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Home My WebLink AboutSwan Lake Club_13000190112000 _ 18402_Septic System Permits_I 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 yWhile — Office Yellow — Inspecior Pink — Owner Card — Owner Permit No. LEGAL DESCRIPTION AND 4t P]3_ ML.3p* *1^1 VvOUXLLOCATION TWP NameTWPRangeLake Cla&sif.Sec.Lake No.Lake Name IDENTIFICATION: Please Print All Information. Tel. No.Zip No.Mailling Address —No. Street, City and StateInitialFirstLast Name CWibOWNER fAcAvv:^p > mi)L5 iviv^ ssvi^l¥X SEWAGE SYSTEM INSTALLER Name This System will be ready for inspection on., 19. This space for office use only ,iyi19 Owner or Agent SignatureDate Rac'd Phone Call Rec'd ByTime Rec'd ^ VNUMBER OF BEDROOMS;ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD l^co Sq. Ft,GIs.Sq. Ft.Capacity (00 Ft.Ft.Ft.Distance from nearest well 7^Ft. Ft. Ft.Distance from lake or stream 20L2.Ft. Ft. Ft.Distance from occupied building lA Ft.Ft. Ft.Distance from property line 3 Ft.Ft.Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS: , 19 , Time M ByInspection was made on /3.^.z.nPERCOLATION TEST DATA:Date of First Test , 19 Rate 1st Test^^aken By -a i 12CL, RateDate of Second Test,19 I /3 10.2^..+ 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 i&seady for inspection. (CalUer use attached mailer notice.) /^ -w-feDated 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 commenc.ed.with«fKsix (6) months. Permit; Issued Date: Shoreland Management Office__ ! fet.- z\q\mitoFee $ Comments:. [^{VIEW BAITLE LAKE, MINNESOTAForm No. MKL 0771-003 1i •r * ' INSPECTION RESULTS Inspector must make all measurements t i * f ‘ SEWAGE DISPOSAL SYSTEM STATISTICS SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORY Actual Should be Actual Should be Actual Should be Capacity GIs.GIs.S F S F S F S F Distance from Nearest Well 75 50 F F F F F F Distance from Lake or Stream F F F F F F Distance from Occupied Building 10 20 20FFFFF F Distance from Property Line 10 10 10FFFFF F Distance from Bottom to Water Table 33FFFF F F Inspector's Comments: V \; \ Date of Inspection .19___ ITime of Inspection,.M ( I Signature of InspectorINTERPRETATION OF ABBREVIATIONS Git - Gallons SF “ Square Feet F “ Linear Feet r \ Job Title AgencyMKL-0771-00Backer 1.- ..Kj I rfs:t!I. /* '/ 'f ■ i fLjUcJi * 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 1-ar- F3 y*llow~lrof Conl-O, 1=_____ , '2.Permit No., LEGAL Gl-t; .DESCRIPTION AND LOCATION TWP NameTWPRangeSec.Lake Classif.Lake No. Lake Name IDENTIFICATION: Please Print All Information. Tel. No.Zip No,Mailling Address —No, Street, City and StateInitialFirstLast Name OWNER SEWAGE SYSTEM INSTALLER Name ^3This System will be ready for inspection on... 19. This space for office use only /3IC.'P ~ \ 1 q ^-3 ^"3^ /?^y| Owner or Agent SignaturePhone Call Rac'd ByDate Rac'd Time Rec'd NUMBER OF BEDROOMS:ESTIMATED COST:/ SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD Sq. Ft.GIs.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 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,,JVI By, TimeInspection was made on 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 (61 months. Issued Date: Shoreland Management Office ^ V\Fee $ \■c \o?-1,Comments:.X [^VIIW ftATTlI UKI, MINNCSOfAForm No. MKL 0771-003 \ 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 Distance from Nearest W^l SF\OCOICOO 74XCapacityGIs.GIs.S F S F S F 75 50FFFF F 1^“^F 20’*. 7^7SDistance from Lake or Stream F F F F F 2l!Distance from Occupied Building 2010 20FFF.F F f10Distance from Property Line 10 10 10FFF F F F +3Distance from Bottom to Water Table 33FFF F F F Inspector's Comments: / vy "P "" ______19_S^ 2 • I S’____ Date of Inspection Time of Inspection. Signature of InspectorINTERPRETATION OF ABBREVIATIONS Git " Gallons SF ■ Square Feet F “ Linear Feet Job Title AgencyM KL-0771-003-Backer PERCOLATION TEST DATA Price $ 1.00 per ^ SHORELAIMD MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Ph. No.Owner:Mailing Address: H a P-/y:’ P/. 5.P rp-o a’ ts £T j/'/uvnj Zip No.Last Name First Middle St. & No.City StateLegal Description: LAKE OR RIVER NO.NAME SEC.TWP.RANGE TWP NAME 3 Q K.Ciorr\ TEST HOLE NO. 2TEST HOLE NO. 1 /^ n Depth to Bottom of Hole c**- \P'Depth To Bottom of Hole.inches; Diameter of Hole inches; Diameter of Hole.inches inches /I19 (L ’X. )Depth, Inches Soil Texture yr 19 "YAJYDepth, Inches Soil Texture Date LZ/ L'O // Date, Ui^PicL [)ifc 0 12.'^PaoL T) £ l-.'y E, it'z noN-^.r. Percolation Test By____Q LUFirmName.'~^£L'Z.£/LQCFirmName.D OLU CC "7‘:.LUY r - rJ-.// ’ ' rjAJ>.Address.CC Address< Otter Tall County License No..Otter Tail County License No... - ; ' • / ________________ Depth in Water Level, Inches h-00♦ LUMeasurement, Inches •Depth in Water Level, Inches I-Measurement, ____InchesTimeRemarksTime RemarksO/ - J5 ✓i2. TL7 y V Jy^h/^L.'^.5 y7; /5 K K7^3. (£,-> ^<(Y' jJ/ 2Pj/2 yi./ 7^yy>y/ 22oP ^ ' //t-> eV.' 30}7'3b 2)2:25 3 %I >' /5/ : I; 35 sjk I ypP f 3 iLitP r\ / f ■ , Y LO- £ 3 >9 . J3.9^: !53/ C?5 V lyPJ/A. yAJ/JJjY q-35 yjUy/AyP9 •' V.5QJn__J :o5 3 1 i6T* 5mZ—3:35 a 9 - vs [I 3. -^3 30 9^.,?S I-I2 MKL-0871-028 See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn. If /ooo 6A\- % V 4 <