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Home My WebLink AboutTwin Pines Resort_38000990644000_Septic System Permits_Department of LAND AND RESOURCE MANAGEMENT OTTER TAIL COUNTY 121 W. Junius Ave., Suite 130 Fergus Falls, MN 56537 Ph: 218-998-8095 Otter Tail County’s Website: www.co.ottertail.mn.us SEWAGE SYSTEM ABATEMENT NOTICE July 14, 2003 CURRENT PROPERTY OWNER:Richard & Charlotte Burns Twin Pines Resort 101 Centennial Ct. Underwood, MN 56586 Parcel Number: 38000990644000 Section:32 Township Name: Maine Lake Name:West Lost Lake (56-481) E-9il Address: 29917 Twin Pine Rd. You are hereby notified that the sewage system which you maintain on the above identified parcel, is. not constructed and/or located in accordance with minimum standards of the Shoreland Managemerit Ordinance of Otter Tail County. V-. Please be advised that you must correct this situation within 30 days. You should contact this office in order tojdetermine what corrections and permits are required prior to complying with this notification. 6^eotr({e ______ Land & Rifesource Management Official STATE OF MINNESOTA ) )ss. AFFIDAVIT OF SERVICE BY MAIL COUNTY OF OTTER TAIL) Mavis Samuelson, of the City of Fergus Falls, County of Otter Tail, in the State of Minnesota, being duly sworn, says that on the 14™ day of July 2003, she served the annexed: SEWEAGE SYSTEM ABATEMENT NOTICE On the following person, by mailing a copy thereof, enclosed in an envelope, postage prepaid, and by depositing same in the post office at Fergus Falls, Minnesota, directed to said person at the following address: RICHARD & CHARLOTTE BURNS TWIN PINES RESORT 101 CENTENNIAL CT. UNDERWOOD, MN 56586 Mavis Samuelson Land 86 Resource Management Official Subscribed and sworn to before me this day of July in the year of 2003. Notary My Commission Expires January 31. 2005 >!X AMY JO MARK m NOTARY PUBLIC-MINNESOTA y My Commission Expires JAN, 31,2005 |m \\i FormLtrs-CertifiedMailingMS ABATEMENT FIELD NOTES :NFLAKE NO: W ________ E911 PROPERTY ADDRESS: Pt HP LAKE NAME: PARCEL NO: TOWNSHIP NAME: UAiH<________ LEGAL DESCRIPTION: LAKE CLASS: 3XSECTION NO: ^^va) \ wV o< ' (lor u 5OWNERS NAME(S):. MAILING ADDRESS:101 7p^yf^N/A//A* (J N I uJool H K/ TYPE OF EXISTING SEWAGE SYSTEM: HOLDING TANK SEPTIC TANK/DRAINFIELD OTHER: SEPTAGE PIT, DRYWELL OR LEACHING PIT CESSPOOL X COMMENTS: SEPARATION DISTANCES fIN FEET^ ABSORPTION AREASEWER LINE TANK OUTHOUSE WELL OHWL LOT LINE ___________ DWELLING ___________ NON DWELLING ___________ GROUND ELEVATION @ ___________ REASONfS^ FOR ABATEMENT (SKETCH ON BACK...) AripOoi' dO ^Ur-{4c f J) (9fl Ola,/ '{'o ^ ^ IH' fo (/hi 10 / DATT flP (~.H INSPECTOR'S SIGNATURE(S) 7 YESEXISTING FILE:NO ABATEMENT FIELD NOTES FORM 01/22/03 UH SEWAGE SYSTEM aist F" e b r u a r yfe-This certificate has been issued this day of to certify that the sewage system installed as per sewage permit number indicated below has been approved for use by Otter Tail County, Minnesota. The premises covered by this certificate are legally described as: MAINE134413256-'181Lake No.Sec.Twp.Range Twp. Name fLl HATFIELD ADDN 1)RES A (TWIN PINES RESORT) (38000990644000)h-. I3RIGMAN, STEF^HEN C BARBARA JMOwner: Name 4905 CHESTNUT SIT GRAND f-QRF'.S, NDAddress w 58201Zip No. 10962Permit No. SP ULbeSigned by:(2 Units @ 2 bedrooms Land & Resource Management Officialeach)Otter Tail County. MinnesotaMKL-0987001 bA M JT 279005 Vk«)r Lundeen Co.. Prifxten. Fergus Falls. Mhmesoca 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 Permit No.LEGAL DESCRIPTION ( ) YesAbatement:No AND LOCATION LAKE NUMBER LAKE/RIVER CLASS SECTIONLAKE/RIVER NAME TWP, NO.RANGE TWP NAME Lv)e^T Luh.'T5&~ PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER Z8 'OOO - 06 '-/‘I - ooo IDENTIFICATION: Please Print All Information liling Address — No. Street, City and StateLast Name First Initial Zip Code Telephone No. 7" O'. /\A AvlProperty Owner 7 5 6-^ Sewage System Installer Name .5 - A^l ?-'ZOThis System will be ready for inspection on P.M., 19 at VThis space for office use only NUMBER OF BEDROOMS: GARBAGE DISPOSAL: ( ) YESDate Rec'd Time Rec'd Phone Call Rec'd By SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) Septic tank ( ) Lift station (Alarm required) Drain field ((^ Trenches ( ) Bed ( ) Mound ( ) Outhouse ( ) Sewer line TANK DRAIN FIELD 7^9. SqR./OOPCapacity GIs. ho/loo /SO bCDistance from nearest well Ft. Ft. /SODistance from lake or stream Ft.Ft. /q>QDistance from building Ft.Ft./O /ODistance from property line /o Ft.Ft. 3Distance 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 Perc Tester Date of Perc Test OS/ORate of 1 St 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 fo 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 reM^i ftMinspection. DATE; Signal Permit: Permission is hereby granted to the above named applicant to perform fhe work described in the above ^tement. 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 rggpects 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. ure 5 -Issued Date: Land & R^^iuCe Management Office Fee $.Rec #. AComments: 277.212 • Victor Lundeon Co., Printers • Fergus Falls, MinnoostaBK 0795-003 - T- ^7 APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM ■\ - WHITE —Office Yellow — Inspector Pink — Owner iLAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218)739-2271 - FERGUS FALLS, MN 56537 LEGAL Permit No.TilaKiDESCRIPTION ) Yes NoAbatement: (AND LOCATION r LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS SECTION TWP. NO.RANGE TWP NAME )'hHK}(=) PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER 1^8-000-'^' 06^^'000 IDENTIFICATION; Please Print All Information Last Name First Initial Mailing Address — No. Street, City and State Krl Zip Code Telephone No. O ^X-CblM A k)^ 5 r~>Property Owner Sewage System Installer Name f ,9;3o 7 This System will be ready for inspection on , 19 at This space for office use only yNUMBER OF BEDROOMS:/■'S^ Time Rec'd ^ "^hone Call Rec’d”By GARBAGE DISPOSAL: ( ) YES PO NODate Rec’d SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM ( ) Holding tank (Alarm Required) (^') Septic tank ( ) Lift station (Alarm required) Drain field (^<^ Trenches ( ) Bed ( ) Mound ( ) Outhouse ( ) Sewer line TANK DRAIN FIELD 7^&a. SqR./OOPCapacity GIs. 5o//gq /50 bCDistance from nearest well Ft.Ft. /SODistance from lake or stream Ft.Ft. )o/^0Distance from building Ft.Ft./o /oDistance from property line yo Ft.Ft. 3Distance 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 s '^'^LPerc Tester.Date of Perc Test.i <?;2>/o 4, LRate 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 Otficical 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 rpady fdr inspection. AA Sigftature T) Permit: Permission is hereby granted to the above named applicant to perform the work described in the above(Matement. 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 r^pects 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. JDATE: c. Issued Date: Land & R^dpre^Management Office Fee $.Rec if. C? hfiJaComments: 277.212 • Victor Lundeen Co.. Primers ■ Fergus Fails. MirmeostaBK 0795-003 y. .' T: . “ t-r1/INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS DRAIN FIELDHOLDING SEPTIC TANK LIFT TANKCATEGORY Actual Minimum s7^ Ire*^Capacity GLS.SF SFGLS. ?-T~ FT11FT FTDistance from Nearest Well FT i*^ance from Buried ^Water Suction Pipe FT FT FTFT50 Distance from Buried Pipe Distributing Water Under Pressure FT FTFTFT10 ft ft FTDistance from Lake or River (OHWL)FT 3<D FTIH-10/20 FTFTDistance from Nearest Building FT 0}^ FT FT FTDistance from Nearest Property Line FT 10 /r h ft FTDistance from Bottom to Water Table FT FT 3 -YES^fieHolding Tank/Lift Alarm NOOld System Pumped & Destroyed Sewer Line to Well Separation DRAINFIELD CALCULATIONINTERPRETATION OF ABBREVIATIONS GLS. = Gallons SF = Square Feet FT = Linear Feet 1ActualMinimum FTX ^ SF20FT ly Inspector's Comments: { SKETCH: 3 - •> Inspector's Signature Date of Inspection jfjTyd Time of inspection GRID PLOT PLAN SKETCHING FORM — (Must Be To Scale) inchesScale: Each grid equals &1^.\ Dated:19 Signature Please sketch yoi3r lot indicating setbacks from road right-of-way, lake and sideyard for each building currently on lot and any proposed structures. 3'5> O -(—1 "D i I PERCOLATION TEST DATA LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, MN 56537 OWNER: TNAME Q LAKE NAME * LEGAL DESCRIPTION: , r\ i H J ^^ 9yaU^ |QjU.vjlA TELEPHONE NUMBERMIDDLEFIRSTLAS ADDRESS: Z//> COZ)£STATECITYSTR./RT. /,? y ^ / riw ' RANGElM\Kt/^VER A//4A/Z5£Ck'£/? AfO.Z./(A: PARCEL NUMBER Hnumber/bIdroomsFIRE NUMBER — TWO TESTS ARE REQUIRED — TEST HOLE NO. 2TEST HOLE NO. 1 63a.y inches; Diameter of Hole inches inches - Depth To Bottom of Holeinches; Diameter^of HoleDepth To Bottom of Hole w fa ^ YTlaa^ Soil Texture Date DaleDepth, Inches Depth, Inches Soil Texture3TX) ' 'i—Percolation -------------------- Test By____ S/Mrf Q)AAb 5/Vg^f C7^t/ / O /O t t-PWcolation ---------- Test BySA Ae^ Kf Firm arm Name-'hd- IG 7 3-Sj^ 2^ ^ ?< 5 t./Address Address U-l6yOtter Tail County License No. Otter Tail County License No. PERC TEST # 2PERC TEST # 1 WATER DROP PERC RATE TIME tWTBRVALfMPnjTBS^WATBI^^i^TO WATER DROPPnERVALfMPItnBg)w>PERC RATETIME TM -22/TIMB ^ D^OP iTAXT7a -/j:7^ PERC RATEWATER DROP INTERVAL fMIWUTEyi WaTI^PB^M WATER DROPINTERVAL n>nNt/TBS}PERC RATEaLiIS-JdT. riMH • Brop pbrc RBPlJLLTd... PERC RATEWATER DEPTHla WATER DROP ■TIME INTERVAL n^IHUTEO WATER WATER DROPINTERVAL Q»nNUTBa PERC RATE /K I .lt> TIMB I^^P PBRC RSy^m...i3:7 ^3 PERC RATH TIMEWATERpHpn|^ WATER DROP PnERVALfMlNinESI WATER WATER DROP PERC RATEINTERVAL fMlWTBaTIMB JAIk--ak:^3 Ptl6^ ^riRC ^ RBPII^/£.IS-.'a-reRCRATB INTERVAL tMIWUTESIWATER PROP WATER DEPTH WATER DROPIKTBIVALIMlWUTBa PBRC RATETIME 13?7-i mJ'S'.AA’ TD>fe DROP PBRC ( I RBPILf.RBFILL/i5. TIMB TCRCRATE TIME INTERVAL fMTNUTBSIWATER PROP water DEPTH WATER PROPINTERVAL (MINUTEST WATER DEPTH PERC RATERBPILLRBPILL **TTME“ DROP PERC 'HMU DROP PERC PERC RATE TIME INTERVAL (MINUTSfl WATER DEPTHINTERVAL (MWUTBST WATER DEPTH WATER PROP WATER PROP PERC RATETIMB RBPILLRBPILL Y1K4M" DROP PERC YiNlli' DROPTIMS PERC RATE INTERVAL (MINUTEST RBPILL INTERVAL (MINUTES)WATER DEPTH WATER PROP WATER DEPTH WATER DROP PERORATETIME REFILL TIME DROP PBRC TIME DROP PBRC COMMENTS/CALCULA TIONS: MKL — 0390 - 005 250,615 — Victor Lundeen Co.. Printers, Fergus Falls, Minnesota ^1^ m^M.LV^^K^■■SEfci1^Bti 1^fat;5?tS''/'« '1 Iv''u 2to CERTIFICATE OF APPROVAL SEWAGE SYSTEM m.m ii“ m DRAIN FIELD ADDNm J: SfThis Certificate has been issued this 1ST of FEBRUARY, 1999 , to certify that the sewage system installed as per Sewage Treatment System Permit Number 12222 has been approved for use by Otter Tail County, g:.T m S' Minnesota.i]fv M The property served by this Sewage System is legally described as: (TWIN PINES RESORT)SImq HATFIELD ADDN RES A Parcel Number(s): 38000990644000 Section: 32 Township: 134 Range: 041 Township Name: MAINE TOWNSHIP Lake/River Number: 56-481 Lake/River Name: W LOST to# ifi'm0^, *'i s H m£ m Current Property Owner: RICHARD C & CHARLOTTE BURNS Number of Bedrooms: 3 r * ADDN'L DP TO (SP1313) SERVICING DWELLING Land & Resource Management Official i ni m m [W r. <7 284.709 • Victor Lundeon Co , Pfimefs » Fergus Falls, MN • 1-800-346-4870 APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENTOTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 - FERGUS FALLS, MN 56537 e jSpector .ner f(sL% A [-foof A/ilA LEGAL Permit No. DESCRIPTION Abatement: ( ) YesAND LOCATION I.AKE NUMBER LAKE/RIVER NAME SECTIONLAKE/RIVER CLASS, __(Ot TWR NO.RANGE TWPNAME 3^ l^f |Lf| PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER .3Y~ouo- ?/- IDENTIFICATION; Please Print All Information Last Name—_________________________First Initial Mailing Address — No. Street. City and State im/i^ioooo M/v Zip Code Telephone No. Property Owner r%s^Cl’SSewage System Installer Name State Lie. # A.M. ► This System will be ready for inspection on the year of PM..at. 1This space for office use only NUMBER OF BEDROOMS: A.M. PM.GARBAGE DISPOSAL: ( ) YES (NO Date Rec'd Year of Time Rec’d Phone Call Rec'd By TYPE OF SEWAGE SYSTEM ) Holding tank (Alarm Required) ) Septic tank Lift station (Alarm Required) Drainfield ( Trenches ( '^ ) Bed ) Mound ) Outhouse ) Sewer line SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTS TANK DRAINFIELD( 373 3v^//C7l>i isn (Capacity GIs. ( -3/PH ; - Distance from nearest well Ft.( Distance from lake or stream Ft. Ft. Distance from dwelling Ft. Ft. (lODistance from non-dwelling Ft. Ft.( la(Distance from property line Ft.Ft. EFFLUENT DISTRIBUTION ( yC) Gravity ) Pressure Distance from bottom to Water Table Ft.Ft. All distances are shortest distance between nearest points( PERCOLATION TEST DATA:WATER WELL DEPTH Perc Tester te of Perc Test 3 33Rate of 1 St 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 Official shall become a part of the permit. Applicant further agrees that no part of the system shall hoovered until It has been inspected and accepted. It shall be the respon sibility of the applicant for the permit to notify the County Shoreland Management that the Jpg uBVeady for inspection. (ADATE: 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 con dition 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 S Resource Management OllicewFee $Rec # Comments: 291.095 • Viciot i.utui.;,;n t'o . • f c nius r,-jil'%. lv1inn.'V)i;iBK 0795-003 / APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM LAND & RESOURCE MANAGEMENTOTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 - FERGUS FALLS, MN 56537 WH/fE — Office YELLOW — inspector PfNK — Owner ■> IZZT-Rs-i Lo-i ALEGAL Permit No. DESCRIPTION 'H Abatement: ( ) Yes %AND LOCATION ( K ^ 7LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS SECTION TWP. NO.TWP NAMERANGE /" (—I Zf HI mfit7.2-// PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER / V " - Tj- ^^NTIFICATION: Please Print All Information /V‘ Last Name First Initial Mailing Address — No. Street, City and State Zip Code Telephone No. 1^1 Uu/l^ruJOO/.i H^y __________.Q W Property Owner iZlili 1_(L ^Sewage System Installer iName4. V. state Lie. # vu ffi>■ This System wilt be ready for inspection on.the year of .at. This space for otth 7NUMBER OF BEDROOMS: y GARBAGE DISPOSAL: ( )YES NO(Date Rac'd TYPE OF SEWAGE SYSTEM ) Holding tank (Alarm Required) ) Septic tank '(( >fl ) Lift station (Alarm Require Drainfield SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTS TANK DRAINFIELD( Ft"(Capacity GIs.rz(>///(/(Distance from nearest well Ft.<V>/<jO/Distance from lake or stream Ft. Ft.Trenches 1 ( ) Bed ( ) Mound ) Outhouse ) Sewer line Distance from dwelling f4 Ft.Ft. lODistance from non-dwelling Ft.Ft.( (laDistance from property line Ft. Ft. EFFLUENT DISTRIBUTION ( 'yl) Gravity ) Pressure Distance from bottom to Water Table Ft.Ft. All distances are shortest distance between nearest points( PERCOLATION TEST DATA:iMfWATER WELL DEPTH 0.^1 i. ii-rPerc Tester Date of Perc Test 3 33Rate of 1 St Test Rate of 2nd Test Average Rate Agreement: The undersigned hereby makes application tor 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 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 accepted. It shall be the respon sibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. /'t /' UPDATE: dSignature 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 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. li- 'uIssued Date: Land & Resource Management Office '7Fee $ 7 k 1 7Rec # Comments: BK 0795-003 291,095 ■ Victlor Lundoen Co, Pfiirtef*. • frrgus Fiills, M'nu*tsr>l*» INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS DRAINFIELDHOLDING SEPTIC TANK LIFT TANKCATEGORY Actual Minimum Capacity FT^-FT2GLS. GLS. /^f FTDistance from Nearest Well FT FF FT Distance from Buried Water Suction Pipe FT FT FT FT50fDistance from Buried Pipe Distributing Water Under Pressure FT FT FT10 FT Distance from Lake or River (OHWL)ft)FT FT ft Distance from Dwelling FT FT 10/20 FT Distance from Non-Dwelling 3 / FTFT FT FT Distance form Nearest Property Line FTFT 10 n;FT Distance from Bottom to Water Table FT FT FT3 Holding Tank/Lift Alarm YES NO Old System Pumped & Destroyed YES NO Sewer Line to Well Separation DRAINFIELD CALCULATIONINTERPRETATION OF ABBREVIATIONS GLS. = Gallons FT^ = Square Feet FT = Linear Feet Actual Minimum FTX /<W- FT .ft^20 ROCK REDUCTION Inspector’s Comments: Rock trenches with inches Hoof rock under pipe for .% 4=^V40 ,ft2 DF.reduction / equivalent to IKETCH: % u4 15u. Inspector’s Signature Date ot Inspection Time ol Inspection 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 and all water wells within 150' of the sewage system. GRID PLOT PLAN feet SKETCHING FORMJ____grid(s) equals inch(es) equalsScale:feet, or ft SIGNATURE:SUBMITTED BY: ( DATE: MPCA LICENSE #: LICENSE CATEG0RY:_k£t^ FIRM NAME:^ ADDRESS: ( JUwSjL 76if AJaJtJ-hL )50 y* n: 281.183 • Vidor Lui^doon Co , Pflntors • Fergus Falls, MN • 1-800-346-4870BK — 0496 — 029 1 • •.I SITE DATA LAND AND RESOURCE NIANAGEMENT Otter Tail County Fergus Falls, MN 56537 i -.'i' OWMER: LAST NAME FIRST MIDDLE TELEPHONE NUMBER ADDRESS: CITYSTR./RT ZIP CODESTATE LAKE/RIVER NO.LAKE NAME SEC.TWP.RANGE TWP. NAME LEGAL DESCRIPTIOM:SOIL BORING LOG COLOR & MUNSELL NO. DEPTH (INCHES)STRUCTURETEXTURE BLOCKY PLATY PRISMATIC NONEPARCEL NUMBER BLOCKY PLATY PRISMATIC NONE FIRE NUMBER NUMBER OF BEDROOMS BLOCKY PLATY PRISMATIC NONE GARBAGE DISPOSAL: YES NO WELL CASING DEPTH;ft.BLOCKY PLATY PRISMATIC NONE FLOODPLAIN: YES NO VEGETATION: AQUATIC TERRESTRIAL BLOCKY PLATY PRISMATIC NONE SLOPE AT INSTALLATION SITE:% ? 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 - WATER DEPTH*TtME INTERVAL (MINUTESt WATER DROP PERC RATE TIME WATER DEPTH PERC RATEINTERVAL (MINUTES)WATER DROP START START TIME DROP PERC PERCTIMEDROP TIME INTERVAL (MINUTES) WATER DROP-WATER DEPTH PERC RATE TIME INTERVAL (MINUTESI WATER DEPTH PERC RATEWATER DROP REFILL REFILL TIME DROP PERC DROP PERCTIME TIME INTERVAL IMINUTESI WATER DEPTH WATER DROP PERC RATE PERC RATETIMEINTERVAL (MINUTESI WATER DEPTH WATER DROP REFia REFILL TIME DROP PERC DROP PERCTIME INTERVAL IMINUTES)WATER DROP PERC RATETIMEWATER DEPTH PERC RATE TIME INTERVAL (MINUTESI WATER DEPTH WATER DROP REFILL REFILL TIME DROP TIME DROP PERCPERC TIME INTERVAL (MINUTES)WATER DROPWATER DEPTH PERC RATE TIME INTERVAL (MINUTESI WATER DEPTH WATER DROP PERC RATE REFILL REFILL TIME DROP PERCDROPPERCTIMETIMEINTERVAL (MINUTES) REFILL WATER DEPTH WATER DROP PERC RATEPERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROPREFia TIME DROP DROP PERCPERC• TIME INTERVAL IMINUTES)WATER DROPTIME WATER DEPTH PERC RATE TIME INTERVAL (MINUTESI WATER DEPTH WATER DROP PERC RATEREFIUREFILL TIME DROP PERC DROP PERCTIME TIME INTERVAL (MINUTESI WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATEREFILLREFILL TIME DROP DROP PERCPERCTIME PROPOSED DESIGN: TRENCH BED.ATGRADE.MOUND,PRESSURE DIST._HOLDING TANK GRAVITY DIST SEWER LINE.OUTHOUSE.OTHER___ SPECIFY: SYSTEM DESIGN ON BACK — \ . 3^^®i ^S;ml§M u c«v-; ^W1 m CERTIFICATE OF APPROVAL SEWAGE SYSTEM HOLVJNG TANK mm &ii>t V2.cmb2A !9i±This certificate has been issued this to certify that the sewage system installed as per sewage permit number indicated below has been approved for use by Otter Tail County, Minnesota. day of m¥‘<:ni 'i-A-9. mThe premises covered by this certificate are legally described as: E»56-481 Sec.Twp. ^Range dl McUmLake No.Twp. Name 7/ jMfn PfneA RtiohX. (10 BndA.oom&/6 (JKuXi)m-m MMV fe§Rfc-hajid BiiAMi% :■Owner: Name RH2 Box 7 59. UndeAutood. MM f *%i»i Address m 56586Zip No. Ms&7966Permit No. SPml 5^"i^n K- Lee, Land & Rcsc^urce Management Administraior Signed by: Male Oner Tail County, Minnesotam§MKL-0987001 ,V; 243.984 — Victor Lundean Co., Printers. Fergus Falls. Minnesota 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 * . WhUe — Office Yellow — Inspector Pink — Owner \Permit No.LEGAL DESCRIPTION AND 35i^-W uJ^Lost NT Lake No. LOCATION Lake Cla&sif.TWPLake Name Range TWP Name IDENTIFICATION; | Please Print All Information. Last Name Mailing Address — No. Street, City and State Zip No.Tel. No.InitialFirst f] /[\ u A aAc!OWNER SEWAGE SYSTEM INSTALLER Name, This System wilt be ready for inspection on. This space for office use only . 19. 19 ,M / £tih dioki.k'H/0Date Rec'd Time Rec'd Phone Call Rec'd By Signature NUMBER OF BEDROOMS;ESTIMATED COST;I HQUbr N<f 1SEWAGE DISPOSAL SYSTEM DATA: SEP I lU" I ANK \SEEPAGE PIT DRAIN FIELDdyCUATi/^‘)/0O GIs.Sq. Ft.Sq. Ft.Capacity 5T?Ft.Ft.Ft.Distance from nearest well ISO Ft. Ft.Ft.Distance from lake or stream iO Ft. Ft.Ft.Distance from occupied building /oDistance from property line Ft.Ft.Ft. \Ft. 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 + 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 jordinances 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 cial shall become a parjt of the permit. Applicant further agrees that no part of the system shall responsibility of the applicant for the permit to notify the County Shoreland Management that^ aegroved by Shoreland Management Offi- lernriSpetyed and^Pcepted. It shall be the!^fi-CQvered until i the job)is ready fp^nspe6tion. I understand that I have been granted a sewage system site permit in accordance wit^ the requirements of the Shoreland Management Ordinance of Otter Tail County.(l understand I must contact my township in order to determine whether or not any adcjj;^ tional permits are required by the township for my proposed project. 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 comn^ced within six (6) months. T-------- Signature Permit: I 6Issued Date:/Shoreland Management Office Fee $Rec # Comments: Form No. MKL-032085 237,443 — Victor Lundeen Co.. Printers, Fergus Palis, Minnesota V/y.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 mitf'— Office Yellow — Inspector Pink — Owner t ■1 \a7'^Permit No.,LEGAL DESCRIPTION AND K! c:^0 I);, Lo sf /j-UiLOCATION Lake No.Lake Name Lake Classil.Sec.TWP Range TWP Name IDENTIFICATION: Please Print All Information. Last Name Mailing Address — No. Street, City and StateFirstInitial Zip No. Tel. No. t ■4^- OWNER 4 \ / '& SEWAGE SYSTEM INSTALLER Name.jJ. \ 1 , . As- k- f vuo^^d tioj n/s System will be ready for inspection on.V y PTVf IThis space for office use only 3:^ f Phone Call Rac'd By f OO . Ch' pr Agent Signature 19 ,M 6Date Rec'i Time Rec'd 7 NUMBER OF BEDROOMS;Ui\ if\ESTIMATED COST; SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD Ay--1Capacity GIs.\Sq. Ft.Sq. Ft. Ft.Ft.Distance from nearest well Ft.J .. Z5t Ft.Distance from lake or stream Ft.Ft. Distance from occupied building Ft.Ft.Ft. Distance from property line Ft.Ft.Ft. \Distance from bottom to Water Table Ft.Ft.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 , Rate Date of Second Test 19 , Rate 1st Test Taken By First Test + 2nd Test 22nd Test Taken By Rate The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management 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. I understand that I have been granted a sewage system site permit in accordance with the requirements of the Shoreland Management Ordinance of Otter Tail County. I understand I must contact my township in order to determine whether or not any addi tional permits are required by the township for my proposed project. 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. Agreement: /-Signature Permit: iL 1)Issued Date:i Shoreland Management Officevssvjeo^nrs'j VFee $Rec # V.-: ■3Comments: iForm No. MKL-032085 237,443 — Victor Lundeen Co., Printers. Fergus Falls. Minn^ota > / INSPECTION RESULTS Inspector must make all measurements Ceaiih'^WAGE DISPOSAL SYSTEM STATISTICS SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORYShould BeActual Actual Should Be Actual Should Be Capacity GIs.GIs.S F S F S F S F Distance from Nearest Well F F F F F F 1 *-/ 50>Distance from Lake or Stream F F F F F F o!Distance from Occupied Building F F F F F F Distance from Property Line F F F F F F !I Distance from Bottom to Water Table 3 3FFFFF F ‘ Inspector^ CorA^ents: \ T% T>i$ ^ ^ oir hsr%sT -------------------------- DatehadP Ins pectionl \ ^ ITimefOTln ipectioni M Signature of InapecioliNTERPf ETATION OF ABBR EVIATIONS G 5 = Ga Ions S = Sq jare Feet F = Lir ear Feet M :L - 032085 - Btcker o-1- r i r, i % ?• % ;I Depart7nent of LAND & RESOURCE MANAGEMENT COUNTY OF OTTER TAIL Phone 218-739-2271 Court House Fergus Falls, Minnesota 56537 MALCOLM K. LEE, Administrator November 28, 1988 Richard .& Charlotte Bums R#2 Underwood, MN 565 86 RE: Sewage System located on property on West Lost Lake (56-481). Dear Mr. & Mrs. Bums: Upon reviewing our records, it does not appear that the nonconforming sewage system on the above referenced property has been brought into compliance with the provisions of the Sanitation Code of Otter Tail County as was required by the Abatement Notice (copy enclosed) issued July 22, 1988. Since this is the case, on or before December 15, 1988 please advise our office of your intentions regarding this matter.! r Sincerely, "I Bill Kalar Asst. Administrator # mgb i ■ SHORELAND MANAGEMENT ORDINANCE - DIVISION OF EMERGENCY SERVICE - SUBDIVISION CONTROL.ORDINANCE RIGHT-OF-WAY SETBACK ORDINANCE FUEL AND ENERGY COORDINATIONSOLID WASTE ORDINANCESEWAGE SYSTEM CLEANERS ORDINANCE - RECORDER, OTTER TAIL COUNTY PLANNING ADVISORY COMMISSION !) Jb -2^ 'hr^ / -'^''70 ~y4_^ ^^3-^eW-v „i*^^)-^..,_^,^<.4^Z2<^<l X-W-vCf" *75- 3-l-iSl ci.^>JtsuJ ju^ ^ C^^b^^Lnry ^ l~jiy\.yy'‘~^ JUr7^* Jb ABATEMENT NOTICE Shoreland Management COUNTY OF OTTER TAIL Court House Fergus Falls, Minn. 56537 19 M.day of -'ulyDated this.? f TT To '~*!r^~iprr1 Piiirn.g; A ddress i . 2 Zip Code 56586City and State Underwood. MK You are hereby notified that the Sewane system Which you maintain at (Legal Description and Location) - Plus Fire No. i'ttSTwin Pine Resort Lot 2, 3 & Res A Hatfield Addn. 134 4132 MaineHE56-481 U. Lott Lake RangeLake No.Lake Narni Class.Sec.Twp.Twp. Name constructed and/or locatedis not. ta Shoreland Management Ordinance. —days from this date. If you fail to function proceedings. ianagement Official ^ 19___ by handing a copy thereof fthe (owner-occupant-agent) of the above described premises. *By posting a copy thereof upon the above described premises. Otter Tail County Sheriff Department *Strike out words that do not apply. CC: Otter Tail County Attorney MKL-0372-03S-01 220S22 Victor Lundcon Cf Co., Printort, Porgua Folli, Minn. ABATEMENT NOTICE Shoreland Management COUNTY OF OTTER TAIL Court House Fergus Falls, Minn. 56537 day nf July IQ 8822ndDated this. Tn n-tnhflrH & r.harlotite Burns Address Rt. 2__________________ Zip Code 56586City and State Underwood. MN You are hereby notified that the sewage system Which you maintain at (Legal Description and Location) - Plus Fire No. Twin Pine Resort Lot 2, 3 & Res A Hatfield Addn. 134 4132 l^ine56-481 •W. Lost Lake NE RangeLake Nome constructed and/or located Class.Sec.Twp.Lake No.Twp. Name is not. in accordance with minimum standards of the Otter Tail County, Minnesota Shoreland Management Ordinance. You are hereby ordered to abate the above described condition within ^0 days from this date. If you fail to correct the above defect you may be subject to a fine, imprisonment or injunction proceedings. Shoreland Management Official PROOF OF SERVICE State of Minnesota County of Otter Tail Fergus Falls, Minnesota 56537 The above notice and order was served by me on._______________ 19___ by handing a copy thereof fthe (owner-occupant-agent) of the above describedto premises. *By posting a copy thereof upon the above described premises. Otter Tail County Sheriff Department *Strike out words that do not apply. CC: Otter Tail County Attorney MKL-0372-035-01 120512®''“'III. Minn.O' Co., P 473 70S TIS REGEiPT FOR CERTIFIED MAIL NO NbuPASCf PHu.-JtI, NOT hOR iNrfnNA'lQNAL MA'I I Sep Re'.ercip) 5 Se'"t Richard & Charlotte Burns Rt. 2SIretM .1' P OP Underwood, MN 56586 P Posiacj^ i3f* • Certified Special Delivery Restricted Delivery Fee Returri Receipt showing to whom arid Dale DeliveredtoooReturn Receipt showing to whom. Dale and Address ot delivery a> 4)c ■^uMl Pos'age ancj fees s Postmark nr DatesEIo7-25-88u. (/)a A SENDER: Complete items 1 end 2 when additional sarvicas are desired, and complete items 3 and 4. Put vout address in the "RETURN TO" Space on the reverse side. Failure to do this will prevent this card from being returned to you. The return receipt fee will provide vou the name of the person delivered to and the date of delivery. For additional fees the following services are available. Consult postmaster for fees and check box(es) for additional service(s) requested. 1. □ Show to whom delivered, date, and addressee's address. t (Extra chargeJt 2. □ Restricted Delivery t (Ex tra charge) t (A56-481) 3. Article Addressed to:4. Article Number P 473 705 912Richard & Charlotte Burns Rt. 2 Underwood, M 56586 type of Service: Registered Certified Express Mail Q Insured □ COD Always obtain signature of addressee or agent and DATE DELIVERED. 8. Addressee’s Address (ONLY if requested and fee paid)5. Signature — Addre^e X 6. Signature — Agent X 7. Date of Delivery '7 ^ PS Form 3811, Mai. 1987 DOMESTIC RETURN RECEIPT* U.S.G.P.O. 1987-178-268 / OTTER TAIL COUNTY 1 -I Y?c!S'/i Sewage Permit No. SP Location: Ns 2108 c7 Twp. Name^^6:i:22f^Lake Nnr^f^ Sec. Twp/^^-^ ... Range / /V /;> '7fc.'/ y ///'- ■J'f ,^c’ 7"O f^J /•■'A' c .■<-/ /■^z: ftZ r A- 'S ^ ,‘"T^ / /iz' /t A- ^ ^ '' / Owner’s Name ____ //Lake 19M19^, To 1 / T y 7y^£ c-^' 7 Valid 1^3 Work Authorized^"7 'j A,G.-/^J f / ^ 7(> C'i.f-ZA // NO'riv. 'I'his card must be placed in a conspicuous place not more than 12 feet above j^rade on the premises on which work is to be done, and must Ite maintained there until completion of such work. No part of system shall be covered until it has been inspected or approved. Notify Shoreland Management office when job is ready for inspection. !Zz OTTER TAIL COUNTY, MINNESOTA Board of County Commissioners y'/'UUA./ Shoreland Management Official FORM MKL-0871-006 1 ff 1 .2fi6-A ,uc iO- L’Jt.C ren n C.0 . F'MN ri-o'JS :al. 5. Mit.•. 1 I /i ——Hf -'I...—f ■ SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 - Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTBM W :te ~ I)fflce V low Iritpector PU Card — Owner Owner Permit No..LEGAL Date DESCRIPTION f^A Cy/A/ /I ff yy AND 6~^~ yjr//JY/^ Y/LOCATION Lake No. Lake Name Lake Classif.Sec.TWP Range TWP Name IDENTIFICATION: Please Print All Information. Last Name InitialFirst Mailling Address —No. Street, City and State Zip No,Tel. No. J?c'/ p / / g /Pa a /2OWNER SEWAGE SYSTEM INSTALLER Name. Thh 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 Signa;ture NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC-T-ANK OEEPAGC FIT -F4E4D Sq. Ft. c'»-WWW^I /zAJt:7 pU ^vyut^L Distance from nearest well Distance from lake or stream GIs.Sq, Ft.Capacity '■‘-epj. Ct^y Ft.Ft.Ft. yjj Jpp^ ^ Cc^ /s^oi Ft.u.Distance from occupied building 7o Ft. Distance from property line y.yTjiy1ykJp^y-Ft. c 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..By PERCOLATION TEST DATA:Date oKTirst Test 19 , 19 t Rate Date of , RateintKTest 1st Test Taken By First Test -I- 2niSJest i Rate2nd Test Taken By The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do alt 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 .4. 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: ^7' 2^:.Lyr—LIssued Date:/rz7 Shoreland Management Office Fee Surcharge $ Comments:. Form No. MKL 0771-003 vi«Tea LuNGKM » ee.. PGiiiTtea. Fiaeus r«LLi ,158906 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 W te - Office V low — Inspector Ph^. — Owner Card — Owner Permit No.,LEGAL Date DESCRIPTION AND LOCATION Lake No. Lake Classif.Lake Name Sec.TWP Range TWP Name IDENTIFICATION: Please Print All Information. Mailiing Address —No. Street, City and StateLast Name First Initial Zip No.Tel. No. 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 Cali 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 Ft.Distance from lake or stream Ft.Ft. Ft.Distance from occupied building Ft.Ft. Distance from property line Ft.Ft.Ft. Ft.Distance from bottom to Water Table Ft. Ft. AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on 19 , Time ,JVI 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.) 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 resF»^'^ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. C' \3 NOTE: Permit void if work is not commenced within six (6) months. Permit: ' 2 ' '•\Issued Date: r ^Shoreland Management Office Fee $Surcharge $ Comments:, Form No. MKL-0771-003 vicroi LuaftECM « M.. pRinttaa. rtusus rM.Lt. mihn 15S906 INSPECTION RESULTS «Inspector must make all 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 SF 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:"^ h/J ,'kLQ f )P Ui /4 3 J-n’A/c^Cl ) g/fs r f' f I t /^h I fn. k. ’ n fO fi t V A^ji^ if a/ <i n£ fn g ^r t f f ^ "bct-isaJt f / s.'JU A/O A, tT 'I- S 19_Z_^Date of Inspection S!'o iTime of Inspection.M / 7 &ignati/re of InspectorINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF = Square Feet F = Linear Feet Job Title AgencyMKL-0771-003> Backer i-£ /V TN cmt> Stres 'VSo' 'TIC Ei^iT Jbo' I I II '>-Voj jm6 srf^s wUi \A «/>3 0 7oo* y ^ i-flO/i s 'ZZ'’^’^£T *U)1- lo^XI7.y ■3P • • ‘'. sa'TTHtO'■ T^46fr '.(ir' \v S)SoI • ■■A— Af£VS — Tou.er Z-ilVvjri* -2/?0^S TlilL£T TXeMCH ss-£i9r//jfe ^'V "4 \ I hS—I S\.-^S''T Qs ■■■-.. ~r /\r $ —_••TCs Ai—?5b' /-r» f. jk SITES BmpHL£\o f-fCf)m9 SIT^S PDC>/T7CaI/1L ‘-Uu PfleiiW6> I o mmm f/C ® CERTIFICATE OF COMPLIANCE iM l»| SEWAGE SYSTEM I:>S 30th 19 7hDecember SISif llm)mii PI day of_This certificate has been issued this mi '§&Ahti p5?■' to certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota. The premises covered by this certificate are legally described as: Twp. I3ULake No $6-U6l Sec.Ji^Range_Jfl.Twp. Name Maine teww>j'* Reserve Lot A Hatfield Addn, Wm mfmmW'^ Name Richard BurnsOwner: Route #2, Underwood. MinnesotaAddress. Zip No. 1313Permit No. SP_ Signed by:. Malcolm K. Lee, Shoreland Administrator Otter Tail County, Minnesota MKL-087 1-009 X mm@159035 viCTS* IUH9CCN « CO. r«i>ir(ii9. rctsui r>Li«. untia 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 Office - nspector Owner ''wner id /?ckl / ? /Permit No.,LEGAL Date DESCRIPTION AND /l y 'iO ^Air .-?,0 ^3^/LOCATION Lake Classif.Sec.TWPLake No.Lake Name Range TWP Name IDENTIFICATION: Please Print All Information. Initial Mailling Address —No. Street, City and StateFirst Zip No,Last Name Tel. No. /2 /^^7<d^r/jJocun/ /^i X y^MjinOWNER f'>L/T fr ! SEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection on.19. This space for office use only M,19 Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signa^ture NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD 3nnGIs.[. Ft.Sq. Ft.Capacity Ft.Ft.Ft.J50Distance from nearest well /S Ox'S(3 Ft.Ft.Ft.Distance from lake or stream Ft.Ft.Ft.Distance from occupied building Distance from property line Ft.Ft.ZCl Ft.ZO iZFt. Ft.Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points T RECORD OF TESTS: Inspection was made on 19 , Time ........JVI By . 19 .?..y..... , 19...?..y.... 3PERCOLATION TEST DATA:Date of First Test Rate 3.Z.^,xTDate of Second Test Rate 1st Test Taker^By 333First 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 re for inspection. (Call or use attached mailer notice.) /'Dated.ySi^iii Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upoPermit; 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. xpress Issued Date: Shoreland Management Office--- oo 3/Fee $_^Surcharge $ Comments:. Form No. MKL-0771-003 I .... 158906VICTOI LiMieCCIi • CO.. 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 ■ Office •! nspector Pink — Owner Card — Owner W. .11 * !t / r)Permit No.,LEGAL /DateA/c/d/ ^\DESCRIPTION t AND /A :LOCATION Lake No.Lake Name Lake Classif.Sec.TWP Range TWP Name IDENTIFICATION: Please Print All Information. Last Name First Initial Mailling Address —No. Street, City and State Zip No.Tel. No. \dd'■'//>OWNER SEWAGE SYSTEM INSTALLER Name. VThis System will be ready for inspection on.// -, 19. This space for office use only / f - / 5 19 Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Slgna^ture NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD Sq. Ft.GIs.Capacity Sq. Ft. Ft.Ft.Ft.Distance from nearest well T7 Ft.Distance from lake or stream Ft.■■ ■)Ft. Distance from occupied building Ft.Ft.Ft. Distance from property line Ft.Ft.Ft. /Ft.Distance from bottom to Water Table Ft.Ft. AH distances are shortest distance between nearest points •a-iRECORD OF TESTS: Inspection was made on 19,, Time M By 1yPERCOLATION TEST DATA:Date of First Test 19 , 19..:.;..'/.... > Rate i Date of Second Test•' ---I '’.T!:':Rate I 1st Test Taken-'By - ,rFirst 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 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: ■ 1//I if /7 Issued Date: Shoreland Management Office 'T / -r VFee $Surcharge $ fN M r n \■/ rComments:.1 \ SSUEDCEHTtrlQATS Form No. MKL-0771-003 158906 viCTo* uiHOCCM « CO.. eoiauNO. rcoeua rm.L0. wma INSPECTION RESULTS k•>Inspector must make all measurements rr - za. ) 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 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 4FF F F F F Inspector's Comments: I 7 \ t/ Date of Inspection 19___ Time of Inspection M Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs * Gallons SF = Square Feet ■ Linear Feet Job TitleF Agency M KL-0771.003- Backer ; ■y ;•I t—- % ..i A( - f '• PERCOLATION TEST DATA Price $1.00 per pad. SHORELAND MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Ph. No. Owner:Mailing Address:(3 .tx-'Ww Last Name First Middle St. & No.Zip No.City State Legal Description: ')lA 12^HI SEC.TWP.RANGE TWP NAMELAKE OR RIVER NO.NAME -1 c TEST HOLE NO. 2TEST HOLE NO. 1 Co(jf Depth to Bottom of Hole inches; Diameter of Hole inchesDepth To Bottom of Hole,inches;Diameter of Hole inches 7 P) (j3 ^uj\/C :5W719 ~)yDepth, Inches Soil Texture 19Depth, Inches Soil Texture Ax. Dateate Srj -^-Xy i/^^^iL^W>%rco,ation S^L_ l/Z. r)'.?y Qy-qo i-j 6 ' O Q ^3’~ 36 E 34- - V BeyFirmNameVu^3 c/aLU ccQf/- .2 LL.’Vtj2gA.yx<-gr:,9^ 0^:7___ LU Address.CC Address < ^SJL ifi Otter Tail County License No..Otter Tail County License No.,coLUMeasurement, Inches___Depth in Water Level, Inches Measurement, Inches 1-Depth in Water Level. Inches Time Remarks Time Remarks o A///3^ ^ hiO_ 9 ■ 9 ■ slA^/5' A'^ .J-n ‘^1 • jj' A - v\ 9 ^ ■'>1 V y 9- 4 9 ‘ Ht I-ss555M4 i7£ ^R2 9/-a.^7^ss l-./faVp .' ^ i .y^:- ^ .-•0/n OAr-^-^ 10-(Pc ,0.1 3?'^3-^30^ ^ ‘I O 43V-^ 13 ^55ISQ . J-T /f/»\ jl; . c f AAl (^(33:!{3^ 3c- ■,»/4^ /; ^13 .U-^v i/ <r o MKL-0871-028159179 ®t CO . ^DiHTEM. rcaous r*cLi. See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn. J'. .-v/to certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota. I J ! I 1 159035 v.c 101 t- 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 Yellow — Inspector Pink — Owner Card Office iOwner /io/ /} //L / Permit No..3 c-fToPLEGAL Date DESCRIPTION AND y/4/^/ /j).J2. /3YLOCATION Lake No.Lake Name Lake Classif.Sec.TWP Range TWP Name IDENTIFICATION: Please Print All Information. Last Name First Initial Mailling Address —No. Street, City and State Zip No.Tel. No. AOWNER /C^ dJCt.SEWAGE SYSTEM INSTALLER Name, This System will be ready for inspection ., 19.on. This space for office use only .M.19 Date Rec'd Phone Call Rec'd ByTime Rec'd Owner or Agent Signature NUMBER OF BEDROOMS: jZ,ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD /KO Sq. Ft.GIs.P£~o >q. Ft.Capacity Ft.Ft.Ft.Distance from nearest well /3~0Ft.Distance from lake or stream Ft.Ft. J2/O Ft.Distance from occupied building Ft.Ft. /ODistance from property line Ft.Ft.Ft.ZO. ti-Ft.Distance from bottom to Water Table Ft.Ft. AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on 19 , Time ..........M By............ 19 Rate. , 19....Rate 7. ..Z/..3 PERFLATION TEST DATA: 1st Test Taken'By 2nd Test Taken'By Date of First Test 3Date of Second Test ; 2First Test + 2nd Test Rate 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.) SignUure O Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express 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. ^ //V 5 Issued Date: Shoreland Management Office 0 'L’o /HFee $Surcharge $ Comments:. Form No. MKL-0771-003 ^ vteni ufagecH a c«.. MiafCM. pcmui ratua. iHHa.158906 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 '■ix>ffice Inspector Pink — 'Owner Card — Owner Yerfbw ir r9 // /L fd Permit No.,LEGAL Datec/c/DESCRIPTION /■■*A___ AND -VI /LOCATION I Lake No.Lake Name Lake Classif.Sec.TWP Range TWP Name IDENTIFICATION: Please Print All Information. First Initial Mailling Address —No. Street, City and State Zip No.Last Name Tel. No. I riV.OWNER SEWAGE SYSTEM INSTALLER / ■Name.f This System will be ready for inspection on., 19. This space for office use only ,19 .M Date Rec'd Phone Call Rac'd ByTime Rec'd Owner or Agent Signa.ture „rs NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD Gis.Sq. Ft.Sq. Ft.Capacity Ft.Ft.Ft.■5 0‘ Distance from nearest well Ft.Ft.Distance from lake or stream Ft. Ft.Ft.Distance from occupied building Ft. Distance from property line Ft.Ft.Ft..''C Ft.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 ..........JVI By............ ,, 19 Rate. , Rate V .0 "i” / ^ 3 PERCOLATION TEST DATA:Date of First Test Date of Second Test 19 1st Test Taken By )9 / ---- ■ : '' ! './First Test.....'+ 2nd Test 2 Rate2nd Test Taken By Agreement: 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.) The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in Dated iSignature 6Permission 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. /•■' / 4/ 3 Permit: /? 'tW''Issued Date: Sho^and Management Office5^0- oc /Fee $Surcharge $/C.^C Comments:. QER’iriFIDATE ISSUED Form No. MKL-0771-003 .158906 VICTOK LUNBEfM t CO.. MIHTtflO. FCItBUS FM.L8. . r\ INSPECTION RESULTS 4 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 F 75 50F F F F 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: 7l/ ^ J- Date of Inspection 19___ Time of Inspection M ! 'Ji', 1 Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs ■= Gallons SF * Square Feet F * Linear Feet Job Title AgencvMKL-0771-003-Backer r (_ •* t-s' t »>r V. PERCOLATION TEST DATA Price $ 1.00 per, pad. SHORELAND MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Mailing Address: Ph. No.Owner:.. ' Last Name , First Middle St. & No.City Zip No.State Legal Description: LAKE OR RIVER NO.SEC.NAME TWP.RANGE TWP NAME TEST HOLE NO. 2TEST HOLE NO. 1 y/Depth to Bottom of HoleDepth To Bottom of Hole.inches; Diameter of Hole.inchesinches; Diameter of Hole inches 19Depth, Inches Soil Texture Depth. Inches Soil TextureDate Date o - /yPercola Test By Percolation Test By — V 7 - vy <5-=# /oryr^at Q A - rr* ■/'" /E'=?2_3<^ oyO.-y. y’X? Ayi ^ ^'/ir77m//'yy^rr/ S jnc^ Firm Name / OC Address.Address /u COOtter Tail County License No..Otter Tail County License NOvHcoLUMeasurement, Inches . Depth in Water Level, Inches H Measurement, Inches Depth in Water Level. Inches Time Remarks Time Remarks ^777 I /X> I X?.’JO y,3/^ si ly/O-./S' /y 'P-7T fr/// o?>i?gs? C» — JrO : VtO /n' V/0 /y>: gro yy.-n jife 7/t .SoiA / V'/ X?r)y>' <=^yy 3B./y // ■ //\C>£7 y/: /A y-r,//u/// /A // .' A.ZZW ujyp_ piLic- Ac^ y rr7Ok 'i.yL fiaipy D6 MKL-0871-028 See Booklet. "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn.