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733 Bradford Pl Parcel Files Cover Sheet Unique ID: 2120 733 Bradford PI 100240001052 I li /-O-=;L CITY OF EAGAN 3795 Pilot Knob Road Eagan, Minnesota 55122 PERMIT NO.: 7M The City of Eagan hereby grants to -n NO&ti.s cb_ of 26SO Uhl mar St_ pinl 55106 a Pe t jj (Owner) UNIX= at ----733 Un&A , pursuant to application dated 7/4 n Fee Paid: $zo_n© dated this 2A_day of spiv , 19, 7% .50 p/c Building Inspector Mechanical Permits: Bid Total: CITY OF EAG'P'N 3795 Pilot Knob Road Eagan, :Minnesota 55122 PERMIT NO. 581 The City of Eaan hereby grants to North St. Paul Plumbing & Heating of 2572 - 7th Ave., No. St. Paul 55109 a PLUMBING Permit for: (Owner) F. T. Hughs at - 4055 )Odd goad , pursuant to application dated 7/21/75 Fee Paid: $20.00 dated this 25 day of July , 19 75 .50 S/c Building Inspector Mechanical Permits: Bid Total: INSI?E ftI(N RECORD CITY OFIAGAN PERMIT TYPE: V Ou I L to 4 NO 3830 Pilot Knob Road a A ~ Permit Plumber: ~ t>' /~~tg Eagan, Minnesota 55122-1897 Date Issued: 07 (612) 681-4675 +¢1~~-~ a a SITE ADDRESS: 1.101 t t r~ r APPLICANT: 1 t11] la li F Pt I U PEF~A 1,T SUBTYPE: TYPE OF WORK:. INSPECTION! YPE DAi E I HSPT A, INSPI- C1 ION TYPE DATE Nsp FP., I '114 6.; INAt ~R 1 m m CA 99) pF9v MO M LO ~Qp Nz t o O rmAA- T ~ ^'is S v C < z2 z z z n -I a> - -z 4 c, Q p Q Q z r Q r F- O Q n m m m r CITY OF EAGM Rernarks Addlt Sect t 1,.+ lk 1 1010 '32Z rl~rt~ i,, Street 400 Rd., State ~ ~i8~ot~ll~lt, `~51~3 1m vement Date Amount . Annual Years Psvr nt. Racalpt oats STREET SURF, STREET RESTOR. GRADING - - - s - - SANSEW TRUNK SEWER LATERAL ii WATERMAIN WATER LATERAL WATER AREA r, is STORM SEW TRK STORM SEW LAT Ctl GUTTER SIDEWALK STREETLIGHT I; WATER CONN. BUILDWG PER. SAC ~ 'r PARK 733 ~2D PL city of aagan Addendum Report for Dodd Road (Diffley Road to Wescott Road) Service Utility Improvements City Project Nos. 850 & 862 Eagan, Minnesota September 9, 2002 File No. 49-01-115 LV 38nou ' ~ ~ Y6 m ~ m o ■ O m TT I I I I I Ill:j ICI F I I I Ui I IIlj g ~ei~di y•! II I I i 4 4 ~ C4 .a i e: * 111 S i ~2^ S -1 S I isl - -~i _ ~ I 1 3p I u I S~_ ~ I ( Ili r s LLI i 5 - I c, oil t~ U; tj I ¢.y~ = y fa i E t 1^ r w } L •ru I p ! • °R i ,q, I ~ w i r 6 7. Y /II~ I ~ 7i1H1 0 mom_ =Ii i as i i _ I; 1 ly tl'p I ylf-- Io >~t' Y~ I I~~ I j W Y- _ a: I ~ I ~ E ~ ~ ° `sue, ''~,:~R ~ ' I } ui "x V S I ~ OIL r ~ ~ ` ~R U I' I 4-~ ~e I C i _ I tt OL- r~ , 'J S LLl I j Currently, water main exists along the west side of Dodd Road, adjacent to this property as shown in Figure No 45. A 1" service has also been provided to serve the existing use (one single family) of this parcel. Proposed Improvement - Sanitary Sewer It is proposed to stub an 8" line to the east property line of this parcel. This line can be connected to the existing manhole in Dodd Road. This line could service both the immediate and future needs of this parcel. The proposed improvement is shown in Figure No. 46. Proposed Improvement - Water Since this parcel already has water service for its current needs met, it is felt that at the time of land use changes, a connection could be made to the 6" water man line that exists adjacent to Dodd Road. This water main line exists outside of the new curb line of Dodd Road such that a connection could be made without damage to the new roadway. Therefore, no additional water improvements for this property will be done at this time. Parcel 010-52, PIN # 10-0240 gure Number 47 Existing Conditions - Sanitary Sewer This parcel currently has access to a 6" sanitary sewer line as shown in Figure No. 47. Existing Conditions - Water This parcel currently has access to a 6" water main line as shown in Figure No. 47. Proposed Improvement - Sanitary Sewer No improvements are necessary at this time. Proposed Improvement - Water No improvements are necessary at this time. Parcel 010-53, PIN # 10-02400-010-53 Figure Numbers 44,48 Existing Conditions - Sanitary Sewer This parcel currently has access to sanitary sewer off of Witham Lane. The current owners have an individual service line connect to the sewer in Witham Lane. The existing sewer line in Witham Lane is shown on Figure No. 44. Existing Conditions - Water Currently, water main exists for this parcel on the opposite side of Dodd Road (West). A 1" service has also been provided to serve the existing use (one single family) of this parcel as shown in Figure No. 48. Proposed Improvement -Sanitary Sewer Dodd Road Street and Utility Improvements 6 city of aagan THOMAS EGAN MOM PATRICIA AWADA SHAWN HUNTER CHANGE OF ADDRESS SANDRA A. MASIN THEODORE WACHTER Councl Mwnbsa THOMAS HEDGES Clfy Adn iWrotor E. J. VAN OVERBEKE I OLD ADDRESS, CHY Clerk NEW ADDRESS: I LOT ZO BLOCK PLAT NAME REASON FOR CHANGE: (SIGNATURE) (DATE) MUNICIPAL CENTER MAINTENANCE FACILITY 3830 PILOT KNOB ROAD THE LONE OAK TREE EAGAN, MINNESOTA 55122-1897 THE SYMBOL OF STRENGTH AND GROWTH IN OUR COMMUNITY 3501 COACHMAN POINT PHONE: (612) 681-4600 EAGAN. MINNESOTA 55122 PHONE.- (612) 681-4612 681-4300 Equal Opportunity/Affirmative Action Employer FAX; (612) ) 661-4 360 TDD: (612) 454-8538 TDD: (612) 454.8535 U P A L e 0 A _I _ t 000 low .00 000 T PERMIT nY OF EAGAN BUILDING 3830 Pilot Knob Road PERMIT TYPE: 0 2 8 2 3 3 Eagan, Minnesota 55122-1897 Permit Number: 07112/96 (612) 681-4675 Date Issued: SITE ADDRESS: LOT: 1 BLOCK: 52 . SECTION 24 P.I.N.: 10-02400-010-52 DESCRIPTION: Building Permit Type DECK Building Work Type NEW Census Code 434 ALT. RESIDENTIAL i REMARKS: FEE SUMMARY: Base Fee $45.00 Surcharge $.50 Total Fee $45.50 CONTRACTOR: O~N - pp LESn - 4055 DODD RD EAGAN MN (621)456-0575 I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Mn. Statutes and City of Eagan Ordinances. I APPLICANT/PERMITEE SIGNATURE ISSUED BY VI NATURE CITY OF EAGAN a 3 3830 PILOT KNOB RD - 55122 C~S-- 19%:4 BUILDING PERMIT APPLICATION (RESIDENTIAL) 681-4675 ♦ 3 registered oft surveys ♦ 2 copies of plan ♦ 2 copies of plans ftLode beam & window sizes; poured fnd. design; etc.) * 2 site surveys (exterior additions 3 decks) ♦ t energy calculations ♦ 1 energy calculations for heated additions ♦ 3 copies of tree preservation plan K lot platted after 7/1/93 required: _Yes _ No DATE: CONSTRUCTION COST:1 3.p °Z' DESCRIPTION OF WORK: STREET ADDRESS: bODz> p f~ LOT d O BLOCK S~ SUBDJP.I.D. M PROPERTY Name: ~araQs~.v L~ S Phone OWNER Street Address: 2 O City: e-11 A-) State: r4/u - Zip- CONTRACTOR. Company: Sg e- Phone M Street Address: License City: State: Zip- ARCHITECT/ Company: Phone ENGINEER Name: Registration # Street Address* City: State: zip. Sewer & water licensed plumber. Penalty applies when address change and lot change are requested once permit is issued. I hereby acknowledge that I have read this application and state that the information Is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant: OFFICE USE ONLY L' =s ` J✓I [D; Certificates of Survey Received Yes No .1111 0 9 1996 Tree Preservation Plan Received Yes No 7.36 7.40, 6.8 13RADF- .35 OR C/Ro 65 6~? 8 2 • 36 6a' •0 121 • o 00 :.o 7.70 0 0- s ~ w~ •oo. 141, Nil .a ce:t:.•t,:y}}:.:} :::•::•a•`•`~.•?2::`.'~'^•%:...:. 'fix, ,.•..•`r!6,:?r. f'z•: ~ . J-M .:...C:. n}}:..}.:j.G'xii ..r•.y:.v:.:;J}:q :;:;•;$r+nY SX_x :a.x.. vv v.....? :.t::. iv...i.x •...v?•.}. ..%•L,:•:•: :{yn '"i$.i .v" , n•.,:..>:i••;;{•;}}.... . r.. ,.v.•wr,~•~'", Aix, w{:,:•:?': ..{•}}.....?tr,~.~,•? .:.:::;h•x}rrY~::..; ..7•'..w . t .~^'r... r..... ..kii..:t.,...... r . , .~~•s•~~.•.•}.• :•Y, SY•...:.: ^:.:::v:•.w::; n•}:::::::.~r:.v: x:::::: n::w: {v....... vn,,.ti:•; x:::: r;? v; ..,.rr.:.:::..,.n....., r •:Yr .:v .n>::::.. .........:~`.w:::.v.....,• > ...u•:::.v:. :.s. rn.,..... w:: r:;;; 'v;.`,. r.:4:r•::,r:::: ; S r..: • r •:.:.pn• r: r v.:::: r. x.. n•:. ~}}{v\^I •:{n:;•: r. ~.Y: :S : v...~S:r ~ i':::.................:...}...........r~,.r.fi..:..:: ia...:.?,.,;; a ?i•.}.,.; i::{ti:::•,?•.,ti?v.•}.:>:,,: n.. r... n..n \\:%}:;itii:ii%i:iiri:i::Si::•:•.'i' • r, f.:}::.}::•:::.v:'::::::::.{x:.}:}}:•}}}}}},!\'nr•}}~.`l•,f!;.:02 } ?.?,bty.;~,..:::.:HAkiv:::::::.}}}}}}:.,.}:?{L'?,:rYv, ,:i:•}::. .:..r: 1993 MECHANICAL PERMIT (RESIDENTIAL) CTIY OF EAGAN 3830 PILOT KNOB RD EAGAN MN 55122 (612) 6814675 PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOMES AND CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT. - - - - NEW CONSTRUCTION ADD-ON A/C ADD-ON FURNACE I y to DATE I O lk FEES_ HVAC: 0-100 M BTU $ 24.00 ADDITIONAL 50 M BTU 6.00 GAS OUTLETS (MINIMUM I @ $3.00 EACH) ADD-ON/REMODEL (EXISTING CONSTRUCTION) $ 15.00 STATE SURCHARGE x~.50 TOTAL L.. 50 SITE ADDRESS: OWNER NAME: TELEPHONE INSTALLER: Oo rn-e. c c~ n-e r ADDRESS: CITY: STATE: ZIP CODE: TELEPHONE n~lZi • SIG A URE OF PERMITTEE i r Usk- s7~ l 'r Qe 11__~ J J✓o o~ -to ,r ~m ov~ 71-~•1 119 1 a,3 d 7o~. /en , mAr v9I l ~y5 oz? has a~ Y a 710,o~ - Q O .J 01"41 r r~ ~/vim! ~Sk l 3'~S~aa 00 1-211 /3.76/ 3815;a- a T to I - TRANSACTION ID: R768 SPECIAL ASSESSMENTS SPECIAL ASSESSMENTS SEARCH SUMMARY PROPERTY I.D. TODAYS DATE: 10/27/89 ---SPECIAL FLAGS---- 1-2-3-4-5-6-7-8-9-10 10-02400-010-52 S.A.# ASSESSMENT DESCR. YR YRS RATE TOTAL ANN.PRIN. PAYOFF COMMENT 101684 STk:491 88 15 9.00% 2327.00 .00 .00 PREPAY 101689 SSTK 491 88 15 9.00% 1749.00 .00 .00 PREPAY 10P581 WATER & STORM TRK 00 10 .00% 6474.00 647.40 6474.00 PEND SUMMARY OF ACTIVE .OCR .00 .00 THIS YEAR'S TOT PR_<I .00 SUMMARY OF PENDING 6474.00 6474.00 i V CITY~o EAGAN N'2 _._3617 BUILDING PERMIT ...l1Q,L,r.~y(:.............................. 3795 Pilot Knob Road, Owner - Eagan, Minnesota 551371 Address (present) o :e 454-910 Builder ........le. % f OLa Date G - / 4 Address . DESCRIPTION Stories To Be Used For Front Depth Height Est. Cos! 'permit Fee Remarks Al- LOCATION u is'o Street. Road or other Description of Location Lot Block Addition or Tract -7a3 AAAJ" I ~ 5 1k This permit does not authorise the use of streets, roads, alleys or sidewalks nor does it give the owner or his agent the right to create any situation which is a nuisance or which presents a hazard to the health, safety, convenience and general welfare to anyone in the community. THIS PERMIT MUST BE KEPT ON THE PREMISE WHILE THE WORK IS IN PROOR I g, This is to certify, that C!'~stix ..............has permission to erect a 1P..:................... ..upon the above described premise subj ct to the provisions of all applicable Ordinances for the Ci cf Eagan: 6C a Per Mayor 4 Building Inspector o~yoo o% s MASTER CARD LOCATION ac 3 ja CIdt e!& OWNER STRUCTURE AND LAND USED AS . O Issued To Permit No. Issued Contractor Owner BUILDING ro, 7V,, 41 PLUMBING CESSPOOL - SEPTIC TANK Q WELL ELECTRICAL HEATING GAS INSTALLING SANITARY SEWER OTHER OTHER Approved Items (Initial) Date Remarks Distance From Well FOOTING 7J SEPTIC I FOUNDATION L S CESSPOOL FRAMING TILE FIELD FT. FINAL ELECTRICAL DEPTH HEATING OF WELL= GAS INSTALLATION SEPTIC TANK _3o _7J CESSPOOL DRAINFIELD PLUMBING 7-r WELL SANITARY SEWER Violations Noted on Back COMMENTS: SEVERSON, WILCOX & SHELDON, P.A. A PROFESSIONAL ASSOCIATION ATTORNEYS AT LAW LARRY S.SEVERSON' PAUL J. STIER JAMES F. SHELDON KENNETH J. J. PATRICK WILCOX* 7300 WEST 147TH STREET '''SCOTT D. H R. HALL HALL TERENCE P. DURKIN P.O. BOX 24329 O NSTON MICHAEL. G. DOUGHERTY APPLE VALLEY, MINNESOTA 55124 JOSEPH EARLEY MICHAEL E. MOLENDA•' TELEFAX NUMBER 432-3780 MARY IAREN M. L. . GOLIKE LIKT (612) 432-3136 'ALSO LICENSED IN IOWA "ALSO LICENSED IN WISCONSIN OFCOUNSEL: JOHN E. VUKELICH '''ALSO LICENSED IN NEBRASKA November 16, 1989 Ms. Hertha cCarthy 4 733 Eagan, 55123 RE: ity of Eagan/McCarthy Agreement Project No. 581 - Stonebridge 2nd Addition Our File No.: 206-7487 Dear Ms, McCarthy: Pursuant to your request, I enclose fully executed agreement between you and the City of Eagan regarding special assessments for Project No. 581. If you should have any questions, please feel free to contact this office. Thank you for your cooperation in this matter. Very truly yours, SEVERSON, WILCOX & SHELDON, P.A. Roxann S. Duffy Legal Assistant to James F. Sheldon RSD/djk Enclosures r AGREEMENT This Agreement is between HERTHA McCARTHY, a single person ("Owner"), Owner and occupier of land in the City of Eagan, Dakota County, Minnesota ("City") as shown on Exhibit A ("Premises") and the CITY OF EAGAN in connection with City Project No. 581, Stonebridge 2nd Addition. The City of Eagan had proposed to assess Premises pursuant to Minnesota Statutes Section 429 for the lateral benefit from watermain in the amount of $3,852.00. It has been determined by the City that an alternative watermain hook-up is available. That being the case, the Owner and City have agreed that the Premises will not be assessed for lateral benefit relating to the watermain in Dodd Road unless and until the Premises were hooked up to the watermain in Dodd Road. NOW, THEREFORE, the City of Eagan and the owner do hereby agree as follows: 1. That the City will not assess the lateral benefit for watermain as part of the special assessment levy for Project No. 581, Hills of Stonebridge 2nd Addition. If and when the Premises are connected to the watermain in Dodd Road which was installed as part of Project No. 581, the owner, her heirs, successors, or assigns, shall pay to the City of Eagan, the then current rate for lateral benefit for watermain for 280 front feet. Said payment shall be made within 30 days of the hook-up. i 2. In the event that the premises are not hooked up to the watermain installed in Dodd Road as part of City Project No. 581, neither the owner nor the Premises shall be obligated nor responsible for any payment for lateral benefit for watermain from City Project No. 581 as part of this Agreement. Dated this /3 day of il&,, ,S&7z , 1989. CITY OF E GAN l ,i ! r1. By: Victor L. Ellison Its: Mayor By: J. VanOver eke Its City Clerk r s1~ HERTHA McCART Owner i STATE OF MINNESOTA } COUNTY OFa" rte- } s s . On this / day of 1989, before me a Notary Public within and for said County, personally appeared VICTOR L. ELLISON and E. J. VanOVERBEKE to me personally known, who being each by me duly sworn, each did say that they are respectively the Mayor and Clerk of the City of Eagan, the municipality named in the foregoing instrument, and that the seal affixed on behalf of said municipality by authority of its City Council and said Mayor and Clerk acknowledged said instrument to be the free act and deed of said municipality. MARILYN L WUCHERPFENNIG NOTARY PUBLIC - MINNESOTA N ary ub lc DAKOTA COUNTY My Commission Exp, Feb. 8, 1993 -2- STATE OF MINNESOTA ) ss. COUNTY OF b A K, rA ) On this /3dL day of fYe)ve-m r3L~ 1989, before me a Notary Public within and for said County, personally appeared HERTHA McCARTHY, a single person, to me personally known to be the person described in and who executed the foregoing instrument and acknowledged that she executed the same as her free act and deed. THOMAS A. COLBERT NOTARY PUBLIC - MINNESOTA DAKOTA COUNTY My commission Expires Sept. B, t990 146tary Public Mfv1.V '~lci1 r ~l"~ APPROVED AS TO FORM: - A&AA-,.,l ity Attorney Ps Office Da e• Z• APPROVED AS TO CONTENT: Pu is Works Department Date: J/-Z ' THIS INSTRUMENT WAS DRAFTED BY: SEVERSON, WILCOX & SHELDON, P.A. 7300 West 147th Street P.O. Box 24329 Apple Valley, MN 55124 (612) 432-3136 MGD -3- EXHIBIT A PT OF NE 1/4 OF SW 1/4 COM NE COR S ON E LINE 628 FT TO C/L CR S 38D 47M 47S W 137.62 FT TO BEG CONT S 38D 47M 47S W ON C/L 290.48 FT N 26D 48M 24S W 448.65 FT N 70D 29M 14S E 225.08 FT S 34D 31M 51S E 302.76 FT TO BEG SECTION 24, TOWNSHIP 27, RANGE 23 1ty of Qngen 3830 PILOT KNOB ROAD, P.O. BOX 21199 BEA BLOMOUIST EAGAN, MINNESOTA 55121 Mayor PHONE: (612) 454-8100 THOMAS EGAN May 18, 1987 JAMES A SMITH THEODORE WACHTER COUrCJ Members THOMAS HEDGES Cey A&nwWraFor MS ERTHA MCCARTHY EUGENE VAN OVERBEKE 4055 D &W~H City ' MN 55123 w~ Re: Pro'ect 491, Special Assessment Breakdown Dear Ms. McCarthy: As you requested in our meeting on May 7, 1987, I am forwarding to your attention a summary breakdown of the special assessments that are proposed against your property as a result of the above- referenced City project. - These are based on 1987 rates which will not change and also on the area of your parcel being 1.79 acres as identified by your Homestead Evaluation Notice from the County. This information is summarized as follows: 1. Trunk area sanitary sewer 1.79 acres @ $1,300/ac. = $2,327 2. Trunk area storm sewer 33,000 sq.ft.* $0.053/sf = 1,749 TOTAL PENDING ASSESSMENTS - PROJECT 491 $4,076 *Reduction for large lot credit where only the first 16,500 sq.ft. of each acre is assessed. It is not anticipated that the final assessment hearing would be held until the summer of 1988. It is proposed that these assessments would be spread over IS years at an estimated interest rate of 9.0%. The first payment would be due with your property tax statement in May of 1989. The following is a calculation of what your annual principal and interest payments would be. YEAR PRINCIPAL INTEREST TOTAL 1989 $271.73 1990 '271.73 $342.00 $613.73 1991 317.93 589.66 271.73 293.47 565.20 1992 271.73 269.02 540.75 1993 271.73 244.56 516.29 1993 271.73 220.11 491.84 1994 271.73 195.65 Etc. 467.38 THE LONE OAK TREE ...THE SYMBOL OF STRENGTH AND GROWTH IN OUR COMMUNITY Y MR ERTHA MCCARTHY MAY 18, 1987 PAGE 2 The estimated interest rate of 9.0% is calculated on the remaining unpaid balance at the end of any given year. Any prepayment of all or any portion of the outstanding principal amount will reduce the annual principal and interest installments accordingly. As I indicated to you at our meeting, the City does have an ordinance that provides for a "senior citizen deferment" of the assessment. This assessment would continue to accrue interest at the same estimated 9.0% rate, but the annual installment payments for principal and interest would not be due until the property is either sold or developed. If you would like any additional information regarding your proposed assessments, please feel free to contact me. Sincerely, Thomas A. Colbert, P.E. Director of Public Works TAC/jj cc: Deanna Kivi, Special Assessment Clerk Mark Hanson, Consulting Engineer i 932440 7 .33 AFFIDAVIT OF E. J. VANOVERBERE TO CORRECT THE LEGAL DESCRIPTION IN THE AGREEMENT BETWEEN THE CITY OF RAGAN AND HERTHA MQCARTHY DATED NOVEMBER 13, 1989 STATE OF MINNESOTA ) COUNTY OF DAKOTA ) I, E. J. VanOverbeke, being duly qualified and acting Clerk of the City of Eagan, Dakota County, Minnesota, upon oath, states as follows: 1. That the attached Agreement (Exhibit A) is a true and correct copy of an Agreement entered into by the City of Eagan and Hertha McCarthy on the 13th day of November, 1989 regarding Project No. 581. 2. That said Agreement was filed on the 27th day of November, 1989 as Dakota County Document No. 914312 and incorrectly stated the legal description as "Stonebridge 2nd Addition". The plat of "Stonebridge 2nd Addition" is located in the City of Rosemount. 3. That the correct legal description for this Agreement should be "Hills of Stonebridge Plat 211, which plat is located in the City of Eagan. 4. That this Affidavit should be recorded with the Dakota Count Recorder's Office Y to correct the legal description in and the filing of Dakota County Document No. 914312. 41312 i t AGREEMENT This Agreement is between HERTHA McCARTHY, a single person ("Owner"), owner and occupier of land in the City of Eagan, Dakota County, Minnesota ("City") as shown on Exhibit A ("Premises") and the CITY OF EAGAN in connection with City Project No. 581, Stonebridge 2nd Addition. The City of Eagan had proposed to assess Premises pursuant to Minnesota Statutes Section 429 for the lateral benefit from watermain in the amount of $3,852.00. It has been determined by the City that an alternative watermain hook-up is available. That being the case, the Owner and City have agreed that the Premises will not be assessed for lateral benefit relating to the watermain in Dodd Road unless and until the Premises were hooked up to the watermain in Dodd Road. NOW, THEREFORE, the City of Eagan and the owner do hereby agree as follows: 1. That the City will not assess the lateral benefit for watermain as part of the special assessment levy for Project No. 581, Hills of Stonebridge 2nd Addition. If and when the Premises are connected to the watermain in Dodd Road which was installed as part of Project No. 581, the Owner, her heirs, successors, or assigns, shall pay to the City of Eagan, the then current rate for lateral benefit for watermain for 280 front feet. Said payment shall be made within 30 days of the hook-up. ,w 2. In the event that the premises are not hooked up to the watermain installed in Dodd Road as part of City Project No. 581, neither the Owner nor the Premises shall be obligated nor responsible for any payment for lateral benefit for watermain from City Project No. 581 as part of this Agreement. Dated this /3 day of 1989. CITY ;OF A'AN [r jam; By: Victor L. Ellison Its: Mayor 5- J By: J. VanOverbeke Its% City Clerk Ate' ~C!f~~ HERTHA McCARTHY, ner STATE OF MINNESOTA ) COUNTY OF ss. On this rj~day of 8,~~•- Notary Public within and for said County1~ pebefore rsonally appeared a VICTOR L. ELLISON and E. J. VanOVERBEKEto me personally appeared being each by me duly sworn, each did say thattheyare known, who respectively the Mayor and Clerk of the City of Eagan, the municipality named in the foregoing instrument, and that the seal affixed on behalf of said municipality by authority of its City Council and said Mayor and Clerk acknowledged said instrument to be the free act and deed of said municipality. JNd~N/NIIINItlJl ~ ~ 61AI'I'.YI L WUCL'ERPFENNIG _ CGC; x1,~~. NOTARY PUU1. - MINNESOTA No ary ubllc ()l DAKOTA COUNTY ~'~;Ie My commicslon Exp fcb B. 19M 171 r re~~o rHe aersVr~es~a; -2- EXHIBIT A PT OF NE 1/4 OF SW 1/4 COM NE COR S ON E LINE 628 FT TO C/L CR S 38D 47M 47S W 137.62 FT TO BEG CONT S 38D 47M 47S W ON C/L 290.48 FT N 26D 48M 24S W 448.65 FT N 70D 29M 14S E 225.08 FT S 34D 31M 51S E 302.76 FT TO BEG SECTION 24, TOWNSHIP 27, RANGE 23 _ f 1 r STATE OF MINNESOTA ) ss. COUNTY OF p 4K o r-A- ) On this 13E day of //#y&7gAg:,2 1989, before me a Notary Public within and for said County, personally appeared HERTHA McCARTHY, a single person, to me personally known to be the person described in and who executed the foregoing instrument and. acknowledged that she executed the same as her free act and deed. THOMAS A. COLBERT O-My NO TARY PUBUC - MINNESOTA DAKOTA COUNTY CommlaalonExplre3Sept.6.1990 Notary Public APPROVED AS TO FORM: it Attorne 's O 'ce a ?-v - APPROVED AS TO CONTENT: P lic Works Department Date: THIS INSTRUMENT WAS DRAFTED BY: SEVERSON, WILCOX & SHELDON, P.A. Or 7300 West 147th Street 1.1 P.O. Box 24329 _R Apple Valley, MN 55124 (612) 432-3136 MGD r i t..~ ti -3- 914312 OFFICE OF THE COUNTY RECORDER-DAKOTA COUNTY, MN. CERTIFIED THAT THE WITHIN INSTRUMENT WAS FILED FOR RECORD IN THIS OFFICE ON AND AT NOV 21 2 23 PM'89 DOC. NO 914312 JAMES N. DOLAN, COUNTY RECORDER DEPUTY s FEE AQ CASH ❑ CHECK [P9 CHARGE ❑ CHARGE WHOM REFUND DO NOT REMOVE G Tganorle 19 Connly Andity DWmft co. .J e,),e so r, l c~ C-6 yC ° S J e ' FURTHER YOUR AFFIANT SAYETH NOT. E. VanOver eke Subscribed and sworn to before me this .ZNb day of , 1990. MARILYN L WUCNERPFENNIG NOTARY PUBLIC - MINNESOTA { DAKOTA COUNTY My Commission Exp. Feb. 8, 1993 - N ary Pu 1ic THIS INSTRUMENT WAS DRAFTED BY: SEVERSON, WILCOX & SHELDON, P.A. 600 Midway National Bank Building 7300 West 147th Street Apple Valley, MN 55124 RD 206-7487 s ~ m 2 D m D ZM02 A~11 C:13 2 c CD' ZOmi 8n vm~ ZO v~3m am . pp izm0 m~i ' gm Z 0 0 ~ z co ptDn-1 pn O 0 CJ m m c0 z!nx -4 C: -nm DZ O D `44 v 9 mai W m m 7° Z N m 8 o :D z o SEVERSON, WILCOX & SHELDON, P.A. A PROFESSIONAL ASSOCIATION ATTORNEYS AT LAW LARRYS.SEVERSON• KENNETH R. HALL JAMES F. SHELDON *"*SCOTT D. JOHNSTON J. PATRICK WILCOX* 600 MIDWAY NATIONAL BANK BUILDING JOSEPH P. EAR.LEY TERENCE R DURKIN 7300 WEST 147TH STREET LOREN M. SOLFEST MICHAEL G. DOUGHERTY APPLE VALLEY, MINNESOTA 55124 CHRISTINE M. SCOTILLO MICHAEL E. MOLENDA•• (612) 432-3136 ANNETTE M. MARGARIT PAUL J. STIER DANIEL M. SHERIDAN TELEFAX NUMBER 432-3780 'ALSO LICENSED IN IOWA OF COUNSEL: ''ALSO LICENSED IN WISCONSIN JOHN E. VUKELICH ...ALSO LICENSED IN NEBRASKA April 24, 1990 Mr. E. J. VanOverbeke City Clerk City of Eagan 3830 Pilot Knob Road P.O. Box 21199 Eagan, MN 55121 RE: Affidavit of E. J. VanOverbeke to Correct the Legal Description in the Agreement between the City of Eagan and Hertha McCarthy Dated November 13, 1989 Stonebridge 2nd Addition Our File No.: 206-6890 Dear Gene: In connection with the above matter, I enclose the original recorded Affidavit of E. J. VanOverbeke to Correct the Legal Description in the Agreement Between the City of Eagan and Hertha McCarthy Dated November 13, 1989 - Document Number 932440 for the official City records. If you should have a question, please feel free to contact me. Thank you for your consideration and cooperation in this matter. Very truly yours, SEVERSON, WILCOX & SHELDON, P.A. Roxann S. Duffy Legal Assistant RSD dj Enclosure •r ~ ~ - 1312 AGREEMENT This Agreement is between HERTHA MCCARTHY, a single person ("Owner"), Owner and occupier of land in the City of Eagan, Dakota County, Minnesota ("City") as shown on Exhibit A ("Premises") and the CITY OF EAGAN in connection with City Project No. 581, Stonebridge 2nd Addition. The City of Eagan had proposed to assess Premises pursuant to Minnesota Statutes Section 429 for the lateral benefit from watermain in the amount of $3,852.00. It has been determined by the City that an alternative watermain hook-up is available. That being the case, the Owner and City have agreed that the Premises will not be assessed for lateral benefit relating to the watermain in Dodd Road unless and until the Premises were hooked up to the watermain in Dodd Road. NOW, THEREFORE, the City of Eagan and the Owner do hereby agree as follows: 1. That the City will not assess the lateral benefit for watermain as part of the special assessment levy for Project No. 581, Hills of Stonebridge 2nd Addition. If and when the Premises are connected to the watermain in Dodd Road which was installed as part of Project No. 581, the owner, her heirs, successors, or assigns, shall pay to the City of Eagan, the then current rate for lateral benefit for watermain for 280 front feet. Said payment shall be made within 30 days of the hook-up. 2. In the eventthat the premises are not hooked up to the watermain installed in Dodd Road as part of City Project No. 581, neither the Owner nor the Premises shall be obligated nor responsible for any payment for lateral benefit for watermain from City Project No. 581 as part of this Agreement. Dated this / 3 day of A &-?z 1989. CITY ;OF GAN By: Victor L. Ellison Its: Mayor &A 16'A By: Ai . anOverbeke Its City Clerk HERTHA McCARTHY, er STATE OF MINNESOTA ) ss. COUNTY OF ) On this 2!2L day of 1989, before me a Notary Public within and for said County, personally appeared VICTOR L. ELLISON and E. J. VanOVERBERE to me personally known, who being each by me duly sworn, each did say that they are respectively the Mayor and Clerk of the City of Eagan, the municipality named in the foregoing instrument, and that the seal affixed on behalf of said municipality by authority of its City Council and said Mayor and Clerk acknowledged said instr nt to be the free act and deed of said municipality. MARI"YN L WUCHERPFENNI6 ALL2-~-Z- NOTARY PUBLIC - MINNESOTA No ary lic DAKOTA COUNTY r My Commission Exp. Feb 8, 1993 -2- A EXHIBIT A PT OF NE 1/4 OF SW 1/4 COM NE COR S ON E LINE 628 FT TO C/L CR S 38D 47M 47S W 137.62 FT TO BEG CONT S 38D 47M 47S W ON C/L 290.48 FT N 26D 48M 24S W 448.65 FT N 70D 29M 14S E 225.08 FT S 34D 31M 51S E 302.76 FT TO BEG SECTION 24, TOWNSHIP 27, RANGE 23 i .r STATE OF MINNESOTA ) ss. COUNTY OF Z h K o r-A- ) On this / 3' day of A1& v&- i,&gr2 1989, before me a Notary Public within and for said. County, personally appeared HERTHA McCARTHY, a single person, to me personally known to be the person described in and who executed the foregoing instrument and acknowledged that she executed the same as her free act and deed. THOMAS A. COLBERT 1990 940 4 NOTARY PUBLIC - MINNESOTA DAKOTA COUNTY X011'""" SW. e. Notary Public APPROVED AS TO FORM: it Attorne Is J~Vce APPROVED AS TO CONTENT: Wii[c Works Department Date: Z,/ Z THIS INSTRUMENT WAS DRAFTED BY: SEVERSON, WILCOX & SHELDON, P.A. 7300 West 147th Street P.O. Box 24329 ~R Apple Valley, MN 55124 (612) 432-3136 MGD 47. 1 -3- 914312 OFFICE OF THE COUNTY RECORDER-DAKOTA COUNTY, MN. CERTIFIED THAT THE WITHIN INSTRUMENT WAS FILED FOR RECORD IN THIS OFFICE ON AND AT DOC. NO 914312 JAMES N. DOLAN, COUNTY RED RDER DEPUTY ~ FEE AQ. CASH ❑ CHECK Ep CHARGE El CHARGE WHOM REFUND DO NOT REMOVE ~rf1i■ri9l1 apd Glow Seve-r So Y\, I.c~c I~o~ ~dOh SEVERSON, WILCOX & SHELDON, P.A. A PROFESSIONAL ASSOCIATION ATTORNEYS AT LAW LARRYS. SEVERSON• PAUL J. STIER JAMES F. SHELDON • Epp MIDWAY NATIONAL BANK BUILDING KENNETH R. HALL J. PATRICK WILCOX WA WEST 147TH STREET SCOTT D. JOHNSTON TERENCE P. DURKIN 7300 JOSEPH P. EARLEY MICHAEL G. DOUGHERTY APPLE VALLEY, MINNESOTA 66124 LOREN M. SOLFEST MICHAEL E. MOLENDA•• (612) 432-3136 ANNETTE M. MARGARIT 'ALSO LICENSED IN IOWA TELEFAX NUMBER 432-3780 OFCOUNSEL: ''ALSO LICENSED IN WISCONSIN JOHN E. VUKELICH ...ALSO LICENSED IN NEBRASKA December 7, 1989 E. J. VanOverbeke Eagan City Clerk $ 3830 Pilot Knob Road 0 P.O. Box 21199 Eagan, MN 55121 RE: Hertha McCarthy's Assessment Agreement ~t 1 Project No. 581 - Stonebridge 2nd Addition 7 Our File No.: 206-7487 Dear Gene: In connection with the above matter, I enclose original recorded Assessment Agreement (Hertha McCarthy) - Document Number 914312 for the official City records. If you should have a question, please feel free to contact me. Thank you for your consideration and cooperation in this matter. V4rry t my yours, SEVER ON, WILCOX & SHELDON, P.A. t Roxann S. Duffy Legal Assistant RSD/djk Enclosures - ~1 Department ul ltre 1 Ieasury--inter nal Revenue %eivi4e 1040 c., + O _ 6 8% CL E 5450014 U.S. Individual Income Tax Return U t" : . lg No. for the ear Jan -Dec. 31, 1989, or other tax year tie mnm 1989. endm Your social security number Last name i label Y. lust name and initial rA _ * * * * * * 5 - D I G 17 5512 3 Speuse'a eea41 acurlty number UselRSlabel R509 80 Otherwise, AA 474-54-3586 please print H E R T H A M C C A R T H Y R Apt, no. for prrttracy Act and or type. Home 249 S p8 k RUduetlon E 4055 DQDD RD p E 5 512 3 E /►ct s lot, saw R A G A N MN Institiati+fn>f, city.to.E - es Chukaw "yes" win ' Y r not ixianRe your tax or Presidential ' Do you want $1 to go to this fund? . . . . • • • • • • Yes q * our tax Election Campaign If 'oint return, does ourspouse want 1 to o to this fund? . 1 Single w„ Q of L 0 ore- Wile Filing Status 2 Married filing joint return (even if only one had income) s e11e 3 Married filing separate return. Ent" spouse's social security no. above and toil nalne here. Is your child but not Check only 4 Head of hoasehold (with qualifying pefson). (See page 7 of Instructions,) If the r14ltufY 01 one box. 0 your dependent, enter child'e name here. ~Jil_ s eU g oaf s in widow er with de ndent child ears se died ► 19 S" 7 I On 6a Yourself If someone (such as your parent) tan claim you as # dependent on hie or her ~ p Ilot< : Exemptions return, do not check box 6a. Rut be sure to check the look on fine 33b on page ; BAey t7 (See b spouse (5) Ne. d I~aNla ta k s Instructions ndents: (2) Cluck (3) 11 sp 2 or older, dtW*0hs Well in r ` (a, a.~~.e 11H l I I un» 11 4001 on page 8.) 2 rural secunty ouroba (I) Name (lull, initial, and lul iulw) °et to Pit ' Ifa11111 wo anoge q I awl3 er w pip (aee )Inonn If more than 6 ~DDOZ dependents, see on Doe 3 Instructions on P,I Page 8' Add rtMabsra nt der 4 pre 1965 agreement, rho;k We I0 M r d If your child didn't live with you but is Claimed ee yoW depende on u z a Total number of exemptions claimed . . • • _ Virlml 2q 7 , Wages, salaries, tips. qtp, (mach ForM(s) W-R) n0A 10 income Toplale iriterost income W attach Schedule Bit over ~40D1 b Tarr-lsr9!r+fl!t lnlEtf sl !f+~CR'?;7a:0" retie 10 9"'T incluot an line 8a sauil P Please attach , • Copy B of your 9 .s( 'vidend Income (also attach $Gbout 9!(.pver $400) eJ Forms W2, W2G, at}1 apt If and you W do 2P not here. have 10 -10liablo refunds of state and local income taxes, if any, from worksheet on Paga 11 of Inslructiptss, r; 041 Jai 11 gfimony received . a W2, see 12 Rumness income Qr,(lot)s) (Attach Schedule 0) . . iB 9q; page 6 of 13 Capital gain or (loss) (attach Schedule D) ; 8Pa11la Instructions. l' 14 Capital gain distributi" not rgpWted on lisle 13 (see page 11) . * r is f Other gains 91 (losses)( attach Flrm.4797) . . . . . . kr 164 Total IRA Qistributipr!s lib Taxable amount (see pop W twos 17a Total pensions and aa(+uities 9E:]~Ift Taxable amount( aet pawe.1A j 6861 14 ' Rents, royalties, partnerships, estates. trusts, etc, (attach Schedule E) oos an 19 Farm income or (loss) (attach Schedule F) • . • • • ' del noA a nt, i gimp cation (in:tlriASre) fide 13) ' Sul 20 ; Please 21aSwisppie} ; oym4 ! 21a I 21bT W9amal+n!(III ' d>f i4AMtttlk.` ~ ~ !S~J~ attach check or money 22 91ber income (114t, twla and amount--eee page order here. ? the amounts shown in the for right Column for lines thr4. h 22, This is nor tat 01 24',,?dour IRA deduction, from oppliobitf w.arksbtgt on page 14 or 15 Adjustments IS Spouse's IRA dedoetion, from applicable wor'ks4ot on page 14 or 15 25 26 to Income 26 Self-employed health inROr$nce deduction, from worksheet on page 15 27 27 Keggh ieWorr ent plan and sett-employed $EP deduction • 28 28 Penalty on early withdrawal of savings . • • • . (See ,'Alimony pants, @ Rpici*nt's last name 29 Instructions t-ond b social security number. . . 30 on page 14.) i 4 throw h . These are our tot ad ustments . • • . u r Inp from I ne 2 his is yoy[ adjusted gross Income. If this line is less t a t" (line 5f3) on Page 2Q.oF 19„340 arld a child lived wrth Earned become Credi Adjusted n Y9u, " Gross Income the InsrruClions, it you want IRs tq f ure you► tax see page 16 of the instructions f> 1111 RESIDENTIAL BUILDING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB RD - 55122 pl 651-681-4675 New Construction Requirements RemodettReaair Requirements • 3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and all roofed areas • 2 copies of plan (20% maximum lot coverage allowed) . 1 set of Energy Calculations for heated additions • 2 copies of plan showing beam & window sizes; poured found design, etc.) . 1 site survey for exterior additions & decks • 1 set of Energy Calculations • 3 copies of Tree Preservation Plan if lot platted after 7/1/93 • Rim Joist Detail Options selection sheet (bldgs with 3 or less units) DATE 3 Z VALUATION (EXCLUDING LAND) JOB SITE ADDRESS 73 3 ;qoD )JPL1_ IF MULTI-FAMILY BUILDING, HOW MANY UNITS? PROPERTY OWNER Z-9-5 6020S010 r TYPE OF WORK A) ecc.LJ ?/LV 55 5 elu Afe ~e~ a FIRE LACE(S) -0 -1 -2 _3 APPLICANT PHONE # &3_/_gS6'0 7a_ ADDRESS ZIP CODE S~.S-l 2 3 PAGER # CELL PHONE # !off 2' 364 3- 5 FAX # NIEW RESIDENTIAL BUILDING ONLY - FILL OUT COMPLETELY Energy Code Category _ MINNESOTA RULES 7670 CATEGORY 1 (check one) - Residential Ventilation Category 1 Worksheet Submitted - Energy Envelope Calculations Submitted MINNESOTA RULES 7672 - New Energy Code Worksheet Submitted Plumbing Contractor: Phone Plumbing System Includes: Water Softener - Lawn Sprinkler Fee: $90.00 Water Heater No. of R.I. Baths No. of Baths Mechanical Contractor: Phone # Mechanical System Includes: Air Conditioning Fee: $70.00 Heat Recovery System 1 Sewer/Water Contractor: Phone # L2 U UJ L13 1111 All above information must be submitted prior to processing of application. ' r 1~~ 1 hereby acknowledge that I have read this application, state that the information is c t, and agree to com ly with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant /4-.17 P (~7_ 6 Certificates of Survey Received - Tree Preservation Plan Received Not Required - Updated 1/01 I OFFICE USE ONLY ❑ 01 Foundation ❑ 07 05-plex ❑ 13 16-plex ❑ 20 Pool ❑ 30 Accessory Bldg ❑ 02 SF Dwelling ❑ 08 06-plex ❑ 16 Fireplace ❑ 21 Porch (3-sea.) ❑ 31 Ext. Alt - Multi ❑ 03 01 of_ plex ❑ 09 07-plex ❑ 17 Garage ❑ 22 Porch/Addn. (4-sea.) ❑ 33 Ext. Alt - SF ❑ 04 02-plex ❑ 10 08-plex ❑ 18 Deck ❑ 23 Porch (screened) ❑ 36 Multi ❑ 05 03-plex ❑ 11 10-plex ❑ 19 Lower Level ❑ 24 Storm Damage ❑ 06 04-plex ❑ 12 12-plex Plbg_Y or_ N ❑ 25 Miscellaneous ❑ 31 New ❑ 35 Int Improvement ❑ 38 Demolish (Interior) ❑ 44 Siding ❑ 32 Addition ❑ 36 Move Bldg. ❑ 42 Demolish (Foundation) ❑ 45 Fire Repair ❑ 33 Alteration ❑ 37 Demolish (Bldg)* ❑ 43 Reroof ❑ 46 Windows/Doors ❑ 34 Replacement *Demolition (Entire Bldg only) - Give PCA handout to applicant Valuation Occupancy MC/ES System Census Code Zoning City Water SAC Units Stories Booster Pump Nbr. of Units Sq. Ft. PRV Nbr. of Bldgs Length Fire Sprinklered Type of Const Width REQUIRED INSPECTIONS Footings (new bldg) _ Final/C.O. - Footings (deck) _ Final/No C.O. - Footings (addition) _ Plumbing _ Foundation _ HVAC _ Drain Tile Roof _ Ice & Water _ Final _ Other - Framing _ Pool _ Ftgs _ Air/Gas Tests _ Final - Fireplace _ R.I. -Air Test -Final _ Siding _ Stucco _ Stone - Insulation - Windows (new/replacement) Approved By , Building Inspector Base Fee . ~ Surcharge s Plan Review MC/ES SAC City SAC Water Supply & Storage S&W Permit & Surcharge Treatment Plant Plumbing Permit Mechanical Permit License Search Copies Other Total Use BLUE or BLACK Ink r----------------I C"h6-6r cy (7 ( ~ I For Office Use I~,/ 666 I Permit#: ~y3 ~I I City of Ea a~ l L I Permit Fee: I 3830 Pilot Knob Road I Date Received: / Eagan MN 55122 RECEIVED 1 I Phone: (651) 675-5675 I I 1 Staff: Fax: (651) 675-5694 MAR 2 3 2011 `-----------------1 2012 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: 3 Site Address: ~ ~ e Tenant: Suite RESIDENT/OWNER Name: ~_e5 %wr se~~ Phone: Address / City / Zip: 3 3 _ P(ctc-P Name: License CONTRACTOR Address: -loo-3/0 !97'.- city: .~fis~ rKg -G State: /Vr Zip: Phone: Contact: C t'~ 2Z Email: X cl TYPE OF WORK - New replacement _ Repair Rebuild - Modify Space - Work in R.O.W. Description of work: n ?if 'i ✓=S5 k/e-'4 a RESIDENTIAL Water Heater Water Softener PERMIT TYPE Lawn Irrigation RPZ PVB) Septic System k Add Plumbing Fixtures Main Lower Level) 1 Water Turnaround Jew ^ G' Abandonment 1 RESIDENTIAL FEES: $60.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge) $60.00 Lawn Irrigation (includes $5.00 State Surcharge) $60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge) *Water Turnaround (add $189.00 if a 5/8" meter is required) $105.00 Septic.System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge) TOTAL FEES $ ~e5_ 00 CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.aopherstateonecall.org I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. x f GL K Q-Pe"_ X Applicant'd plicantignature FOR OFFICE USE Reviewed By: I i'I t 4eio Date: ~G r✓ Required Inspections: Under Ground V Rough-In Air Test Gas Test Final C.' do LX a SITE EVALUATION SOIL BORINGS PERC. TEST AND DESIGN . EAGAN REVIII~~ED, k EY BUILDINIG INSPECTIONS CUT-, FO : ~ r/ 3 SITE. 113Y: JERRY SAUBER MPCA# 925 #317 Office (651) 463-7434 Home (651) 463-2597 UNIVERWY OF MINNESOTA OSTP Preliminary Evaluation Form : . 1. Contact Information v 11.09.22 Property Owner/Client les bordsen Client Phone Number: b12 366 4275 Mailing Address 733 bradfad place eagan mn. Project ID: Site Address same Parcel l.D.I Township Range #1 Section I.te 2 16 2012 Township name Legal Desc or Lat/Long Evaluation for system type ❑ New Construction ® Replacement Parcel dimensions 2. Flow information client-Provided Information Type(s) of use (all that apply) 0 Residential ❑ Commercial by J.❑ Other Use (Specify) No. of bedrooms' (if applicable) Unfinished space (ft) No. of residents in home Adults~❑Children F]Teenagers Daycare Existing flow measurements ❑ Yes (If Yes.; attach readings) 13 No ❑ Garbage Disposal ❑ Water Softene' ❑iron Fitter' Water-using devices (check all that 0 Dishwasher Other sP~fy ) apply) 13 sump Pump' ( ❑ Large bathtub/Jacuzzi ❑ High Efficiency Furnace' ❑ Laundry/ Large Tub on 2nd Floor ❑ Hot Tub" `Clear water source Water use concerns (check all that El apply) Faucet/Toilet [I Multiple Loads of Laundry/Day 13 Lang-Term Prescription Mew p In Home Business ❑ No Lint Screen 0 use of Anti•Bactedat Soap ❑ Frequent Entertaining of Out-of-Town Guests Any additional current or future uses on this parcel (specify) addition Any non-sewage discharges to system (specify) none T Sewage ejector or grinder pump in home ❑ Yes ® No I acknowledge the above is complete and accurate (Client(s) signature and datel Designer-determined Flow Information 00- V Se if i. v A. Estimated Design Flow (gallons per day) [1 Ste'' Anticipated waste strength vaalluues: ❑ Domestic 1 ugh Suengih ----in 7 BOD: mg/L CBOD:mg/L (TSS):mg/L 0&G:g/L 3. Preliminary Site Information B(t). Water supply well(s) within 100 ft of absorption area ❑ Yes ® No Weti(s) were located ® Direct Observation ❑ County Welt Index Maps ❑ Personal Communication MN Unique Well Id k: Depth of weH(s) >SOft~it Welt casing depth(s) 1 11 ft Source Impervious Layer 13 No ❑Yes If Yes, Define $ Source: Required Setback: ~ft B(2). Site within ZOO ft of noncommunity transient supply well ❑ Yes ®No Source 8(3). Site within a drinking water supply management area ❑ Yes 0 No Source B(4). Location of all existing and proposed buildings and improvements on lot (see Site Evaluation map) B(5). Buried water supply pipes within 50 it of proposed system ❑ Yes ®No C. Location of all easements on lot (see Site Evaluation map) Source D. Elevation of ordinary high water level (OWHL) - MN DNR (if adjacent to parcel) E. Floodplain designation &W flood elevation Source F. Determine property lines (see Site Evaluation map } a survey ❑ Plat Map ❑ Other Site located in a shorela id district/area ❑ Yes El No G. Distance of setbacks ❑ Property Lines ❑ OHWL ❑ Easements ❑ Water Supply Pipes ❑ Well(s) Other Buildings H. Soil Survey Information (from web soil survey) Map Map Units on Parcel List landforms glacial till Slope Range Z~ Parent materials -check all that apply Landscape Position (check all that apply) )9 Till 0 outv sh 0 Loess Q Bedrock Alluvium ❑ Colkrvium ❑ Summit ❑ Shoulder ®Backsiope ❑ footsbpe ❑ Tceslope ❑ Lacustrine ❑ Organic Q Cut/Fill ❑ Depression ❑ Stream ❑ Terrace ❑ Manmade Q Plain Minimum bedrock depth: ❑inches Minimum bedrock depth:❑inches Maximum bedrock depth:ninches Maximum bedrock depth: D inches Map Unit dJ1111Septic Tank Absorption Field - Trench (MN) pressure bed Ratings Septic Tank Absorption Field - At-grade (MN) Septic Tank Absorption Field - Mound (MN) UNIVERSITY OF MINNESOTA QSTP Preliminary Evacuation Form 4. Preliminary Soil Profile information (from web soil survey • map unit deseription & official series descriptions ) Enter information here or attach map and description. see attached Map Unit Depth Texture(s) Structure(s) Consistence Other (flooding, ponding, etc.) Horizon 1 Horizon 2 Horizon 3 Horizon 4 Horizon 5 Map Unit Depth Texture(s) Structure(s) Consistence Other (flooding, ponding, etc.) Horizon I Horizon 2 Horizon 3 Horizon 4 Horizon 5 Map Unit Depth Texture(s) Structure(s) Consistence Other (flooding, ponding, etc.) Horizon t Horizon 2 - Horizon 3 Horizon 4 Horizon 5 map Unft' Depth Texture(s) Structure(s) Consistence Other (flooding, ponding, etc.) Horizon i Horizon 2 Horizon 3 Horizon4 Horizon 5 5. Local Government Unit Information Name of LGU t GU Contact LGU-specific setbacks LGU-specific design requirements LGU-specific installation requirements I hereby certify that l have completed this work in accordance with all applicable ordinances, rules and laws. (Designer) (Signature) (License (Date) tjlVJVERSITY OF MINNESOTA OST'P Field Evaluation Form 1. Contact information v 11.09.22 Property Owner/Client Les bordsen Client Phone Number: 612 366 4275 Address same Date J2 16 2012 Weather Conditions sunny 2. Utility and Structure Information Utility Locations Identified ❑ Gopher State one Cad # 651 454'0002 ❑ Any Private Utilities Property Lines ® Determined and Approved By Client ~~Client's Approval (initial) 1 Determined But Not Approved Approximate ❑ Property Lines Surveyed Locate and Verify (see Site Evaluation mop) ❑ Existing Buildings [J Improvements 0 Easements Setbacks 3. Site Information Percent Slope 2 Slope Direction sw Landscape Position backstope Slope Shape t. 1. Vegetation type(s) wooded Evidence of cut, fill, compacted or disturbed areas ❑ Yes ® No © Locate Areas on Site Evaluation Map Discuss the flooding or run-on potential of site Identify benchmarks and elevations (Site Evaluation Map ) Proposed soil treatment area adequately protected Yes ❑ No 4. General Soils Information Original soits ® Yes C] No Type of observation ❑ Soil Probe p Soil Boring la soil Pit Number of soil observations Soil observations were conducted in the proposed system location ® Yes C1 No A soil observation was made within the most limiting area of the proposed system ® Yes ❑ No Soil boring tog forms completed and attached ® Yes 17 No Percolation tests performed, forms completed and attached ® Yes E3 No 5. Phase I. Reporting Information Depth to standing water na inches Anticipated construction issues Flood elevation as /4_ feet Depth to bedrock na inches Depth to periodically saturated soil 60 inches Maximum depth of system 24 inches Elevation at system bottom feet Differences between soil survey and field evaluation Percolation rate 13 min/inch Loading rate.. 12 gpd/ft` Contour loading rate .7-k 1'1/ gpd/ft Site evaluation issues /comments I hereby certify that i have completed this work in accordance with all applicable ordinances, rules and laws. (Designer) (Signature) (License (Date} Page 1 of 1 UStiP1 s~ e1 ~,I s Contact Un bows- „6._a S is Data :a.°d+r+. ea fail wive - ~ l3t~~t~~ Ns " Soil Survey Status Glossary prefer , , ,s Link Logout Helps x A A Area of Inters;:;t (.~~i3 Soil Map Soi! Data'Ex lorer - p Sho Ing Cart (Free) C?J Pena a6_ Area of Interest Interactive i4ap _J ~.r1I -11t - I Ad . ~57 ~~i I FA,, o f -2-j YiyYareyY ~ ~ View Extent Contiguous U.S. scale Quick Navigation Address View t Address 733bradford place eagan inn. ' AflN~} 11 1 ~ k Show location Y marker View State and County A Soil Survey Area lj Latitude andLongitude PLSS (Section, Township, Range) Bureau of Land Management bepartmentof Defense Forest Service National Park Service Hydrologic Unit FOIA 1 Accessibility Statement I Privacy Policy I Non-Discrimination Statement I Information Quality I USA.gov I White House http://websoilsurvey.nres.usda,gov/app/WebSoilSurvey.aspx 2/20/2012 IV vv vvu ua.u vv.7 .L CI~V 1 Vl 1 Contact Us Onwwc~ -'n Soils Data Archived Soil Surveys Soil Skirvey status Glossary Prmr'erericcs Link Logout HkAp w A ~ Area of Interest(AOI) 53ii Map Soil Data Explorer Shopping Cart (Rer Printable Version] Add to shopping cart` L Sc as ch Soil Ma Map Unit Legend Dakota County, Minnesota (MN037) <t Map Unit Map Unit Name Acres in Percent of Symbol A01 AOI x 342E Kingsley sandy 0.3 3.71/o loam, 15 to 25,,. r ` percent slopes . 4 344 Quam silt loam.. 1.1 14.8% 895C Kingsley- 4.1 53.0% Mahtomedi Spencer complex, 8 to 15 percent slopes 896E Kingsley- 2.2 28.5% Mahtome`di; complex, 15 to 25 percent slopes Totals for Area of interest 7.7 100.00/0 / Warning: Soil Map may not be valid at this scale. You have zoomed in beyond the scale at which the soil map for this area is intended to be used. Mapping of soils is done at a particular scale. The soil surveys that comprise your AOI were mapped at 1:15,840. The design of map units and the level of detail shown to the resulting soil reap are dependent on that map scale. Enlargement of maps beyond the scale of mapping can cause misunderstanding of the detail of mapping and accuracy of soil line placement. The maps do not show the small areas of contrasting soils that could have been shown at a more detailed scale. FORA I Accessibility Statement I Privacy Policy I Non-Discrimination Statement I Information Quality I USA.gov I White House http://websoilsurvey.nres.usda.gov/app/WebSoilSurvey.aspx 2/20/2012 Y.Y VV 17V11 A7 U1 V V,' 1 Q~'V 1 VI L Ur,.Lti L7)!~I 2", ~ 1,' } I'~ it es" Ot , Contact U. Downloaa .-oils data Ar.rivad Snit ~~e vay~ soil Survey Status Glossary rieri;e3ces Lh-w Lcyuut Help A: A A . Area of Interest (AOI) Soil Map Soil Data Explorer Shopping Cart (Free) View Soil Information By Use: All Uses Printable Version Add to Shopping Cart I) Intro to Sultabilltl~L5 &aJ Soil Propert(es and Ecological Site Soil Soils Limitation for ii i= Qualities Assessment Reports Search ® Nid - Septic Tank Absorption Fields - Trench (i4' N) i ec J 1 Scales 4J rSuitabilities and Limitations Ratings All Close Ai{ I Building Site Development ~d Construction Materials Disaster Recovery Planning 41. \ Land Classifications Land Management Military Operations Recreational Development a . Sanitary Facilities Aquifer Assessment (MN) ,,Warning. Soil Ratings Map may not be valid at this scale. X1 You have zoomed in beyond the scale at which the soil map for this area is Daily Cover for Landfill intended to be used. Mappingg of soils is done at a particular scale. The soil surveys that comprise your COI were mapped at 1:15,840, The design of map units and the level of detail shown in the resulting soil map are dependent on Sanitary Landfill (Area) that map scale. Enlargement of maps beyond the scale of mapping can cause misunderstanding Sanitary Landfill of the detail of mapping and accuracy of soil line placement. The maps do not (Trench) show the small areas of contrasting soils that could have been shown at a more detailed scale. 5eptage Application - Incorporation or Injection (MN) Septage Application - Surface (MN) Tables - Septic Tank Absorption Fields --Trench (HN) --w Summary By Map Unit Septic Tank Absorption Fields -At-Grade (MN) Summary by Map Unit - Dakota County, Minnesota (MM037) Map Map unit Rating Component Rating reasons Acres Percent of Septic Tank Absorption Fields Mound (MN) unit name name (numeric in ADZ symbol (percent) values) AOI Septic Tank Absorption Fields - Trend, (MN) 342E Kingsley Very limited Kingsley Slope (0.86) 0.3 3.7% View Description View Rating sandy loam, (85%) 15 to 25 Restricted percent percolation slopes (0.35) 344 Quam silt Extremely Quam (85%) Ponding (1.00) 1.1 14.8% loam limited Soli saturation (1.00) Restricted percolation (0.35) 895C Kingsley- Moderately Kingsley Restricted 4.1 53.0% Mahtomedi- limited (50%) percolation Spencer (0.35) complex, 8 to 15 percent slopes Slope (0.09) 896E Kingsley- Moderately Kingsley Slope (0.73) 2.2 28.5% 'View Description view Rati Mahtomedl limited (65%) Restricted complex, 15 percolation http//websoilsurveynres.usda.gov/app/WebSoilSurvey.aspx 2/24/2012 - - - rage L of L Sewage Lagoons to 25 percent (0.35) slopes Soil-Based Residential Wastewater Disposal Ratings Mahtomedi Slope (0.73) (35°Jo) Excessive percolation Vegetative Productivity (a.11) (;)r Totals for Area of Interest 7.7 300.09'0 Waste Management l Table Septic lank Absorption Fields - Cream t~ (MN) m Summary by hating Value Summary by Rating Value Rating Acres in AOI Percent of AOI Moderately limited 6.3 81.5% Extremely limited 1.1 14.8% Very limited 0.3 3,7% Totals for Area of Interest 7.7 100.0% Description Septic Tank Absorption Fields Trench (MN) Trench septic tank absorption fields are areas In which effluent from a septic tank Is distributed Into the soft through perforated pipe. In this system the drain field is placed In a trench and covered with soil material." The ratings are based on the soil properties that affect absorption of the effluent, construction and maintenance of the system, and public health. Saturated hydraulic conductivity (Ksat) Is evaluated from a depth of 30 to 107 centimeters. Depth to saturation and depth to bedrock are evaluated from the surface to a depth of 203 centimeters. The frequency of ponding and flooding also is evaluated. Excessive slope may cause lateral seepage and surfacing of the effluent in downslope areas. The ratings are both verbal and numerical. Rating class terms indicate the extent to which the soils are limited by all of the soil features that affect this use. "Not limited" indicates that the soil has features that are very favorable for the specified use. Good performance and very low maintenance can be expected. "Slightly limited" Indicates that the soil has features that are favorable for the specified use. "Moderately limited" indicates that the soil has features that are moderately favorable for the specified use. The limitations can be overcome or minimized by special planning, design, or Installation. Good performance and moderate maintenance can be expected. "Very limited" indicates that the soil has one or more features that are unfavorable for the specified use. The limitations generally cannot be overcome without special design or expensive installation procedures. "Extremely limited" indicates that the soil has one or more features that are very unfavorable for the specified use. The limitations generally cannot be overcome. Numerical ratings indicate the severity of individual limitations. The ratings are shown as decimal fractions ranging from 0.01 to 1.00. They indicate gradations between the point at which a soil feature has the greatest negative Impact on the use (1.00) and the point at which the soil feature is not a limitation (0.00). The components listed for each map unit in the accompanying Summary by Map Unit table In Web Soil Survey or the Aggregation Report in Soil Data Viewer are determined by the aggregation method chosen. An aggregated rating class is shown for each map unit. The components listed for each map unit are only those that have the same rating class as the one shown for the map unit. The percent composition of each component in a particular mao unit is given to help the user better understand the extent to which the rating applies to the map unit. Other components with different ratings may occur in each map unit. The ratings for alt components, regardless the aggregated rating of the map unit, can be viewed by generating the equivalent report from the Soil Reports tab In Web Soil Survey or from the Soil, Data Mart site. On5ite investigation may be needed to validate these interpretations and to confirm the identi of the soil on ,a given site. Rating Options- Septic Tank Absorption Fields:- `i'reiich (MN) Aggregation Method: Dominant Condition Component Percent Cutoff: Atone Specified Tie-break Rule: Higher E01A I Accessibility Statement I Privacy Policy I Non-Discrimination Statement i Information Quality I USA.gov i White House http://websoilsurvey.nres.usda.gov/app/WebSoilSurvey.aspx 2/20/2012 o v r+ m -0 o w C) a? _ v ra n 0` nom 0 :3 , Loll . Q. y (D •Gy n r r o °n a' a M L/1 (D LA c to 0-4 ~71 2) eD Op O O d - O - °~y O t1 m o v O uo o rb rp x X, t1 N p~ cl - - - ❑ co cam" i C 0, W A+ CL 3 0 119 -4 41 ' O O A W N Q O S O C ELI r m v a 3 ! o v (D -1 3 =r 03 rD -0 ° c a ❑ v rrt•-D m N w w z3 v' C~ N c O cn d w O N j In 7 3 .d• u o m a v o a ❑ ❑ o m o 0 (D X r* (A N (D uck C j 0 d. 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Contact Information Project ID: v 11.09.22 Property Owner/Client: Les Bordsen Address: 733 bradford lace ea an mn. 2. General Percolation inrorm-allon DiameterF in Date prepared and/or soaked: I~ Method of scratching sidewait: Is pre-soak required*? * Not required in sandy soils Soak* start time: L___j Soak* end hrs of soak time: Method to maintain 12 in of water during soak Percolation T9"t Data Test hole: #1 Location Date reading taken: Elevation: Starting time: Depth**:Ilinches Soil texture descri tion: Depth (in) Soil Texture 12 inches for mounds £r at-grades, depth of absorption area for trenches & - beds Reading Start Time End Time Start Reading End Reading Perc rate % Difference Pass (in) (in) (mpi) Last 3 Rates NA NA _ NA NA Chosen Percolation Rate for Test Hole #1 13.0 mpi Additional percolation test data may be included on attached pages Design Percolation Rate (maximum of all tests) = 13.00 ]mpi I hereby certify that 1 have completed this work in accordance with all applicable ordinances, rules and laws. (Design er (Si nature) License # Date OSTP Trench bt Bed Design UNIVERSITY Minnesota Poilurtio>n Worksheet OF MINNESOTA Control Agency 1- SYSTEM SIZING: Project ID: v 11.09.22 A. Design Flow (Design Sum. 1A): 450 GPD S. Maximum Depth*: 24 inches C. Soil Loading Rate (Design Sum. 2D): 1.20 GPD/fe *Depth to limiting condition(Design Sum. 2A) - 3 ft 3 ft separation may be reduced for Trt. Level A or B D. Required Bottom Area: Design Flow (I. A) - Loading Rate (1. C) = Initial Required Bottom Area 450 GPD _ 0.78 GPD/ftz= 577 it2 E. Select Dispersal Media : p Rock ® Other Approved Media rock A F. Select Distribution Method : pressure 13 Gravity-Drop Box 0 Gravity-Other ~ pressure G.. Select Dispersal Type : E3 Trench - Rock 13 Trench - Registered Product: Bed Rock ❑ Bed - Registered Product: 2. TRENCH CONFIGURATION: (Rock or equivalent media) A. Initial required Sidewall Bottom Design trench bottom area Absorption Area Bottom Area trench. (fe): (from 1.D (inches) Reduction Multiplier bottom area ~ Cove,- 6 to 11 0% l Distribution 12 to 17 20% 0.8 18 to 23 34% 7.66 Sidewall 24 40% 0.6 B. Select Sidewall Height: inches = ft Width C. Design Bottom Area (2.A): ft2 D. Select Trench Width: inches - F___1ft E. Total Designed Trench Length: Bottom Area (2.C) Trench Width (2.1))= Total Required Trench Length I ft2 ft = ~ft F. Select Trench Spacing : ft (typically 5 - 12 ft from center to center) G. Calculate Lawn Area: Trench Length (2.E) X Trench Spacing (2.F) = ft2 lawn area 1 -1 ft X ft = ~it2 lawn area H. Calculate Minimum length based on Contour Loading Rate: Flow(1A) : CLR (10) _ I gpd gal/ft = ~ft 1. If using rock, select Depth Required to Cover Distribution Pipe: Ift (0.33 for pressure, 0.5 for gravity) J. Calculate Rock Volume : (Sidewall Height (2.6) + Depth to Cover Pipe (2.1)) X Bottom Area (2.C) cubic feet ( ft + ft) X fe = 1ft3 Divide ft3 by 27 fe/yd3 to calculate cubic Lyards: ~ft3 + 27 = yd3 K. If using a registered product, enter the Component Length : in 12ft L. Number of Components =Total Length Required (2.E) divided by Component Length (2.K) (Round up) L= ft T = ft = =Components 3. BED CONFIGURATION: (for sites with less than 6% slope) A. Select size Multiplier: 1.Q 1.0 = pressurized or 1.5 = gravity B. Req'd Bottom Area = Bottom Area (1.1)) X Size Multiplier = 577.0 ft2 x 1.0 ft = 577 ftZ C. Select Bed Width : 12 ft Maximum width = 25 ft. (pressurized) Maximum width= 12 ft. (gravity) D. Calculate Bed Length: Designed Bottom Area (3.13) + Bed Width (3.C) = Bed Length 577 ft2 + 12.0 ft = 48.1 ft = E. If drainfield rock is being used, select sidewall absorption 8.0 inches = Q.b7 ft F. If drainfield rock Is used, calculate Media Volume (Media Depth (3.E) + depth to cover pipe) X Designed Bottom Area (3.8) = ft3 ( 0.7 ft + 0.33 ft) X 577.0 ft, 595.0 ft3 Calculate Volume in cubic yards : Media volume in cubic feet (3.F) + 27 = cubic yards 595 ft3 + 27 22 yd3 G. If using a registered product, enter the Component Length : in : 12 = ft H. If using a registered product, enter the Component Width: in : 12 = ft 1. Number of Components per Row = Bed Length (2.E) divided by Component Length (2.K) (Round up) ft : ft = components J. Number of Rows = Bed Width (2.E) divided by Component Width (2.K) (Round up) Adjust Bed Width (3.C) until this number is a whole number ft ft = r~ rows K. Total Number of Components = Number of Components per Row X Number of Rows x = components Comments: OSTP Pressure Distribution Minnesota Pollution UNIVERSITY Design Worksheet OF MINNESOTA Control Agency Project ID: v 11.09.22 1. Select Number of Perforated Laterals in system/zone: nuulaied accbox. (1 feet Is minimum and 3 feet Is maximum spacing) 2. Select Perforation Spacing 'h' perforations spaced 3' apart 2" of rock 12' 3. Select Perforation Diameter Size 7132 in _ _ 6" of rock 4. Length of Laterals Media Bed Length - 2 Feet. Perforet on =,=,no. .ry„ to Pert .c-pp spacing: 2• t34 48 - 2ft = 46 ft Perforation can not be closer then ? foot from edge. 5• Determine the Number of Perforation Spaces. Divide the Length of Laterals (Line 4) by the Perforation Spacing (Line 2) and round down to the nearest whole number. Number of Perforation Spaces = 46 ft + L T Jft _ 15 Spaces 6. Number of Perforations per Lateral is equal to 1.0 plus the Number of Perforation Spaces (Line 5). Perforations Per Lateral = 15 Spaces + 1 = 16 Perfs. Per Lateral Check table below to verify the number of perforations per lateral guarantees less than a 10% discharge variation. The value is double if the a center manifold is used. Aaximum Number of Perforations Per Lateral to Guarantee 00% Dischwje Variation In P oratsolns 7:•132 Inch Perforations Perforation Spacing (feet) Pipe Diameter (Inches) Perforation Swng Pipe Diameter (inches) I 11~ % 2 3 (Feet t ISM lit 2 3 2 10 13 18 30 60 2 11 16 21 34 68 2$~ a 12 16 28 54 2Yi 10 14 20 32 64 3 8 12 16 25 52 3 9 14 19 30 60 3/16 Inch Perforatim 1/8 Inch Perforations Pipe Diaa ter (inches) Perforation Spacing Pipe Diameter (inches) Perforat on Spacing (Feet) I 11K 11: 2 8 (Feet! i f 1; 1 A 2 3 2 12 18 26 46 87 2 21 33 44 74 149 211 12 17 24 40 80 21i 20 30 41 69 135 3 12 16 22 37 75 3 20 29 38 u4 128 7• Total Number of Perforations equals the Number of Perforations per Lateral (Line 6) multiplied by the Number of Perforated Laterals (Line 1). 16 Perf: Per Lateral X JNumber of Perf. Laterals = 64 Total Number of Perf. 8. Calculate the Square Feet per Perforation. Recommended value is 4-10 ft 2 per perforation. Perforation DtfchMV (GPM) Does not apply to At-Grades Pafforattwl Diameter stead (ftl ,!o „ '!,z Bed Area = Bed Width (ft) X Bed Length (ft) f.M 0:16 0.41 0,86 0.74 ~p 1.5 0.22 0.51 - G." 6.9 12 it X 4l3 ft = 577.2 ft2 2,Oa O.26 0.64 0.80 1.04 2.5 0,29 0.65 - 0.89 1.17 3.0 0.32 0.72 0.98 1-28 Square Foot per Perforation = Bed Area divided by the Total Number of Perforations (Line 7). 4-11 6.37 o:g3 s.o 0.41 o p3 f.z6 1 65 2 Dweitlhgs with 3116 inch to 1/4 inch 577.2 ft t 64 perforations ft2/perforations 'foot Perfwatwns 8no wkh 1/$. irchperforetions 9. Select Minimum Average Head : 1.0 ft 2 feet . Other estabishments and LASTS with 3116 ,rch to 1/4 Inch perforations 5 feet Other estabbbhments and AIM with 1/a irch 10. Select Perforation Discharge (GPM) based on Table III: 0.56 GPM per Perforation 11 • Determine required Flow Rate by multiplying the Total Number of Perforations (Line 7) by the Perforation Discharge (Line 10). tSTP Pressure Distribution Minnesota Pollution Design Worksheet, UNIVERSITY Control A Agent QFINNESOT.1 64 Perforations X A.56 GPM per Perforation 37 GPM OSTP Pressure Distribution UNIVERSITY Minnesota Control Agency Design Worksheet OF MINNESOTA'-_ 12. Select Type of Manifold Connection (End or Center): t nd Center 13. Select Lateral Diameter: 1.50 in Table If Volume of Liquid in 14. Volume of Liquid Per Foot of Distribution Piping : 0.110 Gallons/ft Pipe 15. Volume of Distribution Piping Pipe Liquid _ Diameter Per Foot _ [Number of Perforated Laterals (Line 1) X Length of Laterals (Line 4) X (inches) (Gallons) (Volume of Liquid Per Foot of Distribution Piping (Line 14)] 1 0.045 X 46 It x 0.110 1.25 0.078 gal/ft 20.3 Gallons 1.5 0.116-- 16. Minimum Dose - Volume of Distribution Piping (Line 15) X 4 2 0.170 3 0.380 E20.3 gals X 4 = 81.1 Gallons 4 0.661 manifold pipe - - Cleanouts ` I pipe from pump manifold pipe, r L-leanouts Afternate location of pipe from pump alternate location of i from m Pi from pump Comments/Special Design Considerations: OST'P Basic Pump Selection Design uN> ERSrTY Minnesota Pollution Worksheet OF MINNESOTA Control Agency 1. PUMP CAPACITY Project ID: v 11.09.22 Pumping to Gravity or Pressure Distribution: Q Cuavtty Q Presaurosu l Selection required 2 1. If pumping to gravity enter the gallon per minute of the pump: GPM (10 45 gpm) 2. If pumping to a pressurized distribution system: 37.0 GPM (Lire f f of Pressure Distribution) Sol] treatment & pant of discharge 2. HEAD REQUIREMENTS A. Elevation Difference ~ft s between pump and point of discharge: Met WPe Eleva[wn m S. Distribution Head Loss: L~J ft difFerence C. Additional Head Loss: 0 ~ft (due to special equipment, etc.) Fable (.Friction Loss in Plastic Pipe per 100ft Distribution Head Loss Gravity Distribution S Oft Flow Rate Pi Diameter (inches) (GPM) 1 1.25 1.5 2 Pressure Distribution based on Minimum Average Head 10 9.1 3.1 13 0.3 Value on Pressure Distribution Worksheet: 12 12.8 4,3 1.8 0.4 PAnimum Avera a Head Distribution Head Loss 14 17.0 5.7 2.4 0.6 1ft 5ft 16 21.8 7.3 3.0 0.7 2ft Eft 1s 9.1 3.8 0.9 5ft 1Oft 20 11.1 4.6 1.1 25 16.8 6.9 1.7 D. 1. Supply Pipe Diameter. 2.0 in 30 23.5 9.7 2.4 35 12.9 3.2 2. Supply Pipe Length: b0 it 40 16.5 4.1 E. Friction Loss in Plastic Pipe per 100ft from Table 1: 45 20.5 5.0 50 6.1 Friction Loss = 3.50 ft per 100ft of pipe 55 7.3 60 8.6 F. Determine Equivalent Pipe Length from pump discharge to soil dispersal area discharge 65 10.0 point. Estimate by adding 25% to supply pipe length for fitting loss. Supply Pipe Length; 70 11.4 (D. 2) X 1.25 = EquivalentPipe Length 75 13.0 60 ft x 1.25 = 75.0 ft 85 16.4 95 20.1 G. Calculate Supply Friction Loss by multiplying friction Loss Per 100ft (Line E) by the Equivalent Pipe Length (Line F) and divide by 100. Supply Friction Loss = 3,50 ft per 100ft x 75.0 ft 100 = 2, 6 ft H. Total Head requirement is the sum of the Elevation Difference (Line A), the Distribution Head Loss (Line B), Additional Head Loss (Line C), and the Supply Friction Loss (Line G 7.0 ft 5,0 ft ft + 2,b ft = 14.6 ft 3. PUMP SELECTION A pump must be selected to deliver at least 37 GPM (Line 1 or Line 2) with at least 15 feet of total head. Comments: OSTP Pump Tank Sizing, Dosing and Moat Minnesota Pollution and Timer Setting Design Worksheet UNIVERSITY Control Agency OF MINNESOI:A _ DETERMINE AREA AND/OR GALLONS PER INCH Project ID: v 11.04.22 1. A. , Rectangle area = Length (L) X Width (W) Width ft x ft ~W B. Circle area - 3.14x2 (3.14 X radius X radius) If Length 3.14 X 2 ft = fe C. Tank model and manufacturer: Radiu D. Get area from manufacturer t_ ft2 E. Get gallons per inch from manufacturer 21-.0 Gallons per inch 2. Calculate Gallons Per Inch: There are 7.48 gallons per cubic foot. Therefore, multiply the area from 1.A, 1.8, or 1. C by 7.48 to determine the gallons per foot the tank holds. Then divide that number by 12 to calculate the gallons per inch. (Area X 7.48 gallons/ft')/(f2 fin/ft) _ E= fe X 7.48 gat 1W + 12 in/ft = 21.0 Gallons per inch TANK CAPACITY 3. Enter the Designed Pump Tank Capacity (minimum provided in the table): 1000 Gallons 4. Calculate Total Tank Volume` A. Depth from bottom of inlet pipe to tank bottom: in B. Total Tank Volume = Depth from bottom of inlet pipe (Line 4.A) X Gallonslinch (Line 2) in X 21.0 Gallons Per inch = 1008.0 Gallons L--J 48 f 5. ` Calculate Volume to Cover Pump (The inlet of the pump must be at least 4-inches from the bottom of the pump tank & 2 inches of water covering the pump is recommended) (Pump and block height + 2 inches) X Gallons Per Inch (11) or 2) ([:=in + 2 inches) X ' 21.0 Gallons Per Inch 168 Gallons DOSING VOLUME 6. Minimum Pumpout Volume - 4 X Volume of Distribution Piping; 81.1 Gallons - Line 17 of the Pressure Distribution or Line 1 f of Non-level 7. Calculate Maximum Pumpout Volume (25% of Design Flow) Design Flow: 450` GPD X 0.25 _ 112.5 Gallons 8. Select o pumpout volume that meets both items above (Line B ft 7): 125 Gallons 9. Calculate Doses Per My = Design Flow : Dosing Volume 450, gpd 125 gat =F____3_.6 Doses Volume of Liquid in 10. Calculate Drainback: Pipe A. Diameter of Supply Pipe inches Pipe Liquid Diameter B. Length of Supply Pipe = 60 feet Per Foot C.. Volume of Liquid Per Lineal Foot of Pipe = 0.170 Gallons/ft ~1 nCi1e5~ (Gallons) D. Drainback = Length of Supply Pipe X Volume of Liquid Per Lineal Foot of Pipe 1 0.045 b0 ft X 0.170 gal/ft = 10.2 Gallons 1.25 0.078 11. Total Dosing Volume= Dosing Volume (Line 8) plus Drainback (Line 10.1)) 1.5 0.110 125 gal + 10.2 gal = 135 Gallons 2 0.170 E 12. Minimum Alarm Volume = Depth of alarm (2 or 3 inches) X'gallons per inch of tank (Line 1 or 2) 3 0.380 in X 21.00 gat/in 63.0 Gallons 4 0.661 OSTP Pump Tank Sizing, Dosing and Moat Minnesota Pollution UNIVERSITY ..and Timer Setting Design Worksheet Control Agency OF MINNESOTA TUNER or DEMAND FLOAT SETTINGS Select Timer or Demand Dosing O Tuner p DOMW Dose A. Timer Settings 13. Required Flow Rate: A. From Design (Line 11 of Pressure Distribution or Line 10 of Non-Level'): GPM "dote: This value must be B. Or calculated: GPM = Change adjusted after field .in Depth (in) x Gallons Per inch (Line 1 or 2) Time Interval in Minutes measurement & In X ~galWin+C:==min - GPM calculation. 14. Choose a-Flow Rate from Line 13.A or 13.B above. GPM 15. Calculate TIMER ON setting: Total Dosing Volume (Line f 1)IGPM(Line 14) gal ` 13Pm =Minutes ON 16. Calculate TIMER OFF setting: Minutes Per Day (1440)IDoses Per Day (Line 9) - Minutes On (Line 15) 1440 min doses/day -min = Minutes OFF t7. Pump Off Float -Measuring from bottom of tank: Distance to set Pump Off Float=Gallons to Cover Pump (Line 5) / Gallons Per Inch (Line 1 or 2): 1 gat gat/in = [Inches 18. Alarm Float - Measuring from bottom of tank: Distance to set Alarm Float = Tank Depth(4A) X 90% of Tank Depth in X 0.90 = E=in B. DEMAND DOSE FLOAT SETTINGS 18. Calculate Float Separation Distance using Dosing Volume. Total Dosing Volume (Line 12)IGalions Per Inch (Line 2) 135 gat = 21.0 gat/in =L-T4=4 Inches 19. Measuring from bottom of tank: A. (Distance to set Pump Off Float= Pump Height + Black Height (Line 5) + Alarm Depth (Line 12) 6_1 in + = in = F9 I Inches B. Distance to set Pump On Float-Distance to Set Pump-Off Float (Line 19.A) + Float Separation Distance (Line 18) L9_ J in + 6.4 in = 15 Inches C. Distance to set Alarm Float = Distance to set Pump-On Float (19.B) + Alarm Depth (2-3 inches) 15 in 3.4 in= 18 Inches FLOAT SETTINGS DEMAND DOSING TIMED DOSING Alarm Depth 18 in Alarm Depth in Pump On 155 in 63 Gal r-' Pump Off 9 in 135.2 Gal Pump Off in AF 189 Gal ISe c/ 645f J~c b r ~l0 v e r . o.. r(C U CJ ~ e- i Toe, rL~ T Y~=~ ~f - ~r u c 02,1 S f Lt / L° j e etf h)14 ~~1r 11-e , Oe,.- y JLRRY SAUOVJ~ M.01-C,A. WC. #925, #:~3 r SAUBER PLUMBING & HEATING CO. 100 THIRD STREET FARM940'PDN,I► N 56024 C NORTH Pi (851) 1.7484 SCALE HM! #483-2507 UATE DONE d> 73j3-9-_ ~rcc ~(ac c~~aAl /~j.C 4 r! J V a~ 'Ve qt too, f'j-tA. Wei' Z/d ~ 4Y r u's v ( Ln to 0 w CA 14 Pi _ I 44 tv ' 0 El I ~ C to S 1 I „ 3 I a+ Va- o IV 13 A _ _ - I T,~ R. ' ~ 1 5 ~ rd~ sa.,t~i rt t hT:TP •°~41'id 3iiltl'~S SLCZ £ V TS9 M VC:60 UTOZ/ZZ/90 LZ b1 ~ b~~9 uinLUAGia.a-j qc)q dL0:,7 L 7L 7 7, 9' r r . bW I CL r ro.L 1 ucl 1 a i. - { - JD. ID - _ N ~ 1 ea rh a OF *2 0 a r,~ ~T~ ~r "5A'TrY' H} ~ CIS CSC YVA VC:64 ztuz/zz/zu INDIVIDUAL SEWAGE SYSTEM AS -BUILT Owner: 5.61c <4521''l Project Address House Typ- $ 1 111 Property ID No.(PIN) City ► p a-, --. r Installed for? Bdrms or •al/day Commercial Use? Y rI ['New !-eplace ['Repair ['Addition Property Transfer Ugrade?�Y' Bsmt Lift Pump¥(.91 Future. Y JacuzCy/N Garb Disp? Y Soil Survey Map Unit Soil Compac6te�f�? Yep Fill Soil? Y Circle Soil Texture: (Faster than 0.1 mpi) Coarse Sand Medium Sand Loamy Sand 0.83 FINE .67 andy Loam 1.2y Loam 1.67 Silt Loam, Silt 2.00 Sandy Clay Loam 2.2 Silty Clay Loam Clay Loam Silty Clay, Clay 4.2 (Slower than 120 mpi) Date Installed /- fZPermit No 511.13c6 733--b4-D—i- r 914 -Lr www.co.dakota.mn.us) -2N /1..A thf - t 15 - S'-3 ?LI z' pi,, 8- -6, 7 6, 5-3 A ' <� Soil dry enough for construction? Y / N SETBACKS: Pro .Lines 10'11 0 Bldgs 10' to Tank & 20' to Drnfld� z -O Well(s) setback ( )not installed yet Well Depth ��c )Orig. Well Record ( )Measured Distance to Lake 7V/9 -Creek )(09-- Wetland Buried Water Pressure Lines 10' to Tank & Drnfld? System located by Photos? Y ?GPS? Y SEPTIC / HOLDING TANK(S) New ❑ Existing Liquid Capa •ty w - 2__ 1 compartment • i0 Made by p__ L Watertight? V N Baffle Type: 'lastic Fiberglass Sanitary -T Conc e No. of Inspec •n 'ipes - 4" / 6" diam. Tank Level? YY N No./Diam. Manhole Access3'ZY" Inlet / Outle / Center_ ct No. & Height of Manhole Risers New Tanks 4 ft or less below Final Grade D N Pipes into Tank Sealed? with Riser into Tank Base Sealed? with Outlet Effluent Filter? Y N Type MOUND / ATGRADE: Percent Slope % Scarification Method: Dike Width Up Down Side Clean Rock? Y / N Depth Below Pipe inches Clean Sand? Y / N Depth Upslope " Downslope " Inches to Mottling Pipe Size/Spacing Perf Size/Spacing Final Cover Depth Rock Bed Size Supplier: Sand Base Size Supplier: Upslope needing drainage/diversion? Y / N Provided? Y/ N Grading done: Rough / Final ( )Seeding ( )Sod to be done by: I hereby certify, as installer, that this individual sewage treatment system was installed according to the appro d designnand as applicable, this Municipality's Sewa.e Treatment , tem Or ance, & accurately locates all sys - componen s for later Instal r„� Sign Inspector Sign White copy:County Yellow:Owner Pink:Installer o:\emgmt\forms\walm\ists\as-built-form.doc Line drawn from Tas to Pump Truck Access < 100'(Y RESERVE AREA . rY N Fenced Off? Y N Owner informed to preserve Reserve Area? Q. N Owner given Septic System Owner Guide? Y /OR GRAVELLESS DRAIN LD: D(g� i'xesevel? Y / N Type `-'- concrete / plas, c Depth ,j,�. I k Width Z Number of Trenches Trench Bottom Level Y / N Trench Len the Spacing Rock Clear? J 2" over Pipe' (N GeoTextile Cove Depth Below Pipe? ci " Soil Backfill Depth '_ Gravelless Pipe Size? Made by Chamber Size? Made by Absorption Area: Sq Ft 5-7 7 Lineal Ft Trench Bottom to mottling / bedro ? ‘7'3 G inches PUMP TANK Made by 1 K(c;j�Capacit /d�)C� No. & & Height of Risers? V� / Sealed? N Pump Manufacturer /y, �r J Model # Z / Horsepower 7Z GPM r�� Feet of Head /S Cycles Per Day 3-7' Gallons Per Cycle (. Size of Discharge Line _ Type of Electrical Hookup -post & box by tanly Alarm L• - '•n garage asemen-r> Alar Tank Alevel Alarm / Other C cle Counter? Y N ) Water Meter? Yi N Designated Registered Professional Onsite r Z-- Pt:.9—/`3- 74 Address Name /bo -3(051 PCA Lic. NX17 Company Date: /! 'Approved: No // es) Yes with Conditions: Use BLUE or BLACK Ink I For Office Use ; Permit J C j Ila City of EaRd I Permit Fee: 3830 Pilot Knob Road I I Eagan MN 55122 Date Received: I I Phone: (651) 675-5675 RECEIVED I I I Staff: I Fax: (651) 675-5694 MAY 0 3 2012 2012 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: Unit M y 1~ Name: Phone: RESIDENT / OWNER Address / City / Zip: Applicant is: Owner Contractor TYPE OF WORK Description of work: kk2La2`k_ " Dg.rnvyy~q t +ZF_ Construction Cost: -70 CCe) Multi-Family Building: (Yes / No Company: `JL i ° 2 2 ,,vr►,~ Contact: S CONTRACTOR Address: Sr"i~ry~• City: State: Zip: Phone: 6;~ i 7- ` 3 6 6; - `i 2'7 5 License A) A Lead Certificate M A- If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? _Yes _No If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer & Water Contractor: Phone: NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that the are trade secrets. CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. Exterior work authorized by a building permit issued in accordance with the Minnesota Stat Building Code must be completed within 180 days of permit issuance. Applicant's Printed Name App ant's Signature Page 1 of 3 DO NOT WRITE BELOW THIS LINE A), 1 3 ' SUB TYPES - S3 &-4,4 f v,cj e L Foundation _ Fireplace _ Porch (3-Season) _ Storm Damage Single Family _ Garage Porch (4-Season) Exterior Alteration (Single Family) Multi Deck _ Porch (Screen/Gazebo/Pergola) _ Exterior Alteration (Multi) _ 01 of Plex _ Lower Level Pool Miscellaneous Accessory Building WORK TYPES E 174V Ws lVn4T~r _ New Interior Improvement _ Siding _ Demolish Building* _ Addition _ Move Building Reroof Demolish Interior Alteration _ Fire Repair _ Windows Demolish Foundation Replace _ Repair _ Egress Window Water Damage Retaining Wall *Demolition of entire building - give PCA handout to applicant DESCRIPTION p Valuation ® / Occupancy MCES System Plan Review Code Edition hj 'Z 7 SAC Units (25%-100%) Zoning_ City Water Census Code Stories Booster Pump # of Units Square Feet PRV # of Buildings Length Fire Sprinklers Type of Construction Width REQUIRED INSPECTIONS Footings (New Building) Meter Size: Footings (Deck) Final / C.O. Required Footings (Addition) Final / No C.O. Required Foundation HVAC - Gas Service Test Gas Line Air Test Drain Tile Other: Roof: Ice & Water Final Pool: -Footings Air/Gas Tests Final ~t Framing Siding: -Stucco Lath -Stone Lath -Brick Fireplace: -Rough In -Air Test -Final Windows ~G Insulation Retaining Wall: - Footings Backfill - Final Sheathing Radon Control Sheetrock Erosion Control Reviewed By: TL , Building Inspector RESIDENTIAL FEES Base Fee Surcharge Plan Review ✓S'C. MCES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant Copies ` TOTAL / Page 2 of 3 A~j 1,10 'JA j 'All N S RS , N N e rx V 11O7, s~ d1 ~ N a c-~ jL~f ~Q N go. a_ ~ ...•`lt r Use BLUE or BLACK Ink r I For Office Use I Permit#: A-0 / I City of Eap I o b I Permit Fee: IQiJ_ 3830 Pilot Knob Road Eagan MN 55122 _ I Date Receive ~ Phone: (651) 675-5675 RE"C"L' "VED I I Fax: (651) 675-5694 MAY 3 0 2012 L Staff: - - - i 2012 RESIDENTIAL PLUMBING PERMIT APPLICATION C Date: 5/30/12, Site Address: 7.33 6A CA_ Tenant: Suite M RESIDENT I OWNER Name: l£S 900U I Phone: 411 i2 3(06 275' Address/ City/ Zip: 733 32AIDE2kA p 1 LAct- EA6 4N AYA) -S$-,Z-r Name: 6AM_ 6(AjtUt4. License CONTRACTOR Address: City: State: Zip: Phone: Contact: Email TYPE OF WORK ~ew _ Replacement - Repair _ Rebuild - Modify Space - Work in R.O.W. Description of work: /-DV 01-A ~2. l+AGDM t!V /Vgw ft>1776A_) / J RESIDENTIAL Water Heater Water Softener PERMIT TYPE Lawn Irrigation RPZ PVB) Septic System Add Plumbing Fixtures Main Lower Level) New Water Turnaround Abandonment RESIDENTIAL FEES: $60.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge) $60.00 Lawn Irrigation (includes $5.00 State Surcharge) $60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge) *Water Turnaround (add $189.00 if a 5/8" meter is required) $105.00 Septic System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge) TOTAL FEES $ CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.ciopherstateonecall.org I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval f plans Applicant's Printed Name / icant's Signature FOR OFFICE USE Reviewed By: 11&k sell'-ce- Date: 6l E~ Required Inspections: Under Ground ✓ Rough-In Air Test Gas Test t- Final Use BLUE or BLACK Ink r For Office Use City Permit EaV 0 ~ I P ermit Fee: I 3830 Pilot Knob Road (9~f3'(21 Eagan MN 55122 Date Received: i Phone: (651) 675-5675 _ I ✓I~ Fax: (651) 675-5694 I Staff: -----------------I 2012 MECHANICAL PERMIT APPLICATION Date: Site Address: 733 324049-0 ~'L Tenant: Suite RESIDENT / OWNER Name: Z- j ~A05; ~,u Phone: ~O/2 - ~(oCo- ~l Z7 S Address / City ! Zip: 733 r6/ZFYp Name: ~RM~ Y0 License CONTRACTOR Address: City: State: Zip: Phone: Contact: Email: New Replacement Additional Alteration Demolition TYPE OF WORK Description of work: C~iu~ (>jU NOTE: Roof mounted and ground mounted mechanical equipment is required to be screened by City Code. Please contact the Mechanical Inspector for information on permitted screening methods. RESIDENTIAL COMMERCIAL Furnace New Construction Interior Improvement PERMIT TYPE Air Conditioner Install Piping Processed Air Exchanger Gas Exterior HVAC Unit Heat Pump _ Under / Above ground Tank(_ Install / -Remove) Other RESIDENTIAL FEES: $60.00 Minimum Add-on or alteration to an existing unit (includes $5.00 State Surcharge) $100.00 Fire repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge) = $ TOTAL FEE COMMERCIAL FEES: $75.00 Underground tank installation/removal (includes $5.00 State Surcharge) OR Contract Value $ x1% $60.00 Minimum (includes State Surcharge) _ $ Permit Fee - If the Permit Fee is less than $10,010, surcharge is $ 5.00 - If the Permit Fee is > $10,010, surcharge increases by $.50 for each $1,000 Permit Fee - $ Surcharge (i.e. a $10,010-$11,010 Permit Fee requires a$ 5.50 surcharge) TOTAL FEE CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. x &1- 5 ?-A::~> r2 o 51ey, x Applicant's Printed Name App ' nt's Signature FOR OFFICE USE Required Inspections: Reviewed By: Date: Underground Rough In Air Test Gas Service Test In-floor Heat Final HVAC Screening Abb. 41T' City of Ea�all 3830 Pilot Knob Road Eagan MN 55122 wifLffie w�If. c7L r4 T Fax: (651) 675-5694 Use BLUE or BLACK Ink For Office Use Permit #: b/J 16 Permit Fee: QOM Date Received: 2 - i 3-13 Staff: 2013 RESIDENTIAL PLUMBING PERMIT APPLICATION tiQIAA Date: €, /2— /3Site Address: 23 ` — �/a cC 1 /4C p '1/4:5 Tenant: Suite #: Name: L.5 4ii Phone: e---4/2 — 3 t r2 % 5— Name: J�ic � Al64 _ License #: rr C Address: /e)o State: //i,.: Zip: 50"--5-0- Z V Contact: City: 7,,"//tl //e1.- Phone: G5/ f‘3- % 737 Email: f/ New _ Replacement _ Repair Rebuild _ Modify Space _ Work in R.O.W. Description of work: 01\4 b« Vin RESIDENTIAL Water Heater Lawn irrigation (_ RPZ / PVB) Septic System New Abandonment Water Softener Add Plumbing Fixtures ( Main / _ Lower Level) Water Turnaround 1 RESIDENTIAL FEES: $60.00 Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge) $60.00 Lawn Irrigation (includes $5.00 minimum State Surcharge) $60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge) *Water Turnaround (add $200.00 if a 5/8" meter is required) $105.00 Septic System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge) TOTAL FEES $ CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.orq I hereby acknowledge that this information is cemptctc and accurate; that the work will be in > er ancc with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to st ithout a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. x Applic.. s ignature FOR OFFICE t. Required Inspec D gh-I