HomeMy WebLinkAboutWild Walleye Resort_53000990338000_Septic System Permits_LAND & RESOURCE MANAGEMENTOTTER TAIL COUNTY COURT HOUSE
121 W. JUNIUS AVE. • SUITE 130
Phone:(218)739-2271 • FERGUS FALLS, MN 56537
APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM
WHITE - Office
YELLOW -L&R Inspector
PINK - Owner / Contactor
PLEASE PRINT OR TYPE ALL INFORMATION Permit No.
LAKE NUMBER TWP NAMELAKBRIVER NAME LAKE/RIVER
CLASS
SECTION TWP NO.RANGE
5 4 isr 3S'?c)
PARCEL NUMBER (S)E-911 ADDRESS
o oo/
LEGAL DESCRIPTIONs^LLls B ^ C 0-L 2- f£Daytime Phone No.Last Name First Mailing AddressInitial
RrZ I Bcncsg-yProperty
Owner
Contractor
Lie.#/tn/U
A.M.
>■ This System will be ready for inspection on_P.M.the year of .at.
This space for office use only
A.M. P.M.
L&R OfficialDate Received Time Received
SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF INSTALLATION DRAINFIElgJTl^TANK( 1 ) System
( 2 ) Holding Tank (Alarm Required)
( 3 ) Septic Tank
(4) Lift Station (Alarm Required) ^TJ)l)rainfield
Size GIs.
Setback to nearest well Ft.Ft./tTZ)
Setback to OHWL (lake, river, wetland)Ft.Ft.
( A ) Trenches, Rock ( B ) Seepage Bed
( C) Trenches, Graveless ( D ) Mound
fenches, Chamber ( F ) At-grade
Setback to dwelling Ft.Ft.
/ O Ft.Setback to non-dwelling Ft.
(6) Collector
( 7 ) Outhouse
( 8 ) Greywater System
( 9 ) Sewer Line
(10) Performance
(11) Other
/ 0Setback to property line Ft. Ft.
3Elevation above water table (OHWL)Ft.Ft.NA3# Bedrooms
Garb. Disp. Y
Abatement Y / ^
3Depth to restrictive layer in soil Ft.Ft.NA
()^ Gravity
( ) Pressure
ABSORPTION AREA FOR MOUNDS / AT-GRADES
(AHACH DESIGN WORKSHEETS)
EFFLUENT
DISTRIBUTION
Ft^WATER WELL DEPTH HOLDING TANK
MONITOR/DISPOSAL CONTRACT
Designer___
Designer Lie. #
PERCOLATION
TEST DATA( )Ves
( ) No - L & R Can Not Process /0~Z~oo /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./O /
Date:
Signature of Property Owptqer/Agent for Owner
Date:
Land & Resource Management Office
PERMIT FEE $cJc/3dcnRECEIPT NO.
Comments:
Form No. BK — 1099-003 301,772 • Victor Lundeen Co.. Printers • Fergus Falls, MN » 1 •800-346-4870
SITE DATA
*LAND AND RESOURCE MANAGEMENT
Otter Tail County
Fergus Falls, MN 56537
OWMER:
S67 7<d
LAST NAME FIRST MIDDLE TELEPHONE NUMBER
ADDRESS:
56s 7/
STR./RT.CITY STATE ZIP CODE
3(9 _us (9-tto3^
LAKE/RIVER NO.LAKE NAME SEC.TWP.RANGE TWP. NAME
LEGAL DESCRIPTIOW:SOIL BORING LOG
V7 noo .^€>0 .-T^n/oo!
PARCEL NUMBER
COLOR &
MUNSELL NO.
DEPTH
(INCHES)TEXTURE STRUCTURE
7.^
BLOCKY
PLATY
PRISMATIC
/0-3f"y.y BLOCKY
PLATY
PRISMATIC
QiONi^
FIRE NUMBER 7.^
3^NUMBER OF BEDROOMS
7^"
BLOCKY
PLATY
PRISMATICGARBAGE DISPOSAL: YES
ft.WELL CASING DEPTH;
FLOODPLAIN: YES
VEGETATION; AQUATIC (fERRESTRI^
BLOCKY
PLATY
PRISMATIC
NONE
BLOCKY
PLATY
PRISMATIC
NONE
/SLOPE AT INSTALLATION SITE:%
(|6bring^TYPE OF OBSERVATION: Probe Pit
PARENT MATERIAL: Till ^ tfutwasl]^ Loess
ORIGINAL SOIL: No
Bedrock Alluvium COMMENTS:.
COMPACTED SOIL;Yes
mDEPTH OF BORING:.ft.
PERC TEST # 1 PERC TEST #2- T\A/0 TESTS ARE REQUIRED -
WATCR DEPTiTTIMEINTERVAL (MINUTES!WATER DROP PERC RATE TIME INTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATEiJTdK^30 ...a....START START/I 1JTL2.3!7TIMEDROPPERC
TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE//3//REFILL REFia
TI^E * MOP ^<C/7-i.71 TTTIMEDROPPERC
TIME INTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATE TIME INTERVAL IMINUTES)WATER DEPTH WATER DROP PERC RATE/ 1 SzR^ig REFig
T1ME DROP PERC
/
TIME DROP PERC
LJTJ.7
TIME INTERVAL (MINUTESI WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTESI REFig WATER DEPTH WATER DROP PERC RATEREFig
TIME DROP PERC TIME DROP PERCTIMEINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTESI WATER DEPTH WATER DROP PERC RATEREFHLREFig
TIME DROP PERC TIME DROP PERCTIMEINTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTESI WATER DEPTH WATER DROP PERC RATEREFigREFig
TIME DROP PERC TIME DROP PERC
TIME INTERVAL (MINUTES) WATER DEPTH WATER DROP-PERC RATE INTERVAL (MINUTES)TIME WATER DEPTH WATER DROP PERC RATEREFigREFig
TIME DROP PERC TIME DROP PERCTIMEINTERVAL (MINUTESI WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTESI WATER DEPTH WATER DROP PERC RATEREFigREFig
=DROPTIME PERC TIME DROP PERC
PROPOSED DESIGN:
XTRENCH BED.ATGRADE.MOUND.HOLDING TANK.PRESSURE DIST.GRAVITY DIST..
SEWER LINE.OUTHOUSE.OTHER.SPECIFY:______________
— SYSTEM DESIGN ON BACK —
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 PLOTPLAN
feet SKETCHING FORMIS'Scale:.grid(s) equals inch(es) equalsfeet, or
SUBMITTED BY: AL
Excavating & Trenchin*:»
-------Rt. 3 Box 6SA----------
^Wadena, MN 56482
----------631-3389--------------
SIGNATURE:
/(? - z. -o<=>DATE:FIRM NAME:
MPCA LICENSE #:ADDRESS:
2^ I ^LICENSE CATEGORY:
300 ^
2
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BK— 0496 - 029 281,183 • Victor Lund*»n Co . Printers ■ Fergus Fslls. MN • 1‘800*346>4870
4-:)l + p^c-k
, APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM
LAND & RESOURCE MANAGEMENT
OTTER TAIL COUNTY COURT HOUSE
121 W. JUNIUS AVE. • SUITE 130
Phone: (218) 739-2271 • FERGUS FALLS. MN 56537
WHITE - Offic9.
YELLOW-L & R Inspector
PINK - Owner / Contactor
Permit No.PLEASE PRINT OR TYPE ALL INFORMATION
TWP NAMETWP NO.RANGELAKE/RIVER
CLASS
SECTIONLAKE NUMBER LAKE/RIVER NAME
4 b /r 5- /V/6ILr
E-911 ADDRESSPARCEL NUMBER (S)
o (^zo y OO/
W
LEGAL DESCRIPTIONScLL-i s B ^ c 1
Daytime Phone No.Mailing AddressFirstInitialLast Name
/■L /,•/ -T.,JJZ
7
t\ Yc I i^cf/ ZZVProperty
Owner 4^ ‘i ^ r y O-i'4-x r~t^. ! A! S7/- q ;> f/-1
b> e>>7 j-Contractor
Lie.#p <ff
f ^ CK y-
4/(>-IO (^0 AM.
P.M.the year of .at.► This System will be ready for inspection on.
This space for office use only ]
^ Date Received A.M. P.M.
R OfficialTime Received
SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF INSTALLATION DRAINFIELQ,;TANK(1 ) System
( 2 ) Holding Tank (Alarm Required)
( 3 ) Septic Tank
(4^ Lift Station (Alarm Required)((s^rainfieid
( A ) Trenches, Rock ( B ) Seepage Bed
(^Trenches, Graveiess ( D ) Mound
(tE ) trenches, Chamber ( F ) At-grade
-r^
Gis.Size
//era Ft.Ft.Setback to nearest weil \
•yiT) Ft.Ft.Setback to OHWL (lake, river, wetland)
V Ft.Ft.Setback to dwelling O
/ O Ft.Ft.Setback to non-dwelling
^ 0 Ft.Ft.(6) Ooiiector Setback to property line
(7) Outhouse
( 8 ) Greywater System
( 9 ) Sewer Line
(10) Performance
(11) Other
3 Ft.Ft.NAEievation above water table (OHWL)3# Bedrooms.
Garb. Disp. Y !
Abatement Y / (^
3 Ft.Ft.NADepth to restrictive layer in soil
(Xl Gravity
( ) Pressure
ABSORPTiON AREA FOR MOUNDS / AT-GRADES
(ATTACH DESIGN WORKSHEETS)
EFFLUENT
DISTRIBUTION
Ft^HOLDING TANK
MONITOR/DISPOSAL CONTRACT
WATER WELL DEPTH
A' ( ^ J<^—Designer___
Designer Lie. #
PERCOLATION
TEST DATA
A( )Yes
( ) No - L & R Can Not Process
•75 9
/Highest RateDate 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 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 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 Offer Tail County,
Minnesota. This permit may be revoked at any time upon violation of the Sanitation Code.
NOTE: This permit is vaiid for a period of six (6) months.
/(P/^j-':Date:7^Signatum of Property Ovtff>\jter/Agent for Owner '1t/r)0Date;
Land & Resource Managemw^t Office
TO-"ly/iJty eJe jiacnPERMIT FEE $RECEIPT NO.
TIT./J-7 ir- ?/7 A■<.Comments:
Form No. BK — 1099-003 301.772 * Victor Lundeen Co . Pnntsri • Fergus Fells. MN • 1-800-34fl-4870
SEWAGE TREATMENT SYSTEM PERMIT
INSPECTION RESULTS
Inspector must make all measurements
HOLDING
SEPTIC TANK OUTHOUSEDRAINFIELDLIFT TANKCATEGORY
Capacity 33 / fj2GLS,GLS.
Setback from Nearest Well
ftFTFT
Setback from Buried
Water Suction Pipe
-----------------------------------------Setback from Buried Pipe
Distributing Water Under Pressure
FT FT FT
'A- fO ftFTFT
Setback from Lake, Wetland or River OHWL 4^10 0 PTFTFT
Setback from Dwelling S'FT FT FT
Setback from Non-Dwelling /X____<FT FT
Setback form Nearest Property Line FTFTFT
Elevation from Bottom to Water Table / Restrictive Layer 4-3 FTFTFT
/v’/iHolding Tank/Lift Alarm YES NO
YES A/.<^Old System Pumped & Destroyed NO
SEPTIC TANK Sewer Line to Well SeparationFILTER DRAINFIELD CALCULATION
Actual Minimum
Manuf..□ YES FTX
Model #__..ft"□ NO FT 20
MOUND CALCULATION
MOUND /AT-GRADE ROCK REDUCTIONInspector’s Comments:
ABSORBTION AREA inchestrenches with
oTrecl^Dneletpipe for <-<->
33/
Ft. X %
.Ft2 .ft" DF.reduction / equivalent to
JSKETCH:
t7
I
(Print Inspector's NameIi
Inspector's Signature
Date / Time of Inspection
^installation Approved
L & R Official Initial / Date
Department of
LAND & RESOURCE MANAGEMENT
COUNTY OF OTTER TAIL
Phone; (218) 739-2271
Court House
FERGUS FALLS, MINNESOTA 56537
November 20, 2000
Judith A Held
RR 1 Box 584
OttertaiI MN 56571-9781
RE: Sewer Permit #13948, Parcel 47000300201001, Rush Lake (56-141);
Dear Ms Held,
I have not received a response to my previous letter (copy enclosed). This sewage system
installation is a violation of the Shoreland Management Ordinance and Sanitation Code of
Otter Tail County. Therefore, we will require that any portion of the Drainfield that is not in
compliance be removed. This will need to be completed before November 30, 2000. We
must be notified at least 4 hours in advance of project completion so we can reinspect.
Please contact this office if you have any questions.
Sincerely ///tV
Patrick Eckert
Inspector
Rtu
Department of
LAND & RESOURCE MANAGEMENT
COUNTY OF OTTER TAIL
Phone: (218) 739-2271
Court House
FERGUS FALLS, MINNESOTA 56537
October 12, 2000
Judith A Held
RR1 Box 584
OttertailMN 56571-9781
RE; Sewer Permit #13948, Parcel 47000300201001, Rush Lake (56-141)
Dear Ms Held,
On October 10, 2000 I inspected the installation of your new drainfield addition. Two items I
found wrong and need to be corrected are the distances between the drainfield and a deck
and an RGU. Both items are less than 20 feet from the drainfield. Please contact this office
before October 27, 2000, in regards to this matter.
Sincer^
Patrick Eckert
Inspector
CERTIFICATE OF APPROVAL
SEWAGE SYSTEM
'fi
9721stFeb r u-3r \)p-Utis certificate has been issued this
to certify that the sewage system installed as per sewage permit number indicated below has been approved for use
day of 19 mmIIiMby Otter Tail County, Minnesota.
a;11 The premises covered by this certificate are legally described as:l-JfMTwp. Name135Range56-141 30Lake No.Sec.Twp.
mi
30 135 38 13. 74
SUB LOTS B C OF
GOVT LOT 2
FX TRS
WILD WALLEYE RESORT
i)
iM
m.HELCL, JUDITH A%Owner: Name
mi.RR 1 BOX 534, QT TEFMAIL, NNAddress
mm 56571Zip No.
IT”IQ 971Permit No. SP
(System services Office/Dwelling)Signed by:
Land & Resource Management Official
Otter Tail County, Minnesota alu
MKL-0987001
It.
mm
JT 279005 VktorLnndeen Co.. Printm,Fdgiu Falls. Minneaatt
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
/077/Permit No.LEGAL
DESCRIPTION
AND
LOCATION
TWP NAMERANGESECTIONLAKE/RIVER
CLASS TWP. NO.LAKE/RIVER NAMELAKE NUMBER
IfC'O /
FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER(S)
3 0-0^0/ -Oo /(^JiT
IDENTIFICATION: Please Print All Information
Zip Code Telephone No.Mailing Address — No. Street, City and StateFirst InitialLast Name
^6SHProperty
Owner 2^/ 70
Sewage
System
Installer
Nam
¥?
A.M.
P.M.. 19.atThis System will be ready for inspection on.
This space for office use oniy SNUMBER OF BEDROOMS:
A.M.P.M19 ) YES ( ^ ) NOGARBAGE DISPOSAL: (Phone Call Rec’d ByTime Rec’dDate Rec’d
SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM
( ) Holding tank (Alarm Required)DRAIN FIELDTANK
,/Ot^
U /OZ^O /A/C£€~j ?7V Sq Ft.Capacity( ) Septic tank -/■
S'O Ft.Ft.Distance from nearest well( Drain field
( ) Standard ( ) Bed (^) Trench
( ) Modified
( ) Mound
Ft.Ft.Distance from lake or stream
jo/>Id c>Ft.Distance from building
JO /o Ft.Ft.Distance from property line
EFFLUENT DISTRIBUTION
( X) Gravity
( ) Pressure
Ft.Ft.Distance from bottom to Water Table
All distances are shortest distance between nearest points
WATER WELL DEPTH:
PE^OLATION TEST DATA: Date of First Test
Date of Second Test
f/ 1st T4stCTaken By^ ^ _______First Test
Rate, 19
{f tf Rate. 19
,s6"3
2
+ 2nd Test Rate2nd Test Taken By
Agreement: The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in strict
accordance with Ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minnesota Department
of Health. Applicant agrees that plot plan sketches and specifications submitted herewith and which are approved by Shoreland Management Officical shall become a part
of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibilty of the applicant for
the permit to notify the County Shoreland Management that the job is ready for inspection.
signature 7/ ■-5- - a 3 -DATE:
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.
fIssued Date:
Land & Resource M^agement Office
2 ieiifIRec #.Fee $.
*4^ \N\oLS f ^ o 'IComments:
2 4 I99fi"U!!■
rUii'I
Form No. BK-0993-003 Printers - Fergus Falls, MN • 600-346-4870268,559 • Victor LundeetI:
.‘•ar,.
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 5652
JoJ7/Permit No.
p ~Sy^S
LEGAL
! /yJt/ '/,S^£yY-^
0'H~^e^y^ yjy »
' V^. NO.^ RAMGE
DESCRIPTION
:AND rLOCATION
&
fi SECTION TWP NAMELAKE/RIVER NAME LAKE/RIVER
CLASSLAKE NUMBER
"Zf aff2>
■;)
G-0 ZO /
PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER
/ *7/ J ]^T'OCp ^ o -0^0/ -c>0 I
!>
IDENTIFICATION: Please Print All Information '
Zip Code Telephone No.Mailing Address — No. Street, City and StateInitialFirstLast Nameo~
/^■h ! ^'tSS H
______________________________________________
'?^7-^ Property
Owner Z^/ 70
y££A-^ (/(YSewage
System
Installer
Nam^
\ -y^ip ilxd^
srem will be ready for imf^ction on__y J
j/y^.■A </F ^
.7
. 19_atThis Sy
This space for office use oniy
NUMBER OF BEDROOMS:a A.M.
P.M.,19 GARBAGE DISPOSAL: ( ) YES ( ^ ) NOPhone Call Rac'd ByTime Rac’dDate Rec;^7
SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM
( ) Holding tank DRAIN FIELDTANK
Hi %r
~lTrTv Sq Ft.
//Cnjj
Js.lacity( ^) Septic tank 4 '4-
\ -Ft.listance from nearest well( ^ Drain field \
( ) Standard (
( ) Modified
( ) Mound
f^^^^Trench Ft.led-Ft.Distance from lake or stream S Q 50joAc^lA Ft. Ft.Distance from building
/o /o Ft.Ft.Distance from property line
EFFLUENT DISTRIBUTION
( X) Gravity
( ) Pressure
3 Ft.Distance from bottom to Water Table Ft.
All distances are shortest distance between nearest points
WATER WELL DEPTH:■>
1
9/b ' /O RatePERCOLATION TEST DATA: Date of First Test ^
-^p> Date of Second Test
____First Test
. 19.
, 19_y Rateist^3r
^ 7-S-?aken By 3
2+ 2nd Test Rate2nd Test Taken By
Agreement: The undersigned hereby makes application'for permit to instail or extencT 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. ,
flA-5~' a 5 /DATE:
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.
y liIssued Date:
Land & Resource Management Office
pec #.Fee $.
Comments:JL:r
1 ^U
5A/1Ha0/urj.r-La J*
Form No. BK-0993-003 sessss ■ VlclorLun(lMnCo..PiMin ■ Faigus Fala. MN - a0IF34<-4S70
INSPECTION RESULTS
Inspector must make all measurements
SEWAGE DISPOSAL SYSTEM STATISTICS
\
SEPTIC TANK DRAIN FIELD
CATEGORY Actual Minimum Actual Minimum
S fo SF S7V SFGLS.
/ 0^ FT
Capacity GLS.
FTDistance from Nearest Well FT FT50
Distance from Buried
Water Suction Pipe FT FT FT50 50
Distance from Buried Pipe
Distributing Water Under Pressure -h W FT FTFT10FT 10
't ft ^Z.OO FTDistance from Lake or River (OHWL)FT FT
^ FTDistance from Nearest Building SI 10/20 FTFTFT10
FTJi- 2,0 FTDistance from Nearest Property Line 10 FT FT10
■i-S ftDistance from Bottom to Water Table FT FT FT3
YES HOHolding Tank/Lift Alarm
Sewer Line to Well Separation DRAINFIELD CALCULATIONINTERPRETATION
OF ABBREVIATIONS
GLS. = Gallons
SF = Square Feet
FT = Linear Feet
Actual Minimum 3 5/30/30/pT X <3
J30'3 ~ gF-t' So ft FT20
-5^ -5^ 3S ^ S±J^ / OInspector’s Comments:
^ M . .
Uj/SiC^
SKETCH:
J6’'^r^uA-es^
V X '
\'.L>.
\
TX'
•ii
/nspecfor's Signatum
Dale ol Inspection
y: orK/
I/IA 5
Time of Inspection
GRID PLOT PLAN SKETCHING FORM — (Must Be To Scale)
feet/inchesScale: Each grid equais
Please sketch your lot indicating setbacks frcun road right-of-way, lake and sideyard for each building currentiy
on iot and any proposed structures. /
19 .S'- ■Z,/Dated:
^oo'tz
'/
0
v>,s
r“.
3. —^
1
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IT^O'\Py
u^-eJL^
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PERCOLATION TEST DATA
LAND AND RESOURCE MANAGEMENT
Otter Tail County
Fergus Falls, MN 56537
OWNER:
^FIRSTf-l- >
LAST NAME IAddle telephone number
ADDRESS:
STR/RT.
^6 6 li
ZIP CODESTATE
Ott^TWP.
CITY
LAKE NAME TWP. NAMESEC.RANGELAKE/RIVER NO.
LEGAL DESCRIPTION:
PARCEL NUMBER
TIRE NUMBER NUMBER/BEDROOMS
— TWO TESTS ARE REQUIRED —
TEST HOLE NO. 2TEST HOLE NO. 1 Af
inches Depth To Bottom of Hole Diameter of Hole inchesinches; Diameter of Hole_^inches;Depth To Bottom of Hole
19DateI3cpth, Inches Soil Texture Soil Texture DateDepth, Inches
Test By
i>V y
7^"?____ “
Percolation
Name
Address Address
Otter Tail County
License No.
Otter Tail County
License No.
PERC TEST # 2PERC TEST # 1
PERC RATE PfraRVALfltflWUTTO WATER DEPTHINTERVAL n»qNUTBR
STARTI
WAIBR DEPTH WATER DROP TIME WATER DROP PERCRATqTIME
3,-Qo■2_li....._L‘ ‘i'-'i"
TIRB" * PRgP' PBRC~DROP PfaRC
ST^RT X......j.a...JjiL
PERC RATEPERC RATEWAJg^BPTH
WATER DROP TIME INTERVAL IMDA/TBSI WiOER DEPTH WATER DROPTIMEINTERVAL iMTNtlTEa LjL...
-l-S—5?C i R^ILLR^LL y...E.....
DROP PBRC
PERC RATE INTERVAL rMINUTBSI Water depthWAIERDROPTIME WATER DROPINTERVAL fMINUTSa
WATER^EPTH PERCRAT^
1-io.s'R^ILLREEILL 7.i Zc.Y1 J.JS..^3
f?Rb> PBRC DROP PHRC
PERC RATE INTERVAL fMINUTBSl water DEPTHWATER DROP TIME WATER DROP PERORATE
WATER DEPTHTIMEINTERVAL IMTNUTBn S L<?.bLS -----
REFILLRB^LL .3./.2=.7.
DROP PbRC'TlMli ^ DROPreRCRATBwater DEPTHTIMEINTERVAL (MINUTES)WATER DROPWATER DEPTH WATER DROP PERORATEINTERVAL (MINUTES)TIME
1QM-RB^LL
TOftJli DROP PBRC.rRE^LL / 4 ^ -
'nWE~ DROP ^bkC~
5!:7^.z..
PERORATE TIME INTERVAL (MINUTES)WATER DEPTHWATER DROP WATER DROP PERORATEINTERVAL (MINUTES)WATER DEPTHTIME
S'oS~...r.RB^LLRByLLi
'IIML ^DROP PERC/2^—jf......^DROP PBRC
PERORATE INTERVAL (MINUTES)TIME WATER DEPTHWATER DROP WATER DROP PERORATETIMEINTERVAL (MINUTBS)WjOER DEPTH....2......t‘fIMK DROP PERC
RB^LLREFILL/
TiMB" DRO^" ffiRC
Q3_i-<S2
PERO RATE TIME INTERVAL (MimnES)WA1 DEPTHWATER DROP WATER DROP PERORATEINTERVAL (MINUTES)WATER DEPTHTIME
CJ_T^E ^ DROP PERCREyLLREFILLiTil^ ^ DROP pjLcI as.its
yV. S3
AO-AXA-"^ •
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1a
COMMENTS/CALCULA TIONS:
If
t’
/i
^ z<lZy<LZ^f
250,815 — Victor Lundeen Co.. Printers, Fergus Falls, MinnesotaMKL — 0390 - 005
■•^■'^^ ■" jsfl
ov/.j *••f>-
'?■
m/,P(.(7
CERTIFICATE OF APPROVAL
SEWAGE SYSTEM
f.
W)gjv
3
Wl:M 9419THDECEMBER fiThis 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 19
mKi iS7X-
PSiThe premises covered by this certificate are legally described as:
56-141 Twp. ^ ^ ^Range ^ ^30 OTTOLake No.Sec.Twp. Name
r-
fc]M3G 135 38 13.74
SLB LOTS B SC OF
GCVT LOT 2
E> TRS
M
mm
1,.
mi mSHELCLr JL'CITH A«Owner: Name
RR 1 BOX 534/ OTTERTAIL/ MNAddress
56571Zip No.
9827APermit No. SP Ujjubuj^PSigned by:?
Land & Resource Managemenl OfTicial
Oiler Tail Counly, MinnesotaMKL-0987001
n wVi
5535
•X^!:M.
JT-272472 Viclor Lundeen Co., Primeni, Fergus Falls, Minncsoia
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
WHITE — Office
Yellow — Inspector
Pink — Owner
/^6'So-2 r Permit No.LEGAL
T^s,
DESCRIPTION
AND
LOCATION
SECTION RANGELAKE NUMBER LAKE/RIVER NAME LAKE/RIVER
CLASS
TWP TWP NAME
) s-b/HI 50 QTTO
FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER(S)
Hy-ooo-^o-og-oi 'OG/
IDENTIFICATION: Please Print All Information
Mailing Address — No. Street, City and Stale Zip CodeLast Name First Initial Telephone No.
SaxProperty
Owner S6ST/OTT^itnn-L.mnJ7
Sewage
System
Installer
UjFdFUAName
A.M.
► This System will be ready for inspection on.P.M., 19.at
This space for office use oniy
NUMBER OF BEDROOMS:cv—AA.M.
P.M19 GARBAGE DISPOSAL: ( ) YES ) NODate Rec'd Time Rec'd Phone Call Rec’d By
SEWAGE DISPOSAL SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM
( ) Holding tank
) Septic tank
Drain field
( ) Standard ( ) Bed ) Trench
( ) Modified
( ) Mound
TANK DRAIN FIELD
/C79 SqFl^OOOCapacity GIs.
■Sq/zcoqbeDistance from nearest well Ft. Ft.
bO 50Distance from lake or stream Ft.Ft.
lo/XoDistance from building 1C Ft.Ft.
10Distance from property line Ft. Ft./CEFFLUENT DISTRIBUTION
(Y ) Gravity
( ) Pressure
5Distance from bottom to Water Table Ft.Ft.
All distances are shortest distance between nearest points
WATER WELL DEPTH:
. s93Jo - XS
JQ ~
PERCOLATION TEST DATA: Date of First Test^ odC(taJ
1st Test Taken Byf)AkA/0 l^66dKJ /A-vF
, 19 Rate
9 3Date of Second Test Rate, 19
. V7. 5 , yvFirst Test + 2nd Test 2 Rate2nd Test Taken By
Agreement: The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in strict
accordance with Ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minnesota Department
of Health. Applicant agrees that plot plan sketches and specifications submitted herewith and which are approved by Shoreland Management Officical shall become a part
of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibilty of the applicant for
the permit to notify the County Shoreland Management that the job is ready for inspection.
rii,CAnr\O0DATE:
^ ^_Sigosrtlre
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 i^all respects to the Ordinance of Otter Tail County, Minnesota.
This permit rnay be revoked at any time upon violation of any said ordinances. yr Z
NOTE: Permit void if work is not commenced within six (6) months. ^ / / y /---------^
//- 3-93Issued Date:
LanFSTResource Management Office35"^Fee $.Rec it__________
(S CkA. Cry^ALilO|T\ io €)C/S/rrlc^ dytyro'^e./ci
Comments:
Form No. BK — 0292>003 260.771 — Victor Lundeen Co,, Printers, Fergus Falls, Minnesota
4 V-
•>
'i;. . .
SHORgLAND MANAGEMENT — COUNTY OF OTTER TAIL
COUNTY COURT HOUSE V
Phone: (218) 739-2271 • FERGUS FALLS, MN 56537 \
APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM
WHITE — Office
Yellow — Inspector
Pink — Owner
/'^eboi^T Permit No.LEGAL
o8>o\
DESCRIPTION
I A OOOVAND
(73.7Sc/B/Lor3 ir-K T^S.LOCATION
LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER
CLASS
SECTION TWP RANGE TWP NAME
'hS1^.5^0GD otto
PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER
i -oo/A
\
IDENTIFICATION: Please Print All Information
Last Name First Initial Mailing Address — No. Street, City and State Zip Code Telephone No.
~o------------------
Property
Owner 5^57/OTraaerjtti.,tr),0
dt'OA'______Sewage
System
Installer
Name
A.M.975-/3This System will be read)(^'^spection on., 19.P.M.at
ijO
J €>Aci\ (3
This space for office use only
NUMBER OF BEDROOMS:Ic.5-1S (/IfS9y19 GARBAGE DISPOSAL: ( ) YES ) NODate Rec'd Time Rec’d Phone Call Rec'd By
SEWAGE DISPOSAL SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM
( ) Holding tank
{)><^) Septic tank
Drain field
( ) Standard ( ) Bed ) Trench
( ) Modified
( ) Mound
TANK DRAIN FIELD
/0_79 SqF'3^000Capacity GIs.
^o/lOdQ5oDistance from nearest well Ft. Ft.(Ap
50 50Distance from lake or stream Ft. Ft.
Distance from building lO Ft. Ft.
10Distance from property line /o Ft.Ft.
EFFLUENT DISTRIBUTION
) Gravity
) Pressure
5Distance from bottom to Water Table Ft.Ft.
All distances are shortest distance between nearest points(
WATER WELL DEPTH;
• 593Jo -
Jo^ ^9)
PERCOLATION TEST DATA; Date of First Test
f\Lk^K} \io66(rrJ
. 19 Rate
7W9 3Date of Second Test . 19 Rate
1st Test Taken ByK0'(^(jCrK/ 1 . V7- yy.5First Test -I- 2nd Test
22nd Test Taken By 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 for inspection.
1 I
DATE:
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 iivall fespects 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.
7
//- 3 - 93Issued Date;
Lands' Resource Management Office35^Fee $.Rec If.
Ov^AlH’Ioa. io J Jup idI S o> A.Comments:
Form No. BK 0292-003 260,771 — Victor Lundeen Co., Printers, Fergus Fails, Minnesota
INSPECTION RESULTS
Inspector must make all measurements
SEWAGE DISPOSAL SYSTEM STATISTICS
SEPTIC TANK DRAIN FIELDCATEGORYActualMinimumActuaiMinimum
£i*/)+.cJOOO Kff ^000 =/OSo SFSOOO GLS.Capacity GLS.SF
IO"i> FTSo^ FTDistance from Nearest Well FT50 FT
Distance from Buried Water Suction Pipe FT 50 FT FT 50 FT
Distance from Buried Pipe Distributing Water Under Pressure FTicyt^ FT 10 FT 10 FT
/OO"^ FT/OO^Distance from Lake or River (OHWL)FT FT FT
FTJODistance from Nearest Building FT 10 FT FT20
FTFTDistance from Nearest Property Line 10 FT 10 FT/O
V-5Distance from Bottom to Water Table FT FT FT 3 FT
Sewer Line to Well Separation DRAINFIELD CALCULATIONINTERPRETATION
OF ABBREVIATIONS
GLS. = Gallons
SF = Square Feet
FT = Linear Feet
Actual Minimum
/odo81FTFT20 SF
Inspector's Comments:
I‘■1
- 'J
4
SKETCH:
%
•;-- i
I
r: -■
•V
Inspector’s Signature
Date of Inspection!V'oai
1''-Time of Inspection
Scale: Each grid equals feet/inches GRID PLOT PLAN SKETCHING FORM<
Dated:19
Signature
Please sketch your lot indicating setbacks from road right-of-way, iake and sideyard for each building currentiy
on lot and any proposed structures.
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MKL-0871-029 21S987®
VICTOM LUHDCCN CO.. PRINTER!. F|RCu! PALLS. HINM.' ^
K5
m •• -
1^®2^M!
W.iTi /.i:X,
CERTIFICATE OF APPROVAL
SEWAGE SYSTEMla
V K sSEPTIC TANK
19TH
iS
mM 9 ^A94DECEMBERThis 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 19 WiDl
ir.%dt
mi yTte premises covered by this certificate are legally described as:
%Twp. 3 556-141 5ec. 30 Range 38 Twp. Name O^’TOLake No.
3C 135 38 13.74
SUB LOTS B a C OF
6CVT LOT 2
EX TRS
M
fci
HELCL/ JUtITH AKKr'; ‘
Owner: Name
RR 1 BOX 584/ OTTERTAIL/ MNAddress
mn 56571Zip No.
9827BPermit No. SP
Signed by:
Land & Resource Managemenl Official
Oiler Tail County, MinnesotaMKL-0987001
’/
R33 [W
5V
JT-272472 Victor Lundecn Co.. Primers. 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
WHITE — Office
Yellow — Inspector
Pink — Owner
Permit No.LEGAL
DESCRIPTION
AND
LOCATION
SECTION TWP RANGE TWP NAMELAKE NUMBER LAKE/RIVER NAME LAKE/RIVER
CLASS
FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER(S)
IDENTIFICATION: Please Print All Information
Mailing Address — No. Street, City and Stale Zip CodeInitial Telephone No.Last Name First
Property
Owner
Sewage
System
Installer
Name
A.M.
This System will be ready for inspection on P.M., 19-at
This space for office use oniy 7NUMBER OF BEDROOMS:
A.M.
P.M19 GARBAGE DISPOSAL: ( ) YESDate Rec’d Time Rec'd Phone Call Rec'd By
SEWAGE DISPOSAL SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM
( ) Holding tank
TANK DRAIN FIELDfcZ(V) Septic tank ,■ i ^
( ) Drain field ^
O^oooCapacity GIs.Sq Ft.
50Distance from nearest well Ft.Ft.5^
5 O( ) Standard ( ) Bed ( ) Trench
( ) Modified
( ) Mound
Distance from lake or stream Ft.Ft.
Distance from building lO Ft.Ft.
lODistance from property line Ft.Ft.
EFFLUENT DISTRIBUTION
( ) Gravity
( ) Pressure
Distance from bottom to Water Table Ft. Ft.
AH distances are shortest distance between nearest points
WATER WELL DEPTH:
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
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 fhe County of Offer 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.
U-3-7 cDATE:5 cf 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 rpspects fo 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:
?>5-Landj^esource Management OfficeII 56Fee $.Rec #.
Comments:
Form No. BK — 0292-003 260,771 — Victor Lundeen 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 SYSTEIi/h
WHITE — Office
Yellow — Inspector
Pink — Owner \
■i
BLEGALPermit No.
DESCRIPTION CXro\L ‘AND 4T
LOCATION T ^ V ;
LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER
CLASS
SECTION RANGEIWP TWP NAME
PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER
i
Ik
IDENTIFICATION: Please Print All InformatioiV
First Mailing Address —No. Street, City and State Zip CodeLast Name Initial Telephone No.
OProperty
Owner '^f
!
i-.wiSewage
System
Installer
Name y\~c^
a► This System va|// be ready for inspection on - , 19.at
"7^
This space for offic&use only 7VNUMBER OF BEDROOMS:5'iO .7Date Rec'd f
A.M.
7 ' ' P.M )YES (XjNOGARBAGE DISPOSAL; (Plrone CaJI^Rec’d ByTime Rec'd
SEWAGE DISPOSAL SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM
TANK DRAIN FIELD) Holding tank
(X^) Septic tank ^ J 3
( ) Drain field ^
(Capacity i:XfS>i'tY\2oco GIs.Sq Ft.
50Distance from nearest well Ft.Ft.
( ) Standard ( ) Bed ( ) Trench
( ) Modified
( ) Mound
5 0Distance from lake or stream Ft. Ft./’*
T
Distance from building Ft.Ft.(O
|0Distance from property line Ft.Ft.
EFFLUENT DISTRIBUTION
( ) Gravity
( ) Pressure
Distance from bottom to Water Table Ft. Ft.
All distances are shortest distance between nearest points
WATER WELL DEPTH;
^ t(/\cLC/C^¥
PERCOLATION TEST DATA; Date of First Test__
Date of Second Test
il , 19__;Rate
. 19 Rate;
1st Test Taken By
First Test + 2nd Test
22nd Test Taken By 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 fhe 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.
DATE:
Signature
Permit; Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition
that the person to whom it is granted, and his agent, employees and workmen shall conform in all mspects 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-^esource Management Office7.5-7
/Rec #.Fee $.
Comments:
u I
iForm No. BK — 0292-003 260,771 — Victor Lundeen Co.. Printers. Fergus Falls. Minnesota1'C'
INSPECTION RESULTS
Inspector must make all measurements
SEWAGE DISPOSAL SYSTEM STATISTICS
SEPTIC TANK DRAIN FIELDCATEGORYActualMinimum Actual Minimum
'IcrcOCapacity GLS.GLS.SF SF
y -f- FTDistance from Nearest Well FT FT50 FT
Distance from Buried
Water Suction Pipe FT 50 FT FT 50 FT
Distance from Buried Pipe
Distributing Water Under Pressure FT FT FT10 10 FT
ttfODistance from Lake or River (OHWL)FT FT FT FT
HoDistance from Nearest Building FT 10 FT FT FT20
‘TODistance from Nearest Property Line FT FT10 FT 10 FT
Distance from Bottom to Water Table FT FT FT FT3
Sewer Line to Well Separation DRAINFIELD CALCULATIONINTERPRETATION
OF ABBREVIATIONS
GLS. = Gallons
SF = Square Feet
FT = Linear Feet
Actual Minimum
FTX
FT FT20 SF
Inspector's Comments:
SKETCH:
}
I
i
ij
Inspector's Signature
Date of Inspection
I w
Time ol Inspection ^ or
PERCOLATION TEST DATA\
LAND AND RESOURCE MANAGEMENT
Otter Tail County
Fergus Falls, MN 56537
OWNER:
70fi'
TELEPHONE NUMBERMIDDLEFIRSTLAST NAME
ADDRESS:
/V)/V
ZIP CODESTATECITYSTR./RT.
orrc>
TWP. NAMERANGESEC. TWP.LAKE NAMELAKE/RIVER NO.
LEGAL DESCRIPTION:
PARCEL NUMBER
y
LkliFIRE NUMBER NUMBER/BEDROOMS
— TWO TESTS ARE REQUIRED —
TEST HOLE NO. 2TEST HOLE NO. 130"
Depth To Bottom of Hole inches; Diameter of Hole inches.inchesinches; Diameter of Hole,Depth To Bottom of Hole
8
^ «iv. ,
^3 )6-^-819 19Date DateSoil Texture y Soil TextureDepth, Inches Depth, Inches
AhSU^-S>-CscJ^ Percolation
;63»»«<esl By____cCat-x^ CM^uiA
T '^'1 iy
/'J8 Firm
NameName
Address Address
Otter Tail County
License No.
Otter Tail County
License No.^c>/f
PERC TEST # 2PERC TEST # 1
WKCRATB TIMB IKTBKVAL|^^fP*yT<^WATBRDBPTH WATHKDItOrPfTB»V)a.04I>HITB»WAyBK DBPTH WATBRD>Of FBRCKATBme2-/"'iO£L/(7.JJ7 / . 4'S _
Tggur^PROp "^hrc
3:^»TA^TSTART
'fuar ^ picgf fHKcLIS-
TIME IKTBKVALft*pinrrg||WAlBRPgPTH WAiatDROPWXCRAfHWATBRDBPTH WAIHRDROP reRCRATBTiwePfTBRVALfMlWtJTBg)
„S~3L38I
"HMIB' ^ droK WtRC
RB^LL Z-l-JSiREFILL
'flMB ^ PROP i^Srtc53/
INTERVAL rUIMUTBR^WATER DEPTHWATER DROP PERC RATE TIME WATER DROP PERC RATEWATER DEPTHINTERVAL rvitmrTBaTIME
S3.'i,.v-/-S-O—.J-2r-t£^—52./
‘IIMB ^ PROP PBRC
R8PILLREFILL
roan PROP p^c
L/
pnERVALflunNlfTBR^PERC RATE TIMB WATER DEPT WATER DROPWATER DROP PERC RATEWATER DBPTHTIMEINTERVAL o>miirrBm / ^,0 .J.U£a'-^0 ,7iT /
TIMB PROP Wkt
REFILL Zl.?3RBFILLy.*IL L WMB
II4E INTERVAL TMDniTEt)WATER DBPTH Wi^ERDROPPERC RATEWATERDEPIHWitfERDROP fERCRATEINTERVAL fMlNUTEPTIME
-2.7.^..
---
t//2-s:.IJ.ri'.i
TIMH PROP ^BRC
I i 25/ ^/.75:.3 7
Tmti" DROP PERC
REFILL/. ?S"RBFILL
J -l S<2A
PERC RATE PME INTERVAL flXINinEft WATER DEPTH WATER DROP FERCRATEWATER DROPINTERVAL TMINIHESI WATER DEPTHTIME
_9.S
.¥..A—/, 2«r I j,n{.S
raaE~^PRgp~ PBRC
/ , /.i .6^A 3 KBPILLKBFILL
S,~7 1.__J.___+TIMB dr5# PBRC
INTERVAL fMPgJTBS)PERC RATE PMB _2^.A>J.2r.^WATER DROP FERCRATEWATER PROPINTERVAL IMIWUTBP
WATBRDBPTH
~C1±±J2ii A3
TlMAt ^ PROP
REFILL
'HMM ~PROP PERC
RBFILL /3.__
nta INTERVAL nuHNIfTEftFERCRATE WATBRDBPTH
WATER DROPWimjitor.FERCRATEIWTBRVALIMINinEmw^miyTHTIME
«/v A a.3Tf fA , 6>b I X, /. si I
TIME " PROP PBRC/.r-/.<rREFILLRBFILLyy.
TIME DROP PERC
COMMENTS/CALCULA TIONS:
£mpSAuCr
>
MKL — 0390 - 005 250.B15 — Victor Lundeen Co.. Printers. Fergus Falls. Minnesota
9C<=^.
) rh ) ^
Sep-f-’L sto^poo
I- ^QfL 4te~.c.*»iu-
/o 0 K /o -c I 00
3(50/S-O- X -2 ---
/ 300 fo 7^ S(\ ^ (~
/ /C ^C-O v\ r^ » C.-/- i
J oo o L\
Lv ^ +~
f~'ci\AU^ .t ^«*W t V
* * A
L- c6 »V p-* y''J(^VaS^
|3>®S^<=» wc.-/1^/
S-f tt 1^r->^rsW\
) Po. ^C.A S i^«. 4a /
3, vr-'C®vbi »^S
")
7 -
^,0C5OI5'“'2^ .0 00I C-r)^
^72 S-y -C ^
+-L\i (~ r^,4-J O O Q ; 0
^•r
BB Ashby, lU S6309
747-2519
Ions Pusping
lorsan Perrin
PJ A Son Septic Pusping ( Bepair B#1 Box 143 Erharti, HI S6S34
Pourier, Pourrier A Jorgenson 736-6224
B»S Box 122 Fergus Falls, HI S6S37
739-4320
Petersann Pusping
John Petersann
Box 93 Bertha, HH 56437
924-2161
RAJ Septic Service
Boy A June Poaeranz
B*3 Box 170 Perhas, HI 56573
346-7436
Sever Service
Bernard Holzer
Sherbrooke Septic Service
Ross Seifert
R«4 Box lllB Pelican Rapids, HI 56572
B63-2800
South Turtle Lake Resort
Roger Haugse
R*1 Box 151 Undervood, HI 56586
826-6913
Rf5 Detroit Lakes, HI 56501
532-2673
Stros's Resort
Donald A DuHayne Stroa
The Puaper
Harold H. Davis
R«3 Box 110 Pelican Rapids, HI 56572
663-8191
Val's Septic Pusping,
Valentine Karasch
B«2 Henning, HI 56551
563-4170
fSf!-.-7^
CERTIFICATE OF COMPLIANCE
SEWAGE SYSTEM
day of_This certificate has been issued this 28 th nprptnhpr
to certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota.
The premises covered by this certificate are legally described as:
Twp. 135 Range 3830 Ottof,ake No. 56-141 Twp. Name.Sec.
Wagon Wheel Resort
Kenneth HunterName.Owner:
Adrlress nttertailj, Minnesota
56571Zip No..
Malcdfm K. Lee, Shoreland Administrator
Permit No. SP_mu Signed by:.
otter Tail County, Minnesota
MKL-087 1-009
159035 VICTOR LUXOttR I CO, rCRSOI t*LL5.
I
SHORELAIMD MANAGEMENT - COUNTY OF OTTER TAIL
COUNTY COURT HOUSE
Phone 218-739-2271 - Fergus Falls, Mn. 56537
APPLICATION fiOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM
Office;te
V low — InspectorPli..Owner
OwnerCard
/<?
IX) I Permit No.___LEGAL
Date
DESCRIPTION
AND
tgy-iC)LOCATION <__y
Lake No. Lake Name Lake Classif.Sec.TWP Range TWP Name
IDENTIFICATION: Please Print All Information.
Zip No.Tel. No.Initial Mailling Address —No. Street, City and StateLast Name First
lA "hlx /h.x\.OWNER
SEWAGE
SYSTEM
INSTALLER
Name.
This System will be ready for inspection on., 19.
This space for office use only
.19 .M
Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signature
NUMBER OFJE&fteeiVtSrESTIMATED COST:
SEWAGE DISPOSAL SYSTEM DATA:
SEPTIC TANK SEEPAGE PIT .. DRAIN FIELD ^^30
/35t:> g's.Sq. Ft.Sq. Ft.Capacity
Ft.Ft.Ft.s~oDistance from nearest well 3=0
go Ft.Ft.Ft.Distance from lake or stream ‘TO
Ft.Ft.Ft.Distance from occupied building LD.
Distance from property line Ft.Ft.Ft./O /Q
y.Ft.Ft. Ft.Distance from bottom to Water Table
All 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
/
2
(IFirst Test -I- 2nd Test 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.)
/>L
Signature
Dated.
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 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
V-Fee Surcharge $
I y/J-ST
)A 'A . yo 3
Comments:.Cc
viCToa LuNBCEN 4 CO., aanafcet. rt*6us rw.L*. hiForm No. MKL-0771-003 NN158906
SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL
COUNTY COURT HOUSE
Phone 218-739-2271 - Fergus Falls, Mn. 56537
APPLICATION f^OR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM
W ;te - Office
V low — Inspector OwnerPli..
Card — Owner
j
Permit No..LEGAL
Date
DESCRIPTION
AND
LOCATION
Lake No.Lake Name Lake Classif.Sec.TWP Range TWP Name
IDENTIFICATION; Please Print All Information.
Mailling Address —No. Street, City and State Tel. No.Last Name First Initial Zip No.
OWNER
SEWAGE
SYSTEM
INSTALLER
Name.
Th/S S/stem will be ready for ir/spection on.
/O'This space for office use only
\
.19 .M
Date Rec'd Time Rec'd Phone Call Rac'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.Ft.Distance from bottom to Water Table Ft.
AH distances are shortest distance between nearest points
RECORD OF TESTS;
Inspection was made on ,, 19 , Time JVI By
PERCOLATION TEST DATA:Date of First Test ., 19
, 19
, Rate
Date of Second Test ,, Rate
1st Test Taken By
First Test -F 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
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 perform the work described in the above statement. This permit is granted upon express .
Issued Date:
Shoreland Management Office
Fee $Surcharge $
Comments:.
CERTTnCATEForm No. MKL-0771-003 VICTeil LWHPCCH t CP.. PIIHTIPP. riBPUt rM.Ll. HIMH.158906/S3UE£>
t * *m
INSPECTION RESULTS
*-'• ,e
Inspector must make all measurements
SEWAGE DISPOSAL SYSTEM STATISTICS
SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORY
Actual Should be Actual Should be Actual Should be
Capacity GIs.GIs.S F S F S F S F
Distance from Nearest Well 75FF 50F 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;
7
L t
r )VV
V
///
Date of Inspection___^
Time of Inspection.,M
Signature of InspectorINTERPRETATION
OF ABBREVIATIONS
GIs - Gallons
SF » Square Feet
=■ Linear Feet
Job TitleF
AgencyMKL-0771-003>Backer
'i
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
rWhite — Office
Yellow — Inspector
Pink — Owner
Card — Owner
Permit No..j-/d /LEGAL
Date
DESCRIPTION
AND
LOCATION 3<^ >?<.-' /H /
Lake No.Lake ClassIf.Sec.TWPLake Name Range TWP Name
IDENTIFICATION: Please Print All Information.
Initial Mailling Address —No. Street, City and State Zip No.First Tel. No.Last Name
Ac r">ArOWNER
SEWAGE
SYSTEM
INSTALLER
Name.
This System will be ready for inspection on.., 19.
This space for office use only
.M.19
Phone Call Rec'd ByDate Rec'd Time Rec'd Owner or Agent Signa,ture
NUMBER OF BEDROOMS;ESTIMATED COST:
SEWAGE DISPOSAL SYSTEM DATA:
SEEPAGE PITSEPTIC TANK DRAIN FIELD
/VPGIs.Sq. Ft.Sq. Ft.Capacity
Ft.Ft. Ft.Distance from nearest well ^ r~)
Ft.Ft.Ft.Distance from lake or stream ■Sir?<~r)
,-0-nFt.Ft.Distance from occupied building Ft.
Distance from property line Ft.Ft.Ft.
iZ- 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...........
19 Rate
, 19 a A:.
,ZPERCOLATION TEST DATA:Date of First Test -I e?
/oCDate of Second Test Rate
1st Test Taken By
1 .Z IFirst Test -f 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
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 perform the work described in the above statement. This permit is granted upon express
/> y5~
Issued Date:
Sh^celand Management Office
Fee $Surcharge $
Comments:.
Form No. MKL-0771-003 ...... IS8906vieraa uiaatca • ca.,
ifC<
/
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
t
White — Office
Yeilow — inspector
Pink — Owner
Card — Owner
3 y}Permit No..LEGAL A 50 ^-33Of^Date
DESCRIPTION
AND
77 3"IfLOCATION
Lake Classif.Sec.TWPLake No. Lake Name Range TWP Name
IDENTIFICATION: Please Print All Information.
Initial Mailling Address —No. Street, City and State Zip No.Tel. No.Last Name First
/'OWNER - V-
SEWAGE
SYSTEM
INSTALLER
Name.
This System will be ready for inspection on... 19.
This space for office use only
,19_____M
Date Rec'd Phone Call Rec'd ByTime Rec'd Owner or Agent Signature
NUMBER OF BEDROOMS:ESTIMATED COST:
SEWAGE DISPOSAL SYSTEM DATA:
SEPTIC TANK SEEPAGE PIT DRAIN FIELD
GIs.Sq. Ft.Capacity Sq. F^
Ft.Ft.Ft.-1Distance from nearest well
r; :>Ft.Ft.Distance from lake or stream Ft.
Ft.Distance from occupied building Ft.Ft.
Distance from property line Ft.Ft.Ft.
Ft.Ft.Distance from bottom to Water Table Ft.
AH distances are shortest distance between nearest points
RECORD OF TESTS:
Inspection was made on , 19 , Time ,JVI By
3 /' !^ ^PERCOLATION TEST DATA:Date of First Test , 19 Rate.
19.....RateIr\Date of Second Testr- r
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 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.)
"/V >-V'-"Dated
Signature
Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express
condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota.
This permit may be revoked at any time upon violation of any said ordinance.
NOTE: Permit void if work is not commenced within six (6) months.
Permit:
Issued Date:
Shoreland Management Office
3 53 3
NOT called FOR INSPECT
Fee $)Surcharge $
Comments:.
/Form No. MKL-0771-003 158906
viero* LiiHBCdi « c«.. PHiNTtat. rcttut rAs.Lt.
■, > t>, I 't.-c ‘
••• rllftCINSPECTION RESULTS
«•* ,,*
Inspector must make all measurements
SEWAGE DISPOSAL SYSTEM STATISTICS
SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORY
Actual Should be Actual Should be Actual Should be
Capacity GIs.GIs.S F S F S F SF
Distance from Nearest Well 75F 50FF F F F
Distance from Lake or Stream F F F F F F
Distance from Occupied Building 201020F F F F F F
Distance from Property Line 10 10 10FFFFF F
Distance from Bottom to Water Table 4 4FFFFF F
Inspector's Comments:
Date of Inspection 19___
Time of Inspection,.M
‘
Signature of inspectorINTERPRETATION
OF ABBREVIATIONS
GIs = Gallons
SF = Square Feet
F * Linear Feet
Job Title
Agency
M KL-07 71-003- Backer
>
;
\
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
White — Office
Yellow — Inspector
Pink — Owner
Card — Owner
- 4-
~7 7 4kPermit No.,Uy 2 0 kN ■«- -eLEGAL
Date
DESCRIPTION
AND
3 0 I 3 > c~) 7-~?w)LOCATION
Lake Classif.Sec.TWP Range TWP NameLake No.Lake Name
IDENTIFICATION: Please Print All Information.
Zip No.Tel. No.Mailling Address —No. Street, City and StateInitialFirstLast Name
k T) fy e~t A nyi p n'AiLJr!OWNER
r.e/ <SEWAGE
SYSTEM
INSTALLER
Name.
This System will be ready for inspection on., 19.
This space for office use only
.19
Phone Call Rec'd ByDate Rec'd Time Rec'd Owner or Agent Signature
SEWAGE DISPOSAL SYSTEM DATA:
SEEPAGE PITPTIC TANK DRAIN FIELD
GIs.Sq. Ft.Sq. Ft. ,Capacity
Ft.Ft.Distance from nearest well
I( c Q y\Ft. Ft. Ft.Distance from lake or stream
/ 0 Ft.Ft.Ft.Distance from occupied building
/Distance 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 ,JVI By
PERCOLATION TEST DATA:Date of First Test 19 , Rate
Date of Second Test 19 , Rate
1st Test Taken By
-I- 2nd lieEt V 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.)
Signature
Dated
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:
A---issued Date:
Shoreland Managemi Office
on . C7JFee $Surcharge $
Comments:.
Form No. MKL-0771-003 viCTOi LuastCtt A CO . PiiMTiai. 'all*
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
White — Office
Yellow — Inspector
Pink — Owner
Card — Owner
&
Permit No.LEGAL
Date
DESCRIPTION
AND
LOCATION
TWP NameLake Classif.Sec.TWPLake Name RangeLake No.
IDENTIFICATION: Please Print All Information.
Mailling Address —No. Street, City and State Zip No.Tel. No.InitialFirstLast Name
OWNER
SEWAGE
SYSTEM
INSTALLER
Name
m9//<?This System will be ready for inspection , 19_Hon.
This space for office use only
2:^ _9LL3Cu1.m19
Phone Cal! Rec'd By Owner or Agent SignatureDate Rec'd Time Rec'd
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
Distance 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 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
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
Signature
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 perform the work described in the above statement. This permit is granted upon express
Issued Date:
Shoreland Management Office
Fee $Surcharge $NO certificate
-----------ISSUED-----Comments:.
Form No. MKL-0771-003 YICTOi LUHOCtM A ce.. MINTIAI. ri««U« SALk*. ItlliH
158906
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 75F 50FFFF F
Distance from Lake or Stream F F F F F F
Distance from Occupied Building 10 2020FFFF F F
Distance from Property Line 10 10 10FFFF F F
Distance from Bottom to Water Table 4 4FF F F F F
C-JL^'•'Cr'Inspector's Comments:
c tot)-e
■) I- 7VDate of Inspection 19___
Time of Inspection M
■L C-r Q
y/ Signature c
c
ispecto
A.
of InsINTERPRETATION
OF ABBREVIATIONS
GIs = Gallons
SF ** Square Feet
“ Linear Feet
Job TitleF
AgencyMKL-0771-003-Backer
)
Mim!)
'AU
\
sJlTCN?
CERTIFICATE OF COMPLIANCE
SEWAGE SYSTEM
mla;v'iifpifiJIday of.—January 19jUi-This certificate has been issued this 3rdH & J/A
to certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota.mmSM
m
\
WiTMml
The premises covered by this certificate are legally described as:
Range__Twp. .13S Twp. Name QttoLake No. Sec. _3d
i P SJ
telMm ra
Wagon Wheel Resort
■
Mm
iiMM
ft
\\
Kenneth HunterOwner: Name.
C.-m:Rt. 1 Ottertallf MinnesotaAddress.Pi56S71Zip No.
mPermit No. SP 225
Signed by:.
Malcolm K. Lee, Shoreland Administrator Otter Tail County, Minnesota
Two Systems OnlyMKL-087 1-009
v:;
a.■V
159035 > ='■
SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL
COUNTY COURT HOUSE
‘Vhone 218-739-2271 - Fergus Falls, Mn.
APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM
(
White — Office
Yellow — InspectorPink — Owner
Card — Owner 56537
Permit No.,
LEGAL
Date
DESCRIPTION
AND
GOSL' /Q )LOCATION
TWP TWP NameLake Classif.Sec.RangeLake NameLake No.
IDENTIFICATION: Please Print All Information.
Zip No,Tel. No.Mailling Address —No, Street, City and StateInitialFirstLast Name
kV ^ / /Vf\/Jlj n'fr^r-OWNER
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 Signature
,/rr
SEWAGE DISPOSAL SYSTEM DATA:
SEEPAGE PITSEPTIC TANK DRAIN FIELD7VGIs.Sq. Ft.Sq. Ft.Capacity
^)0 h Ft.Ft.Ft.Sn -h 7ryDistance from nearest well
SCi fFt. Ft. Ft.Distance from lake or stream -bO T
yCl ^ Ft.^ Ft./n t- Ft.Distance from occupied building
/O rDistance from property line /O Ft.Ft.Ft.
‘J-Ft. Ft.Ft.Distance from bottom to Water Table f-
AU distances are shortest distance between nearest points
RECORD OF TESTS:
Inspection was made on 19 , Time .........JVl By...........
19 Rate.
, 19...?^..., Rate
/L/zPERCOLATION TEST DATA:Date of First Test
I.Date of Second Test
1st Test Taken By
az I; I 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.)
^ Aid /> 0
Signature
Dated
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.
J[nAx 7U£LIssued Date:
Shoreland Management Office
33/Fee $Surcharge $
Comments:.t j/\^
. ^ y 0 .'■9^oO
Form No. MKL-0771-003 V>CT0« LUNOCCH I CO.. PBlHTtlll. fOOuS tkLLi .... 158906
SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL
COUNTY COURT HOUSE
Phone 218-739-2271 — Fergus Falls, Win. 56537
APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM
White — Office
Yellow — Inspector
Pink — Owner
Card — Owner
Permit No.,
LEGAL
Date
DESCRIPTION
AND
LOCATION
TWP NameTWPLake Classif.Sec.RangeLake NameLake No.
IDENTIFICATION; Please Print All Information.
Zip No,Tel. No.Mailling Address —No. Street, City and StateInitialFirstLast Name
OWNER
SEWAGE
SYSTEM
INSTALLER
Name,
This System will be ready for inspection 19.on.
This space for office use only
.19 .M
Phone Call Rec'd By Owner or Agent SignatureDate Rec'd Time Rec'd
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
Distance 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:
19Inspection was made on , 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 s: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
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 perform the work described in the above statement. This permit is granted upon express
Issued Date:
Shoreland Management Office
Fee $Surcharge $
Comments:.T
Form No. MKL-0771-003 C F RT fr ffTF...8906
, >l«
M
INSPECTION RESULTS
Inspector must make all measurements
SEWAGE DISPOSAL SYSTEM STATISTICS
SEPTIC TANK SEEPAGE PIT 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 F 50F F
Distance from Lake or Stream F F F F FT
Distance from Occupied Building 10 20 F\ 20FFFF F
Distance from Property Line 10 10FF \10FFF F
\
Distance from Bottom to Water Table 4F 4FFFF F
V
I //? r'y/AInspector's Comments:
■><
^
: --i
Date of Inspection 19.
Time of Inspection,
Signature of inspectorINTERPRETATION
OF ABBREVIATIONS
GIs = Gallons
SF « Square Feet
F » Linear Feet
Job Title
Agency
MKL-0771-00 3-Backer
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PERCOLATION TEST DATA Price $ 1.00 per pad.
SHORELAND MANAGEMENT
OTTER TAIL COUNTY
Fergus Falls, Minnesota 56537
Ph. No.
Owner:Mailing Address:
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Last Name First Zip No.Middle St. & No.City State
Legal
Description:- ><4I i?o s d TTcr
SEC.TWP.TWP NAMELAKE OR RIVER NO.NAME RANGE
TEST HOLE NO. 2TEST HOLE NO.
iT7^4’C,Depth to Bottom of Hole inches; Diameter of Hole inchesDepth To Bottom of Hole,inches;Diameter of Hole inches
n' ti ^197-2-Depth, Inches Soil Texture i Depth. Inches Soil TextureDate.19 Date
i!- /I L Percolation
Test By____
Percolation
Test By .A1 ^pPled Soc/P QHIFirm
Name.FirmName.OC
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Inches Depth In Water
Level, Inches
H Measurement,
Inches Depth in Water
Level. Inches
Time Remarks Time Remarks
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See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn.
MKL-0871-028159179 ®yiCTO* LuMOtta 4 CO aOlMTtK*. re*«uS fall!.
PERCOLATION TEST DATA Price $ 1.00 per pad.
SHORELAND MANAGEMENT
OTTER TAIL COUNTY
Fergus Falls, Minnesota 56537 Ph. No. ^6 r - 7g
Owner:Mailing Address:
f4u /c re: /j KjzJ?._L ■m
Last Name First Middle St. & No.Zip No.City State
Legal
Description:CPTTcd- /V/
SEC.TWP.TWP NAMELAKE OR RIVER NO.NAME RANGE
TEST HOLE NO. 2TEST HOLE NO. 1
L4.Depth to Bottom of Hole inches; Diameter of Hole.jnchesDepth To Bottom of Hole.Diameter of Holeinches;inches
19^Depth, Inches Soil Texture Depth, Inches Soil Texture <rDate 19
ZiT /U‘-j /- /(-■Percolation
Test By____
Percolation
Test By .6 J Bihf .cT ^ 0 ^V
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Name.
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Otter Tail County License No..Otter Tail County License No..I-C/)LUMeasurement,
Inches Depth in Water
Level, Inches
H Measurement,
Inches Depth in Water
Level. InchesTimeRemarksTime Remarks
o
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See Booklet, "How to Run a Percolation Test" by Agriculture Ext Service, Un. of Minn.
MKL-0871-028159179 ®VlCTOt LUaCEIM 4 CO ORiMTCM. fCOOuS fkLLl