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Utility Connection 16.0938
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N r > mmzr a T ..Tri 73 11 ■ r s -It z m -4r o Pz41 - civ, j ex_.zotc. OF PR�O� CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd a TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ' AND UTILITY CONNECTION PERMIT /$ ° / U x rn +04,EsOi� I. White File PERMIT NO. l 2. Pink City / ..3, 3 �'i 3 Yellow Applicant (( ✓✓ 66�� (Please type or print and sign at bottom) ADDRESS ZONING(office use) 17 Q z GIk-c l ivy✓ ) o LEGAL DESCRIPTION(office use only) LOT BLOCK ADDITION PID aS-- ¶1/- Og KEVIN R STOCKE OWNER (Name) 17025 MUSHTOWN RD SE (Phone) l5—)--'Li 9?--'73 '7 PRIOR LAKE MN 55372 (Address) BUILDER (Company Name) (Phone) ,A;.:.,.:. (Contact Name) (Phone) (Address) TYPE OF WORK ❑New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ['Lower Level Finish ❑Fireplace ['Addition ❑Alteration 1CJtility Connection CODE: ❑I.R.C. ❑I.B.C. ❑Misc. Type of Construction: I II III IV V A B PROJECT COST/VALUE $ Occupancy Group: A B E F H I M R SU (excluding land) Division: 1 2 3 4 5 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 submitted plans. I am aware that the building official can revoke this permit for Just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections. X K, sem. 2hoi, Sgnature Contractor's License No. Date Permit Valuation Park Support Fee # $ Permit Fee $ SAC # $ 2e7SC / �/ "" J Plan Check Fee $ Water Meter Siz(�; 1"; $ / State Surcharge $ Pressure Reducer - $ � 'V Penalty $ Sewer/Water Connection Fee # $ 4506 Plumbing Permit Fee $ _ CWater Tower Fee # $ /D Mechanical Permit Fee $ �>yt Builder's Deposit $ Sewer&Water Permit Fee $ 52 Other $ Gas Fireplace Permit Fee $ TOTAL DUE $ .5I 7 3S This Application Becomes Your Building Permit When Approved Paid i 3 ge k Date f I g. I /„ By x/ S ... 1.-- 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 4646 Dakota Street Prior Lake,MN 55372 tRIS) Date Rec'd CITY OF PRIOR LAKE PLUMBING PERMIT & VES I.sole File .YelPERMIT NO. l0 pp 3 3.YellowCity Applicant 73e (Please type or print and sign at bottom) ADDRESS ZONING(office use) 70Zfa.U3797V644 40 LEGAL DESCRIPTION(office use only) LOT BLOCK ADDITION PID OWNER KEVIN R STOCKE • (Name) 17025 MUSHTOWN RD SE (Phone) (Address) PRIOR LAKE MN 55372 APPLICANT /�(Name) C� pi ("b.K) l eC-11 rpt G I (Phone` q C — 3°6— c 7 <1Addressj 20(9- k k/G.5 1,,, /24 Jct. 53-3 7,), (Address) (City) (Zip Code) (Contact Pers 53e 1e ('>--t (Phone) JS �`- S`'" S-6 73 'PLICANT SIGNATURE AT _ Vc2`)Jao%6 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 $ Building Permit# PLUMBING PERMIT FEE $ RAID WITH STATE SURCHARGE $ I r IP P77-711i1 TOTAL PERMIT FEE $ (Office Use Only) This Application Becomes Your Building Permit When Approved Paid Receipt No. Date By Building Official Date 24 hour notice for all inspections(952)447-9850,fax(952)447-4245 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372 " i City of Prior LakeRECEIPT 707 Prior Lake MN 55372 4646 Dakota Street SE FILE e Iii' y 4 C ` /14,'' 952-447-9840 " -tt V St' ,1';" Receipt: 6612 Received Of: Date: 08/18/16 Kevin Stocke Customer: Kevin Stocke 17025 Mushtown Rd SE Prior Lake MN 55372 Re i�en ite ilpt descriiptibrr'' � qt Nu k Tptai Utility Connection 16-0938/17025 Mushtown Rd SAC Fee 2,485.00 Water Meter 500.00 Pressure Reducer 150.00 Water Connection 900.00 Sewer Connection 600.00 Water Tower Fee 1,000.00 Plumbing Permit 16-0938/17025 Mushtown Rd Plumbing Permit 49.50 State Surcharge-Plumbing 1.00 Sewer-New Construction 16-0938/17025 Mushtown Rd Sewer Permit 51.50 State Surcharge-Sewer 1.00 Receipt Total 5,738.00 TENDERED: Checks 5018 5,738.00 Total:5,738.00 RECEIPT PR/04) DAT ( a ,��AvANe� CITY OF C..) t� PRIOR LAKE 116200 Eagle Creek Avenue S.E. 1 l�. -ESO,Q, Prior Lake,MN 55372 t DEPARTMENT: / L_ /L irf Received of 41,°_, _ „� \`�� J • I _ �_z� rfi / - The s �t of / ✓ � 41167 r a .ice / ,. x. 10s� For le purp 1 e of J `� i / i y i i i or ,...e,te,71 217.. .) icei #f/17, 0 $ 51� .+gv Accou t# 76 .. ( 49Cgi Receipt Clerk for the City of Prior Lake • lUll UiIiii ? If • O `d is " SS o • o ca i 0 5- " w o e o 5 (� � a � LflI1. [ gcA ..(-c., ..ci- = ..., ..... AO" o w (,(17 y c g 0 co go G o - a .� o 0 0 0 o ' o o0. 0 n b a CA 1 5 � f 1 r A, r• a 0-c_ 0 ❑ U E •til -3 ao w 51"cs 1 a <D0 El a C/1 oo \ �e o e. < co Q 0. to C p t. tD o mFD) gt < cT ° �'I M 1 r,� CD K • o a 5 ❑ of C'bl'1 14.a DO 'b Cj it n eba O b 3 ''V R. El �✓ y O CD 0 o o d 9-) U\ or • L__. 6 a 3 J 1 p � � ! .. h G 0 • WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 3 3 7 0 3 0 County Name WELL AND BORING SEALING RECORD SealSinning NoUnique Well No. ,� 5-S 6 , t5 Minnesota Statutes,Chapter 1031 or W-series No. (Leave Bonk H net km.) T¢yvniip JjaTe Township No. Range No. Section No. F ion,(,ry -+ Date Sealed J P �`( r �/4C � �,7•�•) Date Well or Boring Constructed 1- Alf , ! l tit 2- 1 l� i , � 7, 0 /6 1 9 9 9 GPS LOCATION-decimal degrees(to four decimalplaces) Latitude I.91 ° /f7 3 0 Longitude! • 4/,3 2-•. 6 Depth Before Sealing /�0 0 ft. Original Depth ,/�O b ft. AQUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well Boring Location e•Single Aquifer ❑Multiaquifer / 70 / /f - WELL/BORING ❑Measured Estimated Date Measured 7 /6' X0-4.4 ®Water-Supply Well ❑Monit.Well Show exact location of well or boring Sketch map of well or boring i action grid wit 1�,�.-S 3 Py location,showingproperty ❑Env.Bore Hole ❑Other ft. below _Jl.fiD� .. ,1"-"-"..`, ,2 line— d an ildinas. 0 ❑above land surface �( ` �� CASING TYPE(S) f ..0. ®Steel ❑Plastic 0 Tile ❑Other •--i••---r----•!• f--• WELLHEAD w E .4j COMPLETION r-_ --f --- '3 n. Outside: ❑Well House 0 At Grade Inside: 0 Basement Offset t i I h I 1 r (0 Pitless Adapter/Unit ❑Buried ❑Well Pit ---t-----_---- 1 I �, ❑Burled S ❑Well Pit I---t Mite--{ \ .\ 0 Other ❑Other PROPERTY OWNER'S NAME/COMPAN NAME CASING(S) 9.„aej), --t-pV, c...O/ Diameter Depth/ 7 A. Set in oversize hole? Annular space initially grouted? Property owner's mailing address if different than well location address indicated above 0 /in.from to ❑Yes 0 No 0 Yes 0 No 0 Unknown in.from to ft. 0 Yes 0 No ❑Yes ❑No ❑Unknown in.from to ft. 0 Yes 0 No 0 Yes 0 No 0 Unknown WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE 7'�cJ. Well owner's mailing address if different than property owner's address Indicated above Screen from to ft. Open Hole from `' to 0 0 ft. OBSTRUCTIONS ®Rods/Drop Pipe 0 Check Valve(s) ❑Debris 0 Fill 0 No Obstruction • Type of Obstructions(Describe) ///- --•€2t- / -yez.Qir Q.. _iyya� a / i,[� /___ GEOLOGICAL MATERIAL COLOR HARDNESS OR FROM TO Obstructions removed? Yes 0 No Describe•"(-1--"'4-4-e.-, iL/ce, pci....4y2-)., FORMATION PUMP nearby well or boring. If not known,indicate estimated formation logfrom Type y0 / Removed ❑Not Present 0 Other cz �� /^ / 8,r METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: 'l a _4te No Annular Space Exists ❑Annular Space Grouted with Tremie Pipe ❑Casing Perforation/Removal ✓� in.from to ft. 0 Perforated 0 Removed -414ye.2.4.' 85'/6 ti in.from to ft. ❑Perforated ❑Removed Cts 1� ? OOVARTIAYPNeCoEf Perforator e/4., Was a variance granted from the MDH for this well? ❑Yes P No TN# GROUTING MATERIAL(S) 'e-e411-e41•'6 p,,,(One bagg of cement=94 lbs.,one bag of bentonke a 50 lbs.) �1 Grouting Material "�t'C from -3 to/'00 ft. yards "". bags . W-P� d•fr -e-44...1? - from to ft. yards bags . ..e 9-tz2i.• ppr f� rom 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? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION 2L--- J ��� This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The information contained in this report � ,I _ A is true to the best of my knowledge. -c;`'. 51, 2,‘ 442_. .{,t,-ea ,,,,,,,6, 7-icz4. .a..4L.n 2 2J-eGC by l.r . /6 Licensee Business Name. License or Registration No. 69.. .5sbv. �'. � a� �. J/ 91 1. 616 Certified Representative Signature Certified Rep.No. Date MINN.DEPT OFAI IETH COPY H 3 3 7 0 3 0 X-e-v t',t. 2-1 -,— ., . Name of Person Sealing Well or Boring HE-01434-14 ID#53159 5/13R • i HARTMAINN WELL COMPANY WATER WELL CONTRACTORS • • 308 East Main t NEW PRAGUE,MINNESOTA 56071 WA Drilling ; ROGER L.HARTMANN Pump d Well Service DONALD S.HARTMANN • • • k-e.t,,-.-.-14.. • • ..6. .L.,o-L ��"714,i . 5 3.7 2 We -e m e n t grouted a n o i.cJ w c:I I at �� e-artv-Qi(,t�-a4-e4-4---/ • • • State Permit a.,u/./4441. .,'w 1 0 d 00 Our•• Fee ...2-S sacks of cement C it; ,S uv I ° .a S� . OCA Extra sLacks .__.` �' • o O CA-e,G4 # ,S-0 G .- 8. U 0 CA-e4A;t. -- 8 9- . .S 0 Total Balance Due / / / kro II . g0 - d �� 11 1.4-0rd. the • Thant; you• . !Oti • fi� f Rage ' L. Hartmann `' State License Number 1. b �. �. 19s,-•— 14.7 - '73 7/ ��ISR LI�.� •" i AP D, y: t .j6 w W W A y Licensed Member Minnesota Water Well Association ifs 4� ,. ��� y WELL' P "Since 1932�� lid 11143gfirrlifiritrd . PRIG+ I - OSc t--34 COPY 4646 Dakota Street SE 0 Prior Lake,MN 55372 4Thvxssd ' June 24, 2016 Kevin Stocke 17025 Mushtown Rd SE Prior Lake, MN 55372 Re: Utility Connection &Approaching Hookup Deadline (9/25/16) Dear Owner: The month of September, 2016 will be here before you know it and the one year deadline (9/25/16) for your utility connection is quickly approaching. This is just a reminder to help you begin your process for connection if you haven't already done so as we are only 90 days away from the deadline for hookup. Contractor's schedules can get booked out for several months this time of year and/or you may get a better price if you get quotes now if others in your area are also working with the same contractor(s). After 9/25/16, your permit fees will revert back to the increased 2016 permit fees and they also may increase again in 2017. Current Permit Fees (good till 9/25/16) are as follows: Plumbing Permit $ 50.50 Sewer& Water Permit $ 52.50 Sewer Access Charge $ 2485.00 Water Meter(1") $ 740.00 Sewer/Water Connection $ 1500.00 Water Tower Fee $ 1000.00 Total $ 5828.00 ($6483.00 after 9/25/16) Plumbing Permit $ 50.50 Sewer& Water Permit $ 52.50 Sewer Access Charge $ 2485.00 Water Meter(5/8") $ 650.00 Sewer/Water Connection $ 1500.00 Water Tower Fee . A!:.:: Total (5738.00 ($6393.0► after 9/25/16) Phone 952 447 9850 I www.cityofpriorlake.com COPY For those who have connection fees rolled into their assessments, the fee above remains until the 9/25/16 deadline. After 9/25/16,there will be additional fees incurred as 2016 Fees are higher. The Building Permit will stipulate requirements for the connection as well as abandonment requirements for the existing septic system. Your existing well can be maintained for outside non-domestic use or can be abandoned& sealed. It should be noted that the sanitary sewer service is required to be located at least 20 feet away from any well or the well will need to be abandoned. Sections 704.300 and 705.400 of the Prior Lake City Code requires connection to City water and sewer within one year of availability(by 9/25/16). Section 4715.0310 of the State of Minnesota Plumbing Code also requires connection to municipal sewer& water systems once they are available. If you have questions or concerns regarding the building permit process, please contact the Building Department at 952 447 9850. Sincerely, Larry Poppler City Engineer/Inspections Director CITY OF PRIOR LAKE Cc: Bob Hutchins, Building Official Lynda Allen, Building/Inspections Assistant Susan Zick, Engineering Assistant Dale Chard, Building Inspector Seng Thongvanh, Project Engineer 01 PR/O4P E 4646 Dakota Street SE Prior Lake, MN 55372 44NNEsoll" April 6, 2016 Kevin Stocke 17025 Mushtown RD SE Prior Lake,MN 55372 2015 Sewer &Water Utility Connection Fee Extended to 9/25/16 At the Prior Lake City Council Meeting on 3/28/16,a motion was carried to charge 2015 connection fees for the Mushtown Road,Maple Lane &Panama Avenue Sewer &Water Project Connection. Now you may connect to the services at the 2015 fee rate until 9/25/16. 9/25/16 is also the one year deadline for connection to City utility services per City Code. Permit fees for a 1" Water Meter is as follows: Plumbing Permit $ 50.50 Sewer&Water Permit $ 52.50 Sewer Access Charge $2485.00 Water Meter (1") $ 740.00 Sewer/Water Connection $1500.00 Water Tower Fee $1000.00 Total $5828.00 ($6483.00 after 9/25/16) 5/8" Water Meter Plumbing Permit $ 50.50 Sewer& Water Permit $ 52.50 Sewer Access Charge $2485.00 Water Meter (5/8") $ 650.00 Sewer &Water Connection $1500.00 Water Tower Fee $1000.00 Total $5738.00 ($6393.00 after 9/25/16) For those who signed the assessment waiver &rolled the connection fees into their assessment, there is no additional fee for 2016 as fees will remain at the 2015 level until 9/25/16. Additional fee increases are also expected in 2017. Page 1 of 2 Phone 952.447.9800 / Fax 952.447.4245/www.cityofpriorlake.com • • The Building Permit will stipulate requirements for the connection as well as abandonment requirements for the existing septic system. Your existing well can be maintained for outside non- domestic use or can be abandoned&sealed. It should be noted that the sanitary sewer service is required to be located at least 20 feet away from any well or the well will need to be abandoned. Please contact Jon Hess at 952 492 5425 or by email atsem. for more information. Sections 704.300 and 705.400 of the Prior Lake City Code requires connection to City water and sewer within one year of availability(by 9/25/16). Section 4715.0310 of the State of Minnesota Plumbing Code also requires connection to municipal sewer&water systems once they are available. If you have questions or concerns regarding the building permit process,please contact the Building Department at 952 447 9850. Sincerely, Larry Poppler City Engineer/Inspections Director CITY OF PRIOR LAKE Cc: Bob Hutchins,Building Official Lynda Allen,Building/Inspections Assistant Susan Zick,Engineering Assistant Dale Chard,Building Inspector Seng Thongvanh,Project Engineer Page 2 of 2 note 9S/4473400 I Fac M4474245/AmysaitAittgriatagiyik P OOH 1 f ' 4646 Dakota Street SE e� Prior Lake, MN 55372 February 24,2016 Kevin Stocke 17025 Mushtown Rd SE Prior Lake,MN 55372 RE: INCREASED FEE NOTICE&REMINDER OF 1 YEAR DEADLINE DATE FOR UTILITY CONNECTION FOR MUSHTOWN ROAD,MAPLE LANE AND PANAMA AVENUE SEWER AND WATER PROJECT CONNECTION It is never too early to begin thinking about your sewer and water connection. Contractor's schedules can get booked or you may get a better price if you get quotes now for your water and sewer connection. A copy of the original City letter dated 9/25/15,sent to you regarding the Utility connection project is attached. The letter included the ordinance requirement that the utility connection be completed within 1 year from the date of the letter or by the deadline date of 9/25t2016. The original letter also gave the costs for the Permit fees of either $5,828.00 for a 1" water meter for service or $5,738.00 for a 5/8"water meter for service. Fees have changed for 2016 and the new connection permit fees have increased. Building Permit Fees are due at the time of building permit issuance. Therefore,the new dollar amounts are shown below: 1"Meter-2016 Connection Fees Plumbing Permit $50.50 Sewer and Water Permit $52.50 Sewer Access Charge $2,485.00 Water Meter(1") $740.00 Sewer/Water Connection $1,755.00 (was$1,500.00) Water Tower Fee $1,400.00 (was$1,000.00) New total for 2016 $6,483.00 (was$5,828.00) 5/8"Meter—2016 Connection Fees Plumbing Permit $50.50 Sewer and Water Permit $52.50 Sewer Access Charge $2,485.00 Water Meter(5/8") $650.00 Sewer/Water Connection $1,755.00 (was$1,500.00) Water Tower Fee $1,400.00 (was$1,000.00) V New total for 2016 $6,393.00 (was$5,738.00) For those that signed the assessment waiver and rolled the connection fees into the assessment,the additional fees will be due at the time of permit issuance. This additional fee amount cannot be rolled into the assessments. domestic use or can be abandoned and sealed. It should be noted that the sanitary sewer service is required to be located at least 20 feet away from any well (yours or your neighbors) or the well will need to be abandoned. If you decide to abandon your well, you may be eligible for funding through Scott County. Please contact Jon Hess at 952-492-5425 or by email at jhes @co.scott.mn.us for more information. The building permit will give further details regarding these items. Sections 704.300 and 705.400 of the Prior Lake City Code requires connection to City water and sewer within one year of availability. Section 4715.0310 of the State of Minnesota Plumbing Code also requires connection to municipal sewer and water systems once they are available. This letter also serves as a reminder that the connection date must be completed by September 25,2016. For your convenience attached are the building, plumbing, and sewer and water permits and a checklist of requirements. If you have any questions or concerns regarding the building permit process,please contact the Building Department at 952-447-9850. Sincerely, Larry Poppler City Engineer I Inspections Director CITY OF PRIOR LAKE cc: Bob Hutchins,Building Official Lynda Allen,Building/Inspections Assistant Dale Chard,Inspector Seng Thongvanh,Project Engineer Enclosures .1:1Utilily Cmmactiona4a1.?l-.;Mushtowu,Panama Utility Conilutiotatr 2.11.16 F PRt� CITY-OF PRIOR LAKE BUILDING PERMIT, • Date Recd ,,o �` TEMPORARY CERTIFICATE OF ZONING COMPLIANCE I-, ,z14-57 x AND UTILITY CONNECTION PERMIT • ,z..,_ „..i.„), •NNESolP • I. White File PERMIT NO. • 2. Pink City 3 Yellow Applicant - (Please type or print and sign at bottom) ADDRESS ZONING(office use) LEGAL DESCRIPTION(office use only) - LOT BLOCK ADDITION • PID OWNER (Name) (Phone) (Address) l - r- (Cor�ipany IN amen e r (Phone) • (Contact Name) (Phone) . (Address) • • TYPE OF WORK ❑New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ElLower Level Finish ❑Fireplace • ❑Addition ❑Alteration DUtility Connection . CODE: ❑I.R.C. ❑LB.C. LI Misc. • - Type of Construction: I II III IV V A B • Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $ (excluding land) Division: 1 2 3 4 . 5 i I hereby certify that I have furnished information on this application which is to the begs 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. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections. X **5/8" $650 . 00 Signature Contractor's License No. Total $6,5g.6,00 Permit Valuation Park Support Fee # $ Permit Fee $ SAC # $ Plan Check Fee $ Water Meter Size 5/8"; 1"; 1 " $ 740 ,00 ** State Surcharge $ • Pressure Reducer included $above Penalty $ Sewer/Water Connection Fee # $ 1 ,755 .00 Plumbing Permit Fee $ 50 ,50 Water Tower Fee # $ 1 ,400nn Mechanical Permit Fee $ Builder's Deposit $ Sewer&Water Permit Fee $ 52 . 50 . Other $ Gas Fireplace Permit Fee $ TOTAL DUE $ with 5/'"-Meter fi.'393A6 This Application Becomes Your Building Permit When Approved Paid Receipt No. Date By - 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 • . ,PRX0, Date Rec'd 2; z CITY OF PRIOR LAKE � n ? !g SEWER AND WATER PERMIT li'INNEso�� 1. Green Fite Yellow City PERMIT NO. 2. 3. Gold Applicant (Please type or print and sign at bottom) ADDRESS ZONING(office use) LEGAL DESCRIPTION(office use only) LOT BLOCK ADDITION PID • OWNER (Name) (Phone) (Address) (Address) (City) (Zip Code) APPLICANT **Sewer & Water Contractor (Name) (Phone) (Address) (Address) (City) (Zip Code) (Contact Person) (Phone) **Sewer & Water Contractor Signature: DATE APPLICANT PLEASE COMPLETE BELOW • Size of water service inches. Location of any couplings from structure feet. Type of sewer pipe. n ABC n PVC Cast Iron Estimated length of sewer line feet. Clean out(if required) located at feet from structure. FEE SCHEDULE Residential sewer and water line connection $51 .50 Industrial,Com'l&Multi-family 1%of job cost with a$51.50 minimum Sewer connection only $25.50 Water connection only $25.50 Estimated Cost $ Building Peiiiiit# SEWER AND WATER PERMIT FEE $ 51. ,50 FEES PAID BY STATE SURCHARGE $ 1 .00 FEES PAID BYEOWNER TOTAL PERMIT FEE $ 52 ,50 (Office Use Only) This Application Becomes Your Building Permit When Approved Paid Receipt No. Date By Building Official Date 24 hour notice for all inspections(952)447-9850,fax(952)447-4245 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372 • (4 VR.i Date Rec'd CITY OF PRIOR LAKE PLUMBING PERMIT 2.coin File PERMIT NO. 3.Yellow Applicant (Please type or print and sign.at bottom) ADDRESS ZONING(office use) LEGAL DESCRIPTION(office use only) LOT BLOCK ADDITION PID OWNER (Name) (Phone) (Address) APPLICANT *Plumber/C o n t ra c to r (Name) (Phone) (Address) (Address) (City) (Zip Code) (#Contact Person) (Phone) Plumber/ ontractor Signature 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&MuIti-family 1%of job cost with a$49.50 minimum Residential,New One&Two-Family $149.50 Residential,Additions&Alterations $49.50 Estimated Cost $ Building Permit# FEE PAID BY PLUMBING PERMIT FEE $ 49 . 50 TAXPAYER/OWNER STATE SURCHARGE $ 1 .00 • TOTAL PERMIT FEE $ 50 .50 (Office Use Only) This Application Becomes Your Building Permit When Approved Paid Receipt No. Date By Bnildine Official Date • 24 hour notice for all inspections(952)447-9850,fax(952)447-4245 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372 ****ORIGINAL INSTRUCTIONS SENT TO TAXPAYERS/OWNERS 2/24/2016 Use same instructions for what's needed MUSHTOWN, MAPLE & PANAMA HOMEOWNERS UTILITY CONNECTION CHECKLIST ALL CONNECTIONS MUST BE COMPLETED BY SEPTEMBER 25,2016 This checklist is to assist homeowners through the utility connection conversion from private sewer and water to city sewer and water. Since the ultimate responsibility for proper connection per city ordinance sits solely with each respective homeowner, a checklist may be beneficial. ONE YEAR TIMELINE: CONNECTION DEADLINE IS SEPTEMBER 25,2016 From the time the Sewer and Water is installed,the City of Prior Lake allows one year to complete private property connection to city sewer and water. This may sound like a long time but weather, frost and contractor availability quickly can cut the time to roughly half. 1. COMPLETE & PAY FOR BUILDING PERMIT FOR UTILITY CONNECTION, SEWER AND WATER PERMIT,AND PLUMBING PERMIT. Fees For 2015,the utility connection permit fee is $5,738 for 5/8"water meter or$5,828 for a 1" Increased water meter and includes all fees for all three permits in this packet. The peilnits are: UTILITY For r6 CONNECTION PERMIT, SEWER AND WATER PERMIT,AND PLUMBING PERMIT and are all filled out 2for your convenience. This permit fee is subject to change in 2016. 2. HIRE A SEWER/WATER CONTRACTOR. 1. Find a suitable contractor. 2. Contractor must complete permit from city building department. This fee is paid for in the Utility Connection Peimit fee. 3. If you choose to leave the existing Well in place,the Well must have a minimum 20 feet separation from all sewer lines, this includes your neighbors. 4. Ensure work is completed to city standards. a. Septic work performed by Contractor: i. Pump Septic Tank. Give copy of Pump ticket to City Inspector ii. Crush or remove septic tank(sometimes it's filled). iii. Ensure sump discharge is out of sewer line. iv. Install connection lines water/sewer lines to city utilities at curb stop. v. Back-fill pipes and grade dig area. vi. Ensure CURB STOP IS VISIBLE AND AT GRADE AFTER SOD IS INSTALLED. Please plan for sod-height before curb-stop is set. vii. We suggest that all work is finished to city standards prior to paying contractors. b. Well work performed by Contractor. i. Have Contractor locate and mark all existing Wells and sewer systems on enclosed Aerial Photo including adjacent property's wells and sewer. ii. If Well is required to be sealed, contact your well company (wells often have name of installer on them.) Have Well sealed. See enclosed information for a cost-share program for sealing wells.