HomeMy WebLinkAboutStar Point Trust_56000100068000_Septic System Permits_Department of
LmDJmB RESOU^^CE MANAGEMENT
OTTER TAIL COUNTY
Government Services Cent^ - :54G West Fir
Fergus Fai_ls, MN 56537
PH: 218-998-S095
Otter Tail County's Website: www.co.otter-tail.mn.us
July 6, 2009
Star Point Trust
31497 Bank Rd W
Dent, MN 56528-9231
RE: Sewage Treatment System Servicing Tax Parcel Number 56000100068000
Described as 6.2 AC TR ALONG LAKE IN LOTS 8 & 9, Section 10 of Star Lake
Township, Star Lake (56-385)
As of 07/02/09, the sewage treatment system (Sewage Treatment Installation Permit
#20289) servicing your property was determined to be in compliance with the provisions of
the Sanitation Code of Otter Tail County for a 2 bedroom home.
As of 07/02/09, the sewage treatment system (Sewage Treatment Installation Permit
#20289) servicing your property was determined to be in compliance with the provisions of
the Sanitation Code of Otter Tail County for a 2 -1 bedroom cabins.
If you have any questions regarding this matter, please contact our office.
Sincerely
Denise Gubrud
Inspector
APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM
LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095)
GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537
www.co.otter-tail.mn.usWHITE - Office
YELLOW -L&R Inspector
PINK - Owner / Contractor (after issue)
APPLICATION MUST BE COMPLETE IN ORDER TO BE PROCESSED Permit No.
RANGELAKE/RIVER
CLASS
SECTION TWP NO.TWP NAMELAKE NUMBER LAKE/RIVER NAME
'J S'/a
E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROADPARCEL NUMBER (S) OF PROPERTY BEING SERVICED
/h ErYP uj ■5/V-7 7 g.
LEGAL DESCRIPTION
^« 0^ y4c "Ty^ ^ L g ^ A "7
Daytime Phone No.Initial Mailing AddressLast Name First
3 7 ^
/2—ir
ys^X9‘d<:-Property
Owner
>4/('L/ cy>-7Contractor
Lie.#
THIS SPACE FOR OFFICE USE ONLY
A.M.
, the year of P.M.>■ This System will be ready for inspection on at
A.M. P.M.
L&R OfficialDate Received Time Received
SEWAGE TREATMENT SYSTEM DESIGN DATA
AS SHOWN ON DRAW NG
NSTALLATION (circle one)TYPE OF
Residential
New
Replacement
Collector Other Est.
(E) New
(F) Replacement
(C) New
(D) Replacement
Soil
TreatmentLiftTank
Design Flow (Gallons/Oay)
1 — 2,499
(H) 2,500 — 4,999
(I) 5,000— 10,000
Effluent Distribution
( X ) Gravity
( ) Pressure
a<1^
GIsGIs Ft.
Size
Setback To
Nearest WeliType I Type II Ft. Ft.
rench. Rock (27) Rapidly Permeable
Ft.Ft.Ft.Setback To OHWL m.(21) Trench, Gravelless (28) Flood Plain //c?
(22) Trench, Chamber (29) Privies Ft. Ft.Ft.Setback To Bluff(23) Seepage Bed (30) Holding Tank
( ) Monitoring/Disposal Contract(24) Mound ^ OFt. Ft.Ft.Setback To Dwelling >0
(25) At Grade Type III
Setback To Non-Dwelling ___ Ft.Ft. Ft.(26) Greywater (31) Other/Problem Soils/<12" Soil
Type IV Setback To Nearest
Lot Line Ft. Ft.Ft.<20 'SO(32) Public Domain &
Proprietary Technologies
Depth of Well
Setback To Road Right-Of-Way Ft. Ft.Ft.Type VTotal # Bedrooms
3 (33) Performance Elevation Above
Restrictive Layer Ft.Ft.Ft.r 9'Garbage Disposal Y / CfiE>YAbatement
PERCTEST DATA
3^ja V—Date of Test Highest RateDesigner
Agreement: The undersigned hereby makes application for permit to install, alter, repair or extend Sewage Treatment System herein specified, agreeing to do all such work In strict accor
dance with Sanitation Code of Otter Tail County, Minnesota. Applicant agrees that the Site Data Worksheet submitted herewith and which is approved by a Land & Resource 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 approved for use. It shall be the responsibility
of the applicant for the permit to notify Land & Resource Management that the installation is ready for inspection.
License #
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 Sanitation Code of Otter Tail County, Minnesota. This permit may be revoked at any time
upon violation of the Sanitation Code.
NOTE: I.This permit is valid for a period of six (6) months. 2.This permit does not include the building sewer (sewer line).
U.fjc/a’f /cyi—.130Permit Fee $Date:
Signature of Property Owner/Agent for Ow
/^3CrrRec. No..Date:
S. JO ^//I cLiS^c> -Comments:
/^je/*^A iro__
Form No. BK — 0209-003 335.612 • Victor Lundeen Co.. Printers • Fergus Falls, Minnesota
^i\r^APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM
LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095)
GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537
www.co.otter-tail.mn.usWHITE - Office
YELLOW- L&R Inspector
PINK - Owner / Contractor (after issue)
V
- d. I hcirri.
J Permit No.
b';2c;^9APPLICATION MUST BE COMPLETE IN ORDER TO BE PROCESSED
RANGE TWP NAMETWP NO.LAKE/RIVER
CLASS
SECTIONLAKE/RIVER NAMELAKE NUMBER
GOS L c"/O
E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROADPARCEL NUMBER (S) OF PROPERTY BEING SERVICED
Jr uj ■S<^ iXOQ /oc^o /O-
LEGAL DESCRIPTION
Jp • ^ y4 C ^ (o / c; ^ ^ ^ ^ 4 '7
Daytime Phone No.Mailing AddressFirst InitialLast Name 3 C<J
Ou\(
Property
Owner J.’/Z.2±/i
~P^<~(Contractor
Lie.#1^0 'j ]
GQyy-7
THIS SPACE FOR OFFICE USE ONLY
-:sc709 .., the year of>■ This System will be ready for inspection on
vO6 ■■05’1 -Ol-O^%.M./.M.
L&R OfficialTime ReceivedDate Received
SEWAGE TREATMENT SYSTEM DESIGN DATA
AS SHOWN ON DRAWING
TYPE OF NSTALLATION (circle one)
Collector Other Est.
(E) New
(F) Replacement
Residential
(A) New
(B) Replacement
(C) New
(D) Replacement
Soil
Treatment
Area
LiftTank
Effluent Distribution
{ : ) Gravity
( ) Pressure
Design Flow (Gallons/Day)
(G) 1 — 2,499
(H) 2,500 — 4,999
(I) 5,000 — 10,000
GIs Ft.GIs I
Size /
Setback To
Nearest Well Ft.Ft.Ft.Type IIType I
(27) Rapidly Permeable(20) Trench, Rock
Ft.Ft.Ft.Setback To OHWL 0/1 /.■ L '(28) Flood Plain(21) Trench, Gravelless
(29) Privies(22) Trench, Chamber Ft.Ft.Ft.Setback To Bluff(30) Holding Tank
( ) Monitoring/Disposal Contract
(23) Seepage Bed
(24) Mound '3o Ft.Ft.Ft.Setback To Dwelling cType III(25) At Grade
Setback To Non-Dwelling Ft.Ft.Ft.(31) Other/Problem Soils/<12" Soil(26) Greywater
Type IV Setback To Nearest
Lot Line Ft.Ft.Ft.TC7(32) Public Domain &
Proprietary Technologies
Depth of Well
Setback To Road Right-Of-Way Ft. Ft..— Ft.Type VTotal # Bedrooms
(33) Performance Elevation Above
Restrictive Layer Ft.Ft.Ft.Garbage Disposal Y / N 7Abatement Y / N
PERC TEST DATA
I f Highest RateDate of Test ^License #Designer
Agreement: The undersigned hereby makes application for permit to install, alter, repair or extend Sewage Treatment System herein specified, agreeing to do all such work in strict accor-
dance with Sanitation Code of Otter Tail County, Minnesota, Applicant agrees that the Site Data Worksheet submitted herewith and which is approved by a Land & Resource 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 approved for use. It shall be the responsibility
of the applicant for the permit to notify Land & Resource Management that the installation is ready for inspection.
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 Sanitation Code of Otter Tail County, Minnesota. This permit may be revoked at any time
upon violation of the Sanitation Code.
NOTE: I.This permit is vaiid for a period of six (6) months. 2.This permit does not Include the building sewer (sewer line).
i
130r.■itPermit Fee $ t'•'iDate:
Signature of Property Owner/Agent for Owner^j•/’7I r~ C*
,j> jf
i 9 Rec. No.___LDate:
Land & Resound Management Office
(oZ L -)1 Hr-Comments:
/ J
' /
335,812 • Victor Lundoen Co.. Printers • Fergus Falls. Mlnneso^Form No. BK — 0209-003
6- ^ '
SEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTS
Inspector must make all measurements i —
SOIL TREATMENT
AREA
HOLDING
. SEPTICXA^K^lOQO
OUTHOUSELIFT TANKCATEGORY
Capacity FT*GLS./
FT go ft FTFTSetback from Nearest Well /
Setback from Buried
Water Suction Pipe FTFTFT FT \tSetback from Buried Pipe
Distributing Water Under Pressure
A-^4— 1FT ^0'^ FT FTFT
tu \ ftW ftSetback from OHWL (lake &/or river)FTFT
Setback from Setback from Bluff FT FTFT
FTSetback from Dwelling FT
FTSetback from Non-Dwelling FTFT
T■Pr'yv FTSetback from Nearest Property Line FTFT FTno no
)50'^ft '^FT FTSetback from Right-of-Way FT
3^FTElevation above Restrictive Layer FT FT FT1
f no)YESHolding Tank/Lift Alarm
Old System Pumped & Destroyed ■ YES NO
TRENCH REDUCTIONMOUND / AT-GRApE SOIL TREATMENT AREA
CALCULATION
9 //V/J*
FILTERSEPTIC TANK(S)
# TanksJnstalled d)ROCK BEI 3^-Rock trenches with inches
□ YESManuf.of sidewall for.,%Ft: X Ft.Ft. X
3: ^ )
Ft.
ff2reduction / equivalent ter
Soil Treatment Area.
NOModel #\.Ft^FP
Inspector's Comments:
Sketch:
I
dniB-t Dal}
As of _ 'l j ^ joh-------
Code of Otter Tail County.
IniS/L&ROtncialTime
the above described sewage system installation was found to be compliant with the provisions of the Sanitation
■*«
Land SR
u \
Management OfKcial
Form No. BK — 0209-003 336.656 • Victor Lundoon Co., Printort • Forgo* FoM, Mirwtosota
+t t ■rr 1-a T
.„ISimEtDATAtWiORKSHEETi . Tf! l..hT[Ti_i--L-!
LAND ;&|f{ESOUF^CE MANAGEMENT* COUNTY OF OTTER TAIL ]
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OWNER: j S7At^ \Pc,f^r\f*^'^9T | Sewage TreatmentSystem Permit
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r-pORIGINALiSOIL:! 'No *' * ! *
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'DEPTH OF BORING (To 7'or rest7ictivelayer):i_ZI
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System design must be to scale and must include the proposed location of the sewage system, all
existing/proposed buildings, property lines, the ordinary high water level of the water body, wetlands,
bluff and all water wells within 150' of the sewage system. If there are any questions, see the University
of Minnesota Site Evaluation worksheets.
grid(s) equals__^inch(es) equalsScale:L feet, or feet
MPCA LICENSE #:
LICENSE CATEGORY: IT
. /•/o ^_______
DESIGNED BY: _J.
FIRM NAME: Ten
DATE:
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ADDRESS:SIGNATURE:
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BK — 1003 — 029 315,904 • Victof Lundeen Co, Pnniers •. Fergus Falls, MN • 1-800-346-4870
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CERTIFICATE OF COMPLIANCE
SEWAGE SYSTEM
* J22ndThis certificate has been issued this 19_J1March H, ■- '/fAday of.
imto certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota.
%
The premises covered by this certificate are legally described as:
Lake No. 56-385 Sec. 10 135 Range 41Twp.Twp. Name Star Lake
Gm 8 & 9
Plate #68
; 4;
Donald BockOwner: Name,
aDent, MinnesotaAddress.
i 56528Zip No.
K. Lee, Shoreland Administrator
OttCT Tail County, Minnesota
3451Permit No. SP.i
Signed by:.5
f
MKL-0871-009
159035 •'<It. «l«
-
SHORELAIMD MANAGEMENT - COUNTY OF OTTER TAIL
COUNTY COURT HOUSE
Phone 218-739-2271 - Fergus Falls, Mn. 56537
APPLICATION FOR PERMIT TO INSTALL SEIMGF DISPOSAL SYSTEM
V^' ;te — Office
V low — Inspector Pii..Card OwnerOwner
Jvr/Permit No___LEGAL
Date
DESCRIPTION
AND
sr-iei" 3-£r-/o /a 6^LOCATIOW
Lake No. Lake Classif.TWP NameLake Name Sec.TWP Range
IDENTIFICATION: Please Print All Information.
First Initial Mailling Address -~No. Street, City and State-Zip No,Tel. No.Last Name 7GQr>rOWNERi
SEWAGE
SYSTEM
INSTALLER
Name.
This System will be ready for inspection on., 19.
This space for office use only
19 .M
Date Rac'd Time Rec'd Phone Cal) Rec'd By Owner or Agent Signa.tu re
NUMBER OF BEDROOMS:ESTIMATED COST:
SEWAGE DISPOSAL SYSTEM DATA:
SEPTIC TANK SEEPAGE PIT DRAIN FIELD
2^^ Sq. Ft.GIs.Sq. Ft.Capacity
/tj oFt.Ft.Ft.Distance from nearest well
Ft.Ft.Distance from lake or stream Ft.
2=^Ft.Distance from occupied building Ft.Ft.
Distance from property line Ft.Ft.Ft.
Ft.Ft.Distance from bottom to Water Table Ft.— c —
AH distances are shortest distance between nearest points
RECORD OF TESTS:
Inspection was made on , Time M By
i;PERCOLATION TEST DATA:Date of First Test . Rate
Q^^n;u£tr:.
Date of Se , Rate
1st Test Tabien By
.jr..Ffate
First Test -I- 2nd Test 22nd Test Tfiken By
The undersigned hereby makes application for permit to install^or extend Sewage Disposal System herein specified, agreeing to do all such work in
strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn
esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi
cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the
responsibility of the applicant for the permit to notify the County Shoreland Management that the job i^eady for inspection. (Call or use attached mailer notice.)
Agreement;
Dated
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.
Issued Date:/ Slioreland Management Office
Fee $Surcharge $
Comments:.
Form No. MKL-0771-003 LI .... 158906VICTO* LUNOECH 4 CO.. •■iNttlt. FCKCUI
SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL
COUNTY COURT HOUSE
Phone 218-739-2271 - Fergus Falls, Mn. 56537
APPLICATION FOR PERMIT TO INSTALL SEWAGE
W te — Office •V low — Inspector
Pii.. — Owner
Card — Owner
DISPOSALjSYSTEM
J Vi'/Permit No..LEGAL /r- 7/*Date
DESCRIPTION
AND
' V 5LOCATION
Lake No.Lake Name Lake Classif.Sec.TWP Range TWP Name
IDENTIFICATION: Please Print All Information.
Last Name First Initial Mailling Address —No. Street, City and State Zip No.Tel. No.
OWNER
SEWAGE
SYSTEM
INSTALLER
Name.
fThis System will be ready for inspection on.,, 192X
This space for office use only
' ) 6 7;X’ > ^ A- M.19
Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signature
NUMBER OF BEDROOMS;ESTIMATED COST:
SEWAGE DISPOSAL SYSTEM DATA:
SEPTIC TANK SEEPAGE PIT DRAIN FIELD
GIs.Capacity Sq. Ft.Sq. Ft.
Ft.' 7 ■ }Ft.Ft.Distance from nearest well
Ft.Distance from lake or stream Ft.Ft.
Distance from occupied building Ft.Ft.Ft.
Distance from property line Ft.Ft.Ft.
Ft.Distance from bottom to Water Table Ft.Ft.
AH distances are shortest distance between nearest points
RECORD OF TESTS:
Inspection was made on , 19 , Time .JVI By
PERCOLATION TEST DATA:Date of First Test 19......, Rate■(
Date of Second Test 19 ., Rate
1st Test Taken By
First Test -t- 2nd Test
2nd Test Taken By Rate
Agreement:
strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn
esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi
cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the
responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. (Call or use attached mailer notice.)
The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in
/,/ 7,7 \ //r'VtDated A v.i. '/ ^ 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:
; ,7-7
- . r:Issued Date:
Shoreland Management Office
' ,7 S' f /Fee $Surcharge $
1S-U~DComments:.UERTIFICATES
Form No. MKL-0771-003 yiCToa LuMecCN a co . eniNtcaa rcxeus racLt .... 158906
*■INSPECTION RESULTS
Inspector must make all measurements
SEWAGE DISPOSAL SYSTEM STATISTICS
SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORYActualShould be Actual Should beActualShould be
Capacity GIs.GIs.SF S F S FS F
Distance from Nearest Well 5075F F FF F F
Distance from Lake or Stream F F F F F F
20Distance from Occupied Building 10 20F F F F F F
Distance from Property Line 10 10 10FFFFF F
4 4Distance from Bottom to Water Table F F F F 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-077 UOO 3- Backer
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f ,
PERCOLATION TEST DATA
SHORELAND MANAGEMENT
OTTER TAIL COUNTY
Fergus Falls, Minnesota 56537
Mailing Address:
Ph. No.Owner:
Last Name
fir/?
First Middle St. & No.City State Zip No.Legal
Description:
TWP NAME
<//
RANGELAKE OR RIVER NO.SEC.NAME TWP.
(LeeC—AoT~ ^ ^
TEST HOLE NO. 2TEST HOLE NO. 1
Depth to Bottom of Hole ^ "'sQ•>inches; Diameter of Hole JnchesDepth To Bottom of Hole.inches; Diameter of Hole inches
^<rf- T 7^Depth, Inches Soil Texture Soil TextureDepth, InchesDate19 Date 19
^7 ^./c,/ /vZ- -7 Percolation
Test By____
Percolation
Test Bv .r-■f/>C'
DlUFirm
Name.QC Firm
Name.D
OLU
tr
/"Pj. ir/'cHr £fUJAddress.CC Address.
<
COOtter Tail County License No..Otter Tail County License No.«H
coUJMeasurement,
Inches Drop in Water
Levei. UKhes
Drop in Water
Level. Inches
Measurement,
inches
I-Time Remarks Time Remarks
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7 KL-0871-028
'owNro Run a Percolation Test" by AgrTi xt. Service. Un. of Minn.