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Home My WebLink AboutDemo Permit #00-0356 & well rec ~") tA./ 6-- L- ~ /'--<- {-€-U7/Z-/J ~ I~ TO ,;::::&-~ ff{ ~A.;cy C~ h/~ CITY OF PRIOR LAKE INSPECTION NOTICE ADDRESS OWNER PHONE NO. o FOOTING o FOUNDATION o FRAMING o INSULATION WINAL o SITE INSPECTION COMMENTS: I I<€-cd "' o~/~, "I-z -Z-'45"-7g3>'S"" B r<U".,tf1 DATE TIME SCHEDULED /o.;)-rcJ/ fL/, 302.,0 154TH sf. NW CONTR. PERMIT NO. (JO -035~ o PLUMBING RI o MECH RI o WATER HOOKUP o SEWER HOOKUP o PLUMBING FINAL o MECH FINAL o EXIGRAD/FILLING o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GASLlNE AIR TST o .o6f10 ~ ) )f-woRK SATISFACT Y, P CEED o CORRECT ACT N A OCEED o CORRECT FOR REINSPECTION BEFORE COVERING Inspector: CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. Owner/Contr: CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY! INSNOTl CITY OF PRIOR LAKE DEMOLITION PERMIT 1. White - File 2. Blue - City 3. Yellow - Applicant Permit No. 00..D35(p DIRECTIONS 1. DATE BUILDING INFORMATION 7. SIZE OF STRUCTURE SPACES NUMBERED 1 THRU 10 MUST BE FILLED IN BEFORE PERMIT ISSUED (Please print or type and sign at bottom). ops/oo 8. NO. OF STORIES 2. SITE ADDRESS 3 () 2 0 3. LEGAL DESCRIPTION NW 9. TYPE OF CONSTRUCTION /5+TH ST. PID 25 - Q3t./- - O()~-O ADDITION~.3~ 71JL/:J //5 ~6f ()Z2- S.I 11. NN ~/~ l5X I JA . I w....L{. 10. COMPLETION DATE LOT BLOCK 4. OWNER (Name) 5#A/1!eO C!K... 0 eV. 5. ARCHITECT (Name) (Address) . :Tit" 1/2.-1 - "1 sr;O OeI.No.) ~ "i- -; .s...:tPO (Tel. No.) (Address) 6. CONTRACTOR (Name) (Address) (Tel. No.) I hereby certify I have furnished information which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the above mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building official can revoke this permit for just cause. Furt .,,, "ore, I hereby a~th.z?he~fficial or a designee may enter upon the property to perform needed inspections. X ~ ')A~~ ~ --- 51t~/oo / / Signature - . Oate :/ METRO SAC UNIT DETERMINATION FOR ADMINISTRATIVE USE lA57Tee.. Or {J,l!ef;)/T NO /91/65' ;e~e'o 5/5'/(10 111/ V/lv/.; I MATERIAL FILED WITH APPLICATION D CJ Site Restoration Plan CJ Utility Abandonment Plan CJSewer Abandonment USE OF BUILDING SITE RESTORATION PLAN CJ Water Abandonment Accepted by Rejected by CJ Electrical Abandonment CJ Other TYPE OF CONSTRUCTION: II III IV @ H f:P M 2 6:J 4 CREDITS Park Oed. Credit .......;?gp.T.J~.............. $ SAC Credit ............................................ ............ $ Sewer & Water Connec. Fee Credit .. ............... $ Water Tower Fee Credit ...................... .............$ o ~ -IT- -e- Occupancy Group A B E Division m~s ur en By Date Issued by Date Thi~' 0 certify lat the request in the above and accompanying documents is in accordance with the City Zoning Ordinance and ma pr ce~J re~sted. --rh.-r ~ V7J / ~~ " './ I;J(jjcJD C&,Planner J Date Other .................................................. ............ $ TOTAL CREDITS ........................ $ Special Conditions if any Site Restoration Proposal for Demolition 5i-1A.;Y) ;?-.:..X-rL ,Uc 1/. Applicant: Address: 3D 2.0 /5-1 ru- 5'.,. /\;~ LV, Check boxes below: X-Fill excavation to grade )t Sod or seed all bare soils o Erosion control (see handout) Maintain erosion control until turf is established. o Cap sewer below grade. * Mark location. Licensed contractor required. o Cap water below grade. * Mark location. Licensed contractor required. o Cap gas line.* (By gas company) - PRDPr"'(-1V'6 Ji. Disconnect electric at meter. (By electric company) - PULL- 5zS-el/ILb ~ Pump and fill cesspool/septic tanle Certified contractor required. ~Abandon well. Certified contractor required. 0 Existing well ')8lRemove existing structure foundation and footings, materials, and debris. * * Comments: (provide surveyor draw site plan) /'Ie/A./ DE-VCLoP/<1c-NT &/\/' SlTE *Capping of utilities must be inspected. **Final inspection and approval of restored site required. (2::ed fmal inspection Deposit will be returned jl'ignatore , r 5/zu /0 v Date DEMO.DOC l cH.Henner B Sons rfh 0/ - 35 WELL DRILLING FOR FOUR GENERATIONS \' wJ..eJ $ \' 15688 JARVIS STREET N.W. I ELK RIVER, MN 55330 ~.~ PHONE: (612) 427-6100 I FAX: (612) 427-0533 INCORPORATED '. / IV ( \LvI 1"1 rl t; Dear Sir or Madam, ~) [~ OJr [t 0 IV I~ r~;1 U JUN 0 8 2001~)1 By___ I --....,......~---'..:.:::-- ----:::.:.::~.::.:..-===::.. The following Well Record(s) and/or Sealing Record(s) are from the construction of new wells and/or the sealing of old wells within the past months. Please notify us if you no longer wish to retain these documents for your records, or if any of the forwarding information has changed. Thank you for your prompt attention to this matter. Please notify us if we can be of any further assistance to you. Sincerely, Emy M. White General Office Clerk An Equal Opportunity Employer WELL OR BORING LOCATION County Name scarr MINNESOTA DEPARTMENT OF HEALTH WELL AND BORING SEALING RECORD Minnesota Well and Boring Sealing No. Minnesota Unique Well No. or W-series No. (Leave blank " not known) F~ &J~ H 177379-l ~u i T'fi~'P No "e No s1*n ldnftfNlg) Mmnesota Statutes, Chapter 103/ APRIL 1. 200t T~me l..A.J{E ~.L:>l~ST'R!IT"mber and City of Well or BOring Location ". Show exact location of well or boring in section grid with "X" Sketch map of well or bOring locanon, showing property hnes, roads, and buildings N ~+-'-+---+----~--1 W~u~-. n~u_-~-----~--1 E II-LL- --Lh-~L T +++ : JI1m;~ --t-- --t-- --t-----j-- 1 ---'- ---'- ---'- S f 1m.. + CY".} ~ PROPERTY OWNER'S NAME XAAURCV"Y DEVI!LOPMENT Property owner's mailing address if different than well location address indicated above 3200 MAIN SI'R.EBT COON I.APIDS. MN S5448 WELL OWNER'S NAME SAME Well owne(s mailing address ij different than property owner's address indicated above. GEOLOGICAL MATERIAL COLOR I HARDNESS OFI FROM I TO FORMATION If not known, indicate estimated formation log from nearby well or boring. CL." YII.OCf: 8ItOWN ~ BCXJLDEItIOllVL 10 GltA VEL 170 6IlAWL 196 REMARKS, SOURCE OF DATA, DIFFICULTIES IN SEALING tmMAU.S:~ UDULOOY ROM: TIU.1l22. S34 WATEll LEVEL IN ABOVE WELL: 17"- DAD WA'J'BR L8VEL TAKEN: t lJ24I99 12S~~At:ED According to MN State Regulations LOCAL COpy JH111379 Date Sealed Dale Well or Bortng Constructed Im"8 ". ',. 27~ '1 Depth Before Sealing anginal Depth h AQUIFER(S) jC Single AqUifer 0 Mulliaqulfer WELUBORING Ii Water Supply Well o Env Bore Hole STATIC WATER LEVEL lJr Measured 0 Estimated o Monit Well o Other ft ~ below o above land sur1ace --H4" CASING TYPE(S) IV Steel 0 Plastic 0 Trle 0 Other CASING(S) Diameter ~ o Depth 1_' Set in oversize hole? Annuler space initially grouted? in. from to h. o Ves CJ.NO o Ves o No o Unknc;>wn in. from to h. o Ves o No o Ves o No o Unknown in. from to h. o Ves o No o Ves o No o Unknown SCREEN/OPEN HOLE Screen from to h. Open Hole from I_ 275 to h. OBSTRUCTIONS o Rods/Drop Pipe 0 Check Valve(s) 0 Debris 0 Fill 5i! No Obstruction Type of Obstructions (Describe) Obstructions removed? D Ves 0 No Describp PUMP SUBMERSIBLE Typo> Ii Removed 0 Not Present 0 Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND BORE HOLE: IJNo Annular Space Exists to D Annular space grouted with tremie pipe D Casing PerforationlRemoval 11') h. o Perforated 0 Removed in. from to 190) o Perforated D Removed in. from to h. ~ t Type of perforator D Other GROUTING MATERIAL(S) (One bag of cement = 94 Ibs., one bag of bentonite = 50 Ibs.) Grouting Material POIt."D..AMD from 27~ h yards .fO begs from to h yards bags from to h. yards begs from to h. yards begs OTHER WELLS AND BORINGS " Other unsealed and unused well or boring on property? D Ves fSl No How many? LICENSED OR REGISTERED CONTRACTOR CERTIfiCATION This well or boring was sealed in accordance with Minnesota Rules, Chapter 4725. The information contained in this report is true to the best of my knowledge. E. H.llRNNEll ~ SONS. JNC. 7tOl~ Contractor BUSiness~a e ~-J ~"... r :t..c...~.J Authorized R8pre8ent~ive S;gIBture-- _ -. . -. ---,,--- License or Registration /".;0. .Apil 1'2001 Date KEVIN HvIJ: "i 'to f KEVIN SCh.c;taAALEIN Name 01 Person Sealing We/lor Boring t"<" WELL OR BORING LOCATION County Name 'MINNESOTA DEPARTMENT OF HEALTH WELL AND BORING SEALING RECORD Minnesota Well and Boring Sealing No. Minnesota Unique Well No. or W-series No. (leaYe bin If not known) , IH I I 177311- ~ I'CaIT Minnesota Statutes, Chapter 103/ Date Well or BOring Constructed TiiiOame TOii;'P No Rile No se34n N~~;W_,g~ ~ ..,- N~a tr.ress or Fore Number and City of Well or Borong Location ....-1., ""A.lS.U Show exact location of welt or boring in section grid with "X. Sketch map of well or bonng location, showing property lines, roads, and buildings N ~' , , , I I I I -t-. nt-. --l--. --lu- , I I I . --,-- .-,----,--. --,--. W I I I I E ~=t=tFt T i i i i ~mi~ L__~__ --+-. u+-lt: 1 LL 1 I: I S r !mHo + Piimi~~ 19Ft Property owner's mailing address if different than well location address indicated above. 3200 MAIN S'I'1lu.I. COON RAP", ~ lei sst48 ~ER'S NAME Well owne(s mailing address if different then property owner's address indicated above ..".. GEOLOGICAL MATERIAL COLOR I HARDNESS OFI FROM I TO FORMATION If not known, indicate estimated formation log from nearby well or boring. CLAYIIlOCK. BllOWN o BOO1.DBItIOa.-iL 1& ORA VEL 110 (}RAVJi. 190 REMARKS, SOURCE OF DATA, DIFFICULTIES IN SEALING REMAlU(S:~ OEOLOOY PROM: TlI'. R22. S34 WATlUl LEVEL IN ABOVE WELL: 17.r DATE WATER. LEVEL TAKEN: llfl.f199 SEALED According to MN State Regulations LOCAL COP-" IH117371 Date Sealed APIUL 1._1 INri Depth Before Sealing 22T << Original Depth STATIC WATER LEVEL ? << I I AQUIFER(S) :jC Single AqUifer q. Multlaqulfer WELUBORING IiiI Water Supply Well 0 Monit. Well o Env Bore Hole 0 Other o above land surface ~ Measured 0 EstlfT'ated 21~ ~ I)l below CASING TYPE(S) I)f Steel 0 Plastic 0 Tile 0 Other CASING(S) Diameter .f'" o Depth 1.. Set in oversize hole? Annular space initially grouted? in. from to ~. DYes ijil No DYes o No o Unknown in. from to ~ DYes o No DYes o No o Unknown in. from to ~. DYes o No DYes o No o Unknown SCREENIOPEN HOLE ~. 160 222 ~. Screen from to Open Hole from to OBSTRUCTIONS o Rods/Drop Pipe 0 Check Valve(s) 0 Debris 0 Fill ~ No Obstruction Type of Obstructions (Describe) Obstructions removed? 0 Yes 0 No Describe PUMP SUBMRRSIBLE Type ~ Removed 0 Not Present 0 Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND BORE HOLE: 1l No Annular Spece Exists .. D Annular space grouted with tremie pipe D Casing PerforationlRemoval J:1t) o Pelforated 0 Removed in. from to <<. 190 to <<. o Pelforated 0 RemO\led in. trom ?2:~ Type of pelforator o Other GROUTING MATERIAL(S) (One bag of cement = 94 Ibs., one bag of bentonite = 50 Ibs.) Grouting Material ~ ..1oI~TLAND from ~ ~. yards 2S bags from to ~. yardS bags from to ~. yards begs from to ~. yards bags OTHER WELLS AND BORINGS Olher unsealed and unused well or boring on property? 0 Yes 0 No How many? LICENSED OR REGISTERED CONTRACTOR CERTIfiCATION This well or boring was sealed in accordance with Minnesota Rules, Chapter 4725. The intormation contained in thiS report is true to the best of my knowledge. E. H. R.ENNER.... SONS, INC. 71015 contractor8usine~ '1'._ ~ ~'.eA..... C" ~,.~ Authorized Represe,ntative S#nature License or Registration /"io. Api IS. 2001 Date KEVIN nv"'r:e I KEVIN SCIuu l.ctU.EJN Name of Person Sealing Well or Boring