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Home My WebLink AboutStuart & Corinne Peterson Tst_ 56000030013000_Septic System Permits_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 07/25/2013 Stuart & Corinne Peterson Tsts 31494 395th St DentMN 56528 9222 RE: Primary Owner: Stuart & Corinne Peterson Tsts Sewage Treatment System Servicing Tax Parcel Number: 56000020008000 Described as:Sec 02 Twp Star Lake Township Sect-02 Twp-135 Range-041 13.75 AC LOT 2 EX TR Lake: 56-385 Star As of 07/23/2013 the sewage treatment system (Sewage Treatment Installation Permit # 22350 servicing your property was determined to be in compliance with the provisions of the Sanitation Code of Otter Tail County for a holding tank for workshop. If you have any questions regarding this matter, please contact our office. Sincerely Denise Gubrud Inspector SCANNED 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 COMPLETED IN ORDER TO BE PROCESSED Permit No. LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS SECTION TWP NO.RANGE TWP NAME Gn g?<F ^ PARCEL NUMBER (S) OF PROPERTY BEING SERVICED g to - - ^Cj> — E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROAD -S-t.e%ee>I3~ot30 oZ^00§“O0Z> — <90 6»^.< OtJO—OOOLEGAL DESCRIPTION O 0. Mailing Address Daytime Phone No.InitialLast Name First ^\V\gyU - ~r>>P o^ ^ vr>o Property Owner jriUS 'Xir\ cContractor Lie.# r3m TWS SPACE FOB OFFICE USE ONLY A.M. , the year of P.M.at.► This System will be ready tor Inspection on A.M. P.M. L&R OfficialTime ReceivedDate Received SEWAGE TREATMENT SYSTEM DESIGN DATA AS SHOWN ON DRAWING TYPE OF NSTALLATION (circle one) ^ftesidential ■r^New i , (B) Replacement Collector Other Est. (E) New (F) Replacement (C) New (D) Replacement Soil Treatment Area LiftTank Design Flow (Gallons/Day) —2,499 (H) 2,500 — 4,999 (I) 5,000 — 10,000 Effluent Distribution ( ) Gravity ( ) Pressure GIsGIs Ft.If5ooSize Setback To Nearest Well Ft.Ft.^30 Ft.Type i Type II (27) Rapidly Permeable(20) Trench, Rock Ft.Ft.Ft.Setback To OHWL(28) Flood Plain(21) Trench, Gravelless (29) Privies ^^Holding Tank (Y) Monitoring/Disposal Contract (22) Trench, Chamber Ft.Ft.Ft.Setback To Bluff tv>A(23) Bed (24) Mound Ft.Ft.Ft.Setback To Dwelling aiaType III(25) At Grade Setback To Non-Dwelling Ft.Ft.Ft.(31) Other/Problem Soils/<12" Soil(26) Grey water Type IV Setback To Nearest Lot Line Ft.Ft.Ft.i-(32) Public Domain & Proprietary Technologies Depth of WeiV.Setback To Road Right-Of-Way Ft.Ft. Ft.Type VTotal # BedroomsMe Abatement t/Tn) (33) Performance Garbage Disposal Y Elevation Above Restrictive Layer Ft.Ft.Ft. PERC TEST DATA Designer ___ License #Highest RateDate of Test 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. Appiicant 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 valid for a period^of^sb^^^^onths.'..Tj/d^peanit does not include the building sewer (sewer line). 7- o7^ Signature of Property Ovmer/Agent for Owner Land & RS^ource Management Official Permit Fee $Date: Rec. No..Date: ^ Qate StampComments: f'* . ■ L&R InitialForm No. BK — 07-2011-06 , 345.197 • Victor Lundesn Co.. Printers • Fergus Falls, Minnesota 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.us f UWHITE - Office YELLOW -L&R Inspector PINK - Owner / Contractor (after issue) ZZ').i Permit No.APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED ■I TWP NAMETWPNO.RANGELAKE/RIVER CLASS SECTIONLAKE/RIVER NAMELAKE NUMBER r .Y— I AcGO aT" PARCEL NUMBER (S) OF PROPERTY BEING SERVICED o E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROAD.a-5 Cp - COq l3 -o( c — O0Q(^1 Z) SU-^T'-S'C-OOC.- oz-o00g-o02> ~ ooc-g- oUO—OOOLEGAL DESCRIPTION \ ^=^0 G Daytime Phone No.Initial Mailing AddressFirstLast Name 1 Property Owner -■s t i Y . U -I ,K - i 1T,1 i .■SiA J ^ nn LContractor Lie.# } P^-' t .i r^r -s > 'T\ . 'A 0 > . ''i/ THIS SPACE FOR OFFICE USE ONLY <D_P.M., the year of at► This System will be ready for inspection on sn-o7-t^>HMOA.M. L&R OfficialTime ReceivedDate Received SEWAGE TREATMENT SYSTEM DESIGN DATA AS SHOWN ON DRAWING TYPE OF NSTALLATION (circle ONE) Other Est. (E) New (F) Replacement CollectorResidential (C) New (D) Replacement ew Soil Treatment Area (B) Replacement LiftTank Design Flow (Gallons/Day) IQJ^I — 2,499 (H) 2,500 — 4,999 (I) 5,000 — 10,000 Effluent Distribution ( ) Gravity I , ' 1( ) Pressure (- f-'Y GIs GIsSize /Setback To Nearest Well I Ft.Ft.Ft.Type IIType I 1 .j \(27) Rapidly Permeable(20) Trench, Rock \'\Ft.Ft.Ft.Setback To OHWL(21) Trench, Gravelless (28) Flood Plain f ; T*f (29) Privies y(22) Trench, Chamber /Ft. Ft.Ft.Setback To Bluff(30) Holding Tank(23) Bed /I( .. ) Monitoring/Disposal Contract(24) Mound Ft.Ft. Ft.\Setback To Dwelling AIA I (25) At Grade Type III ISetback To Non-Dwelling \Ft.Ft.Ft.(31) Other/Problem Soils/<12" Soil(26) Greywater f {Type IV 'Setback To Nearest Lot Line Ft.Ft.Ft./\(32) Public Domain & Proprietary Technologies Depth of Well -Y-\fSetback To Road Right-Of-Way Ft.Ft.Ft.Type VTotal If Bedrooms 1(33) Performance Elevation Above Restrictive Layer Ft.Ft.Ft.• -3 AY /■ •kT\Abatement Y /' N Garbage Disposal i PERC TEST DATA H Highest RateDate of TestLicense ftDesigner 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. y' t 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. , - Z" / NOTE: I.This permit is valid for a period of six (6) months. 2.This permit does not include the building sewer (sewer line). I - ,C<Date: ^Permit Fee $y '* l' •—> p—^-----------''#1^^'»—------------------Signature of Property Owner/Ag4nt for Owner I>■ l-z2-7J)p t. Rec. No..Date: Land & Resource Management Official SCANNEDComments: --tt Form No. BK — 07-2011-06 . 345,197 • Victor Lundeen Co., Printers • Fergus Falls. Minnesota r T'- S- SEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTS Inspector must make all measurements SOIL TREATMENT AREA HOLDING SEPTIC TANK OUTHOUSELIFT TANKCATEGORY I CPU FT Capacity FT2 FT2GLS.GLS. FTFTFTSetback from Nearest Well Setback from Buried Water Suction Pipe FTFTFTFT Setback from Buried Pipe Distributing Water Under Pressure FTFTFT FT Setback from OHWL (lake &/or river)FTFTFTFT FTSetback from Bluff FT FTFT FTSetback from Dwelling FTFT FT FTFT FTSetback from Non-Dwelling FT 7-, ft FTSetback from Nearest Property Line FT FTSetback from Right-of-Way FTFT FTElevation above Restrictive Layer FT FT FT Holding Tank/Lift Alarm NO Old System Pumped & Destroyed YES NO TRENCH REDUCTIONMOUND / AT-GRADE SOIL TREATMENT AREA CALCULATION FILTERSEPTIC TANK(s) # Tanks Installed ROCK Bl/Rock trendies wil inches %of sidewaHlbr. XFt. X Ft.Ft. ft®reduction / equivalent to Soil Treatment Area./W>Ft* Inspectorfs Comments:____ * 19-, »vmUi d,JM\iju\1 Sketch: t i </S^oV^i\ \I / 0 0 F 10 « V<Uw( Initial / L S R OfficialTimeDate As of n-x'i'U_ Code of Otter Tail County. the above described sewage system installation was found to be compliant with the provisions of the Sanitation I(jg, ~"^^^^~~LXdARwou^Manage^nt OfRcial Form No. BK — 07-2011-06 345,197 • Victor Lundoon Co., Printoro • Forgo* Falls, Minrtasota 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. L__inch(es) equals feetgrid(s) equals feet, orScale; MPCA LICENSE #: LICENSE CATEGORY: DATE: 'Z'- ! 3 DESIGNED BY: FIRM NAME://I ✓ ADDRESS:^SIGNATURE; VT\4-if i f i '■i- .15i Ja *Tv I■1 i3/V a. aifIL;a / V /! \^Ppf‘oxi0ot« W. L ne of Sec. 3 \ % 4'^ 4-. ^.-;f •- i ;V'/ i;r ■y/k, * »■ i 315.904 • Victor Lundeen --------‘^er^us^alls. MN • 1-800-346-4870,;7 ■ai # SITE DATA WORKSHEET V LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 218-998-8095 www.co.otter-tail.mn.us 2Z36T:>Sewage Treatment System Permit #OWNER: LAST NAME FIRST MIDDLE TELEPHONE NUMBER ADDRESS: 4k ^ CITYSTR./RT STATE ZIP CODE /IS' V /SA-u^S LAKE/RIVER NO.LAKE NAME X<r<, 7e^rmi-f- ■p=- Z7<>kO. SEC.TWP RANGE TWP. NAME LEGAL DESCRIPTION:SOIL BORING LOG STRUCTURE BLOCKY PLATY PRISMATIC NONE 2.Z>Z> -P'S- PARCEL NUMBER BLOCKY PLATY PRISMATIC NONE E-911 Address or Directions From Nearest Public Road t/aL/y SA^- pAj-e-ZAj GARBAGE DISPOSAL: YES /N^ •y- TrWELL: CASING DEPTHS2:> ft. SEWER LINE SEPARATION: FLOODPLAIN: YES VEGETATION: AQUATIC NUMBER OF BEDROOMS BLOCKY PLATY PRISMATIC NONE BLOCKY PLATY PRISMATIC NONE BLUFF: YES TERRESTRI BLOCKY PLATY PRISMATIC NONE SLOPE At INSTALLATION SITEl % TYPE OF OBSERVATION: Pr<Pit Boringe PARENT MATERIAL: Till Outwash Loess Bedrock Alluvium ORIGINAL SOIL: Ye No Date of Soil Boring. COMPACTED SOIL:No 4r"DEPTH OF BORING mo T oL restrictive layer):.ft.Date of Perc Test PERC TEST # 1 PERC TEST #2- TWO TESTS ARE REQUIRED - TIME INTERVAL [MfNUTES)WATER DEf^WATER DROP PERC RATE TIME INTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATE START START TIME DROP PERC DROP PERCTIME WATER DEPTHTIMEINTERVAL (MINUTES)WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER PROP PERC RA1 REFILL REFia TIME ’ DROp^o-^PERC TIME lOP PERCPEBg^ATETIMEINTERVAL (MINUTES)WATER DEPTH >TERC RAtTWATER DROP TIME INTERVAL (MINUTES) WATER DEPTH WATER DROP REFILL REFILL -r-------- =TIME WOP PERC TIME DROP PERC WATER DROPX^TIME INTERVAL (MINUTES!WATER DEPTH PERC RATE water^oTTIMEINTERVAL (MINUTES)WATER DEPTH PERC RATEREFILL REFILL TIME DROP PERC PERCTIMEDROP >^fVATER DROPTIMEINTERVAL (MINUTES)WATER DEPTH WATER DEPinPERC RATE TIME INTERVAL (MINUTES)WATER DROP PERC RATEREFILLREFILL PERCTIMEDROP TIME DROP PERC TIME INTERVAL IMINUTES)WATJfi DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)/ATER DEPTH PERC RATEWATER DROPREFILLREFIU TIME DROP PERC TIME DROP PERC TIME INTERVAL (MINUI^)WATER DEPTH WATER DROP PERC RATE TIME WATER DEPTH WATER DROPINTERVAL (NTTNUTESI PERC RATEREFILl•ILL TIME DROP PERC TIME DROP PERC TIME INT6HVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME JTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE/REFia REFILL TIME DfiOP PERC TIME DROP PERC PROPOSED DESIGN: TRENCH BED.ATGRADE.MOUND.HOLDING TANK.GRAVITY DIST..PRESSURE DIST. SEWER LINE.OUTHOUSE.OTHER.SPECIFY:. — SYSTEM DESIGN ON BACK — % •- DEWEY’S SEPTIC SERVICE 13384 CO HWY4 LAKE PARK, MN 565SJ PHON® 218-532-2516 LIC.L2884 Dewey’s Septic Service has agreed to pump septic system DRP Owner Tim Smith V ^ "LV.1^ "VU>o ^ • H \ tup tO LOCATION; . *S\Oc PARCEL NUMBER: -C»OCt>— ^^OO'-W-CXTjO ^Cji - OOCO ' c3CX:> ■' c% —OoQ PROPERTY DESCRIPTION; [OPERTY OWNER SCANNED APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENTOTTER TAIL COUNTY COURT HOUSE ^2^ 739-2271 - FERGUS FALLS, MN 56537 WHITE—Office YELLOW L&R Inspector PINK — Owner/ Contractor Phnno- ^ L o -h 7 n\oHLEGALPermit No. l^-h XDESCRIPTION()Yes : ( y)NoAbatement: (AND / *3 LOCATION ."7Co-t*x,p c\>l Lake/fwLAKENUMBERLAKE/RIVER NAME ER SECTION IVz /3STWP. NO.RANGE TWPNAMECLASSJLjiMS-fa,rHICrt>' 3%S PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER ’ OdO -O'} ' 6>oi3 ^aoo IDENTIFICATidN: Please Print All Information Last Name First Initial Mailing Address — No. Street, City and State Telephone No.Zip Code i'bd K.ts4~^ S4-Property Owner 4. -S4‘U.<L.r-S'h. SSJO^ SSewage System Installer Name Curt state Lie. #t A.M. ► This System will be ready for inspection on.the year of .P.M. V.at. This space for office use only NUMBER OF BEDROOMS: 2. A.M. .P.M.( X ) NOGARBAGE DISPOSAL: ( )YESDate Rec'd Phone Call Rec'd ByYear of Time Rec'd TYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) (^) Septic tank ( ) Lift station (Alarm Required) ( Drainfield ( )^) Trenches ( ) Bed -( ) Mound * ( ) Outhouse ( ) Sewer line SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTS TANK DRAINFIELD ^Yf Ft-Capacity 7SO GIs. <o//^ f *Distance from nearest well Ft. Ft.Ft;Distance from lake, wetland or river (OHWL)<5 <7 2-0Distance from dwelling Ft./O Distance from non-dwelling Ft.Ft.O/C? -'■■At ■ ;;Distance from property line Ft./O Ft./^5? I' ?-•.EFFLUENT DISTRIBUTION ("^Gravity ( ) Pressure i/' - -' <3 -Distance from bottom to Water Table Ft. All distances are shortest distance between nearest points PERCOLATION TEST DATA:WATER WELL DEPTH DirABSORBTION^EA FOR MOUNDS ^Date of Perc TestPerc Tester ft2 Z,/S 2./rRate of 1st Test Rate of 2nd Test Ave^e 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 ol 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 job is ready for inspection. DATE: ^ /^/^/f ^ 6 Signature / Perinit: 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. /PUfyt-a^ Issued Date: Land & Resource Management Office 3^^Fee $._Rec # Comments: 291.095 ■ Victor Lundeen Co. Printers * Fergus Falls. MirtnesotaBK 079&003 Ho ^liOMdJ Som/^dxurnJ 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 and all water wells within 150' of the sewage system. GRID PLOT PLAN feet SKETCHING FORMScale:.grid(s) equals feet, or .inch(es) equals SUBMITTED BY:SIGNATURE:4- FIRM NAME:DATE: > > • ■>ADDRESS:MPCA LICENSE #: 7.LICENSE CATEGORY:. STA/i, T T N “*r iI TI ';5-^r 1 '5"t T 1 T T 1yf y/3 295.213 • Victoi Lundeer^ Co . Pnnwrs • Fergus Falls. MN • 1 •000-346-4870BK — 0496 — 029 SITE DATA LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Fails, MN 56537 OWNER: MIDDLE TELEPHONE NUMBERFIRSTLAST NAME ADDRESS: /y/ ZIP CODECITYSTATESTR./RT. 3 /3ST V/crt^-ysrr- LAKE/RIVER NO.SEC.RANGE TWP. NAMETWPLAKE NAME. \■alEGAL DESCRIPTION:SOIL BORING LOG — Date. COLOR & MUNSELL NO. DEPTH (INCHES)STRUCTURETEXTURE BLOCKY PLATY PRISMATIC NONE / i PARCEL NUMBER BLOCKY PLATY PRISMATIC NONEs/zFIRE NUMBER Jer-I ? a.NUMBER OF BEDROOMS BLOCKY PLATY PRISMATIC NONE GARBAGE DISPOSAL: YES ft.WELL CASING DEPTH:BLOCKY PLATY PRISMATIC NONE V FLOODPLAIN: YES i(^RE^^i^ VEGETATION: AQUATIC BLOCKY PLATY PRISMATIC NONE /SLOPE AT INSTALLATION SITE: TYPE OF OBSERVATION: Probe Pit / f >PARENT MATERIAL:Outwash Loess Bedrock Alluvium COMMENTS:. ORIGINAL SOIL: COMPACTED SOIL: nDEPTH OF BORING:.ft. r PERC TEST #2PERC TEST # 1 - TWO TESTS ARE REQUIRED - WATER DROP PERC RATEPERC RATE TIME INTERVAL (MINUTES)WATER DEPTHWATER DEPTH WATER DROPINTERVAL (MINUTES)TIME Z?:/s-S'/2.START Jo. START / ®2L/lO.TIME DROP PERCTIMEDROPPERC WATER DROP PERC RATETIME •INTERVAL (MINUTES)WATER DEPTHWATER DROP PERC RATEINTERVAL (MINUTES)WATER DEPTH _..jr___ TIME ff'■ %. c.7REFILLREFILL V TIME DROP PERC ___/fc____-—rO — -TIME DROP PERC PERC RATEWATER DEPTH WATER DROPPERC RATE TIME INTERVAL(MINUTES)WATER DEPTH WATER DROPINTERVAL (MINUTES)TIME wZJL yREFILL^FILLtoLQ.TIME •DROP PERCTIMEDROPPERC • PERC RATEWATER DEPTH WATER DRQJPERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROPINTERVAL (MINUTES)TIME 3REFILLREFILL /DROP PERCDROPPERCTIME PERC RATEWATER DEPTH .^.ATgp WATER DROP PERC RATE TIME INTERVAL (MINUTES)INTERVAL (MINUTES)WATER DEPTHTIME .REFILLREFILL TIME DROP PERCPERCTIMEDROP PERC RATEINTERVAL (MINUTES)WATER DEPTH WATER DROPWATER DROP PERC RATE TIMEINTERVAL (MINUTES)WATER DEPTHTIME REFILLREFIU DROP PERCTIMETIMEDROPPERC PERC RATEWATER DROPPERC RATE TIME INTERVAL (MINUTES)WATER DEPTHWATER DROPINTERVAL (MINUTES)WATER DEPTHTIME REFILLREFILL -----^^ =DROP PERCTIMETIMEDROPPERC PERC RATEWATER DEPTH WATER DROPWATER DROP PERC RATE TIME INTERVAL (MINUTES)INTERVAL (MINUTES)WATER DEPTHTIME REFILLREFILL DROP PERCTIMETIMEDROPPERC PROPOSED DESIGN:V XlGRAVITY DIST..PRESSURE DIST..ATGRADE.MOUND.HOLDING TANK.TRENCH.BED. SPECIFY:.OUTHOUSE.OTHER.SEWER LINE. — SYSTEM DESIGN ON BACK — 'SR- CERTIFICATE OF COMPLIANCE SEWAGE SYSTEM fQ I ISth VecmbeA 19_S4\This certificate has been issued this day of.S- m to certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota.\' m The premises covered by this certificate are legally described as:r-L- StoJi la.ko.Twp. ^ 35 Range 4156-3X5 2m Twp. Name.Lake No.Sec.iWi wW'-lI Camp AqiUZaI m!a^-- M*SixioAt PedieA^onOwner: Name. 1311 KoJiton Avznae.. St. Pant, HinnuotaAddress.i I 55108Zip No. Permit No. SP ^6117 Signed by:.^^colm K. Lee, ShorelanrAdministiator Otter Tail County, Minnesota MKL-0871-009 159035 *'6Tot twBMiB » e*. nti SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 - Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEIA/AGE DISPOSAL SYSTEM WhitB — Office Ye/tew — In^secfor Prnk — Owner Cord —Owner Permit No.,LEGAL DESCRIPTION AND ^ u/ sr^<z LkO oLOCATION Lake No.TWP NameLake Name Lake Classlf.Sec.TWP Range IDENTIFICATION: Please Print All Information. Last Name Mailling Address —No, Street, City and State Zip No.Tel. No.First Initial ShA^rf I3ll O VOOWNER sT'^kwI YV1 tV SS/ tSEWAGE SYSTEM INSTALLER ’ Sr^fkiv k\Name. Th/s System will be ready for inspection on., 19. This space for office use only 19 ,M Date Rac'd Time Rec'd Phone Call Rec'd By Owner or Agent Signature HNUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD I OOP GIs.Sq. Ft.Sq. Ft.Capacity ^//aoFt. Ft.Ft.Distance from nearest well Ft.Ft.Distance from lake or stream Ft. Za/a Ft.Distance from occupied building Ft. Ft. /C^/aDistance 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 L9.:d:.kz.. / <3 PERCOLATION TEST DATA: Date of First Test 19 Rate. RateDate of Second Test 1st Test Taken By I \I '0>II l Lr3.First Test -I- 2nd Test 2 Rata2nd Test Taken By The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work inAgreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been ipspected ancLpccepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that job is ready for inspec^o^ /o~ y/Dated zr-Signature Permit: Permission is hereby granted to the above named applicant to perform the work described in the above st 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. t. This permit is granted upon express /o - 9 -Issued Date: Shoreland Management Office Fee S / <3 Comments:. Form No. MKL-0771-003 SAtlU ua. MiNMSOU I ■ '■ INSPECTION RESULTS r’ Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS 'f SFEPAGE PITSEPTIC TANK -DRAINiFIELDCATEGORY ^ Should beShould be' Actual Should beActual Actual S FCapacityGIS;GIs.S F S FS-F I . F'1 'FDistance from; Nearest Well '!5075I !I i F F^F F I ‘ .Distance from Lake or Stream F F F F ■F F 1 : -A20 2010Distance from Occupied Building F F F F F F ■ ■ :i- . . Distance from Property Line 1010 10 F F FFF F 3Distance from Bottom to Water Table 3 ' F’F F 'F F F I ••Inspector's Comments: I ' J J. Y Date of Inspection 19___ Time of Inspection.\.M V 4 .»- ';YV.: , Signature of Inspector VINTERPRETATION OF ABBREVIATIONS GIs Gallons SF ° Square Feet F ■ - = - Linear - Feet Job Title Agency'MKL-0771-00iBackef , ■;I ‘ : i i< • • . > : ’#1 *.I?, f(w '^avt^Y'v* ■’ - • 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 Whi»-office Ye//ow — Inspector Pink — Owner Cord — Owner :IcxLA L \tPermit No., LEGAL o, yv\ jp TX c| 'tv C -FV DESCRIPTION AND / '>A<u /r- T)'..'a -r/■'LOCATION TWP NameRangeSac.TWPLake Claesif.Lake No. Lake Name IDENTIFICATION: Please Print All Information. Zip No,Tel. No.Mailling Address —No, Street, City and StateFirstInitialLast Name S'^I-..L- ■ >vi f-"-OWNER yJ C a / Ox"V'v-'i SEWAGE SYSTEM INSTALLER Name. 31 'n-aaVvm.\ oThis System will be ready for inspection on.. 19 This space for office use only . ^ Rec'd ' Time pic'd \0 '.M Owner or Agent SignaturePhone Call Rec'd ByDate 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 ^ n Ft. Ft.Ft.Distance from lake or stream L£l Ft.Ft.Ft.Distance from occupied building /C^j 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 /•Co /o - Go- PERCOLATION TEST DATA: •____ , (i-j - ,,, Date of First Test ,, 19 Rate I i.£SC....,Date of Second Test 19 Rate 1st Test Taken By i 'Co L 2.:.L.3!-I- 2nd TestFirst 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. 33 3-yZ.^Dated Signature Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon expressPermit: condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six (6) months. Issued Date:. Shoreland Management Office . C7 f> 3Fee $/ certificate issued Comments:. [Review battle lake MinnesotaForm No. MKL-0771-003 1 ,, ^—IT!‘.T . T •• •, •*■- ------TV"'' i ,» •'•V / INSPECTION RESULTS Inspector must make all measurements fSEWAGE DISPOSAL SYSTEM STATISTICS ( K SEEPAGE PITSEPTIC TANK DRAIN FIELDCoveeet2>CATEGORY Actual Should be Should beActualShould be Actual ■^COs F}m<;T£ry0£-g-/oooCapacityGIs.GIs.S FS F S F Distance from Nearest Well 5075FFFF F SOfOO FDistance from Lake or Stream F F F FF \ ^Of20 2010Distance from Occupied Building F F F F F ///O' pf T>10Distance from Property Line 10 10 F F F F F f :^F 3Distance from Bottom to Water Table 3FFF F F MA 7 A/Vi a t\ m Inspector's Comments: lo~,9^ Date of Inspection h2,4f'Time of Inspection..M signature of Inspector4INTERPRETATION OF ABBREVIATIONS GIs - Gallons SF " Square Feet F - Linear Feet Job Title AgencyMKL-0771-003-Backer r V, f/ M Vft • s/ ► 1 21SS02® VICTO* LUNDCCH CO.. POINTERS. FERSU9 FALLt. UINN.MKL -0871 -028 PERCOLATION TEST DATA LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, Minnesota 56537 Ph. No. Owner:Mailing Address: State S'£^/0^/S/f Zip No.CityFirstSt. & No.Last Name Middle Legal Description:•4// TWP NAMETWP.RANGESEC.LAKE OR RIVER NO.NAME TEST HOLE NO. 2TEST HOLE NO. 1 33 Depth to Bottom of Hole inches; Diameter of Hole JnchesDepth To Bottom of Hole,inches; Diameter of Hole inches /O/ L » S(P/ ~fle-f-pAK1 /C/Depth, Inches Soil Texture Depth. Inches Soil TextLyeDate DateTirj\ch / \J Firm Name B ^Percolation Test By____ Percolation est By .lUi QLUly rFirm Name.CC IDO LU QC LUAddress.QC Address < C/)Otter Tail County License No..Otter Tail County License No..KcoLUMeasure ment,inches Time Intervals minutes Drop in water level, inches Percolation rate minutes per inch Time Interval, minutes Measure ment inches Drop in water level, inches Percolation rate minutes per inch Remarks:Time Remarks:TimeogTrMiUI- il:zi n4o m 7 w m /£%Ui / Zia/^'-V 5725 :5e7 tlu la I40-AI Z/^2 i:^Z4^ 3_2.n T=>4m4ulaaz 734-7 2,~k liBlA IIAa See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of MN Percolation rate minutes per inch minutes per inchPercolation rate = ! i / J