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Sunset Beach Resort Inc_52000090041006_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 10/26/2012 Sunset Beach Resort Inc 4928 4th Ave S Minneapolis MN 55419 5638 RE: Primary Owner: Sunset Beach Resort Inc Sewage Treatment System Servicing Tax Parcel Number: 52000990389000 Twp Pine Lake TownshipDescribed as:Sec 09 Sect-09 Twp-136 Range-038 PINE BEACH SUBLOT A LOTS 1,2, 3, 4, 5&6&TR Lake: 56-130 Big Pine As of 10/24/2012 the sewage treatment system (Sewage Treatment Installation Permit # 22124 servicing your property was determined to be in compliance with the provisions of the Sanitation Code of Otter Tail County for a 3 bedroom home. If you have any questions regarding this matter, please contact our office. Sincerely, Eric Babolian Inspector SCO 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)Cvusf(5^‘^ /APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED Permit No; RANGELAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS SECTION TWP NO.TWP NAME 1r.n ;-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROADPARCEL NUMBER (S) OF PROPERTY BEING SERJ^TCED ^Xoo'o^^Ao ooo LEGAL DESCRIPTION 9T r^LZ Daytime Phone No.First Initial Mailing AddressLast Name Slop’S^ OcacA jA^ • n. f\ c<\f> 0 ft I ~ ,?<P i:Property Owner ✓ «. Dan Wegscsield Bluffton Hardware P.O. Box 56_____-____ Bloffton, MN 56518 Contractor Lie.#7SS‘-J7« ( 74 (, THIS SPACE FOR OFFICE USE ONLY A.M. .P.M., the year of at.>■ This System will be ready for inspection on A.M. P.M. L & R OfficialTime ReceivedDate Received SEWAGE TREATMENT SYSTEM DESIGN DATA AS SHOWN ON DRAW NG TYPE OF NSTALLATION (circle ONE) Other Est. (E) New (F) Replacement CollectorResidential (C) New (D) Replacement Soil Treatment Area epiacement Tank Lift Design Flow (Gallons/Day) 1 — 2,499 2,500 — 4,999 (I) 5,000— 10,000 Effluent Distribution ( ) Gravity Pressure GIsGIs/ood ^ oc>Size Setback To Nearest Well Ft.53 Ft.Ft.Type I Type II (27) Rapidly Permeable(20) Trench, Rock ;3/ Ft./i'OFtIds'Ft.Setback To OHWL(21) Trench, Gravelless (28) Flood Plain (22) Trench, Chamber (29) Privies Ft.Ft.Ft.Setback To Bluff(23) Bed (30) Holding Tank ( ) Monitoring/Disposal Contracti^^(2^Mound Jo Ft.Ft.Ft.Setback To Dwelling /o ro(25) At Grade Type III Setback To Non-Dwelling 'iT Ft.Ft.fOOFt.(26) Greywater (31) Other/Problem Soils/<12" Soil IS Type IV Setback To Nearest Lot Line //Ft.Ft. Depth q\W^\(32) Public Domain & Proprietary Technologies Setback To Road Right-Of-Way '^Ft./SorFt.iS o /5oType VTotal It Bedrooms3 (33) Performance 3Elevation Above Restrictive Layer Ft.Ft.------Ft.Garbage Disposal Y N )Abatement Y / PERC TEST DATA U1- /1-Designer-Pl^iLa^__1=^Highest RateDate of TestLicense #j t 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 fhe permif. Applicant further agrees that no part of fhe sysfem 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 Managemenf fhat fhe insfallafion is ready for inspeefion. 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 respeefs to the Sanitation Code of Otter Tail County, Minnesota, This permit may be revoked at any time upon violation of fhe Sanitation Code. (6) months. 2. This permit does not include the building sewer (sewer line).NOTE: I.This permit is valid for a period of Signature of Property Owner/^enl for Owner L^d& Resource Management OfficiaT' Permit Fee $Date: Rec. No..Date: Date StampComments:OCT 15 2012 ^SCAHNED land & RFSOUP.Gc L&R InitialForm No. BK — 07-2011-06 345,197 • Victor Lundaen Co.. Printers • Fergus Falls, Minnesota 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 SITE DATA WORKSHEET Sewage Treatment System Permit # ^ */ 6a- TELEPHONE NUMBER OWNER: P>'. I f-7 6FIRST ^LAST NAME MIDDLE ADDRESS: ' r\ix^A^lo ^ ^A^py. STR./RT.CITY STATE ZIP CODE 1 ll_S'L-t'l o iS -'cj P,\c. Jake name i-vj< e 04LAKE/RIVER NO.SEC.TWP.RANGE TWP. NAME LEGAL DESCRIPTION:SOIL BORING LOG Pr COLOR & MUNSELL NO. DEPTH (INCHES)TEXTURE STRUCTURE BLOCKY PLATY PRISMATIC NONE /I A •■'V 0-'^^.2,000 ^'JfyyPf> !•'> PARCEL NUMBER - S^^JLdOOO^QO<^( x/.'/cXc ukc Rj.BLOCKY PLATY PRISMATIC NONE to 'fr^r'-qg ME-9H Address or Directions From Nearest Public Road 7y 3NUMBER OF BEDROOMS BLOCKY PLATY PRISMATIC NONE '-•A3^GARBAGE DISPOSAL: YES U-WELL: CASING DEPTH ft. SEWER LINE SEPARATION:ft.BLOCKY PLATY PRISMATIC NONE (no)FLOODPLAIN: YES BLUFF: YES VEGETATION: AQUATIC ERRESTRIAL ------------------ SLOPE AT INSTALLATION SITE: tS>- (BLOCKY PLATY PRISMATIC NONE % TYPE OF OBSERVATION: Probe Pit (TpPARENT MATERIAL:Outwash Loess Bedrock Alluvium NoORIGINAL SOIL:Date of Soil Boring. (£)COMPACTED SOIL: Yes DEPTH OF BORING (To 7' or restrictive layer):.ft.Date of Perc Test PERC TEST # 1 PERC TEST #2- TWO TESTS ARE REQUIRED - WATER DEPTH PERC RATEINTERVAL (MINUTES)WATER DROPTIME PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROPSTARTSTART TIME DROP PERC TIME DROP PERC INTERVAL (MINUTES)INTERVAL (MINUTES)WATER DEPTH WATER DROPTIME PERC RATE TIME WATER DEPTH WATER DROP PERC RATE hREFILL REFILL "time" * DROP PERC*"^ I-r_i___ =TIME DROP PERCTIMEINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEREFILLREFILL ______-rTIMEDROPPERCTIME DROP PERCTIMEINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATEREFILLREFILL f -r g =TIME DROP PERC TIME DROP PERC INTERVAL (MINUTES)WATER DEPTH WATER DROPTIME PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER PROP PERC RATEREFILLREFILL -r---------- =TIME DROP PERC TIME DROP PERCTIMEINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL IMINUTESI WATER DEPTH WATER PROP PERC RATEREFILLREFILLI——It- ~ ^ ■ TIME DROP PERC4TIMEDROPPERC INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIMETIME INTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATEREFILLREFILL ^___ =TIME DROP PERC TIME DROP PERC TIME INTERVAL (MINUTES)WATER DEPTH WATER PROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATERtCREFiaREFILL TIME *TIME DROP PERC DROP PERC m ' 5PROPOSED DESIGN: ^PfiBSSUBErOIST..TRENCH BED.ATGRADE.MOUND.HOLDING TANK.GRAVITY DIST.. SEWER LINE.OUTHOUSE.OTHER.SPECIFY:. — SYSTEM DESIGIM ON BACK — 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 Jnch(es) equals feetgrid(s) equals feet, orScale: IU(^MPCA LICENSE #: LICENSE CATEGORY: ---------1 DESIGNED BY: ( FIRM NAME: i ADDRESS: i ban Wegscheid Bluffton P.o. Box 56 ' ! Bluffton,-MN 58518 — DATE:\ SIGNATURE: j \ A A\','i' -r-"V I 'J V Ls) 4-l:I ^TJ//i>‘ TO f‘°t a 10^'”L- -ft <{tp 0^: \ - - I 5 J/i U 4r >/or'^ 1 co <p5\1 0^ i;;uCE!VGD ,-s, Ut; I;f'i-JJ CQ_ j 1\ 1 : ' ! I ■ •— I : , 1 I ( Q U/ < J ' "S V \ \‘■i ^BK- 1003 — 029 315.904 • Vicior Lundoon Co.. PriiUors •. Fergus Falls. MN • 1-800-346-4870 .' -I .''.TT." A'•'• 'J« -I"" •. '11 • •• ■ ' -1 •:• 4’ll• ••?r>. APPLICATION ROR PERMIT TOTNSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095) pj GOVER^IME^ T SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 ' ' I k .WmrE - Office I',' YELLOW- L& R Inspector PINK - Owner/Contractor (after issue). ■ I'' ■■ ■ ■ ■ : ■ ' ' ' r.www.co.otter-tail.mn.us i.s,(:: i.ui ^ ■ J-) c (y ^ ‘ _ , Permit Nor-^ ~2 / ’•''I MUST BE COMPLETED IN ORDER TO BE PROCESSED I'j.LAKE/RIVER NAME LAKE/RIVER CLASS SECTION- LAKE NUMBER TWP NO.RANGE TWP NAME p ..- /-.^P.1^u-\T,o 31I.•> ^ C /3(.GO-V ti <-{ PARCEL NUMBER (S) OF PROPERTY BEING SER/ICED E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROAD 0‘ - r C>2oc>on'^i:)0^/an/. ; ■ ■ ■ YLEGAL DESCRIPTION / ■ ■ - 'W'-r.' ^^iliniAddrbss-'"'"*"''*^fjinitialFirst Daytime Phone No.Last Name LH z.-------------'■^3PC,]f P C f ! u. r ' -S u .'1 / L> '(/ 'A 7 • Property Owner (i'2s f-<fn<■/f J-f..y r ■ ovt^_Gl££!p.2 2o- nvLA-t r-t U-4. Dan Wegscheid Biuffion. Hardware -----P.O. Box ;S8---------------- u-LVtU?- >r .j i / AContractor . Lie. # • ■Till21lA ILL THIS SPACE FOR OFFICE USE ONLY pir\\3r ^, the year of>■ This System will be ready for inspection on "Date Received uA.IVV. P.M. Time Received L&R Officiai SEWAGE TREATMENT SYSTEM DESIGN DATA AS SHOWN ON DRAWING TYPE OF NSTALLATION (Circle one) CollectorResidential Other Est. (E) New (F) Replacement (C) New (D) Replacement (A) New '(B)‘Replacement Soil Treatment Area Tank Lift "Design Flow (Gallons/Day) 2,499: . . ; y • '-(H) 2,500 — 4,999 (I) 5,000 — 10,000 Effluent Distribution a,. ),-Gra7ity ( .) Pressure i., , Gls- /AvO ■■GIs ^YTT'"*'t ' A V c> •SizeyC... Setback To Nearest WellType l|Type I Ft.Ft.Ft. (27) Rapidly Permeable(20) Trench, Rock 3/ Ft.Ft./.rSetback To OHWL ;.7rP(21) Trench, Gravelless (28) Flood Plain } (22) Trench, Chamber (29) Privies Ft.Ft.Ft.Setback To Bluff(30) Holding Tanf ( ) Monitori (23) Bed i5^24))Mound ng/Disposal Contract Ft.5^ 0 Ft.Ft.Setback To Dwelling '/ D/D"(25) At Grade Type III Setback To Non-Dwelling(31) Other/Problem Soils/<12" Soil(26) Greywater '?• r' '"‘■r" Ft.Ft./0(i Type IV Setback To Nearest Lot Line trTFt.MFt.Ft.Depth of Well _____T> iJ ' (32) Public Domain & Proprietary Technologies Setback To Road •Right-Of-Way -- Total # bedrooms - Ft.rFt.iFt.Type V I At o ./irO- 5 (33) Performance Elevation Above Restrictive Layer 3Ft.__ Ft.Abatement Y /Garbage Disposal Y / V. PERC TEST DATA Highest Rate / j 3Date of Test , • > 'f1DesignerLicense #La^ c‘i^ / 5 » -<• , f . Agreement; The.undersigned.hereby makers applicatio i-for,permit to install,iaiter,u-epair-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 thal'the Site Data Worksheet subhnitted herewith and which is approved by a Land & Resource Management " Official shall become a part of the permit. Applicant furt ler 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. jr~pz 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) nonths. 2.This permit does not include the building sewer (sewer line).N, uJ/..J /7> -Permit Fee $Date: 7 f- ■» >r"-27-5 __7-j^' ^_Sig/ia/ure ofl Property Owner/Agent for Oiivner MM iDate: 7^POA'L Rec. No._^ L8n6'& Reso free Management Official Comments: A Form No. BK — 07-2011-06 345.197 • Victor Lundeen Co.. Printers • Farous Falls. Minnesota 1 SEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTS Inspector must make all measurements SOIL TREATMENT AREA HOLDING SEPTIC TANK OUTHOUSELIFT TANKCATEGORY GLS./ GLS.Capacity FT 2 FT 2 ‘f’jT ~FT FT FTSetback from Nearest Well Setback from Buried Water Suction Pipe FTFTFTFT /Setback from Buried Pipe Distributing Water Under Pressure /c.V-'FTFTFTFT/ O /■/ /30 - FTSetback from OHWL (lake &/or river)FT- FT FT FTFT FT FTSetback from Bluff 3S"-:: FTSetback from Dwelling FTFT FTiO ftSetback from Non-Dwelling FT ~ ft FT /-/S" -Setback from Nearest Property Line FT FTFTFT/2 /kJO'/ ft•4--/ O d FTSetback from Right-of-Way FTFT 3 FTElevation above Restrictive Layer FT FTFT Holding Tank/Lift Alarm NO Old System Pumped & Destroyed D/sro'/'/^c NOYES TRENCH REDUCTIONMOUND / AT-GRADE SOIL TREATMENT AREA CALCULATION SEPTIC TANK(s) # Tanks Installed FILTER ROCK BED inchesRock trenches with loManuf.ol sidewall for.%3fVi^Ft. X Ft.Ft. X Ft. ft^reduction / equivalent to Soil Treatment Area. □ NOModel #Ft2 Inspector's Comments: 7 0 t/'/V /r r'f /c 7?^VL 3 Sketch: ! \\1 'V !y ¥^C.I \ 0\A A it :!/ S'.IS ■■ L Ir 'i| /—f Ii !/ / to Date Time Initial / L & R Official tT-, the above described sewage system installation was found to be compliant with the provisions of the SanitatioriAs of Code of Otter Tail County.( r Land & Resource Managomeni Official winsi!.Form No. BK — 07-2011-06 3^S.i9? • Victor Lun.'foen Co,, Prlniar.'', •* Fergus Fails, Winriesoia '(i:MQU:*»?p DESIGN WORK SHEET (For Pig Av rriift liMi^nVLOW Esdnited fpd fw/(fwr# A-2) . X 1.5 iuh^Jixctor) • 8:rs: A-»: Omh CM'I OMiivdinttM89fK30or mauured U. SElT2CTANKC*p«clty J/9(9 0 ___fiUoni(iii/iitirtC-2) C. SO. tS inftr ta iitt nthMtion) 1. Dtpth to wihdetfnf l*ytr ■ 2. Dtpdt of ptfooliitlon tooti ■ 3. Tifhii»« ------ Porcolittw ritt > — mpi *' 4. Soil leading nfet 3. Percantlanatlopa_^ «P«4M 111too ofth* vQlMitH Alh* Ctemt. IL Vt» CCHjttTA in mifiDIM7m410US 100 170100 «l471l«S ~1 T"t «i"isr 'SBwr WI ££!htt "tH iLfi at HM>fNt tfun 0*^ 0. AOCKLAYIllDIMlNtlONS 1 M uW|ly avar^t Mgn flow (A) by 0.f3^o c stato raqulrad rook layw ant. 2. D. lt•raUrv• sS^ laytr %^ih?O.I3 aqft/nd i ^ 0.113 tqlt/glkl X ipd/aqft • 3. Lingthofreeklaywartt-i-Width* ^ J iqft (Dl) *. _tiL, ft (D2) - ft 1. AOi JC^MOLUMB 1. M ddply rock aria (Dp by rock depth of 1 ft 19 gat cubic fact of rock £LlsqftxlA*.T7£-Cuft 2. Di(ridaeuftby27euft/euydtogcteublcyirdi 37.5^ . cult *27 euyd/euft* // euy 1 3 M jiHply cubic yard* ^1.4 to gat weight of n ck in tom - cuyd X t.4 ton/cuyd ■ Mound LLR <120 MPI ‘^IS ^120 MPI .16 17 tai a naiuoi "SZSr m SEV AGE ABSOIlFnON WIDTH nsarpt Ion. width aqucla abaorptlon ratio (Saa Figu .-a D-33) snu K ek layer width (D2) —L-x £0 ftmJO n WWW 'Br-' •nr- , * L *Ji » «a* ocr / ^ LAND & RESOURCE I I ■ rL-P.-4J-p ' ,“T-T-J ^ -I’ •. I -uq ^±EF I t 1 I t f 1 I I 1 XTT Ti~;~rTnbTi'Sn . !..jZ|j. ,; 1; .;t T t.I I TT Ii£&I i I +--------1— •• iil-l —-1^' I ri:W'-' ■ •; ■ . <•' ’•. ' Cv.-- ,• ti- . : 'Q: : . TTT 1'TT 1 l~r 113H41 tCXi:-TUT/;.n I I8t TT ;I ‘tn I I I I )I I izB; t tnO*——r-T I LLOZl f'i >:iTmT'I i : I ^I TT ----------’a_ rmriOis2i1 I|| • ci‘‘; . ■TIT TT ITTTTiTT I 1(T T TI I I T ft(21^KOIi X11 Ti :i TT5^^=bw~lO-i ,'!•IQ I .1 Iscnc&mm T-T?jnS I% I I I L I I I III T C->£I T c#’> ■ ■■ m I £4 i- 1c^1 rS~.SrfiS Tt 1?-©]■I t;I I rr!S.G it:T I iTi I I L#t:Iiici a>'~i rto^T-fi"' jqitel _1_I ~i TIT1 mRTO : : I rr—: X I+I S “ti'XirrlTTT Jin11 H-jl I ■f.1 I & j—1 TT IT 1 I J 1 r- IjiJrT:-, T 1 I3'' n& ■LI J: I 711 1TtT1iTTTTTI i 1 n;rrI t I ■ I J.S 54 Step Jp® I H ^TTTlTg?l T A1Hjy-i Tg;HTj]te 3-^0I;g<TN^rI oITLj_1jdJ s:T T TT!I yr mTrtrffTirri±r±i i iJ2Qi 4UaiLTTj ~A/~o1.I 11 iT? I -U t a LL Sh1I[Iti tIT+II ■ i : ItI I 1 K !t } ■11 TTJli I :IJJi) I IX Xn±L I1I I ;■Jj..!.rX Mill HETS-sH-l-p- gwz]::;r;: I TriiI1r-ftT r -I Q. ! I 'TT MX_i_4_xX TtirUdTE'iTi TtrpTu:;mmi ar *XL I; utxr: .LJ.J I;t;X:i/T ::r;.r/n:u roiurujo:;P-'!'=g-1 -V±l - S-h O1gj--.:)-o3Pui^p- HuUX4s" Tgx'nr~~~ L2.rz:i.1 TTTzI t •TV yT*; ■/-^ //■f' T 0 -CjXT a/ ^ /S hL'UrjJi.^1^, of]: Tvc 9 CO z^iooO 900 Co <?4C. ■—^ -S U.X xo; ^5 X ^-?5^ KA//t,X tT 7Ss u-9 Xj f H __Si'r.'p 0 "> 12/ h^Sl-l Mju.hh\. J 5^ pr^r#-fy 4-I 'IO o CO \ . /i - *-/-.^ i / 1% lin<l alopf<«» Mo und Slept Wldtit Mid Ltufth Uimdilop* laa® duR or tqual to 1%) Absorption width (F) —/-Q.—- Calculate mound size Determins Lipslope edge o< roc* lay at the distinct to rtitilctlng layer (Cl) tkm Z__________k Mound haight at tha upalopa «d|a of rock 4> er « depth of dean tand for atparttiem (G2a updupe ed|e plM d<^^ of layer (1 ft); !ua depth of cover (1 ft) / height (G2b) Imea 4 (4 ft rweomnmdii, hif could gc 3-22; pev^Jsihesumof (C2c)widthplu#rocklaytrwidth(D2)pi ----- I ■ "n* ■••i NHiieiaH depth of clam sand flU iBsrwsjrtSijjf j 8 •' i »5 ft mmmm m •■lUf . ^3 > it . Derm width ■» u ___The total landsca Z2=-Jt + . 'll jjrmwi r,2cy. ' Aciditioivil width rutceaaai^ for ibaorptton » iboorption width (P) minus th# landacape' v 1< It K {C2d ^ 0 — ft - “ ^ )^-ft • ,...rjL!ll-ft^ <f mmn tar ft acfatfiw (at) eaft tof Final barm width - edditional width (C2e) p us the btrm width (C2e) Y.„ ft + ^2- It • ^ ^ ft Total mound width is die rum of barm wid h (G2f or G2c) plus rock layw width (D2) pi 11! t erm >/tdth (C2f or G2c); . 12^-Jt* „,.LQ....ft^ 2=l«ft ■ ft Total mound length la thaaum of btmi (G2' or G2e) plus rock Uver langftt (D9) plus be Setbacks from tha rockbed art calculated as f tUows; the absorption width QP) minus the r>) * t )ed w* yi\ divided by 2i t J n. ft » _ J.n ftt ■*■ 2 » _ D,. ft *r (32for isima .«!gai I J®’.. inal Dimensions: | 9 iiJT-4^ J4. n Wlithu* ,L.<§tiBa$aBbttariUiaAfaMa J*l ■> > «ryy c«rd/y th«( I h«vf cocnp^tltd this w»k tn tceovd __lyy-efO^e^^.'^i*h *ppUe*Mt«dfcia»icai, miss wi4 Is wi. 'nee >(ft8wittra) . ,(4ai I f SCANNED APPUCATION 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; TWP NO.RANGE TWP NAMELAKE/RIVER SECTIONLAKE/RIVER NAMELAKE NUMBER . , CLASSCD 12 E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROADPARC£LMJMDeR r? "OP PROBERTY BEING SERVICED OOO J ^XoOOO°iOOLflObL Q:(jAL UhbUKIP I lUN ~ ----' ' Pr (BA 2- Daytime Phone No.Mailing AddressFirst InitialLast Name Gtorct. ^ C[ujJiCr - £iiy\Se:^ Qu.kckQeJDif A.c. r.Property Owner . f,n.22o-L\l1jA^ • I, i Dan Wegscheid Bluffton Hardware-0 P^g Box 56_____-____ Bluffton, MN 56518 3Sf'.37« ) Contractor Lie.#✓ /H 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 DRAWING TYPE OF NSTALLATION (circle ONE) Collector Other Est. (E) New (F) Replacement Residential (C) New (D) Replacement Soil Treatment Area epiacement Tank Lift Effluent Distribution ( ) Gravity Pressure Design Flow (Gallons/Day) 1 — 2,499 2,500 — 4,999 (I) 5,000— 10,000 2yrGIs Ft.GIs/ooo (g OCBSize Setback To Nearest Well Ft.53 Ft.Ft.Type I Type II (27) Rapidly Permeable(20) Trench, Rock ;3/ Ft./i'OFt-132 Ft.Setback To OHWL(21) Trench, Gravelless (28) Flood Plain (29) Privies(22) Trench, Chamber __ Ft. Ft.Ft.Setback To Bluff(30) Holding Tank ( ) Monitoring/Disposal Contract (23) Bed M2^Mound So/D '"*•Ft.Ft.Setback To Dwelling /o(25) At Grade Type III Setback To Non-Dwelling 74^ Ft.1^ Ft./($0 Ft.(31) Other/Problem Soils/<12” Soil(26) Grey water Type IV Setback To Nearest Lot Line // Ft.Ft.(32) Public Domain & Proprietary Technologies Depth ^1^1^ Setback To Road Right-Of-Way “Ffl /jT<3rFt./5o /5oType VTotai # Bedrooms3 (33) Performance 3 Ft.Elevation Above Restrictive Layer Ft.-----Ft.Garbage Disposal Y /^N 1Y ifN)Abatement PERCTEST DATA m/ 2-Highest RateDate of TestLicense # 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 Officiai 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 ehk(6) months. 2.This permit does not include the building sewer (sewer line). Oo Signature of Property Owner/Agent for Owner Permit Fee $Date: Rec. No..Date:L^nd^^rsou^^4anagement Officii SiDate StampComments:OCT 1 b 2012 (IVx~> ^sa';;;:d [^iwTiwkL L&R InitialForm No. BK — 07-2011-06 345,197 • Victor Lundaen Co.. Printars • Ptrgut Palls. Minnesota APPLrCATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTE« 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 > ^ WHI,TE - Office I^ YELLOW -L&R Inspector ^ PINK - Owner / Contractor (after issue)i r a ^ _ Permit No-:? fH j ' j APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED TWP NAMERANGETWP NO.UVKE/RIVER CLASS SECTIONLAKE/RIVER NAMELAKE NUMBER ■'V •»f ■7,0'13 / 3gD :<•«E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROAD IPARCEL NUMBER (S) OF PROPERTY BEING SERVICED f'' k. G Xcc 0 L 3 y'j COD i.V' XXo oo/) 0 ' •!f u^ L/t/.rcAc I\ LEGAL DESCRIPTION tr< /_______K'f -J'.-- ■ - r-==«^allihlAddress—1 Daytime Phone No.Firdf initial-'■■■SI, Last Name (_ L..- ■ O/ f L9p :i; 7 Property Owner ijizAlIGifJX in.22o- LX\-!\ <1 ."r. ?PI.42l^7* Dan Wegscheid Bluffton Hardware P.O. Box 56— SMoSr-MN=SSM&= Contractor Lie.# •! ILL THIS SPACE FOR OFFICE USE ONLY uVi Od 7\, the year of>• This System wili be ready for inspection on ^'2-0 Time Received ^aP.M. L&R OfficiaiDate Received SEWAGE TREATMENT SYSTEM DESIGN DATA AS SHOWN ON DRAWING TYPE OF NSTALLATION (circle one) Other Est. (E) New (F) Replacement CollectorResidential (A) New (B) Replacement (C) New (D) Replacement Soil Treatment Area LiftTank Effluent Distribution ( ) Gravity ( ) Pressure Design Flow (Gallons/Day) "IG), 1—2,499 (H) 2,500 — 4,999 (i) 5,000— 10,000 ■r —, Ft.Gis GIsSize Setback To Nearest Weil -T. Ft.Ft.Ft.Type I Type II :-*j (27) Rapidiy Permeable(20) Trench, Rock : ; Ft.Ft.Ft.Setback To OHWL(28) Flood Plain(21) Trench, Gravelless /C (29) Privies(22) Trench, Chamber Ft.Ft.Ft.Setback To Bluff(30) Holding Tank ( ) Monitoring/Disposal Contract (23) Bed (24) Mound Ft.Ft. Ft.51cSetback To Dwelling Type 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 /M Ft.Ft.Ft./ >•(32) Public Domain & Proprietary Technologies Depth of Well Setback To Road Right-Of-Way ■Ft.- Ft.- Ft.Type VTotal # Bedrooms r' O - (33) Performance Elevation Above Restrictive Layer Ft.Ft.Ft.J>Garbage Disposal Y / .'fT'-.Abatement Y / /N'/ ■< PERC TEST DATA Highest Rate /, J3Date of Test ^License #Designer f 04-tc r-rL . Agreement: The undersigned hereto 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. ! JPermit: 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 s|x (6) months. 2.This permit does not include the building sewer (sewer line).! //:1Permit Fee $Date:7 ■ 'i ' A , ______ IriirLLO1I Date: ! U j! 1 j \ L Rec. No._^21 7 • rft-LBh(i & Resoulte Management OfftciitI SI'i Comments: SCANNED .i Form No. BK — 07-2011-06 IkW BkI 345.197 • Victor Lundoen Co., Prinlors ■ Forgus Falls. Minnesota .< n ,*%SEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTS Inspector must make all measurements \ SOIL TREATMENT AREA HOLDING SEPTIC TANK OUTHOUSELIFT TANKCATEGORY / ^6?^ GLS.GLS.FT2CapacityFT2 FT FTFTSetback from Nearest Well Setback from Buried Water Suction Pipe FTFTFTFT Setback from Buried Pipe Distributing Water Under Pressure /i>-^FTFTFTFT /?0 - FTFT FTSetback from OHWL (lake &/or river)FT FTFTFTSetback from Bluff FT 3rt ft FTSetback from Dwelling FTFT/O 5'd, t ft ft FTFTSetback from Non-Dwelling /-/s-FT FTSetback from Nearest Property Line FT FT /Z - ft/Od FTSetback from Right-of-Way FTFT 3 FTElevation above Restrictive Layer FT FTFT Holding Tank/Lift Alarm NO Old System Pumped & Destroyed t>/s/ro'r/’ftrc NOYES TRENCH REDUCTIONMOUND / AT-GRADE SOIL TREATMENT AREA CALCULATION SEPTIC TANK(S) ^ Installed FILTER # Tan ROCK BED Rock trenches with inches Manpf./o>of sidewall for.,%Ft. X Ft2 Ft.Ft. X Ft. reduction / equivalent to Soil Treatment Area. ft^ , Model #1(^00 12^Ft* I Inspectors Comments: 0 '' Lt"f^ ll i^ / V/?. 3 Sketch: h ?I 0/V/O \ 4^Vve<( I—f I 9 /C? Initial / L &OfficialTimaData Nthe above described sewage system Installation was found to be compliant with the provisions of the SanitationAs of Code of Otter Tail County. ^e.t'1(?0Land & Resource Management Official i^GBSIForm No. BK — 07-2011-06 345.197 • Victor LundMn Co.. Printors • P«rou» Falls. Mtrmssota rSITE DATA WORKSHEET 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 Sewage Treatment System Permit #_____ 6U' ;2r/- ^S"7X C/2^ ;ij£> - TELEPHONE NUMBER OWNER: p' I f 2 zrae.FIRST ^ I LAST NAME MIDDLE ADDRESS: S, ZIP CODE /?(- 3/ RANGE TWP. NAME STR./RT.CITY STATE 1ofh:r, p,\c Jake nameLAKE/RIVER NO.SEC.TWP. LEGAL DESCRIPTION:SOIL BORING LOG Pr COLOR & MUNSELL NO, DEPTH (INCHES)TEXTURE STRUCTURE BLOCKY PLATY PRISMATIC NONETop-f*'. I /0'^^Xono J^c3P^6£> O PARCEL NUMBER - S'JLdaoo9ooYf'>^<^- A/.'lck^ Ukc 2J,BLOCKY PLATY PRISMATIC NONE lO 'ff^■^-LfrE-911 Address or Directions From Nearest Public Road Vi 1NUMBER OF BEDROOMS BLOCKY PLATY PRISMATIC NONE GARBAGE DISPOSAL: YES 21WELL: CASING DEPTH ft. SEWER LINE SEPARATION:BLOCKY PLATY PRISMATIC NONE (no)FLOODPLAIN: YES BLUFF: YES VEGETATION: AQUATIC SLOPE AT INSTALLATION SITE: f ERRESTRIAL BLOCKY PLATY PRISMATIC NONE % TYPE OF OBSERVATION: Probe Pit dPPARENT MATERIAL:Outwash Loess Bedrock Alluvium 7-0^-/1-No COMPACTED SOIL: Yes (no) ORIGINAL SOIL:Date of Soil Boring. DEPTH OF BORING (To 7' or restrictive layer):.ft.Date of Perc Test PERC TEST # 1 PERC TEST *2- TWO TESTS ARE REQUIRED - TIME INTERVAL IMINUTESI WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE START START -r______ =TIME DROP PERC TIME DROP PERC WATER DEPTHTIMEINTERVAL (MINUTES)WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE li.REFIU REFILL TIME DROP PERC I -L-^-L_=4- TIME DROP PERCTIMEINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEREFILLREFia TIME DROP PERC TIME DROP PERC TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE .7.REFILL REFILL 4 sTIMEDROPPERCTIMEDROP PERC TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEREFiaREFia TIME DROP PERC TIME DROP PERC TIME INTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE .ViREFia REFia TIME DROP / TIME DROP PERC 4PERC TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEREFILLREFia TIME DROP PERC TIME DROP PERC TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEREFiaREFILL ___ =__TIME DROP PERCTIMEDROPPERC or ^opPROPOSED DESIGN: ITRENCH.RBSSlfRE-OIST.BED.ATGRADE.MOUND.HOLDING TANK GRAVITY SEWER LINE.OUTHOUSE.OTHER. SPECIFY:. — SYSTEM DESIGni ON BACK — 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. ^0LJnch(es) equals feet.grid(s) equals feet, orScale: MPCA LICENSE #: LICENSE CATEGORY: bes:. .DESIGNED BY:Dan Wegscheid Blllffton Hardwf^rp P.O. Box 56 ' Blijffton, MN 66518------- \ FIRM NAME:DATE: , ADDRESS:SIGNATURE: A Ay j U ^ I "C w T L ./'t •T.P (N V '. 5I 1 I 1 rj0/or'^ .60 '4 J V/-,4I ioo u-,: 1:^2312o5i) Li'iKb y^'-^y.Oc, /I V) ) V?1 U'' ‘\1 I t V \. \ BK - 1003 — 029 315,904 • Victor Lundeen Co.. Printers •. Fergus Falls, MN • 1-800-346-4870 L - •m ns:fflt t H }.t -U+TTT rTT L-;-Ljfc^z- ! 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ILort* oommni mm4004K47«B. SEI TIC TANK Cxpielty I 5 lao6$90400m7fiUoni (ttt/igun C-l> C. SO:lS(n/4rtatitinottMie7t) 1 Otpih to rtOlrieHni l*y«f ■ 2. Dopth of poreolition tittt ■ 3. T«xturt Porcolition ritt ■ ^ — mpi ‘ 4. Soil loodlnt nto /^o fpd/44|lt fMt 5. Percent laiw dope _£l.—> «iiffmt I . Jggg I /1II htt irUT'TLh ttt a KOCXLAmDlMINilONS I M ultlply evereit dMlfn How (A) by 0J3 to c ?tti» required rock layw im.^y c gpln OlH mqh/gpd ■ _ 77^ ,qft 2. D iteradne xMt layer %irtdlh • 0.13 e^/fpd i Uneer Kale -2 li:. iqft (Di) ^ --IfiL. ft (pa) - il£. ft ^ KOi'JCyDLUMB 1. MiItoiyreckareePl)byrockd«ptho/l ftogetcubiclettolroeli 3?-r_euft 2. DirideeuftbyaPettft/euydtogeteubicyardi 3if _euft ♦ 2Peuyd/eufto //. aiyl 3 M jiuply eubte yerd# by 1.4 lo fet weight of n ck in tone — ——— «uyd X 1»4 ton/ouydj" <120 MR s;12 X120 MR ■£6 m m toi e e SEV AGE ABSOKPnON WIDTH nsarpi ton width equela eboorptlon ratio (Seo Rgu I>33) .iTtei rc ek ityer width (D2) /O ftp.L.X '*r- •nr- OCT ^ 3 20J2 land 8, Pc:QnSCmED >■ I :r^ .y LrvisL.’ L-. fivOURGE l»n<l alop* tion width (P) —‘I 0^— »• 'HI -nl Ik Absorp C«lcul»t* movmd si*»■;l;=rdepth of dtih*«'^Determine upsloptsd** o'----------- di.»nct»tMttlclin* l*y«t tCl) • ^ ■ -T '’■■at. Mound hrtghl .t th« uptlopt id«i o' ro« "eiinnwfdth»upsTopemoundheight<C2b) law4f4ftmommmiMi,iwf<miWU3-12J X 4 * / 2^._it J\\9 totil lindsctpe width b the sum of b« n (C2c) width plus rock bytr width (D2) pi 'TjZc); /y^ lt» - Additional width n*c»eo«y for abeorptlon • tbeorpdon width (P) mlnui the lerdecepe ■ < i* h h (C2d / 0 ft - - ^ /...fi m "A.^ ft. <f KHN kef it iMfetlw (etl Mf rinal t>erm width » eddJlional width <G2e} p us the berm width (G2c) li* IA_-Jf ' Total mound width b die sum of berm wld h (G2f or G2c) plus rodt Isyv width P2) p.' t it t emnUdth (C2f or C2c)i * „JjS,__ft f ^ j=ljt • ft Total mound length is the sum of bem (G2' or G2e) plus rock layer length (D9) plus beir (j3f or^0: Ja f** 3 7.-r’ft* /y, ft<i Setbacks from the rockbad art calculated u f lUows: the absorption width (?) minus the r> i * c led w< :i21 divided by 2if JO....fr» ,J n _ O ft eiteia ii^wiqpwesvi2Qe'• $ ft u :ius the 3 ‘ it 'll tirmwi .iil-ifl I __ ikWiiiiaineod-^i -> fc .i ■ set tnal Dimensions: X i> 21 AS (> m. n Wlaun.'Mi -/d) - - «ap •L. u»rd/y that I hav« cosipttMd this wtuk in aceeid net with spplkA fiS^fciane«r^ end'W . (s»wairtl rnwinfl) I (flan > SCAN^iD SEWAGETRE^FfOtENTSYST^Nr^ LAND & R^OURCE MANAGEMEfJT / f 3 ^ OTTER TAIL COUNTY COURT HOUSeI Phone: (218) 739-2271 - FERGUS FALLS, MN 3653 APPLICATION FOR PERMIT TO I WHITE —office YELLOW — L&R Inspector PINK — Owner/Contractor f I ~-4> +TR LEGAL Permit No. DESCRIPTION Abatement: ( ) Yes ) NoAND LOCATION LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS SECTION TWP. NO.RANGE TWP NAME 6c£(q /3 o /3 t 2S' PARCEL NUMBER(S) ^ q IJ11,1 i ^^OJcf^OOO FIRE OR LAKE ASSOCIATION NUMBER6l^ Si'tL 8^ I c.iTD O IDENT1RCAT10N; PiMM Print All Information First Mailing Address — No. StreetpCity and State Zip CodeLast Name Initial Telephone No. Q-tt . Ja ni/ils. Q /, !x~Property Owner V /?er, (iy /^Scv^7~* l\J€,r^S cJlxJ Z22a■f Sewage System Installer 7? /yy)/o,j/T) a rt/'Name )FState Lie. # L S'ihoZ,-I Cm.^,A.M. the year of PM.>■ This System will be ready for inspection .at. MoThis space tor oMee use only NUMBER OF BEDROOMS: A.M.(i/TNO.PM.GARBAGE DISPOSAL: ( )YES Phone Ceil Rac’d ByTima Rac'dDate Rac'd Year of TYPE OF SEWAGE SYSTEM (L"') Holding tank (Alarm Required) ( ) Septic tank (V/)Lift station (Alarm Required) ( i/^Drainfield ( ) Trenches ( ) Bed ( u^)^ound * SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTS DRAINFIELDTANK Ft*Capacity GIs. Ft.Ft.Distance from nearest well Ft. Ft.Distance from lake, wetland or river (OHWL)It/ Ft.Distance from dwelling Ft.Ft.Distance from non-dwelling( lewer line Ft.Ft.Distance from property line ELUENT distribution ( ) Gravity ( ) Pressure Ft.Ft.Distance from bottom to Water Table All distances are shortest distance between nearest points PERCOLATION TEST DATA: ^ . / f “cf3 t -vM cl (U ^Ufi{ J^IC WATER WELL DEPTH 5CfLl'I * ABSORBTION AREA FOR MOUNDS cV|Date of Perc Tes)Perc Tester Rate of 2nd TestRate of 1st Test verage Hate Agreement: The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to d((al)/such work in strict accordance with Ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set form 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 .g ready for inspection. DATE; Permit: Permission is hereby granted to the above named applicant to perform the work (/escribed in the afcove statement, "piis permit is granted upon express con dition that the person to whom it is granted, and his agent, employees and workmen shall conform in alfTespMts to the Orainance of Otter Taii County, Minnesota. This permit may be revoked at any time upon violation of any said ordinances. NOTE: Permit void if work is not commenced within six (6) months.“< Issued Date: Land S Re^ptirce Management Office S5^Fee $.Rec # CP Comments: 291.095 • Victor Luitdeen Co. Primers • Fergus Feus. MirwtesotaBK 0795003 . r. 7 * /5> SfcL/er cv! L ^ qe -r. —■ hjJ5t> \l^ ¥PV4\^c I Tt> APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM C /U5LAND & RESOURCE MANAGEMENTOTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 - FERGUS FALLS, MN 56537 WHITE — Office YELLOW— L&R Inspector PINK — Owner/Contractor i i- r'< 5 I ■“ LEGAL Permit No. DESCRIPTION Abatement: ( ) Yes )NoAND LOCATION SECTIONUKE NUMBER UAKE/RIVER NAME LAKE/RIVERCLASS TWP. NO.RANGE TWP NAME P P?(:% n •KQ' kloOoPARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBERBib 6ttLOJrB^OOO 5XnOr> ^ o/'-'s iJ/.f<I R IDENTIFICATION: Please Print All Information /ifp /-• -' ■O First Initial Mailing Address — No. Street, City and State Zip CodeLast Name Teiephone No. p.voa.X. . .Property Owner \J o5"A >zi ih A U.yd'>-(r//37■ i L > -i Ip r C r. (r / Sewage System /yiy//7r./Xlri ,>1 r-Name f State Lie. # li Sb'Ol^i / T f3:hl_A.M. > This System will be ready for inspection oni the year of PM..at. NUMBER OF BEDROOMS: //oThis space for office use only A.M. .PM,GARBAGE DISPOSAL: ( )YES Phone Call Rec'd ByYear of Time Rec'dDate Rec'd TYPE OF SEWAGE SYSTEM (Holding tank (Alarm Required) ) Septic tank ( a/) Lift station (Alarm Required) ( Drainfield SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTS TANK DRAINFIELD Ft“(GIs.Capacity Ft.Ft.Distance from nearest well i I Ft.Distance from lake, wetland or river (OHWL)Ft.) Trenches ( )Bed ( V,-) Mound * ( ^^.),Outhouse^— f^C^^rS^er line {I 1 4> Ft. ;U'-Distance from dwelling Ft.Ft.Distance from non-dwelling' Ft.Ft.Distance from property line EFFLUENT DISTRIBUTION ( ) Gravity ( ) Pressure Ft.Ft.Distance from bottom to Water Table All distances are shortest distance between nearest points PERCOLATION TEST DATA:WATER WELL DEPTH Ah' -s.^ 0 /Ai A f * ABSORBTION AREA FOR MOUNDS 6^T,/4PercTestei^ . r ,Z^- > i Date of Perc Test, i - 'W-/v/ ( "fi, ‘ Xvlrlgl'^lgfg^? / 1 .ft2 . rRate of 2nd TestRate of 1 St Test Agreement: The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in strict accordance with Ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minnesota Department of Health. Applicant agrees that plot plan sketches and specifications submitted herewith and which are approved by Shoreland management Official shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the respon sibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. DATE: 4/-'] : 7 ?Signature Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express con dition that the person to whom it is granted, and his agent, employees and workmen shall confer^ ir^ll resMcts to the Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of any said ordinances. ^ x / / NOTE: Permit void if work is not commenced within six (6) months. ■1 i-/6o V'Issued Date:■ Land & Resource Management Office/c^9v<fS0^35Fee $..Rec # Comments: 291.095 • Victor Lundeen Co., Printers • Fergus Falls, MinnesotaBK 0795-003 ■ 'T'.; -T'rif tjs. , INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS HOLDING SEPTIC TANK DRAINFIELDLIFT TANKCATEGORY Actual Minimum Capacity GLS.GLS.FT2 Distance from Nearest Well FT FT FT Distance from Buried Water Suction Pipe FT FT FT 50 Distance from Buried Pipe Distributing Water Under Pressure FT FT FT 10 Distance from Lake, Wetland or River (OHWL) FT FT FT Distance from Dwelling FT FT FT 10/20 Distance from Non-Dwelling FT FT FT Distance form Nearest Property Line FT FT FT 10 Distance from Bottom to Water Table FT FT FT 3 Holding Tank/Lift Alarm YES NO Old System Pumped & Destroyed YES NO Sewer Line to Well Separation DRAINFIELD CALCULATIONINTERPRETATION OF ABBREVIATIONS GLS. = Gallons FT^ = Square Feet FT = Linear Feet Actual Minimum FTX .ft"FT 20 MOUND CALCULATION ROCK REDUCTIONInspector’s Comments:,ABSORBTION AREA Rock trenches with inches .Ft. X Ft of rock under pipe for .% .Ft2 .ft* DF.reduction / equivalent to SKETCH: r 1 ■■ state License Category State License Number J-cl^ # . /.HA, / _____ r ^ r ^ '=5 'faCit't i^\S “iSTri;''^^, 1^4/mC •? 5" A /^ /<^7 vs' /j vs^y rb/ /- / / . ^-tf. .. / / ■•, 57^S/•‘2-, ^..I N N V V nj \io'^ 1s 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 ■While — Office Yellow — Inspector Pink — Owner Permit No. LEGAL DESCRIPTION AND 4 i.v 38 r; 'vj Lake Name LaK^5-A-I9Q ILOCATION TWP NameLake Classif.Sec.TWP RangeLake No. IDENTIFICATION: Please Print All Information. MaUing Address ~^0- Street, City and State Zip No. Tel. No.InitialFirstLast Name UJA/Uce eleA^^rOWNER ('Hi-ii UJaI^ h>Ur) SEWAGE SYSTEM INSTALLER Name T/y/s System will be ready for inspection , 19.on. ]This space for office use only 19 .M Owner or Agent SignatureDate Rec'd Time Rec'd Phone Call Rec'd By ftNUMBER OF BEDROOMS;ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD /ooo WGIs.Sq. Ft.Sq. Ft.Capacity So Ft.Ft.Ft.Distance from nearest well S'!)5oFt.Ft.Ft.Distance from lake or stream Ft.Ft.Ft.Distance from occupied buildinq (0 ilDistance 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 M By PERC “II..ATION TEST DATA:Date of First Test , 19 , Rate •BuDate of Second Test 19 , Rate 1st TeST uaKery oy I ISFirst Test + 2nd Test 2 Rate2nd Test Taken By Agreement; strict accordance with ordinances of the County of Otter Tail. Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspectiOTk The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in T-7 -Dated 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 Minn;-.;;ota. 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: -(iIssued Date: Shoreland Management Office Fee $Rec # Comments:■h Form No. MKL-032085 225239 — Victor Lundeen Co., Printers. Fergus Falls, MN tiV 1 >1 SHORELAND MANAGEMENT — COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 • Fergus Falls, MN 56537APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM X - ^ ' White — Office Yellow — Inspector Pink — Owner Cl 17Permit No. LEGAL Fire ^ H5 DESCRIPTION AND \ I nrLb l A K-?mLOCATION TWP NameLake Name TWP RangeLake Classif.Sac.Lake No. IDENTIFICATION: Please Print All Information. Tel. No.Mailing Address — No. Street, City and State Zip No.InitialFirstLast Name k t I r > r InA rie k/^Norg.-A/lA(gOWNER /Alt'S SEWAGE SYSTEM INSTALLER Name, This System will be ready for inspection .. 19.Xon. This space for office use only t.of.. ><5 PhOTTe^all Rec'd By Owner or Agent SignatureDate Rec'd Time Rec'd UNUMBER OF BEDROOMS:ESTIMATED COST; SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD iooo inIGIs.Sq. Ft.Sq. Ft.Capacity So ODFt.Ft.Ft.Distance from nearest well 5 c)loFt.Ft. Ft.Distance from lake or stream I l)0Ft. Ft. Ft.Distance from occupied building (u UDistance from property line Ft.Ft.Ft. Ft.Ft. Ft.Distance from bottom to Water Table Aii distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on ., 19 , Time ...........JVI By , 19 , 19...^.^....... Rate.L:JA 1PERCOLATION TEST DATA:Date of First Test , Rate ■& Date of Second Test I T 1st Tel /.S'f )rFirst Test + 2nd Test 2 Rate2nd Test Taken By Agreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in Dated Signature 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 Minnexjta. 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. 'SCIssued Date:XT Shoreland Management OfficeP-;uu.sFee $Rec # 5 Comments: -c : Form No. MKL-032085 225239 — Victor LurKteen Co.. Printers, Fergus Falls. MN c >^34^1 I'ef' ' ^—^vrrTjf5 Ccm.9^€cU^A iy^s bj /^‘^cli^c^e'T di ‘r«"^ INSPECTION RESULTS 1-^ Inspector must make all measurements'^\i> fI f^.SEWAGE DISPOSAL SYSTEM STATISTICS V\.. •'■'^i •i SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORYActualShould Be Should BeActual Actual Should Be /OOP /ocoCapacityGIs.GIs.S F S F SF SF ■f -5-6^50fODistance from Nearest Well F F F F F /c^;oo ro^0Distance from Lake or Stream F F F F F F-I !0^11 ppDistance from Occupied Building F F F F FF -f I/o /o10Distance from Property Line F F F FFFin. 3Distance from Bottom to Water Table 3FFFF F F V Inspector’s Comments: ]qo4^^ d prff ’M5’4Ay pi Setn I'vy Ouj}p^ f7 -,'1 r -e ;iL} L V g-l 0oX CLeA<^ 5c^; CffUk g <gcf ^ i> \lSi- 19Date of Inspection Jl't'bOTime of Inspection M 7 Signature oi It '.tor INTERPRETATION OF ABBREVIATIONS GIs = Gallons SF = Square Feet F = Linear Feet Job TUe MKL - 032085 ■ Backer Affency -.1i 0 ^ „13; bi/o^p ^ ^ 53' 3t) )H 0r\y'^>4 4t' 5^ ( n f f- KI.j. i< ) u/ I o- mCOa //e» (j~C'J;Af^ ^ ^ L. ^ ^ *? t /-e* fftt. / ZHo^1/ ^uesf\ O' .7 f'lt e. /'(*>LPftf.r6 . c.lf .N/_ _O 1CD J). fiC(l> 2^ <K<> ^ /^c»*< /<3»>^^// 4Ci^ klcv/j " Ove'v' 'S<^ f^O <f f ^ ^• • tr;I 'f'iAJ f^ ^ <pce. I r r ■ / ’ c, 7^' r - no k*o MKL -0871 -028 ^ ff / C Cf 215502® VICTOH UUNDCCN CO.. PHlHTent. FERCUS r/M.L8. UINN.PERCOLATION TEST DATA LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, Minnesota 56537(^u}u ly j o )^t(Cr - y y z-¥Ph. No.r >-Mailing Address:Owner: r/i S'C>^7>,'{J ' Cl ^ ^/a ffct^h a 2—-( Zip No.StateCitySt. & No.First MiddleLast Name C-yr<—Legal Description:2 ^li 9 /3 60 ^ pJTFUT^^rV 5e/y 2-^ p-^to/y /?3/ V/2. ■ v5"r^ //91 yYy , L ^^ ^ NAMELAKE OR RIVER NO.vS'Z 77c /^a 0 M%0 p /F' TEST HOLE NO. 2TEST HOLE NO. 1 c=>Q>3 VDepth to Bottom of Hole inches; Diameter of Hole JnchesDepth To Bottom of Hole,inches; Diameter of Hole inches Soil .TextureDepth, Inches Depth. Inches Soil TextureDate19 Pf.'UVYYy z //■-5 //O 6~ II yjrj -^-7 ^Percolation Test By____ Percolation Test By ^ I //,/ «• !(' rt 1 - 3 VQ lUFirm Name. Firm Name, QC 3OLU CC r , /f.'( ' /l ef yiFl m Vcy y •'t /■<nrAddress.QC Address < CO Otter Tail County License No.Otter Tail County License No..I-coUJMeasure ment,inches Percolation rate minutes per inch Time Interval, minutes Measure ment inches Drop in water level, inches Drop in water level, inches Percolation rate minutes per inch I-Time I ntervals minutes Remarks:Remarks:TimeTimeo5 7I-LA ZI9 lYi(a ' ^ S!6 :co 3o /V^ 0,0'7• ^ 4 (a;^,0^ ^ * C> iho K<^ .6 t I 2lA I,lA6 S'!' 0 11 oSt.d IL(t1 ^ I At.Ci53^1,0 t 2_It LXjJl h /ti) /r/■O 11 n- ^0 b L, o1.0TH'O 1 ^ y‘I U- /.ol.d0 4 f:E.o\ I 7YYAFt o^/ 1 -A /See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of MNPercolatlon'rate =,minutes per inchminutes per inch Percolation rate = 373ABATEMl... notice, >1 Shoreland Management COUNTY OF OTTER TAIL Court House Fergus Falls, Minn. 56537 5tk Jane.UDated this.day of.19 Ete.gjn.oK WaZZade^ Et AtTo. MlAddress. City and State.56573PeAham, MN Zip Code. the 6etoage 6^6ternYou are hereby notified that. Which you maintain at (Legal Description and Location) - Plus Fire No. Pt GL 2 S 5, Bg HE Ck Lot 1 SL A PH BH, Sety 25' SWly 133' SEty 412.55 NEly 215.46 miy 526.65' SbJly 39.2' on Lk SEly 16S.34' to Bg I Ptne Lake9 J36 3SGOBig Ptne56-130 Class.Sec.Twp.Lake Name Range Twp. NameLake No. gjnutKaeted and/oh locatedis not in accordance with minimum standards of the Otter Tail County, Minnesota Shoreland Management Ordinance. You are hereby ordered to abate the above described condition within 30 days from this date. If you fail to correct the above defect you may be subject to a fine, impriscmment or injunction proceedings. rs>Oo\nShoreland Management Offntjal PROOF OF SERVICE State of Minnesota County of Otter Tail Fergus Falls, Minnesota 56537 The above notice and order was served by me on._______________ 19____ by handing a copy thereof fthe (owner-occupant-agent) of the above describedto premises. *By posting a copy thereof upon the above described premises. Otter Tail County Sheriff Department *Strike out words that do not apply. C; ^ii Sv I '■-'llOwriii CC: Otter Tail County Attorney MKL-03 72-035-01 220522 ^^^****' LundMn V C«.. Prlnt*ri, r*rcu« PalU. Minn. (FIELD NUTCS Rl^ Pi■ B-b^/30 -W 'DATEt FIRE NO.uo m !gf LEGAL DECRIPTION OF LOTi tl^AiVod l/l/JlClM^ ^6 / MmS ADDUSS TTFB OF SEWAGE SYSTEM (Inspactor'a CoHMnCa) KANE h \ ~T)^ 9^ O CO ju p/2, .— c^ /<^3 4 (dA.OL^ \Q V) SEPARATION DISTANCES - FEET - Sapelc TankCatagory Sell Piapeaal Araa 5ottoU -7<o>o-^Pcf)Z)^ Let Line • /Occupied Building ' ^<r~Blevutlon of Araa REASON SYSTEM VAS ABATED: . i -. V. SKETCH OF LOT ON BACK ■ -• f*<7 e -y M' t)i 7 / T^tOlC Odc^^O'l^ f.^jO^cL (-<-^/(jL(^\ 0 \]lAj ^ SENDER: Complete items 1, 2, 3 and 4. Put your address In the "RETURN TO" space on the reverse side. Failure to do this will prevent this card from being returned to you. The return receipt fee will provide you the name of the person delivered to and the date of delivery. For additional fees the following services are available. Consult postmaster for fees and check box(es) \for service(s) requested. oa o B 2 (D09 Show to whom, date and address of delivery. 2. O Restricted Detivery. /w 3. Article Addressed to:56-iyd^ Ralph S Zelda fogel Box 100 Vllwofith, MN 56529 4. Type of Service: . □ Registered D Insured U Certified □ CODn Express Mail Article Number • X P557-606-677 Always obtain signature of addressee or agent and DATE DELIVERED. _____________•* sTsignaturey^idi6oXsm6. Signature — Ageet0)/X ' s.■ ‘c.j ' T) a ■X!7. Date of Delivery '2 (^L Y if requested and /ee mH N. /s 8. Addressee's AddressZ 3) JEf.t)V-i i \ UNITED SIBJES P0S1AL SERVICE OFFICIAL BUSINESS SENDER INSTRUCTIONS Print your name, address, and ZIP Code in the apace below.• Complete items 1,2,3, and 4 on the reverse. • Attach to front of article if space permits, otherwise affix to back of article.e Endorse article "Return Receipt Requested" ■diecent to number. ______________ aS-MAIL PENALTY FOR PRIVATE USE. $300 RETURN TO (Name of Sendar)COUinTY GY OTTLR TAIL FERGUSRE^ JUNO 31986 IAMD C: r.'SOURCE (city, state, and ZIP Code) r ' P SS7 bDb t.77 ’ RECEIPT FOR CERTIFIED MAIL NO INSURANCE COVERAGE PROVIDED NOT FOR INTERNATIONAL MAIL ^See Reverse) N.Sent to Ratph S Iztda FoQzi '^ox 1 0 0■ g Street anCOO) P.O., State and ZIP CodeVlluiofith, MM 56529q $Postageq 3 Certified Fee* Special Delivery Fee Restricted Delivery Fee Return Receipt Showing to whom and Date Delivered CMCO Return receipt showing to whom, Date, and Address of Deliveryo> £$TOTAL Postage and Fees«u. o Postmark or Datesn 5-30-S6E ou. </)Q. r STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE. AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES, (tea front) 1 II you warn mis receipt postmarkea. stick the gummea stub on the left portion ol the address side ol the article leaving the receipt attached and present the article at a post office service window or hand it to your rural earner (no extra charge) 2. If you do not want this receipt postmarked, slick the gummed stub on the let! portion ol the address side of the article, dale, detach and retain the receipt, and mail the article 3. If you want a return receipt, write the certified mail number and your name and address on a return receipt card. Form 3811. and attach il to the front ol the article by means of the gummed ends if space permits Otherwise, affix to back ol article Endorse front of artile RETURN RECEIPT REQUESTED adjacent to the number. 4 It you want delivery restricted to Ihe addressee, or to an authorized agent ol the addressee, endorse RESTRICTED DELIVERY on Ihe front of Ihe article 5, Enter fees for the services requested in the appropriate spaces on the front of this receipt. If return receipt is re quested. check the applicable blocks in item 1 of Form 3811 6. Save this receipt and present il il you make inquiry. t /* ABATEMENT NOTICE 195 Shoreland Management COUNTY OF OTTER TAIL Court House Fergus Falls, Minn. 56537 3 0 th Kin u 19 ^ hDated this..day of_ Ralph S ItZda Foq2.lTo. Box 100Address______ City and State.VllMonth. MM Zip Code.56519 the sewageYou are hereby notified that. Which you maintain at (Legal Description and Location) - Plus Fire No. Tn. Beg UO' WE SW CoA Lot 2 WE 50 SB 134' Sdl 50' WW 126 t GVBig ?tm 9 136 38 Ptm Lake56-130 RangeClass.Sec.Twp.Lake Name Twp. NameLake No. conitAuated andloA locatedis not. in accordance with minimum standards of the Otter Tail County, Minnesota Shoreland Management Ordinance. You are hereby ordered to abate the above described ccjndition within__days from this date. If you fail to correct the above defect you may be subject to a fine, imprisonment or injunction proceedings. \P>rv^Shoreland Management Official PROOF OF SERVICE State of Minnesota County of Otter Tail Fergus Falls, Minnesota 56537 The above notice and order was served by me on.______________, ] 9__, by handing a copy thereof fthe (owner-occupant-agent) of the above describedto premises. *By posting a copy thereof upon the above described premises. Otter Tail County Sheriff Department *Strike out words that do not apply. CC: Otter Tail County Attorney MKL-0372-035-01 220S22 ®Victor Lundoon Co., Printers. Porfu* Polls, Minn. FIELD NOTES Eia:Lae . KIn-fSO ■ DATEUn MAMB 1 /(f'O ^ ^ ^ HRE NO.LAn MO LEGAL DECRIPTION OF LOT: ^ ">!£ SS /3 / OWNERS NAME OWNERS ADDRESS (g) fO;TYPE OF SEWAGE SYSTEM (Inspector's Comments) Gi^ y{,h:pCZ^ SEPARATION DISTANCES Septic Tsnk Soil Dlspoeel AreeCategory -y-5^Well - 7^r~ Lot Line - Occupied Building - Blevetion of Aree REASON SYSTEM WAS ABATED; b ■C,- a s -Tc b y vy-l V SKETCH OF LOT ON Q n c* U • • 4. '. / / ¥ SHORELAIMD MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 - Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM White — Office Yeifow — inspector Pink — Owner Cord — Owner Permit No.,LEGAL r.>DESCRIPTION AND ^ L^e Name .. >v<^ f / ILS-j-juLOCATION Lake Classif.TWP NameLake No.Sec.TWP Range. . . IDENTIFICATION: Please Print All Information. -Zip No.Tel. No.Mailling Address —No. Street, City and State.ast^ame ________First Initial OWNER SEWAGE SYSTEM INSTALLER ->7o/Name, This System will be ready for inspection on., 19. This space for office use only 19 Date Rec'd Time Rec'd Owner or Agent SignaturePhone Call Rac'd By Z/’NUMBER OF BEDROOMS;ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD S^60 c33(pG Sq. Ft.GIs.Sq. Ft.Capacity -5*^ / (0 0Ft.Ft.Ft.Distance from nearest well Ft.Ft.Distance from lake or stream Ft. /o ■3.0Ft.Distance from occupied building Ft.Ft. !0 10Distance 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 ........JM By . ,, 19 ...... , 19...JD.... Crc:...PERCOLATION TEST DATA:Date of First Test Date of Second Test,..../.fr...?....j^. Rate /Rate IstTesrTakerBv 2^First Testt r + 2nd TestSL-e. 2nd Test Taken By 2 Agreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in io~ I‘-I ? 2.Dated IonSignature" 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: / -<3 %I (C/- £7 Issued Date: Shoreland Management Office Commentsr-y~ ^ ^p T 0 T ^ *SV\0Wt1t2. UoVySg. Fee $ M D ( s y g / < J1 ^ ft, 4. Dra'i 0<\-W\Y\^ _____________________ ( f rovY\ \ V\ <2, \>(h:VV\ V" wV? ^r>Q <,~VvO\NL TZ s o \v\ Form No. MKL-0771-003 [^EVItW BATTLE LAKE, MINNESOTA V I wwr---n. f:,,'H 4,■ ■■*. ■:■' >•> \■ ■ ■ •■ 7;|0 dj .\r isT";/ '' V\•:. .• -n' . f '- Inspector must make all measurements INSPECTION RESULTS r.aai-c^ sarr. . " rt:..•. c.- r- '.'..1. 'i • *i. SEWAGE DISPOSAL SYSTEM STATISTICS X V -r ■ SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORY Should beActual ActualShould be Actual Should be Capacity SFGIs.GIs.S F SF SF Distance from Nearest Well 5075FF FFFF Distance from Lake or Stream F F FFFF 202010Distance from Occupied Building FFFFF F 10 10Distance from Property Line 10 FFFFFF 33Distance from Bottom to Water Table FFF F F F Inspector's Comments: V, \V \ T Date of Inspection 19___ V-' V\ .4 ,. 'n >')■Time of Inspection.M ''»'-i »■ . r> i -i Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs * Gallons SF * Square Feet F • Linear Feet i,'a }' Job Title i.V . . Oip ’ r ) J». ,. I- •iw Agency • It. \ - »•■■■? v't.h- < MKL-0771-003-Backer • 1■ s •r*' '.'■jC i» 4 ■ o' 7 ■ . • '4- vf- rt,-.- ■ 'O ' ■ i •oiC'ioji'K''’;-; T ■ : 4 i X V V-A ’OS • f 0 % V-X •er \•47, . ■q V • -r.-t’dsH-*’ •'^•1 ■1 A'-aI ^ .x i " . f^i,: ’ •■ . r > V I i' i". " ' .j*; i.M V-. b 3fi (fi' '-rj. . ■ "o ,i .V31ii; -V 'Vk; ,■>, C'. ' I't • -S : ■' .'i' ■ ■ ■> ^ •»t I •- *fi; r yl.-f", , >.•' i'' . .. . . r*-' ' » -• *v’ .1f t• A*S'■ \\I - 'sM.(■ 'i‘:»:*«■--r-A fv:.15 . { .. -i t- It ' .*>•■'"^c\%' \ . , ’Si o 7 V ■ ♦ •F r■ i .i \ :41 <1 I i ■' ■ 1-: 1 i.VV V ■ ^ .T,' X'A"-■ (-X-i', «*>"7 V<. S.-ys^.V r* -4-' :, ’■■ hi:*..-./i. r :J -i ■ '^i ■ ■' 1,-"] oi.. - y* .^ ■h- • * SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 - Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM While-Offlc* Yei/ow — Inspector Pink — Owner Cord—Owner ;T2p-grPermit No.,LEGAL ;r>DESCRIPTION AND ?LOCATION TWP NameLake No.Lake Claasif.Sec.TWP RangeLake Name IDENTIFICATION; Please Print All Information. Zip No.Tel. No.Mailling Address —No, Street, City and StateFirstInitialLast Name OWNER , / j SEWAGE SYSTEM INSTALLER /r -Name. 19^. This System will be ready for inspection on.\n This space for office use only OM1_Vx>o Date Rec'd Owner or Agent SignatureTime Rec'd Phone Call Rec'd By /?NUMBER OF BEDROOMS;ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD GIs.Sq. Ft.. Sq. Ft.Capacity Ft.Ft.Ft.Distance from nearest well / Ft. Ft.Ft.Distance from lake or stream / o 0Ft.Ft. Ft.Distance from occupied building / Q 10Distance from property line Ft. Ft.Ft. Ft.Ft.Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on 19,, Time .........JVI By 19 Z' ? .« .................r , 19...ij.... ..ZPERCOLATION TEST DATA:Date of First Test Rate /.rT.Date of Second Test Rate 1st Test Taken By IrFirst Test + 2nd Test s Rate2nd Test Taken By Agreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in Dated Signature Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six 16) months. Permit: ) ■ /6—^Issued Date: Shoreland Management Office0e(2Fee $___:CC NO C ^RTIFKATFD X q /1 ^ ^ V' Cl i > •(CL-f( (°l 0 rComments: V- ro m " 'O'. Woks'?.h iY*-(C-V yy T7 CVk V v.V, s\g.^ Vyvj- Form No. MKL-0771-003 j^EVIfW BAmt LAKE, MINNESOTA / >4 f ^ -/-Q4Jy^ ^ s 'iS . ’ W.O- 6 -h-K«.y qf^r^vi-0 O \aX2. C)4? \CJC VjvW ovpprgvO SY5+^r»r> WcovVk'SJL. t^oi- G>.W 'closer o 3SC. vi>\/^tlVivs^iINSPECTION RESULTS (2> ^s£a*ZX' €)<^ Inspector must make all measurements - \A/ .tC06 1/000 33e>] 32-0 -TO SEWAGE DISPOSAL SYSTEM STATISTICS/dj ,0 tol to 2.0 Jt-O'0 / / d SEEPAGE PITSEPTIC TANK DRAIN FIELDlATEGORYActualShould be Actual Should be Actual Should be &3§S(J GIs.B0<3t?/S93 s FCapacityGIs.S FS F Distance from Nearest Well'psti^^60 FUQ-so 5075FFFF F 5b■C'OZ233'Distance from Lake or Stream F F F F F (62.QO F20 20Distance from Occupied Building 10F F F F F /<?'f/o’Distance from Property Line 10 1010FF F FF 3Distance from Bottom to Water Table 3FF F F F F c» 0® fiT. c___ I Inspector's Comments: S<LfV^C ^v^W ADo'fVl -<a sUqW^yI, ^SQ ( Lifi-3 CL(K\aV-v^<. -g 9^0 0 V\ Cl S~hrf^oi^ 1900 4= 3'Co>fc>I V><1 bT \W oil Cov I yg£.ts> 1 ^ 61- 5’£ O ~H\ g ^ v^C>^> g K V>0 X vj'v <rfK<Lir ^X-O/Q 7< ^I .S3/o-Date of Inspection 1% 10 Cj_\0'^<iOTime of Inspection.M / ro signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs • Gallons SF “ Square Feet . F - Linear FeetJ^ Q «l YkS <L. VV\ eC!> Wq- C vy-V Ssy s'l"'^vor\‘ Y H b -b 3 0 ^ r o A Job Title AgencyMKL-0771-003-Backer ^ OecoK D i»v U i.dVl fc ^(oOOI Goo brct'v»s C\ V\ K fooo \ u. <^\v coo <\ «. CO V V. I^twxjve-Ci 27■c iiA^VctU Zt^ / ^1-7I»?f4 3 7 nsCI ■ c« • -'< 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 Card — Owner s~ ? »~7T. /id' ^ Alf 6-o' /3V' so' Alu) Permit No.,<4/ J.CjCTZ,LEGAL 3/>ADate DESCRIPTION AND 3^ 1qX(°.f5Yr.-J30 j8,a P QD.9.__^LOCATION TWP NameLake Classif.Sec.TWP RangeLake No.Lake Name IDENTIFICATION; Please Print All Information. Mailling Address —No. Street, City and State Zip No.Tel. No.InitialFirstLast Name ^JpL.h\ft n,ii07OWNER CyCMj VySEWAGE SYSTEM INSTALLER Name, This System will be ready for inspection on., 19. This space for office use only ,M19 Phone Call Rec'd ByDate Rec'd Time Rec'd Owner or Agent Signature J-Jn/ A ) /9rJ<%I SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD GIs.Sq. Ft.Capacity Ft. Ft.Ft.Distance from nearest well ,-ro Ft.Ft,Ft.Distance from lake or stream in Ft.Ft. Ft.Distance from occupied building Distance from property line in Ft.Ft.Ft. Ft.Ft.Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on 19 By PERCOLATION TEST DATA:Date of First Test , Rate Date of Second Test 19 , Rate 1st Test Taken By First Test -I- 2nd Test 2 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 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 fOF^spection. (Call or UM attached mailer notice.) C- Signature ^ Dated 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; ^ ^3 /> ^JTLIssued Date: Shoreland Management. SO Fee $12-Surcharge $ilO Comments:. Form No. MKL-0771-003 VICT0B LuaeciM 4 co.. aaiMUM. rcavut rktLi. ,158906 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 Card — Owner Permit No., LEGAL Date DESCRIPTION AND LOCATION See.TWP Range TWP NameLake Classif.Lake NameLake No. IDENTIFICATION: Please Print All Information. Mailling Address —No. Street, City and State Zip No.Tel. No.InitialFirstLast Name OWNER SEWAGE SYSTEM INSTALLER Name, This System will be ready for inspection on., 19. This space for office use only ,M,19 Phone Call Rec'd By Owner or Agent SignatureDate Rec'd Time Rec'd SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD Sq. Ft.Sq. Ft.GIs.Capacity Ft.Ft.Ft.Distance from nearest well Ft.Ft.Ft.Distance from lake or stream Ft. Ft.Ft.Distance from occupied building Ft. Ft. Ft.Distance from property line Ft.Ft. Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS: 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 -I- 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. (Call or use attached mailer notice.) Dated Signature Permit: 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. Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express Issued Date: Shoreland Management Office Fee $Surcharge $ Comments:. I^IFICATE ISSJrp VICrON UINOECII « CO.. PMIHtt*! FI»0uS rALLl. 158906Form No. MKL-0771-003L V*-. INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORYActualShould be Actual Should be Actual Should be Capacity GIs.GIs.S F S F S F SF Distance from Nearest Well 75FF 50FFF F Distance from Lake or Stream F F F F F F Distance from Occupied Building 10 2020FFFFF F Distance from Property Line 10 10 10FFFFF F Distance from Bottom to Water Table 4 4FFFFF F Inspector's Comments: i Date of Inspection 19___ Time of Inspection,M 5 i; Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF = Square Feet ~ Linear Feet : !•Job TitleF i AgencyMKL-0771.003-Backet ■; ■'i; It