HomeMy WebLinkAboutBldg Permit 03-0568
CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT d-d<f-03
(Please type or print and sign at bottom)
ADDRESS I-l~ ;)S-
~ 'l)Ack"Cd
1 [2(>1 (
LEGAL DESCRIPTION (office use only)
LOT /3 BLOCK..( ADDITION
OWNER
(Name)
17 f u \ :J ~"-O ,)
/?:J)'--;.'7k L L/<; L:::~,D?-
<::'U.:L' '-,C / [C-l;) I/-
(Address)
,s' 6 7'1
BUILDER
(Name)
tYJrill!I,'
(Contact Name)
(Address)
/;, cf ,'/ ,,J
TYPE OF WORK
o Misc.
f/r)_,/, )
I
/(; :.A../I'yt :7./ ,,'
().
I. White File
2, Pink City
J. Yellow Applicant
PERMIT NO. 03 -o5(P81
)2fNew Construction
OLower Level Finish
ZONING (office use)
/\ j(j,jiu:..J
7Cs
Ot:~,~- f
PIDQS-o~1.- .
(Phone) G/2 - Cj,( ,-;.. ~'r 2~
(Phone)
(Phone)
C; S2 ~ ~17 .~- <j j $. ''j
/;/0,' V) .' c.... , /~ ',_
;
,1';,1/,'
~~Y.;-;)
DDeck
o Porch
DAddition
ORe-Roofing
ORe-Siding
o Fireplace
OAlteration
OUtility Connection
PROJECT COST IV ALUE (excluding land) $
, 7 7 s ~ ,'"-.
f
$
$
$
$
$
$
$
$
#;9 7.t9tJ/7, OD I
"'5'3fplls +
. ~qCJ .0"2 ~
QS, 5b 1
I
I
I
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 ~/'L/~.,,- ,-"),/(.5, 2"))t~ OJ
, - s'ignature Contractor's License No. Date
I Permit Valuation
I Permit Fee
I Plan Check Fee
I State Surcharge
I Penalty
I Plumbing Permit Fee
I Mechanical Permit Fee
I Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
loo.ot)
/00.00
------
40.t)O
1C-Z:P;~:-d
Building Official ' Date
$Vlf050.00
$
$
$ -
$
$'1{700. DO
$ /5tJt). ()~
Other T~~ PfU:;~ervJ"'T1o,J $ - JJA -
TOTALDUE,,~ ~. I:?-OJ ,_ $$4-. ~7
. Recei' J. 4",,~e;J I
By ~ I
C
Park Support Fee
#
-&Ae-
#
V.'.~l.~_ ~:.!'~4
Size 5/8", 1";
---
112:..:.~v_._ :Ldw""4
I r"". r' ~ J............
1::-'J.'iJ U.L'I.'-' au tVftL
I Water Tower Fee
I Builder's Deposit
#
#
I Paid ~ 0/2-'7- 4'7
I 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 PI constitutes a tern orary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
I-) .(ao~
Date Special Conditions. if any
our notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
CwJ.,ite - Buildinv
Canary - Engineering
Pink - Planning
The Crnler of 'he I..kr ('ounll')'
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT .m -'C/A c; 9-./ ,;j~4/ ~
APPLICATION RECEIVED :;)- d f?- 3
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
L/5d5' ~ 1ac-!LsoIU IrQ/I
,
Accepted
Accepted With Corrections
/
Denied
-M-f-J Date: 3/i 9/a 3
~~J~
~ ~ ~I ~,<J~ ~
~ ~ I
1Y~ ~ ~~<-j) f~ -Iv Tt:.():
~~ (1114 l~~o-P ""'- S"-f't--<L s:~..~
pruQY2) to -r~. {}uj, az ~;'trJ'
~ ~ ~ ~ fa T:e.~, ~
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v
~~~ .. Yo ~~~
./ ~ I --..../
Reviewed By:
4~
;(~
Comments:
"The issuance or granting of a permit or approval of plans, specifications and
computations shall not be construed to be a permit for, or an approval of, any violation of
any of the provisions of this code or of any other ordinance of the jurisdiction. Permits
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid."
White - Building
Canary - Enqineering
(Pink, - Plannliig)
The Cente, 01 the Like Counlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
/' /'. 1/', "= II ,1/
/ ,/ l /f
./1 (
, ~
..-.
_. "-:~
'-j
APPLICATION RECEIVEDj
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
-'
/ / L~ ) ~) / ,.I
/'
/ / I
Accepted X'
Accepted With Corrections _
Denied
Reviewed By: C. RfL
I:::=; -1'...." 0 1--,
Date: ../ d- ..-
Comments:
v~d ..f'O ~ CSLr~~ tv
,efl~ LFL.- G o' I O--b:x-c CCD:J. q ,
liThe issuance or granting of a permit or approval of plans, specifications and
computations shall not be construed to be a permit for, or an approval of, any violation of
any of the provisions of this code or of any other ordinance of the jurisdiction. Permits
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid. II
Thf' Cf'n'f'r of Ihf' 1..k~ Counl".
J!lbU - i1ding
c:::::::.cana.nc: Engineer.
PiriK- - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
. /1/, .) j'
NAME OF APPLICANT/Ii //-. /t </ 6')
/) 'I p- '-')
APPLICATION RECEIVED ,,;?';' - c:..'7"' l.) ,-:r
J I .p
A/::.;() / C::S
,
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
;
~ - ....,. J J
L-/ ':-..~ :-J ]'>"'" 1/5",,It I '.'1. V' .'~ I I
I .::J -...... .~ U c. 1(.. - c".../ / I ,_.{ I
/
Accepted
x
Accepted With Corrections
Denied
Reviewed By:
M:f15
s.....- /1- 0 <-
Date: J
Comments: ..see Reverse Side for Additional Information'
~ Su..{J-FAC6 j:::}~ue~ f2-et. -9(U~~ fO
"I~t}) ~',FlCAst-S L'JF c!!}uur~-:J f
See Attachments: 1) Grading Plan, 2) Erosion Control Mea~mrp.~
"The issuance or granting of a permit or approval of plans, specifications and
computations shall not be construed to be a permit for, or an approval of, any violation of
any of the provisions of this code or of any other ordinance of the jurisdiction. Permits
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid."
.~_________. .e____"__.___._.______~_,....,.._".~~.~-".---~'-~"--.m...-~-.,-".-......--~--.-".-~..-..-'.-..~-.-~-.~-~~-........
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION ,CERTIFICATE
a.M.B. No. 3067-0077
Expires December 31, 2005
Important: Read the instructions on pages 1 .7.
SECTION A. PROPERTY OWNER INFORMATION
Fa Insural1cB c".. 't''''' _j Use:
Policy Number
BUILDING OWNER'S NAME
t-iark llesener
BUILDING STREET ADDRESS (Indueling Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO.
4525 Jackson Trail
CITY Prior lake Mn STATE 55279
PROPERlY DESCRIPTION (Lot and Btock Numbers, Tax Parcel Number, Legal Desaiption, etc.)
lot 131 Block 2, Titus 2nd Addition
BUILDING USE (e.g., Residential, Non-residential, Addition, Al:xliJssory, ate. Use a Comments area, if "o......,sary.)
Company NAIC N\....:' "'.
ZIP CODE
LATITUDEJLONGIlUDE (OPTIONAL)
( #If - #If - ##.#If' or ##.#####")
HORIZONTAL DATUM:
o NAD 1927 0 NAD 1983
ResidentiRl
SOURCE: 0 GPS (Type):
o USGS Quad Map
o Other:
SECTION B. FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B7.FIRMPANEL
EFFECTIVEIREVlSEO DATE
88. FLOOO ZQ\lE(S)
X
B3.STATE
t-finnesota
89. BASE FLOOO ELEVA TIOO(S)
(Zooe AO, use deplh ci foodirg)
N/A
81. NFIP COtvMJNlTY NAM: & C<MvlJNlTY NUMlER
Prior Lake
84. Mt\P AND PANEL
NUM3ER 85. SUFFIX 86. FIRM INDEX DATE
2704320002 C 11-19-97.
810. Indicate the souroo ci the Base Flood Elevation (BFE) data or base flood depth entered in 89.
o FIS Profile 0 FIRM 0 Commurity Date.. ..:.. ",J 0 Other (Describe):
B11.lndicatetheelevation datum used for the BFEill 89: 0 NGVD 1929 0 NAVD 1988 0 Other (Descnbe):
B12.ls thebuildil1!ll.....aleJin a Coastal BarrierResouroes Svstem (CBRS) a-eaorOlherNise Protected Area (OPA)? 0 Yes 0 No Desi!lnalion Dale_
SECTION C. BUIlDING B.EVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: 0 Coostruction DmNings* 0 Building Under Construdion* .[X Fll1ished Construction
*A new Elevalion Certificate will be required when constructiorl of the building is w.. ,~d..e.
C2. BuIlding Di~,,,,,, Number! (Select the IxtiIl19 <!i"l:t'CII" roost similar to the building b" which this cerliticae is being ~ - see pages 6 and 7. If no dagrcrn
a::curately 'etA....ants the building, provide a sketch or pholVlj..,.A I.)
C3. Elevations - Zones A1-A30, AE, AH, A (with BFE), VE, V1-Yro, V (with BFE), AR, ARIA, ARJAE, ARlA1-PJJ, ARJAH, ARJAO
Canplete Items C3.-a-i bebN """""Jng k> the building dagrcrn spErified in Item C2. Stie the daum used. If the dcium is dfferent from the datum used for the BFE in
Section B, convert the datum to that used for the BFE. Show field measurements and dalum COI1\'", ..:..." calcuIalion. Use the spa:e provided or the Cv"., 0Cl ,;" area of
Section D or Section G, ac; appropriate, to document the datum conversion.
Datum CooversiorVCooments
Elevation referena! mal< used PP Does the elevation refc,CI'''''' mark used awe<>' on the FIRM? 0 Yes gg No
a) Top of bottom floor (including basement or enclo5ure) 2W ..5Jt.(m}
b) Top of next higher floor 919.5fl(m)
c) Bottom ofk:7Nest holizontal 5tructura ,,,,,,,.Le, (V zones only) . _' _ft.(m)
cI} Attached garage (top a slab) 9 09.. ,Jft.(m}
e) Lowest elevation of ~ ,;,,"" i mor equipment
servicing the building (Describe in a Comments area) _' _fl(m)
Q Lowest CKljemlt (finishecl} grade (LAG) 9 09 ..~fl(m)
g) Highest CKljacent (finished) grade (HAG) 910.3 fl(m}
h} No. ci permooent openings (flood vents) within 1 fl above *""",1 grade 0
i) Tota area of aI permanent UI'"",:..gs (fklod vents) in C3.h 0 sq. in. (sq. an)
SECTION D. SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information.
I certify that the information in Sections A. 8, and C on this certificate represents my best efforts to interpret the date available.
I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
CERTIFIER'S NAME UCENSE NUMBER
Gregory R. Prasch 24992
TIT~gistered Land Surveyor COMPANY NAME
L<:>t Surveys
ADDRESS CITY -
76Ot. 73rd Avenue North Brooklvir
SIGNA,TX!K ~_ _ A " # QATE
,~ ,&~ July 23, 2004
FEMA Fonn 8V!, ~anuary 2003 See reverse side for continuation.
B2. OOJNTY NAM:
Scott
OJ
II>
rn
"0
~fJ
~o
~-g
WOI
'-~ Ii
ils
e1ii
::IC
z.5!'
CD(/) rn
C
2l
::;
Registered Land
Survey NO. 24992
JU~;4(
Company ~ Inc.
STATE
Park
ZIP CODE
55428
TElEPHONE
763-560-3093
Replaces all previous editions
IMPORT ANT: In these spaces, copy the corresponding Information from Section A.
BUIlOING STREET ADDRESS (IrdxfOJ Apt, Unit, SlE, andforB~. No.) 00 P.O. ROOTE AND BOX NO.
4525 Jackson Trail
CIlYPr. Lak ..tr.l STATE 55379 ZIPCOOE
10r e L"IL'
SECTION D . SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy bcth sides of this Elevation Certificale for (1) \AJI.II..unity official, (2) insura1Ce agen~""" '1'0" y, and (3) building CMneI'.
COMMENTS
For Insurar1al CorT1:lanY Use;
Poley Nwmer
Corl1Sny NAIC Nunter
D Check here if attach., ..;.. ,t.;
SECTION E. BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zone AO and Zone A (without BFE), oompIete ttems E1 throogh E4. If the 8evation Certificate is intended for use as supporting inf"" ....:iJl for a LOMA or LOMR-F,
Section C must be com~ted.
E 1. BuBdi~ [lagram Nun1ler _(Seled the buikflll9 diagran most simBar to the building for YAlich this oor1ificale is bei~ completed - see pages 6 and 7. If no ~ all. acx:urately
represents the buiking, provide a sketch orpOO."'dl...A',)
E2. The top ci the bottom floor Qnduding basement or enclosure) of the building is _ ft.(m) _in.(an) 0 above or 0 bekM' (check one) the highest aqocent grOOe. (Use
natural grCKle, if avcilable).
E3. For Building [lagrams 6-8 with openings (see page 7),the next higher floor or elevated floor (elevalion b) cithe buikfll1Q is _ ft.(m) _in.(an) ctxwethe highest~t
grade. Complete ttems C3.h and C3.i on front ct form.
E4. The top cithe p1atfoon cimoJ';lIc.i CI1dIor~V;~."c."lservicing the buDding is _ ft.(m) _in.(an) 0 aIxJve or 0 bekM' (check one) the highest adja::ent grade. (Use
natural grCKle, if available).
E5. For Zone AO only: If no lIood deplh number is available, is the top ci the txXtom floor elevated in OoNU.Jalre with the oorrmunity's fl0odpiain management ordinance?
Dyes 0 No 0 Unknown. The Ioca dIiciaI must ll3t1ify this information in Section G.
SECTION F . PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The JXOPEll1Y CMneI'orCMnel's authorized '''''''\:..:Jc:.Iltalivewhoc:anpetes SeclionsA, B, C (Items C3.h and C3.i only), and EforZoneA (without a FEMA-1ssued or... Jnity-
issued BFE) or Zone AO must si!1l here. The statements in Sections A, B, C, and E 8IB correct to the best of my koovr1edge.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS
STATE
CITY
SIGNATURE
DATE
TELEPHONE
COMMENTS
Z1PCOOE
D Check here if attachments
SECTION G . COMMUNITY INFORMATION (OPTIONAL)
The Ioca official who is authorized by law or ordinaoce to cmvnister the \N1I..nlnity's floodplain mooagement ordinance can complete Sc..iiUl .... A, B, C (or E), and G ci this Bevation
CeItificate. Complete the applicable Kem(s) ood sign below.
G1. 0 The inforrnaion in Section C was taken froo1 other documentation that has been signed and '" I ~ by a licensed surveyor, engineer, or alJ .;levl who is authorized by state
or local law to certify elevation infonnation. (Indicate the source and date of the elevation data in the eo"""",,:S lIeS below.)
G2. 0 A community official completed Section E for a building located in Zone A (without a FEMA-issued or community~sued BFE) or Zone AO.
GJ. 0 The foIlowi~ information (Items G4-G9) is provided for community floodplain management PUI~.
G4.PERMlTNlJtvI3ER I GS. DATE PERMIT ISSUED I GG. DATECERTlFICATEa=~ANCYISSUED
G7. This pennit has been issued for: 0 New ConstrucIion 0 Substantial Improvement
Ga. Elevation of as-buiItk7NestlloorQnduding base""",;} of the building is: _. _fl.(m) Datum:
G9. BFE or On Zone AO) depth of flooding at the buildi~ site is: _' _ll(m} Datum:
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME
SIGNATURE
COMMENTS
TELEPHONE
DATE
FEMA Form 81-31, January 2003
D Check here if ,(.k.J.ments
Replaces all previous editions
F ILE ~.lo .028 07/16 '03
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08:29
I D : PL"/rl0UTH PLur18 I NG
FAX: 7635331121
/11(( Iz td.J
I tllw;: rilt I PERMIT NO l
: "0111 (",,,, ;. ',-::::;/,C:-/ c": ,
l Ytll(\ll" AlIrlic/lrll J ---.J Co 2'5
(l'l~:l~r "/'PC 0" pnm and 'Ij!P JI bonom I
. ADDk.ES~
<i~dj - ~\~'1r
ZONING li\tflC':uW :
I
_J
LOT
LEGA:" ;)ESCRlPTJO'N ("nice usc onlv)
PID
APPLlCANT /j'
(J,lam'~1 PIIJ\N\,("L~"i l., Y 1 i-l./'\'\\I), i^-Q
(..'..,.CO(<:.;;:;) (o4.(\q \"J,,;\Vd+t;::; .jtl~ l.)
(,A.dd;c:~,':)
IC'(lmac: f'.;)'s<..\n) ~"'--L ,^d~ _'
APPLJt0JJT SIGNATULE ( ~~~~ ..
OWNEr::
IN,jmcl
IAdd~css I
QU:WUl".)'
~
I
(
c.;
t
/
(
--
~
BLOCK
,A [lDJTJON
~~~
1':s"S7t ~~l~Gr, \
.I
C;'/~'?59(,11
I
(Phone) 76 d- -
E cfU/\ ~~
(Phone) (rt.I.C ~) ~)?~'-Ljo5 '(
- --- '
r\r (1[1 Ie l '-i.J:~.d(
(City})
(-) c:; L/ ,:.).. 7~
(ZJ.}' C' ode)'
(Phone)
DATE
7-t(F3
Al)PLlCANT PLEASE COMPLETE BELOW
I Typt, of Fixture I QU~llltity
I 8:.tll iub with Or withNll slh\l.ver I
DIsh\.vilsher
Flo0r Drain
LJVZltOf.;' (B.lthrcIOIll Sink) I, (I
L.aLlndry Tr;;)~. ( 1 01'.2 C()l11p<l.~-tmeI11 ;;:11];
Shower Stilll
I Slj)ks
Typ(' of Fixtun:
I
\
Rough-1115
Water He.ll~r
Wattr Soft:ncr
Stand Pipt (Wa~hing Mo:lthll1c)
Sewa"t: Eie::ctar
~ .'
Bilckf)o\.\ Assembly
BJckf]ow Assembl)- itSl
j
--
'-I4.&.; vlllJ\.
~ _.... .'1. _1""111."._.
\Nat~r ('iO:\.;l iTolk:1) J Il
I Other ,. I.....:- ~I~ Ilv--a-
FEE SCHED VLE
IndIlSI(I_11. (:IInil11crcl,J1 & r"1lJIII.r;II11lly I"" o'",b 1.:0,;1 ',~'Ilh J j:3\15(11l11111111Um RC:~ldcnlJlll. New Olle &. Tw,,-I'.JI11II\
Rcs"knll:ll (),t\d~ll'): &0' A~T"c
bllnl:lltd ('OS1 :\, Budding PCnllll # I J ..J~ 0
IUlr,~I, U" 1)111\)
:i:'1";Sil
j;:;'~ 50
PLUMBO'JC PERMIT fEE $
STA TE SURCJ-1ARGE $:
TOTAL PER.lYrIT FEE $
;0 . D",i ~
(PJ hq r
This Applit::JtlOn BCC(InlC, Your Bllrlclln~ Permil When ~.rJlIw'c:cJ
hlld
J
I RO:':~'pl I'-Ie.
I
, -_.-'i71111tl ",:; fJ/r,,'I:11
rl;111
! (1.11>-)_ (5 =3
__.,...""._..L__.. ._...._.._
I.~____.~~- .
:4 IinUl 1I1111~(' r," Jillll~l'~"lll"\' ")~:) 4.j7-~li:;II, I:n (!!5:!i ..4i..j:~:C;
10::0/1 (,;J~d/' I ''-~'i:L '\'.'/', .....1 !'l-h'{ La!,.\,;. \11'\: ~':~-:-:-1'11-l
LITY U~' Y.K1UK LAKE
HEATING/AIR CONDITIONINGlFlREPLACE PE~.ul
(Plea.sc: troe or Drint and siv,n &t bolnlln)
ADDRESS . .
~
4..5 d 5 ~Qc..V( SOn
...-
I l" c{, f
LEGAL DESCRIPTION (office ~e only)
LOT
BLOCK
ADDITION
OWNER -
(Name) (Yl, k e.
;-.( ~ve ~
J{ c) f'V\ c:.. ~
(Address)
APPLICANT /1 1-,
(Name) D U '-\ ~ ~ ":' r- l t' -e... ~ CL C tp
I :-r,-\
(Address) 1?7 Y05 /5 nuf..(l, Of?....
1\ (Addms)
(Contact Person) l)o r/\....
APPUCANTSIGNATURE ~~.- /}t~~___
.-/'
Date Rec'd
I. "'nk Fil. PERMIT NO. 3' -s6f1'
~. c;."", ell)'
) Yell... A.pll"",.
(Phone)
(phone)
Pl., iMocJ+,^
I (City)
ZONING (alficewe)
PID
,"5::5 '#<J ~
(Zip Code:)
(Phone)
DATE
763 --;;1Y- Y66"'3
/ D1r3/o-=S
APPLICANT PLEASE COMPLETE BELOW
~NEW CONSTRUCTION 0 REPLACEMENT 0 AL TERA nONS
FURNACE MAKE AND MODEL I FUEL
FLUE SIZE RETIJRN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM
OWann Air Plants
OGraviry
o Mechanical
OAir Conditioning
OVent. System
REA TING OR POWER PLANT
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
V ~(a ~ S
FIREPLACE MAKE AND MODEL
f:(lI{I
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
'S39.50 minimum
$99.50 Residential, Additions &. Alterations
$64.50 Residential. AC Only
Industrial. Commercial & Multi-Family
Residential, Heating &. AlC (New Constf'JCtion)
Residential. Heating Only (New Construction)
Estimated CoSt $
Building Permit #
HEATING PERMIT FEE
5T A TE SURCHARGE
TOTAL PER.."\1IT FEE
(Office VWt Oqly)
This Application Becomes You," Building Permit When Approved
Buildin!: Official
Datc
:%4 hoor notice for all inspections (952) 447-9850. faJ[ (952) 447-4245
<:00 IPi
X1ddns SH3a1Ing SH31n~
$~~~k>
Paid ~~0~J"ry:'
Date ~~~;>-- By
$
$
$
.50
$39.50
$39.50
$39.50
Receipt No. ------
?J
LSSOCSSC9L XVd <:l:60 CO/Cl/Ol
QI~rfifitaf~ of @ttupantlJ
CITY OF PRIOR LAKE
~~patfm~nf nf ~uilbing Jfnsp~tfinn
o Pinal Permitted D Conditional e.O. Expires
/
This Certificate issued pursuant to the requirements of Section 307 of the Uniform Building Code certifying
that at the time of issuance this structure was in compliance with the various ordinances of the City of Prior
Lake regulating building construction or use. For the following:
Use Classification
SINGLE FAMILY
Bldg. Permit No.
03-0568
Occupancy Type
R3
Type Construction
VN
Fire Zone
N/A
Zoning District
RS
Legal Description
L13, B2, TITUS SECOND ADDITION
Owner of Building
Site Address
4525 JACKSON TRAIL
Contractor'sNarne&AddressMICHAEL HAYES~l6998 KENMORE DRIVE, BLOOMINGTON 55438
,; ,
ROBERT D. HUTCHINS
_ City Planner_
DON RYE
Date:
I : I
! \
Building Official
Date:
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
4-7-oVf
ADDRESS
i-SJ,S '} t(c/c.-SWl
tvl
OWNER
CONTR.
PHONE NO.
PERMIT NO.
~-a?
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
q SJWER HOOKUP
pLUMBING FINAL
o MECH FINAL
o EXIGRAD/FILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
COMMENTS:
(i)
..........
r ~ JA-1 r.i-<- r rxEUf?>'
o WORK SATISFACTORY, PROCEED
~RRECT ACTION AND PROCEED
o CORRECT ~~~&FOR REINSPECTION BEFORE COVERING
Inspector: ! /If./ Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
lNSNon
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
4szc;-
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
D~SULATION
~ FINAL
o SITE INSPECTION
COMMENTS:
DATE TIME
SCHEDULED ~;f';r1~
~~' r}-
CONTR.
PERMIT NO.
--3 - c;~
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
~ G~~t"IR TST
I
Ok::::" - ~
J1'9~2~~50
- -- /
~WORK SATISFACTORY, PROCEED
o CORRECT ON AND PROCEED
o CORREC , CALL FOR REINSPECTION BEFORE COVERING
Inspector:
Owner/Contr:
~ FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
Il'iSNOTl
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
8-/0~
ADDRESS
45-2) Ic,d~o,
Trc" '/
OWNER
CONTR.
PHONE NO.
PERMIT NO.
63- S~~
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~L
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
~LING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
COMMENTS:
/'/'et~- c9 K
~ WORK SATISFACTORY, PROCEED
/ 0 doRRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector:~;fift. .... Owner/Contr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
INSNorl
~#-
4I's-,z ~ - ~ k~ fr/
/ CONTR.
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
OWNER
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~AL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
,JiiHtIIECH FINAL
~3~,y
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
...,.l!!H=rREPLACE FINAL
o GASLlNE AIR TST
o
~E~TS: ~ J ~
~r,,~ I /;:"hCJ / ~-c-L
~Ce'b~ d/ ~~ ~f.10/1-
,
/ " ~. /
h}~AJ~~..t' /;/:.'1/ _ ~~ /
~a/v'e Q /Y~He~r<!
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~Ck ~ h~v~~7't-,.- .
/'"'") . / I ~ /.,,- /\/./l /'
eY /ye~d ~tJd r 'v~<f tt:['rfer- *~ /
~d~ q#d/"O't.he / /- ~ ".. "'- /
y ~~:.,~ CO, .e:;./- ~{/ ?/J!!C}/~
/ '
o ?RK SATISFACTORY, PROCEED
~CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ OwnerfContr:
,
//~
~~~
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSliOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
447.4230 ~~ \1'
I hereby apply for a mechanical systems permit ~~~~a that Ihe
,~ illlormation above is complete and accUfale; thl!!.J'it\~Wili be in conformance
New Conslruclton with the ordinances and codes 01 lhe cily and w.f'lie slale building/mechanical
~ codes; thut this lorm does nol become a permit until signed by the BUlLDING
Est. Comp, Date ~ ~ OFFICIAL; fhat the work will be in accordance with the approved plan in the
'"\C <'1""'\ ---- B 'Id' P Ii'" ~"L" - . caso 01 all work which requires review and a.pprovel 01 plans,
I, ( )V UI Ing arm It .J:"')} - - . fJN
H.LIM Ol~ ~l\,O,
Appl iU-S;gn"iffiJr"ij'-'
BUildingJ'iC, f's Signature
(\J
~~O~.~~-Yr CITY OF PRIOR LAKE Me.. ~ lo<6
iJ . ~ 1620GEagle Creek Av. S.E. P"mll No. '3 :.;
Prior Lake, MN 55372
- HEATING APPLICATION / PERMIT
.., -l (~ - 3 PID N
. C/~.:lS ,~w:-~~\
......-
",
.......
w
("
.3:
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Dal9
Sile Address
"
.......
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.......
.......
('0
('0
lD
(Y\
<6
t'-
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a
LL
Block Addition
OHnel's Name ~
I
.~
o
Lot
ID-r rvu((e.
u
Address
Healing ContI actor Y Il,f Wt.6() {- ~ ~
Address (ocro9 'L0~~~d(~
Tolaphone# ICo~-S:5 ~-(?3S7
Furnace Make & Modol L~ V\V\~
Model Size &~ ~ Q 3/ '? S-
Conn. Load 7-:=) {')OCJ
I
fuel ~\- (...t>-Ylue Sizll 4 ft
(!)
:z
TIPE OF SYSTEM
Warm Air Plants
Gravity
Mochanical ~ '^A..:DG
Air Conditioning ~_""
Vanl. Syslam
~ -h.1r--
en
~
::)
.-J
CL
:r:
f-
--.
C5
~
Supply Openings
HEATING OR POWER PLANT
Steam
Hol Waler
Radiation
Spacial Dovices
Return Openings
::..J
CL
Q
Inpul OUlpUI
Edr.
Other Devices
q
.......
Clm.
.......
.......
TYPE OF WORK
(Y)
o
Alteralions
Raplacamenl
<D
.......
~~
o
Repair
t'-
""'f
o
Esl. Cost $
o
:z
HEATING PERMIT FEE $
W
.-J
~
LL
STATE SURCHARGE $
.50
TOTAL PERMIT FEES $
Rece/pt /I
TYPE OF STRUCTURE
I \'j,k
1. 0,<,<"
J. YeHcr..
nre
Cily
CQl1trrlCl::f
Single Family
/' Two-Family
Induslrial
Public
Mum-Family
Olher
Commercial
Fee Schcdu:e
Industrial, Commercial & Multi-Family
Residenlial, Healing & AC
Residential, Heating Only
Residenlial, Gas Fireplace
Residential, Additions & Alleralions
Residential, AC Only
1% 0/ job cost ($39_50 minimum)
$99.50
$64.50
$39.50
$39.50
$39.50
Remember 10 add the Slale SlIIchslga on Ihe bottom 01 this appticalion.
The price 01 your heating permit includes ooe rough-in and ono Iinal inspeclion.
Additional inspections will be billed al $35.00 each.
House Heating Test Record must be submitted wilh !ll!lJ.lling D-fillIlillli.!!ll!lltr belore bUild-
ing certificate 01 occupancy Will be issued.
HEAT CALCULATIONS ~ wilh /lumber at supply and relurn openings listed por
room willi CFM's per opening. New slruclures or addilions send 1I00r plan willi supply
and relurn localions shown HEAT LOSS CALCULATIONS, PAYMENT AND
APPLlCAllONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, t 6200 EAGLE
CREEK AVE. S.E. PRIOR LAKE, MN 55372.
City Hall business hours are a a.m. - 4:30 p.m.
ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
7-/6- 3
? . Date
~()-3
Dale
PRIOR LAKE
INSPECTI RECORD
SITE ADDRESS ~S7 5 7V!,/t(,S(JAJ L.
NATURE OF WORK ~W ~N'" _
USE OF BUILDING Ui~ z., 1i!tIIJ6 z. 1M. ~O_
PERMIT NO. .(23 -O..s~ DATE ISSUED
CONTRACTOR ~f.., AA\46 PHONE · · ~4.f
NOTE: THIS IS NOT A PERMIT FOR M OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DEPARTMENT OF
BUILDING AND INSPECTION
I
I FOOTING WIG- ~ I ~/~/p3
FOUNDATION (Prior to Backfill) I ~ I &"1 Viis terJ
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
INSPECTOR
DATE
J
SEWER I WATER I SEPTIC
FRAMING ~c:\~ ~o
INSULATION v
ELECTRICAL rtivL....
PLUMBING
HEATING (if required) L~ I ~
FIREPLACE
GAS LINE AIR TEST
lAD IPt l(}j
~
'-:J lie /d!,
CfI'b-e ?e~
0/ ~L{/ C?~
11 -1;\Q
,
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
GRADING (Prior to Sodding) I / fV.Lr" cr. / ()~ C-J-
BUILDING ~~.CO 9L?aft~~~ ~--~r../<L:1F "fill! . 'J'4t~
ELECTRICAL - -0/o~
PLUMBING J/Jp 1./- /'Vl> I
HEATING V~~ .!/('~ FfAr/~
DO NOT OCCUpy UNTIL ABOVE HAS BEEN SIGNED
NOTICE
This card must be posted near an electrical service cabinet prior to rough-in inspections
and maintained until all inspections have been approved. On buildings and additions
where no service cabinet is available, card shall be placed near main entrance.
~
~J.JJ"/
I .
C"" A A
/~
qt4-
10'
FOR ALL INSPECTIONS (952) 447-9850
DATE: October 6, 1999
TO: Paul Baumgartner
FROM: Lani Leichty, Water Resources Coordinator vl/
RE: Proposed Home on Jackson Trail
In order to determine the low entry elevation for this house to be located
along the Prior Lake outlet channel, the following information needs to be
provided:
1. The low point on the road above the 36" cmp culvert should be
determined by survey.
2. The channel top-of-bank elevation needs to be determined by survey
adjacent to the proposed low entry walk-out.
Per zoning ordinance 1104.308 (3) b, the lowest floor shall be at least 3 feet
above the higher of the these two elevations. Once these elevations have
been provided by survey the low entry elevation can then be determined.
Zonina Ordinance 1104.308 (3):
High Water Elevations: Structures must be placed in accordance with any
flood plain regulations applicable to the site. Where these controls do not
exist, the elevation to which the lowest floor, including basement, is placed
must be determined as follows:
b. For rivers and streams, by placing the lowest floor at least 3 feet
above the flood of record, if data are available. If data are not
available, by placing the lowest floor at least 3 feet above the ordinary
high-water level, or by conducting a technical evaluation to determine
effects of proposed construction upon flood stages and flood flows and
to establish a flood protection elevation. Under all three approaches,
technical evaluations must be done by a qualified engineer or
16200 Eagle Creek Ave. S.E., Prior Lake, Minnesota 55372-1714 / Ph. (612) 447-4230 / Fax (612) 447-4245
AN EQUAL OPPORTUNITY EMPLOYER
hydrologist consistent with Parts 6120.5000 to 6120.6200 governing
the management of flood plain areas. If more than one approach is
used, the highest flood protection elevation determined must be used
for placing structures and other facilities.
...
2
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SCOTT COUN 11, lnU~Lu,,~~ _._
INDIVIDUAL SEW AGE TREATMENT SYSTEM (ISTS) PERMIT
(lM \;.!tv'rttS-. i -{ '1'-0 :3
Date Received ~.2/~'..3
Permit # .2!) ;(....1. 5'
r 1/,>_ Receipt # "1\ _ -..._ ""-- ~tc '\
4 f l.... Fee " <;-e .... b J- cd.'
r~eiPtCode S-c~ -b_,
wJRS){ Replacement
Pe ~Uates B':.?.. 5<
eX1,."."J, L _/_. . Numbercl""PotentiaIBedt'ooms-"~
o , "4:..- ~V Vf/ Depth to Restricting Layer (,:, ,
~l~ote to Applicant: only fill t haded section below)
Twp/City fir,~ L<Q. "
Project Address. ,+"""~,", ,J:;('".,&o- 7r / tV G.
City/Zip h.-b.r /.,. /r'" .
Site Evaluator ~~ t../e/I Installer &4... ,
Septic Tank Size as per design submitted and approved /~/y
Pump Tank Size as per design submitted and approved ',1'iOb ~
Drainfield Size as per design submitted and approved (below)
(: ~.,,:):~ '
.': ~. .\. .:'. '"... '<"'" .. C',
'A~ 'liii8ht'
r-rP,. . .
- /T:WNSHIP OR CITY USE ONLY
Recommend Approval
Recommend Disapproval
and Permit complies with the Wetland Conservation Act
Signature of Township or City Clerk (or representative)
Date
COUNTY USE ONLY
ISTS Setbacks: Building: (tanks) 10 (drainfieldLr::'V Lake/CreeklWetland Wells 50 + 10' to Lot Line or ROW/Easemen
Approved Y Denied By Scott County Environmental Health, subject to existing regulations and the following condition!
1. Verif;!o.d maintain all required setbacks and elevations.
2. Protect (fence off) the primary and alternate drainfield locations while any building construction activity is occurrir
on the site and maintain fencing or some other approved barrier if the drainfield could be damaged after installatioJ
3. Install rock bed on contour and maintain at least 36 inches between the rock bed and the water table/mottling.
4. Protect sewer lines and system from freezing.
5. Divert surface water away from or around the drainfield area.
6. Sod or seed the area as soon as possible upon completion to prevent soil erosion and damage to the drainfield (for b
season installations, hay or straw can be substitnted until sodding or seeding can be done in the spring).
7. This permit is valid for 12 months from the date issued.
8. The property owner (or applicant, if different from the property owner) is responsible for assuring that the Install<
receives a copy of the final Department approved design.
9. Nonresidential ISTS shall include a water meter and, if a dosing device is used, an electrical event counter.
Ml1ks qnJ dran~tJt/c/ ~. k dLd ~ ~ / ~
.[};tIVlClK-a . ,,/,fhC:h I~Ur eI~u:;.1ion
Signature ,((ifj-...J),dlac.eL-- Date -r ~ tf/~
White - County Yellow - Township Pink - Applicant Gold - Township
Bohn Well Drilling Co.
16550 Baseline A venue
Shakopee, MN 55379
Phone: 952-445-4809
Fax: 952-445-143l:;ITY COpy
Percolation Tests, Soil Borings
& Septic System Design
CREA TED BY: _Cfnry M. '[!.ohn
LICENSE # 1043
DA TE PREPARED:
A e "":f(~l1e'
Mark & Lois Leisener
02-27-03
'7-1'0 --0.J
PREPARED FOR:
A1J1~ IICtf~S
9r;?-9?5-- f7'lf'
MAIUNG ADDRESS:
8679 Sunset Court
Shakooee. MN 55379
PHONE #:
952-233-5351
WORK #:
952-888-2475
FAX #:
MOBILE #: 612-964-8128
SITE LOCA nON INFORMA nON:
HOMEOWNERS:
SITE ADDRESS:
4510 Jackson Trail Prior Lake
ADDITION: ~ f 2"'J. I:J..JL LOT /]
BLOCK 2.
COUNTY: Scott
TOWNSHIP:
Priqr Lake
T:
115N
R.
22W
S:
23
" - ElECTRIGAl.
H etectIIcaI mJSt be approv~ by t~ ~e ~~tOl
fQ{ permits and inspecti?ns C)1I ~~~r v /01t LUSlun ot
(952l934-0229. 7:0Q-8:jO 0,0' ;'/10n, thlougn Fa.
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BOHN WELL DRIlliNG CO.
GARY M. BOHN
LICENSE # 1 043
16550 BASELINE AVE.
SHAKOPEE. MN 55379
4#1. tYL
Lot 13, ~:~{i~p~-~,
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1
PUMP SELECTION PROCEDURE
All boxed rectangles must be entered, the rest will be calculated.
1. Determine pump capacity:
A. Gravity Distribution
1. Minimum required discharge is 10 gpm
2. Maximum suggested discharge is 45 gpm
For other establishments at least 10% greater than the water
supply rate, but no faster than the rate at which effluent will flow
out of the distribution device.
B. Pressure Distribution - see pressure design worksheet
Selected Pump Capacity:
, 36.4 Igpm
2. Determine head requirements:
A. Elevation difference between pump and point of discharge.
l 7 lfeet
t"""''''1.
in:;et .]ii~r::~:~:::;':';':~~~;';:;:;: ~:::.:
~'" I~.~:d
....................................'....-........\'
B. ::ipeClal head reqUIrement? (~ee rlgure - ~peClal Head f<eqwrements)
5 Ifeet
C. Frictionloss
1. Select pipe diameter' 2 lin
2. Enter Figure E-9 with gpm (1A or B) and pipe diameter (C1)
Read friction loss in feet per 100 feet from Figure E-9
Friction loss= I 0.73 If V 100 ft of pipe
3. Determine total pipe length from pump discharge to soil system discharge point.
Estimate by adding 25 percent to pipe length for fitting loss.
Equivalent pipe length times 1.25 = total pipe length
, 401ft x 1.25 = 50 feet
4. Calculate total friction loss by multiplying friction loss (C2)
by the equivalent pipe length (C3) and divide by 100.
FL= 1 fV100ft X 50 ft I 100:
0.5
feet
D. Total head requirement is the sum of elevation difference (A), special
head requirements (B), and total friction loss (C4).
7 ft + 5 ft + 0.5 ft
Total Head:
12.5 feet
3. Pump Selection
1. A pump must be selected to deliver at least 36.4 gpm (1A or B)
with at least 12.5 feet of total head (2D).
~IJI: '!;e'.:lh~Eml sysjE;!r~
8: po:nl.(,-lfdisclKJlf,lf:l
!::"1-i:":::::::'::::1
I
2A. <';>:I?\"c'1i::mi
""'.'."".1.
Special Head Requirements
Gravity Distribution Oft
Pressure Distribution 5ft
E.9 Friction Loss in Plastic Pipe
per 100 ft
nominal
pipe diameter
1.5" 2.0" 3"
2.47 0.73 0.11
3.73 1.11 0.16
5.23 1.55 0.23
6.96 2.06 0.3
8.91 2.64 0.39
11.07 3.28 0.48
13.46 3.99 0.58
4.76 0.7
5.6 0.82
6.48 0.95
7.44 1.09
Flow Rate
gpm
20
25
30
35
40
45
50
55
60
65
70
I hereby certify that I have completed this work in accordance with all applicable ordinances, rules and laws.
(signature)
1043
(license #) 3'11'2003
Page 1 of 1
SCOTT COUNTY ~<:; - O~-70U"-O
INDIVIDUAL SEWAGE TREATMENT SYSTEM INSPECTION FORM
CitY/TWP.~f JQ..., ,Ins pection D. ates
Owner '. , _ l. A "I ~...J
Project Adejress ',T~ ~
City {:b'~ .p .1L_
o//~/rJ3 I Permit No. ,~~ ~, ~"c9S
Installed for (#Bedrm or gpd).3 Bus/lndiv -L
Designer f,o-n...., Installer --B;mf)
o NEW 0 REPLACE 0 REPAIR 0 ADDITION
TRENCHE~OR GRAVELLESS LEACHFIELD:
Drop box - concrete / plastic
-..., nJrench Depth ~ (It.) Width
-{"""not inst8l!eV ([Xrench Lengths' ~_ ,J^ S~'4..
, ~, 0 ~ L.. -'f" ~~ ji:- Trench Bottom Level
Trench Spacing
Drainfield Rock Below Pipe
or Size of Gravelless Pipe
Actual I Expected Depth of Backfill
Absorption Area: Square Feet
Lineal Feet
SETBACKS:
Buildings to Tank
Buildings to Drainfield
Well(s) setback 50' or 100'
Lake/CreekfWetland /-:;..
Property Line( s) - /i
,.,4'
.;;p.( ;
SEPTIC'HOLDING T ~t5'S) 01_0 New
4 Liquid Capacity l>-I tv. yl(.U"N.
Tank Manu~er J5J(}
Baffle TypE(.. -1'rastw Fiberglass Sanitary-T Concrete
No. of Inspection Pipes -3 4" .tf)diam.
No. & Diam. of Manhole Access .:J~ #I
No. & Height of Manhole Risers. .;a)C ~~"
o Existing
MOUND OR ATGRADE:
Percent Slope
Dike Width up
Drainfield Rock Below Pipe
Inches of Sand Below Rock
Perforation Size & Spacing
Pipe Size and Spacing
Dimensions of Rock Bed
Dimensions of Sand Base
Depth of Final Cover
down
%
side
inches
downslope
upslope
Jf'
Ph
ALTERNATE SITE AVAILABLE
ENV HL TH APPROVED DESIGN ONSITE
_ See Notes added to Design Drawing
_ Drawing of System Below
( <(.)
("yeY/ no
-
~.,
- "
l 3X''' ^;2.0 )
PUMP INFO: .
./,. Liquid Capacityt?-e If~JtI~.
"j,Tank Manufacturer ~ / existing
No. & Height of Risers ~'I
Pump Manuf. & Model No.. .~ lA _~ -Z I
Horsepower €fIIO GPM
Feet of Head ~ installed or as per design
Cycles Per Day2~ Installed or as per design
Gallons Per Cycle )S;~ installed or as per design
Size of Discharge Line & l " "
Type of Electrical Hookup
Alarm 'M loJ+- f'~ ~E1Fa~e / ::'u..'"
Alar' nk Alert / Lev~ Alarm / Other
C e Courifer&"Water Meter (Commercial)
ALTERNATIVE' EXPERIMENTAL SYSTEM:
Type
/()t4N-~l'
L I
~0~1
. 1: -;
, t
1\ . I
J L-
\ \ ;;c 1 .1'/'0 ybl'v
~ ~ I ~ > ,15 t:, ~
'7 , ~ rottt-
~~l
Inspector Comments: Divert all surface water away from or around drainfield area. Sod or seed as soon as Dossible
to Drevent soil erosion.
Corrective Action Reauired:
I hereby certify that based on this inspection
and the information submitted by the site
evaluator/designer, the individual sewage
treatment system appears to be in compliance
with the Scott County Individual/Community Furthermore, I hereby certify, as the installer, that the individual sewage treatment system was or will
sew~ . ,Tr~eatment SYlste~m or.d n~ance No.4. be installed in accordance with the Scott County Individual/ Community Sewage Treatment System
. . Ordinance No.4. I agree to indemnify and save Scott County harmless from all loss. damages, costs,
and charges that may be incurred by the nty because ory fa,~e }o~form to and comply with
nstallation Inspector's Signature the provisions of this Ordinance. ~
FINAL COVER Insp,ctor - J Installer's SIQnature
~ ' V
This system is in compliance 0 not in complian~ ~ with the Scott County Individual/Community Sewage Treatment
System Ordinan e No.4, therefore, this document is a < ] Certificate of Compliance 0 Notice of Noncompliance.
J
White - County Yellow - Owner Pink - Installer
I hereby certify, as the installer. that the following tank openings were or will be constructed to be
watertight: inlet, outlet, inspection pipes and the access to the maintenance hole, including risers.
(Installer Initials)
Bohn Well Drilling Co.
16550 Baseline A venue
Shakopee, MN 55379
Phone: 952-445-4809
Fax: 952-445-1439
Percolation Tests, Soil Borings
& Septic System Design
CREATED BY: _ctcuy M. Bohn
LICENSE # 1043
DA TE PREPARED:
02-27-03
PREPARED FOR:
.
Mark & Lois Leisener
MAILING ADDRESS:
8679 Sunset Court
ShakoDee, MN 55379
PHONE #:
952-233-5351
WORK #:
952-888-2475
FAX #:
MOBILE #:
612-964-8128
SITE LOCA TION INFORMA TION:
HOMEOWNERS.'
SITE ADDRESS:
4510 Jackson Trail, Prior Lake
ADDITION:
LOT
BLOCK
COUNTY:
Scott
TOWNSHIP:
Prior Lake
T:
115N
R.
22W
5:
23
1NGR.otJND SEWAGETREATMENT SYSTEM WORKSHEET
FLOW
Estimated r:,,, 0
me<lsured .x
Septic tank volume
A.
gpd
=
gpd
gallons
:2~c:::..
B.
/ .f7:; Q
SOILS (Site evnluiltion dntn)
C. Depth to restricting layer = (.
D. Mnximum depth of system C - 3 ft == 2-
E. Texture .r...., /610 _ Percolntion rale /. 2 ?
F. SSF t -Is'':' sq HI gpd
G. Slope :J' %
feet
feet
MPI
NUllIher ot
nctlro\J,"~
TRENCH I30TTOM AREA
H. For trenches with 6 inches of rock below the pipe:
A x F = x = sq ft of bottom area
For trenches with 12 inches of rock below lhe pipe:
A x F x 0.8 = too x t.l:2.x 0.8 = ~6) sq H of bottom ilrea
For trenches with 18 inches of rock below lhe pipe:
A x F x 0.66 = x x 0.66 = sq n of bollom nrea
K. For trenches with 24 inches of rock below the pipe:
A x F x 0.6 = x x 0.6 = sq fl of bollom Men
2 or less
J or"
5 or 6
7. R or 9
1.
J.
SEEPAGE BED BOTTOM AREA
L. For grari.ty beds with 6 or 12 inches of rock be ipe;
1.5 x A x F = 1.5 X- ^ sq t of bottom Mea
For pressure b 6 or 12 inches of rocKlJclow ~pipc;
A x = sq ft of bollom area
ROCK VOLUME, WEIGHT
M. Rock depth. below distribution pipe plus 0.5 foottimcs bollom area:
M =Rock depth. + 6 inches x Area (H,I,J,L,K)
( / + 0.5 ft) X ~ = q~o cu ft
N. Volume in cubic yiuds = volume in cu H divided by 27
M+27 = CU yds~+ 27 =77. ~cu yds
O. Weight of rock in tons = cubic yards times 1.4
N x 1.4 = tons .2l!:t.x 1.4 = tt lons
DIsmmUTION
(Check one bilsed on slope) Ued (< 6% slope)
Trenches V-Drop boxes (any slope) Dislribution box (< 3(10)
SYSTEM LENGTH
P. Select width = 7 ft
Q. Divide bottom Clrea by width: (H, I, J, or K) + P = lineal feet
~,?O + L =;2.01> lineal feet
Grave Pipe (lO") (Flow x Grav F)
. eal f
t of Chamberj + width of chamber)
LAWN AREA
R. Select trench spacing, center to center:= 5? feet
S. Multiply trench spacing by lineal fed R x Q := sq ft of lawn area
~ x 200 = I'dt> sq ft
LAYOUT
1. Select em appropriate scale; one square = feel.
2. Show pertinent property boundaries, rights-of-way,
easements.
!;Slllillled ~t*'fe t:Io.t iii 0."""* ~..,
I~, .
N......., . t'1ltll t1.d t1I&t m \ C1iII
n.t- IV
2
J
~
s
,
1
.
m us
410 JOO
600 J1J
7$0 ~'"
om 51$
llm a
1m 61'
110
211
2S6
~
m
)10
..
~
ot_
......
III
1J:.l
II
""-
SCIlHc Tonk CIPlcltlet (In taJlons)
Mlnimuln U'luid Uquitl t~r"city wilh
C3pncily gllrhnRe Ji~~lIl
Liquid ClpllCity
whll di~po~lll&
lin Inside
750
1000
1500
2000
1500
2000
3000
4000
1125
1500
2250
3000
5011 Charad..hllu ""d 5011 ,bins I~'o..
155" I.., Se....se 13' ;e"."'lI....1
~n:n""JOf' tJll'~ 9ft..,.", 'flefl
lml~v.../""hl ...n I,.Iure ~.II,,"/d.y
F.,tt'f ,t,," 0 I ' t.:Ol'f'f ~M\t.I
0,11. ~ Mtdlvm 50nd
~";?:~~
!lond, loom
l...m
5111 L.....
~II'
~, I. 60 aoy lnam ((.1.1
o:o...lvl.1-
Silt Cl
,low,,", IMn 1l.1'- ~., (-1..
SUIt Cla;
"Soil Inn ('o.llr.tf" ftn "('W"lf' '"'..t~.
\J~ 'r~'~",,'m mrklly p","..."hlt .olt!ll.
.~I h.,y.,~ 54,.,.. nt ~ J~ !U'rt41 . .trY tint ...,."d
"'Soli whh I.... h1~ . "".n""S" of .Ioy ,..
1",1=,1~1kM1 (t' .- 'l"n,I",,'I"Cfound ,)',Ir.",
nA:l
011.,
~ I.I~
II'. )0
Jll. 45
161
U1
't7
t.1lO
110
Soil Ch...clt,;,lId and Soil ,bins lad..""
(SSt) I.., G,utll_ ripe
I"'l'I::oI.Uo" u.lf' ~f9 ,~, I
f",lnul.../lnth) toll ,..du", R;"Ilt.n/d.y
r.,Ie,'ha"U.I. eN", ~
0.11. 5 Mtdh.... 50...1 0.~8
011.5 ~::'~ 06
~ 1.15 s.n.Iy I....m 042
16'.'" lttam 0.5'
JII. IS Slll......m OM
Sill
.u.lttM t~IIII.~~~cr l) P.'~
,Iown lh"" "0" ~l~r" CI.
s....1, ll.,
Sllt, CI.,
"Soli 100 (O,,~ '0' WW'f: '"'31m,",.
u~ :\y"''''"'' 'Of '-rId ., I"',"",,,b~ 9011..
''Soil hOvlnt ~~ .. m.... I... ..nd . Vtry ..... ",nd,
"-snil w,'" 100 h1~ .l>tn:..."~ 01 ,1., lor
1......11.110".1 0 ,,,..,lord "'crovnd 1,'1_.
Cool.."" ,......
11- "..l C....
.- tlltl .",.
111-"" WIdth
3. Show location of hous~, g;U-ng~, driv~wl\Y, and all
other improvements, existing or propost!d.
4. Show location and layout of sewage treatment
system.
5. Show location of water $Uppty weU.
6. Dimension all elevations, setbacks and separntion
. rli<;t;m,..,,<; _,_~___.._._.,
.JMP SELECTION PROCEDURE
A. Determine pump capacity:
gravity distribution
1. Minimum required discharge is 10 gpm
2. Maximum suggested discharge is 45 gpm
pressure distribution
see pressure design worksheeet
Selected pump capacity:
fro
gpm
B. Determine head requirements:
1. Elevation difference between pump and point of discharge.
/ CL feet
2. Special head requirement:
If pumping to a pressure distribution system, five feet for pressure
required at manifold. If gravity system, zero. 0 feet
3. Friction loss
a. Enter friction loss table with gpm and pipe diameter.
Read friction loss in feet per 100 feet from table.
F.L. = 2. (, 't ft./lOO ft of pipe
b. Determine total pipe length from pump to discharge
point. Estimate by adding 25 percent to pipe length for fitting
loss. Equivalent pipe length times 1.25 = total pipe length
'-r 0 x 1.25 = ,0 feet
c. Calculate total friction loss by multiplying friction loss
in ft/lOO ft by equivalent pipe length.
Total friction loss = 5'0 x 2." 'T -;-100 = /, Y
4. Total head required is the sum of elevation difference, special head
requirements, and total friction loss.
Ib + (;) + /.y
Total head: ~t.r feet
(l) (2) (3c)
C. Pump selection
1. A pump must be selected to deliver at least '10 gpm
(Step A) with at least II. 't' feet of total head (Step B).
.
.
Perforation Discharges in gpm
perforation diameter
(inches)
1/8. 3/16 7/32
0.18 0.42 0.56
head
(feet)
1.00
1/4
0.74
2.0b 0.26 0.59 0.80 1.04
5.0 0.41 0.94 1.26 I 1.65
o \Jse 1.0 fool for single-family homes.
b Use 2,0 feet for anything else,
. POlenlialfor plugging
elevation
difference
inlet - t~~"" }.
pipe :!
J=~'-,,~~ - -. -. - - -..... -... - -.. -- - - -- - - -- - --
feet
Friction Loss in Plastic Pipe
Per 100 feet
,
nominal
pipe diameter
1.5" 2" 3"
flow rate
gpm
20
25
30
35
40
45
50
55.: .'
60
65
70
2.47 0.73 0.11
" ....3:73:,,~GJt;jJ..' 0.16
5.23 1.55 0.23
6.96 2.06 0.30
)<~, .8.91: .~:q4 '.,:,',,0~39,
11.07 3.28 0,118
13.46 3.99 0.58
:t:':';';~,;;,1f4:76 ;:';.0:70.
5.60 0.82
6.48 0.95
7.44 1.09
Bohn Well Drilling Co.
16550 Baseline A venue
Shakopee, MN 55379
952-445-4809
Gary M. Bohn Lie. #1043
* ~~ ~ ~
t7
2--2.7--03'
Date: J J-, == ']" ~
6 ~ 1.,.,<< "...
J d-,,~
17U
11,,1
IJ')
. f-,~{ ~
J v&o'''' , '" "
~ I#rtr,,.c"":' ~,..j a.
tl/
~
~/<
J1/t
.
A., f ,t:?ro.. ,j
.
(' i/ c.. ~ 'I' '
2. ,..c.. rel'kO:: 7;.... ((
h()q 5e
E !"'.
9f'D. 0
71'9. r
9YCf. 0
~'tr:"
9);::0
t?""r e.T /'0"'/"<
I:" Ie"" /-y 7t~ Tc...1<
1~/(l""I'''''7' r_l(
1'""....."
4=( c1,.". /'6 X
'--
--......
ORIGINAL GRADE
A
MAXIMUM TRENCH DEPTH
:l 7" INCHES
y
TRENCH CROSS-SECTION
--
FINISHED GRADE
--...
--
~r 0 INCHES OF
BACKFILL OVER ROCK
y
NONWOVEN GEOTEXTILE FABRIC
2 INCHES OF ROCK OVER PIPE
4 INCHQIPE
A
I 2 INCHES
OF 3/4" TO 2 1/2"
WASHED SEWER ROCKS
BELOW DISTRIBUTION PIPE
y
3' INCHES TRENCH WIDTII
-
........
-
---
ORIGINAL GRADE
FILL SOIL TO A MINIMUM
OF 6 INCHES OVER ROCK
2" OF ROCK OVER PIPE
4" DISTRIBUTION PIPE
A
6 - 24 INCHES OF
WASHED ROCK BELOW
DISTRIBUTION PIPE
,
vU11 UUIIIIY LUY
{;c../( ("~"" Tn,,'/
Project Location: ~r'/t:J
Client:
Address:
City
BorinQ method: Auger
Boring Number
Surface Elevation
Soil type at system depth:
~e
~J Probe
Deplh
(Feel)
Texture
Aoukj I~VV\
1 --- ..
5 C\, V\ ~ I 00. It\^- '
I 0 h. o-\- f{ ex..J..s
2---
-r,::t
3---
4---
5---
6---
7 u_
Zip
Other
Color
Ii?,,!' VI'-{
. /Py rS-;r
'.-
lily 1" 5jy
Structure: Blocky Platy Prismatic None
Slope: _ %
End of boring at ~
feet.
Standing water table: yes (Ra?
Present at feet of deptf:(
hours after boring.
Mottled soil:
Observed at feet of deptty
Not present in boring hole V ,
Observations and comments:
-
Date: ~ r).?-o3
Twp.
Borings made by:
6Ae~ .tlA. '&'\Ilt--J
1043
lid. .
Color' classification system: <1'V'unsetO othet
. Boring Number d~-
Surface Elevation
Soil type at system depth:
Depth
(Feel)
Texture
Color
1 u_
15A fiIl.e .A5
~Ptr Alb 1-
2 n_
3 ---
4---'
5 ---
6 ---
7 ---
Structure: Blocky Plaly Prismatic None
Slope: %
End of boring at
?
feet.
Standing water table: yes (riD)
Present at feet of deplJi:'
hours after boring.
Mottled soil:
Observed at feet of demh.
Not present in boring hole \/ .
Observations and comments:
vU11 UUIIII~ LU~
~roject Location: '1)"16 .~~A-rd" Tu,,'/
Client:
Address:
CIIy
Boring method: Auger ~
Boring Number
Surface Elevation
Soil type at system depth:
Shale Zip
(1lii) Probe Olher
-- ~3
Deplh
(Feel)
Texture
I~
1 n_
-- -
(/I hit t-: 5a f1d I ()q #y\.
2---
3 ---
4---
5 ---
6---
7 ---
Structure:
Blocky
Plaly
Slope: J.- %
End of boring at
o
feel.
Standing water table: yes no
Present at feet of depth,
hours after boring.
Mottled soil:
Observed at feet of de;rth.
Not presenlln bOring hole v .
Observations and comments:
Color
JO'lf %
Q, s- Y ~
~
Prismalic
None
"
.t'~~i\>
V
~'
" ,
, .
',.'
\
Date:
Twp.
Borings made by:
6AJZ~ ..,u. '&'11 ~
1043
lie. .
_ Color classification system: ~
Boring Number f5 LJ -
Surface Elevation .
Soil type at system depth:
Depth -
(Feel)
Texture
/txe~
1 ---
'5,.1 f / tlq J1/L
2---
3 --- -----
. , iJ (0(,( f'S (. . SC11/l J.
4 -.. .
5-00
-- .
6 ---
7 ---
Structure:
Blocky
Plaly
Prismatic
Slope: %
End of boring at (P
feet.
Standing water table: yes no
Present at feet of depth,
hours after boring.
Mottled soil:
Observed at feet of dep.th.
Not present in boring hole V .
Observations and comments:
"
,; -J. 7-03
other
Color
l.e7yr~
IDy,.
76
Illy"
r~
None
)(
-~",
'l, ,
"
~o,~w,~u~w ~~.~~
(O,;t\.JOt.lw\.JL~
L..UI WU"'y'~T
LOT SURVEYS COMPANY
GRIQORY R. PRASCH
MINN. AEG. NO. 24992
LAND SURVEYORS
RBCISTUEO UNDU. LAWS OF STAT! OF MINNESOTA
1580-3093 FAX 580-3522
1801 . 73rd M. No.
MInneapoHe, MlnnIIOla S!428
MIKE HAYES
rH~ ~J.
@~@~a[J]~T
lul JUN 1 8 1003 J II
~-)J
8y
--
This is to certify that on June 10,2003, we checked the Top of Block (equals first floor)
elevation on Lot 13, Block 2, TITUS 2ND ADDmONj Prior Lake, Minnesota and find it to be
&10.5 feet (N.G,V.D. 29 Adj.).
s~: ctJ21 aa
Charles F. Anderson, Minn. Reg. No. 21753
fllJV V.J, 'tU j JYj l'LlVJYl,mnnl\ J.:J c,tJJ:,J~J:,n
rt\h: 'j)LL.JJ'JJ'J;
t'l'I.\.rt J
Doc. No. A 569826
OFFICE OF THE COUNTY RECORDER
SCU I I COUNTY, MINNESOTA
Certified RIed and/Or Recorded on
1(),,30-2002 at 11:~ Receipt: 223911
,
Pat BoeGkman, cOunty Recorder D1
Fee: $ 20.00
STATE OF MINNESOTA)
)is.
COUNTY OF ~CO'IT )
The undersigned, duly qualified and City Clerk of the City o!Prior Lake, hereby certifies
the attached hereto ,is the original true and correct copy of
RESOLUTION ~14PC
A USOLtrnON APPR.OVlNG A 54,492 SQUARE POOT V AlUANCE PROM THE
MINIMUM 2 ACRE LOT AREA FOR PROPERTIES ZONED :as (RURAL
SUBDIVISION RESIDENTIAL) AND A 70 POOT VARIANCE PROM THE
REQUIRED 100 FOOT MIN1MUM SETBACK PROM AN UNNAMED TRIBUTARY
; 'W:K~COURSB FOR THE CONSTRUCTION OP A GLE FAMILY 0 w ~G
. . I .
I ',I" ' ,
.,' "
filO2-097' ~k Lie'tIle:
J'
r
~M_
City of Prior Lake
..~mi1l\tt~~ ,ot'October, 2002
.-" '\,,~ ,". ..~f..4h..ltf :'. '
/~l1:Q~":~1 ' ~~~.~i " Dl'6ikd. by: City Dt ftuy~
:';:{~{;;:~~ ,;" \~~.. IlI200 ~1l.Cr/eK Mt SS
. j,Sll. (j, J, ow..,.,,;r;,
/,-' \~~ ' ;..-v #1 ~
.1~,~".:,:. 'l.'f,",l (~' lo~.t \1wlDit)1>>J 5?372..." 11(4-
.. :.... ",,', \" I ^-T .,;..... "
" '''~. ':'1"'1 ~ ......J . . .
l I)", ,''.' ~.. ,....
" /.,1-..,.". ,~". .~
" . , .( '" 3 \ ,:r.~ " -
\',,' _.l ','
..... ,. ' .
11'Q2jll~'\I'IIIaOPY.doo
)( ~\urn fa',
,~~ Lie-sener-
~Y1q ~~tr~~~7q
~p~ liMN .
_I, ~~
j11 01/L.
STATE OF MINNESOTA)
)ss.
COUNTY OF SCOTT )
The undersigned, duly qualified and City Clerk of the City of Prior Lake, hereby certifies
the attached hereto is the original true and correct copy of
RESOLUTION 02-14PC
A RESOLUTION APPROVING A 54,492 SQUARE FOOT VARIANCE FROM THE
MINIMUM 2 ACRE LOT AREA FOR PROPERTIES ZONED
RS (RURAL SUBDNISION RESIDENTIAL) AND
A 70 FOOT VARIANCE FROM THE REQUIRED 100 FOOT MINIMUM SETBACK
FROM AN UNNAMED TRIBUTARY WATER COURSE FOR THE
CONSTRUCTION OF A SINGLE FAMILY DWELLING.
#02-097 Mark Liesener
- elly~eyei/?
City ofPriVttake
Dated this 24th day of October, 2002
(City Seal)
I: \02files\02variances\truecopy .doc
RESOLUTION 02-014PC
A RESOLUTION APPROVING A 54,492 SQUARE FOOT VARIANCE FROM THE
MINIMUM 2 ACRE LOT AREA FOR PROPERTIES ZONED RS (RURAL
SUBDMSION RESIDENTIAL) AND A 70 FOOT VARIANCE FROM THE
REQUIRED 100 FOOT MINIMUM SETBACK FROM AN UNNAMED TRIBUTARY
W Al.t.KCOURSE FOR THE CONSTRUCTION OF A SINGLE FAMILY DWELLING
BE IT RESOLVED BY the Board of Adjustment of the City of Prior Lake, Minnesota;
FINDINGS
1. Mark Liesener has applied for variances from the Zoning Ordinance in order to permit the
construction of a single family dwelling on property located in the R-S (Rural Subdivision
Residential) and SD (Shoreland Overlay) Districts at the following location, to wit;
4525 Jackson Trial, Prior Lake, MN, legally described as follows: Lot 13, Block 2,
Titus 2nd Addition, Scott County, Minnesota.
2. The Board of Adjustment has reviewed the application for variances as contained in Case
#02-097PC and held a hearing thereon on October 14, 2002.
3. The Board of Adjustment has considered the effect of the proposed variance upon the
health, safety, and welfare of the community, the existing and anticipated traffic
conditions, light and air, danger of fire, risk to the public safety, the effect on property
values in the surrounding area and the effect of the proposed variance on the
Comprehensive Plan.
4. The property is a legal, nonconforming lot. Although it was legally platted in 1974, it does
not meet the current minimum lot area required for properties zoned R-S. Thus, the strict
application of the ordinance would result in an undue hardship upon the property owner
because without the variance the property cannot be developed.
5. The lot complies with minimum lot width required of properties in the R-S zoning
district, but a 100 foot setback from the OHW of the tributary watercourse limits the
buildable width to a range of 15 to 25 feet, so strict interpretation of the ordinance would
result in difficulties in using the lot for a single family dwelling.
6. The property is a substandard lot of record and is un buildable without relief from
minimum dimensional requirements. The 100 foot setback from the tributary watercourse
is a unique condition applying to a few properties within the vicinity.
7. The lot area variance is essential for the preservation and enjoyment of a substantial
property right. A reasonable use cannot be constructed within the buildable area, so a
-
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16200 Eagle Creek Ave. S,E.. Prior Lake, Minnesota 55372-1714 / Ph. (952) 447-4230 / Fax (952) 447-4245
AN EQUAL OPPORTUNITY EMPLOYER
variance from the minimum tributary watercourse setback is necessary for the enjoyment
of the property.
8. The granting of the lot area variance will not be contrary to the intent of the R-S zoning
district, which states that its purpose is to provide suitable areas for large lot development
outside of the MUSA.
9. A demonstrable hardship is present to warrant variances from minimum lot area, because
without relief the property would remain unbuildable.
10. The applicant did not create the nonconforming lot, so the hardship results from the
application of the provisions of the zoning ordinance and not from action of the applicant.
11. The contents of Planning Case #02-097PC are hereby entered into and made a pan of the
public record and the record of decision for this case.
CONCLUSION
Based upon the Findings set forth above, the Board of Adjustment hereby approves the
following variances to allow for the construction of a single family dwelling:
1. A 52,492 square foot variance from the required minimum 2 acre lot area in the R-
S zoning district to allow a 34,628 square foot lot (Zoning Ordinance Section
1102.306 (3) Dimensional Standards.)
2. A 70 foot variance from the required 100 foot setback from an unnamed tributary
watercourse to allow a 30 foot setback (Zoning Ordinance Section 1104.301 (3)
Setback Requirements.)
The following conditions shall be complied with prior to the issuance of a building permit for
the construction of a single family dwelling on the subject site:
1. The resolution must be recorded at Scott County within 60 days of adoption. Proof of
recording, along with the acknowledged City Assent Form, shall be submitted to the
Planning Department prior to the issuance of a building permit.
2. The building permit is subject to all other applicable city, county, and state agency
regulations.
3. The applicant shall obtain all necessary permits for an Individual Sewage Treatment
System (ISTS) from Scott County.
4. The ISTS shall comply with applicable regulations.
5. A tree preservation plan shall be submitted with the building permit application.
.
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Adopted by the Board of Adjustment on October 1~~
Anthony r Stan!son, Commission Chair
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Donald R. Rye, Planning ~ector
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