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Home My WebLink AboutThe Boardwalk at Balmoral_46000310116027_Septic System Permits_■ VSHOP ELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 — Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM *te — Office V low — Inspector Pu.7 — Owner Card — Owner % . 3^^/^cr Permit No..3LEGAL Date DESCRIPTION AND C^P _2L JM.LOCATION Lake Name TWP NameLake No.Lake Clatsif.Sec.TWP Range IDENTIFICATION: Please Print All Information. Zip No,Tel. No.Initial Mailling Address —No, Street, City and StateFirstLast Name OiareOWNER /SEWAGE SYSTEM INSTALLER Name, This System will be ready for inspection on.19. This space for office use only 19 .M Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signature NUMBER OF BEDROOMS: S-tS€- S’/^CdZ'Y—ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD Sq. Ft./07c;^^GIs.Sq/Ft.Capacity Ftc^C:>Ft.Ft.Distance from nearest well Ft.Ft.Distance from lake or stream Ft. /t5 Ft.Distance from occupied building Ft.Ft. Distance from property line Ft.Ft.t. XFt.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 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.) I ~ SignatuS 1Dated 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 is ndt commenced within six (6) months. (7^ Permit: Issued Date: ^)/Management OfficeShorelan Fee $Surcharge $ Comments:. Form No. MKL-0771-003 158906 viCToa uiNOCtN « c« . aaianas. rtaaus fall* 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 te - Office > low — Inspector Pii.. Card Owner Owner Permit No..LEGAL Date DESCRIPTION AND LOCATION Lake No,Lake Name Lake Classif.TWPSec.TWP NameRange IDENTIFICATION: Please Print All Information. Tel. No.Initial Mailling Address —No. Street, City and State Zip No.Last Name First OWNER SEWAGE SYSTEM INSTALLER Name This System will be ready for inspection on.., 19. This space for office use only 19 Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signature NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD GIs.Sq. Ft.Capacity Sq. Ft. Ft.Ft.Ft.Distance from nearest well Distance from lake or stream Ft.Ft.Ft. Distance from occupied building Ft.Ft.Ft. Distance from property line Ft.Ft.Ft. Ft. Ft.Distance from bottom to Water Table Ft. AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on 19 , Time ,JVI By PERCOLATION TEST DATA:Date of First Test , 19 r 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- I 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 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: Shoreland Management Office Fee $Surcharge $ Comments:. Form No. MKL-077^003 iviCTO* uinttcca • co.. paiHtciu. rciieus r*Lk«. Mi«a 158906 .'5 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 F S F Distance from Nearest Well F 75F 50FFF F Distance from Lake or Stream F F F F F F Distance from Occupied Building 10 2020FFFFF F Distance from Property Line 10 10 10FFFFF F Distance from Bottom to Water Table 4 4FFFFF F Inspector's Comments: Date of Inspection,.19. Time of Inspection.M Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF - Square Feet “ Linear Feet Job TitleF AgencyMKL-0771-003-Backei '-mV W:iI \ Ii /am 4 ^ }sr<9ze \ i e_<5 o c) /<Rd:Vd //6bS^ 9CoOo 7 C^o•h / Oy y^'S" X .7 l-t^ ^ P4 '97s' pp PERCOLATION TEST DATA SHORELAND MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Ph. No.Owner:Mailing Address: a - Si. & No.State Zip No.Last Name First Middle City OJtt-s tJLegal Description:TWP NAME ^3/ I3y LAKE OR RIVER NO.NAME SEC.TWP.RANGEQ.L 3 TEST HOLE NO. 2 ^ ^ ^TEST HOLE NO. 1 43<~ Depth to Bottom of Hole inches; Diameter of HoleDepth To Bottom of Hole.Jnchesinches; Diameter of Hole inches lr,...AV-^ 3- ,»7fDepth, inches Soil Texture Depth, Inches Soil Texture 0-Percolation Test By____ Percolation Test Bv .O UJFirm Name.GC Firm Name. oUJ DC UJ LA/v^Address.GC Address < A LJ 4^C/)Otter Tail County License No..Otter Tail County License No..h-C/5UJMeasurement, Inches Drop In Water -Level, irKhes Drop in Water Level. Inches I-Measurement, InchesTimeRemarksTime Remarks II Q ’ D. [ 1. 3 Yl f' i'! /r/ //:P7 a1 //:L41^ qy-?- aii TA_i 3 r '' '<a-2A 7 ' y-V\i zS3/ lOcty?'aJ 183818 ®MKL-0871-028 VlCTOB U>H8Cf« 8 C« ■inTTi See Booklet/'How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn.