4225 Lexington Way?Csf? I
C O
,? U N ?
ENVIRONMENTAL MANAGEMENT DEPARTMENT ?
GROUNDWATER PROTEC710N SECTION
14955 Gaiaxie Avenue • Apple Valley, MN 55124
952.891.7557 • Fax 952.897.7588 • www.co.dakota.mn.us
MUNICIPAL NOTICE OF WELL SEALING PERMIT APPLICATION
DATE: July 29, 2004
TO: Tom Colbert/Wayne Schwanz (EM)
RE: Well Permit #: 04-1-1225138
Municipality: Eagan
Fax#: (651) 675-5694
Well Type: Domestic
Environmental Specialist: Rutten
The Water and Land Management Section of the Dakota County Environmental Management Department has
received the following permit application for the well described, lf you require further review of the application or
if you liave any questions or concerns about it, contact the Emironmental Specialist listed above or our office at
(952) 891-7011. If there is no response from your office within 24 HOURS (excluding weekends and hoiidays), we
will assume that you have no objections to the issuance of the permit. Please note that permit issuance is always
conditioned on the permit applicanYs observance of and compliance with all applicable state, county, and municipal
laws and codes.
Well Contractor:
Date Application Received:
Anticipated Drilling Date:
Anticipated Grouting Date:
Property Owner:
Well Owner:
WELL LOCATION:
Don Stodola Well Drilling Co.
7/28/2004
Time:
Time:
Veit & Company
Veit & Company
PLS Coordinates: _ NW 1/4, NE 1/4, NE 1/4, Sec 27 Town 027 Range 23
Street Address: 4225 Lexington AVE S >•
:
PIN Number: 100270001201
WELL INFORMATION:
Diameter: 4
Casing Depth: 121
Total Depth: 125
Static Water Level:
Aquifer:
COMMENTS:
Fjie Edik Wiew Taols ,gpplications Nelp
?+i P R K Y \ f
..d:i
Connection ? Commerrts I
Eagan Building I Eagan Developmsnt ? Farmits
Owrrer I Eagan Assessl5eles I Eagan Proper#y I Eegan
ParcellD 1Q027QQ01201
Addrsss 4225 LEXINGTON 4VAY
Owner 1
C)wnsr 2
Owner 3
Owner 4
Search PID 100270001201 I Search Mouse ? 146
M1LLEH1ALLE lNC ? ry
1556 MURPHY PiCWY "
EAGAN MN 55122 ?.
b S'6?jLq
2004 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.
?J ? ?
S
Date ? / 3 ? ! ol
Site Street Address Unit #
PropertyOwner ? I ?uv11 ?? ??, q M. 11v Telephone #(4?1 ?-7a3 - 713 "1
Contractor _ Vc: Telephone # (76 1 ) yaK - ;0 yz
Address Iyooo 1/c:? Pi"c City??J State M6? Zip Ss37
The Applicant is: _ Owner Contractor _Other
Alterations to existing dwelling
_Add fixtures to rooms, excluding water softener and water heater
XSeptic System Abandonment
_ Water Turnaround (add $121.00 if a 5!8" meter is required)
Other: $ 50.00
Water Softener Water Heater
_ replacement _ additionai $ 15.00
Lawn Irrigation System RPZ_ new _ repair _rebuild $ 30.00
State Surcharge $ .50
Total $ 5a. Sa
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 accordance with the approved plan in
the event a plan is required to be reviewed and approved.
-- :51f o.. Muc 1 j» Z?2?
ApplicanYs Printed Name Ap i anYs Signature
? s6;?3
-7s s 19
2004 RESIDENTIAL BUILDING PERMIT APPLICATIOPT
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone 9 651-675-5675 FAX # 651-675-5694
New Conslrudion Renuirements RemodeUReoair Reoulremenls Office Use Onlv
3 registered site surveys showmg sq. fl. of lot, sq. ft, of hause; end aU mofed areas 2 wpies ot plan Ceri of Survey Recd Y _ N
(20°k maximum lot coverage allowed) 1 set of Energy Calculations for heatetl additions Tree Pres Plan Recd _Y _ N
2 Copies of plan showing beam & window s¢es; poured found design, etc. 7 site survey toradditions & decks Tree Pres Required _Y _ N
lselofEnergyCalalations AddiBon-indicatei(an-sitesepficsystem On-siteSepticSystem _Y _N
3 copies of Tree Preservatlon Plan'rflot platted after7/1193
Rim Joist Detail Options seledion sheat (bldgs with 3 or less units
nace 7t i 3 o r
o`f lM+lil.' e -
tratthM cost 13,? a oo. o 0
SiteAddress YRa15 L.tx' .ivn L.1t Unit/Ste #
DescriptiooofWork RtJ.de...4 ..( UausG
Multi-Family Bldg _ Yk N Fireplace(s) _ 0 _ 1 _ 2
PropertyOwner Ka-. M: lt'r v?j 1, ?.{.nr. Telephone#(61? ) 7.2,3 -713'7
Contractor VG'? 4- C? _-i c ,
Address 1,4400 ?
Ve:k Plqi, CiTy f2ojers ?;,?a%4
State /N hl Zip Ss3 ? y Telephone #(763 ) y-77•0!?
COMPLETE THIS AREA ONLY IF
Energy Code Category - Minnesota Rules 7670 Cateeorv 1
• Residential Ventilation Category 1 Worksheet
(J su6mission type) Submitted
• Energy Envelope Calculations Submitted
A NEW BUILDING
Minnesota Rules 7672
. New Energy Code Worksheet
Submitted
Have you previously constructed a building in Eagan with a similar plan2 _ Y
fee applies.
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone # (
Telephone # (
Telephone #(
N If so, 25% plan review
I hereby apply for a Residential Building 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 State of MN
Statutes; 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.
7saso.. Muellcr
Applicant's Printed Name
A ' ant's Signature
QFFICE USE ONLY
Sub Types
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bidg
? 02 SF Dwelling ? OS 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 OS-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc,
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Pibg_v or_ N ? 25 Miscellaneous
Work Types
? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 32 Addition ? 36 Move Building ? 42 Demolish Fountlation ? 45 Fire Repair
? 33 Alteration ? 37 pemolish Building* ? 43 Reroof ? 46 Windows/Doors
M 34 Replacement `Demolition (Entire Bldg) - Give PCA handout to applicant
0 1 3 aa
Valuation
?`?? Occupancy MCES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED I NSPECTIONS
_ Footings(new bldg) FinaUC.O.
_ Fooangs(deck) FinaUNo C.O.
_ Footings (addition) _ Plumbing
_ Founda6ion HVAC
_ Drain Tile Other
Roof - Ice & Water _ Final Pool
Ftgs
Air/Gas Tests Final
_ Framing _ _
_
Siding
Stucco
Stone
Brick
_ Fireplace _ R.I. _ Air Tes[ _ _
Final _
_
_
Windows
_ Insulation _ Retaining Wall
Approved By: , Bu ilding Inspectar
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
EI . `
, CUPLA-MANMa 74000 Veit Place • Rpgers, MN 55374 • Phone 763.428.2242 • Fax 763.428.8348 • www.veltcompanies.com
9.CI'.19]X
Earthwork
Demvtitian
UnAerground
Uiiiities
Environmental
i0untletlon
Systems
Induzviai
Sarvlces
amrme5re acnon
Eq-1 oavawniM
bnpieyer
?
VEIT & COMPANX9 INC.
Date: Wednesday, August 18, 2004
Total Pages Including Cover Page: 2
To: Craig Novaczyk - Ciry of Eagan
Fax Number: 651-675-5694
From: Jason Muelker- Veit & Company, Inc.
' .?., f.i' • .
,.r., .?. ?
Notes/Comments:
Re: SeptiC Tank Abandonment @ 4225 Lexington Way, Eagan, MN
The fpllowing is a copy of the septic pumping service report by Boss Pumping.
Three septic tanks existed on the site. Two were pumped and one was dry.
All tanks were removed by Veit and ihe holes were backFilled. The concrete tanks
were hauled to Vonco II LLG Landfill in Becker MN.
Please call me if you have any quesrions or if you require any additional
information.
Thanks,
Jason Muelfer
763-428-6743
Confltlentialily NoGce: Tha CCam0ntl51 accornPanYoS thps fax co^oIns renfidenttal infomolan. "fhe informanon is onty for the
ue6 Of tl79 Irtten6atl reclpreM nametl ehovC, N you are not the "sdenOeC reciDienC, you are hemby nvtlfl2d thet arry dixlosure.
oopying, disMbution, er the laking of any action m rtlience on tlhe mntents of the IBieMPied IMOrtna[ion excea[ 115 tlMect tlefvery
to tha intended reaDierR named is strfetly prohibited. H you have recenred lhm fax in ertor, pl9ase no5{y us immediateVy hY
tN9phane ta artange for retum M the Ori9inal Aocuments te M.
"Best Servicp in rhe eusiness"
VdE-d Z00/100 d Y10-1 BYEB BZY E9! gB!uEaWOo 11an-008i El:ll YOOZ-9fIY-Bl
87Z88zb29L
Name: t I f?.
Address: ?
c;ty:
Zip:
Phone: (_ )
or BiII To: -
State:
. ,.i [1
Day ?
Nigttt
Wnrk Deccrintinn
P.O. Box 534
Forest Lake, MN 55025
Offtce (651) 466A800
Dffice (763) 434-6744
Fax (651) 982-1357
7[nvoice #: _ D `f js I_
Date: -- Ed-,! G? 4- 5'`
Purchase //p i // Q J') ?
Qrder #: /1( ? ?7 U?7
Type of Service
Xtesideetial ?
Commercial m
Time En:JW-Time put .
Residential Commercial
OY 1 Tauk +?J # of Gallons: Flammable Trap/s: ?
nt1 2 Tanks ? # of Galloas: Sand Trap: ?
? ? Lift Sfation ? # of Callans:
y Sand Pitls or Trench: ?
o,'PLJi,Gallons
x4w G ?e Trsp: ?
?
Dump Site: ?j,J /3-?-. Flolding?aok/s: ? -
WasteType: DomesticlDPhde/Holding LittSration: []
OTHER:
Method af Removat
Total # otGallons:
Dump SFte:
- CleanadthroughManhole [] Waste'Cype: Camrn/1ndsL/Aom/Dilure/?folding
Pumped through Vent Pipc ?
Partioa of Cover lZemavM ? •,Ul aoiid wastc dispoup eneMods arc spproved by
i,
M.C.E.S. aadlor M.P.C.A.
Condition o4 Baft7es: GOOD ? Otder ? ?`ype of Ssrvice
Evideace o[ Urainage Problems: Xes ? No ? Regulsr Maintena , Yes 0 No 0
CommenLt: Urgent/Emergeecy: Yes ? lvo CJ
Commeats:
a
Pumping g . . ?
FaymentMethods
Permit
Cash: ? Check: ?
(# }
Miscellaneous
Sand / Dump $illin 0[ptUCrC48l O` IyIA '
TOTAL DUE , Te s: Net 30 Days '
I
?
Thank You for chaosing $OSS Pumping. We appreciate your business. e abo described work
will be / has been completed properly based on the xn£ormation and descriprions givezt. We are
eommitted to "doing the job night", the first time, every time.
Service Accepted By: _
YZE-d i00/200 d Y10-1
8YE8 BdY 891
? Date: _
saiuedwoO 3iBAiYOtll
£ V l l 900d-90tl-B l