HomeMy WebLinkAbout1992 - 004517 - water softner PERMIT
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PERMIT TYPE:
TY OF ORONO
1335 Brown Rd. South • P.O. Box 66 pi t)� IrH�
Permit Number: 0 4.._
Crystal Bay, Minnesota 55323 Date Issued: 07/24/92
(612) 473-7357
SITE ADDRESS:
4760 WEST BRANCH RD
CH
P. 1 . N. : 06-117-23-33-0002
DESCRIPTION:
1 FIXTURE
Plurrtbling Permit Type FIXTURE'S
PlumbingWorkType REPLACE EXISTING
1 WATER SOFTNER
•
;ITV OF ORONO
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sREMARKS:
CITY
V. v1VL .50
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FEE SUMMARY: 50
"i " I.00
Ease Fee $30. 00 MAIL I N
--Ely t� 07,124/9,
Surcharge
las° Total Fee $:3'2.00
Subtotal30.Ss:r
I -n- _
CONTRACTOR: Appz c tt. OWNER:
CULL I GAN ':9337200 BART I G PETER
60 0 E:t_tLL I GAN WAY 4760WEST BRANCH RD
M I NNET�iNKA MN 55345 ORONO
i_ENi j MN 55364
i.F.1 .� 933-7200
472-4236
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
CITY OF ORONO APPLICATION FOR PLUMBING PERMIT
Box 66 (1335 So Brown Rd)
- Crystal Bay, MN 55323
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General InstructionsIj�
1. You may apply for plumbing permits by mail or in person at the City offices J
2. Mailed in applications are subject to the postage and handling fees shown below.
Permit cards will be sent by return mail the same day the application is received.
3. Permits are not valid until you receive a permit card.
4. Work must not begin unless the permit card is available on the job site.
5. Plumbing permits may be issued to licensed contractors only.
ail �y
6. When any new construction or remodeling is involved, a separate IJLii-ld g�permit must
be obtained.
7. All work must be done in accordance with State Code requirements.
8. All work must be inspected before it is covered. Call 473-7357.
24 hour notice required.
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JOB SITE ADDRESS: 147(p) (-J s( &d n[, ) k'4
Occupancy Type: ? Residential Commercial
OWNER'S NAME: Pe.-i-e( (6Or-4-)c Phone No. : 474- '43�c
Mailing Address: 4-7(00 u) branr to (2d City: Y11&ure./
CONTRACTOR'S NAME: Cakl�✓� Bus. No. : -13 �7a--C11)
Mailing Address: Li)p30 CLULLAcirLin IOU.( City: r 1c&_- Zip:
Master Plumber's State License Nb. : City Cert. No. :
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PLUMBING FIXTURE SCHEDULE
(Show number of fixtures of each type on each floor)
FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER
Water Closet [- Sewer Ejector
Lavatory Laundry Tray
Bathtub Washer
Shower Water Heater
Kitchen Sink 1 - ----- Water Softner
Disposal I `--- ------ Wet Bar ( --
Dishwasher 1 Sump Pump
Siilcocks 1 ----- IMisc. (List) 1 ---_ I
Floor Drains I1 1 -
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1. Fixture Fee The minimum permit fee is $30.00 $
Compute number of fixtures x $8/fixture
x $5/fixture reset
2. State Surcharge $ .50
3. Postage & Handling (Only mail-in applications) $ 21.50 3
4. TOTAL PERMIT FEE (add lines 1-3 above) $ � UP
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The undersigned hereby applies to the City of Orono for issuance of a Plumbing Permit,
agrees to do all work in strict accordance with the ordinances of the City and the
regulations of the State of Minnesota, and certifies that all statements made on this
application are complete, true and correct.
Signature of Applicant: ; • "-- Date:
7-7— 2-
STATE OF MINNESOTA DEPARTMENT OF HEALTH
ABANDONED WELL RECORD
1. LOCATION OF WELL MINNESOTA UNIQUE WELL NO.
(leave blank If not known)
County Name HENNEP I N
-
Township Name Township Number Range Number Section No. Fraction 4. WELL DEPTH (completed) Date sealed
MOUND 117N or 23W or 6 5'i kSW of SW 70' ft. 02/02/92
S W
Numerical Street Address and City of Well Location or Distance from Road 5. DRILLING METHOD (if known)
Intersection 14 Cable tool 40 Reverse 70 Driven 1C{]Dug
4760 WEST BRANCH ROAD, MOUND, MN 55364 20 Hollow Rod 50 Air BQ Bored 110
30 Rotary 60 Jetted 90 Power Auger
Show exact location of well
(in section grid with 'X') Sketch map of well location
N '`' I\ r`(‘-,,(‘-,,,,,V-'r6. OBSTRUCTIONS
W�n Well obstructed 0 Yes No
- _ ._� �l Obstructions removed 0 Yes 0 No If obstructions cannot be
1 . ( , ..J 1 removed, contact MOH
W _ - -,•- -, -I- _ E \ '\ '-)"') I before sealing.
- �
` T , ')+ . 7, USE
-' ti.C. 1�Domestic 40 Monitoring 80 Heat Loop
20 Irrigation 50 Public 90 Industry
1 wl �\ ?)(e.tit LAS R 7 \I� 30 Test Well 60 Municipal 140 Commercial,
1 $�—� 70 Air Conditioning 110
2. PROPERTY OWNER'S NAME Mailing Address if different than 8. CASINGS)
property address indicated above a Black 40 Threaded 70
ROBERT WAAG SAME 2[)Galy. 50 Welded
3[]Plastic 60 Stainless Steel
HARDNESS OF 2', in. to 70' ft.
3. FORMATION LOG COLOR FORMATION FROM TO
If not known, indicate formation log from new well or nearby well. in. to ft.
r
j 9. SCREEN
fi Screened well from_ ft. to_ ft.
i (If known)
.. 0 Open Hole from_ft. to_ ft.
10. STATIC WATER LEVEL
50 ft. VI below 0 above 02/02/92
land surface Date Measured
9
11. WELLHEAD COMPLETION
10 Pitless Adapter 4Q Found Buried
20 Basement offset 50
34 Well Pit
16. REMARKS, ELEVATION, SOURCE OF DATA - CASINGS REMOVED, CASINGS PERFORATED, ETC.
12. GROUTING INFORMATION
WELL LOCATED IN PIT ON NORTHEAST CORNER OF Neat Cement z0 Bentonite
Grout material cement from7 O to 0 ft. cu. yds
BASEMENT. . . — 1.5 bags
MEASUREMENTS TANKEN FROM BASEMENT FLOOR. . . 13. NEAREST SOURCES OF CONTAMINATION , loor drain
OFI
feet 11 directio type
Well disinfected before sealing? at Yes
14. PUMP 4 Removed 0 Not Present
DISTRIBUTION OF COPIES:
STATE OF MINNESOTA
LOCAL CITY
CUSTOMER FILE
Type: 10 Submersible 31:1 L.S. Turbine 50 Reciprocating
a Jet 40 Centrifugal 60
15. EXISTING WELLS (Please sketch locations of abandoned and
active wells in remarks section or on back.)
CUSTOMER COPY Other unused weil(s) on property? 0 Yes a No
MALENKE WATER SERVICES Abandoned: 0 Permanent 0 Temporary 0 Not sealed
OTHER 17. WATER WELL CONTRACTORS CERTIFICATION
This well was sealed under my jurisdiction and this report
is true to the best of my knowledge and belief.
10,6 ,-.)-7,-)6, 1-(
Licensee Bus ness Name License No.
Address UJ (.. (21() -Y(14 1jt cc.—C -J
PID# 06-117-23 33 0002 Signet_ .—OflY'l I' _,I,.(-•
A rte. 0 Date .� �rQ
/�_tA ,--It , ,'�r^ I''', Date c0 q -
OFFiCIAL ABANDONED WELL RECORD (May be used for Property Transfer) of Driller
IMPORTANT: PILE MITI MIND MYRO MALENKE / JESSE MALENKE