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Home My WebLink AboutSwan Lake Club_13000190112000 _ 22712_Septic System Permits_APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE 121 W. JUNIUS AVE. • SUITE 130 Phone: (218) 739-2271 • FERGUS FALLS, MN 56537 www.co.ottertail.mn.us APPLICATION MUST BE COMPLETE IN ORDER TO BE PROCESSED WHITE - bffice YELLOW- L&R Inspector PINK - Owner / Contractor (after issue) 4"^ Permit No. SECTION TWP NO.RANGE TWP NAMELAKE/RIVER NAME LAKE/RIVER CLASSLAKE NUMBER /9 P7^/■ J Cl. fiAj- A ^I- Qc ((S (cT PARCEL NUMBER (S) OF PROPERTY BEING SERVICED E-911 ADDRESS U^krL^ /We-/3c c r /9cn:ir.oc-. LEGAL DESCRIPTION ^ I ■ f . 3 C. b c\ 'B ic 3o £X TfZ3 Daytime Phone No.Last Name First Initial Mailing Address H M'aj ciMJ .M/2 pp*Property Owner 5 L t-ficK)AcT-'t -t- y 7'- yA -C^C/ZaTZ 3Contractor Lie.#/■ / /-/.T - /- THIS SPACE FOR OFFICE USE ONLY AM. >■ This System will be ready for inspection on.the year of .P.M..at. A.M. P.M. L&R OfficialTime ReceivedDate Received SEWAGE TREATMENT SYSTEM DESIGN DATATYPE OF INSTALLATION (CIRCLE ONE) TANK DRAINFIELD I Ft’*GIs.Size /COa-4^Add-On/New System (20) Trench, Rock (21) Trench, Gravelless (22) Trench, Chamber (23) Bed (24) Mound (25) At Grade Replacement (32) Tank, Septic (33) Tank, Lift (34) Trench, Rock (35) Trench, Gravelless (36) Trench, Chamber (37) Bed (38) Mound (39) At Grade (40) Combination 5oSetback to nearest well Ft.Ft. Setback to OHWL (lake &/or river)Ft.Ft.7,^ Setback to wetland Ft.Ft. Setback to dwelling Ft.Ft.Collector System (26) Trench, Rock (27) Trench, Gravelless (28) Trench, Chamber (29) Bed (30) Mound (31) At Grade (CSetback to non-dwelling Ft.Ft. 'c7Setback to nearest property line Ft.Ft.Other Tank, Holding Outhouse (43) Sewer Line (44) Performance (45) Miscellaneous 1CSetback to road right-of-way Ft.Ft. Elevation above restrictive layer Ft.-Ft. ALL DISTANCES ARE SHORTEST DISTANCE BETWEEN NEAREST POINTS. DEPTH OF WATER WELL # BEDROOMS GARBAGE DISP. Y /.-W-" ABATEMENT Y LM—- ABSORPTION AREA FOR MOUNDS .Ft^HOLDING TANK MONITOR/ DISPOSAL CONTRACT ( )Yes ( ) No-L&R Can Not Process EFFLUENT DISTRIBUTION ( ) Gravity ( ) Pressure Designer '■ Designer Lie.# -3 / PERCOLATION TEST DATA Date of Test,Highest Rate 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 accordance 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. 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 Sanitation Code of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of the Sanitation Code. NOTE: This permit is vaiid for a period of six (6) months. 7,r^Date: 7 C'3 cizr\yyY\ c—7/ f i:'Permit Fee $ &gnahire of Property Owner/Agent for Owner 73413Date:Rec. No. Land & Resource Mar)agement Office Comments: Form No. BK — 0208-003 311,054 • Victor Lundeen Co.. Printers • Fergus Falls. Minnesota application for permit to install sewage treatment system .(?r LAND & RESOURCE MANAGEMENTOTTER TAIL COUNTY COURT HOUSE 121 W. JUNIUS AVE. • SUITE 130 Phone; (218) 739-2271 • FERGUS FALLS, MN 56537 , www.co.ottertail.mn.us APPLICATION MUST BE COMPLETE IN ORDER TO BE PROCESSED WHITE- L & R Inspector -INK - Owner / Contractor (after issue) Permit No. / LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS SECTION TWP NO.RANGE TWPNAME 7 <y /\J UJ ihOciie/ 1 c: E-911 ADDRESSPARCEL NUMBER (S) OF PROPERTY BEING SERVICED ' -R j ! i C jOcn' ) LEGAL DESCRIPTION H-'rftn') Ex. 3;17 £B !A Ro ^ First Initial Mailing Address Daytime Phone No.Last Name y AJ -Property Owner o L CJC^ _ , n fi kj fcci jj.-dcCU .A i'jT*y rT*, » ^<P> \ 3TTT y 7-'7 P' 'P.^6-Contractor Lie.# 7P~t A /> THIS SPACE FOR OFFICE USE ONLY 0at ' PM. I)~\b^/o^ >■ This System will be ready for inspection on.the year of /4mcf L&yOfficial A.M Date Received Time Received SEWAGE TREATMENT SYSTEM DESIGN DATATYPE OF INSTALLATION (CIRCLE ONE) TANK DRAINFIELD t- " GIs.Ft'Size C.' i--Add-On/New System (20) Trench, Rock (21) Trench, Gravelless (22) Trench, Chamber (23) Bed (24) Mound (25) At Grade Replacement (32) Tank, Septic (33) Tank, Lift (34) Trench, Rock (35) Trench, Gravelless (36) Trench, Chamber (37) Bed (38) Mound (39) At Grade (40) Combination Setback to nearest well Ft. Ft.70■7^ Setback to OHWL (lake &/or river)Ft.Ft.yr-/ Setback to wetland Ft.Ft. Setback to dwelling Ft.Ft.(Q)Collector System (26) Trench, Rock (27) Trench, Gravelless (28) Trench, Chamber (29) Bed (30) Mound (31) At Grade Setback to non-dwelling m Ft.Ft. Setback to nearest property line ZA2 Ft. Ft.Other (41) Tank, Holding (42) Outhouse (43) Sewer Line (44) Performance (45) Miscellaneous V Setback to road right-of-way Ft.-------------. Ft. Elevation above restrictive layer Ft.Ft. ALL DISTANCES ARE SHORTEST DISTANCE BETWEEN NEAREST POINTS. DEPTH OF WATER WELL #BEDROOMS GARBAGE DISP. Y /J«L- ABATEMENT Y /JJ----- ABSORPTION AREA FOR MOUNDS %.Ft"EFFLUENT DISTRIBUTION ( ) Gravity ( ) Pressure HOLDING TANK MONITOR/ DISPOSAL CONTRACT ( )Yes ( ) No-L&R Can Not Process Designer___________________ Designer Lie. # .1 , 7 ^ PERCOLATION TEST DATA Date of Test,Highest Rate 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 accordance 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. 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 Sanitation Code of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of the Sanitation Code. NOTE: This permit is valid for a period of six (6) months. 7,rPermit Fee $Date:_ Signature of Prr^rty Owner/Agent for Owner j ho cDate:Rec. No. Land & Resource Management Office Comments: Form No. BK — 0208-003 311.054 • Victor Lundeen Co.. Printers * Fergus Falls, Minnesota SEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTS Inspector must make all measurements % j HOLDING^ SEPTIC TANK OUTHOUSt.DRAINFIELDLIFT TANKCATEGORY / 5^(70 GLS.3 JO GLS.Capacity FT2FT2 ^ V ft ^ h FT FT FTSetback from Nearest Well Setback from Buried Water Suction Pipe 4 FT FT FT FT y' FT04 FTSetback from Buried Pipe Distributing Water Under Pressure FT FT 7S- ^/O FTSetback from OHWL (lake &/or river)FT FT X/SSetback from Setback from Wetland FT FT FT FT Setback from Dwelling FT FT FT ftyjjO'O ftSetback from Non-Dwelling FT FT /Or FTSetback from Nearest Property Line FT FT ft^ '0 / ftSetback from Right-of-Way FT FT Elevation above Restrictive Layer FT FT FT FT Holding Tank/Lift Alarm NO Old System Pumped & Destroyed YES NO SEPTIC TANK WlA cl-i OO / 3 70~ FILTER Sewer Line to Well Separation DRAINFIELD CALCULATION Actual Minimum Manuf..□ YES FTX Model #.ft^FT FT20 MOUND CALCULATION MOUND /AT-GRADE ROCK REDUCTIONInspector’s Comments: l4)o\ABSORBTION AREA Rock trenches with inchesC y\ J of rock under pipe for %Ft. Xit r DF.reduction / equivalent toFt2 SKETCH: bc4-\ m i ff Oats Time Initial/L & R Official As of Code of Otter Tail County. the above described sewage system installation was found to be compliant with the provisions of the Sanitation Land S Resource Management Official t System design must be to scale and must include the proposed location of the sewage system, all existing/prdposed buildings, property lines, the ordinary high water level of the water body, wetlands, bluff and all water wells within 150' of the sewage system. grid(s) equals feet, orScale;I__inch(es) equals feet an/yr7^—^SUBMITTED BY: FIRM NAME: ADDRESS: SIGNATURE: DATE: 3-93 - 03___ MPCA LICENSE #: yp LICENSE CATEGORY:/7? ^ K 1H -5 BK - 0599 - 029 300.817 • Victor Lundoen Co.. Printers • Fergus Falls. MN • 1-800-346-‘i870 SITE DATA WORKSHEETI LAND AND RESOURCE MANAGEMENT Otter Tail County 121 W. Junius Ave., Suite 130 Fergus Falls, MN 56537 OWNER: I444~PP LAST NAME TELEPHONE NUMBERFIRSTMIDDLE ADDRESS: ma]/■; ) ASA/'tcj <v3/a 'A" S-+. fj.e.^ C> o c> Q. ■» ZIP CODESTR./RT.CITY STATE J3oL\i/ io pA/Ufe TWP. NAME 419'7S! RANGELAKE/RIVER NO.LAKE NAME SEC.TWP. LEGAL DESCRIPTION:SOIL BORING LOG - Date COLOR & MUNSELL NO. DEPTH(INCHES)STRUCTURETEXTURE BLOCKY PLATY PRISMATIC NONEPARCEL NUMBER BLOCKY PLATY PRISMATIC NONE FIRE NUMBER NUMBER OF BEDROOMS________ GARBAGE DISPOSAL: YES NO BLOCKY PLATY PRISMATIC NONEWELL CASING DEPTH:ft.BLOCKY PLATY PRISMATIC NONE FLOODPLAIN: YES NO VEGETATION: AQUATIC TERRESTRIAL BLOCKY PLATY PRISMATIC NONE SLOPE AT INSTALLATION SITE:% 1 TYPE OF OBSERVATION: Probe Pit Boring PARENT MATERIAL: Till Outwash Loess Bedrock Alluvium COMMENTS: ORIGINAL SOIL: Yes No COMPACTED SOIL:Yes No DEPTH OF BORING:ft. PERC TEST #1 PERC TEST #2- TWO TESTS ARE REQUIRED - PERC RATEPERC RATE WATER DEPTH WATER DROPTIMEINTERVAL fMINUTESi WATER DEPTH WATER DROP TIME INTERVAL (MINUTES!START START DROPTIME PERC PERC RATEWATER DROPINTERVAL IMINUTES)PERC RATE TIME INTERVAL (MINUTES!WATER DEPTHTIMEWATER DEPTH WATER DROP yREFILL REFILL —DROP PERCTIMEDROPTIMEPERC PERC RATEWATER DEPTH WATER DROPTIMEINTERVAL (MINUTES)WATER DEPTH PERC RATE TIME INTERVAL (MINUTES)WATER DROPREFILL REFILL DROP PERCTIMEDROPTIMEPERC PERC RATEPERC RATE WATER DEPTH WATER DROPTIMEINTERVAL (MINUTES)WATER DEPTH WATER DROP TIME INTERVAL (MINUTES)REFILL REFILL DROP PERCTIMEDROPTIMEPERC PERC RATEWATER DEPTH WATER DROPPERC RATE TIME INTERVAL (MINUTES!TIME INTERVAL (MINUTES)WATER DEPTH WATER DROPREFILL REFILL! DROPTIME PERCDROPTIMEPERC PERC RATEWATER DROPPERC RATE WATER DEPTHTIME 'INTERVAL (MINUTES)WATER DEPTH WATER DROP TIME INTERVAL (MINUTES)REFILL REFILL DROP PERCTIMEDROPTIMEPERC PERC RATEPERC RATE INTERVAL (MINUTES)WATER DEPTH WATER DROPTIME I INTERVAL (MINUTES)WATER DEPTH WATER DROP TIME REFILL REFILL i . -r--------- =TIME DROP PERCDROPPERCTIME PERC RATEWATER DROPPERC RATE TIME INTERVAL (MINUTES)WATER DEPTHTIMEINTERVAL (MINUTES)WATER DEPTH WATER DROPREFILL REFILL DROP PERCDROPTIMEPERCTIME PROPOSED DESIGN: PRESSURE DIST.GRAVITY DIST.TRENCH___ SEWER LINE ATGRADE MOUND HOLDING TANKBED SPECIFY: — SYSTEM DESIGN ON BACK — OUTHOUSE OTHER X CERTIFICATE OF APPROVAL SEWAGE SYSTEM This certificate has been issued this 19th December 19 94 .day of to certify that the sewage system installed as per sewage permit number indicated below has been approved for by Otter Tail County, Minnesota. s *"S use m The premises covered by this certificate are legally described as: WTM 56-781 19 Twp. 132Lake No.Range 42 Twp. Name DANE PRAIRIESec.m.mi i19 132 42 28. 45 PT G. L. 3 <REC BK 203 PG 486) EX TRS 1 imm • s.5UAN LAKE CLUB INCOwner: NameWi m ay. FRED DAHL5TROM. FERGUS FALLS. MNAddress m 56537Zip No.[S 9979Permit No. SP "ySigned by:(Charles & Robert Hyslop)Land & Resource Managemeni Official Oiler Tail Couniy, Minnesotak; MKL^87001 Vi JT-272472 Victor Uindeen Co., Printers. Fergus Fails, Minnesota APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM WHITE — Office Yellow — Inspector Pink — Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218)739-2271 - FERGUS FALLS, MN 56537 StOANLEGAL Permit No. DESCRIPTION AND LPCATION LAKE/RIVER NAME LAKE/RIVER CLASS SECTION RANGELAKE NUMBER TWP. NO.TWP NAME S(mah RD 11 :e PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER IDENTIFICATION: Please Print All Information Mailing Address — No. Street, City and State Zip Code Telephone No.Last Name First Initial CliArlO^tbp AvcmispProperty Owner Mz-€HuSewage System Installer Name A.M. P.M.This System will be ready for Inspection on , 19.at This space for office use oniy NUMBER OF BEDROOMS: A.M. P.M.,19 GARBAGE DISPOSAL: ( ) YES ( ) NOPhone Call Rec’d ByTime Rec'dDate Rec’d SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) ( ) Septic tank ( ) Drain field ( ) Standard ( ) Bed ( ) Trench ( ) Modified ( ) Mound DRAIN FIELDTANK /CoDitCapacity GIs.Ft. sz>Ft. Ft.Distance from nearest well 7£Distance from lake or stream Ft.Ft. Distance from building Ft. Ft. 10Distance from property line Ft. Ft. EFFLUENT DISTRIBUTION ( ) Gravity ( ) Pressure Distance from bottom to Water Table Ft. Ft. All distances are shortest distance between nearest points WATER WELL DEPTH: PERCOLATION TEST DATA: Date of First Test Rate, 19. Date of Second Test Rate, 19 1st Test Taken By First Test + 2nd Test Rate22nd 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 Minnesota Department of Health. Applicant agrees that plot plan sketches and specifications submitted herewith and which are approved by Shoreland Management Officical 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 responsibilty of the applicant for the permit to notify the County Shoreland Management that the job is ready jnspection. .^QfVWYN (fO DATE: 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 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 any said ordinances. NOTE: Permit void if work is not commenced within six (6) months. 6'/3- 1 TIssued Date: Bv/d Land & Resource Management OfficellS3.3iP ^ o re.^/4-c-e i Fee $.Rec #. Comments: Form No. BK-0993-003 266,559 • Victor Lundeen Co.. Printers - Fergus Palls. MN • 800<^46-4870 'a APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTJ aA^ Vi WH/TE — Office Yellow — Inspector Pink — Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 - FERGUS FALLS, MN 56537 miSUOAN La^ Cl^i’Permit No.LEGAL DESCRIPTION AND oLPCATION -J TWP NAMERANGESECTIONLAKE/RIVER CLASS TWP. NO.LAKE/RIVER NAMELAKE NUMBER )3xSWA(J 11RD I FIRE OR LAKE ASSOCIATION NUMBIPARCEL NUMBER(S) £ll'OOO-2 IDENTIFICATION: Please Print All Information Telephone N8:>'^Ip CodeLaitNefoeMailing Address — No. Street, City and StateInitial Property Owner Sewage Systerp^ Installer lh\s System will be ready for iifspection on This space for office use oniy NUMBER OF BEDROOMS: A.M. P.M..19 GARBAGE DISPOSAL: ( ) YES ( ) NOPhone Call Rac'd ByTime Rac’dDate Rac’d SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM ) Holding tank (Alarm Required) ) Septic tank ) DiaiTTfleid ( ) Standard ( ) Bed ( ) Trench ( ) Modified ( ) Mound DRAIN FIELDTANK IDOOtT Sq Ft.GIs.Capacity /( Gt>Ft.Ft.Distance from nearest well 7£Ft. Ft.Distance from lake or stream; Ft.Ft.Distance from building 10 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 WATER WELL DEPTH: Rate. 19PERCOLATION TEST DATA: Date of First Test Rate, 19Date of Second Test 1st Test Taken By + 2nd TestFirst Test Rate22nd 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 Minnesota Department of Health. Applicant agrees that plot plan sketches and specifications submitted herewith and which are approved by Shoreland Management Officical 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 responsibilty of the applicant for the permit to notify the County Shoreland Management that the job is ready^for.inspection. n\JDATE: 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 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 any said ordinances. NOTE: Permit void if work is not commenced within six (6) months. 6-/3- 1 VIssued Date: Land & Resource Management Office________iis:iAD rr>^,4-ir n A'/ir.j-inJn 'Tw Rec #.Fee $. Comments: Form No. BK-0993-003 268^ • Victor LundMn Co.. PrtnlM • Forgut Fata. MN • 8CO-346-4870 iVi INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEPTIC TANK DRAIN FIELDCATEGORYActualMinimumActualMinimum Capacity GLS.GLS.SF SF Distance from Nearest Well FT FT50 FT FT Distance from Buried Water Suction Pipe FT FT50 FT FT50 Distance from Buried Pipe Distributing Water Under Pressure FT FT10 FT 10 FT Distance from Lake or River (OHWL)FT FT FT FT Distance from Nearest Building 10/20 FTFT FT10 FT Distance from Nearest Property Line FT FT10 FT 10 FT Distance from Bottom to Water Table FT FT FT FT3 YESHolding Tank/Lift Alarm NO\I Sewer Line to Well Separation DRAINFIELD CALCULATIONINTERPRETATION OF ABBREVIATIONS GLS. = Gallons SF = Square Feet FT = Linear Feet Actual Minimum FTX FT 20 FT SF 'I- Li a IL-Inspector’s Comments: I L SKETCH: lit j I j T Inspector’s Signature Date of Inspection 'Time o1 Inspection 1