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HomeMy WebLinkAboutSwan Lake Club_13000190112000 _ 22696_Septic System Permits_APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENT GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 218-998-8095 www.co.otter-tail.mn.us WHITE-Ofnce GOLDENROD - Inspector YELLOW - Owner (after issue) OTTER Tflll COVATY MIAAIIOTII Permit No.APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED. ^LAKE / RIVER Na LAKE/RIVER NAME AJ( 5~6 - Lie 'cii . 0 ^RCEy^ SECTION TWPNO.RANGE TWP NAME l±ER4S)PROPERTY (E-911) ADDRESS / ^ CO Of f I T£ LEGAL DESCRIPTION 9, DEVELOPEDF'^6cs Cecc Bt j>o^UNDEVELOPED Last Name First Initial Mailing Address Daytime Phone No. dJ/F/TC F^u'//Hu^/ojOProperty Owner fklk^ npA) Contractor Name Lie.# AlT^tPK d/FCdSS /J-^uAJ rC7 / PROPOSED PROJECT (please circle the appropriate number) (1 ) New Dwelling (4) MH/YR____ (7) Add'n To Non-Dwelling (8 ) Storage Structure (10) Non-Conf. Replacement (identify)'’_______ (11) Other (identify)______________________ (12 ) Deck______________________________ (13)Fence_____________________________ ONSITE WATER SUPPLY ONSITE SEWAGE TREATMENT SYSTEM ( ) L&R Cert, of Compliance within 5 yrs. ( ) Compliance Inspection Report within 3 yrs. (Attached) ( ) OTWMD ‘Must have Sewage System Approval from OTWMD prior to issuing Site Permit. Contact Roilie Mann at 218-884-5533 ( ) New Septic Permit Issued Permit #____________ (2 ) Add'n to Dwelling/Attached Garage (3) Replacement Dwelling* (^.)^etached Garage (9) W.O.A.S. ( ) Individual ( ) Public ( ) None NOTE: MN Rules Chpt. 4725 (MN Well Code) requires a 3' (minimum) structure setback to a well. (5) RCU/Year. •Removal of Existing Dwelling Verified by L&R "Existing Non-Conf. Structure Verified by L&R \nspec\or’s hitiaVDale \r\spectofs Inilial/Date CHARACTERISTICS OF PROPOSED W.O.A.S. (WATER ORIENTED ACCESSORY STRUCTURE) Outside Dimension CHARACTERISTICS OF PROPOSED DWELLING (Must Include Attached Garage) Outside Dimension___ Sq. Ft. Setback to Lotline ____ Setback to Right of Way Setback to Ordinary High WaterVevel / Elevation Above Ordinary High vAtpfLevel Setback to Septic Tank___ Setback to Drainfield____ Setback to Bluff / Total Bedrooms y Maximum Proposed Height Roof Change ( ) Yes ( ) No \ Basement ( ) Yes ( ) No \ Walkout Basement ( ) Yes (side profile requiM ( ) No CHARACTERISTICS OF PROPOSED NON-DWELLING Outside Dimension 3^ Ft. x Ft.**Ft. X Ft.**Ft. X Ft.** Sq. Ft. Setback to Lotline Setback to Right of Way r2F) Ft.** Setback to Ordinary High Water Level __ Elevation Above Ordinary High Water Level Setback to Septic Tank__ Setback to Drainfield AJA pt. Setback to Bluff Maximum Proposed Height Roof Change ( ) Yes (A) No Bathroom Proposed ( ) Yes {^] No /o'' Ft. & fO ^Sq.Ft._________ \ Setback to Lotline ___ Setback to Right of Way Setback to Ordinary High Vfate^vel Elevation Above Ordinary Hj^ Water Level Setback to Septic Tank / Setback to Draintielcr Setback to Bluff/iL______ Maximum Proposed Height ( ) Boathouse ( ) Gazebo **Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Appiication / Inspection Ft.&Ft."Ft.**Ft.&Ft."Ft.** ■t.**Ft.90) Ft.Ft.Ft. Ft.Ft.Ft.^Ft. Ft.Ft, Ft. Ft.Ft./*/ Ft.;t. Ft. ( ) Screen Porch ( ) Storage Structure Topographical Alteration / Earthmoving □ None * Must include on scale drawing, additional Permit may be required.□ 20 Cubic Yards or Less *1 Cubic Yards - 999 Cubic Yards*□ 1,000 Cubic Yards or More* ^ _\LjI ( )Yes ()^NoCHARACTERISTICS OF LOT:Lot Area, Sq. Ft.Water Frontage Ft.Bluff .%.% Building Surface Ratio Impervious Surface Ratio THIS IS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STATE STATUTES. Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above set forth and according to the provisions of the Ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewith shall become a part of this permit application. I also understand that this permit is valid for a period of six (6) months. 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 conform in all respects to the Ordinances of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said Ordinances.I understand that it is my responsibility to inform the Land & Re^inagem^t office once the building footings have been constructed.rce //:>Date:tr- Signature ^ Property 6-9-R-iCDate:% Land & Resource Management Official P~7C>Sr ~boo MmPERMIT FEE $PROJECT(S) TOTAL SQ. FT.,RECEIPT NO.Jt RECEIvW JUN 29 2016 land & RESOURCE Date StampComments: cW V. L&R InitialForm No. BK — 04-2016 360,647 • Victor Lundeen Co., Printers * Fergus Falls, Minnesota r WHITE - Office GOLDENROD - Inspector YELLOW - Owner (after issue) APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENT GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 218-998-8095 www.co.otter-tail.mn.us JF-OTTCR Tflll C O U n T T • M n A < I O T II evoieen Permit No.APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED.i LAKE / RIVER NO.LAKE/RIVER NAME . .LAKE/RIVER 'CLASS ' r l/^C SECTION TWPNO.RANGE TWP NAME!/iiU IMNC I £ ! £! PARCEL^j^^il^ERiS)PROPERTY (E-911) ADDRESS I a!folh j:,/J ‘TOSS') ------------------------1-------------------------- DEVELOPED, UNDEVELOPED, IfO / 7 o//T)con f:)/f ll£ 7LEGAL DESCRIPTION -■//Tio.■ if- 3 C;0] Mailing AddressLast Name First Initial Daytime Phone No. Property Owner (’'c 'S./ " <6Contractor Name Lie.# ' ..'V/-' UAOeeS £1' J''\0 -L ^1A> jL^Cf'r'JT T* / PROPOSED PROJECT (please circle the appropriate number) (1 ) New Dwelling (4) MH/YR_____ (7) Add’n To Non-Dwelling (8 ) Storage Structure (10) Non-Conf. Replacement (identify)"_______ (11) Other (identify)_______________________ (12) Deck______________________________ (13) Fence_____________________________ ONSITE WATER SUPPLY ( ) Individual ( ) Public ( ) None NOTE: MN Rules Chpt. 4725 (MN Well Code) requires a 3' (minimum) structure setback to a well. ONSITE SEWAGE TREATMENT SYSTEM ( ) L&R Cert, of Compliance within 5 yrs. ( ) Compliance Inspection Report within 3 yrs. (Attached) ( ) OTWMD ‘Must have Sewage System Approval from OTWMD prior to issuing Site Permit. Contact Rollie Mann at 218-864-5533 ( ) New Septic Permit Issued Permit ft (2 ) Add’n to Dwelling/Attached Garage (3.) Replacement Dwelling* ( 5 ) RCU/Year________ (f e-l-betached Garage (9) W.O.A.S. •Removal of Existing Dwelling Verified by L&R •‘Existing Non-Conf. Structure Verified by L&R inspector’s hitiat/Date inspector's initiai/Date CHARACTERISTICS OF PROPOSED W.O.A.S. (WATER ORIENTED ACCESSORY STRUCTURE)CHARACTERISTICS OF PROPOSED DWELLING (Must Include Attached Garage) Outside Dimension___ Sq. Ft. Setback to Lotline____ Setback to Right of Way Setback to Ordinary High Water Level Elevation Above Ordinary High Watef Level Setback to Septic Tank Setback to Drainfield _ Setback to Bluff_____ Total Bedrooms Maximum Proposed Height_____ Roof Change ( ) Yes ( ) No Basement ( ) Yes ( ) No Walkout Basement ( ) Yes (side profiie required) { ) No CHARACTERISTICS OF PROPOSED NON-DWELLING Outside Dimension Outside DimensionFt. X Ft.**Ft. X Ft.**Ft. X Ft.** -Sq. Ft. Setback to Lotline Xfi.**Sq. Ft. Setback to Lotline ___ Setback to Right of Way Setback to Ordinary High Water Level __ Elevation Above Ordinary High Water Level Setback to Septic Tank ^ Setback to Drainfield'. Setback to Bluff____ Maximum Proposed Height ( ) Boathouse ( ) Gazebo **Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Appiication / Inspection \ R.&Ft.&_ Ft.**Ft.&Ft.**1.£ '/Setback to Right of Way Setback to Ordinary High Water Level __ Elevation Above Ordinary High Water Level Setback to Septic Tank Setback to Drainfield _ Setback to Bluff Maximum Proposed Height___, Roof Change ( ) Yes (A ) No Bathroom Proposed ( ) Yes ( ' ) No Ft.** Ft.**Ft. Ft.Ft.Ft.A /" ’ Ft.Ft. Ft.Ft,\Ft. iFt.Ft./\ Ft.VR.Ft.\ R.i ;Ft.T ( ) Screen Porch ( ) Storage Structure Topographical Alteration / Earthmoving □ None * Must include on scale drawing, additional Permit may be required.^21 Cubic Yards - 999 Cubic Yards*□ 20 Cubic Yards or Less *□ 1,000 Cubic Yards or More* ( )Yes ()<[noCHARACTERISTICS OF LOT:Lot Area .Ft.Water Frontage Ft.Bluff .%.% Building Surface Ratio Impervious Surface Ratio THIS IS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STATE STATUTES. Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above set forth and according to the provisions of the Ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewith shall become a part of this permit application. I also understand that this permit is valid for a period of six (6) months. 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 conform in all respects to the Ordinances of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said Ordinances.I understand that it is my responsibiiity to inform the Land & Resource Management office once the buiiding footings have been constructed. Date:__________________ _______________________ Signature of Property.Ownar/Agent tor Owner A A A"" Land & Resource fJanagement Office 6Date: 16.^RECEIPrNOPERMIT FEE $PROJECT(S) TOTAL SQ. FT. Comments: Form No. BK — 04-2016 360,647 • Victor Lundeen Co.. Printers • Fergus Falls, Minnesotalimflil SITE PERMIT INSPECTION RESULTS Inspector must make all measurements and computations ^5' /\^d'Structure Set Back from Ordinary High Water Level Ft. Ft. Structure Set Back from Top of Bluff Ft.Ft. Structure Set Back from Road Right of Way Ft. Ft. Ft.& VOStructure Set Back from Lot Lines Ft.Ft.&Ft. Structure Height Ft. Ft. Structure Set Back from Septic Tank Ft. Ft. Structure Set Back from Drainfield Ft. Ft. Elevation Of Lowest Floor Above Ordinary High Water Level •V-3 Ft.Ft. Land Slope at Building Site %% Inspector’s Comments / Sketch: o VsP h-ioM10^ - J 2o" Inspector's Signature -ibihn Date of Inspection '3 Time of Inspection95 JFU-Project Approved Date / Initial Gf?AVELkOAD r.y fmr: 101-V4- DRIVEWAY 30’5-V4're*-jpyo’ CaiECnON AREA WILL NOT FILL PR0P05EDDRIVEWAYT I APRON25’2-5/a"PRE-EdSTlNO OARAGE1Z3-3/-C WAFER COL,ECTION /•sffvvr doh-vd’ T7S65 SQ. FT.dsri-VA"13T3-3/©' 'DRAIN TILftTO CONTRa V^ATER LEVEL 3 4” DRAIN TILE mil- CHUCK HYSLOP. T0MHY5L0P tZJ SWANL^ Landscape Design by: Mark Jacobs Hyslop Residence- Swan Lake pMMh Country Lawns Scale:Landscape Plan: 01Revision #: Date: 5/12/2016 1" = 30' Pl^APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218) 739-2271 • FERGUS FALLS. MN 56537 WHITE - Officer GOLlJENROD - Inspector YELLOW - Owner PINK - Assessor Permit No.LEGAL DESCRIPTION - BLUFF ZONEAND □ YESLOCATION SECTIONLAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS _ TWP NO. RANGE TWP NAME pv M OaiJ(7 PARCEL NUMBER (S)GRADING / FILLING □ YES # OF CUBIC YARDS FIRE NUMBER J'^ ' COO ~ n-Cd^- coo IDENTIFICATION: Please Print All Information TELEPHONE NO. First Mailing Address — No. Street, City, State, and Zip Code (Daytime)Last Name Initial Lay.c'Property Owner H ''i ~l /'fc'U—! ICa)clc J.A/Uj' NameContractor State Lie. # ONSITE WATER SUPPLY ..i^^[Tndividual ( ) Public ( ) None NOTE: MN Rules Chpt. 4725 (MN Well Code) requires a 3’ (minimum) struclure setback to a well. ONSITE SEWAGE TREATMENT SYSTEM PROPOSED PROJECT .^^^ew Structure(s) ( ) Addition(s) ( )MH/RV________________ PROPOSED USE ( ) Dwelling ■-^”^on-Dwelling ( ) Water Oriented Accessory Structure (WOAS) -^^dividual Permit H ( ) Collector Permit #. ( )OTLSD*YEAR CHARACTERISTICS OF WOAS^CHARACTERISTICS OF NON-DWELLING ^^^^^etached Garage CHARACTERISTICS OF DWELLING ( ) Screen Porch( ) Utility Structure ( )thouse( ) Basement ( )Walkou)/ (iwelling ( ) Re)>lqcement Dwelling ( )AdditionXDwelling ( ) Existing Dweilih9.shall be remov^d^n or before. ( ) Gazebo ( ) Utility Structure( ) Other Outside Dimension (ched Garage( ) Ft. X ( ) Other. Outside Dimension Ft. Outside Dimension.5o 5C.Ft..Ft. X Ft.Lotline Setbacks .Ft,&.Ft.[. X ICOFt.Lotline Setbacks Ft.OHWL Setback Ft.&Ft.Lotline Setbacks Bathroom: ( )Yes p^ftio (If Yes / a complying Sewage System Required) Ft,OHWL Set^k OHWL SetlTot^edrooms__________________ 'Maximum Height / 35 Ft. (2 story) /\ Maximum Height /10 ft. (1 story)Maximum Height story .Sq. Ft. Impervious Surface Ratio .%.Sq. Ft. Impervious SurfaceLot Area 3y//'Ft. (3’ minimum)Ft. Elevation of lowest floor above OHWLWater Frontage ao .%Ft. Slope of lotStructure setback to right-of-way jQ Ft. (10’minimum) (Sewage System Permit required before installation). Ft. (20’minimum) (Sewage System Permit required before installation). .Ft. (10’minimum) (Sewage System Permit required before installation). Structure setback to septic tank_____________ Dwelling setback to Soil Absorption System___ Non dwelling setback to Soil Absorption System THIS IS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STATE STATUTES. Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above set forth and according to the provisions of the Ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewith shall become a part of this permit application. I also understand that this permit is valid for a period of six (6) months. 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 Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said ordinances. I understand that it is my responsibility to inform the Land & Resource Management office once the building footings have been constructed. * This permit is oniy vaiid after verification from the O. T.L.SD. that a conforming sewalges^tem wili be installed to xrvice this lot... Contact Roilie Mann at 864-5533. \Dated:i Signature of Owner -99 /Dated: Land & ResouedeManagemenl Office PERMIT ryRECEIPT NO. Comments: No. BK — 0597-002Form 290,821 • Victor Lundeen Co.. Printers • Fergus Falls. MN • 1-800-346-4870 %<D /<- N- APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENTOTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 • FERGUS FALLS, MN 56537 WHITE-Office GOLDENROD - Inspector YELLOW -Owner PINK - Assessor Permit No. / fo'-/ ^LEGAL CL'b, - .DESCRIPTION BLUFF ZONEAND □ YES -^^'NOLOCATION LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS SECTION TWP NO. RANGE TWP NAME\Oau.njOj lUtt PARCEL NUMBER (S)GRADING / FILLING .□ YES # OF CUBIC YARDS FIRE NUMBER / .J OOO - ooo JJ ^ ^ IDENTIFICATION: Please Print All Information TELEPHONE NO. Mailing Address — No. Street, City, State, and Zip CodeLast Name First Initial (Daytime) Property Owner La Ye' H V A S / StA)cL( IALY: ' i\e . hj^uS TorU 7)C 1-7^6NameContractor State Lie. # ONSITE WATER SUPPLY Individual ( ) Public ( ) None NOTE: MN Rules Chpt. 4725 (MN Well Code) requires a 3' (minimum) structure setback to a well. ONSITE SEWAGE TREATMENT SYSTEM -(^Individual Permit #__ ( ) Collector Permit #_____ ( )CTLSD* PROPOSED PROJECT New Structure(s) ( ) Addition(s) { ) MH/RV _________ PROPOSED USE ( ) Dwelling Non-Dwelling ( ) Water Criented Accessory Structure (WCAS)YEAR ^CHARACTERISTICS OF NON-DWELLING ^<)’'Detached Garage CHARACTERISTICS OF WOASCHARACTERISTICS OF DWELLING ( ) Boathouse ( ) Screen Porch( ) Utility Structure( ) Dwelling ( ) Replacement Dwelling ( ) Addition 1o Dwelling ( ) Existing Dwelling,shall be removed-lSn or before '''^Ft.x ( ) Basement ( ) Walkout ( ) Attached Garage ( ) Gazebo ( ) Utility Structure( ) ether Cutside Dimension V Ft. X 50 FL& 50 loo ( ) ether. Cutside Dimension Ft.XCutside Dimension,.Ft..Ft.Lotline Setbacks .Ft.T X .Ft.Lotline Setbacks .Ft.CHWL Setback .Ft.Lotline Setbacks \7^<fN0.Ft.CHWL Setback Bathroom: ( ) Yes (It Yes / a complying Sewage System Required)CHWL Setbacit, Total Bedrooms__________________ IMaximum Height / 35 Ft. (2 story) V\NMaximum Height / 10 ft. (1 story)Ft.,Maximum Height storyi ^<^rVS /fC %,Sq. Ft. Impervious Surface Ratio,Sq. Ft. Impervious SurfaceLot Area 2>.Ft. (3’ minimum).Ft. Elevation of lowest floor above OHWLWater Frontage <?0 .%.Ft. Slope of lotStructure setback to right-of-way. y O .Ft. (10’minimum) (Sewage System Permit required before installation). .Ft. (20’minimum) (Sewage System Permit required before installation). .Ft. (10’minimum) (Sewage System Permit required before installation). Structure setback to septic tank Dwelling setback to Soil Absorption System___ Non dwelling setback to Soil Absorption System THIS IS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STATE STATUTES. Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above set forth and according to the provisions of the Ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewith shall become a part of this permit application. I also understand that this permit is valid for a period of six (6) months. 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 Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said ordinances. I understand that it is my responsibiiity to inform the Land & Resource Management office once the building footings have been constructed. * This permit is oniy vaiid after verification from the O.T.LSD. that a conforming sewage system wiii be instaiied to service this iot... Contact Roiiie Mann at 864-5533. Signature of Owner ^ yi u Dated: Dated; Land & Resoui^ Management Office RECEIPT NO. /PERMIT FEES Comments: 290.821 • Victor Lundeen Co.. Printers • Fergus Falls. MN • 1-800-346-4870Form No. BK — 0597-002 INSPECTION RESULTS Make all measurements and computations Structure Set Back from Ordinary High Water Level Ft.Ft. Structure set Back from Top of Bluff Ft.Ft. Structure Set Back from Road Right of Way Ft.Ft. Ft.& Xj/^Ft.Structure set Back from Lot Lines Ft.&.Ft. Structure Height Ft.Ft. Structure Set Back from Septic Tank Ft.Ft./o t-~ Structure Set Back from Absorption System Ft.Ft.dr Elevation Of Lowest Floor Above Ordinary High Water Level____________________3 Ft. Ft.11 Land Slope at Building Line %% Inspector’s Comments / Sketch:, -i T tor's Signaturofi 7 Date ol Inspection Tbno tn^)oction ! * -4. I 31I n/ ^ //2 Acre Farce/ (Exception) Section !9, TJ32N., R.42IV. iEhV l3in (^77 Luh-'t^ l^Yi6 V \ *(V^ J (^v^A ■^\r i'n y.iuY\ u}t£<r^'^ JT>7-.>gf!(3 iiiiiXt<^:X’ p iVs>p>- <7 Si X >w ... ' 1 ' *^ j/VvCA^-^ I I ■v^ 4t>p L.-■pUilV)^^I /