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HomeMy WebLinkAboutSwan Lake Club_13000190112000 _ 22661_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 WhlM-0%n Y*/(ow — Inspector Pinit *- Osvnef Cord— Own»f Sa;/<N LAte Ciol Permit No. LEGAL DESCRIPTION AND Pnfit'i'eRD 1^ 1.^GIr'Iil Sid^ULOCATION TWP NameTWPRangeSec.Lake Cla&sif.Lake NameLake No. IDENTIFICATION: Please Print All Information. Tel. No.Zip No.Mailling Address —No. Street, City and State_____________1003 Jd4Wr^0N ?iA-cc First InitialLast NameSeAsLoreOWNER 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 NUMBER OF BEDROOMS;ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: fEPAGE PITSEPTIC TANK DRAIN FIELD%>■ I DQO Gis.Sq. Ft.iq. Ft.Capacity SO//ODSOFt.Ft. Ft.Distance from nearest well 75 ISFt.Ft.Ft.Distance from lake or stream \0 Ft.Ft.Ft.Distance from occupied building Iv10 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 JVI ByInspection was made on ♦ r fo “ wL 3L PERCOLATipN TEST DATA: Date of First Test ft f , 19 Rate IS.^53..,Date of Second Test 19 Rate 1st Test Taken By (-1'Iii - ...MFirst 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 Offi­cial shall become a part of the permit. Applicant further agrees that no part of the system shall be o^ered until it has been ins|5ebted and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that tne joblis ready for inspection. Kail pr u^ipached mailer notice.) Dated Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. / Ij NOTE: Permit void if work is not commenced within six (6) months. — / II —uI J^nag,f\ooFee $_1±L___ Issued Date;Shoreland nagement Office Comments:. Form No. MKL-0771-003 [^V«W lATTU lAKI. M:NNI$0TA % s INSPECTION RESULTS Inspector must make all measurements ',=3^;. >■' '.C'KmSEWAGE 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 50FFF'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 33FFFFF F Inspector's Comments: A Date of Inspection 19___ I Time of Inspection.r>-M “-; \ Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs ■ Gallons SF Square Feet F * Linear Feet Job Title AgencyMKL-0771-003-Backer • ‘c^\ -V r (V.J-. . s(V .; ii , . rV \v; 1 ... ■ . :.r-i r •j Qe.cVt VNw 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(« - O(’jf0 ♦ Ye/Jow — Inspector Pink — Owner Cord —Owner 1 LAiCC (liu y APermit No.. LEGAL DESCRIPTION AND ILOCATION TWP NameSec.TWP RangeLake Classif.Lake NameLake No. IDENTIFICATION: Please Print All Information. Tel. No.Zip No.Mailling Address -No. Street, City and StateFirstInitialLast Name OWNER SEWAGE SYSTEM INSTALLER Name. fa pP^This System will be ready for inspection , 19on. This space for office use only CMC19 Owner or Agent SignatureDate Rec'd Time Rec'd Phone Call Rec'd By NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PIT DRAIN FIELDSEPTIC TANK 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 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 fPERCOLATION TEST DATA:Date of First Test 19 Rate J 1 I ■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: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agents, employees and workmen shall conform In all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six (6) months. Issued Date: Shoreland jManagement Office Fee $ Comments:. (Review kattle lake. MinnesotaForm No. MKL-0771-003 INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS EyOSri SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORY Actual Should be Actual Should be Actual Should be ^ F^ -- SPo ucunop^r \nooCapacityGIs.GIs.S F SF ■goDistance from Nearest Well Pt£.P 75 50FFFF F XT7^1£LDistance from Lake or Stream F F F F F SS"Distance from Occupied Building 2010 20FFFF F / FDistance from Property Line 10 10 10FFFF F Distance from Bottom to Water Table 33FFF F F Inspector's Comments; ^ k 'l •f*Picrh (wS'hilltJD -H mA. Q +i M iv> ipcj^id K go, r ^ \ I2)IC fo CA/ /) S' tj^s Y L (7f I Pigxy(X o d Vv\ O 'JCb V^j<i-\V V Not, ■(ayy-.ovtc. 'hjr £rt^^lL ^ "^1.' / III! fxU -Date of Inspection l^'iconTime of Inspection M 7^ signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs “ Gallons SF ■ Square Feet F ■ Linear Feet Job Title L~ —V ^ ^ AgencyM KL>07 71-00 3- Backer ziip 7<f0, -iv. V ■:.y / m MWr^2 ?^' * *M;im£yi:*«a** ■•.;r‘\-j! CERTIFICATE OF COMPLIANCE SEWAGE SYSTEM :C J' -V) HOLDING TANK ilirff mmmmw 5tb 19 76AprilZ’AA certificate has been issued this day of_^ to certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota. The premises covered by this certificate are legally described as: 56-781 Sec. ^9 Twp.Range 1|2 Pt. of G.L. 3 132 Twp. Name Pali e PrairieLake No. imiiif Sx-Jan Lake Club Isi #38 MiS ‘ p:ifamM m wmmkiJaxnas SeashoreOwner: Name, B1003 Jefferson Place. Fergus Fells. MinnesotaA ddress. Pmmi ^6t^37Zip No. mkPermit No. SP_ Signed by:. ^ Maleolm K. Lee, Shoreland Administrator Otter Tail County, Minnesota €sm.m................ MKL-087 1-009 m. 159035 t,u*>3CCN t eo, ^RiirtPi, Pt*:ua f*us 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., O.A ^ 3 LEGAL Date DESCRIPTION AND /^diV/VLOCATION Lake Classif.Sec.TWPLake NameLake No.Range TWP Name IDENTIFICATION: Please Print All Information. Initial Mailling Address —No. Street, City and StateFirst Zip No.Tel. No.Last Name ^r^:S>k/>,rPOWNER i) *3 j ty\ Y\. SEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection on.., 19. This space for office use only .M19 Date Rac'd Time Rec'd Phone Call Rec'd By Owner or Agent Signa^ture NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIEiLD jnn n gis.Sq/ Ft.Sq. Ft.Capacity Ft.Ft.Ft.Distance from nearest well :?5"Ft.Ft.Ft.Distance from lake or stream /O Ft.Ft.Distance from occupied building Ft. Distance from property line Ft.Ft.Ft. Ft.Ft.Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest ppints RECORD OF TESTS: Inspection was made on ,, 19,, Time..,M By PERCOLATION TEST DATA:Date of First Test , 19 , 19 r Rate Date of Second Test ,, Rate 1st Test Taken By First Tei + 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 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 me job is ready for inso^^on. (Call or use attached mailer notice.) J.\/V<~l ^ Signature -'-LDated 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. /> 6Issued Date: y—ac)5,Fee $Surcharge $ Comments:. Form No. MKL-0771-003 , . .. 158906VICTO* UiaOtCH 8 M.. SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 - Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTFM White - Office Yellow — Inspector Pink — Owner- Card — Owner /y tjPermit No.. u Cl, h ^ O.A ^ 3 LEGAL /.•r- /Date DESCRIPTION / AND 3"C-'J !,<=f fLOCATION K t-r.,, •- . e~ M Cl . A / Lake Classif.Lake No.Lake Name Sec.TWP Range TWP Name IDENTIFICATION: Please Print All Information. Last Name First Initial Mailling Address —No. Street, City and State Zip No.Tel. No. I Ci /' ^r - - -!"S h.cA VOWNER ■ •' rr- ' ■''U SEWAGE SYSTEM INSTALLER Name. I •This System will be ready for inspection T-' ,, 19.ion. This space for office use only EAR•%19 .M Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signa^ture NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD GIs.Capacity Sq. Ft.Sq. Ft. Ft.Ft.Ft.Distance from nearest well Ft.Distance from lake or stream Ft.Ft. /ri Ft.Distance from occupied building Ft.Ft. Distance from property line Ft.Ft.Ft. Ft.Distance from bottom to Water Table Ft.Ft. AH distances are shortest distance between nearest points \RECORD OF TESTS: Inspection was made on 19 , Time.,„M By PERCOLATION TEST DATA:Date of First Test 19 , 19 . Rate Date of Second Test , Rate 1st Test Taken By First Te^-I- 2nd Test 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 covert lio^il 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 jobXsVdBdy for inspection. (Call or use attached mailer notice.) , \ Dated Signature Permit: condition that the person to whom it is granted, and his agents, e 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 a^Uoaf^1^perform the work described in the above statement. This permit is granted upon express ees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. •■■7 ./'i k. , n , rJ r\/ /'''''Issued Date: Shoreland Management Office' / r ■oc Fee $Surcharge $ \sate I Comments:. ( Form No. MKL-0771-003 VICTftR LUH»CIN » C»., PRINTtltt. rtHaul rW.L>. HINH.158906 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 75 50FFFF F F Distance from Lake or Stream F F F F F F Distance from Occupied Building 201020FF F F F F Distance from Property Line 10 10 10FFFFF F Distance from Bottom to Water Table 4 4FFFFF F uA f y ^ 5 1 Co f ^Inspector's Comments: .19JZ.<Date of I nsnection 1 j H c 7 /LTime of Inspection,M Slgr/ature of^l nspectorINTERPRETATION OF ABBREVIATIONS GIs ~ Gallons SF = Square Feet * Linear Feet Job TitleF AgencyMKL-0771-003-Backer t SHORELAND MANAGEMENT OTTER TAIL COUNTY FERGUS FALLS, MINN. MKL-0871-030 19 ^File Opening Date. Individual File Subdivision File ( ) Name of Applicant: Special Use ( )Subdivision Name.Use Descriptioa Sl a No. (y (JO city ^ ✓stow zip No. Gl/KiL PA^AjUU'^ y33^'7</^Address: Last Name First Middle Phone No. V£QLegal Description 19 /-SD- ^Kxyy^ Lake or River Name.Classtf.See.Twp.Range Twp NameLake No.P.<sAj! C (Lu^ PL ■ -Pknj . O BUILDING PERMITS VARIANCES ON RUILDINr; PFRMITR Date NotifiedHearing JudflamentDate inspected Appl. Date Hearing DateDatePurpose ResultsNO. 0 SEWAGE SYSTEM PERMITS VARIANCFS ON SEWAGE SYSTEM PERMITS Hearing JudgementHearing DateDate inspected Appt. Date Date NotifiedPurpose ResultsDateNO. pC)^ ii 'AAA1444(a-yO--7^4>-\ Mr-15 a 0 SPECIAL USE PERMITS COMMENTS SECTION:Notice MailedHearing DateApplication Date Accompanying Documents Filed in Cabinet No. @ mtM IMMI* ( «. nMM rau. Bm.l 69093ANOTE: O 0 See enclosed Inspectors Copy of Permit Application. 0 See enclosed Special Use Permit Application.