELD Sb/lOZ) ^tOOOCapacity GIs. l5DDistance from nearest well Ft. Ft. 7^( ) Standard ( ) Bed ( ( ) Modified ( ) Mound ) Trench Distance from lake or stream ~7S Ft.Ft. /ODistance from building Ft.Ft. lO LaDistance from property line Ft. Ft. EFFLUENT DISTRIBUTION ( Gravity ( ) Pressure 5Distance from bottom to Water Table Ft. Ft. All distances are shortest distance between nearest points WATER WELL DEPTH:hdpf , 19_ ii__-idd-2 ' tPERCOLATION TEST DATA: Date of First Test Rate /- / Date of Second Test Rate 1st Test Taken By'(.a Vr\9 First Test + 2nd Test Rate2nd Test Taken By Agreement: The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in strict accordance with Ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by 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 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: anoLS-SeSource h/fanagement Office Fee $.Rec #. Comments: Form No. BK — 0292-003 260,771 — Victor Lundeen Co., Printers. Fergus Falls,’Minnesota / r . ^ 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 — Of>Tce Yellow — fnspectdr Pink — ^wner * imScenic ^oi<i4 I f| Q-LZ^ Permit No.LEGAL DESCRIPTION AND j3A^ CtMoJLOCATION SECTIONLAKE NUMBER LAKE/RIVEH NAME LAKE/RIVER TWP RANGE TWP NAME , {I 1 i'■ \-/oI'■I PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER jO- OGO- l^-Oof'Ci-oic^ IDENTIFICATION: Please Print All Information First Mailing Address — No. Street, City and StateU'Last Name Initial Zip Code Telephone No. i»/. Z03Property Owner A ' /Jn ■f- iJkILSewage System Installer /Name X ::^'4^ 9:cX)(0-1 A.M. This System will be ready for inspection on P.M.at This space for office use oniy NUMBER OF BEDROOMS:>1^\lA.M. P.M GARBAGE DISPOSAL: ( ) YES ( X, ) NODateifne Rec'd mone Call Rec'd By SEWAGE DISPOSAL SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM ( ) Holding tank ) Septic tank ( >( ) Drain field ( ) Standard ( ) Bed ( ( ) Modified ( ) Mound TANK DRAIN FIELD - • y- Sq Ft.V“"''Capacity GIs. 4 'l.y Ft.Distance from nearest well Ft. ) Trench Distance from lake or stream Ft.Ft.!/Distance from building Ft. LoDistance from property line Ft.Ft. EFFLUENT DISTRIBUTION ( /) Gravity ( ) Pressure Distance from bottom to Water Table Ft. Ft. All distances are shortest distance between nearest points WATER WELL DEPTH: iII V A- J V rPERCOLATION TEST DATA: Date of First Test . r'T' 1st Test Taken By Rate. 19 n. 19 7-4 .j Date of Second Test Rate ;// First Test -I- 2nd Test I 2nd Test Taken By 2 Rate Agreement: The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in strict accordance with Ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minnesota Department of Health. Applicant agrees that plot plan sketches and specifications submitted herewith and which are approved by Shoreland Management Officical shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibilty of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. 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.I ____/ ! / //yIssued Date:/ Land & Resource Management Office Fee $Rec #. Comments: Form No. BK — 0292-003 260,771 — Victor Lundeen Co.. Printers. Fergus Falls, Minnesota IINSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS \ * ■V SEPTIC TANK DRAIN FIELDCATEGORYActualMinimumActual Minimum J ^ ^ OSFCapacityGLS.GLS.SF -5b f FTDistance from Nearest Well FT FT50 FT Distance from Buried Water Suction Pipe FTFTFT50 FT50 Distance from Buried Pipe Distributing Water Under Pressure ^6 FTFT10FT FT10 FTDistance from Lake or River (OHWL)FT FT FT 50 FTDistance from Nearest Building FT FT FT1020 FTDistance from Nearest Property Line FT FT FT1010 ^ CP j— FTDistance from Bottom to Water Table FT FT FT3 Sewer Line to Well Separation DRAINFIELD CALCULATIONINTERPRETATION OF ABBREVIATIONS GLS. = Gallons SF = Square Feet FT = Linear Feet Actual Minimum •3FTX FT FT 20 FT SF Inspector’s Comments: r- " SKETCH: /i- lUI (TO ^ Inspector's Signature I 0- 7 7/ Date of Inspection i 1 Time of Inspection i ■i % \ ^ '«=i3 -- 1 ,t ! fvVI I \'-^fr\c>\rv r1 203^/ ptpa C 3c5j<y p ^-TTC . [i/cLL^ /aT/- 10--^^ 9^ ' lcu^4> ~ <f~-^ ^ C^ cy S -^-o/v: ^ ^(*-6/ / /Jpi^C6>^ - (>—t? c^«3o-<^3 /-6n^ i< urJ^/ -rioi Wv'O ^ , <^'i SCJl»t^v»io|■ <d . 0'^v^‘y' vjv" bt, j.. '''<-^**aV\V^ A*-»V«^a'y 1 V»V«.-v> V\JL W^\^<l¥»A, 1^ VWj'^ • ‘y- ^ /H60 1 O'-P V -rx. 1ii * e0 0G 3o3c/ ! I 1 •V I ,^5r/Kv GRID PLOT PLAN SKETCHING FORMScale: Each grid equals 19^-3Dated: 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. 1 4 ii cro1Sftt X- •j ■5. Vxs ♦ —r-— I->cr 5 rcrcrr;+ crc? \r - Cz ! -C:c-^ SI Cu 1Lo St c?V5 \w \ \ CR>^ n MKL-0871-029 21598 7®VICTOR LUNDEEN CO.. PRINTERS. FERGUS FALLS. MINN. V 'fd \ \/\u OO'\1 fI 3G)\ 1 /\\I I\ 1 u j// a(2>t~Ai/ell^/Zfll/f ////.»// (1//// /J /I/f ];J)////■’//o///I n .o./ //y y //sJ n/I /J ;\ //■' f/•/ / si t;I /s// FfoP Lin\l<z i • ‘S - <a-®^Sov-*'3, B<, '>y£ YO'^ryJl To-r-^ c. •j SS" S'Z ^8|^!k /s^o pty </ ©£ ' X » - ^S'ScD V X ''5*0 oi 6^0 ^ 0 (Jy X (a 1^0 M3 'I S 7. SID C'^p. rV3 ^4 J)ry^f-C. I y t 1Ti<jV> pLP^e-i- VvqV^' 4^ev<fi 0 ^ I i (■+V<^>'V b>CJ^VV./^ rs fttk j5-,n2- p'^'nT'jpiVV> S ■I r.L.ni- ' II 11 I ^ i CPpy/On / i (/} PoicA^O /?3^0£jOc£ ^ SsA/looit^ T^/>& / B C PS/*is @ y F&fi/e fki C4S/F (jc2^ X ¥2 = i1!r-> e«P2)r'( I 'I i;>:• ::i- t! 3 d4B/4i> CS f^plc /kjt I! ^ V'Z- Ii ; I 1 ysi. rI P7ooi : ^ 7^0 pcoeo;i ,;i \ i i i! i ;t7ao Y-.es ^,S‘ff * sii'f 7 9Z. Bcfhn & /2,*Rk^ii!■ !i i /m '. I.S- I Jte? ^_P7 ’ 99-fc C* ! ' 1!■ I 1;S77 le^tgH^.I /,7?i 3- l;!; !• PERCOLATION TEST DATA LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, MN 56537 OWNER: TELEPHONE NUMBERMIDDLEFIRSTLAST NAME ADDRESS: 17*! STR./RT. /UaJ. STATECITY 13 /j?7- 4/W (t Lir^^// 7W RANGE TWP. NAMESEC.LAKE NAMELAKE/RIVER NO. LEGAL DESCRIPTION: Lo/ 2- PARCEL NUMBER FIRE NUMBER NUMBER/BEDROOMS — TWO TESTS ARE REQUIRED If,S I HOLE NO. 2TEST HOLE NO. I //43C^"Depth To Bottom of HoIej_^2^_ inches; Diameter of Hole.inches inches; Diameter of HoleDepth To Bottom of Hole inches 19 ^2^ ColTgM T2DateSoil TextureDepth, Inches Date 19Soil TextureDepth. Inches ^ Percolation" ^ ' Name o"-/z"lx>/M ^Percolation t By__ML Name Address Address Otter Tail County License No. _Otter Tail County License No. PERC TEST # 1 PERC TEST # 2 INTERVAL tMmUTBS>WATER DROP PERC RATETIME TIME INTERVAL fMPAJTES) Wji WATER DROP PERC RATH Jl.START START -/ - > SZ. * ERgy regg^ WATER DROP PERC RATETIMEINTERVAL (MINUTES)DEPTH TIME INTERVAL fMIKUTHS)WATER DEPTH WATER DROP PERC RATE V ____I'LJ.LREFILL REFILLis3. y . TrWri * Er5F 8. INTERVAL (MINUTES) m. WATER DROP PERC RateTTKffi TIME INTERVAL IMINUTBS)W:.WATER DROP PERC RATE T te •.S7, I ..57 TIME DROP PBRC REFILL REFILL) PERC RATEINTERVAL (MINUTES)T^HR DEPTH WATER DROP TIME INTERVAL tMINUTES)W/WATER DROP PERC RATH*.L'lr^ DROP PERC” REFILL REFILL? INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATH TIME INTERVAL (MINUTES)TIME WATER DEPTH WATER DROP PERC RATE m....7........REFILL )LL REFILL;>S3;JL. ‘ ss' TIME DROP PfeRfc _____ J INTBIVAL (MINUTES)WATER DEPTH WATER DROP PERC RATH TIME INTERVAL (MINUTES)- TIME WATTO DEPTH WATER PROP PERC RATH 11REFILL REFILL T 'IIMM bROP PERC INTERVAL (MINUTES)WATER DEPTH PERC RATE TIME INTERVAL (MINUTES)WATER PROP WATER DEPTH WATER l»«»PERC RATE REFILL REFILL 4 TIMfi" DROP PERC TSE“ bkOP PERC INTERVAL (MINUTES)WATER DEPTH WATER PROP PERC RATE TIMETIME INTERVAL (MINUTES)WATER DEPTH WATER DR(M»PERC RATEREFILLREFILL T TIME DROP PErC”TIME bROP PEKC” COMMENTS/CALCULA TIONS: -• j MKL — 0390 - 005 250,815 — Victor Lundeen Co.. Printers, Fergus Falls. Minnesota- 5/ Department of LAND & RESOURCE MANAGEMENT COUNTY OF OTTER TAIL Phone 218-739-2271 Court House Fergus Falls, Minnesota 56537 July 26, 1993 Terry Colton Scenic Point Resort R#1 Box 205 Clitherall, HN 56515 RE: Verification Clitherall Lake <56-238). of Failed Sevage Systems at Scenic Point Resort, Dear Hr. Colton: On August 14, 1991, tvo of our inspectors were onsite to do a field survey on the existing sevage systems. They found that the systems serving the 8 cabins, office/home and mobile home vere all cesspools, were located in the ground vater table. Based on this an Abatement Notice vas Issued. These cesspools If you require more information or have any questions, please contact our office. Sincerely, Pat Eckert Inspectorf mgb SHORELAND MANAGEMENT ORDINANCE — SUBDIVISION CONTROL ORDINANCE RIGHT-OF-WAY SETBACK ORDINANCE — SEWAGE SYSTEM CLEANERS ORDINANCE RECORDER, OTTER TAIL COUNTY PLANNING COMMISSION a -rr y PART TWO Oj?f« Use Only The following documentation will constitute priority I application criteria. 15. Only written bids from septic system installers certified by the Minnesota Pollution Control Agency can be used as evidence of the cost of a replacement system. All bids shall include the following information: (a} estimated water use (b) septic tank sizing (c) drain field type (d) drain field soil type and sizing factor. Also provide evidence that the installer(s) are certified to install septic systems in the State of Minnesota. 16. Explain why you think your project would correct existing health or safety problems related to ground or surface water contamination. Provide any supporting documentation available such as well water tests, surface water tests, etc. 17. Provide any documentation that shows that the septic system has been verified as a failing system by local or state government authorities. A failing system is defined as one that discharges raw or partially treated sewage to the ground surface, surface water or ground water. 18. Provide any written order that has been issued by local authorities to repair or replace a system and the reason for such order. □ □: □ □; PART THREE Office The following documentation will constitute priority II application criteria. 19. If your septic system is a nonconforming system, describe what makes it nonconforming. To what extent has this impeded, or will likely impede, the operation of your business. 20. Describe the extent to which the project has or will contribute to the economic viability of your business. 21. Will this project serve more than one eligible business? Provide information requested in items 1 through 11 (page 1) for each business to be connected to the system. 22. Describe whether the proposed project represents a different approach or technology for on-site treatment that might have potential for adoption by other persons currently using traditional individual septic systems and would be permitted under state and local regulations. NOTE: After the system has been constructed, you will be required to produce a copy of a certified inspector's report indicating that the new system has been inspected and is in conformance before you receive any grant funds. Only, □ O;;;: □ I RETURN THIS APPLICATION TO: Septic System Grant Program Department of Trade and Economic Development Business and Community Development Division 500 Metro Square 121 7th Place East St. Paul, MN 55101-2146 -2- FIELD NOTES /7/DATELAKE NAME / - ^<=^17FIRE NO.LAKE NO. LEGAL DESCRIPTON OF LOT! /O-d0D - /3 - 005 9-012^PARCEL NO. 6^ OWNERS NAME ■fi- /?^/EctvOWNERS ADDRESS p^oMt /s\JL TYPE OF SEWAGE SYSTEM (INSPECTOR'S COMMENTS); CaJj^ ^ E ^ ^ 'tPU^ CaJbx^T ^ f E&tiiAac^ r Po jrC. /O ' P SEPARATION DISTANCES (IN FEET); C^iC-cO, SEPTIC TANK SOIL DISPOSAL AREA j WELL LAKE LOT LINE OCCUPIED BUILDING ELEVATION OF THE AREA REASON SYSTEM WAS ABATED; ^^3 7k cE/Ux^"- 51.3 CtJP- t^Ec 3^ okL- S ~t^7U J >(A^ S-^’OLJ^e^^ J^) “Pt^ks fzir ^ ^ 3) C) cdE^ < 7s'' Jtx^lcj:-. SKETCH OF LOT/ON BACK 7^ Tlsii-'iks S^Qr Ck^/x^ s 7~£> U>'-€iE£.rt/^Ui •c C^' ■ , f ; ^ _ ' ' ~Ta^{<i h i f f I 3oi^ dk>^ \/ nHh'.672^t«. \bJ 0-“^c-507f Bcii-oi^I f' (100I ''s. \ \\ rA V'. cS {y ^//\w'^J-\\j [ FIELD NOTES DATELAKE NAME J~- 2^nFIRE NO.LAKE NO. LEGAL DESCRIPTON OF LOT: /o -060 -j2>-on^PARCEL NO. CfJjbn^ . flvnj!^ a/.OWNERS NAME / OWNERS ADDRESS BaJtU /J^c^ , ^ ^/5~ TYPE OF SEWAGE SYSTEM (INSPECTOR'S COMMENTS): cA SEPARATION DISTANCES (IN FEET): SEPTIC TANK SOIL DISPOSAL AREA 15' /SE WELL ■tsLAKE ///?LOT LINE 20OCCUPIED BUILDING >±ELEVATION OF THE AREA REASON SYSTEM WAS ABATED: CL&>7 t2~0St) ^ j) *-A. h) * •) ,r SKETCH OF LOT/ON BACK i 7 •x \ (9 IaHM 75 L/ • • CERTinCATE OF APPROVAL SEWAGE SYSTEM Uth ¥tbflJUL(VLy SS I77iis 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 Count}’, Minnesota. day of 19 y A , gj The premises covered by this certificate are legally described as: kmCtitkeA-dllSec. ^ ^ Twp. ^ Range56-25SLake No.Twp. Name <1 m■Scenic Point Re^ont L J ■Sf' Ebneh. ColtonOwner: Name%-"i L -M ’WiCtitheAdtl, MinneiiotaAddress m 56524Zip No.■m. CSnbsPermit No. SP Signed by: Malccnm K. Lee. Land & Resource Management Administrator Otter Tail County, MinnesotaI*; MKL-0987001 237,987 — Victor Lundeen Co.. Printers. Fergus Falls. Minnesota SHORELAND MANAGEMENT — COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 • Fergus Falls, MN 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM WhM — omca Yeffow — Inspector Pink — Owner 72-6=5" Permit No., LEGAL aelTDESCRIPTION AND aocA'vV^^ycxVX /IZ- upLOCATION 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.First InitialLast Name O ACTotO •"i~vk.r f y £l(n(irOWNER Ho^ViO UT=MOF^*s//d~r'SEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection , 19.on. This space for office use only 19 M Date Rac'd Owner or Agent SignatureTime Rac'd Phone Call Rac'd By > - 3 6e a«r>-^ rvi c I Cl a i-2NUMBER OF BEDROOMS:ESTIMATED COST:£A^ SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD 3(13 ^2^0 Sq. Ft.GIs.Sq/Fx.Capacity SiD Ft.Ft.Ft.Distance from nearest well 75"7S^Ft.Ft.Ft.Distance from lake or stream /o Zc3Ft.Ft.Distance from occupied building Ft. /oDistance from property line Ft.Ft.Ft. 3Ft.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 ....19.^.W...., n-jj'. J/-/7 - .a..PERCOLATION TEST DATA: Mogfvs ________ Date of First Test ., 19 Rate Date of Second Test Rate 1st Teft Taken Byn11 7-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. Signature 14 ~3<j-8-7Dated. 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 (61 months. L( ~ Shoreland Managen^t Office Issued Date: Fee $Rec # Comments: Form No. MKL-032085 225239 — Victor Lundeen Co.. Prints. Fergus Fans. MN 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 — Office Yellow — Inspector Pink — Owner Permit No., LEGAL FT QDESCRIPTION AND 13 I'iZ. UO - \ ^7 /LOCATION 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 c_Tqk,^rT fOWNER Fhi .(■ >' SEWAGE SYSTEM INSTALLER xjj.L.Name. This System will be ready for inspection , 19.on. This space for office use only 19 M Date Rec'd Time Rec'd Owner or Agent SignaturePhone Call Rec'd By NUMBER OF BEDROOMS: /'ESTIMATED COST:^ ... SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD /3IIJ>:x2-ooGIs.So: Ft.Capacity Sq. Ft. Ft. Ft.Ft.Distance from nearest well IS'7 S'Ft.Ft.Distance from lake or stream Ft. /oDistance from occupied building Ft.Ft.Ft. /ODistance from property line Ft.Ft.Ft. 3Ft.Ft.Distance from bottom to Water Table Ft. AH distances are shortest distance between nearest points RECORD OF TESTS:\ Inspection was made on „ 19 , Time .JVl By........................ ..... Rate.....^ 19.E..^....yJi-/7 - PERCOLATION TEST DATA:Date of First Test , 19 Date of Second Test Rate 1st Test Taken By)l\ I 7_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. LjDated Signature Permit:Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all 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.— Oxj L/ - 31 XTv>r\Issued Date: Shorelanii Managen^l Office " 0Fee $Rec # Comments: No. MKL-032085 225239 — Victor Lundeen Co., Printers. Fergus Faiis, MN J r V/ '4 'V4 <ftN. ■ ■'i > INSPECTION RESULTS- V- \, ~ ^ Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS f fV/ ysG SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORYActualShould Be Actual Should Be Actual Should Be f 2-Capacity GIs. GIs.SF S F S F S F I «?</I^UDistance from Nearest Well F F F F F F ISOlooDistance from Lake or Stream F F F F F F Distance from Occupied Building F F F F F F A-Distance from Property Line F FloF F F F /- Distance from Bottom to Water Table 3 3FF F F F F Inspector’s Comments: _tt-, 2.----------------------------- vr\ o bxVx V>\\c trwA_C'O V 7 roo(</ OS y 03 <r J N'X^tn-Ao-i. C Av^«r»y.30eON ■% Lf — 3o ^7Date of Inspection 19 5'./sr^Time of Inspection M ^ g(E |P/I yv^ S^nafure of InspectorINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF = Square Feet F = Linear Feet 1 Job Title'1 MKL • 032085 > Backer Agency \ j: - '■* • V*H». . t ■ f{ .. 2- ' • S'/ V • •A- >3-S'7?+■^ \ /--Llo y o Cc>v\ V'-s»^f S ^ ■f'-' P Ul C l''"^^ /0~ C^Ci m^ljPQ-Y' UwvVs ) Q CD CJ vro 7. [OO - usc> ^]-''S>B(L I4d^s-s^A { 2^0 o X '32-G.S'O ^\ i- *•.;i'A' /'5r§' / / ir" J I / 3/t 3 i I 3 Tn /\/'(< ■ \\ / / D -^ ■'■-T ’! 'Z X I J’ .3 ( S C CJ^ ^ -ty ^ y l(Or) h«»u,g^ ^ ' 3v \\'vwc^ X 3<^c> U M C^i oo 3QCj a 'y \ K / (K ^^00I / / / c^Cj oo3^00 o?3 /■ fOd I / 2^ ca p ' S C) pi e-/^^ .D to \r[ \"Hs y oo^ pie.^?'y\Ido ‘^i^c X loc ^OOB V z D'^J‘11'3oQ)I \ y\)5 I loo ^/Oc fLY o^Y J I loo I A^/kI (oa ^%L p JL / J2 c<i D fOv'i'vv'^ Q I <?1 ^ Vav\\-|-S 4,3 D ^ 11 ) v> O Yc\; r|-p(’ 9-1^ 2Zgr^A Cci SHORELAND MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 NOTICE OF HEARING FOR CONDITIONAL USE PERMIT APPLICANT MUST BE PRESENT AT HEARING TO WHOM IT MAY CONCERN: Fat/e S TzAAy Schuia/UzenbeAgeA RR 2 Box 3S S^eAhatn, MN 56573 has made application to the Otter Tail CouSs.v Planning Commission fw a Conditional Use Permit as per requirements of the Otter Tail County Sho%eland Management C^dinance. The Otter Tail County ^cX-OboA 1 19_UPlanning Commission will assemble for this hearin^n________J GoveArmznt505 South Cout\stAzeX/7:30 P.Fergus Falls, Minnesota.M. PlaceTime. This notice is to advise you that you may attend the\pfove hearing and express your views on the Conditional Use requested. The property concerned in the application is legally describedS^: Rush Lake1MzUJsec.Jl Range \ Twp. Name. .nenaJt VeoeZopment Twp.Lake No.. Round Lake ClassLake Name:. X 5, See. 22, Twp. 13 R. 39The East i o^ Gov. The conditional use requested is. Would IXke to constAuct dnXvmay appaoxlmaXely 350 ^eet A length, running jjAom the eul-de-sa/ o{^ Round Lake ReDieat westerly to a ^atuAe buXlding site. VfiXvmay tp be located appaoxXmately 250 ^eet nonXhe^y o{, shoKelXne.dhXveway a(peh. May 15,19S7. Would tike A cut tAees thXsPlan to constAuc iatl and wtnXey. I Otter Tail County Planning^’^optpmho/i 19 j 19R6Dated. mmission Chm. MKL -0871-011 [/tcXoE PetteuonBy:. 1219101® VierOA LUHBCCN 4 CO.. fOlMTCIIt. FERGUS FALLS. MINN. 215S02® VICTOR LUNDECH CO.. PRINTER*. FERGUS FALLS. UINN.PERCOLATION TEST DATAMKL -0871 -028 LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, Minnesota 56537 864-5748 Ph. No. Mailing Address:Owner: s_^s2yZip No. Col ton,□ mor RR 1 Box 201L.Clitheral1 ,MN StateCityLast Name First Middle St. & No. Legal Description:1356-238 132 nithpral1C1itherallM TWP NAMETWP.RANGESEC.LAKE OR RIVER NO.NAME TEST HOLE NO. 2TEST HOLE NO. 1 SJa.S.s.Depth to Bottom of Hole inches; Diameter of HoleDepth To Bottom of Hole,Jnchesinches; Diameter of Hole inches 0tr^y£'Csz tL &Depth, Inches Soil Texture Depth. Inches Soil Texture19 19 uj -----------------Firm Name.CC Firm Name,3)O LUoc LUAddreiq:Address-i-</3-/A COOtter Tail County License No..Otter Tail County License No_I-coLUMeasure ment,inches Time Intervals minutes Drop in water level, inches Percolation rate minutes per inch Time I nterval, minutes Percolation rate minutes per inch Measure ment inches Drop in water level, inches Remarks:Time Remarks:Timeo5I- o 0- ^7.3.7 7 loLI 3//•3 3 p a iJ ,7 ^ M-XL ToloUXL2; ^ 3 cr 3o 3 a:X '."'7 ')•' 7^ ■ -Z-lglL- M i 0 L 3':t 7-3 '(h ^-MS u /o If2SH^3 u16-IdA7L/A -A^S-L- 1 ''6 7 iAil7_3 i i Zii2J-M-JL V A.I PaAacitToLa.t*tl6 5^u XLs.. See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of MN Percolation rate minutes per inch minutes per inchPercolation rate = ,V y£'' jui»-i. m? ■ .......................... - ■■■•'ifr;v.-s.'\,'t';: ;• V-.-,' ‘i. [nTj] minnesota department of health 717 s.e. delaware St. p.o. box 9441 minneapoiis 55440 (612) 623-5000(an] iTv ■7 V ^ ■V-■r- '; ■ ':/- •- V-‘ S;-; Ife*. Theoddr« G. Naskosky Maskosky Kell Drilling Contractors Route 2EIDom Lake* Minnesota S6S31 .• .i"A ■ •-•»>.-2y1>^ ' * f ,f <. -V3J. Mr. Elmer Colton Scenic Point Resort Rural RouteBattle Lake, Minnesota 5651S • • • ‘ >^.t* <’ Messrs. Maskosky and;•- Subject; Variance Request - Clltherall Lake, Clltherall Township, T132II Range 110, Section 11, Otter Tall County. Minnesota :■:> r. This is In response to your reqwst for a variance tron the Minnesota A'/ Mater Mel1 Construction Code to install a well 30 feet from the lake shore. •.'v- .'-V . <In accordance with the Minnesota Mater Nell Construction Code, your request for the variance 1$ grantMl based on the following conditions: 1. The well sYiall be located above the nomal flood level of the lake. a,. A-. •- if- ■>■ ■’ 'V*-* •,'i4 ^*■> ■:4’A• ■> >.v. ■ ■•'V-Ki?'.'-:" !jr‘ * '* tTv'. 2. All other provisions of the Code shall be In effect. 4'..The variance Is granted because the well construction Indicates the well should deliver a potable water supply. The Minnesota Department of Health has consulted with Mike Douglas, Otter Tall County Zoning Administrator, who approves of the location of the well based on the r A variance request. PAi-- i,> • ' y> .-N A7' •Vv If you have any questions, please contact duies Mye at (612) 623-5339 •__#>_____________/otr. \ Tfifi -JCt.c . . ■ 'r--':' '■'■ ■'' ' .' > ,■.«Mi A If y®u nave any questions, pleas739-7565.91 sincerely yours.A \ A . .. .Raymond M. Thron, Ph.p., P*E., Director Division of Envfroeaiental Itealth l<r. 4f A'A■4, -■■■'- ‘- S' * ,•*tf- 'j Ai#i ■.....................■ T'" a/r //jaHir^Icolm Lee, Zoning A<ta1n1strator Otter Tall County . v Mike Douglas, Zoning Adarinistrator .o4SfSfiJi«rVe'iSS5j;e, /.V ; ■'■•'i-v'i',.'; ■'. •>. :■ gisr ^ ■ RMT: ’■*. s»mMmr Sv’