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912 Lakewood Hills Rd NlflU ll;gt m a.r tt vuu< <r c.c tiVanesota Pollution Control Agefttlf Cep ReadNatit.i LRAM sems.4124 $utt ary Farm (Completed form rnpai be Inkrnated to the Meal u it of ljotOmment whin 15 days) Patel number; SYllem status; 04 eh � rrve gt4rethents) Property Information p, wider phone: . L:...�= Properly *Mier ry m(s); Propeity ate Propartr a wrier address gf dfffeemtit Date sye*orn constructed= System Description Brief eyyetam desorVilarr: Load pemdit number le the system: hi Moreland area? • 0 Yea An US. Enitironmanral Pioteation Agway (E=PA) Clare V Notion Weil? 0 Yea Compliance Status • Mend op Arts re4ulterrronk •- orklifforral rover raquinsrrreurfs may also *Pile) Based on the infix gathered and napotted on attached forms, etas c omppencs etatts 01 tills sy it t ' %Coati: ate of Compliance —1rald until f3 ~seers titian date of repot* W . ❑ Notice of NOncOmplierme • For Norm/400W. Wetenw 'The reason for nencomPlIenca It This noncompliant *~stem la olasalf d as heck one belaw *M y O Imminent threat to public health & My 0 Filling to protect ground water © Not in compliance with opening p+ Certification 1 hereby cat* That ed the necessary Worm ton has ben gamete9 to adenine the.c;amplfe roe step mg* m defeenhat on of tutors system performance has been nor can be made due h unknown candUlbna during ayskm ooristruodon, passible abuse ofttrs system, ina.. _ te mom, ortttute.water rage. b., neaten Name: �; Business ilcent nartie and Marne of load unit of pouemnient Sionaturd +Cornptuance inspection Form Existing Sutiteurtac+r Sewage Treatment Systems (SSTS) r ,t artd enforcement Instr tion$ on page 6 • Pa r Local Tra ing Purpoiet. 51, No In Wellhead Protection Area? • 0 Yes 1;4144 Syarn serving n Minnesota Department % Yes AIM) •No . of l MOH) A A r . Date; , f -fir /e Ref ired AttaChinents.' ydrates Performance Temte integrity oil Baring Soil Separation $ System drawinglAs -bulk drawing Any local requiretr'tents that are efferent from what is required on We form C] Other Wotmatian Otst): end safely trr>aH9) be upgr� upgrade Rectairsrrtants (dwiv d hoar Aeon. SYat. § 1 5 err airs seed 1h of to public hoskit 1 protectsround aefet,, th � beyp�Qrsdet r> are use .d 000 'dg �re bY Ulla 01001 w agi ng & to of ''ae chard in law, artpl ilea 41 tenet he feet c>tr Mir NO scraratiort, then tee err+ needrrot be epgredt9d Mow, mocett orb pale Oft•confku4K4nobviltsionstiog aoylooal 01411101100 f at te• two • Mt p►ovleilM does oot*PO to ayet ematn a ftaFalertd • epees. Wellhead Protection Jtraaa,'or thole used in oormeafloe whrh ttnod, boverpo, and lodging aglabgthinent et (Mined;h law Wiww.pCa.stateasur a 681•296.6300 • 800-661 -3364 • i'rY 651•2b2.5332 or 100-6574564 4 , Avaibtlia in alternative for PAgiv mats wgtwwrrts -31 + 412410P E} Operating Permit Fenn OI:rppl L Y COmplient 0 NocQn • - ' System this fon* Poo* numtset" 1 r Ca ianci *» Cvm i tics if et:A*1 F4 far' Existing SSTS Hydraulic �� find Comptiance Issue #1 of 4 Reason for observation: �, ► : �, . Date of observation! • Ws . , rohesr�e'' occur* wires road Inspection or In Wee Yiltir:�an Medlar: (optional) Gpmp +t u ipnstoriter : titer ) peck* * pp:W boot) 'lt�µ 121 Searched for surface outlet a Performed hydrae tCtest 1$1 Slouched for rulecirKI In Yard Checked Forum fn home Ext3OseW$ . ndira in aoU AY4 tiQmeRwnO butintiortyc Examitatd far staging in wit . ] "look eor" shove soil deposal system Cl System reoulteeeritergeocy pump ng 0 Parfoirmed dyne test • Qom ttte system Swage to dnan Does the sybtatn clause reevrage beep rsta r• s , ores 'Do other situations .xiet Chet haws the pcteftlat trr mediate a�lyar impactor theeetarr pu t'eeith or safely cei j , i -. Am" " stunver b1dkCates Stet the systo'r' three to pub*: haat& end satett DOott thOOYOtOM POSO a thtOttt la ground water for any wndtSdns deemed non. "You" a lncf ar that ; f the Bond mod std wtwt ff ' as Scenes name and Nome atom! unit or government: stettuee: wee .O No . 0 Yee 0140 0 Yea prNo Ad frrrml!renf No Other * NO startdaird" protocol Mats. This lief la not extra+ ■ Cetica't1Ot1 Form .of M htno t'0C"r s Campliartse • and a ttached to the 8 r rol Agency's o' fin$ must u be Ins loam ls'6o he completed. spume O ��n , Inte Wirt 16 pays: tnrp f eted Porn+ for . o forma b st tat bcat uf..cf go completed by alt inspector. Property owner/tams Prope'ty adder: 1'- Property °,arena address ateliererin: A sf per= �' ""- � � pp fhb fort that they Are I hereby cert� that 1 p�drann It made the abststvel o fntemrelalfans, afuf � re cooed • •beriaftcon number: .018 or or Date; 8 657.38Y'4 Arri n att�eraat1ve format9 www.prsaters.mn.ur • 01496•630o • 8004514464 • TfY 6'#4 Rf t 2 4 R32 o r tg we-ww:OW3i • 4124109 NV 26. 2010 11:42AM bcott bounty community uev, Pai'c ;umber: I v, V /V7 sy statue: €)ors Pram E3 Nom (as determined this t Tank lnit rlty and Safety Compliance — Corrptlence inspevttof Fain 'Or SSTS Compliance Issue #2 of 4 Date of abserva8on: Reason for bbseivatlon: Thts form expires on twee years): R.E 13_. Corriplance questioneloriterNls (Requited) erdt #be b as) Does the system .00 i ref a ee All ", ❑ Yes No ' cealpoop *WOOL or ie* Go any sewage teak(i) teak betas their 0 Yee lif No doe}pned oireYattin *CO _ - -- If yes, identity Whlth wage lank leaks. Any "Yee" snow* Wiesen Mar Omsystem Is halm to prefect groundwater. Property owner rsaune(A: Property addres Property owner's address (it different). • County; rs A Butr,esat licence name'end putter: Name of focal tall of government: Signature: wriw.pca st ed e.mn.ua • 6514296 - wrr- rawiat*i.3r . 4134109 * Seepage pits meeting 'T0804 I may be compbant if allowed In ordinance by local permitting authority. Explain; *stern is an imminent Valletta public health end sat !. Property owner phone: Verification Method": (Colima)) (Cheek The app te• Probed tank teem ❑ Odesrvsd tow ttquid level p assented construction records . Examined empty (pumped) tank El Probed outside tank for lied so! Ji pmesurefvectnam check Other: ir; it , sionuaratprobooi Caul& This Serie Alt rY#mstivk it) aegwetifiat order, nordoes it frr*etr3 Nitich Combinations' are netapssaty to me m thk deternrkiation. Safety Check 1. Are meintenence hole were damaged, cracked, or appeared to be structurally un U Yes' "(No 2. Were makden®crac+ trela ;av!ess replaced tit a fallatied manner (e.g., wows rued)? ;gifts • Mice 3. Was woodsy access restraint present (safety pan, sew cover, or a*W nett – him recommended. ❑ Yee RI No 4. Are borer SWANK' segue Dyer pi Na Certification This farm is to be .comp led and Witched to the Summary Form of the Minnesota Pollution Control Agenctt'a.(MPCA) Compliance Inspection Form ter Usti subsurface taakage Tresenent Systeme. ObeerwsttonL tnlerpngepns, and conclusion, rated be completed by an inspector, .maintainer, or service provider. Completed form must be submitted to ttte local unit of gr erttmeet Within • 15 days, i hereby t anify OW Iperrao mW/ made the observations, intarprotarions, and conclusions reported an pile form and thattney ate • correct. - - , Name: /4 /72ger't1r e.80457 0 Pr 800- 613N4 • IT( 651.2112 -5332 er 5004574184 • Available to temath" formats Page Jot Mite. 16 --0-1.6 anutt vvuntf vutnmvntty Ut;y. (14.0109 r. 4 - • System statue; Compttani 1:3 Non pliant (s dotorr ►ed ythls if • Son Separation Compliance a Other•CoroPil rues - Connpfanos IMP Foam fort dsfing SSTS Cornpliance Issue #3 of 4 - • Mate of °beervaibcnr: • 1 -t t) •lean for observation: Mier 'abandon on thta loon does not ova. , Compliance gtt nWcrri!teds; (Required) . --/02liglaktlieVilato ttmr�.- For system bunk prior to Ate 1 199% and not located in Moreland or Wellhead Protection Area or not salving a food, beverage or lodging establishment: Cow ttre.systam beve *least a two- vertical seperadvn &tenet from periodically • red or b rock? For non•peroormance sye ems burnt April t 1996, later or for non pertbrrrlsnve system) located In Moreland or Wellhead Protection . Aran or Ong a toad. beverage or lodging establishment: [lcei the ayeeorn have artt•fowt vertical separation Odense IV= periodically saturated ._!lam Dry' For reduced separation distance systems 'performance" systems under Old ne0.o179 or Type IV or V eyetem under new 70813. 2350 or 7080,24130): • Does the system meat the designed vertical eeparation4reiance from periodically saturated ,,,soli or bedredc?',__ - Antr "me *rawer rncttcetes that the system is Wing to pm** • gmuad Wafer:- • Name: 8uelnooe license name and number: Name ofldcei unit of government SFr Signature; Yee 1 as ■ No o Yea It Verification Method: (Cq ona4 • (aleck the appropriate box) Conducted sob obsel v,$on(e:) (attach boring Loge) ,Q Tr" pnevfoes ver4fcalteno (attach boring bee) C! Other: ion obeervatton does not expina..Previeuse obaetva8otss by twolndependant parties are sufficient, unless site • conditions have been entered, • May be reidused by up to 10•percent in teal arlInance. „, "No stomtonIpiatocatWes. This list is notes, In nomad artier, nor does 1 ladfidete Wftb combityptions ei nesosseey to nutio this • • dstam Inatlort. Certifira ion This ton to to be completed and attached to the Suovtnery Fom of the 3Alnnesot* Pollution Control Agency's (A6f?CA) Coinplierfrce inspection Form for existing Subsurface Sewage Treatment Systems. Obaarvaggns, renterpratptlo c, end exxtduetar s must be ramepteied by stn kspeolar or designer. Completed farm must be subnmited to the focal unit of government *Min 15 days, Properly owner neaten fs): Property address; ) t Preperly mele' a address (tidifieraog: County: `» tethq. Property ovi ner phone: 1,; ` ' •° 1. 1� 1 hereby certify #tot ipeawls* made the obsdrvallon , Intetpretallons, end pltte4G11s reported an Oft form end Mot they we Cd1tut. Cad + «: ,, onnumber: e 7 Dates 24) — A www,pca.state.aw us • 014964300 • 9d040 -3864 • 'try 651.205332 or 490 • • Arseabte to a�ttemattve formats n vists431 • '4/24109 P o f 8 - z . ` 3 e,".INN (1; 6E • DAKOTA COUNTY SEWAGE SYSTEM MAINTENANCE LOG • .i.�r. • ::. ril,:> '.' Sea rrilcp3 :ayi� :i't:.,:?;: <'v Date Pumped:/ t LIP No. of Tanks Pumped: I Total Gallons Pumped: 6 ,2 ce Owner. . ei -k 9 Phi 11 It Site Address: 9 P.— Lo. / ' I /4J/.A Municipality/Township: Owner Address :._ P vate Residence ❑ Ren al ❑Commercial (Owner described type of tank(s) g-Yes 0 No) Septage Disposal Location:_alite Condition of Baffles: Type of Tank(s) 1, ,..`r+ t,• 2 3 (septic tank, holding tank, cesspool, pump tank, sand trap, flammable water trap, etc.) Size of Tank(s) 1 j... _ 2 — 3- -_ Pumped through: (Aan-hole 0 Inspection Pipe Effluent Surface Discharge: ❑ Yes (;o Comments: • Date Pumped: / / No. of Tanks Pumped:„ Total Gallons Pumped:__ Owner: Site Address: Municipality/Township: Owner Address: , ❑ Private Residence ❑ Rental ❑Commercial (Owner described type of tank(s) ❑ Yes ❑ No) Septage Disposal Location: — Condition of Baffles: Type of Tank(s) 1 2 3 — —. (septic tank, holding tank, cesspool, pump tank, sand trap, flammable water trap, etc.) Size of Tank(s) 1. 2 3 Pumped through: 0 Man -hole 0 Inspection Pipe Effluent Surface Discharge: ❑ Yes ❑ No Comments: Lend Applic lion ins added .; Pumper Name ` ' , �- MPCA# I (65: Month/Yr Report /6/1a Date Pumped: / / No. of Tanks Pumped: Owner: Site Address: _ Owner Address: Municipality/Township: ❑ Private Residence ❑ Rental Septage Disposal Location: o: pumpform Total Gallons Pumped:_ ❑Commercial (Owner described type of tank(s) ❑ Yes ❑ No) Condition of Baffles: • 3. Type of Tank(s) 1 2 _.-- (septic tank, holding tank, cesspool, pump tank, sand trap, flammable water trap, etc.) Size of Tank(s) 1 2 - 3 Pumped through: ❑ Man -hole ❑ inspection Pipe Effluent Surface Discharge: ❑ Yes ❑ No Comments: Land Application Area .. • marine Material used Added Y Liquid !be added . ph initial ph after 30 Minutes • Gal Applied -„_ , . :Total Gaf Applied to Area ò þýýüûÿû úüüýýÿñøùüðýü õ þý ÿþýüûú ùèþø ÷øüûú ö õ øúð ùø ð øÿÞ ð øüûú ð þæ þø øÿ ø öþóý øë ó öþóý ø ÿÞ è ø ý äèïï å ø ðö âà éîïîïâ ÷ú ÿþøñ ø ùè éîî í þ î öõô óù úú ÿõ ø ëý øð Ýø õë å øðö ðö ìâàê ñ ø ýû õ ñ ñ ç ø ñ úú ñ ñ æøó øø ø óúûõñ úú ý ÿ æð ÿ þ åûæ äø î úú ß þ ûÿ þø PERMIT City of Eagan Permit Type:Building Permit Number:EA179210 Date Issued:09/23/2022 Permit Category:ePermit Site Address: 912 Lakewood Hills Rd Lot:1 Block: 1 Addition: Lakewood Hills 2nd PID:10-44351-01-010 Use: Description: Sub Type:Windows/Doors Work Type:Replace Description:Two or More Windows/Doors Census Code:434 - Residential Additions, Alterations Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow windows, call for framing inspection. Call for final inspection after installation. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Valuation: 5,000.00 Fee Summary:BL - Base Fee $5K $118.00 0801.4085 Surcharge - Based on Valuation $5K $2.50 9001.2195 $120.50 Total: This permit shall be null and void if work does not start within 180 days of issuance, or if work is suspended for 180 days or more after started. I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Robert Jr Mickelson 912 Lakewood Dr Eagan MN 55123 (651) 558-6115 Window World Twin Cities 2220 Castle Ave E St. Paul MN 55109 (651) 770-5570 Applicant/Permitee: Signature Issued By: Signature