904 Lakewood Hills Rd NCITY OF EAGAN Remarks
Addition Lakewood Hills Lot 19 sik 1 Parcel 10 44350 190 00 „xj?g.
owner?6- street `946" No. Lakewood H311s Rd'state Eagan, MN 55123
tmprovement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK
SEWER LATERAL
WATERMAIN -
WATER LATERAL
WATER AREA
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER.
sac $375.00 9187 10-11-73
PARK
c= c^ EAcaN
3?"i Pi.7.ot Knob Foad
EaG-M, N;inr.Leaota 55122
T?.e City oi Eagan herehy grs.n ts to
rGo ?
PEPlilIT IVTO.:____ {q_
of 1001 !larie Ave. 30. , 30. St. Paul. P4Q 55072
J. Haxaann, X. stroaky, J. Dacaqar, C. Irish,
=_ iTZ" PMR _ Permitsfor: (Owner) p, Gaueman. B. MOrcan, lnd M. Her ?
4270 Stir-='r. 7223rL +?^---, • e?i er.? . ? ui ?».• --??=?s?a od ?
?- ? rt to applic ation da ced 5/5%16 _
Fce P^._j.da _---$35.00 dzted this ?.. 25 day of Play ?. ??_ 76,.i
3,50 sJc ?
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Ferr°its:
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3830 PILOT KNOB ROAD, P.O. BOX 21199
EAGAN, MINNESOTA 55121
PHONE: (612) 454-8100
April 28, 1987
MR. LARRY GliTHRIE
904 LAKEWOOD HILLS DR
EAGAN, MN 55123
TO WHOM IT MAY CONCERN:
8EA BLOM9UIST
Mayor
THOMPS EGAN
JAMES A. SMRH
VIC ELLiSON
7HEODORE WACHTER
Coundl Members
THOMAS HEDGES
CNy Adminishator
EUGENE VAN OVERBEKE
aN awk
The original building permit for construction of the above referenced property
was issued October 11, 1983. Construction of this residence began with a
footing inspection on November 14, 1973 and continued inspections of the home
and private disposal system were made through February 1984. At that time,
this re.sidence was constructed according to City and State building codes.
Sincerely,
Doug Reid /L-?--i t?-
?
Chief Building Official
DR/is
THE LONE OAK TREE. ..THE SYMBOL OF STRENGTH AND GROWTH IN OUR COMMUNIN
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2005 RESIDENTIAL PLUMBING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please complete for modifications to existing residential dwellings.
*100.5o
Date1/ ! //-/ I G S }J.
site street Address . i9?°?%? ?y Unit # 14
Z
Property Owner /7 Telephone # ( ,?d4?5
Contractor Telephone # (21v ) NIa'.X19
Address Gz7 11 :wll 4g74 , N-uJ City 1VALV•zV1 State %d4 Zip !56464
The Applicant is: -z?, Owner _ Contractor _Other
Alterations to existing dwelling $ 50.00
_ Add plumbing fixtures. This fee includes putting in a water softener and/or water
heater at the same time. !f You are installinp only a water softener and/or water
heater, do not complete this section. Move to the next section and check-th-e
appliance(s) you are installing. ?.7',
i;
,
_Septic System Abandonment
_WaterTurnaround (add $125.00 if a 5/8" meter is required
-
Other:
-?
R 30-:4-c? 10105
Water Softener Water Heater $ 15.00
_ new _ replacement
Lawn Irrigation _RPZ _PVB _new _repair _rebuild $ 30.00
State Surcharge $ •50
Total $?
I hereby apply for a Residential Plumbing Permit and acknowledge that the information is complete
and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan and the plumbing codes; that I understand this is not a permit, but only an application for a
permit, work is not to start without a permit and work will be in accor d the approved plan in
?
the eve?,is r?i?e be reviewed and 2bk
?' /IV a
Applicant's Printed Name re
Qov
, ° - CASS COUNTY ENVIRONMENTAL SERVICES
` TRENCH DESIGN SHEET
APPLICANT NA t U h? - TOWNSHIP FIRE#_
?' p ? Lct -tJ?oe
PERMIT# m' DATE
DESIGNER NA E Z;E 6?zif S-ZA CERTIFICATION # 12100
SIGNATURE: let? DATE: Im - 1'l- D 5 SITE EVALUATION #
WATER USE APPLIANCES (CHECK ALL THAT APPLY)
CLOTHES WASHER_ WATER SOFTf?ER_ DISHWASHER_ WHIRLPOOL_ HUMIDIFIER_
/
NUMBER OF BEDROOMS 3 TYPE: I?II_ GARBAGE DISPOSAL:YES_NOK AIR TEST: YES_ NO_
WELL: DEEP (50'+)Zt SHALLOW _ SETBACKS: TANK DRAINFIELD SEWER LINE
FLOW
A. ESTIMATED A-S-b GPD OR MEASURED GPD
B.SEPTIC TANK VOLUME 164C -EauS i ,/JfOGALLONS
C. PUMP TANK VOLUME GALLONS
SOILS
D. DEPTH TO RESTRICTING LAYER S?-fFEET
E. MAXIMUM SYSTEM DEPTH (D-3) 2 FT OR ELEV.
F. PERCOLATION RATE MPI
G. SOIL SIZING FACTOR 1,tcj SQ FT/GPD
TRENCH BOTTOM AREA
H. 6 IN. OF ROCK OR GRAVELLESS:A x G= x= SQ.FT.
1. 12 IN. OF ROCK: A xG x 0.8= x = SQ.FT
J. 18 IN. OF ROCK: A x G x 0.66= x = SQ.FT
K. 24 IN. OF ROCK: A x G x 0.6 ?x. (p =45 i_SQ.FT
BED BOTTOM AREA (6 OR 12 INCHES OF ROCK)
L. SEEPAGE BEDS: 1.5 x A x G= 1.5 x x = SQ. FT.
M. PRESSURE BEDS: A x G= x = SQ. FT.
ROCK VOLUME IN CU FT
7 CU FT.
N. ROCK DEPTH 2+0.5FT.x(H,I,J,K)45= lll
ROCK VOLUME IN CU YDS ROCK WEIGHT
O. N. Il2'7 =27= A-2 CU YDS P.O.x1.4=5$-?L TONS
SYSTEM LENGTH
Q. BOTTOM AREA (H-K) AS-L = TRENCH WIDTH?_= I? LINEAL FT
LAWN AREA
R. SELECT TRENCH SPACING, CENTER TO CENTER= ? FT.
S. MULTIPLY TRENCH SPACING BY LINEAL FEET R_?_xQ lL,& _1152> SQ FT OF LAWN AREA
ESD APPROVAL:
TE:
COMMENTS:
CHECK OFF LIST--HAVE ALL OF THE FaLLOWING BEEN DRAWN ON THE MAP??
SHOW EXISTING OR PROPOSED--? WATEK WELLS WITHIN 100 FT OF TREATMENT AREAS ? PRESSURE WATER LINES
WITHIN 10 FT OF TREATMENT AREAS ? STRUCTURES ? LOT IMPROVEMEf,JTS ? ALL SOIL TREATMENT AREAS
REQUIRED SET BACKS-? STRUCTURES ? PROPERTY LINES ? OHWL
? HORIZONTAL AND VERTICAL REFERENCE ? POINT OF SOIL BORINGS ? DIRECTION OF SLOPE
? LOT EASEMENTS ? ALL LOT DIMENSIONS ? DISTUR2ED/ COMPACTED AREAS
? ACCESS ROUTE FOR TANK MAINTEN NCE ? SITE PROTECTION-LFTHE AND R16BION E'?JERY 15 FT
COMMENTS: I? ? :
DESIGNER SIGNATURE: .44r'1 DATE 1-^)I-D S
LICENSE # ? Z&
FIELD EVALUATION SHEET
Preliminary Evaluation Date _ 10-05-05 Field Evaluation Date 10-05-05
Property Owner S7EVE pNp DEBBY NEINE Phor?e X
Address X Clty, Stdte, Zip X
Legal Desc x
PIN # X Sec X Twp X Rng X, Township X
Fire # Lake/River_ Lake Ciass ,_ OiWI _ ft
Description of Saii Treatment
Area #1 Area # 2 Reference BM fit
Disturbed Areas Yes No X Yes _ No N Reference BM Description
Compacted Areas Yes No X Yes _ No X
Flooding Yes No X Yes _ No XX
Run on Potential Yes No N Yes _ No X
S10pe % 4 4
Direcdon of Slope N TQ,S N TO S
Landscape Pqsition OPEN OPEN
Vegetation Types ?w ED5 WEDS
Depth (ft) to Standing w0ter ar mottied soii--Boring ,11 5+ 3A) SxA 21 5+ ZA) 2xA
Bottom elevation- first trench or bottom of rock bed i) 3' R 21 3' ft
Sail sizing factor i] 1.67 2) 1.67
Construction Related Tssues
Site Evaluator license #
Evaluator Signature Telephone
System approved by
Lug Review Date
Comment
Soil Boring Logs on Reverse Side
This form prodaced by Septlc System DesFqner, copyright 2000 - 2002 MC SoRware
Stephen Heine
904 Lakewood Hills Rd.
Eagan, Mn. 55123-1912
- SOIL BORINGS FOR BOTH PROPOSED AND ALTERNATE SITES
? 1(BROP03M) 30IL3 DATA 2(PROPQSED) SOTL9 DATA
. D8PTH TEXTURE MANSELL AEPTH TEXTURE MUNSEI,L
(INCHES) COLOR (INCHES) COLOR
0-10 TaPSOIL lOYR 2/2 0-12 TOPSOIL lOYR 2f2
11-30 I,pAM 10YR 5/4 13-32 IAAM IOYR 5/6
31-60 SANDY I,OAM IOYR 6/6 33-60 SANDY LOAM IOYR 6/e
1(ALTERl3ATE) SOILS DATA 2{AT,T&RNA'1'ffi) SOILS AATA
DEPTH TEXTURE MUNSELL DEPTH TEXTURE MIJNSELI,
(INCHES) COLOR (INCHES) COLOR
0-14 TOPSCII, IOYR 2/2 0-11 TOPSOTL lOYR 2/2
15-33 LUAM IOYR 5/4 12-31 I+OADi lOYR 5/8
_...T-.
34-60 SANDY LOAM IOYR 6/6 13-60 SANDY LdAM IOYR 6/8
ADDITIONAL SdIL BORINGS MAY BE REQUSRED
This form produced from Septic System Designer, Copyright 2000-2002 MC
Software
JOB #
.PEKC6LA • DA
Company Name_[,? License Number_!
Percolation Test Performed by?-QJX?6 GJ1 ll???? __ ___
?Atl
Homeowner Name__
Address 904- ?l?`?cl.±.???J__ t/lC.CJS UAwL---?A!?
,?
Test Hole Diameter of hole _ _inches
Location
Method of scratching sidewall
Depth at bottom of hole ? _inches Depth of gravel at bpttom inches
Date presoak started Starting atG]' AM ! PM
Depth of initial water filling `24 above hole bottom
Method used to maintain 12" of water depth in hole for 4 hours t?
?°
Date presoak ended i__ Ending at ?? __AM /6m
v?
Date perc readings conducted ?_ Starting at J_? _AM /-
r
Maximum depth a6ove hole bottom during test _ 2 inches
Surface elevation (in reference to benchmark):
Directions: Enter elapsed time and drop in waterlevel and the rest will be calculafed
* 3 consecutive percolation rates must be within 10% or less of each other
I hereby certify that I have completed this work in accordance with all applicable ordinances, rules and laws
(date)
(signature) _________(license -
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA153761
Date Issued:01/22/2019
Permit Category:ePermit
Site Address: 904 Lakewood Hills Rd N
Lot:19 Block: 0 Addition: Lakewood Hills
PID:10-44350-00-190
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener).
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
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 -
Matthew Gmach
904 Lakewood Hills Rd N
Eagan MN 55123
(612) 834-0681
Champion Plumbing
3670 Dodd Rd., #100
Eagan MN 55123
(651) 365-1340
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA161375
Date Issued:05/20/2020
Permit Category:ePermit
Site Address: 904 Lakewood Hills Rd N
Lot:19 Block: 0 Addition: Lakewood Hills
PID:10-44350-00-190
Use:
Description:
Sub Type:Fireplace
Work Type:Gas Fireplace (new)
Description:
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home may require smoke detectors in all bedrooms. Chimney / flue must be inspected prior to
concealing.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Valuation: 3,000.00
Fee Summary:BL - Base Fee $3K $88.50 0801.4085
Surcharge - Based on Valuation $3K $1.50 9001.2195
$90.00 Total:
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 -
Matthew Gmach
904 Lakewood Hills Rd N
Eagan MN 55123
(952) 513-7706
Glowing Hearth And Home Llc
100 Eldorado Dr.
Jordan MN 55352
(952) 492-9276
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA178744
Date Issued:08/31/2022
Permit Category:ePermit
Site Address: 904 Lakewood Hills Rd N
Lot:19 Block: 0 Addition: Lakewood Hills
PID:10-44350-00-190
Use:
Description:
Sub Type:Fireplace
Work Type:Gas Fireplace (new)
Description:
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home may require smoke detectors in all bedrooms. Chimney / flue must be inspected prior to
concealing.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Valuation: 3,000.00
Fee Summary:BL - Base Fee $3K $88.50 0801.4085
Surcharge - Based on Valuation $3K $1.50 9001.2195
$90.00 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 -
Matthew & Jessica L Gmach
904 Lakewood Hills Rd
Eagan MN 55123
Glowing Hearth And Home Llc
100 Eldorado Dr.
Jordan MN 55352
(952) 492-9276
Applicant/Permitee: Signature Issued By: Signature