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Troje's Resort_14000160136000_Septic System Permits_
^ . Department of LAND AND RESOURCE MANAGEMENT OTTER TAIL COUNTY Government Services Center - 540 West Fir Fergus Falls, MN 56537 PH: 218-998-8095 Otter Tail County’s Website: www.co.otter-tail.mn.us I 07/25/2011 DEBRAATROJE 38092 COUNTY HIGHWAY 44 RICHVILLE MN 56576 9624 RE: Sewage Treatment System Servicing Tax Parcel Number: 14000160136000 Described as:1 Section: 16 DEAD LAKE TWP 2.50 AC PT GL 3 COM El/4 COR SEC 16, N 474' TO PT BG, N 272', W TO LK, SELY ALG LK TO INTSEC LN PARALLEL TO S LN GL 3 FR PT BG Lake: 56-383 Dead As of 07/21/2011 the sewage treatment system (Sewage Treatment Installation Permit# 21317) servicing your property was determined to be in compliance with the provisions of the Sanitation Code of Otter Tail County for a holding tank. If you have any questions regarding this matter, please contact our office. r-: Sincerely,I K Mark Ronning Inspector 1 ; APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095) GOVERNMENT SEF^VICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 www.co.otter-tail.mn.usWHITE - Office YELLOW-L & R Inspector PINK - Owner / Contractor (after issue) APPLICATION MUST BE COMPLETE IN ORDER TO BE PROCESSED Permit No. TWP NO.LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER SECTION RANGE TWP NAMECLASSl3S~ 4^ parcel NUMBER (S) OF PROPERTY BEING SERVICED E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROAD . j /ifC£>C>/(£> G4 oQO LEGAL DESCRIPTION First Mailing Address Daytime Phone No.Last Name Initial Lro^-z.___^Property Owner '9- Contractor Lie.# THIS SPACE FOR OFFICE USE ONLY A.M. >• This System will be ready for inspection on P.M., the year of at. A.M. P.M. L & R OfficialTime ReceivedDate Received TYPE OF NSTALLATION (CIRCIiEONE)SEWAGE TREATMENT SYSTEM DESIGN DATA AS SHOWN ON DRAWINGResidential New (B) Replacement Collector Other Est. (E) New (F) Replacement (C) New (D) Replacement Soil TreatmentLiftTank Design Flow (Gallons/Day) 1 — 2,499 (H) 2,500 — 4,999 (I) 5,000 — 10,000 Effluent Distribution ( ) Gravity ( ) Pressure GIs GIs Ft.Size Setback To Nearest WellType I Type II Ft.f3 Ft. (27) Rapidly Permeable(20) Trench, Rock Ft.Ft. Ft.Setback To OHWL /0%(21) Trench, Gravelless (28) Flood Plain (22) Trench, Chamber (29) Privies Ft.Ft. Ft.Setback To Bluff(30) Holding Tanl^^^^^ Monitoring/Disposal Contract(24) Mound Ft.^Ft.Setback To Dwelling (25) At Grade Type III FTSetback To Non-Dwelling(31) Other/Problem Soils/<12" Soil ^44 Ft.Ft. Ft.(26) Greywater Type IV Setback To Nearest Lot Line Ft.Ft. Ft.DepU^ Weli (32) Public Domain & Proprietary Technologies5^Total # Bedrooms Setback To Road Right-Of-Way /ST Ft. Ft.Type V (33) Performance Elevation Above Restrictive Layer o '"'■Ft. Ft.Garbage Disposal Y /Abatement Y / PERCTEST DATA smDesigner^^^^ Agreement: The undersigned hereby makes application for permit to instail, alter, repair or extend Sewage Treatment System herein specified, agreeing to do ail such work in strict accor dance 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 shali be covered until it has been inspected and approved for use. It shall be the responsibility of the appiicant for the permit to notify Land & Resource Management that the instailation is ready for inspection. Permit: Permission is hereby granted to the above named appiicant 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, empioyees and workmen shail conform in ali 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: I.This permit is vaiid for a period of six (6) months. 2.This permit does not inciude the building sewer (sewer line). License #Highest RateDate of Test C>-fO'/l Permit Fee $Date: mner/Agent for OwnerVope/ //5 ^/3 Land & Resource Managemerit Office Rec. No..Date; Comments: Form No. BK — 0209-003 335,812 • Victor Lundeen Co., Printers • Fergus Faiis, Minnesota APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095) GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 www.co.otter-tail.mn.us <21WHITE - Office YELLOW -L&R Inspector PINK - Owner / Contractor (after issue) O'Permit No.APPLICATION MUST BE COMPLETE IN ORDER TO BE PROCESSED JTWP NAMERANGELAKE/RIVER CLASS SECTION TWP NO.LAKBRIVER NAMELAKE NUMBER r.'i 6'1E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROADPARCEL NUMBER (S) OF PROPERTY BEING SERVICED qq, qcoo/CO '3C ooo>--i C-O • LEGAL DESCRIPTION A of OTP' ofLaf z Daytime Phone No.Mailing AddressFirstInitialLast Name qi- AIM Property Owner yl/i Af Contractor Lie.# !■ /-.r_-j c THIS SPACE FOR OFFICE USE ONLY ___ %.^‘v ZfO\\ \V'0()AM. .P.M., the year of► This System will be ready for inspection on n--7\- u A.MJ P.M. i Time Received L&R OfficialDate Received SEWAGE TREATMENT SYSTEM DESIGN DATA AS SHOWN ON DRAW NG TYPE OF NSTALLATION (circle one) Other Est. (E) New (F) Replacement Residential i(l&) New (B) Replacement Collector (C) New (D) Replacement Soil Treatment Area LiftTank y/y<~Design Flow (Gallons/Day) 1 — 2,499 (H) 2,500 — 4,999 (I) 5,000— 10,000 Effluent Distribution { ) Gravity ( ) Pressure !Ft.GIs GIs I Size Setback To Nearest Well Ft.Ft.Ft.Type IIType I n i (27) Rapidly Permeable(20) Trench, Rock Ft.Ft.Ft.Setback To OHWL J07(21) Trench, Gravelless (28) Flood Plain i (22) Trench, Chamber (29) Privies Ft.Ft.Ft.■Setback To Bluff iBed(30) Holding Tank i (v- ') Monitoring/Disposal Contract :1(24) Mound Ft.' Ft.Ft.;Setback To Dwelling (25) At Grade Type III Setback To Non-Dwelling Ft.Ft.Ft.(31) Other/Problem Soils/<12" Soil(26) Greywater i i Type IV Setback To Nearest Lot Line I Ft.Ft.Ft. Deptf) of Well (32) Public Domain & Proprietary Technologies 4I I .ir- ..■**Setback To Road Right-Of-Way Ft. Ft./r7 Ft.!Total # Bedrooms Type V 1 (33) Performance Elevation Above Restrictive Layer iFt.' Ft.Ft.Garbage Disposal Y /Abatement PERC TEST DATA 3mDesigner Agreement: The undersijjrfed hereby makes application for permit to instali, aiter, repair or extend Sewage Treatment System herein specified, agreeing to do aii such work in strict accor dance with Sanitation C6de 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 tor 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 condition 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: I.This permit is valid for a period of six (6) months. 2.This permit does not include the building sewer (sewer line). Highest RateDate of TestLicense # O- <0^ n _ orPf^e^0wner/Agent for Owner Permit Fee $Date: 4^-/ Land & Resource Management Office •7- //- ///Rec. No..Date: 7Comments: Form No. BK — 0209-003 335,612 ■ Victor Lundeen Co.. Printers • Fergus Pells. Minnesotah ’4 SEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTS Inspector must make all measurements SOIL TREATMENTHOLDING TANK OUTHOUSELIFT TANKCATEGORY REA Capacity /S^FT2 FT2GLS. GLS. FTSetback from Nearest Well FT FT FT Setback from Buried Water Suction Pipe /OOc^ /OyC FT FT FT FT Setback from Buried Pipe Distributing Water Under Pressure FT FT FT FT /s-oSetback from OHWL (lake &/or river) FT FT.FT FT/ Setback from Setback from Bluff FT FT FT Setback from Dwelling Z1 FT FT FT FT Setback from Non-Dwelling FT FT FT //Setback from Nearest Property Line FT FT FT FTSetback from Right-of-Way FT FT FT /Elevation above Restrictive Layer FT FT FT FT Holding Tank/Lift Alarm NO Old System Pumped & Destroyed NO SEPTIC TANK(s) # Tar)ks Installed MOUND / AT-GRADEFILTER SOIL TREATMENT AREA CALCULATION TRENCH REDUCTION ROCK BED/Rock trenches with inches □ YES 0 NO n Manuf. /roo of sidewall for.%Ft. X Ft.Ft. X Ft. fPreduction / equivalent to. Soil Treatment Area. Model #Ft*Ft* Inspectors Comments: Sketch: <r o ar i t] Date '7j24jn J/?U Time Initial / L S R Official As of Code of Otter Tail County. , the above described installation was found to be compliant with the provisions of the Sanitation Land & Resource Managemen^t^fmM Form No. BK ~ 0209-003 336,S56 • Victor Lundotn Co.. Phntart • Forgut Falls. Minnasota 'T ■r jTiq*~rTTi! I i ;.! '-f ! }■ ! :■........................:4- ISysterhj desigrji jmustr be to, scale arid must include tbe !p:ropdsed Idqajtion of the |sewage|systemj jall | i iexistingp'p|qppSed Ibuildingsi ppperty lines,! the ordinary high wateri level of the water body, wetlands, ; ^bluff-iaWd-all-watef-weili-within-i-150i-of--the-sewage-system.4lf~triere-jare-any4questionSr-seej-the+Univefs|ty-H-4- of Minnesota Site Evaldatibn worksheets. I , - i r - ! I I : i [ ' ' i I i , t i ' ' i I -it': -1 i f t r-| : -I + : t -f.I-I f i’T-;" t H-r rt--................. i - tl..l..r f.I..r :. !!I 7' ri![I iI iI-h; r rrIj grid(s) equals ..j..r]Lfeet, or Jnch(es)j equals__I feet Xf±U±t Scale: rt !Iir 'I-;!' MPCA lldENlSE I#:I - ‘ ' ...^.............^ ^ ’ I 4: _. , I ' I LICENSE CATEGORY: ’ :-.bATE:l i-i -T - ! f-j-^I I..l.I.(.1.! iDESIG'NED-BY: I j [FIRM N«F>I6<JJ,. ■. JJ__ jXU-r-, :i |/^bbREss:i^ I 1 ...r : r-‘; -; !“r [ f.Is i *11T”T I ; !!t 4- I .Lr4-Li 74SIGNATURE:i [ '!' XH4i 4X<_ fff 7 I- i I.rti:fI[\1 I 1-i I.JI I..i.4.1 xr■I r■ i Li.1 -f~H~.j^L . ;,!: ~7K T•i-■.................................................. r . I !i .I.. i„■i - h-rJ.•I..j...1tiihl:.1:•j..lIj ifT~C i i [i n:TIt■f"i i"; t:L V 1•I-'[...i" r- :..^ . J . f rT'1 .1.I-■r .p Mi.•ii iPII,■|--ff-;■jT' , „! f II Xt:LI....kXl It TIIII Wi tri:r t^4.11 L I I.I IE4 II V- m!"1 I L_..'1! I hhI I ■ m 1 rtf tr If—j j " I !}44.4-!t tI[:I I..rIi It 4-r _....[1 I II -]..j..i=iHi...............-I-...4! 4^J>-f--1\7,-1 —f--t-XXXtI-ii 7]Ft4.f-i.f—t[41 i#X r.W-i4—1 1 nr T +4I.1—4—t r:j7 .1..xr f 1.1.IrrfhTXa.. :___i„rtt ■1rifI\[■t?v .1..I rL^-L-XI i !;J•f xmiiii"T' t1I.i r11I!■-T 4.J.+rTTtr]tnI i:1' FroScl'^yd' ,1f Tj 74 Xl p,,/ ev/ii,i r:4..Y«^fnL.I H.IT T;L'!i[ rtI I iiiXnTIL.I T ■TiI■t'L-iXiriX I TIIX,4.,1.i:n:t r~L5 • i ri -4 ■'Ti XI[.1.I..i I1I-[ „j„r1 r:I ii .1..J../57*I t1r-I rrr"1..T...!'I t i4L r -Lt±id:j... M I i : i ' I -I...L Tl.!t I-Xf- ■4.^X I i-I r, „71 I1 pi.p-i .1...l„ !, iI4..I'r 'J.'rx] L'^.i.i..f.i"T 1.t i I f.I ■ E‘"r J tiI.X.X TTI-4—X-i—4—X •I-l17"..I..I i X..i"T i .u.I- -I..l..I.i-1..J.u t ..L L!4 f ■I.hi—}1- iXXLi L J.I"I I'■f I ;--j ■■ -j---p • I —j-..I—|—L -U.UP.ttu fI I ■ ! iI iI...I...I..rXitIf-I !.rT 4 Ii[■'i i1 I t"]..Li-I"4-I,I i- i J 1 ! M M M I ;BK 1003 — 029■....J....!~hi—r-l—'.....f-i-t- FailsilMN..■...1'-800-34L4870"'! .. Pix [rintefs *. F.ergus ! i i i • ! Lundeen;Co !..M" i 1"r « Victor-Ht:l:_ I f .f..4i j ,LX.i i i II SITE DATA WORKSHEET « LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 218-998-8095 www.co.otter-tail.mn.us Sewage Treatment System Permit #OWNER: lasH^ame FIRST'TELEPHONE NUMBERMIDDLE ADDRESS: STR./RT ( CITY ^ T)ascr AxjL STATE ZIP CODE /3^ LAKE/RIVER NO.LAKE NAME SEC.TWP RANGE TWP. NAME LEGAL DESCRIPTION: ,AJ XO' oF >73^ af/oF 3 SOIL BORING LOG COLOR a MUNSELL NO. DEPTH (INCHES)STRUCTURETEXTURE BLOCKY PLATY PRISMATIC NONE /Yaso/£o/Jii'^ PARCEL NUMBER Y%. E-911 Address or Directions From Nearest Public Road BLOCKY PLATY PRISMATIC NONEoO-NUMBER OF BEDROOMS \BLOCKY PLATY PRISMATIC NONE GARBAGE DISPOSAL: YES WELL: CASING DEPTH I^f?. SEWER LINE SEPARATION: ft BLUFF: YES l^ C ( BLOCKY PLATY PRISMATIC NONE FLOODPLAIN: YES VEGETATION: AQUATIC TBRRESTBJAL BLOCKY PLATY PRISMATIC NONE <?-SLOPE AT INSTALLATION SITE:% TYPE OF OBSERVATION:Probe Pit Boring PARENT MATERIAL: Till Outwash Loess Bedrock Alluvium ORIGINAL SOIL:Yes No Date of Soil Boring, COMPACTED SOIL: Yes No DEPTH OF BORING (To T or restrictive layer):.ft.Date of Perc Test PERC TEST # 1 PERC TEST #2- TWO TESTS ARE REQUIRED - TIME INTERVAL, IMINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTESI WATER DEPTH WATER DROP PERC RATESTARTSTART PERCTIMEDROP DROPTIME PERCPERg**RATETIMEINTERVAL (MINUTES)WATER DEPTH WATER DROP TIME INTERV^K (MINUTES)WATER DEPTH WATER DROP PERC RATE REFILL RE(\l -J-_____ =IE DROP PERC TIME DROP PERC WATER DROP > ^TIME INTERVAV(MINUTES)WATER DEPTH PERC RATE TIME INTERVAL (MINl^ES)WATER DEPTH WATER DRQPy PERC RATEREFlCtREFILL TIME DROP PERC DROP PERCTIME >fl/ATER DEPTH WAIgR DROFTIMEINTERVAL (MINUTES)PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEREFILLREFILL TIME DROP PERC TIME DROP PERC WATER DE&TH WATER DROPTIMEINTERVAL (MINUTES)PERC RATE TIME INTERVAL (MINUTES)WAllER DE^WATER DROP PERC RATEREFILLREFILL TIME DROP PERC TIME DROP PERC ^ATER DEPTHTIMEINTERVAL (MINUTES)WATER DRI PERC RATE TIME INTERVAL (MINUTES)'ER D^TH WATER DROP PERC RATE7REFILLREFILL ___ =IE DROP PERC TIME DROP PERC TIME INTERVAL (MV^UTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUT WATER DEPTH WATER DROP PERC RATEREFILL TIME DR<PERC TIME DROP PERC TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC Rate TIME INTERVA/(MINUTES)WATER DEPTH WAXER DROP PERC RATEREFILLlEFILL TIME DROP PERC TIME DROP PERC PROPOSED DESIGN: TRENCH.BED.ATGRADE.MOUND.HOLDING TANK.GRAVITY DIST.PRESSURE DIST, SEWER LINE.OUTHOUSE,OTHER,SPECIFY:, — SYSTEM DESIGN ON BACK — Department of LAND AND RESOURCE MANAGEMENT OTTER TAIL COUNTY Government Services Center • 540 West Fir Fergus Falls, MN 56537 Ph: 218-998-8095 Otter Tail County’s Website: www.co.ottertail.mn.us May 21, 2004 Craig & Debra Troje, Et Al 38092 County Hwy 44 Richville, MN 56576 RE: Sewage Treatment System Servicing Tax Parcel Number 14000160136000 Described as N 260' of S 734' of Lot 3, Section 16 of Dead Lake Township, Dead Lake (56-383) As of May 11, 2004, the sewage treatment system (Sewage Treatment Installation Permit #16633) servicing your property was determined to be in compliance with the provisions of the Sanitation Code of Otter Tail County for a Holding Tank for Cabins 4 & 5. If you have any questions regarding this matter, please contact our office. Sincerj l^le WesJj^ard Inspector r . APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998^8095) GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 www.co.otter-tail.mn.us WHITE - Office YELLOW- L&R Inspector PINK - Owner / Contractor (alter issue), . ILL 33APPLICATION MUST BE COMPLETE IN ORDER TO BE PROCESSED 'Permit No. LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS SECTION TWP NO.RANGE TWP NAME i3S^73 KdA ICAJ^ PARCEL NUMBER (S) OF PROPERTY BEING SERVICED E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROAD '5Td9X Co/3^ LEGAL DESCRIPTION Last Name First Mailing AddressInitial Daytime Phone No. r Property Owner r .( /^r5'ko-t S^L /A,yContractor ’ Lie.# THIS SPACE FOR OFFICE USE ONLY A.M. >■ This System will be ready for inspection on.the year of P.M..at. .A.M. P.M. Date Received Time Received L&R Official SEWAGE TREATMENT SYSTEM DESIGN DATA - AS SHOWN ON DRAWiNGTYPE OF INSTALLATION (CIRCLE ONE) TANK DRAINFIELD Ft^-Size GIs.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) CombTnation Setback to nearest well Ft.Ft. Setback to OHWL (lake &/or river)Ft.Ft. 4- s <3 Ft.Setback to wetland Ft. Setback to dwelling Ft.■ Ft.Collector System (26) Trench, Rock (27) Trench, Gravelless (28) Trench, Chamber (29) Bed (30) Mound (31) At Grade Setback to non-dwelling /Oi-Ft.Ft. Setback to nearest property line Ft.Ft../OPOther ^^1^ Tank, Holding (42) Outhouse (43) Sewer Line (44) Performance (45) Miscellaneous Setback to road right-of-way Ft.Ft. Elevation above restrictive layer Ft.Ft.’ ALL DISTANCES ARE SHORTEST DI^ANCE BETWEEN NEAREST POINTS. ABSORPTION AREA FOR MOUNDS ■DEPTH OF WATER WELL # BEDROOMS GARBAGE DISP. Y / ^ ABATEMENT Y / £)I)g^ l^kcdlof^Ft^EFFLUENTDISTRIBUTION ( ) Gravity ( ) Pressure HOLDING TANK MONITOR/ DISPOSAL CONTRACT [Kl'ies ( ) No-L&R Can Not Process Designer (jCKn ^o/f y Designer Lie. # ,______ Highest Rate PERCOLATION TEST DATA Date of Test 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 parf 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. Permit Fee $Date: ^nature of Property Owner/At (xir Date:Rec. No. Land & Resource Management Office Comments: Form No. BK — 0203-003 315,609 > Victor Lundeen Co., Printers • Fergus Falls. Minnesota - , APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095) GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 www.co.otter-tail.mn.us tWHITE - Office YELLOW - L & R Inspector PINK - Owner / Contractor (after issue) Permit No. IL L T3APPLICATION MUST BE COMPLETE IN ORDER TO BE PROCESSED J LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS SECTION TWP NO.RANGE TWP NAME jl3^ lecMK321AjE APARtfEL NUMBER (S) OF PROPERTY BEING SERVICED E-911 ADDRESS OR DIRECTIONS FROM NEAREST PUBLIC ROAD i (<o 2 h -.rrfc/coo/^o /34 <0^0 ^Oofc^ ^+A\ dress LEGAL DESCRIPTION /J TiGo' o-T/o-l- % Last Name First Initial Mailing Ad Daytime Phone No.5 "rr riu>e, rm, ^prsLc-f \ ? J ^; ' Contractor Lie. Ill f THIS SPACE FOR OFFICE USE ONLY 3'hlo^> This System will be ready for inspection on the year of _P.M. ^liOlo‘1 A.M. P.M. Date Received Time Received L & R Officiai SEWAGE TREATMENT SYSTEM DESIGN DATA - AS SHOWN ON DRAWINGTYPE OF INSTALLATION (CIRCLE ONE) TANK DRAINFIELD Ft"Size Gis.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. Setback to OHWL (lake &/or river)Ft. Ft. a SoSetback 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 Setback to non-dwelling Ft.Ft./Of Setback to nearest property line Ft.Ft.AD-hOther <J41) Tank, Holding (42) Outhouse (43) Sewer Line (44) Performance (45) Miscellaneous Setback to road right-of-way /Cfeo f-Ft. Ft. Elevation above restrictive layer Ft.Ft. ALL DISTANCES ARE SHORTEST DISTANCE BETWEEN NEAREST POINTS.# BEDROOMS 1 GARBAGE DISP. Y ABATEMENT Y DEPTH OF WATER WELL ABSORPTION AREA FOR MOUNDS rV'<^ ^'3hrJ:r ■Ft^EFFLUENT DISTRIBUTION ( ) Gravity ( ) Pressure HOLDING TANK MONITOR/ DISPOSAL CONTRACT (x)Yes ( ) No-L&R Can Not Process Ty-j ^Designer Designer Lie. 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. Permit Fee $ //Tl--' —Date; signature of Property dwner/AgentMr~Owner a key-7- 6' 3 41Date:Rec. No.■V Land St Resource Management Office Comments: 'fForm No. BK — 0203-003 315,609 • Victor Lundeen Co., Printers ■ Fergus Falls, Minnesota SEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTS Inspector must make all measurements HOLDING SEPTIC TANK DRAINFIELD OUTHOUSELIFT TANKCATEGORY Capacity FT2 FT2GLS.GLS.1^00 lo o'*’ FT FT FTFTSetback from Nearest Well Setback from Buried Water Suction Pipe FT FT FTFT Setback from Buried Pipe Distributing Water Under Pressure FT FT FT FT ISlsSetback from OHWL (lake &/or river) FT FT FT FT Setback from Setback from Wetland FT FT FT FT 10^Setback from Dwelling FT FT FT FT N.5Setback from Non-Dwelling FT FT FT FT 10^Setback from Nearest Property Line FT FTFT FT lOO^ FTSetback from Right-of-Way FT FT FT Elevation above Restrictive Layer FT FT FT FT Holding Tank/Lift Alarm NO Old System Pumped & Destroyed aJ/A YES NO SEPTIC TANK FILTER Sewer Line to Well Separation DRAINFIELD CALCULATION Actual Minimums+r .FTFTX□ YESManuf.. 50"^ FTModel #.ft^□ NO 20 MOUND CALCULATION MOUND /AT-GRADE ROCK REDUCTION Inspector’s Comments: s,ABSORBTION AREA Rock trenches with inches of rock under pipe for .%Ft. X DF.reduction / equivalent to.Ft2 SKETCH: u/^11 / loo^ / \\loo'6r ur«i I 5 S/53 S'll'OM Initial/L S R OfficialDateTime S- H-qS the above described sewage system installation was found to be compliant with the provisions of the SanitationAs of Code of Otter Tai^ounty. lurce Management OfficialLand iS System design must be to scale and must include the proposed location of the sewage system, all existing/proposed buildings, property lines, the ordinary high water level of the water body, wetlands, bluff an^ all water wells within 150' of the sewage system. If there are any questions, see the University of Minnesota Site Evaluation worksheets. Scale: ^inch(es) equals.grid(s) equals feetfeet, or MPCA LICENSE #: LICENSE CATEGORY: DATE: DESIGNED BY: , - 'V / ADDRESS:;\ 7^ ry FIRM NAME:; I SIGNATURE: t I TkJ L“^i f (! 1!•1 ;iI 9; !i:1 A. i ;1 1 i. ; : jiigt ;I U %!!!I (11 \?t !:i f i j !'ft o ^r'!i\Jy^'^5“T-I ;)I i': ,0*i 1 'L_£. I Li ! er1 I i/ ii fi i I -I —r / / ’■ s'i' ; ■ /■:;I ii 7^; "■it !iPyO4>y ! Lri • FergusfFalls, MN • 1-800-346-4876315.904 • Victor Lurideen Co.. PrintersBK - 1003 - 029 ' 1 SITE DATA WORKSHEET LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 218-998-8095 www.co.otter-tail.nnn.us __________ _________ V Sewage Treatment System Permit #OWNER: Irro' LAST NA FIRST MIDDLE TELEPHONE NUMBER ADDRESS: %sj4- STR./RT.CITY ZIP CODESTATE /(>7)eeRcl AoAeTiyj LAKE/RIVER NO.LAKE NAME SEC.TWP.RANGE TWP. NAME LEGAL DESCRIPTION:SOIL BORING LOG A/^0 ^ o-f ' o-i^Ao'h 5 /W)/^i:^^QOO_________ COLOR & MUNSELL NO. DEPTH (INCHES)TEXTURE STRUCTURE BLOCKY PLATY PRISMATIC NONEPARCEL NUMBER ?2o9;l BLOCKY PLATY PRISMATIC NONE 1E-911 Address or Directions From Nearest Public Road NUMBER OF BEDROOMS BLOCKY PLATY PRISMATIC NONE GARBAGE DISPOSAL: YES ft. SEWER LINE SEPARATION:WELL: CASING DEPTH BLOCKY PLATY PRISMATIC NONE FLOODPLAIN: YES BLUFF: YES VEGETATION: AQUATIC TERRESTRIAL BLOCKY PLATY PRISMATIC NONE SLOPE AT INSTALLATION SITE:% TYPE OF OBSERVATION:Probe Pit Boring PARENT MATERIAL: Till Outwash Loess Bedrock Alluvium ORIGINAL SOIL:Yes No Date of Soil Boring. COMPACTED SOIL: Yes No DEPTH OF BORING (To 7' or restrictive layer):.ft.Date of Perc Test PERC TEST # 1 PERC TEST #2- TWO TESTS ARE REQUIRED - TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATESTARTSTART TIME DROP PERC TIME DROP PERCTIMEINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEREFILLREFILL TIME DROP PERC TIME DROP PERC TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATEREFILLREFILL TIME DROP PERC TIME DROP PERCTIMEINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTESI WATER DEPTH WATER DROP PERC RATEREFILLREFILL TIME DROP PERC TIME DROP PERCTIMEINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEREFILLREFILL TIME DROP PERC TIME DROP PERCTIMEINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEREFILLREFILL TIME DROP PERC TIME DROP PERCTIMEINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEREFILLREFILL TIME DROP PERC TIME DROP PERCTIMEWATER DEPTHINTERVAL (MINUTES)WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEREFILLREFILL TIME DROP PERC TIME DROP PERC PROPOSED DESIGN: TRENCH BED.ATGRADE.MOUND.HOLDING TANK.GRAVITY DIST..PRESSURE DIST.. SEWER LINE.OUTHOUSE.OTHER.SPECIFY:. — SYSTEM DESIGN ON BACK — aw 'St m 'h LV''ll m mt CERTIFICATE OF APPROVAL SEWAGE SYSTEMft: • "a LThis Certificate has been issued this 1ST of FEBRUARY, 1999 certify that the sewage system installed as per Sewage Treatment System Permit Number 12004 has been approved for use by Otter Tail County, Minnesota. , tos’a E» typ"r#The property served by this Sewage System is legally described as: UNPLATTED N 260' OF S 734' OF LOT 3. Parcel Number(s): 14000160136000 Section: 16 Township: 135 Range: 040 Township Name: DEAD LAKE TOWNSHIP Lake/River Number: 56-383 Lake/River Name: DEAD sMmi ml (HORSESHOE SHORES) H iiliCurrent Property Owner: DEBRA A TROJE Number of Bedrooms: * Ujie^ * DWELLING/SYSTEM/4 BEDROOM CABIN 8/HOLDING TANK Land & Resource Management Official ki i mM v_284.709 • Victor Lundeen Co., Printers • Fergus Falls, MN • 1-800-346-4870 APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM WHITE — Office Yellow — Inspector Pink — Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOtfSE— Phone:(218)739-2271 - FERGUS F^LtSTK(Kr5B537 ijw4-LEGAL Permit No. DESCRIPTION Abatement: () Yes ( ) NoAND k)T'3LOCATION LAKE NUMBER LAKE/RIVER I^MEj^SLdUi LAKE/RIVER SECTION RANGEP. NO.TWP NAME >/ E /v ^ ^5 Ho PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER 0^75 IDENTIFICATION: Please Print All Information Last Name First Mailing Address — No Street City and Statejsrgj I Ff l &)/- VInitial Zip Code Telephone No. .paAA Property Owner vl fSewage System Installer Name a A.M. This System will be ready for inspection on., 19-P.M.at Lj.This space for office use only NUMBER OF BEDROOMS: A.M. 19 P.M GARBAGE DISPOSAL: ( ) YES NODate Rec'd Time Rec'd Phone Call Rec’d By SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSi. TYPE OF SEWAGE SYSTEM ( Holding tank (Alarm Required)TANK DRAIN FIELD an( L-YS^X\c\ank ( ) Lift station (Alarm required) (t„--)'l5rain field ( i^^^^rr^nThes ( ) Bed ( ) Mound ( ) Outhouse ( ) Sewer line Capacity GIs.Sq Ft. feiTVitr.50 hoomDistance from nearest well Ft.Ft. 150Distance from lake or stream Ft.Ft. JO 101^Distance from building Ft.Ft. lOlaDistance from property line Ft. Ft. Distance from bottom to Water Table Ft.Ft. EFFLUENT DISTRIBUTION (i-'-T^ravity ( ) Pressure All distances are shortest distance between nearest points PERCOLATION TEST DATA: WATER WELL DEPTH 1-J77t Perc Tester.Date of Perc Test \M.Rate of 1st Test Rate of 2nd Test Average Rate 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 tor inspection. DATE: Sionalurec^. J ^ ^ /j 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. Issued Date: Land & Resource Management Office Fee $.Rec #.^,/4L3q- o~- \Jm) MjJmComments:( |7nQjo f[r/n 277.212 • Victor Lundeen Co . Printers ■ Fergus Falls. MinneostaBK 0795-003 APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM WHITE — Office Yellow — Inspector Pink — Owner ir LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE— Phone: (218) 739-2271 - FERGUS FALLS, MN 56537' lOncp/M '0±LEGAL Pernml DESCRIPTION Abatement: ( >A) Yes ( ) NoAND LOCATION SECTION -TWPJJO^LAKE NUMBER LAKE/RIVER ^ME LAKE/RIVER CLASS jnt l/v RANGE TWP NAME c\4‘fOLfift A->Y PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER L)L-V4-lXJO- l(r^ll(/~oOO \ r~ IDENTIFICATION: Please Print All Information Last Name First Initial Mailing Address — No.„Street, City and State ' iLiol V ^ h--' v'i ^ Zip Code Telephone No. fO i k hiCUProperty Owner - fm'’ bc^.v'Y'tSewage System Installer Name /T ( TVr/l IThis System will be ready for inspection on , 19.at \+5 ■VThis space for office use only NUMBER OF BEDROOMS:75a L(j^ 9 Date Recfp 10:15^ Mrv\_ Time Rec'd Phone Call Rec^ By 19 GARBAGE DISPOSAL: ( ) YES (NO SEWAGE TREATMENT SYSTEM DATA; MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM (•^) Holding tank (Alarm Required) ( u)'Septic tank ( ) Lift Station (Alarm required) ((,-^tl^rain field ( Trenches ( ) Bed ( ) Mound ( ) Outhouse ( ) Sewer line TANK DRAIN FIELD Y(.VumCapacity.GIs.Sq Ft.1'^ laSi-vnr TODistance from nearest well Ft.Ft. M2Distance from lake or stream Ft. Ft. lU l0h>O Ft.Distance from building Ft. in lODistance from property line Ft.Ft. Distance from bottom to Water Table Ft.Ft. EFFLUENT DISTRIBUTION (-- ) Gravity ( ) Pressure All distances are shortest distance between nearest points PERCOLATION TEST DATA: WATER WELL DEPTH '■y ■ -Y11~hT Perc Tester_Date of Perc Test, IkOt')i\k "7I/V'n Rate of 2nd Test I f J Average RateRate of 1 St Test 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. ;z:DATE:. Xy'’ '7^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. O' Issued Date:nnf(mil y Land & Resource Management Office Fee $.Rec #./\r^PO~ IrS-Of) ( < V(cVz • o' ^ Comments:^ :) LdO (jn l(r7Y ts Y 277.212 ' Victor Luitdeen Co.. Prituers • Fergus Falls. MinneostaBK 0796-003 INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS 4 V% DRAIN FIELDHOLDING SEPTIC TANKCATEGORY Actual Minimum ^ HOBt 3pJCrlrO gls.SFGLS.Capacity Sf-f- ft FTFTDistance from Nearest Well Distance from Buried Water Suction Pipe FTFT50FTFT Distance from Buried Pipe Distributing Water Under Pressure FT FT10FTFT ftFT FTFTDistance from Lake or River (OHWL) ^ /f ft^ I 10/20 FTFT FT"Distance from Nearest Building FTFT FTFT10Distance from Nearest Property Line FTFT3FTFTDistance from Bottom to Water Table YES NOHolding Tank/Lift Alarm ES NOOld System Pumped & Destroyed . DRAINFIELD CALCULATIONr Line to Well SeparationINTERPRETATION OF ABBREVIATIONS GLS. = Gallons SF = Square Feet FT = Linear Feet 3ActualMinimum FTX FT FT20 SF IInspector’s Comments: / r-iI ClVrv^ 4-SKETCH:h 0H4L ^ Inspector’s Signature Date of Inspection 6‘^JoilhC Time ot Inspection ; Alft TEST CERTIFICATION ‘‘i- ' 7 /??r (date), an air test of the sewer line installedOn jooa^funder Sewage Disposal System Permit Number (lake/river) was made. At that time, the sewer line held forV; (owner), on L^Ke pounds per square inch for minutes. ^ ?r j, h‘f? ^ Ddte ^Installer's Si^h^iture License No.l Systern design must be to scale and must include the proposed location of the sewage system, all existing/proposed buildings, property lines, the ordinary high water level of the water body and all water wells within 150' of the sewage system. GRID PLOT PLAN feet SKETCHING FORMfeet, or Jnch(es) equals.grid(s) equalsScale; SIGNATURE:SUBMITTED BY: a7-/ .-r MPCA LICENSE #: LICENSE CATEGORY: FIRM NAME:DATE: ADDRESS: 3<^-7 C' Ijitf: i\o6e5Ko-t. f , ShD^ ^}/oi A'^Cji irt 'r 4^ V - IbLhT > 4 i0UI >tA&’VA0.i/ 2 ^ V - ^ oa:- D d\ u■*• 'Ti <F3 ^/ - \Cl rx x'y I ■ rI.-y\ ■=^.1 Cl to\ Ji t f JiNf 281,183 • Victor Lundeen Co,, Printers • Fergus Falls. MN • 1-800-346-4870BK — 0496 - V\ SITE DATA A LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, MN 56537 OWMER: ¥MIDDLE TELEPHONE NUMBERLAST NAM ADDRESS: A>/i/ ZIP CODECITYSTATESTR./RT. RANGE TWP NAMELAKE/RIVER NO.SEC.LAKE NAME TWP.; LEGAL DESCRIPTION: . " 5 > ? * SOIL BORING LOG COLOR & MUNSELL NO. DEPTH (INCHES)STRUCTURETEXTURE BLOCKY PLATY PRISMATIC NONE ft A ml PARCEL'NUMBER if -4 MOL-BLOCKY PLATY PRISMATIC NONE FIRE NUMBER NUMBER OF BEDROOMS BLOCKY PLATY PRISMATIC NONE J m(f!9iGARBAGE DISPOSAL; YES i^O WELL CASING DEPTH;ft.BLOCKY PLATY PRISMATIC NONEifMFLOODPLAIN; YES TERRESTRIALSVEGETATION; AQUATIC BLOCKY PLATY PRISMATIC NONE SLOPE AT INSTALLATION SITE;% TYPE OF OBSERVATION; Probe Pit COMMENTS; ^PARENT MATERIAL;Outwash Loess Bedrock Alluvium ORIGINAL SOIL;/f Yes i COMPACTED SOIL; DEPTH OF BORING;ft.f. 1 PERC TEST #2PERC TEST # 1 - TWO TESTS ARE REQUIRED - PERC RATEWATER DEPTH WATER DROPPERC RATE TIME INTERVAL (MINUTES)WATER DEPTHTIMEINTERVAL (MINUTES)WATER DROP77.STARTJ^ART i IS. 'TIME DROP PERC TIME DROP PERC y,:e>£P --.Jo^lALD- WATER DROP PERC RATEPERC RATE TIME INTERVAL (MINUTES)WATERJ)EPTHINTERVAL (MINUTES!WATER DROPTIMEWATER DEPTH (^UZ r'REFILLREFILL DROP PERC7-S-Jq ^ = /j A‘A>;^njL J2.TIME DROP PERCTIME PERC RATEWATER DROPPERC RATE TIME INTERVAL (MINUTES)WATER DEPTHINTERVAL (MINUTES)WATER DEPTH WATER DROPTIME ..TUlZUIf'lA JA.tly REFiaREFIU>0 TIME^ DROP PERC .. JO D.__LO....---YL TIME DROP PERC PERC RATEWATER DROPPERC RATE TIME INTERVAL (MINUTES)WATER DEPTHINTERVAL (MINUTES)WATER DEPTH WATER DROPTIME REFILLREFia -----------r-------^ =^_____ s ______DROPTIME PERCriMEDROPPERC PERC RATEWATER DROPWATER DEPTH H^OTflRDROS"________.PERC RATE A i WATER DEPTHTIMEINTERVAY (MINUTES)TIME INTERVAL (MINUTES!lEFILLREFILL ----=DROP PERCTIMEDROPTIMEPERC PERC RATEWATER DEPTH WATER DROPTIMEWATERSaEPTH* WATER DROP PERC RATE-TIME INTERVAL (MINUTES)INTERVAL (MINUTES)REFILLREFILL DROPTIME PERCTIMEDROPPERC PERC RATEWATER DROPINTERVAL (MINUTES)WATER DEPTHWATER DROP-PERC RATE TIMETIMEINTERVAL (MINUTES)WATER DEPTH REFILLREFILL DROP PERCTIMEDROPPERCTIME PERC RATEWATER DROPTIMEINTERVAL (MINUTES)WATER DEPTHWATER DROP PERC RATETIMEINTERVAL (MINUTES)WATER DEPTH REFILLREFia TIME DROP PERCDROPPERCTIME PROPOSED DESIGN: TRENCH > BED. I SEWER LINE PRESSURE DIST._ATGRADE.MOUND.HOLDING TANK. GRAVITY DIST.. SPECIFY;.OUTHOUSE.OTHER. — SYSTEM DESIGN ON BACK — LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURTHOUSE 121 West Junius Ave. FERGUS FALLS, MN 56537 218-739-2271 >• June 5, 1998 '•j John Daubney 500 Degree of Honor Bldg. , St. Paul, MN 55101 •;v ' ?''r •C-RE: Abatement Notice, N 260’ of S 734’ of Lot 3 (2.5 Acres), Dead Lake (56-383). Dear Mr. Daubney, It has been almost one year since you received the Abatement Notice on your Dead Lake property. To date, this matter remains unsatisfied.c. Please bring your septic system into compliance with the Sanitation Code of Otter Tail County by July 1, 1998 or this matter will be referred to the County Attorney’s Office. >.Sincerely, ^ ■■ George Hausske Inspector i; T GH/mls ;■ Date Resolved CHRONOLOGY REGARDING THE SEWAGE SYSTEM ABATEMENT Djt, LIp/ jProperty Owner: 3^2>Lake No. 56-Lake Name: /y - d>^o-i(o ^ei3G -Parcel No.: S’/-"//? 7 Owner's Initial Response (date): </ jn^o(^ .toA ^S, ", -h ^ <9 y ^O-A.-c ^ abatement.chronology7-94 SEWAGE SYSTEM ABATEMENT NOTICE✓ LAND & RESOURCE MANAGEMENTCOUNTY OF OTTER TAIL COURTHOUSE, FERGUS FALLS, MN 56537 (218) 739-2271 Lake Number: (56-383) Lake Name: DEAD JOHN E DAUBNEY 500 DEGREE OF HONOR BLDG ST PAUL, MN 55101 You are hereby notified that the sewage system which you maintain on the following described property: UNPLATTED N 260' OF S 734' OF LOT 3. Sec: 16 Twp: 135 Range: 040 DEAD LAKE TOWNSHIP Parcel Number: 14000160136000 Lake Assoc/Fire #: DL95 is not constructed and/or located in accordance with minimum standards of the Shoreland Managemei Ordinance of Otter Tail County. Please be advised that you must correct this situation within 30 days. You should contact this office i order to determine what corrections and permits are required prior to complying with this notification. Land & Resource Management Official - Dated 7/28/97 FIELD NOTES LAKE NAME: DEAD LAKE NO.: 56- 383 DATE Parcel No.: 14000160136000LEGAL DESCRIPTION FIRE NO.: 16 135 40 2.50 N 260' OF S 734' OF LOT 3. f^£>r9U. 5^0-^ ^or^S OWNERS NAME AND ADDRESS: X- Co.L>i^ 5 / - 3 477C. cX //7 / //--r-f^ /My TROJEr'-ttENRY-gr JR^-ET AL DcxU-t* >^-c y ! T-&4 6-JEANNE BR- ^OO i5-f hi LINO-LAKES, MN-> * i t- t sicL<s^ »f - A/e^ cJ< sys-f^c^&5triTt 3T/^/V Comments:? SEPARATION DISTANCES(IN FEET) ABSORF^^N AREA f/ ^ I OUTHOUSESEWER/LINE V7JWELL ^Jop iZiOHWL C4»&4lt?LOT LINE 47DWELLING \ NON DWELLING 47GROUND ELEVATION @ REASON(S) FOR ABATEMENT: S'BTAJ - ' 11 k < I o' |c <. ^O' -fro^ jc ©-(• Cc^ lo^0 j'[ ije / I i) / ovu «) 5) I u> t f i — ~i) p('c k". j? IjxA l4/n <ic/ _£c ^ ^ iy 3) vfl,/). II, 'i'^U Uyvxlcx^o ‘X'nS-XPro‘^ - AiW 5 •//• tv c^->~ i/C^nlov\ 0-uJ^ C#r\ JctiG-nJ^ ,. X MitfJV’V*- S I tA. -4^C,<yxx SKETCH ON BACK.• • Inspector's Signature Ul UL '\y \/ iV in V■ J c '. 0^ Delhi rtment of LAND & RESOURCE MANAGEMENT COUNTY OF OTTER TAIL Phone 218-739-2271 Court House Fergus Falls, Minnesota 56537 MALCOLM K. LEE, Administrator Fe.biw.(Viy 10, 19S4 Mu, l/-ince Coattzh. Rz'paJji Rt. 1 0( (v'l (<i(f, MN 06071 Rz: Smagz 6y6tzjv pzAmit numbzn.’6 4776 (Leo Lukcu), 5414, 5415 ilfiv KAmzA], 5569 {Ron ChAiAtianion], and 5413 {Jamz6 Bazhottz]. VzoA Ma. CoultzA: Upon Azvd.zwd,ng oua azcoacU AzgoAcUng thz idvz ^zimgz ■6yi,tzm lehich you haoz d.yi6taLizd, we {^ound tkat onty SP**4776 (Lufetu) and SP#54J3 [Buchottz] kavz been D)6uzd czAZiid.ccutzA> oi compl-iancz w-cth thz pAovAj>toyu> oi thz OttzA TatZ County Santtatton Codz. OuA AzzoAd6 tndtcatz that thz constAucZion o^ thz actual sewage &yi>tzm you tn- ttallzd {jOA thz Azmatning thAzz sewage iyitzmt compltzd with thz con6tAuctlon codz, howzvzA, a czAtlhlcatz o^ comptlancz hoi not been Azlzjx&zd by oua o^^lcz duz to l^actoA(i bzyond youA ccntAol. Foa Imtancz, at thz tmz oi Inspection oi SP^5569 (ChAlstlanson) thz well had not yet been Installed and as oi today's date oua oUlcz has not been notlilzd that thz well has been Installed, thzAzioAz, thz szpoAatlon distance between thz well and thz sewage system has not yet been vzAlilzd as complying with oua cuAAznt standoAds and as such a czAtlilcatz has not been Azlzaszd by oua oUlcz. In thz cases oi SP^5414 and SP^5415 {KAomzA), thz actual constAuctlon oi thz sewage system compiled with oua SanltoAy Code, howzvzA, since thz dwelling units had not been placed on thz lot pAloA to thz time oi Inspection, and wz have not yet been notlilzd that thz dwelling units oaz In place, oua oUlcz has not been able to vzAliy thz sepoAotlon distance between thz sewage system and thz dwelling units and as Such has not Issued a czAtlilcatz oi compliance ioA these systems as oi today's date, Ji you have any iuAthzA questions AzgoAdlng these sewage systems please contact OUA oiilez. SlnczAzly, Bill KaloA InspzctoA SHORELAND MANAGEMENT ORDINANCE - DIVISION OF EMERGENCY SERVICE - SUBDIVISION CONTROL ORDINANCE SOLID WASTE ORDINANCE SEWAGE SYSTEM CLEANERS ORDINANCE - RECORDER, OTTER TAIL COUNTY PLANNING ADVISORY COMMISSION RIGHT-OF-WAY SETBACK ORDINANCE FUEL AND ENERGY COORDINATION apk CERTmCATE OF COMPLIANCE SEWAGE SYSTEM HOLVING TANK S2day nf VzcmbeAThis certificate has been issued this 19. to certify compliance with regulations of Shoreland Management Ordinance, Ojter Tail County, Minnesota. The premises covered by this certificate are legally described as: Vzad LakeTwp. ^ 35 Range_A^Lake No. 56-3S3 Sec. 16 Twp. Name. 5^; Vdjoud Lake ouXpoit at the Ft6h and Fun ReiOAt. m*■ Leo LukasmOwner:Name. Addrexs Route 1 Box 91. Zickv-itZe. Mtnne^ota ! 56516Zip No.I 4776Permit No. SP_ Signed by:. Malcolm K. Lee, Shoreland Administrator Otter Tail County, Minnesota MKL-0871-009 mk>may.an 159035 viaTM uMit • M. MiwTiu. ru«M fauj. mm 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 Whil»-Office Y0IIOW — Inspector Pink — Own»r Cord — Owner H17COuTPr^^r Pr 7//^ pun/ Permit No.,LEGAL ) DESCRIPTION AND JVC3?f3 OEnoLOCATION TWP NameTWPRangeLake Classif.Sec.Lake No.Lake Name IDENTIFICATION: Please Print All Information. Tel. No.Zip No,Mailling Address —No. Street, City and StateFirstInitialLast Name i<hZ I &UA 7/Lcr)<^f4S L EOOWNER l<T/V \/ ! lLC P) A/_____S 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 Phone Call Rac'd ByTime Rec'd lANUMBER OF BEDROOMS;ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PIT /SEPTIC TANK DRAIN FIELD s/ific-i.o,n/G Lj - /C>O0 GIs.Ft.Sq/ Ft.Capacity Ft. Ft. Ft.Distance from nearest well Ft. Ft.Ft.Distance from lake or stream IP Ft.Ft. Ft.Distance from occupied building /P Ft. Ft. Ft.Distance from property line 7Ft. Ft.Ft.Distance from bottom to Water Table All distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on..., PERCOLATION TEST/DATA:19 , 19 1st Test Taken 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.) \■y - /,c-Dated Permit: 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. Permission is hereby granted to the above named applicant to p>erform the work described in the above statement. This permit is granted upon express V - IS - ft aIssued Date: Shoreland Management Office ICi ,00Fee $ Comments:. (^VKW lATTlt lAKI. MI»«NISOtAForm No. MKL-0771-003 / // 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 S F • Distance from Nearest Well 75 50FFFFF F Distance from Lake or Stream F F F F F F 20Distance from Occupied Building 10 20FFFFF F Distance from Property Line 1010 10FFF F F F Distance from Bottom to Water Table 33FFFFF F Inspector's Comments: Date of Inspection 19___ Time of Inspection,M Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF B Square Feet F = Linear Feet Job Title AgencyMKL-0771-003-Backef I . */•X % 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 Wh/I»-Office • y»flow — Inspector P/nk — Own*r Cord — Oivn«f Permit No.,LEGAL DESCRIPTION AND LOCATION TWP NamaSec.TWP RangeLake Classif.Lake No.Lake Name IDENTIFICATION: Please Print All Information. Zip No,Tel. No.Mailling Address —No, Street, City and StateFirstInitialLast Name OWNER SEWAGE SYSTEM INSTALLER Name. ^ 3 aThis System will be ready for inspection on., 19i This space for office use only V- .?/ ,„f-2 Owner or Agent SignatureDate Rec'd Time Rec'd Phone Call Rec'd By NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD 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.Distance from property line Ft. Ft. Ft.Ft.Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS: 19 , Time JM ByInspection was made on Date of First TestPERCOLATION TEST DATA:19 , Rate Date of Second Test 19 , Rate 1»t Test Taken By First Test + 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 (6) months. Issued Date: Shoreland Management Office Fee $ CERTIF U/xTe !SSyEd Comments:. @(VtfW tATTU LAKi, MiNMSOTAForm No. MKL-0771-003 I< . I4 t INSPECTION RESULTS Inspector must make at! measurements 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 SF ^0Distance from Nearest Well 75 50FFFF F 7i^o1^0Distance from Lake or Stream F F FV 7IDDistance from Occupied Building 10 ,20 20FFFFF F IDDistance from Property Line 10 1FFF F F F Distance from Bottom to Water Table 33FFFF Inspector's Comments: /a I V- :2 ^19_STc^Date of Inspection. / ■• ygTime of Inspection. signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs ~ Gallons SF • Square Feet F " Linear Feet Job Title AgencyMKL-0771-003-Backer ^JSJI ^ 3 .A^vn, f ZV2,.<w-s#v<sv-^ ^ c-aJ^ / ^ /" ' ^ ) GRID PLOT PLAN SKETCHING FORM.feet/inches.' • Scale: Each grid equals 4 .19.Application for Building Permit Dated_____ Application for Sewage System Permit Dated Building Permit Number_________________ Applicant agrees that this plot plan is a part of application (s) indicated above. ,19 Sewage System Permit Number. 19.Dated Signature I 1 A __i. LI -I : ») J-ctTitN -1 4I [ '■I U ,I I t i 1-^ I !- ■ f t : 1 r 1 T Y !CERTIFK/TF 'SSU^D 159104 ®VICTOII U>MCC» 4 CO.. MlHTCCa. rCKGUS FM.1.0. MiMR.MKL-0871-029