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HomeMy WebLinkAboutDemolition Permit 14-1065 DATE TIME CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED 2/L1../.3 ADDRESS 13906OU �=� OWNER CONTR. PHONE NO. PERMIT NO. !c� .-- 0 -❑ FOOTING 0 PLUMBING RI 0 EX/GRAD/FILLING O FOUNDATION 0 MECH RI 0 COMPLAINT ❑ FRAMING 0 WATER HOOKUP 0 FIREPLACE RI O INSULATION 0 SEWER HOOKUP 0 FIREPLACE FINAL $FINAL 0 PLUMBING FINAL 0 GASUNE AIR TST ❑ SITE INSPECTION + 0 MECH FINAL ❑ COMMENTS: e,+At i (a5 112Z) WORK SATISFACTORY,PROCEED ❑ CORRECT ACTION AND PROCEED ❑ CORRECT W K,CALL FOR REINSPECTION BEFORE COVERING Inspector. Owner/Contra CAL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH&SAFETY! vation �� PRIQ� CITY OF PRIOR LAKE Date Rec d DEMOLITION PERMIT 9: 2.5./4- - N,NBsort PERMIT NO./4. /Aft (Please type or print and sign at bottom) 170017 -141 e. ADDRESS ZONING(office uso) • 3 7 0 0 • 8444,11e,r 0-4/itti kid NO Cis (k). Mu S-55-7 7 - LEGAL DESCRIPTION(office use only) , LOT . BLOCK ADDITION • FID 2512./ci J 30 OWNER (Name) 5/145C, , A#h i at4; /�� / 4-r (Phone) el z-Z?3•--97 1 (Address) 233o 51/9a/ V^ //4) J9r for 4Eg .th/1-1 $ 3'7Z. • -- CONTRACTOR �^l� f (Company Name) '>/ 'l 5C- PL IdI C , RYAS• (Phone) 95Z-4/71,--6/76 (Contact Name) ��re--rIl LI AO Se—W:3 c 4 (Phone) qc Z'/'ice"6/77' (Address) 2-330 iek r, Ai& / "n gieu 53? . Use of Building;• INTERNATIONAL BUILDING CODE ( L.- s / Type of Constriction; I It III IV V A B 1 if(,Si e h 12 k,,� '4,61-4,4,-e,- Occupancy Group: A B E F H I M R S U Division; 1 2 3 4 5 [19MPCA 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 constructionwill 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, Furthermore, I hereby ahat the city official a designee may enter upon the property to perform needed inspections. "7 --At-4- • 24//, Signature �� bare • kAr ri 6+ °4 a hC.e���///Y S dl' -�...,,,JJJ((( J5, �y.�r� �q#.L _ This Application•Becomes Your De litio 1 r i (�.� 6, . yp.3'e ; P r 1 hen Approved 111 .0 „..,,.,..+•..,„ r& r{N:*. •TT1 , % ice r° D r RLQLD, ulldingOfficial _ i.- •<tc • • This is to certify that req .st in tlw abnve a.pl{cmlon and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. .rte/ .:! _ f-3/—/ .t1"mgDirector ' Data Special Conditions,if any _ • 24 hour notice for all inspections(952)447.9850,faz(952)447-4245 16200 Eagle Creek Avenue,Prior Lake,Minnesota 55372 DEPARTMENT OF PRIOR LAKE BUILDING AND INSPECTION INSPECTION ECORD SITE ADDRESS 13�aa ��"�' TYPE OF WORK ve e9 pr190 (-666" USE OF BUILDING g-e5 — PERMIT NO. ill-, 110(5 DATE ISSUED `� 3o/4 — BUILDER St4 SGP I.If � S PHONE # fo NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW THE PERMIT IS BY SEPARATE DOCUMENT INSPECTOR DATE L.MININeruJ u.. SL.S5Le1, « I PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED IMINSIIWnzosik IFINAL � I FOR ALL INSPECTIONS (952) 447-9850 SCOTT COUNTY, MINNESOTA Permit# 363970- INDIVIDUAL 6397 -INDIVIDUAL SEWAGE TREATMENT SYSTEM (ISTS) PUMPING PERMIT Owner Ls L' \3 C. Address /c3 7 90 CA 137E48 txiiy Pumper INLILKCL5 'ILL. No.of Tanks Pumped 2 Total Gallons Pumped 2060 Check all that apply: esidential ❑ Commercial ❑Rental 1 i�•eptic ❑ Holding ❑Pump Chamber ❑ Cesspool ❑ Abandoned ❑ Other:_ Condition of Baffles (baffles must be inspected) ❑Acceptable ❑Unacceptable ❑ Replaced Baffles Depth of sludge layer inches Disposal Location(be specific) Did you observe a surface discharge? ❑Yes ❑No Pumped From: ❑Maintenance Hole ❑Removed Tank Lid(stave, for example) ❑Inspection Pipe(see below) I have been informed about the correct tank cleaning procedures and understand that I risk having my system fail prematurely if the tank is not pumped through the .4 aintennnrP ole/Tank Lid to enable the removal of solids. Signature of Owner/ •wner's Agent Reason for not pum.ing thro gh the Maintenance Hole/Tank Lid jckComments s 1 v • •/ jj, it �©- Pumper/Inspector Signature yr Fair/ Date Only one permit is needed per ISTS.If ther. is more tha. one ISTS on a property,submit a separate permit for each ISIS. Submit a permit whenever a tank is pumped for abandonment.Pumping the tank does not constitute a compliance inspection. White-County Canary-Homeowner Pink-Pumper Form#1120 SCOTT COUNTY, MINNESOTA Permit# 36431. INDIVIDUAL SEWAGE TREATMENT SYSTEM (ISTS) PUMPING PERMIT !: Owner �L`-� U<. � V'C� -��5 lJ�� ' 5 Address � �� :J�o�C nrz U �ryk Pumper I ..Lk ,S J4*1-L No. of Tanks Pumped Total Gallons Pumped Z2J° Check all that apply:Residential ❑ Commercial ❑Rental 'Septic ❑ Holding ❑Pump Chamber ❑Cesspool ❑Abandoned ❑ Other: Condition of Baffles (baffles must be inspected) jaAcceptable ❑Unacceptable ❑Replaced Baffles Depth of sludge layer (Q inches Disposal Location(be specific) �! — Did you observe a surface discharge? ❑ Yes ...„ No Pumped From: ,Maintenance Hole ❑Removed Tank Lid(stave,for example) ❑Inspection Pipe(see below) I have been informed about the correct tank cleaning procedures and understand that I risk having my system fail prematurely if the tank is not pumped through the Maintenance Hole/Tank Lid to enable the removal of solids. r " Signature of Owner/Owner's Agent Reason for not pumping through the Maintenance Hole/Tank Lid Comments I t AI 6 tO �/J Pumper/Inspector Signature l'PLAA 4 A- - Date LU Only one permit is needed per ISTS.If there is more than one ISTS on a property,submit a separate permit for each ISTS. Submit a permit whenever a tank is pumped for abandonment.Pumping the tank does not constitute a compliance inspection. White-County Canary-Homeowner Pink-Pumper Form aiizo 0 CoMinntrolnesoAgencta Pollyution SSTS Abandonment, 520 Lafayette Road North Reporting Form St.Paul,MN 55155-4194 Subsurface Sewage Treatment Systems (SSTS) Program) Instructions This form is offered to meet the abandonment requirements of Minn.R.7080.2500 and Disclosure Requirements of Minn.Stat. §115.55,subd.6.Future water supply well placement can also be affected by an abandoned SSTS. The use of this form is not mandatory;however the information on this form must be submitted to the local government unit(LGU) within 90 days after the abandonment.This form may be completed by a certified SSTS practitioner or by an individual who has direct knowledge of how the system was abandoned. Property Information i� Date of abandonment: f4/V//if Reason for abandonment: lA144o 4 o(ed` Property owner name(s): $015 c Property owner's address: 2.3313 510- _ir 1 ecf.r/ //w (404 L-i City: ff:9i L ICi State: yL4,IV Zip: 53'S1 Z. JAdeN L /viaSite address(if different): /v?7D 0 �-$'+`� TJJ v �"'T — City: rj`ta-IOf�tar? Al State: Al/LJ Zip: 5 37 Compliance Information 1. All solids and liquids removed from all tanks? teYes ❑ No Disposal Site: 2. All electrical devices and devices containing mercury removed? ales 0 No Disposal Site: 3. All underground sewage tanks crushed and filled with soil or rock material? , Yes 0 No or Removed and disposed off site? 'Yes ❑No Disposal Site: — 4. Contaminated materials`removed and disposed off site? [ Yes 0 No Disposal Site: 5. All underground cavities"crushed and filled with soil or rock material? flees 0 No or: Removed and disposed off site? 0 Yes 0 No Disposal Site: 6. Future discharge to system permanently denied? gYes 0 No Method(s)used: 'Contaminated materials= Distribution media,soil or sand within three feet of the system bottom,distribution pipes,geotextile fabric/rosin paper/straw, tanks,contaminated soil around leaking tanks,any soil that received sewage from a surface failure(7080.2500 subp.3). "Underground cavities= Cesspools,leaching pits,drywells,seepage pits,vault privies,pit privies,pump chambers (7080.2500 subp. 1).Does not Include chamber media,drop boxes,or distribution boxes. www.pca.state.mn.us • 651.296.6300 • 800.657-3864 • TTY 651-282.5332 or 800-657-3864 • Available in alternative for rmaf2 wq-wwists4-03 • 11/21/08 Page Map Include location of building sewer, septic tank(s),soil dispersal system, cesspools, seepage pits, and other pits.Also include a permanent reference point(s) and dimensions. 1' North Certification I hereby certify the system was abandoned in accordance with Minn.R. 7080.25002and any local requirements. Name(please print): P4ytJ�( n tluit'ir Title: 6 /A, zrispec.i� Address: 233() S{`D�-LX rh N<A) — City: PiA;Y,V' /fr- . State: MO Zip: 37 — Phone: 152-- z 3.g--412/6S" s� License#if applicable): Date: r �8/t /4( Signature: ' `, .--r www.pca.state.mn.us • 651.296.6300 • 800-657-3864 • TTY 651-282.5332 or 800.657-3864 • Available in alternative formats wq-wwists4-03 • 11121/08 Page 2 of 2 SCOTT COUi I.TY . !NW 9i/1®UAL SE'ot &GE TREATMENT SYSTEM I d.ECT!ON FORM - Cityi wp. is) E..C,.G . ins ection Dates 5:744:1.1/(9 %t -HO t.'r�'Y0- c:<,, e�a i p / t- Permit No.,: t; Owner �. r � "d''';?' r 6,.l,� /E`Cz. ,-, rOci[X Installed for(#egdrm or gpd) -,, B siness/l d v Project Address .: fce) 700 ,-,/4147,, avt - .7. �;. „ Designer . I.i [listener Aix.: - City 0 NEW ;[ '.REPL'•ACE,._.❑ REPAIR LI-ADDITION SETBACKS: TRENCHES,BED OR GRAVELLESS•LEACHFIELD: Buildings to Tank / r Droq box .- . concrete/plastic Buildings toDrainfleid :;' Trench,D,epth A. Width•... Well(s)setback 50'or 100' _,v`'.`'.s' ;:a not Installed Trench Len'gti Distance to Lake -" Creek —Wetland •- Trench Bottom Level. yes/no Property Line(s) it, .,— Trench Spacing - Drainfleld Rock Below Pipe' ... SEPTIC/HOLDING T'ANK(S) j New ❑ Existing ` or Size of Gravelless Pipe "` Liquid Capacity • 4,17,1k,..1-..2,- - 'Actual/Expected Depth of Backfill '' .. Tank Manufacturer r.N-Z/,¢:,r,e, Absorption Area: Square Feet "`<,y� Baffle Type: Plastic Fiberglass Sanitary-T Concrete Lineal Feet "„ No. of Inspection Pipes - 4"./e"darn. M • No. &Diam.of Manhdle Access ..is„79—I PUMP INFO: No. &Height of Manhole Risers ,,Ar , " Liquid Capacity Jcmc ;:� Connections: Tank Manufacturer 1,..4.1„41.. . <n:$.w/existing No. &Height of Risers r..-7:0,.e`- ;-.=h '- MOUND OR ATGRADE: Pump Manuf. &Model No. ef.n.,a( .ZI'A` c Percent Slope r % Horsepower .- GPM Dike Width 1; up 'down 8:i` side Feet of Head .� flailed or-as per dE�sI m Drainfleld Rock Below Pipe 9•'' inches Cycles Per Day J. tailed o ias per drisfgA`- Inches of Sand Below Rock 7g upsiope downslope Gallons Per Cycle alied oras per deisjgri , Perforation Size &Spacing ;' -4 7 ' Size of Discharge Line .-----%`,.-----;1:6•'t22' Pipe Size and Spacing /;',-";",. e'0 " • Type of Electrical Hookup spas?&boX"6y'tailiCr:Z;n, Dimensions of Rock Bed rc;', T.. 9' Alarm Location gatage/15asei-hent Dimensions of Sand Base r 'X -,<,;• Alarm:cTarikAlert"/Level Alarm/Other Depth of Final Cover /g'''.,--.141) / 'r ;,u( n= .�„_,_.zCycle Cou t:r&Water Meter(Commercial) I. ALTERNATE SITE AVAILABLE J?cis; ------•-•••-,,-1., F Pre Alternative/Experimental S stern.%Pretrea#men$: ENV HLTH APPROVED DESIGN ONSITE 'Fir ,Type 4,4. A - /'” — �' Pretreatment Alarm ____ See Notes added to'Design Drawing or "f _ Drawing of System Below ,-„�°"' 1-,—,_ i ` i'r ,,4r 7 ��. f . /tom •<.t t=.d.v�;L4,4,4- •4 < ---r- If ...5--d �e r v �me-vi ...%Y% S r ?:<—). , f i .,�' _ — _.._: _ • max, • �� ter'-' Per -,,,,,;;..2 tt•1 kilt L • l F 5• . — :yrs, 1 I °`'' � / i^S St Inspector Comments: The top of all tanks must be installed 4 feet or less eiow•finai,grate tub less exempted btu I r , Inspector). Divert surface water away from or around drainfleld area. Sot! oilseed ASAP'-to_prevent soil erosion. &. ` 0 4 0 a. . C x > O 4 0 a 'V .. .ia'r I a) 0 . , L_ — �kt;«< -...,+ a +1YSr '�". "'e Tri. .;.z. , : ,,ii°*o-2,--4,...1.;.;.,,,,,,, r.••'-^...e......',,*ri�x �._,. =-S h v✓,!.. '4 ,3kwt"S`3 rb ww.r 'gaffe W§'. 5& >s,.< 01 41, Sit �• e Restoration Pro osal For Demolition Applicant: S/'/5 C-- Address: o s,`e xx %e-- Check boxes below: • 'Fill Excavation to grade Sod or seed all bare soils Erosion control (see handout). Maintain erosion control until turf is established. Cap sewer below grade.* Mark location. Licensed contractor required. a Cap water below grade.* Mark location. Licensed contractor required. a Call City of Prior Lake Public Works Department(Call 952.447.9843 or 952.447.9844) for water meter removal. S'Cap gas line.* (By gas company) Disconnect electric at meter. (By electric company) /Pump and fill cesspool/septic tank. Certified contractor required, abandon well. Certified contractor required. Existing well '>(Remove existing structure foundation and footings, materials, and debris.** Provid t control by following means: ater mist from a water supply(i.e. neighbors, water tank) 2. Enclosure 1 Other 4" 11 = OR LAKE ,.R r.T PLAN REVIEW BU Comments: (provide survey or draw site plaoT� , i/' ATE SD f PERMIT NO: EI-ACCEPTE A SUBMITTED O ACCEPTED WITH CORRECTIONS AS NOTED ❑ NOT ACCEPTED-CORRECT& RESUBMIT These comments are for your information. All work shall be done in full compliance with all applicable building&zoning code requirements Including items not specificallynoted in this review. KEEP THIS PLAN SET ON SITE AT ALL TIMES *Capping of utilities must be inspected. ** Final inspection and approval of restored site required. Deposit will be returned after approved final inspection. P64't ate Signature JAHANDOUTS\Demolition Restoration.doc