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J W < J W 0 O Z f C aa5tnaa 3 W W Ui W icy 000000 p p x z oC Ce a a Ili ix J z } J Q' W 0 1.14 N 0 a V ry' � O Z in 04 0 N a o 0 co Oz O 0 w H- � a 3 ~ W �� O C7 < OH N Z a V V oC d - d1 Z - 0 - D Z W el, N w w J W 4.V0 la Will w HZa -O+ -I •W a Q O Z re z 0 0 LLLLLZ N 0 3 v ° v v C) a 0 a 000 ❑ 0 (..) 00 _ F..,1:-R-- RCITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd A. 1 -.- TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �, �� AND UTILITY CONNECTION PERMIT ((2k, I + ... t27 • 4,...,0- I. White File PERMIT NO. Pink p #.4_ 132_c_f3 Yellow Appll icant 3 Applicant (Please type or print and sign at bottom) ADDRESS ZONING(office use) / 7/4/ / Sc .4.aJZ J Gil. S. LEGAL DESCRIPTION(office use only) LOT BLOCK ADDITION PID OWNER q (Name) (Phone) ;/;z / /O?/ r'3' (Address) BUILDER (Company Name) (Phone) (Contact Name) (Phone) (Address) • TYPE OF WORK ❑New Construction ['Deck ❑Porch ❑Re-Roofing ❑Re-Siding ['Lower Level Finish ❑Fireplace ❑Addition DAlteration ['Utility Connection CODE: ❑I.R.C. ❑I.B.C. _ ❑Misc. • Type of Construction: I � II III IV V A B E Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $ Division: rl 2 3 4 5 (excluding land) u 1 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 onstruc 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 rlust e. ermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections. 9$1114/--,0/ - — Signature Contractor's License No. Date Permit Valuation Park Support Fee # $ 1 Permit Fee $ SAC # s2/485 .00 Plan Check Fee $ Water Meter Size 5/8"; 1"; $590 .00 N$ 7/40 .00 State Surcharge $ Pressure Reducer $ Penalty $ Sewer/Water Connection Fee # $ 1500 00 Plumbing Permit Fee $ 54 .50 Water Tower Fee # $ 1000 .00 Mechanical Permit Fee • $ Builder's Deposit $ Sewer&Water Permit Fee $ 56 .50 Other $ Gas Fireplace Permit Fee $ TOTAL DUE$5686 5/8 METER 01$5836.00 W/1' This Application ;- / / our :uilding Permit When pprove Paid ®!, 56l6� Receipt No. /'7 0 G Date -i/•e ( By /'4.4,7 t &AA.. " ZC if" Building Official Date 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. This document when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy,a Certificate of Occupancy must be issued. Planning Director Date Special Conditions,if any 24 hour notice for all inspections(952)447-9850,fax(952)447-4245 4646 Dakota Street Prior Lake,MN 55372 ©� a Date Rev'd` �,eITY fl PRS.QR LAI • ',' , -:..-,,,',='',,',,J','_,-„---...,.!''.".-'',,40,„-,,17!4),'::;,,.;;„;,;I,',-t''!..''..L,',',,'-,'','_i,.-.,.-.-.c..:-"...',4-1.,.:k:-fl.,;,`,Tir--,-,,,,.„-,,,'..,,--',-,'-,`-,._,, ,-, - .,,,,,,,„.„,,,,',,,,,.,`:.,,,,.,.,,.,c..',.,,.'.:'' .4,,.,',,',,-'„-,',.,,,,'..`.,_,,,:_::,,.-._,„„',-,,,,',,,c,,',,,,,,.,,,,.',,,,,.,,„'`,..,,,...,-,,-',,,,.,.,,,,-,.,,, ,'.'- , ,,,T,-,,',,'.,,,,,,'''..„'- « F PT NC104 > (Please tYPeFoz.pzint and sa u8t,bo to ,, 2 Gold i Cary „ � 3 Crold' Applican . 1II-7/,A1.4 ADI)RErJS , . ZONING(of5ce use) 1-1 1 1 fur Se,/ LEGAL Z E C.' ' `ION(bf cep epn1y °L©T ! ,„.,-,,,,-00-010,N,,,,-..„,.,-_,,:,,,,,-- PIS7 OW NE /,01,,, " '=:;1(4,0 " 03 (Address) '. ' ! q (Address)' (Cay) (Zip Code) ii .., ,, , ,...,..,„:: :,;;,„,.,-.::::,:__:_.s.„,,,...7,-...,.....,.....,,..,...Li.,.:v-4,„..7:,,,,,,,-.-- ‘2,2.,....- :- .--....._,„:.::::,,,,,.- -,„-,.--„:,---- , , {Co „ -..., ., 1 ntae Psora : (P n t ��io e} ...,,,,, ,. .,......„= „,_.„:„,,,.. ._ „.„,,,,„,,,... ,7..,,,,..„,..,.._ i . ,..,, , ,,„,„..,, . ,_ .,_,, ..„..., ._ } $t fly , j C ,, 4.; .. ��- .,— , _ ' , e r,�f ate iioe , -1#i jigs Locationf air e .��s���m�sc � ryfeet T of se e . "G,,� C D Cas�t�Iron: Es as i et �s s ., ,,,',,,i'-.1,,4 O qe ' .;,,..2-,,,,,,,°---.." ' .cot �,�- e1ocatecI( -.--' .-7r r ie ,tre tde-' .„,, ewer wa'teIune connectign $5 . .(~ ry:Id istxnal,,Com'l Mu ?-""` y Z%- o fob costwit s S1.50ininiz�aum Sewer oonaeoian;onty -$25.3.0-_,': Vater rcQnne t on othy $25.50'` tfirnated Cost:w nil i}ng r n t � A't.EI .'ERI FES STFfi? rCAR .5th PE 1 X' EE (Ofl1ce Ise Qnly) lru ppZtc tk a n es 'o Btu „ ;e?- a�eo ,pro"ved Pad ,Reeei " . P Bl[lldin*dt'fic�iai Date B 24 hour.not[ce for hU in'specti.nsw(952)447-9850,fax(952);447-4245 , '464.60.kata,.S�tireet .E„t'rior' .. . ltniuesota 55372 4 PRI° Date Rec'd cDtri CITY OF PRIOR LAKE PLUMBING PERMIT soarr . el»e File PERMIT NO. u 2.Yell App l —11 ) ) f 3 �1 J.Yellow Applicant t (Please type or paint and sign at bottom) ADDRESS ZONING(office use) 1-11141 . k_1-1. -4- LEGAL DESCRIPTION(office use only) LOT BLOCK ADDITION PID OWNER (r L(Name) C �- r ,x.1,0, -"& 11 (Phone) (DI 2-- 9190 — 2 ) 63 (Address) Plumber must sign this form even_ though Property owner is paying APPLICANT ,_:..the fee # (Name) Joilo O e-V g n (3(A-tr.-An (Phone) 1 5 Z-" 1- I-0-3 19 2. (Address) r A • .. Al ' ilic--1„'Nr4 L.4lam. (Address) (City) (Zip Code) (Contact Person) (Phone) APPLICANT SIGNATURE * DATE APPLICANT PLEASE COMPLETE BELOW Quantity Type of Fixture Quantity Type of Fixture Bath Tub with or without shower Rough-ins Dishwasher Water Heater Floor Drain Water Softener Lavatory(Bathroom Sink) Stand Pipe(Washing Machine) Laundry Tray(1 or 2 compartment sink Sewage Ejector Shower Stall Backflow Assembly Sinks Backflow Assembly Test Bar Sink Lawn Sprinkler Water Closet(Toilet) Other FEE SCHEDULE Industrial,Commercial&Multi-family 1%of job cost with a$49.50 minimum Residential,New One&Two-Family $149.50 Residential,Additions&Alterations $49.50 Estimated Cost $ 49 ,50 Building Permit# 1lie iv111111eSULd J.UAL ULea 5l JGOD...VW "SURCHARGE"has been extended PLUMBING PERMIT FEE $ 49 ,50 , The minimum surcharge for a STATE SURCHARGE $ 5 .00 "fixed fee"permit is$5.00 TOTAL PERMIT FEE $ 54 ,50 (Office Use Only) rrt.,. na:................ 04-..4-..4.,...P'3rcn 1 40 This Application Becomes Your Building Permit When Approved F' 's above to LeRe&ei[tt�jioby Property it *Jeri Plumber stdlssign this form Buildine Official Date 24 hour notice for all inspections(952)447-9850,fax(952)447-4245 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372 Hartmann Well Company Statement 308 East Main St New Prague, MN 56071 Invoice # Date 952-758-2202 13455 3/10/2016 } Bill To ;:, • JAMES ROCKWELL 17141 SUNSET AVE S SHAKOPEE,MN 55379 Technician Work Done Kevin 03/10/2016 Terms Due Date Ticket# Telephone Due on receipt 3/10/2016 612-940-2103 .. _ We sealed the old well according to state code. 2,005.00 2,005.00 A finance charge of 1.5%per month,which is an annual percentage rate of Total 18%,will be charged on any portion of an unpaid balance that remains $2,005.00 unpaid 30 days or more after receipt of statement. I j I ; l'' t''''''' '' .....'‘ , ..... ..Itz: , &..: l' ,' Al t '' I ‘,.. I v (--.i , 1 i''....s.t i F, , ,r i , , , I i , ,, , , , , , , , , , , , ,,.. , „..), , ., , , (‘ k. I , , , , , , , , , , , , : , , : , , . , , , , I__ , , . , • \\LI)11 . , i ' I I i !Nb, I i \I I I I I i 1W t 1 r r --- f - ' T .4- - I: ..c...\' 'LI i I , 1 : - --IH R, f ,, ,4 „ , .„ , 1 , .,,1 i , . , .. , N.1 , ......7.-. h 1 1N 1j I Ali \ `�1 I 1 . I gl: i , t--c'Nf ,, I rnbr �1 '..--.1)1 \I ! ' 1 ti �I , , , ,, , . � ' ti , ... �i �, LI ` t 41 n 1 j W `� I\ ,\ iii R „,„,,' N, , , , , , , , , , , , , iss\,,1 I \\.:..N........\,'`' i , r , , , , , t, ,r , 1, . , , , r i„‘,J iX , 1 I`I I I 1 L. I , , L — — - - - !, • 4 II , 1 (952) 44)rnill-005'1,111111, 11 1 01 01 CUSTOMERS ORDER NO. PHONE DATE ,......, / ...._ ,„. W , /t NAME ADDRESS ) II 1 Fl ,_1,",I, f., .? ,-, k:, 1, 1 . •,,, „„,0, 4, ,4,,,,„, 4. ..,, _ er / SOLD BY CASH C.O.D. CHARGE ON ACCT. MDSE.RET'D. PAID OUT 1 1 ; i QTY. DESCRIPTION PRICE AMOUNT ')- 1 ' i i . . ..,...., . ' „.',-,,,f,,i::”' , I ,d, 1 l 1 i li lie /k ' i'''' , 1 , e s, ( E , I l , r„,1r1r,t", ,, TA RECEIVED BY TOTAL 1 .,.., All claims and returned goods MUST be accompanied by this bill. Ili 1 857b 1 , THANK YOU • O 0 o V'- h a d d d 0 Zr : 4 Z C(') AD cr P c ¢ 0 0 0 0 ",S' �3 0 ti n C fD A a, o-41 A: r4 0 td CD tj r4974Cr 17n U I 0 't 5- 0- A 8 r R • I S 3 0 " A CD p, 0 0 `CA r v, f )-i Uni CD .. 0 A ❑ a C) Z ct 4 cr o 1` )' AD cu v, 0 0 CM 0 0.,----0\ r ! IIi ---As Eig c! 120° 0-3 CD g CZ b • C 0 0 �. co i i co 4 Cfci W r+ 0 Q.. A,' r h-I CD `c3 i :✓ ° 0 o C n AD 0 cm o i 0 0 C CI+ cD 0 `-� ":i o CA CD 0 P°-n A:AD �d or CD CD ? 0 • 5 ,-,:i 7zt 0 O 'LI H co CAD 0 Q- ,`- - CDD -•••4�' CD CD CA CD n Co c/a C4 ° C c CTI a ' �. oC N O • HARTMANN WELL COMPANY WATER WELL CONTRACTORS . 308•East Main NEW PRAGUE,MINNESOTA 56071 Well Drilling Pump a Well Service ROGER L.HARTMANN DONALD S.HARTMANN • 771 L iG 9--0l6 ._-- .----¢ -- Pet/)11.e4--1 • We cement g r o u t o d an old w e I I at.., -ve-4-) �✓L--�t�..-� d d' State ' Permit €G,u/j42e. 1, . .e.� $ I 0 0 , 00 Our• Fee C ' q. g •- . p C> _kicks of @ !ls... -t? 9 1 0 . UG ExtraLabor C ________, • c Total Ba I ar,c e Due $---• -. Q o .v-; har,hyou. Mol 'Ito IreP Roger L. Har tmann State Li cense Number • a .• rf • • 4444 ,-u Licensed Member Minnesota Water Woll eissociatn r01/ �y;, �� '" 4W WA t� f ►�_, ti WELL - `Since 1932" • WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 331209 Sealing o. County Name WELL AND BORING SEALING RECORD Minnesota Unique Well No. Minnesota Statutes,Chapter 1031 or W-series Y No. Lrave Dank r et No. nshi Name Township No. RangeanNo. Section No. Fopetion q-i. .) Date�Sealed'! Q 1'616^ { Date Well or Boring Constructed `. . /Pi 'L F w.'7 ' ii,11" 15. ,n-t `'K//1 ]� f''616 GPS LOCATION-decimal degrees(to four decimal places) J./ �p p U Latitude it At C �7O 1.5 Longitude q3 P . p {? Depth Before Sealing O0 ft. Original Depth / �� ft. AQUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location 0 Single Aquifer ❑Multiaquifer 2 p � WELL/BORING •Measured ❑Estimated Date Measured J 7 "f.t/ � ✓ J / - �� / 1e 0 Water-Supply Well ❑Monit.Well Show exact location of well or boring Sketch map of well or boring in -ction.rid with"X" location,showing property ❑Env.Bore Hole ❑Other aft. 4 below ❑above land surface r - - �-_w %CS-3'7 lines,roads,and buildings. 4/ 7�"'t / N 0 T CASING TYPE(S) ;.._.__'_._ .� I `�� p ,�•'e �.tr� 0 Steel Li Plastic ❑Tile ❑Other `. 3WELLHEAD COMPLETION w E T k.1 ...A.4- Outside: ❑Well House ❑At Grade Inside: ❑Basement Offset 'h.Mil r ► #Pitless Adapter/Unit ❑Buried ❑Well Pit H ❑Buried s 1 ❑Well Pit �� ❑Other i----1 — �-1 Mile ) [4 c]Other PRO ERTY OWNER'S NAME/COMP !Y NAME YCASING(S) Diameter Depth Set in oversize hole? Annular space initially grouted? P rty owner's mailing address if different than well location address indicated above ii. in.from 0 to 3 80 ft. ❑Yes B No ❑Yes E No ❑Unknown in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE z µ Q Well owners malting address if different than property owners address indicated above Screen from to ft. Open Hole from ++ Q to r c/ ft. OBSTRUCTIONS G Rods/Drop Pipe `Check Valve(s)Q ❑Debris ❑Fill ❑No Obstruction bru / ���s,�," Type of Obstructions(Describe)1 3 9 /_/ _ ../ 1/ -T- GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? Q Yes ❑No Describe tib�i J a4 .*„.e.12.44,„,„ FORMATIf� N If not known,indicate estimated formation log from nearby well or boring. PUMP Type ��- ��Jjjj ��- ® 80 4 Removed ❑Not Present ❑Other 90 9 0 METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: J d No Annular Space Exists ❑Annular Space Grouted with Tremie Pipe ❑Casing Perforation/Removal 1 in.from to ft. ❑Perforated ❑Removed �.4`_�_ in.Gila from to_ ft. ❑Perforated ❑Removed (219.7�� r/ Jt4 "'' Type of Perforator VARIANCE ..w4IKei 374 a/,7/Was a variance granted from the MDH for this well? ❑Yes a No TN# ,/� AirtA, ii 70 'IRS'GROUTING MATERIAL(S) (One bagg of cement=94 lbs.,one bag of bentonite a 50 lbs.) �y� Grouting Material 's"t�I�""e4f from to 7 f ft. yards 3 S. bags from to ft. yards bags from to ft. yards bags OTHER WELLS AND BORINGS REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING Other unsealed and unused well or boring on property? ❑Yes •No How many? 44.-- „11441, -ell-fp)" LICENSED OR REGISTERED CONTRACTOR CERTIFICATION �, , (01 , This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The information contained in this report .?t_ !,'_FJ / - � .��.�ie 2i�true to the best of my knowledge. -w-ee 7 6 S 3 S'/ 7¢ ?41,.-ele ce-rf . /6 A 0— Licensee — �2.4 ! 7 LC e,4:... .7714" e Business Name / " _.__ 13r�L A44p%. y�.,M.41 ,S-6 4r Re0?/ion No. a'�^�� 4/444. , . . ( 3 • (A. �, �vuu`r.�tJ- '.T_ iir+7 3 —t o —( I 5.5'' 3 7 9 Certified Representative Signature Certified Rep.No. Date �G i MINN.DEPT OPIIIId1lFIt COPY H 331209 7 '` e .0N , •-I,• Name of Person Sealing Well or Boring HE-01434-14 IC#140-0423 5/13R Brad Overby •• Engineered Wood Market Manager IP •• 2871 W.Service Road • St Paul, o • • (6 2)803-1580 55121 B I u e L i n x • (651)452-5291 Fax brad.overby@blue)inxco.com I f -71 4f-1 d'Li nse 4 , e..c / WA~ ifL' / 7 i rs w NAME: - _ DATE: BY: COMPANY: ENGINEERED PHONE NO: LOCATION: FAX NO: AGeorgia-Pacific I 04 PRIQ� • 1 vt214646 Dakota Street SE Prior Lake,MN 55372 ' vxsscAt" June 1, 2015 James Rockwell 17141 Sunset Avenue NW Shakopee, MN 55379 RE: IMPORTANT ANNOUNCEMENT CONCERNING CONNECTION TO CITY SEWER AND WATER FOR 17141 SUNSET AVENUE NW,SHAKOPEE, MN 55379 Dear Property Owner: Prior Lake Ordinance requires that properties with dwelling units connect to city utilities (domestic water and sewer) no more than one year after the services become available. The one year deadline for your property was March 14,2015. Five properties on the Sunset Avenue project have not completed connection, although some are currently in process. Some have asked the City Council for extensions to the deadline. The City Council discussed these extension requests and all other non-connected properties. The City Council has provided one last opportunity for property owners to connect by following the steps below: 1. By June 12, 2015,the Property Owner will need to secure a utility installation permit from the city, including payment of permit and connection fees. The cost for the permit is$5,686 for a 5/8" water meter. 2. Once the utility permit has been secured,the Property Owner will have 180 days(6 months) from the permit date to complete the physical connections through a private contractor. If needed,the City has a listing of companies who complete this type of work. Costs for connection will be based upon the immediate circumstances of each lot through quotes secured by the Property Owner. Some property owners have discussed demolition of the structure on the property. If a Property Owner intends to demolish the existing structure on the lot,then a demolition permit must be obtained from the city and the work concluded by June 12, 2015. As long as there is no dwelling unit on the property by that date,there is no need to connect to sewer and water. However,the fact that a property is for sale, occupied or unoccupied, will not affect the deadlines or process described herein. In accordance with City Code and City Council direction, if a Property Owner fails to secure a connection permit by the deadline shown above,or if permit is secured but the work is not completed Phone 952.447.9800 / Fax 952.447.4245/www.cityofpriorlake.com r within 180 days of the permit date,the city will be forced to take action to complete the connection. The City will seek a court order from Scott County District Court to inspect each property and authorize the completion of the connections. If this process is required,the City will secure quotes, award a contract,assure the work is completed,and impose a special assessment for all the costs associated with the connection including an additional administrative fee for the coordination efforts toward making the connection. We appreciate that connection is both a costly and time consuming process, but for public safety and health reasons, prompt connection to the city facilities is critical. If you have additional questions concerning this matter, please call me at(952)447-9832. Sincerely, Lar Poppler, P.E. City Engineer/Inspections Director CITY OF PRIOR LAKE cc: Frank Boyles,City Manager U.S. Postal Servicer' CERTIFIED MAIL° RECEIPT ru ru Domestic Mail Only M1 OFFICIAL USE ru .d Postage $ 1-4 Postmark Fee Postmark C3, Return Receipt Fee Here (Endorsement Required) Restricted Delivery Fee p (Endorsement Required) nJ 'l Total Postage&Fees ru a- Sent To- e..00 O Street&Apt. o-, 1 .7 ,4 ) �I N or PO Box No. �I�J City,State,Z1P+4 PS Form 3800,July 2014 See Reverse for Instructions