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Home My WebLink AboutSwan Lake Club_13000190112000 _ 18364_Septic System Permits_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 Cord — Owner GL J ^2JLalpPermit No., LEGAL Tr.DESCRIPTION AND 5b.LOCATION TWP NameRangeSec.TWPLake No. Lake C(a&$if.Lake Name IDENTIFICATION: Please Print All Information. Tel. No.Zip No.Mailling Address —No. Street, City and StateInitialFirstLast Name OWNER ^ Ch-K St . jSjum, Tfr •j. SEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection on., 19. This space for office use only 19 ,M Owner or Agent SignatureDate Rec'd Time Rec'd Phone Call Rec'd By 4NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD loop GIs.Sq. Ft.Sq. Ft.Capacity 100/50SOFt. Ft. Ft.Distance from nearest well 75 75Ft. Ft.Ft.Distance from lake or stream ■XO10Ft.Ft. Ft.Distance from occupied building 16 (VFt. Ft.Distance from property line 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 £-0 /ri.3..PERCOLATION TEST DATA:Date of First Test , 19 Rate ^3Dat-3 of Second Test 19 , Rate 11st Test Ta^en By IS"[1J2......-First Test + 2nd Test 2nd Test TaKen By 2 Rate 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 inspectiorertCall or use attached mailer notice.) iU LSignature 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: Issued Date: Shorelai^ Management Office IP.QOFee $ ---------»------------------------------------------- Comments:. [^fVltW BATHE LAKE, M.iNNESOTAForm No. MKL-0771-003 •«r • ■’'''—>* ^7F *’v*nr-'-7’ »’•««! ^ ■•*iP|{^^'''<» ..4 . t 'J * ,>i- INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS #.SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORY Actual Should be Actual Should be Actual Should be Capacity GIs.GIs.S F S F S FSF Distance from Nearest Well 5075FFFFF F Distance from Lake or Stream F F F F F F 20Distance from Occupied Building 10 20FFFF FF Distance from Property Line 10 10 10FF F F F F Distance from Bottom to Water Table 33FF F F FF Inspector's Comments; . V Date of Inspection 19___ ^f Time of Inspection.M •j: I Signature of InspectorINTERPRETATION OF ABBREVIATIONS Git “ Gallons SF ■ Square Feet F " Linear Feet ■■y} i> Job Title AgencyMKL-0771.003>Backer , ^ M/ /fM.. .f ^ .'-1 . litn. • : \\i -i-hV-L. ■ ■V. J f -i7 • i i- r 'J.'l ■\a -s\ •?- ■■ .»■’ ^ ■ >-)^Xo-'Sr34 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 ¥ Whim - Office Yeihw — tnspecfor Pink —Owner Card —Owner li . L,Cf- -L L.Permit No.,LEGAL Tf,\/VsDESCRIPTION AND LOCATION TWP NameRangeLake Classif.Sec.TWPLake NameLake No. IDENTIFICATION: Please Print All Information. Zip No.Tel. No.Mailling Address —No. Street, City and StateFirstInitialLast Name OWNER :•i SEWAGE SYSTEM INSTALLER Name This System will be ready for inspection on.., 19. This space for office use only Owner or Agent SignatureDate Rec'd Time 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 Ft. Ft.Ft.Distance from occupied building Distance 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: 19 , TimeInspection was made on JVI By I 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 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 Fee $ 2\'~\ in\4 i I n \ror yi, ~T/, L''>*v .4Comments:. (^EVttW ftATUE lAKE. MINNESOTAForm No. MKL-0771-003 < INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORYActualShould be Actual Should be Actual Should be l^ant fY Co loooCapacityGIs.GIs.S F S F (I/ao F/a?Distance from Nearest Well 75 50FFFF F FDistance from Lake or Stream F F F F Y-9a FDistance from Occupied Building 10 '20 20FFFF F IlO FDistance from Property Line 10 10 10FFFF F / Distance from Bottom to Water Table 33FFFFF F Inspector's Comments: n<Lvj^ 0. YY\0 V -C^ DLJP s ys 5CI nyv\ 1- 3LD- / /I Date of Inspection 3’^Time of Inspection.M Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs ~ Gallons SF - Square Feet F ■ Linear Feet Job Title Agency MKL-0771-00 3-Backer '“/'V */-Lc W \'Zo '«* awe in / PERCOLA TION TEST DA TA Price $1.00 per pad. SHORELAND MAIMAGEMEIMT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Ph. No.Owner:Mailing Address:r /Q State PY)Ot^K “Sr:OTg,y ExJy Last Name First Middle St. & No.City Zip No.Legal Description:S>a)E\rr^ LAKE OR RIVER NO.NAME SEC.TWP.RANGE TWP NAME a TEST HOLE NO. 2TEST HOLE NO. 1 dp53Ip3:5Depth To Bottom of Hole,Depth to Bottom of Holeinches; Diameter of Hole inches; Diameter of Hole.Jnchesinches . /*?■ 19 Som rv\oC Depth, Inches Soil Texture Dateii-Depth, Inches Soil Texture Date^0 "- Sf~)nz.y CJy.Py___ ^:>ack: oif3 'P/^jyLPercolation Test By____ Percolation Test By____la A/• toUJ'.D r ■r.FirmName,V*.// .5.3:QC FirmName.DaUJ cc H/^L’TTJf J rn ]r}h}LUAddress.OC Address< C/)Otter Tail County License No.,Otter Tail County License No.HinLUMeasurement, Inches ■Depth in Water Level, Inches H Measurement, Inches DefMh in Water Level, Inches Time Remarks Time Remarks oId 1 i^'.soo Dl 3 7%3\Xi34?: ^ 6 y 3o % jpQ yy yO .3//(^3aj. ■ pMJ_ ’/ o l ] /'^IS /'JO 32q/63 j yj ■'E **3%LL1£L -:2 d^’.uO3 0d 3• .mSd.As///l? A .Jjjd J ■ g ''EycA: 55 3>\ 00 (d /dJk3>/3J_S5 dToo3L3:55 /AAyy'AzsI' 2o_7rl/ MKL-0871-028 See Booklet, "How to Run a Percolation Test" by Agriculture Ext Service, Un. of Minn. /Ai^^ 11 \\ oN> \&Q