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Home My WebLink AboutWilson Bay Resort_08000160119002_Septic System Permits_t FIELD NOTES 52^LAKE NO. 56-DATE:LAKE NAME: • O^OMIloOlf^OOd-- FIEEAAKE NO £^]/^-e^yun(i Tr/ \Z^(/^o(5 f /^/\/ LEGAL DESCRIPTION: Parcel No ft- GL3l bU IOWNERS NAME AND ADDRESS:jsot\ So>c 273 /P7/Vos/ TYPE OF SEWAGE SYSTEM: Cesspool: ___Septic Tank / Drainfield: ___Holding Tank: ___ Septage Pit, Drywell, or Leaching Pit: ___Other: COMMENTS: SEPARATION DISTANCES fIN FEET) ABSORPTION AREA OUTHOUSETANKSEWER LINE WELL OHWL LOT LINE DWELLING NON DWELLING GROUND ELEVATION @ REASON(S) FOR ABATEMENT: /A •/"7!)t\ ^€Ci/'tr' y~0 S7ct<^ I Inspector's Signature(s)SKETCH ON BACK • • • \ I ' : \ \ \ /; .* rrf cc:U.L j i! mm 9 wm! m CERTIFICATE OF COMPLIANCE SEWAGE SYSTEM m«4 tei M Mm 19 772ndNovemberThis certificate has been issued this day of. to certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota.<5V M The premises covered by this certificate are legally described as: CandorTwp. 137 Range ^1Lake No. 56-532 Sec. 16 Twp. Name.%■■y jvTJj iy m»»fei G.L. 3Wilson Bay Resort IIim m mT» %■ pii Owner: Name Robert Wilson /..Q m ■r Detroit Lakes. MinnesotaAddress. 56501Zip No. ^8 wm2635Permit No. SP_ Signed by:.w MaloOlm K. Lee, Shoreland X^inistrator Otter Tail County, Minnesota MKL-087 1-009--Tl m ft. ®159035 SHORELAISID 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 — I nspector Ph.. — Owner Card — Owner tAJiL.'^ery^<T4. 3 Permit No..LEGAL Date DESCRIPTION AND Rt> JJ^Ai2//CLOCATION Lake No.Lake Name Lake Classif.Sec.TWP NameTWPRange IDENTIFICATION; Please Print All Information. Last Name First Initial Mailling Address —No. Street, City and StateP^ioTi* s Zip No.Tel. No. (^J/( (-5 /Ha/OWNER SEWAGE SYSTEM INSTALLER Name, Thh System will be ready for inspection on., 19. This space for office use only .19 Date Rec'd Time Rec'd Phone Call Rac'd By Owner or Agent Signa,ture NUMBER OF BEDROOMS:ESTIMATED COST:I SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK EEPAGE PIT DRAIN FIELD u±/6 O GIs.Sq. Ft.Capacity Sq. Ft. f-Ft.Ft.Ft.Distance from nearest well r-f-yr Ft.Distance from lake or stream Ft.Ft. 10^2=^Ft.Distance from occupied building Ft.Ft. i-l±LADistance from property line Ft.Ft.Ft. 4'^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 A ) "4 PERCOLATION TEST DATA: f(in^ Date of First Test , 19 . Rate Date of Second Test 19 Rate 1st Test Taken By t( ............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 herewi cial shall become a part of the permit. Applicant further agrees that no part of the system shall be co responsibility of the applicant for the permit to notify the County Shoreland Management that the i The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in ind which are approved by Shoreland Management Dffi- (d until it has been inspected and accepted. It shall be the Ts ready for inspection. (CalLor use attached mailer notice.) ^7S2 5 !/'ADated YustSIa\ Permit; Permission is hereby gfanted to the above named applicant to perform thlf work ^scribed in the above stat condition that the person to whom it is granted, and his agents, employees and workmen shall cok This permit may be revokej),at any time>ipon violation of any said ordinance. need withinsix (6) months. t. This permit is granted upon express iform in all respects to |brdinS|pces of Dtter Tail County Minnesota. \NOTE; Permit voiditworl/is not I57^\\; ^^oreland Management Office Issued Date:~ IFee $Surcharge $ nnnComments:. IJ- Form No. MKL-0771-003 158906men* ft C«.. PftiMTiaft. rciuus 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 Pi».. — Owner Card — Owner /Permit No.LEGAL 5-c (C.(c.U:r.Date7/DESCRIPTION /- AND LOCATION Lake No.Lake Name Lake Classif.Sec.TWP Range TWP Name lOENTIFICATION; Please Print All Information. Last Name First Initial Mailling Address —No. Street, City and State 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 M Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signature NUMBER OF BEDROOMS;ESTIMATED COST; SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD GIs.Capacity Sq. Ft.Sq. Ft. Ft.Ft.Ft.Distance from nearest well 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 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 -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: 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 tLFee $Surcharge $/ Comments;. r //7 U. Form No. MKL-0771-003 VICTO* LUHOiCN I C«.. eailiT[R|. r(R<Ui r^LLt. HIHn 158906 INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORY Should be Actual Should beActual Actual Should be Capacity GIs.GIs.S F S FS F S F Distance from Nearest Well 75 50F F F F F F Distance from Lake or Stream F F FF F F Distance from Occupied Building 201020FFFFF F Distance from Property Line 10 10 10FFFFF F Distance from Bottom to Water Table 4 4FFFF F F Inspector's Comments: Date of Inspection 19___ Time of Inspection M Signature of inspectorINTERPRETATION OF ABBREVIATIONS GIs » Gallons SF “ Square Feet * Linear Feet Job TitleF Agency MKL-0771*00 3-Backer • cx,^SL^ ■ /L'^ ^ i L/yiS(JV\/ ■ /. P iSY\ />lxA^it ?/ aJU^ 0'/-- 11 iTK^ Yv B-^. ; o ‘V Y-V /fly^jO^ // t^ r ff /-~ppc^ ptj^& \ Vn V-. >• //•5 6 ' i . i/n /N\y ^o \~ ) *i. Jr o 5>\ \ SHORELAiMD MANAGEMENT - COUNTY OF OTTER TAEL COUNTY COURT HOUSE Phone 218-739-2271 — Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM Office — InspectorOwner Owner V le • V low Pi... - Card — r5c^I /37,i' Cryn Permit No.. LEGAL Date UESCRiPTION /2.P-AND RP /3'? /LOCATION ! ''C-'P3'Z^As?,’ K Lake Clossif.TWP NameLake Name Soc.TWP RangeLake No. IDLNTjFICATJON: Please Print All Information. To). No.Zip No.First Initial Mailling Address —No. Street, City and StateLast Name AZ7Z3.^'^ j-DeAiO/ TOV''JN£R SEWAGE SYSTEM INSTALLER Name This System will be ready for inspection on., 19. TI' This space for office use only !19 .M Dote Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signa,ture NUMBER OF BEDROOMS;ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: fSEEPAGE PITSEPTIC TANK DRAIN field p-A-A/t>6 O gis.d z:.Sq. Ft.Ca[33city 4^ ■f ■SUL Ft.Ft.Ft.Distance from nearest well ryj•7 -rFt.Ft.Ft.Distance from lake or stream zaTl 2rCFt.Ft.Ft.Distance from occupied building f"7^/ t)lAFt.Distance from property line Ft.F,. Ft.Ft.Ft.Distance from bottom to Water Table AH distances are shortest distance between nearest points RECORD OF TESTS; 19,, Time JVI ByInspection was made on..................................................... PERCOLATION TEST DATA: * Date of First Test 'K'Aq , 19 , Rate yt-P-s T }/. }u,■; 'r Date of Second Test Rate19;\/"St Test Taken By ..i.Ty ..........2...... n .7.l71Lj.7.;First Test.....+ 2nd Test Rate P.nd Tes. Taken By I he undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work mAgreement: 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 herewjjh/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 co' responsibility of the applicant for the peri^it to notify the County Shoreland Management that thejpbj JgrBd until it has been inspected and accepted. It shall he the \s ready for inspection. (C^.^r use attached,rnailer novice.)/Ap/As PERCOLATION TEST DATA Price $1.00 per pad. SHORELAND MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Ph. No. Owner:Mailing Address:Ll) I 1^0/%/Oej-^r^c^ / 7• //e-n /Last Name Middle St. & No.Zip No.City StateLegal Description;kLAKE OR RIVER NO.NAME SEC.TWP.RANGE TWP NAME TEST HOLE NO, 2TEST HOLE NO. 1 L 24 4,Dopth to Bottom of HoleDepth To Bottom of Hole inches; Diameter of Hole.inches; Diameter of Hole inchesinches Depth, Inches Soil Texture Depth. Inches Soil TextureDate19 Date 19_____ Uilin/X C\ Kihc?. K La-L ! ^ 2APercolation Test By___ Percolation Test By____55-Q LUFirm Name.CC Firm Name.^UjiCQ. t oLU CC LU Address.CC Address < (/)Otter Tall County License No.,Otter Tail County License No^.H(/)uMeasurement, Inches Depth in Water Level, Inches H Measurement, Inches Depth in Water Level, Inches Time Remarks Time Remarks o/P 2J/j< !2 jp iPrlU J2'^’ff I /ez>l ^\P7 5-2J1 -5-2S 5 nZ) 3j5 n Q\. 1%5T%kir,ii Zj inn£_2B. [HI 11'I/)/TzJWi zw/X4 12iV//) % I?U% 1/2 zz/y^Jp c! %\kkHl fx^yfi I^ m Z Z iz: LV<. 4’V^iZJi'Vp5 5Z I 6Z^ .f:iZA TM iZULtZIM UlTk YYaiz n'Z /O A., c., /.p ry MKL-0871-028 See Booklet. "How to-Run a-Percdlation Test" by Agriculture Ext. Service, Un. of Minn. TO BE CO'r’LF.T"^ Bv ^EBCOLATIO:i TESTER I hereby attest that I ar* faniliar with the nininur; standards rec’iired by the OTTER TAIL CniTITY SH0REI_A':D 'LA'IA<”-E'ENT ORDINA^i’CE re^ardino: ser-rape svsteir.s and that the land elevation where soil absorption portion of sewase syscer. will be installed in not less chan six (6) feet above the high water level of the lake, stream or flowape involved. ■9 Legal Description: I^ejeX*• W(z>.•I Ovmers Name Signature of Perco'latbr Tester V- Lake Name"Dated Please return w’hen completed to Land and Resource 'lanagement Office, Court House, Fergus Falls, Minnesota percolation test results. 56537.Attach a copy of the .* i ! !IKL-05 74-045 TO BE COMPLErr.D BY PERSON INSTALLING SYSTEM I herah)' atte;;c thix’: minimum standards required ly the OTTER TAIL COUNTY SHOREL/uN!) MANAGEMENT ORDINANCE regarding sewage systems and that I have installed the above system in accordance with those standards. ;iTT. familiar ''nth the /3(x y ^ ^ ^ 3 If cJl&J G-lb 1st, u\yJ ILegal Description:> Fx>0*^/ U> T/S-0 H Owners Name y tav7/n? Date of Installation Date Please return when completed to Shoreland Management Zoning Office - Court House, Fergus Falls, Minnesota 56537. Myk pM mi CERTIFICATE OF COMPLIANCE SEWAGE SYSTEM 5--J2^1. mpi mpcjg te 19 7U ■30th Decemberday of_This certificate has been issued this mito certify compliance with regulations of Shoreland Management Ordinance, Otter Tail County, Minnesota.Ir.v Wi I'll Pf W'llW$ w>mSfi The premises covered by this certificate are legally described as: Range_hiLS^-S32Ser 16 Twp. 137 Twp. Name. Candot?Lake No. Wilson Bay Resort formerly called Gib Resort in G.L. 3 m fmpH fel Robert WilsonOwner: Name. rr Pit-«ft?.!kh Verf^as, MinnesotaAddress. M ^6^87Zip No. 983Permit No. SP_-I Signed by:. Malcolm K. Lee, Shoreland Administrator Otter Tail County, Minnesota MKL-087 1-009 1S903S vietan LUKorci 4 eo. rvi^rios. fcice* *ilk. umn 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 ^»nk — Owner Card — Owner & y 9^3U// 1 GJ- 3 Permit No..LEGAL /iff f/y Ca I U if (> I ?tr f Date DESCRIPTION r i^aAND Lake No. Lake Name ^on MlLOCATION Lake Ciassif.Sec.TWP Range TWP Name IDENTIFICATION: Please Print All Information. First Initial Mailling Address —No. Street, City and StateLast Name Zip No.Tel. No. Wi 1?f/\ /AkJL0 KOWNER ti..:..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 Rac'd ByTime Rec'd Owner or Agent Signa.ture NUMBER OF BEDROOMS: XESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD ~7rv GIs.Sq. Ft.Capacity Sq. Ft. T y£LFt.Ft.Ft.Distance from nearest well ~7rFt.Ft.Distance from lake or stream Ft. Ft.Distance from occupied building Ft.Ft. T-10Distance from property line Ft.Ft.Ft. VFt.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 PERCOLATION TEST DATA:Date of First Test ,, 19 . Rate , no..UlL Date of Second Test Rate 1$t Test Taken By d.f f First Test -I- 2nd Test 2nd 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.) ■T -q-/ -Dated ■.a jSignature 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. r - 3 i/- ~>d JTLIssued Date: Shoreland Managemawt Office■ T7) PJ) (tic tv 0- 6 Li'i 7 Te ^ I’'' '>d‘> ^rt ParLt o If 4y 00Fee $Surcharge $'1 Comments:. Form No. MKL-0771-003 VICTOR LUNBECM t CO.. RIIHTIRI. FIROUS FALL! 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 *iWhite - Office Y^low — Inspector — Owner Card — Owner b /oU/ ; 1 i G.L. 3 V Permit No./s - ^ V- 7 7LEGAL /b ( & I G ti Date DESCRIPTION . r I/\(I y ' *0 jX'^ 57r '-0 r aAND ^3.!Ls f h (312" {-22 ! • >, K i'k(LOCATION r / P Lake Classif.Lake No.Lake Name Sec.TWP Range TWP Name IDENTIFICATION: Please Print All Information. First Initial Mailling Address —No. Street, City and State Zip No.Tel. No.Last Name U- h ( a 0 S0OWNER J /v. •7/SEWAGE SYSTEM INSTALLER Name. r ~ ^ yThis System will be ready for inspection , 19.on.T1This space for office use only ,19 .M Date Rec'd Time Rec'd Phone Cali Rec'd By Owner or Agent Signa.ture NUMBER OF BEDROOMS: 7^ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD «2 'u GIs.Sq. Ft.Sq. Ft.Capacity j Ft.r\Ft.Ft.Distance from nearest well o — 7 .- ’o ' ,Ft.Ft.Ft.Distance from lake or stream -■ 9 Ft.Ft.Ft.Distance from occupied building '/■ ' iDistance 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 i- 7.,^q.l.2..t,-V;, 7 i /Date of Second Test'A__Rate 1st Test Taken By . /aFirst 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 fdl^h 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 isf^ady 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: r . ^Issued Date:. Shoreland Management Office . . DO 12-'Fee $Surcharge $iiUl< 2'U • D{\ Comments:, //f VICToa LUHDCtH « CO., PRINTCKO. fCHSUS fW.L*. WIMN 158906Form No. MKL-0771-003 ^ - ■ ■9 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 SF S F S F Distance from Nearest Well 75F m.F F F F F Distance from Lake or Stream F F F F F F Distance from Occupied Building 201020FFF F F F Distance from Property Line 10 10 10FFFFF F Distance from Bottom to Water Table 4 4FFF F F F Inspector's Comments: i Date of Inspection,19___ Time of Inspection M I/' Sigf^^ure of InspectorINTERPRETATION OF ABBREVIATIONS GIs == Gallons SF “ Square Feet F * Linear Feet Job Title Agency M KL-0771-003-Backer 9 I I § j >I i. If- TO BE COMFLE'Sn BY.PERSON^INSTALLING SYSTEM I hereby atcest th.a’', I familiar *witii the minimum stands "ds required by the OTTER TAIL COUNTY SKORELab-L) MANAGEMENT ORDINANJCE regarding sewage systems and that I have installed the above system in accordance with those standards. Legal Description: 1/License No, Owners Name fIn^^TTerSignatu Date of Installation ^ 7-^ Date Please return when completed to Shoreland Management Zoning Office - Court House, Fergus Falls, Minnesota 56537. 1 PERCOLATION TEST DATA Price $1.00 per pad. SHORELAND MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Ph. No.Owner:Mailing Address: Last Name First Middle Tz.ctc 3t>o^g St. & No.City Zip No.State Legal Description:£C S3C- LAKE OR RIVER NO.SEC.NAME TWP.RANGE TWP NAME TEST HOLE NO. 2TEST HOLE NO. 1 2^(p (a.Depth to Bottom of HoleDepth To Bottom of Hole,inches; Diameter of Hole.inchesinches; Diameter of Hole Inches S ~~ t. ? 197-3 € - Z3Depth, Inches Soil Texture Depth. Inches Soil TextureDate.Date r.0 - ^' C.10 idPercolation Test By____ Percolation Test By .6 SiU.5SQ UJ (L 'i-Firm Name.tr Firm Name.DoUJ oc djL>l/.uiAddress.cc Address. < COOtter Tail County License No..Otter Tail County License No.. ——1------------------------ Depth in Water Level, Inches I-CO LUMeasurement, I nches Depth In Water Level, Inches I-Measurement, InchesTimeRemarksTime Remarks O±t^S'z ^ "/gs~§/I-Y 5 VoC-fZc L> r>i D 2^7L I o THe UJaTo-K TjfSLt£31 AM g<v7~ /?g —;?a^jZjg3%3SO 3A^I/firvH T'^fo- O C<i. /L T & .____________ j, C O ■2-^Ar.hUjJckL c o y %U > o xgO 'ASi(y / Q 3 / ^2,(y KvTg </1 ■ 159179 ®MKL-0871-028 VICTOK luHOIIN 4 CO P*iMni<4. riOCUS FM.LI See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn. TO BE CnTCPLETED BY PEECOLATION TESTER I hereby attest that I am familiar with the minimum standards required by the OTTER TAIL COUNTY SHORELAND >IANAOEMENT ORDINANCE regarding sewage systems and that the land elevation where soil absorption portion of sewage system will be Installed is not less than six (6) feet above the high water level of the lake, stream or flowage involved. Legal Description: i C j ^^ Signature'of Percolator TestejT^^'Owners Name 5- -Z-V- 7V^ Lake Name Dated Please return when completed to Land and Resource Management Office, Attach a copy of theCourt House, Fergus Falls, Minnesota 56537. percolation test results. MKL-0574-045