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Demolition 13.0224
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(Please type or print and sign at bottom) ADDRESS 15231 Howard Road ZONING (office uses Prior Lake MN 55372 LEGAL DESCRIPTION (office use only) . LOT BLOCK ADDITION PID 25.9 32 . o 1 a . 0 OWNER SMSC (Name) (Phone) 952- 233 -4248 2330 Sioux Trail NW (Address) Prior Lake MN 55372 CONTRACTOR SMSC Public Works (Company Name) (Phone) 952- 496 -6176 (Contact Name) Jerem Gosewisch (Phone) 952- 496 -6177 (Address) Use of Building: INTERNATIONAL BUILDING CODE Single family dwelling Type of Construction: I II III IV V AB Occupancy Group: A B E F II I M R S U Division: 1 2 3 4 5 X MPCA NOTIFICATION OF INTENT TO PERFORM A DEMOLITION • I hereby certify that I have furnished information on this application 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 su mined plans. I am aware that the building official can revoke this permit for just cause. Furthermore, I hereby agree that 'city o_fir4,4 , designee may enter upon the property to perform needed inspections. ? • Signature Date _ This Application Becomes Your Demolition > i 8 �„ ,, 4 , , ` ' 2 Perini When Approved ��, $ � w ��� � . A ` �.� ® N 5 TI C- S 7 S r- / Z1 11 3 e( / 3 r Building Official Date �c�ll5 C, IZ-vv'D iz ,lt _.3. _. /cod- &�'ifrrce�a f fl S f/' iii 3.2-0-,i3 This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. .,� / i /A�/ 3/' / i Pb g Dire j Date Special Conditions, if any 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 16200 Eagle Creek Avenue, Prior Lake, Minnesota 55372 • � 1'Rjq� Site Restoration Proposal For Demolition u U" sor Applicant: SMSC 15231 Howard Lake Address: Road Prior Lake MN 55372 Check boxes below: X Fill Excavation to grade X Sod or seed all bare soils X Erosion control (see handout). Maintain erosion control until turf is established. X Cap sewer below grade.* Mark location. Licensed contractor required. X Cap water below grade.* Mark location. Licensed contractor required. X Call City of Prior Lake Public Works Department (Call 952.447.9843 or 952.447.9844) for water meter removal. X Cap gas line.* (By gas company) X Disconnect electric at meter. (By ele - I pang X Pump and fill cesspoolfs ' r ' r 'fled contractor requir- . X Abandon wei rtified contractor reguir- e" xisting well X Remove existing structure foundation and footings, materials, and debris. ** X Provide dust control by following means: O -Water mist from a water supply (i.e. neighbors, water tank) 2. Enclosure 3. Other Comments: (provide survey or draw site �••� O F PRIOR LAKE • (P Y P. c PE RM A ruwtwEw INSPECTOR M a rm � D ACCE ' ' D SUBMITTED ® ACCEPTED WITH CORRECTIONS AS NOTED O Mese comments ere tor NOT ACCEPTED - CORRECT & RESULT In aompllance teen applicable building & zoning code your intormation. M work snw be done NwNd In Ws nMwM. *Capping of utilities must be inspects THIS PLAN SET ON SITE AT ALL iimEs ** Final inspection and approval of restored site required. Deposit will be returned after approved final inspection. d " '/ //' I l Signature Date J:\HANDOUTS\Demolition Restoration.doc • 3)4k1 01Fiq 10 YTI3 W3013PI b1Al" 1 tPARY1 M4 i0.1418 (T3rnms a 8A 03T9300A CI 03TO14 $A 21401T'331RAOTM) H TIW CG3T9303A C1 TIMENZ3A S T3 3HAO.) ' 3 "f 9303A TOM way #1 440- um otufi,10410 , ti ley K +) r'• 1t:Nto l.100IOW r>Cti s rort0 pntily ui foldweico s iii r+.tr* aorlaigrnao 11th i OMIT 11A TA 3T18140 Tae YtA1.1q a' oo N ( c .--- ›-, s I VI 15 cl ui .5 ..., au 0 a (` 0 o . 0 .� 'b U Cr) N cd 0 '. 0 • CO M � c1 0 O H o i' rn — v 0 p4 Al a b ❑ 4 to b x Ei TT�� v, O 0 V 3 ° 111 o `n 0 A 0 ,� - a� o Al 4 ,y O N 1 cti 0 4 Al 7:2 E 0 cd ' —' �• t O P" -� ,© O 0 N H p ct cd U N En O e''''‘ cd 0 . a.> �-" ❑ ❑ o 0 ba �, 0 tii 'd a t go � g. W ❑ te a � a U (/ a U 0 b U -__ Fr hib_--„ A cd . 41E1 Milt co 4 a 'SA 0 2, Pm 0 r "1 o CU no rA E a ) 1 . 'c-1 V-4 'ti) k i -g Cii 0 tip rn cu t 72 , ._( -e 1 °(' ' i 6 ; . " ro,'" m 1=1 c.) . bid ''' ...... : r4E- a . " ---1 1 4. cv. 1:1-4 el ,Fri 2 -0 0 a - 8 'L) cu 0 at a) ›. '—' w ri "E 5" — ....6 0 j t .4 U Z 8. o a) . .0 . 0 , . .P., c 0 ' . rr i■I O U U A A A a ,-, vs U w Q up WELL OR 8OmNG LOCATION VESOTA DEPARTMENT OF HEALTH MIMEO Naa and Boring r — —" County Name — WELL e,IdD'BORING SEALING RECORD Minnesota H Well tsko. Minnesota statutes, Chapter 1031 or W - serves No. weems test*sm I Township Name Townstgp No. Range No Seaton No, Fraction {stn. -r. to Date Seated Date Web or Bourg Constructed Prior Lk m 4 8-31-13 unknown Montana/ Street Address or Fire Number and Cm' of Well or Bonng Location 15231 Howard Lake Rd Depth Before sealing 2 R n h. Original Depth 2 8 n ft Show exact location of wee or boring Sketch map of web or boring AOUWFER(S) STATIC WATER LEVEL in section grid with 'X`. location, snowing property rt sots Aquifer [J MubiaQuter • tines, roads. and bwId*ngs. 's" N WELUBORING 8 Measured ❑ Estimated 1111/1111111 z1 Water supply Wee 0 nit. Wen ���� Mt ❑Env. Bore Hoe Other 209 h 0 below ❑ above and surface W E CASING TYPE(S) '11 -1-- -+- T E3 Steer ❑ Plashc Q The ❑ Other _ tratie MIMI i S Diameter Depth Sam duets ze hoe? Annular space initially grouted? H .--- r mile 4 ( in from n to 151 n. 0 Yes ❑ No ❑ Yes ❑ No ❑ unknown PROPERTY OWNER'S NAME in from to ft. ❑ Yes ❑ No ❑ Yes ❑ No 0 Unknown Property owners mailing address if efferent than we focaeon address rnticcated above. in from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown 15231 Howard Lake Rd SCREEN/OPEN HOLE Prior LK Screen from to ft Open tole fret 151 to 280 ft OBSTRUCTIONS WELL OWNERS NAME ® Rods/Dropp FiPe ❑ cheat ValvetS) ❑ Debris ❑ Fib ❑ No Obstruction SMSC web owners manna address if different run property owners address Mooted above. Type of pbstructktns (Describe) Pump' pipe , wire Obstructions removed? 0 Yes ❑ No Describe PUN" Type submersible S R,.no e° ❑ Nat Present' 0 Omer GEOLOGICAL MATERIAL COLOR HARDNES FORMATION FROM TD t not brown, indicate estimated forenoon log from ewetby web or Wong METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND BORE NOTE: Drift brown m e d 0 151 w{Cf(Ne Aruxaar Space Exists ❑ Annular space grouted with Vernie ppe limerock tanlred hard 151280 07 Casing PerfaahovRerrtovai in. from to ft. ❑ Perforated ❑ Removed . in, from to ft. ❑ Perforated ❑ Removed Type of perforator i t ❑ Other GROUTING MATERtAL(S) On bag of cement 94 Ibs., one bag of bentonite = SO RIO Grouting Materel n e r'7- t r m t from 0 to 2 8 0 it. Yids 40 pays from to ft. - yards bags from to ft. yards bps from to 5. yards bags REMARKS. SOURCE OF DATA, DIFFICULTIES IN SEALING OTHER WELLS AND BORINGS Other unsealed and unused wall or boring on property? 0 Yes Q No How many? Chlorinated sand pumped with LICENSED OR REGISTERED CONTRACTOR CERTIFICATION neat cement from 280' t 0 160' This wet or totem, was sealed n a cnrdance with Minnesota Run. Chapter ftapter < 725. The information contained in this report is true to the best of my knowledge. Mineral S e Plus 1442 � r;ca>se a Asayadaaorr ro. C.ontracrartdu these , i ll f Oate Randy Storms 8 -31 -13 WORK COPY H ofPersonS eating FE- 0143405 ICE 140.04421 4/99 R Z Ai o M 0 14 W \ � H m 0 ID W 1 Z CL 1 4 ..i cn O Z • W W W o WQ d. W _ _ 1 co um, �Z OZ 7N 4. cr cc a ft i n O. H2 E w tN 0 m Cr -' k W LL m s > OV Z p 4- �n ` 0 z o 2 a GL CO W lli _ m Ocl g 1 :( 1 3 j a ,W ~W W a 4 co cc lc if � � I W Z A 0 W m Q J ' z J X ag2 1-1- o U O M z Z p I A Y Z CC cn �o co -1". W O 0 W O --� n ' W V. o s= , ;1a 0 0 LL h- H 1- ' -� CC EIC <WOmoW�,� Q a u) n- w cr — Z cnw n CL 00 Z ► 15231 Howard Lake Road 5/ 12 il ° . a ,, .. : • , Site Drawing for demolition w permit. � I Site will be c leared, fille to grade, s seede and mu lched in one day. l Approxima s tart April 15, 2 01 3` " Demolition ;4* E �� 4k,..4 Q 4 ■ ; �a "° p +.. tea-« kit ` k k M t I Approximate area � � , . of work; (Z1D -'2'. �� 3� 'te a'"'" aq } E t A5yg 3 a , � iar t 7 .f* t� r i u a gyp x ' d y 3 b4 N F , , r ' ,,..,,,� # ar a. Contractor: Shakopee Mdewakanton Sioux Commun >� ;; Rublic Works Department Contact: Eric Schlueter 952- 496 -6935 may