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HomeMy WebLinkAboutWoodland Resort_14000160138000_Septic System Permits_CERTIFICATE OF APPROVAL SEWAGE SYSTEM LIFT & DRAINFIELD This Certificate has been issued this 9th of July, 1997 that the sewage system installed as per Sewage Treatment System Permit Number 11511 has been approved for use by Otter Tail County, Minnesota. , to certify K m 't,;. m The property served by this Sewage System is legally described as:iM UNPLATTED N 100' OF LOT 4 & S 161' OF N 261' EX E 368' OF LOT 4 & EX S 25' ON LAKE (TRI PIECE) WOODLAND RESORT mi •MsParcel Number(s): 14000160138000 Section; 16 Township: 135 Range: 040 Township Name: DEAD LAKE TOWNSHIP Lake Number: 56-383 Lake Name: DEAD 21Ik; 1li Current Property Owner: JAMES & MIRIAM HATLEVIG Number of Bedrooms: 14 Bedrooms & 5 campsites Land & Resource Management Official 264.709 • Victor Lundeen Co . Printers • Fergus Falls. MN • 1-600-346-4870 APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYSTEM r WHITE — Office Yellow — Inspector Pink — Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218)739-2271 - FERGUS FALLS, MN 56537 \=>T (/F GlM - VaJoc3&UAiJL> * *)0 llot o-f /O C.X t of Icf^ Ci^ Lists //5//LEGAL Permit No. DESCRIPTION f Abatement:) NoAND LOCATION LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS SECTION RANGE TWP NAMETWP. NO.SL'ZS'h bfcAb HO\U l^5aJ t AU~ PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER /S'OOO' i4 -oiiS- coo IDENTIFICATION: Please Print All Information Last Name First Initial Mailing Address — No. Street, City and Statef&c-K ^Zip Code Telephone No. W Oo !> r Property Owner Sewage System Installer Name A.M. This System will be ready for inspection on , 19.P.M.at NUMBER OF BEDROOMS: g GARBAGE DISPOSAL: ( ) YES NO This space for office use on/y A.M. 19 P.M Date 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 (X) Trenches ( ) Bed ( ) Mound ( ) Outhouse ( ) Sewer line nearest weliP-^^V<«J»/V'^ TANK DRAIN FIELD SqFt./c'C’t G's-Capacitybuft*-. -s^5o/|0g4Distance from BO Ft.Ft. ISODistance from lake or stream Ft.Ft.»50 \o/^oDistance from building Ft.Ft.10 Distance from property line Ft.Ft./OlO 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-l^'7XPerc Tester.Date of Perc Test. IRate of 1st Test Rate of 2nd Test Average Rate Agreement: The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in strict accordance with Ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minnesota Department of Health. Applicant agrees that plot plan sketches and specifications submitted herewith and which are approved by Shoreland Management Officical shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibilty of the applicant for the permit to notify the County Shoreland Management that the job is ready for.4flspection. 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 resets 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' 7'77Issued Date: Land & Resourc^jyhSffagement Office M ® iNt^AtO fifrLA ^ AcTuf^LLj Q ^ -?A^ctL ^ ^^-000-1 coo Fee $. Comment 277.212 • Victor Lundeen Co Printers • Fergus Falls. MioneostaBK 0796-003 ' APPLICATION FOR PERMIT TO INSTALL SEWAGE TREATMENT SYS WHITE — Office Yellow — Inspector Pink — Owner LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218)739-2271 - FERGUS FALLS, MN 56537 //5//\pT af kJ lOo' cf 4 ^ )lol o-f K) cx i M f Ic'^H AS LEGAL Permit No. DESCRIPTION ^^,^■763 ( ) NoAbatement:AND LDCATION G LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS SECTION RANGE TWP NAMETWP. NO.i Vl^5I lo HOaJ c & PARCEL NUMBER(S)FIRE OR LAKE ASSOCIATION NUMBER 000- ■ Ol3,§- OOO\t L( IDENTIFICATION: Please Print All Information Last Name First Initial Mailing Address — No. Street, City and State kkt r\j Zip Code Telephone No. Property Owner W Oo M-AsiG' (^5^ r 565~7^ Sewage System Installer Name . ir at ^^^0^ NUMBER OF BEDROOMS: ^ GARBAGE DISPOSAL: ( ) YES ( ) NO This System will be ready for inspection on . 19- S' //) This space for office use only 7i3L 19 Date Rec’d Time Rec'd Phone Call Rec'd By SEWAGE TREATMENT SYSTEM DATA: MINIMUM REQUIREMENTSTYPE OF SEWAGE SYSTEM r-( ) Holding tank (Alarm Required) ( ) Septic tank station (Al^^rm required) ( X ) Drain field ' i ■() Trenches ( ) Bed ( ) Mound ( ) Outhouse ( ) Sewer line TANK DRAIN FIELD SqFt. 5g//oc /, U GIs-Capacity /OObuAL- Distance from nearest well Ft.Ft.50IIhODistance from lake or stream Ft.Ft.>5C io/4~oDistance from building Ft.Ft.ic Distance from property line Ft.Ft./olO 3Distance from bottom to Water Table Ft. Ft. EFFLUENT DISTRIBUTION ( ) Gravity ( X ) Pressure All distances are shortest distance between nearest points PERCOLATION TEST DATA: WATER WELL DEPTH :0 0.1^ f^r-JPerc Tester.Date of Perc Test. Rate of 1st Test Rate of 2nd Test Average Rate Agreement; The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in strict accordance with Ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minnesota Department of Health. Applicant agrees that plot plan sketches and specifications submitted herewith and which are approved by Shoreland Management Officical shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibilty of the applicant for the permit to notify the County Shoreland Management that the job is ready 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 respects to the Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of any said ordinances. NOTE: Permit void if work is not commenced within six (6) months./ ] Issued Date: Land & Resource J^ahagement Office1 , A . /■?(/ o 0‘y•* -Fee $./Rec #.!t r i AcTuftLcV arOComments’.iJ ^ -i , i^A 0 i I F ^ t'N f ‘ ' V " 'I -V ' OOP ' IL' O/'bH - Coo \ 277,212 ■ Vicior Lundeen Co.. Printers • Fergus Falls. MinneostaBK 0795-003 INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS DRAIN FIELDHOLDING SEPTIC TANK GLS. CATEGORY Actual Minimum SFCapacityGLS^SF FTFTDistance from Nearest Well FT FT Distance from Buried Water Suction Pipe ft FT FT FTFT 50 Distance from Buried Pipe Distributing Water Under Pressure FT FT FTFT10 a /fO FT ftDistance from Lake or River (OHWL)FT FT J~(3f ft/O 10/20 FTDistance from Nearest Building FT FT ftLZFT FTDistance from Nearest Property Line FT 10 /O-f- FTDistance from Bottom to Water Table FT FT 3 FT •( •i ES NOHolding Tank/Lift Alarm YES NOOld System Pumped & Destroyed ■a Sew^ Line to Well Separation DRAINFIELD CALCULATIONINTERPRETATION OF ABBREVIATIONS GLS. = Gallons SF = Square Feet FT = Linear Feet Actual Minimum FTX •irz.-S6 ft. s; . .FT20 SF Inspector’s Comments:r SKETCH: Time of Inspection i •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 FORM/feet, or Jnch(es) equalsgrid(s) equalsScale: SIGNATURE: DATE: MPCA LICENSE #: ^ SUBMITTED BY: / FIRM NAME: ADDRE I LICENSE CATEGORY: \- / I8ZI i ( ; . ^I ft r ; Titj~ I I 14-Iii«^i V j itl». Iif4 du^l Jpw^,pT 1 g4^Mf< » 1 1 Vr 0t^^) 281.183 • Victor London Co . Pfinieri • Forout MN • l-eOO-346-4870BK ^ 0496 — 029 SITE DATA LAND AND RESOURCE MANAGEMENT Otter Tail County Fergus Falls, MN 56537 OWNER: LAST NAME 'CfiRST TELEPHONE NUMBERMIDDLE ADDRESS: fy _ _________ /2tAX /. AfC/7 .<’csno>/yifn STR./RT.CITY STATE ZIP CODE 4^136 LAKE/RIVER NO.LAKE NAME TWP RANGE TWP. NAME LEGAL DESCRIPTION:SOIL BORING LOG COLOR & MUNSELL NO. DEPTH (INCHES)TEXTURE STRUCTURE BLOCKY PLATY PRISMATIC NONE7A0-^/qoi^o }(p^i3 %oo^ PARCEL NUMBER BLOCKY PLATY PRISMATIC NONE FIRE NUMBER /£>NUMBER OF BEDROOMS BLOCKY PLATY PRISMATIC NONE GARBAGE DISPOSAL: YES 670~f'WELL CASING DEPTH;ft.BLOCKY PLATY PRISMATIC NONE r FLOODPLAIN: YES VEGETATION: AQUATIC /TERRESTRI BLOCKY PLATY PRISMATIC NONE SLOPE AT INSTALLATION SITE:% TYPE OF OBSERVATION: / Pro Pit Boring f^e5^ iry\ tc^ej> /Lj>ecf /U) O I 2^00/^ ______________ PARENT MATERIAL:Outwash Loess Bedrock Alluvium COMMENTS:, ORIGINAL SOIL:No COMPACTED SOIL: Yes 1DEPTH OF BORING:,ft. PERC TEST # 1 PERC TEST #2- TWO TESTS ARE REQUIRED - WATER depth"INTERVAL IMINUTESlTIME WATER DROP PERC RATE TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE START START TIME DROP PERC DROP PERCTIME TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE TIME INTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATE REPILl REFILL TIME DROP PERC DROP PERCTIME INTERVAL (MINUTES)WATER DEPTH WATER DROP PERC RATE PERC RATETIME TIME INTERVAL (MINUTES)WATER DEPTH WATER DROP REFILL REFILL TIME DROP PERC DROP PERCTIME INTERVALIMINUTES)WATER DROP PERC RATETIMEWATER DEPTH PERC RATE TIME INTERVAL (MINUTES!WATER DEPTH WATER DROP REFia REFILL TIME DROP PERC TIME DROP PERC TIME INTERVAL (MINUTES) WATER DROPWATER DEPTH PERC RATE TIME INTERVAL IMINUTESI WATER DEPTH WATER DROP PERC RATE REFia REFia TIME DROP PERC TIME DROP PERCTIMEINTERVAL (MINUTES!WATER DEPTH WATER DROP PERC RATE WATER DEPTH WATER DROP PERC RATETIMEINTERVAL (MINUTESlREFILLREFILL TIME DROP PERC DROP PERCTIME INTERVAL (MINUTES)WATER DROP-PERC RATETIMEWATER DEPTH PERC RATE TIME INTERVAL (MINUTES) REFILL WATER DEPTH WATER DROPREFILL DROPTIMEDROPPERCTIME PERC TIME INTERVAL (MINUTES!WATER DROP PERC RATEWATER DEPTH PERC RATE TIME INTERVAL (MINUTES!WATER DEPTH WATER DROPREFIUREFia TIME DROP PERC DROP PERCTIME PROPOSED DESIGN: TRENCH BED.ATGRADE.MOUND.PRESSURE DIST..HOLDING TANK. GRAVITY DIST.. SEWER LINE.OUTHOUSE.OTHER.SPECIFY:______________ — SYSTEM DESIGN ON BACK — Memorandum To: Mr. James Hatlevig From: Mr. George Ressmeyer Date: July 2,1997 Re: Drain Field This letter is to give my permission for you to install a drain field on my property which is immediately adjacent to the east of your property. Geome Ressmeyer 1 \ ABATEMENT NOTICE Land and Resource Management COUNTY OF OTTER TAIL Court House Fergus Falls, MN 56537 (218)7392271 June 27, 1997 James & Miriam Hatlevig RR#1 Box 94 Richville, MN 56576 You are hereby notified that the sewage system which you maintain on the following described property: Parcel #\ Lake #: Lake Name: Dead 14000160138000 56-383 N 100' of Lot 4 & S 161' of N 261' ex E 368' of Lot 4 & ex S 25' on lake (Woodland Resort) Lake Assoc/Fire #: DL92 Section: 16 Twp: 135 Range: 40 Twp. Name: Dead Lake is not constructed and/or located in accordance with minimum standards of the Shoreland Management Ordinance of Otter Tail County. Please be advised that you must correct this situation within 5 days. You should contact this office in order to determine what corrections and permits are required prior to complying with this notification. Land & Management Official 7hhjDate Resolved CHRONOLOGY REGARDING THE SEWAGE SYSTEM RBRTEMENT /l4- r )Property Owner: Cbt^ctss-Lake Name:Lake No. Parcel No.: Owner's Initial Response (date): Cr^ £)>nvi^ r ^oUyvtA^ /Utcj Df' cl ^4/ /f 4^ C-aJ^J^c^7A^/<i7 C./ / <s^7 ?A ^L^cl CCy\_ / abatement.chronology7-94 FIELD NOTES LAKE NO.: 56- 383 DATELAKE NAME: DEAD Parcel No.: 14000160138000 FIRE NO.:LEGAL DESCRIPTION 16 135 40 N 100' OF LOT 4 & S 161' OF N 261' EX E 368' OF LOT 4 & EX S 25' ON LAKE (TRI PIECE) IaJ6 0^ 3o00 Jl hook uf>s / IC8 1^12,OWNERS NAME AND ADDRESS: HATLEVIG, JAMES HATLEVIG, MIRIAM R#1 BOX 94 C> Csk>CA/^ S' 56576RICHVILLE, MN Comments: 3 Kcm-S SEPARATION DISTANCES(IN FEET) OUTHOUSEABSORPTION AREATANKSEWER LINE WELL OHWL LOT LINE DWELLING NON DWELLING GROUND ELEVATION @ REASON(S) FOR ABATEMENT: c /p^ \1 - V ah A ' .r 0 ■C'VScdsCtxsoS/s 6uS ^ 1© 5 u £ ^y<?7 V>'ao d fy\C^C^Q\^P< *J '/ ^ B^DtC^rm 'ifi ^ B><SO^<iOrv^ \ S' vcr» $T VQjuV\'»~'J 'fV\S^<L>^ rv\ N v\ •s •f"^^ VA cd 0^ V (/ sjp■ry^a 7t «pO n2_\ — X i^o\- X ^a BSDCeZjdr^}, X' ^ Seti^cf^irn^ <^v>/<iH'i S^ CCJ-vv^^^\YQ,5, /I^O Lcc> 2.SO i'^TC)pe.t' d«^ , 4"‘>vv^u <,ViO 0-0 y'1 »-V'& L'l^B ^-/-<v-fi 7$"-^ C^^'ily ^(o\f . 9 rysfW 11 j A p( 0 K>f VCj VA\-rO <i kv\ crv">^vv\ Vr^.-—<'py-s^'S)^y ^V" c\ <K ^ ^ 7V% \ <^V" 1.0^X.p^O'TCO pVi'JV^ SjyT)’f^n^lCp3S^ SC| 2\ ‘^3■X Lf^L.QX ir p. .•?r; 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 V'- ;te — Office V low Pii,. Card — Inspector Corner ^Jwner Permit No.,LEGAL Date DESCRIPTION AND Z33- 4nLOCATION Lake No.TWP NameLake Name Lake Classif.Sec.TWP Range IDENTIFICATION: Please Print All Information. Tel. No.Mailling Address —No. Street, City and StateZip No.InitialLast Name m First 31^OWNER SEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection , 19.on. This space for office use only ,19 Date Rec'd Owner or Agent SignaturePhone Call Rec'd ByTime Rec'd NUMBER OF BEDROOMS:ESTIMATED COST:/ /SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD cR/OO GIs.Sq. F Sq. Ft.Capacity /^uSd//60Ft.Ft.Distance from nearest well / Ft.Ft.Ft.Distance from lake or stream zo Ft.Ft.Ft.Distance from occupied building /d/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 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 Shpreland 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 insoected ^d accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready Jor inspegtfoil?(C^I or/^e attached mailer notice.) A Dated lignature Permission is hereby granted to the above named applicant to perform the work described in the alPermit:<e 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 rest»^ts 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 jp not commenced within six (6) months. V,kv.Issued Date: Shoreland Management Office Fee $Surcharge $ Comments:. Form No. MKL-07-71-003 ® .1 4 CO.. r(»6US ruLl. HIMN.158906 I M tu - i'G-H l,li-<4l‘l7 ' 16, - 0139 3?'3 PS 4-O-P /V- OdO ' !L ’ Otig Pc f Vf7 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* Pj».. Card Owner Owner ,4^Permit No../LEGAL Date DESCRIPTION AND ILOCATION Lake No. Lake Name Lake Classif.Sec.TWP Range TWP Name IDENTIFICATION: Please Print All Information. Tel. No.Zip No.Mailling Address —No. Street, City and StateLast Name First Initial OWNER SEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection on... 19. This space for office use only 5/19 Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signature NUMBER OF BEDROOMS;ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD GIs.Sq. Ft.Capacity Sq. Ft. Ft.Ft.Ft.Distance from nearest well Ft.Ft.Distance from lake or stream Ft. Ft.Distance from occupied building 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 ■ yRECORD OF TESTS: Inspection was made on , 19 , Time ,JW By PERCOLATION TEST DATA;Date of First Test , 19 r Rate Date of Second Test 19 , Rate 1st Test Taken By First Test -I- 2nd Test 2 Rate2nd Test Taken By The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work 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. (Call or use attached mailer notice.) Agreement: Dated Signature Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six (6) months. Permit: Issued Date: Shoreland Management Office Fee $Surcharge $/cert issuedNO Comments;. Form No. MKL-0771-003 >158906 viCTo* tuHOcev 8 e«.. minum. rce«u$ rat.Lt. 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 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: jiyv f /!y0A,y^Sd \^/C/ /Q ^ Jl <rw yf JU Srt tK V Jt^s /o oo^u/ S / Yo ff? r %foo ^ I (/h 3^ t4j?(] / od Date of Inspection 19___ Time of Inspection,M signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF “ Square Feet ■ Linear Feet Job TitleF ■ q;J;>A AgencyMKL-0771-003-Backer I \ ■ MclCIA (5 ,\4 1^ lie(|V0E*A^ 'T~0I ''H— :'-L /PERCOLATION TEST DATA 1 SHORELAND MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 - S’ Ph. Owner:IVIailinq Address:( L^/9Last Name __) ^ I stT&No: \\ Zip No. l> ^ /\ A City D-c^ lMFirst Middle State Legal Description:'3 y'" TWP. k.p,/c LAKE OR RIVEFUMO.SEC.NAME RANGE TWP NAME TEST HOLE NO. 2TEST HOLE NO. 1 6 L.? L i LDepth to Bottom of Hole.inches; Diameter of Hole.Depth To Bottom of Hole.jnchesinches; Diameter of Hole inches //Depth. Inches Soil Texture Depth. Inches Soil TextureDate19 Date \3 L iPercolation Test By____ f Percolation Test Bv -vy / C- -1.//oUJFirm Name.CC Firm Name. oUJ oc iUJAddress.GC Address < COOtter Tail County License No..Otter Tail County License No..HcoLUMeasurement, Inches Drop In Water ■Level, loches Drop In Water Level. Inches Measurement, Inches h-Time Remarks Time Remarks o JJTli'9 ^ I c /:LA 7/< 3 ^7 }I j ‘7T^/J 7/ • ? 9 L /L7_yLLAlU C ''V / r'J) 3 jb VlA 74■Ac i vjLILl t/ 7^ Jx^ri7t i ____ y/Z J? /L ^ ^ f tyX 'r ^ ^ 7-V ,T_-; Ly t-.La<a Ch'L^yC'C .-t. 7Co ooiyfioo. rioiui rM.Lt. .ton. MKL-0871-028183818 ®viCTOt Luaacta 1 See Booklet/'How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn. ■ < 4 / .. 't MINNESOTA DEPARTMENT OF HEALTH Section of Hotels, Resorts and Restaurants 717 Delaware S.E., Minneapolis, Minn. 55440 HEALTH and SAFETY INSPECTION RECORDPUBLIC c BUSINESS DATE OWNER ADDRESSLICENSEE R.O.ADDRESS 2yS^-NO. OF EMPLOYEES _, CABINS dlLie. NO.(g7/ 7Z 3 ?• Z. POSTED ^UNITS, SLEEPING ROOMSNO. OF: BEDS Mobile Home P.irk and/or Recreational Camping Area Sites _TYPE OF BUSINESS ORDERS WRITTEN BELOW MUST BE COMPLIED WITH BY DATE INDICATED // ArJ^-y y-'X /Zy^^ <2yry^ '^ i-yyy. . <y-:i^sy. f^'yyty^- ^y'ry^oy.f * ■ y’yr y" y TP - y^c 9^ ypy y:^y^€yPe-yyy yy/^^y»yy\- ■5>yz. r .-y^y' y y yyysyy^ - /» yy py.-'^ jy3^j y J yy^%4 jfipycy j^y^V (/ 2y^-y-/9^' \^LC^SEWER DIAGRAM \ COMPLIANCE PREVIOUS ORDERS YES NO DISTRICT Ol'I ICbS; I, llemidii (7SS.1K20). 2. Maiikalo (,'iH') f>02S). .1. Koclnslrr (2HS-72K')). a. Doimb (72?-'t(i42). S. Marsball (■',.17-7 I ,S I). b. Mpis, (2')b-S,l.l,S). 7. Fergus l-alls (7,7f,-fi')22). 8. Si. Cloud (2.SS-42 1 b). COPIES — Central Office, Licensee, District Office yYRelclvcflb ^i2 P^lic Hcjlih ■; 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 White — Office Yellow — Inspector Pink — Owr*er Card — Owner %Permit No..seoLEGAL Date DESCRIPTION AND y35~ W 2q ke,CLOCATION Sec.TWP Range TWP NameLake Classif.Lake No. Lake Name IDENTIFICATION: Please Print All Information. Tel. No.MaiHiog Address —No. Street, City and State KiL^UA^J-ic. Zip No,First InitialLast Name /On f O /nLf't' OWNER mSEWAGE SYSTEM INSTALLER Name This System will be ready for inspection .. 19,on. This space for office use only .M19 Phone Cal) Rec'd By Owner or Agent SignatureDate Rec'd Time Rec'd Cje>si~ SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD a sq. Ft.GIs.rq. Ft.Capacity Ft. Ft.Ft.Distance from nearest well Ft. Ft. Ft.Distance from lake or stream /o.Ft.Ft. Ft.Distance from occupied building /n /ClDistance from property line Ft.Ft.Ft. SL 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 ,JV1 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 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, sketchesand 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.) 4A? n VDatedT 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: ^/3r) />D ce (J Issued Date: anagement Offi O , Shorelandnd^anag 76 /I ioOFee $__Sl Surcharge $ klJli___^32_ ------d sad Comments:./yjiaXi Jit o. uIA fcV T ,158906Form No. MKL-0771-003 V'CTO* LUHOCCk 4 CO . rxtLli SHOREL4AND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 - Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM Wlj^e Pink Card spectorOwrter Owner 1 Permit No., • LEGAL Date DESCRIPTION AND LOCATION TWP NameLake Classif.Sec.TWP RangeLake No.Lake Name 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 on., 19. This space for office use only 19 M Phone Call Rac'd By Owner or Agent SignatureDate Rec'd Time Rec'd SEWAGE DISPOSAL SYSTEM DATA: SEEPAGE PITSEPTIC TANK DRAIN FIELD Sq. Ft.GIs.Sq. Ft.Capacity Ft.Ft. Ft.Distance from nearest well Ft.Ft.Ft.Distance from lake or stream Ft. Ft.Ft.Distance from occupied building Ft. Ft.Ft.Distance from property line 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 + 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; MOTcalled FOR INSPECT Issued Date: Shoreland Management Office Fee $Surcharge $ Comments:. .1SS906 vicTo* LuitftCCN ft ca.. Mianaft. fC««us r*LLft.Form No. MKL-0771-003 . V' '7^* (INSPECTION RESULTS Inspector must make all measurements t 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 75FF F 50F F Distance from Lake or Stream F F F F F F Distance from Occupied Building 10 20 20FFFFF F Distance from Property Line 10 10FF 10FFF F Distance from Bottom to Water Table 4F 4FFFF 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 AgencyMKL-0771-003-Backer > 4 T SHOEELANP MAMAGSE/3EMT COUNTY or OTTER TAIL rtvMw 218-739-2271 Court Nous* Forgus Faltiw RiiMiCMta 56*337 MALCOUS K. LCC, AUmlwImiO The Otter Tell County Shorelend Ordinance requires notification of out* office prior to the completion of all permitted sewagesystems. We have not received notice of the completion of your system. PleasG answer the following questions and return to our office: Name Harry L Ward Address Richville, Minn. Permit Number 168Lake Name Dead Lake eZDHas system been installed?Yea No If yes: Who installed the system? If no; Do you want the valid period of your permit extended or•terminated? 0 y I A Price $ 1.00 per pad.PERCOLATION TEST DATA SHORELAND MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Ph. No. Owner:Mailing Address: la /c Miricl 5IL Zip No.Last Name Middle St. & No. - / 3^- TWP. State T)/^/2 T> La kE TWP NAME City Legal Description:'DuA ~D lAKT NAME - 4 /t' It, LAKE OR RIVER NO.4^RANGE TEST HOLE NO. 2TEST HOLE NO. 1 c JnchesDepth to Bottom of Hole inches; Diameter of HoleDepth To Bottom of Hole.inches; Diameter of Hole inches <?>v-/.J-Depth, Inches Soil Texture Depth. Inches Soil TextureDate.19Date7 ------------- 7 PercolationCX. t V L-U ■^^—'^2 Percolation 1 C;Q LU V^ . 'V'CiT AFirm Name. Firm Name.CC 4-DaLUIT ;'t'.JLLU Address.QC Address < CO Otter Tail County License No..Otter Tail County License No..HCOLUMeasurement, Inches Depth In Water Level, Inches Measurement, Inches Depth in Water Level. Inches Time Remarks Time Remarks o jA13>^DS 7 C f; 1 6- e; 77 / .f j 7 -=L ^7? 'A.t7/•7 f%:nrr< o' t it-t <*<- -L. ----- '• c '-l^ C >-■X 7T~^^4 r L- C MKL-0871-028159179 ®viCTO* uiHOCta k c« . p*iHT(a«, fi*«us fall*, mimn. See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn. y 1 •' f t f 4