HomeMy WebLinkAboutBuilding 07-1120
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
D33
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OWNER
CONTR.
DATE TIME
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PHONE NO.
PERMIT NO.
7-((~6
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXIGRAD/FILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
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~ATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL EINSPECTION BEFORE COVERING
Inspector:
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
INSNOTI
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
11/(,.07
~. ~I~ ~::y I PERMIT NO. 07. / /z oj
3. Yellow Applicant . .
ZONING (office use)
5333
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LEGAL DESCRIPTION (office use only)
PID
LOT
BLOCK
ADDITION
OWNER
(N ame)
(Address)
(Phone)
(Contact Person)
(Phone) 50 7~.71.J'; -~~~ ()
J~ s-,L)A-A t: 5S()Jy~
(City) (Zip Code)
(Phone)
5'/f-,""re
II-/~ - cJ7
APPLlCAN~ .. 5:
(Name) ;. '" .., €'s - hi. 5 A!':~
(Address) '1;';/ ~f:'vf~R. I< ,DO:;!
(Address)
DATE
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater
Floor Drain , Water Softner
Lavatory (Bathroom Sink) r\ 777 Stand Pipe (Washing Machine)
Laundry Tray (lor 2 compartment sink \j ^U Sewage Ejector
Shower Stall T\OT Yv. Backflow Assembly
Sinks IY' fI/}J Backflow Assembly Test
Bar Sink "'F-'1 IT Lawn Sprinkler
Water Closet (Toilet) .1 Other
APPLICANT PLEASE COMPLETE BELOW
FEE SCHEDULE
Industrial. Commercial & Multi-family 1% of job cost with a $39.50 minimum Residential. New One & Two-Family $99.50
Residential. Additions & Alterations $39.50
Estimated Cost $
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOT AL PERMIT FEE $
39. 6V
.50
4-6 oV
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Paid if 0 , (/V
Date /l {(p. ,;
o. 55lJ3IP
Building Official
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
,
,I...f';: ., 1f):~1j, 6COTT COUNTY, MINNESOTA
APPLICATION FOR INDIVIDUAL SEWAGE TREATMENT ~YSTEM (ISTS) ~ERMIT
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(Note to Applicant: only fill out the area in box below)
Twp/City l :~V I 2,,"' L o. LA..-
Project Address', D.:) "3 33 ) ~, ..."'! '~;-t
City/Zip j....; ! ry' I (.' k.4:.._
Site Evaluator Installer
Septic Tank Size as per design submitted and approved
Pump Tank Size as per design submitted and approved
Drainfield Size as per design submitted and approved (below)
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Date Received / D ',~:f,l . u/
Permit # .') '7 13 .?S
Receipt # 33(/& c)
Fee </;lt- . ,-;;
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Receipt <;ode~;') .::.>
New ISTS_ Replacement X
Percolation Rates '5 . " ' .:
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Number of Potential Bedrooms 1 (:.).; (
Depth to Restricting Layer . . (
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,APPLICANT FILL OUT INFORMATION IN THIS BOX ONLY
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Applicant ~07.(.') P V,,' "'1 L. ........) c ?;r 11 (' !..:JC (,o-
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Applicant Mail Address "J- 3 :, ~
100'7;) 07' JC
Phone (H) 1 ';:: "Ii ,,' <; to 7\" (W)(( )1.('/ '7 .:~ I,", U
City !tlo.....L.J:9/~ State/~.cI Zip ~ 5 ~ -7;L.
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Phone (H) ,'.,. ,,-
City
Sect_ Subdivision Name (if applicable)
(W)
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Owner (if different)
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State_ Zip
Lot#_Block#_
Owner Mail Address
Parcel Number
Soil tests and a design of the ISTS meeting Minn. Chapter 7080 standards must accompany this application.
Applicant hereby agrees that, upon issuance of this permit, all work shall be done and all materials used shall be in compliance with State Rules
and any applicable township, city, and county ordinances. The applicant must also ensure that the Scott County Environmental Health Dept. is
notified of any ISTS install~ .by 9:00 a.m. of the day thSi1.ls.pes~,ion is requested.
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Applicant Signature .. ...)-. a.,d--' /,E-R.-, (!.-~. ........:;r (;;./7.,,-,-,...-) ...L.~
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Date / i) I ] 'f /: -;
---------------------------------------------
ll()~~S;III]> ()It <:Ill1{ 1JS;~ ()N~1{ ----------------------------------------------
Recommend Approval
Recommend Disapproval
and Permit complies with the Wetland Conservation Act
______________________________________________________ (:()1JNll1{ 1JS~ ()~L1{ -------------------------------------------------------
Signature of Township or City Clerk (or representative)
Date
ISTS Setbacks: ,Building: (tanks)~ (drainfield)~ Lake/Creek/Wetland_ Wells~ +10' to Lot Line or ROWlEasement.
APproved-+- Denied_ By Scott County Environmental Health, subject to existing regulations and the following conditions:
1. Verify and maintain all required setbacks and elevations.
2. Protect (fence off) the primary and alternate drainfield locations while any building construction activity is occurring on the
site and maintain fencing or some other approved barrier if the drainfield could be damaged after installation.
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 late season
installations, hay or straw can be substituted 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 Installer receives a
copy of the final Department approved design.
9. Nonresidential ISTS shall i~clude a water meter and, if a dosing device is used, an electrical event counter.,
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Signature
White - County
Yellow - Township
Date
Pink - Applicant
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Form #1121
SCOTT COUNTY
INDIVIDUAL SEWAGE TREATMENT SYSTEM INSPECTION FORM
61\v'Twp.---.fr~or- L~ ke
~ner ~+eph(,V\
Project Address [,133
City l> f't&"" <e..
SETBACKS: I
Buildings to Tank f ')
Buildings to Drainfield 21 '
Well(s) setback 50' or 100' (,..;i-1 """,-j-U' not installed
Distance to Lake - Creek - Wetland -
Property Line(s) ."'" 1 b'
~HOLDING TANK(S) ~ New
1 ~t\\) Liquid Capacity J ~OD ;)..L
Tank Manufact ~ W''^'- 1-
Baffle Type: las i Fiberglass S:9JIitary- T Conc
No. of Inspectio .pes {4" 6" diam.
No. & Diam. of Manhole Access rz.,--ll.{ l
No. & Height of Manhole Risers 1.. 3 Oil ~ ,~(. i..-.
Connections: .s e. ,,-l~J.
/1-/-07 / I..<P.I/d '7 PermitN. ~1- -';lS"
Installed forpjBedrm'or gpd) 2-Cfi) e div
Designer MI/'(}l1j,~ Installer
D NEW ~ REPLACE D REPAIR 01 ON
CTRENC.~ED OR GRAVELLESS LEACHFIELD:
'I Drop box concrete I~
JO' Trench Depth :3 ]; I ,_Width .:J{,. ,
3,'lTrench Lengths _0 · t'~.k
Trench Bottom Level T'e. ~
Trench Spacing ~ '
i7' Drainfield Rock Below Pipe
or Size of Gravelless Pipe
Actual ~pect~.J>f Backfill
Absorption Area: Square Feet
Lineal Feet
Inspection Dates
S c/" '" P,'tle.r
ib 0 S-I- 515:
yes I no
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ALTERNATE SITE AVAILABLE
ENV HL TH APPROVED DESIGN ONSITE
PUMP INFO:
SOU Liquid Capacity
Tank Manufacturer
No. & Height of Risers
Pump Manuf. & Model N~.
Horsepower '/, D
Feet of Head 7,:1
Cycles Per Day
Gallons Per Cycle
Size of Discharge Line
Type of Electrical. Hookup ~t & box by tan~
Alarm Location ~ ~ ~ b~(~ b,..~ rage / oasement
AlarmQank Air ~vel Alar / Other
Cycle Counter Water Meter (Commercial) yeS
,
MOUND OR A TGRADE: 3
Percent Slope %
Width up down side
Drain ock Below Pipe inches
Inches of Sa elow Rock _upslope_downslope
Perforation Size & ing
Pipe Size and Spacing
Dimensions of Rock Bed
Dimensions of Sand Base
Depth of Final Cover
Alternative / Experimental System I Pretreatment:
Type
Pretreatment Alarm
_ See Notes added to Design Drawing or
_ Drawing of System Below
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The top of all tanks must be installed 4 feet or less below final arade (unless exempted bv
FINAL COVER Ins ector
This system i~compliance D not in compliance with the Scott CountY Individual/Community Sewage Treatment
System Ordinance No.4, therefore, this document is a pCertificate of Compliance D Notice of Noncompliance.
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