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Home My WebLink AboutPermits/inspections � � PERMIT CITY OF ORONO 2750 Kelley Parkway- PO Box 66 Permit Number: p10929 Crystal Bay, Minnesota 55323 Permit Type: Fixtures (952) 249-4600 Date Issued: 4/26/2007 SITE ADDRESS: 440 Big Island Unit# Excelsior, MN 55331 PID: 23-117-23-32-0071 DESCRIPTION: Proposed Use: Residential Permit Class: Plumbing Permit Type: Fixtures Permit Sub-type(s): Multiple Fixtures DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: FEE SUMMARY: Permit Fee: $ 75.00 va�uation: $ 6,000.00 State Surcharge Fee: $ 3.00 TOTAL FEE: $ 78.00 APPLICANT: Dauwalter Plumbing OWNER: Peter Thorkelson C/o Maxine Thorkelson 15525 Green Meadows Cr 7600 Golden Valley Rd#209 � Carver,MN 55315 Golden Valley, MN 55427 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. � . -�� l.%(.(.�� (.h \,a� .�.�:c,�-l�.t J �'v�-�—f-c `` � APPLICANT PERMITEE SIGNATURE SUED BY SIGNATURE Copies: l-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1 t FOR CITY USE OtiLY '�� City of Orono ,� jj/¢ �� P.O.Box 66 Date Received: Permit# �� ''' 2750 Kelley Parkway ��\� j�''x� h�� Crystai Bay,MN 55323 Approved By: Amount$: 't `�- 7 0� (952)249-4600 \i�� CITY OF ORONO—PLUMBING PERMIT (All Commercial permits must be approved by the Building Official or Inspector) GENERAL INFORMATION 1. You may apply for plumbing permits by mail or in person at the City offices. Applications wili be reviewed and a permit will be issued within two working days. 2. Permit cazds will be sent by return mail after a review is completed. PERMITS ARE NOT VALID UNTIL YOU RECEIVE A PERMIT. WORK MUST NOT BEGIN UNTIL THE PERMIT CARD IS POSTED ON THE JOB S[TE. 3. Plumbing permits may be issued ONLY to licensed plumbing contractors and to property owners residing in the dwelling. 4. When any new construction or remodeling is involved,a separate building per►nit must be obtained. 5. All work must be done in accordance with State Code requirements. 6. Ail work must be inspected and air tested before it is covered. Call(952)249-4600. (24-48 hour notice required) TYPE OF PERMIT Check All That A 1 [�Residential ❑Commercial(Approval Required) ❑New Q�,Additional ❑Repairs ❑Replace ❑ In Accessory Struct re? /� {J I/ �— � ��"`�� /V � ! O ' "� *You will need arior aparoval and may need CUP.(Per Orono City Code,Chapter 78,Article IV) Job Site/Owner Information: Site Address: ��-} �; f��►L� 1��.�+lL� Owner: �: ,Q.M� '11, � Mailin Address: ��-�-C �t C%�`,�U�-��{ � �Y�Lf�,l2G'Yl g City: �l�'V i��1C; Zip: Home Phone: AlternatePhone: (;,tZ' �'ll�`�' l�`�� Contractor Information: Contractor: �^� � � � " �"� �� Contact Person: � ��.�,� �,�IA,v►�kj 1 v�c 1 . Address: '�-�.� (�►�?.4.�,� 1ti11a�cti.i��tate Bond#: �L-1 '��D��(,, �lv'c l.e.� City: (��,1,�%��/ Zip:�"��I�' ExpirationDate: �ZI3►�LUO"1 Phone: ��';�2-t.�cE:.�-%�`1(0 � Alternate Phone: (��1 L- Z ZI- ln'1 C(� ❑ Insurance—Current: 1 J PLUMBING FIXTURES BEING INSTALLED FIXTURE BSMT 1 2 OTHER F[XTURE BSMT 1 2 OTHER TYPE FL FL TYPE FL FL Water Closet / Floor Drains Lavatory / Sewer Ejector Bathroom Laundry Tray Shower / Washer Kitchen Sink Water Heater / Disposal Water Softener Dishwasher Wet Bar Sillcocks � Miscellaneous PERMIT FEE CALCULATION(S) BASED OFF -2002 STATE STATUE ❑ Yes,this section applies The replacement of a Residential fixture or appliance that meets all three of the following requirements: i. Does not require modification to electrical or gas service. 2. Has a total cost of$500.00 or less;excludine the cost of the fixture or appliance:and 3. Is improved,installed or replaced by the homeowner or licensed contractor. Skip next section,if this applies; Cost of Permit $ 15.00 State Surcharge $ .50 Mail-In Fee(If Appiicabie) $ 1.50 Total Permit Fee $ (Permit Fees Continued On Next Page) 2 PERMIT FEE CALCULATION S -JOBS OVER$SOQ.00 If above does not apply;follow guidelines below: 1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of$35.00) �(�iDOO� E'�C� xA125$ (contract price) (minimum�35.00) 2. STATE SURCHARGE **Add the State Bldg Code Div.Surcharge(Minimum Fee of 5.50) 1��'CC,�C C� x.0005 $ (contract price) (minimum$ .50) 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ • * CONTRACT PRICE or JOB COST means the actual or estimated dollaz amount charged for the permitted work including materials,labor,profit,and other fixed costs. It is the amount to be charged to the customer for the work done. If any material, equipment, labor or installations are fumished by the owner, tenant or any other party,the reasonable mazket value of such items must be added to the estimated cost or contract price for permit fee purposes. In the event that there is a dispute on the amount of the job cost, the City may request the submission of a signed copy of the actual contract. • ** The STATE SURCHARGE is .0005 of the contract price under$1,000,Q00 or$.50-whichever is greater. For valuations over$1,000,000 ca11 the Building Department at(952)249-4600 for the price. PLUMBING PERMIT APPLICATION AGREEMENT The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do a�� 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. Applicant's Signatu . l�t ' ate: `�- �y' �C� Reset Form 3 (,Jl[..,Ll.� - / �/DAT�/_ TIME v CITY OF ORONO CALLED IN r�� INSPECTION NQ�IC�f�J SCHEDULED :" D-�7 /-�+�� PERMIT NO. / l" " �� COMPLETED �r�� , �3�-) ADDRESS �D � / S` OWNER CONTR. �W�.�°{ ��1� TELEPHONE NO. �Ola — �� — �P7D�O � DESCRIPTION P��m'6 ��g �2� l� 01 FOOTING 11 MECHANICAL 18 EXCAV/GRADING/FILLING � 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS � Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS � 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT � 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP = 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL � OWNERICONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W � o � �S� i � /ti.:n.9 �. � � ti°�:..�' 4l A� i—�� — Sc�.��-nr1" W � Q � � +� �l.�t>;..� ��c�,,» r3.:.� � z � �C�' A1 b✓TS �3,.• � Ls�l��CA�� w � � GW �WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE � ❑CORRECT WORK&PROCEED C ISSUE CERTIFICATE OF OCCUPANCY W O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. C PHOTOTAKEN INSPECTOR W4LL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED G INSPFCTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. �95Z� 249-4600 OwnerlContractor on site: Inspector. („ ��.��V Iy� � C White Copyllnspector's File Canary CopylSite Notice CITY C� ORONO PERMIT 2750 Kelley�arkway - PO Box 66 Permit Number: Pos62s Crystal Bay, Minnesota 55323 P2C'CTllt Typ@: Addition/Remodel/Repair (952) 249-4600 Date Issued: 4i2�i2oos SITE ADDRESS: 440 Big Island Exc el si or,MN 55 331 PID: 23-117-23-32-0071 DESCRIPTION: UBC Occupancy R3 Consri-uction Type VN Proposed Use: Residential Pernut Class: Building Census Code 434 Permit Type: Addition/RemodeURepair Permit Sub-type(s): Addn/Remodel/Repair DETAILS: Approved per resolution#: Separate permits required: �i�m�ai�staiej NOTICES/REMARKS: r.__l__ .'�_ n n' '�_t �_t._ FEE SUMMARY: Pernut Fee: $ 11125 Valuation: $ 4,500.00 Plan Review Fee: $ 72.28 State Surcharge Fee: $ 2.75 TOTAL FEE: $ 186.28 APPLICANT: Owner/Self OWNER: Pete Thorkelson MN 440 Big Island Excelsior MN 55331 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEIVIENTS SPECIFIED AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. / � � _J ��L-•�� _ � ✓ �l� �� APPL[CANT PERMITEE SIGNATURE 'ED BY SIGNATURE Cooies: 1-File(SiQnitures Required), 1-Applicant, 1-Monthlv Reports, 1-Assessin�, 1-Finance Page 1 .✓. ,n.r� K ..w . � k pry_ _ _�__' _ _��_ � � °�� Z x b 5'T'l/ ✓�S �T�l MIN 2X(o ��w5e� Qo� {� we�ll� �dti . -�r#^ �.Y�'�� , � ;� � z x b P�►rz_ � --- __.______: � 2-zx b (��+M .�v�>� Z�C lo �Z" ��- � � . � �_---�,.__. ` � ��KS ('OST � � \ — �� ; j J ot�i 1�'��1� ---T--=-_---- /� _._ �� 1� / 'i �� '�'}�s 3 r,;'P.!�`j -- �� fc'y'4 0.'['"E.i F�j RUc y��` (�2 �a � �{L,� �� ✓NGJr L=n10 u F�os7 � �" s" c.��,� P �� . Fre �� AD ;� 'a � �` !i � '� �e � � f�10 T�E � .'". •{ S, � �tv'[-�� l.ca ca 2 ��15"7"��,ti a'/f�-r4-c.c �ti`� __--�--�_.__��__ I��-��_- ,�: . "'�1.�re�, t. '�'a � _,_..__._.., ...._ _ ' , �d�,to�e» r�.G:� `C'(1x:,��`2:,;7, 1`�n�s'r�. � � � �. ,.. =� .� ��.___----M''��#�------�-'..--- �F W�1"��4-i n.► ��R C�� t��-� CITY '�—�'��°``�rs �t` a_�. �Uit_^:�� n.��.�;,;��-- ;::�: ^,:. �=`- �=;',P -- `;�A � �, ;,,... Avr �z��r,�+5 ?pEr�"i:, _��--l��i^^..----- -__.__� _-{�o5�r ,�, "� 27-V5 - _. . .- .,•. T:- _ , .�--.--. •;� . ...'.��:� .-��J. I�7/ �� " � , �. . �qlt,/�!>aPo2-� TJ�� "ryRA _. .. .._ , _. � . ,... . . ., . ,_�� $ �� ,4. - � . , : � G3 (I �nd� ., '_ .' .�,.:f <. ", a �^ -��7@,..__.......--�---_..._.._.._.....�.___...._.__.-_......._..,..........,....__ __... �j � @. e � i tii�. ��1.S�IV�j IG001- ��Nnll01� �p7`�/Va• � ` :i`. i . r;/.'r.Y. J t'd 1`°i ��,!�� '., i �Iz�: ��=.:� r�!��`� �` _� � _, _—�___._ �,'��:�' k� ��Y'�Yy/� �.. _---� X�s s-;,,,� /':��- �,��c ��:,� _-- —3� --__ �- _ __ _ .. .. �.i. E : ; � " �n�N 2-ZX�, �;r � 4 o� �►e� 3- Zn � G��.. ,-,,,��b3s � 4 a � ; Art �3��«3_ :� k� �C�'��►✓�Z u � �+ ' ,. ��. '-� ! ' � : ; � ��a�� i f � ' r e �� _�_V_ �j iI I � � �' � � 4 � � �F �t e � . ,. . .�..A.._ - ��'� �� Z X L . " .. -" �' .�---�—� � � � �� . - � ._________. � . --. - .. � ...___ �� . .�a.,, a...=u _....�._.._r., } _ .„ ..__. . €� .._-..�..M. ._�,.�...-....--.— . . .r.. � '-..�_ - ._.:>� C_.:e._.., �„_� _. ._...... � � �_v" ..�_____ �-.?-!C f !',�,r.',��F?t.Lvq., .__ ___ ______—,_ --_--Tr�.� -- - ��.�_ Z x � Fll.��0�.9 � � �'-� �J�� Sx b Posr -� Y.___ ---� � _�._..__w�_ �.__. �- -��--� ---_ -- _ _ _ L,� /�-p -{--*> -�-�a o�,^�+�,,� .».. - ;_ , ; _ . � _ . : _. , , �.___. _ ..��._ �`�,. �.� s�a�.l� ��1 Sr�� , �N.��-L 1=M-r.�a� /}-/Lo✓.�O !� G S�lts��C�t:�.v� ��+� "-�;�� C�I �� a4'4. �,:,�,L{`i,��o-d�'��.,.«� �L �.� � ��. �—�-x a � �� .�'�,.��2 ' 'Mi`� Z -�x `' ;�� R� _. . ._a... �"�� (,��e �p ��-�� r�,� - � ; � �� C� �S� z� Total Fee: $ F ��- `� �' Date Received: Entered By: ��e..,�"/�C,��`v� Permit#: �{ / �j —O h�,�� „ ,� _ -t� r�.�� r _ � CITY OF ORONO - BUILDING PERMIT APPLICATION All information must be submitted in full before plan review will be started. (please print all information) ------------------------------------------------------------------------------------------------------------------- THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR JOB SITE ADDRESS: ��C� � i 9 ��S �� n� ZIP: Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �No If yes, a special event permit is re�uired with Police Department and Ciry Council upproval 60 days prior to the event. Shcrttle bc�s sefvice will be r•equired zrnless applicant demonstrates su�cient on-site parking is available. Non permitted events will not be allowed. NAME OF OWNER: �e��. r � 4..0. � !�10�K C�Sdh PHONE: (home) R �J�8�;�y�� (work)lL 1,r h-,.�.Ss_) MAILINGADDRESS: �C�•.�c7X 2,�� CITY: ��Ce(,S ior ZIP: �� --.--CU�T'F�A�TO�Z: ` PHONE: CONTACT PERSON: MOBILE/PAGER: MAILING ADDRESS: CITY: ZIP: STATE LICENSE: # EXPIRATION DATE: ARCHITECT/ENGINEER: QE'_'tP��p./'/Ce C.SGv� PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION: # TYPE OF WORK: New Addition Accessory,5�tructure Move Home emodel/Alteration 1� PROPOSED WORK(describe in detai�: .�-n c L o,s 7'�' O �.l r S d� �.l S t!� ' �o�'� � � �h�_11�s�-' �L ve�r �'.3��X 1�(};�ro w0.,� �-S �i3��,Z. w�„C (, /h'� 7�,vi►�do�,✓s Q co ri c�-g�t ac+;�l� ,� !J�ls/� ��-( OL ��,�� -.�i...,""s 16>C�f'r', wlth .it�L l ;.A11'�10It'�C,J.�. w��f1 Q ��X�� S� �� "�'��'�r��' � STORIES: � 2 SQ.FEET OF EACH FLOOR: � 7� Po�4�' NO. OF BEDROOMS: ..� GARAGE STALLS: ATTACHED -- DETACHED — ��, r , � �-.S� cG ;: ,; ,� � _f� �_- ,.�, ESTIMATED CONSTRUCTION VALUATION(excluding land): $_��SUo � ,n c1 ur�i�� n��, c��o rk I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City and with the State Building Code;that I understand this is not a permit and work is not to start without a permit;and that the work will be in accordance with the approved plan. APPLICANT'S SIGNATURE: �.�C.� C� � ' TE: 31 Sec.13.04 RIGHTS OF SUBJECTS OF DATA � Subd. L Type of data. The rights of individual on whan the data is stored or to be stored shall be as set foRh in this section. Subd.2. Information required to be given individual. M individual asked to supply private or confidential data conceming himself shall be infonned of: (a)the purpose and in[ended use of the requested data within the collecting state agency,political subdivision,or statewide system;(b) whether he may refuse or is legally required to supply the requested data;(c)any]mown consequence arising from his supplying or refusing to supply piivate or confidential data;and(d)the identity of othe��persons or entities authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer. The commissioner of revenue may place the notice required under this subdivision in the individual income tax or prooerty tax refund inshvctions instead of on those fonns. Subd.3. Access to data by individuaL Upon request to a responsible authoiity,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classitied as public,private or confidential. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the data without any charge to him and,if he desires,shall be informed of the content and meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. i'he responsible authority shall provide copies of the p�ivate or public data uponrequest by the individual subject of the data. The responsible authority may require the requesting person to pay the actual costs of making,certifying and compiling the copies. The responsible authority sha(1 comply immediately,if possible,with any request made pursuant to this subdivision,or within five days ofthe date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within that time,he shall so infonn the individual,and may have an additional five days within which to comply with the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accaate or complete. An individual may contest the accuracy or completeness of public or p�ivate data concerning himself. To exercise this�ight,an individual shall notify in writing the responsible authority describing the nature of the disageement. The responsible authority shall within 30 days either. (a)con•ect the data found to be inaccurate or incomplete and attempt to notify past recipients of inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The detennination of the responsible authority may be appealed pursuant to the provisions of the administrative procedure act relating to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04,Subd.2,"Rights of subjects of data",we would like to inform you that your request for a pernut or license from the City of Orono or any of its departments may require you to furnish certain private or confidential information. You are notified that: 1. The information you furnish will be used to determine your qualification for the pemut or license requested. 2. You may refuse to supply data,but refusal may require that the City deny the permit or license. 3. The information may be shared with other local, state or federal agencies to the extent necessary to process the pernut or license. 4. If your requested permit or license requires Council action to approve,some information may become public. 5. You have certain rights under M.S. 13.04(available upon request)to review private data on yourself. 6. Your full name is required to process this application or permit. `��fie� � �c�h �T��,nrX �.�-S�n First Middle Last ,S� te �d�i �e� yyp,��.��.a�,d , D �ano Address r�-�a t � � P d.�3 0�,�`I � , E�[� C .�� ° ,��-,� ��.`"�33� T�w�,��,�%+� City State Zip Phone I understand my rights as stated above. �..�l�/,�� < Signature 32 I ..`.�� o �o � �' t� b � � � N � � � � `b 'b '�j � � N � b 'ba �j o � 'n p ° fi o ° � O � � � � 'ylrt�7h7 � � O � �jb �j . � � �� a' c� a' o � � b � ' ^ n � y � � � � h � ; � - b � a ? � � ° � �� ; � � � �, � � b � � � ? a � < � co a � a '�p�' � c� �7 � o.. � p � i co ti � � 'y O i � (� i �, �7 C7 �, �. QO a O N � � ^ i � � � � �^ I�, i b�j � �/'� (�. , a. �/] .M. � � � � � � '� �. A ^" � N ` J j � r� �7 ti �j 1 �+, N i 7 � � O O � � b �� ^" � � h c� � �-. � i � ~ � � � � � � � O � O � � � p o �, � '�' �° � � � � O :C � ' �1 � � � � � � � � O t� � �. b �. �� ... �- � � � � � � � � � � � � �: � �, ti � o m b � �, � � , �% , � , n �o ' � G� ' !,�+ ' � N m o c., �, v `�,° `�] ' �7 ' p� ' 4 '''�i �' � � `" `_' � � b � '�,' � � h7 � o 0 o n � o o i i i � � ..'. p � � N i �C 't", ",C `.�' tiG' i i � o � b � ; ��., � � � � � i � R1 � �' o s' � � � (I j `C �7 ''C ; � � i i i �' C � � n7 �1 � � :b � � b i ` \ i i (1 � � �t � � pq' p � .,, i \ i � : � `rb �/1 � � � c� � � M' i i i � Q y � � � � � i i i � � i i � � � � a �, n W � �, �� Q� � � � O � O O O O O �: i i � ~ � � � w � � 1 c� i � � l�7 � � � � b � ' c � � � � C � i � � J' � � � a � � \ � � � Z l� � � o � � = n � ; � ° , � o� � � � � � t� � ti b � o � � � � 'b � L' � � bb � � ~c b � � ' yy � � � � ' � a ' '� `° a � ��e � ' � � �? y � � '�] '�3 � '�7 �, � ^; ° � �j ti ✓� �1 � � � �rj �2j � 'TJ n � ,b r, �, b � b � 'Tj b � a' � � � � tr1 0 o b �,� � -� �' �7 n � i �) �! i � � � n o �� ; '�s c� � O O `� 0 'v 'b ; ,n� ° a a M ' � y � � i � � ; ti a, � � ,� � O O � 'y � b ��°. b b � �" � nn � � � � � R � ° � � � � ; bb ; � � � � i ; � � � � N ti � i = J J i i i ' � i o lO� i i i � 1 i i i i i i i i i i i i i B UILDING REVIEW CHECK LIST UBC: R•�i CONSTRUCTION TYPE: V/J Sq Footage �Per Sq Ftg Basement x = Ist Floor x = 2nd Floor x = Garage x = x = TOTAL Estintated Construction Value: $ �/�.5�� Inspections Required: Work Requiring Separate Permits: Site Plurnbing Fi�•e Harcicover Removal Meclzanical Water Connection _�C Footing Septic Sewer Connection K F�•arrting Fireplace Lawn Irrigation Insulation (Muson�y) Other Wall Board (Mfg.) Well(State Permit) c Final Grading/Filling �E[ectrical(State Pennit) Other REMARKS(INHOUSE): ---------------------------------------------------------------------------------------------------------------------- RE IjIEW BY OTHERS: DATE: Access: Existing New Access Approval.• Date By: -------------------------------------------------------------------------------------------��------------------- REMARKS(TO BE NOTED ONPERMIT): 34 CITY OF ORONO PERMIT 2750 Kelley Parkway - PO Box 66 Permit Number: po699� C�-ystal Bay, Minnesota 55323 Permit Type: user Defned (952) 249-4F�0 Date Issued: iiii2i2oo3 SITE ADDRESS: 440 Big Island Excelsior,MN 55331 PID: 23-117-23-32-0071 DESCRI PTION: Proposed Use: Residential Permit Class: General Permit Type: User Defined Permit Sub-type(s): Land Alteration(0-500 cu yc DETAILS: Approved per resolurion#: Separate pernuts required: Other-(Ok'd by G-eg Gappa&Lyle Oman w/notarions) NOTICES/REMARKS: Please see comments on plans FEE SUMMARY: Permit Fee: $ 50.00 Valuation: $ 0.00 TOTAL FEE: $ 50.00 APPLICANT: Owner/Self OWNER: Pete Thorkelson MN 440 Big Island Excelsior MN 55331 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. APPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE Conies: 1-File(Sienitures Required), 1-Applicant, 1-Monthlv Reports, 1-Assessin�, 1-Finance Page 1 ,¢��` City of Orono FOR CITY USE ONLY `r P.O.Box 66 Date Received: Permit# ��: � 2750 Kelley Parkway � � h��:� � Crystal Bay,MN 55323 Amount: $ C.U.P Filed: ��o (952)249�600 Approved By: p� Site Plan: Recommends: A mval Denial ❑ CITY OF ORONO - USER DEFINED/GENERAL PERI�IIT (All permits must be approved by the Building Official and/or Zoning Department) 7ob Site/ �flv�ue� � a � �; , . ` �� R., � � �. 9,�� .�, / Y � / � , Site Address: � �� 1 � Owner: ��' � � �"��. �- �� ---� Mailing Address: _J� �o X p� �� -,� c � C �ror, /�'�h, ciry: d r o h .� zip: - � .- �S�'J�3�� Home Phone• '� �� - � f `" �yd� Alternate Phone: f:� .;l -� � �` • �� ., � .w,�• 'c.�--� Contractor!Applicant Information: Contractor/App.: Contact Person: Address: State License#: City: Zip: Expiration Date: Phone: Alternate Phone: � � �� TYPES�OF USER DEFINED PERNIITS ,�`- �� `` �� x ��'=� � � ��- ❑ Stairwav to Lake ❑ Retaining Walls ❑ Temporarv Trailer General—User Defined Surcharge General—liser Defined Surcharge General—User Defined * (Per UBC) *(Per LBC) *$30.00 *Estimated Cost: $ *Estimated Cost: $ ❑ Docks—42"or Greater �..Land Alteration ❑ Zoning Review Genenl-User Defined Surcharge General-L'ser Defined General-User Defined ❑ Commercial—(Per UBC) � 0-500' -$SO.00(Needs Si[e Plan) *ForO-7S'Zone-$30.00 *Estimated Cost: $ ❑ 501' +_$75.00(Needs C.U.P.) General—User Defined ❑ Residential- $30.00 /o •lr •a3 ❑ Tree Removal � ��(J` Genenl—User Defined � � �Q *Within 0-75' -$30.00 � �'� , I herby apply for a User Defined Permit and I acl�owledge that the information above is complete and accurate;that the work will be in conformance with the Ordinances and Codes of the City and with the State Building Code;that I understand this is not a pernut and work is not to start without a permit;and that the work will be � cco dance with the approved lan. - �� .�z� ,� Applicant Date �DcSne�.P�.Rr� ' x: ' . . � THK K NOT A SURVEY � EXISTING ELEVATIONS: � 6cNCH MARK =100.00 (TaP OF IRON,SW CORNER LOT 6, MCRSc ISLAND PARK) vo,�r � �� I TH�i�SHOLD CABIN DOOR 99.54 I I GRA.;E @ PROPOSED SEPTIC TANK=S8.2L j i '� GRAC� @ PROPOSEC UFT TANK=9I.� � + �� O� i1R��V 80RING #1=95.40 � � BORING #2=94.40 � 80RING #3=96.70 � W � � S�TE t�l.l1l�v � Ci�i�ii.'!NG PLAN 60R{NG #4=93.00 � Q �-Ot 6 � �.r�.t�r`,fil`6�'�.:� BORING #5=94.20 � � �� i'�;`'i'i;Ue�:'.:i.i �:trj!��l�. �'�.�t��ti�.�.'�e� BORING #6=43.80 Z � ►-y � -1 ri" �*5n.^'rli;_ L� [�1.�1r�'i$'� i`l:.r o. PROPCSED ELEVATIONS: i Q i �V � � � FINfSi�1'c� GRADE ABOVE TRENCH #1=97..^�� j � � i � �A�.E y, -� O ` u DErTH OF TRENCH=94.60 FINIS'r{'cD GRADE ABOVE TRENCH #2=96_�7 I + DEP7'N OF TRENCH=94.20 � I I � `v y� + � �y` V _ INLET INVERT OF LIFT TANK TO E� �Ei=MINED i \ ��` - ' O � O � � AFTE� ELEVATION OF SEWER PIPE �=LOv��OAD � � I EAS_MENT IS SET BY OTHERS. � ��/ � �� /` 50 Gnllon Flberglnss Lif� ank � < . � - �� --_________ i `\ � f � i �� V , / �I � e�,+a+ wrac ---'--- , ,a`� / � ►�, �- yti�- �' � M A S S A S Q L T q V E � ��,a�F:�° i e � �.� � � No d e� � 1 ' � •� \\ a ��P,S`�� / � � � � ¢ ,/ . �\ r� ,��,-�e r , Y /` ,� °� I � ! �e G � � - Z � �o t � �.,.• �^ � ,y i f � / -� � d -f- �J � e o , 1 , ��\ 9 f� � � �'0 �G. G-f� � Z ' �' ° �� x7B..taV a � '�V � _ � '__� �\ 0<�'4 �vip � � � L � /� ��\ �� Y �� `"� .v°' 1500 Gallon Fibergla��s Septic Tan'hc� ,��.�� ¢ • � � _._r . �� - � � � �r � REPARED F❑R: LEGAL� � PETER THORKELSON L❑T 1, SCRIVER'S SUBDIVISI�N ❑F LOT E, MORSE ISLAND PARK, AND LOT 6 AND S 1/2 OF LOT 7, MORSE ISLAND PAR, SEC�ND ADDITION, HENNIPEN C�UNTY, MN PREPARED BY: ; £G�O 57y7c'IKS£"�'�£�l" 333 East MQin St Elk River, MN 55330 SC�E t' - 50' onrE: 6/6/03 S�+EEr 1 of 2 PERMIT CITY OF ORONO 2750 Kelley Parkway- PO Box 66 Permit Number: Po6s46 Crystal Bay, Minnesota 55323 Permit Type: sepci� (952) 249-4600 Date Issued: loiii2oo3 SITE R.�IDRESS: 440 Big Island � Excelsior,MN 55331 PID: 23-117-23-32-0071 DESCRIPTION: Proposed Use: Residential Pernut Class: General Permit Type: Septic Pernut Sub-type(s): New Septic System DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: Matt to inspect. Permit pulled 2001 by another contractor,they sa FEE SUMMARY: Permit Fee: $ 100.00 Valuation: $ 0.00 State Surcharge Fee: $ 0.50 TOTAL FEE: $ 100.50 APPLICANT: Hagberg Exc. OWNER: Pete Thorkelson 18545 Roanoke St.NW 440 Big Island Anoka,MN 55303 Excelsior MN 55331 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. /1 � ��'� � � ( � `� � �� (c"f"� � APPLICANT PERMI EE SI ATURE 1 SUED BY SIGNATURE /� Conies: 1-File(SiQnitures Required), 1-Applicant, 1-Monthlv Renorts, 1-Assessin�, 1-Finance Page 1 CITY OF ORONO SEP'TIC SYSTEIVI PERNIlT APPLICATION Bos 66 (2750 Kelley Parkway) Crystal Bay,Mn 55323 r JOB SITE ADDRESS �i/�/� �i /s/u.� Occupancy Type: Residential_� Commercial Other Permit Type: New or Replacement System $100.00 $ 1 �C% , � U Repair Esisting S�stem $ 50.00 (Tanks or Drainfield) $0.50 State surcharge added to above fees * See fee schedule for non-residential permit fees Owner's Name: �� ,e r% v ��%'Z Phone Number: Mailing Address: D �' City: O�'.�:?v Zip: �� Contractor's Name: � r Phone Number: `7G 3 ��'�o �Gi/ Mailing Address: �� " S� �f� S�tGu City: C��i��,�, Zip: SS�? *** DO NOT 1VIA.IL PAYMENT�TTH THIS APPLICATION*** GENERAL Il\STRUCTIONS 1. Applications for septic system permits may be mailed or submitted in person at the City Offices; however, permits will not be mailed out. The pernut must be picked up in person at the City Offices and work must not begin unless the permit card is on the job site. 2. Permits will be issued only to contractors holdinj a Minnesota.Pollution Control Agency(MPCA) Septic System Installers License. 3. All work must be done in accordance with the approved septic system design. Design reports are not considered approved unless accompanied by the "City of Orono Septic System Approval" cover sheet signed by the City Inspector. 4. The following inspections will be required for all septic systems: A. Pre-installation site inspection to include inspector, installer, and general contractor. B. Tank installation prior to covering. C. Drainfield trench installation prior to coverin�. For mounds, inspection is required after rou?h up but prior to sand placement(sand �vill be jar tested for silt content), and again during pressure distribution piping installation in the rock bed. D. Final inspection to verify proper final cover depths and to verify that all pump stations (where required) components are functional and comply with codes. � 5. Individual holdin�I�IPCA Installers License shall be present during all inspections. A 24-hour notice is required for all inspections. NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate boxes. 1. I have received a copy of the system design including the City of Orono Septic System Approval Cover Sheet. ,, 2. I will be installing the following: ,� ��,s, f1. Tanks: ��Precast Concrete ! �tf Other Manufacturer Tank Capacities: 1) gal. 2) gal 3) gal B. Pump Station (if required) Pump make& model__��-��_ (attach pump curve& literature); system design requires gpm at feet of head. Hi�h water alarm make&model . Outside electrical work to be completed by installer electrician other. Z,� C. Treatment System: yh�,��ri►- �_Trenches: s.f. Mound Depth of rock below pipe " Rock bed dimensions ' x ' �' Drop Boxes Sand bed dimensions ' x ' Distribution Box Pressure Dist. Pipe Diam. " Manifold Pipe Diam. " D. Final Cover/Topsoil to be: �_ bonowed from site (show location on site plan) trucked in The undersigned hereby applies to the City of Orono for issuance of a septic system installation permit, ajrees to do all work in strict accordance with 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 ofApplicant '�� ' � �v� � Date: l�-�� MPCA License No. 2�,3'� Staff Revie�v: Approval Denial Reviewer: J � Q�Y. 2�zL,--� Date: ` b - ` -- (;�� Reason for Denial: DATE TIME � CITY OF ORONO CALLED IN INSPECTION N ICE SCHEDULED PERMIT NO. � COMPLETED "�-�'0'� ADDRESS �`�'� �. � S�G^ OWNER CONTR. TELEPHONE NO. � DESCRIPTION �p'1' • C— �^•�`� � 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL � 04 WA�L BD. 12 WATER HOOK-UP 17 SITE INSPECTION Z Q OS FINAL 14 SEWER HOOK-UP O6 PROGRESS � 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP = 09 PLUMBING Rf 23 EPTIC FINAL 35 HARD COVER REMOVAL J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL Z OWNERICONTRACTOR TO MEET YOU:_YES�O � COMMENTS: � — \c,c r� � r— .��— C� 0 a � 0 � W � Q � Z W � W � � a W� ❑WORK SATISFACTORY:PROCEED ROJECT COMPLETE W ❑CORRECT WORK&PROCEED r IS UE CERTIFICATE OF OCCUPANCY � ❑ CORRECT WORK,CA�L FOR REINSPECTION TEMPORARY � BEFORE COVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ PHOTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR n CITATION ISSUED G INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. �95Z� Z49-46�� OwnerlCont actor on sit Inspector. V ` `alJ� White Copyllnspector's File Canary Copy/Site Notice / v' DATE TIME CITY OF ORONO CALLEO IN INSPECTIONNOTICEL, SCHEDULED - "�� "'t=0 PERMIT NO. �''�� 1� COMPL ED ADDRESS ��"�G� �_.� ��c� !C'� --� �� OWNER p�}��p�� Sd�� CONTR. �'�5�") €hC � TELEPHONE NO. � DESCRIPTION J��}`� �— �t � ^`�` � l� 01 FOOTING 11 MECHANICAL RI Q02 FRAMING 13 MECHANICAL FINAL CLp `��,n��V��2� y 03 INSULATION 24/25 WOOD BURNER/FIREF `/�rL'T'-- .ppp- , Z04 WALL BD. 12 WATER HOOK-UP �� y7� ��`'/�� 1 Q OS FINAL 14 SEWER HOOK-UP �SjO Z.3��- 3"3Z -UC7( � 07 DEMO-SITE j SEPTIC MAINT. �n,, Q 07 DEMO-FINAL 15 PTIC INSTALL. / ""� ��`�� W 09 PLUMBING RI 23 SEPTIC FINAL L..� ''W � J 10 PLUMBING FINAL � ,' � � � OWNERICONTRACTORTOMEETYOU�'�YES_NO _ � COMMENTS: ._ `1�� .�.,�5'� c; � Q�NL. � Al S (� r-..��k a �' ��1 ��t�t' � o °� �}l� t. c�� t v,—�v(� �� — �v�\�� h�� , � ` � � �1 '1�.� .lr ' .. � 'r"•�� U !"� �(`� Q — e1t�7��.._, �e�: „� tt�\\� . � �" �J � n�v\ rJr' 1��'f� � � �op _ �.,L — �� b��k� qk Ic' �4��..� � � J _ ,�u a� ,�� x; :�� a W� �VORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE � W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY � BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. O PHOTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑ INSPECTIONREQUIRED.CALLTOARRANGEACCESS. Ca11 for the next inspection 24 hours' advance. (952� 249-4600 OwnerlCon ctor on site: ��%�- Inspector. ��'� `�--� White Copyllnspector's File Canary Copy/Site Notice � *. CITY OF OR N PERMIT � � Permit Number: 2750 Kelley Parkway - PO Box 66 Poso2o Crystal Bay, Minnesota 55323 Permit Type: a��essory snu�cures (952) 249-4600 Date Issued: a�29�2002 SITE ADDRESS: 440 Big Island Excelsior,MN55331 P I D: 23-117-23-32-0071 DESCRIPTION: UBC Occupancy R3 Proposed Use: Residential Pernut Class: Building Census Code 437 Permit Type: Accessory Structures Permit Sub-type(s): Building Undefined DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: m,--- �- - — --_�.- --- - ---�- _...�.�..;:�.....��.;....,.�.,.....:,w�� . ..._ ._ _ . ....... ........... FEE SUMMARY: PermitFee: $ 23.50 Valuation: $ 200.00 State Surcharge Fee: $ 0.50 TOTAL FEE: $ 24.00 APPLICANT: Owner/Self OWNER: Pete Thorkelson MN 440 Big Island Excelsior MN 55331 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. /-� r. �1� �� ` ��tV�/I tr t^""�- ;( .7 `lL--- APPLICANT P RMITEE SIGNATURE ISSUED BY SIGNATURE Copies: 1-File(SiQnitures Required), 1-Applicant, 1-Monthlv Renorts. 1-Assessing, 1-Finance Page 1 t { " ", , Total Fee: $ � Date Received: �� 'f' ? `- Entered B ` y: Pernut#: ==:�,f `';� , � � ,..— � /,�:� ��i `.% < ; � CITY OF ORONO - BUILDING PERNIIT APPLICATION All information must be submitted in full before plan review will be started. (please print all information) -------------------------------------------------------------------------------------------------------------------- THE APPLICANT IS: (circle one) ` OWNER R CONTRACTOR �.,.,..�..,_.� JOB SITE ADDRESS: ��(,� �°"; ,F „�„� ,�,ra'�,t S , �� ZIP: ��,,;�,�,,,�; '� �� /� -��=�.�, �>1��1 NAME OF OWNER: I�✓�� - /�►• ��}G?('/�`��,�'`'�. PHONE: (home.�--�� ` ��, , (work) MAILING ADDRESS: �t�� ,,��`,� CITY: �' �' �'�' r� ZIP: �p`� �' ;,'�,g� /�'1 r;.. CONTRACTOR: �"" PHONE: CONTACT PERSON: MOBILE/PAGER: MAILING ADDRESS: CITY: ZIP: STATE LICENSE: # ARCHITECT/ENGINEER: '�'"'""` PHONE: MAILING ADDRESS: CITY: ZIP: NAME: REGISTRATION# TYi'E OF WORK: New Addition Accessory Structure Move }� Remodel/Alteration Land Alteration PROPOSED WORK(describe in detaa� ��V�), �(.1�/� Q��,„ �`�'°! 4� �,,�J �. e'}x� .�� lr-_ /� ,.»�( �4,../ / .,. �. � ! c= k �w..' ��.,. h ...�.! ��F,E f"�'A'""�. � �1�J�.. A �r STORIES: SQ. FEET OF EACH FLOOR: NO. OF BEDROOMS: GARAGE STALLS: ATT. DET. � ��.�`�"?�.�.. -�� ESTIMATED CONSTRUCTION VALUATION (excluding land): $�,�:,�J;�C'r-� � - r I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City and with the State Building Code; that I understand this is not a permit and work is not to start without a permit; and that the work will be in accordance with the approved plan. � APPLICANT'S SIGNATURE: ;� DAT'E: NOTE! Parade of Homes events require separate permit approval by Police Department and City Council 60 days prior to the event. Non permitted events will not be allowed. 5 t � Sec.13.04 RIGHTS OF SUBJECTS OF DATA ` Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this section. Subd.2. Infom�ation required to be given individual. An individual asked to supply private or confidential data concerning hunself shall be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,political subdivision,or statewide system;(b)whether he may refuse or is legally required to supply the requested data; (c)any lrnown consequence arising from his supplying or refusing ro suppty private or co�dential data;and(d)the idendry of other persons or enuties authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investigative data, pursuant to secdon 13.82, subdivision 5, to a law enforcement officer. The commissioner of revenue mav nlace the notice reauired under this subdivision in the individual income tax or orooertv tax refund instructions instead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public,private or confidential. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the data without any charge to him and,if he desires,shall be informed of the content and mea�ing of that data. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for six months thereafrer unless a dispute or acuon pursuan[to this section is pending or additional data on the individual has been collected or created. The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority may require the requesting person to pay the actual cosu of making,certifying,and compiling the copies. The responsible authoriry shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within that rime, he shall so inform the individual,and may have an additional five days within which to comply with the request, excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data concerning himself. To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature of the disagreement. The responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipieo[s of inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determinadon of the responsible authoriry may be appealed pursuant to the provisions of the administrative procedure act relating to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of data", we would like to inform you that your request for a permit or license from the �ity of Orono or any of its departments may require you to furnish certain private or confidential information. You are notified that: 1. The information you furnish will be used to determine your qualification for the permit or license requested. 2. You may refuse to supply data, but refusal may require that the City deny the permit or license. 3. The information may be shared with other local, state or federal agencies to the extent necessary to process the permit or license. 4. If your requested permit or license requires Council action to approve, some information may become public. 5. You have certain rights under M.S. 13.04(available upon request) to review private data on yourself. 6. Your full name is required to process this application or permit. }��w ��. r � � r,._r., � .�. �� rk � L „ ,��,:.; First , Middle Last y�� .�� _ , ;. F� Addres '�-� . �?�"�:�? ��,�? /Y ) r� �j-�,.��.S' �) �.�� t'r-6 t.`lCO Ciry State Zip Phone I understand my righ as stated above. �� . Signature " 6 CHECK OFF LIST FOR ISSUANCE OF PERMITS FOR OFFICE USE ONLY ADDRESS OR LEGAL: y+�l 0 (�t(� �S�..v4�v� PID: DESCRIPTION OF WORK: M o�� o�� t-��s2 �4v iv�� C�o c,�r,,�v� _---_---_-- - -- -- -----------------------------------------Y ZS------- ZO.vI�1i G REV�W BY: � � ' DATE APPROVED: ..� 2 BUII.,DING REVIEW BY: --- DAT'E APPROVED: FEES TO BE CHARGED: Misc. Fees Calculated By: PER�VIIT Yes �/ No PLAi�1 REVIEW Yes No .�- SEWER CONNECTION STATE SURCHARGE Yes � No WATER CONNECTTON INVESTIGATION FEE Yes No PARK FEE SAC Yes No SITEINSPECTION Number of SAC�Units OTHER (specify) ZONING C�CK LIST Zoning District: /2-S Fire Department: Post Office: School Districr. Lot Area: Sq.ft. Acres Width Depth Survey Submitted: Yes �C No Date of Survey: `1•3�-�'+�j Proposed Setbacks: Front(Lake): Right Side: sv '+ -� coT ��es Rear(Street): Left Side: Adjacent Structures: �o' -� Wetland: N �/'r Building Height: Def. Hgt. O.(c Peal:Hgt. ��i� Lot Coverage: � //-� Grading: Staff Approval Date: — By: Council Approval Date: Septic: Staff Approval Date: �I- Z�--� 'z- By: ��c,� Zoning FIle: # — Resolution: # Resolution Date: Shoreland District: �q�CS Avg. Setback: �� Bluff Setback: /'U�� L.ot Coverage: I✓�A Ezisting Proposed Hardcover: 0-75' 75-250' �•j� 250-500' 500-1000' Hardcover Variance Required: Yes No Date of Council Approval: REMARKS (in house): 7 . � BUILDING REV�W CHECK LIST �C� !/—� CONSTRUCTION TYPE: �'� Sq Footage $ Per Sq Ftg Basement x = lst Floor x = 2nd Floor x = Garage z = R - TOTAL Fstimated Construction Value: $ �O� Inspections Required: `Vork Requiring Separate Permits: Site Plumbing Fire Hardcover Removal Mechanical Water Connection Footing ' Septic Sewer Connection Framing Fireplace Lawn Inigation Insulation (Masonry) Other Wall Board (Mfg.) Well (State Permit) _�Final Grading/Filling Electrical (State Permit) Other REMARKS(IN HOUSE): --------------------------------- REVIEW BY OTHERS: DATE: Access: Existing New Access Approval: Date gy: ------------------------- REMARKS (TO BE NOTED ON PERiI�II'1�: 8 . � c`` � m �� ,�' �� i ' x � — -----�' � -`—,___._----___--__.___. _ \ I �� \`�� I �� I � a I I � � �e 11 1 � � a ' ,� y �� I r � �� s �' � �, c �� t�� /- c µ ' i � y \ C � � I � � \�J �; \� I � ---'_..-'" u \ -1 l f a' I � � F l, I -�� _-- •. �_ \��, > �_ _—c� a s J . \ ----- �-._� � __-.� c t �' L1 ��_ �'r R, M��SL�N f1 VE rn rt' n) �` 1� L!, , � � �� — ------�.. � / o� d� . � � __ _ _ _ "C� : �._ _- - � _-- - ---� --_----.,_ � _ ...___ _--___... -_------� _-----_ _ f� ____ __ . _ __ _..__ ..�_ __ _ __ ' � �._ �_______ _�__ __ ____.___�_ __�--____ _____._ r - -_.___._______----- _�__ _ _ _ � , , � _ � , , _ _ � , : __ _ , __ . I � � �. i n . �____ �____.__��__ � ; - ,� . ; � � ; � . , ,� ; . _ : � � �.___ G , _ '� � _ __ . __------�__ � .__ . __ . _ _ . _ , . � , O � , � � _ �_ � __ _� _ C _ , �__.______. � �____} ; -a - - _�_. __ ,� �_._. . __ _� � � � = i � ��_ � ___ _ � -� � � . � � _____..�_. __ � , � _ _��__ �_ � _ _- -- I : � �� ; _ , � _�._ ___ ---- -- . _ ..__._�_ - - - _ ___ , ��.A� '. � �� ,. . ',. �'. t . . ��., '�. 't . ' �. ��. ', ', ', � . � . " '. '. r e .. _ _. _:_..! _ .�. .. .. ... , .. ___._. _ _..._. ' _'._.'. . ..___....._._ ; __ _ ' _' � � . ..... ..�. � ... ......_ _.. _._._ __.. ._. ... . ........ . . ..... .�.. .. , . .. , . . . . . - . . ._.__.__.. _.___ . ... .._._. �. : . � � � , �. '�. :� , � . , . . .,, .,. ',, ',�. � � � � ' � � . ��. . .. ..... , ... . . . . .. . _% ... ._ . _:_ , . . � ........ ..... . . . .. . ... . . .. ... .... . . . . .. .._.. ... . __�.. ..:.. � , .. .,. .. . . _ . . . � . .. ._.�. ..._. .. .. . ..... .... ... _.._. .. ... . . _.... . � ` ... . ...__..._� __�..__._..----_._��"_.__.._........ �__l-- .____.'__�__ _;_ _._._. —_.�___�.----�_._;_._._ __._:________;_- ---------'--� __ ___._ 39tl1NVAQtl NOI1tlW8OdN1 � -� Scc�Le _ 4 - , --�- _ - _ _ _ ��O�l� `��✓' . ._. �_��. __ . _ _ ._ 4`�`' � � � _ VEN�' . ___ _ . � e._ . __ __ . G ; __. - __ ___ . .__ . f _ _�� _____.___ _-.__ _____�...____ _ � . ._ _ � . _- _ --__ _ __ l,J�� _ � ._ __ __ �m._ _. _ ____ . __. _. . _ - � ---- --, _ _. _ __ __'�__ j _. , _ _ __ y. _ _ ._.. _ � / �_.__ —_ � . . � � ._ __ _ � _ _ � � ; � : _ __ . �__..._ . . _..__ ___.,...___ ' I ' ; _ �.�_ __. _ f _. ! .___ , k ( i _ , i f _ � _ i } e _. _--�_._ ,� (� � rt �� LL � . /�'r _ _ _ _ _ __ _ __.__ G r o v n �W 0 L_cti y e rs o`� ��.�"�-�i h � �� ',��.�.1. �;�,�� S � � � � � 1('�;\ r. �'._ ►,�� '�: �'`�''C _ �'�'� ��' ' I � �� CITY OF ORONO HENNEPIN COUNTY, MINNESOTA OUTHOUSE AGREEMENT FOR Cc�_ C _ ��t�� 1 `� �!'��% n � (Property Owner's Name) �'�ia l �� .� .s � �� ,� (A ress) THIS AGREEMENT, Made and entered into this � day of prp� ".� , �C��'�.�- , by and between the City of Orono, a municipal corp iora on organized under the laws th State of innes a ereinafter called "City"), and - �. _ , their heirs, successors and assigns, (hereinafter called "Property Owner"). , WITNESSETH: WHEREAS, the Property Owner is the owner of certain property and has made application to the City of Orono for a Outhouse Permit for 440 Big Island WHEREAS, the Property Owner desires to obtain an Outhouse Permit. NOW, THEREFORE, in consideration of the premises and of the mutual promises and conditions hereinafter contained, it is hereby agreed as follows: 1. Issuance of Outhouse Permit: The City agrees to issue a Outhouse permit for the Property at this time, subject to conformance with all current City standards and ordinances for all applicable work. This permit allows for the applicant to have a mobile catch basin in the outhouse that must be pumped at a licensed facility when it is full. The applicant must provide receipts of pumping when the bucket is full. This must be done a minimum of once per calender year. If the applicant fails to abide by this agreement than the outhouse permit shall be null and void. 2. Binding Effect The terms and provisions hereof shall be binding upon and inure to the benefit of the heirs, representatives, successors and assigns of the parties hereto and shall be binding deemed covenants running with the land. References herein to Property Owner, if there be more than one, shall mean each and all of them. This agreement shall be executed by the Property Owner and City and shall be placed of record so as to give notice hereof to subsequent purchasers and encumbrancers of all or any part of the property, and all recording fees, if any, shall be paid by the Property Owner. .-�� 3. Notices: Whenever in this agreement, it shall be required or permitted that notice or demand be given or served by either party to this agreement to or on the other party, such notice or demand shall be delivered personally or mailed by United States certified mail (return receipt requested) to the addresses set forth below. Such notice or demand shall be deemed timely given when delivered personally or when deposited in the mail in accordance with the above. 4. Disclaimer bv Citv: It is understood and agreed that the City, the City Council, and the agents and employees of the City shall not be personally liable or responsible in any manner to the Property Owner or the Property Owner's contractors, subcontractors, materialmen, laborers, or any other person, firm or corporation, for any debt, claim, demand, damages, actions, or causes of action of any kind or character, arising out of or by reason of the execution of this agreement or the performance and completion of the Septic Improvements. 5. Hold Harmless and Indemnification: The Property Owner shall indemnify and hold harmless the City, the City Council, and the agents and employees of the City from and against all claims, damages, losses or expenses, including attorney fees, which the City, City Council and agents and employees of the City may suffer or for which it may be held liable, arising out of or resulting from the assertion against them of any claims, debts or obligations in consequence of the performance of this agreement by the Property Owner, its employees, agents or subcontractars, whether or not caused in part by a party indemnified hereunder. 6. Remedv for Default: Default by the Property Owner of any of the terms of this agreement shall automatically result in the suspension or withholding of all permits, licenses, occupancy certificates or other authorizations issued by the City in connection with the Property. A. The Property Owner hereby grants to the City, its agents and its employees, the right to enter on the Property for the specific purpose of monitoring the use of the outhouse. B. The remedies afforded to the City under this Section shall be in addition to any other remedies which the City may be entitled by law or equity or other agreement. � PERMIT CITY^OF ORONO 275C�. Ke�ley Parkway - PO Box 66 Permit Number: Po449� Crystal Eiay, Minnesota 55323 Permit Type: septi� (952) 249-4600 Date Issued: to��si2ooi SITE ADDRESS: 440 Big Island Excelsior, MN 55331 P ID: 23-117-23-32-0071 DESCRIPTION: Proposed Use: Residential Permit Class: General Permit Type: Septic Permit Sub-type(s): New Septic System DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: FEE SUMMARY: Permit Fee: $ 100.00 Vatuation: $ 0.00 State Surcharge Fee: $ 0.50 TOTAL FEE: $ 100.50 APPLICANT: Sather Brothers, Inc. (See Comments) OWNER: Pete Thorkelson 9255 County Road 19 440 Big Island Loretto,MN 55357 Excelsior MN 55331 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. I l� Ct�, � ��.a/t..- B ��r1/jryQ�/{,,. APPLI ANT P R ITE I NATURE I UED BY SIGNATi.JRE �� Copies: 1-File(Signitures Required), 1-Applicant, 1-MonthlyReports, 1-Assessing, 1-Finance Page 1 , c� �� ` ' ' '��? � �1:� ' _.� a^�� , � � (0� I`1 CITY OF ORONO SEPTIC SYSTE�I PER.i'��IIT APPLICATION� Bos 66 (2750 Kelley Park�vay) Crystal Bay, I�In 5�323 E ADDRESS �/ �•) ��/� �� v" JOB SIT � Occupancy Type: Residential �� Commercial Other Permit Type: New or Replacement System �100.00 i� Repair Esisting System $ 50.00 (Tanks or Drainfield) $0.50 State surcharge added to above fees * See fee schedule for non-residential permit fees Otiti-ner's Name: fl��. 70 � G�_SfifJ Phone I\Tumber: �/�— � 3�^ ��/U Mailing Address: Cr�r,�.,� V �- City:��£'�' U,�� ip: _S S�l� 7 �- Contractor's Name:�,��/��2 �'j/�'ss �;�,r' Phone I�Tumber: 7�3--y9�-7y�CC� NlailingAddress: �f�,�s �,�� /� City: �0.�£-7`f'o Zip: SS 357 *** DO NOT NI�IL PAYI�IENT`ti'ITH T�IIS APPLICATION*** GENERAL INSTRUCTIONS l. Applications for septic system permits may be mailed or submitted in person at the City Off`ices; ho�vever, permits will not be mailed out. The permit must be picked up in person at the City Off'ices and work must not be�in unless the permit card is on the job site. 2. Permits will be issued only to contractors holdinj a Minnesota Pollution Control A�ency(l�IPCA) Septic System Installers License. 3. All work must be done in accordance with the approved septic system desi�n. Desijn reports are not considered approved unless accompanied by the "City of Orono Septic System Approval" cover sheet si�ned by the City Inspector. 4. The follo�vin� inspections �vill be required for all septic systems: A. Pre-installation site inspection to include inspector, installer, and general contractor. B. Tank installation prior to coverin�. C. Drainfield trench installation prior to coverin�. For mounds, inspection is required after rou�h up but prior to sand placement(sand will be jar tested for silt content), and a�ain durin� pressure distribution pipin� installation in the rock bed. D. Final inspection to verify proper final cover depths and to verify that all pump stations (where required) components are functional and comply with codes. 5. Individual holding�fPCAlnstallers License shall be present durin�all inspections. A24-hour notice is required for all inspections. . � ' . NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate boxes. 1. I have received a copy of the system design includin� the City of Orono Septic System Approval Cover Sheet. 2. I�vill be installi�the following: /�, � A. Tanks: Y Precast Concrete Other Manufacturer/7��'�"SrSyS��S Tank Capacities: 1) �G'gal. 2)�gal 3)_�G gal B. Pump Station (if required) Pump make & model � p '�t � (attach pump curve& literature); system design requires gpm at feet of head. High water alarm make&model n;�- � Sc rt,' � �Outside electrical work to be completed by installer electrician'` other. _�-- C. Treatment System: Trenches: s.f. � Mound Depth of rock below pipe " Rock bed dimensions 10 ' x �.S' Drop Boxes Sand bed dimensions �S ' x 3�' Distribution Box Pressure Dist. Pipe Diam. I %z' " Manifold Pipe Diam. �-" " D. Final Cover/Topsoil to be: borrowed from site (show location on site plan) � trucked in The undersigned hereby applies to the City of Orono for issuance of a septic system installation permit, a�rees to do all �vork in strict accordance with ordinances of the City and the regulations of the State of l�linnesota,and certifies that all statements made on this application are complete,true and correct. Si�nature ofApplicant Date: �� r � � MPCA License No. �3�v -------------------------------------------------------------------------------------------------------------------------� Staff Revie�ti•: Approval � Denial Reviewer: '�1�`- � _ Date: � � — � 6" � � Reason for Denial: � , . SEPTIC SYSTEM APPROVAL � � . ;� �lV' � , � � ��+��;.� � O O R�� ' ��-::�' ��-- '� ='=r � �ITY of ORONO �.� 'II i'.;�a�j`'�5:�� - � j �� ` ' � ., `: 19 �: r _ t �, � ��,,� � ��'� ,�t4 � Niunicipal Offices � � yG �:� ,�� ?„ �. �:�� kz��r�, ,�� Street Address: Mailing Address: $'EggO � 2150 Kelley Parkway P.O. Box 66 �� . -._ticono MN 55356 C stal . ry Bay, MN 55323-0066 Owner ��1 T�,or kelSo� Phone (Home)763-5��-�`��(Work) Address '-4`-t� '��,� Zs 4a�� City O c o�o State Zip Site Evaluator�oscQ� olSo� State License # 4i 10 Phone# 763- yg$- �6��q Type of Establishment: Single Family x Multi Family Commercial Garbage Disposal Yes No�_ No. Potential Bedrooms a Est. Gallons Per Day 30� Water Meter Required: Yes_ No�( Soil Sizing Factor p,�b3 Perc Rates P-1 5.`6 P-2 9.3 P-3 P-4 P-5 P-6 P-7 Restricting Layer Depth B-1 �.5 � B-2 a' B-31.q ' B-4 B-� B-6 Type of Treatment System: Standard X Experimental Alternative Pressurized Mound System X At-Grade System Gravity Trenches System Pressurized Trench System Gravity Trenches W/ Lift " Pressurized Bed System Holding Tank W/ Alann Septic Tank Size IOoO # of Tanks a Lift Tank Size )00 v Pump Brand GPM_ � � Head � 7 Treatment System: Minimum (IT x�5�3y� Square Feet with � inches of rock belo�v pipe Type of covering Fabric_� Other THIS IS NOT A PERMIT. This is a design approval form which must accompany the site plan. A permit must be issued to a licensed septic contractor prior to installation. NOTICE TO INSTALLERS: Any changes to the approved plans must have prior approval of the inspector (952-249-4600) Call for inspection 24 hours in advance. ALL DRAINFIELD AREAS NIUST BE FENCED OFF prior to building site excavation and fencing must remain in place until final site grading. Approval to pour footings will not be granted until the Inspections Department has verified the primary and alternate sites are protected. NO VEHICULAR TRAFFIC OF ANY KIND is allowed within 20'of tested drainfield sites ever. ACCEPTED�_ DENIED By the City of Orono subject to existing regulations and thefollo�vingconditions: vyr.�„c� ;SS��d +-� 9a �.=�rl•� io' of T�c�-�r I:�cs G�J To ��o�- I:��S �-u �o 'C�CJJ��, ca�c� easen.��-�- . By: � oddc �1- 1�. - O � Matt Bolterman, On-Site Systems Manager Date Telephone(952)249-4600 • Fax(952)249-4616 www.ci.orono.mn.us . � , ,. Rusty Olson's--Soil and Percolation Testing ��,��,� .a..�r�oo�. �wra��l Joseph J. Olson--MPCA License#S10 ��DR�M�r�i�� 11481 Riverview Rd. NE, Hanover, MN 55341 (763) 498-8779 Fag{763) 498-8290 July 21,2001 Bill Tharkelson 440 Big Island Orono,Henn.Co. This on-site Sewage Treatment Systeru is designed for a Type 1,Two-bedroom home in accordance with the Mumesota Pollution Control Agency Chapter 7080 and local ordinauces. The soils on this site are SCS soils mapped-HbC-Hayed loam. The seasonally saturated soils were located at 18"-24"(moitled soil). IJue to seasonally saturatecl soils,a ptessutized Mound System wili need to be installed to treat septic effiuent. The bottom of the treatment area must be located at least 3'above the saturated soils. The soils at a depth of 12"have a percolation rate averaguig 7 MPI. All neighboring wells are located greater than 100'away from proposed treatment area. The new well for this property must have a well shaft greater than 50 feet deep. A variance will be needed to cross the easement.The supply line under the easement should be sleeved in a larger pipe to keep it from cn�shing if heavy equipment travels over it. A pumping chamber will need to be installed to lift the ef�luent to the treatment area. The power supply and switches must be located outside the manhole and pumping chamber in a weatherproof enclosure. A warning device must be installed with light and sound devices;this is in case of a pump failure. T1ie m�wifold and supply line must have back drainage to the pumping chamber. The distribution pipes shall have their ends capped. Be sure the rock and sand fill materials are clean. The sod layer below the entire mounded area must be turned over,just break up the sod and be sute not to over work. Kez�all heaw,��,��'�,oment off of th�prop�� ' �atment area�before during and after con�trucrion The ar�� n.v.nnn hnth�,tP�mLat he fenced off �y the contmctor before�ny constn:ction be�ns This Dest�n is nQt valid and the Systsm y!��1 ne�ri t4 be relocated if fai�m tq�rotPct the areas pronesed for On-Site Sew� Treatment occurs. With proper installation and maintenance,this system should have no problem in treating septic ef3luent et�ectively. Nottung other thau gray water,(laundry,showers,etc.) Human water and toilet tissue should be disposed of into the septic tanks. Garbage disposals are not recommended. Additives must not be used;they may cause hannful damage to your septic system. It is recommended that you pump the tank everv year for i tank every rivo years for two tanks. incerely, i� "Jos�ep J.Olson �� Percolation Test Data Sheet Lic.#810 Percolation test readings made by: Rusty Olson's Perc. starting at 10:15 A.M. On 06/28/01 L,ocation: 440 Big Island Hole number: 2 Date hole was prepared: 06/27/01 Depth of hole bottom_12"_inches, Diameter of hole_6"_inches. Soil data from test hole: Depth, inches Soil texture p_g^ Dark brown loam 10yr3/2 g��_24�� Brown loam 1 Qyr4/4 Method of scratching side wall: Knife Depth of gravel in bottom of hole 2 inches: Date and hour of initiai water filling 06/27/01 At 1:30 P.M. depth of initial water filling 12 inches above hole bottom. Method used to maintain at least 12 inches of water depth in hole for at least 4 hours Automatic Siphon Maximum water depth above hole bottom during tests 6 inches Time Time Depth Drop in H20 Perc Rate 10:30 10:45 6" �•6 9•3 10:46 11:01 6" 1.6 9.3 11:04 11:19 6" �.6 9•3 AVERAGE PERC. 9.3 �r�F o�orrv� �c� ��► t�vsrEcra& � AATB �o-i,,,,,,, �...,:�.�.,�pERMiT I�tt� ��swsMrrs� �cn►sA�Re�� TMe.e oe�ena�.br yow iol6eaa�ie�. Aa x��11�s�.�r ia PoN a�npli�na rrid�dl spplicabls�eptle a1i mnioi ca1r. �eqaitemeab iaclndl�itsms oot speciticsUy ewt�i in Wi�wripli. �EB►TNIs►LAI�i iBT Gi�i WTB AT AU.TiMis Percolation Test Data Sheet Lic.#810 Percolation test readings made by: Rusty Olson's Perc. starting at 10:15 A.M. On 06/28/01 Location: 440 Big Island Hole number: 1 Date hole was prepared: 06/27/01 Depth of hole bottom_12"_inches, Diameter of hole_6"_inches. Soil data from test hole: Depth, inches Soil texture 0-8'� Dark brown loam 10yr3/2 g"-24" Brown loam 10yr4/4 Method of scratching side wall: Knife Depth of gravel in bottom of hole 2 inches: Date and hour of initial water filling 06/27/01 At 1:3Q P.M. depth of initial water filling 12 inches above hole bottom. Method used to maintain at feast 12 inches of water depth in hole for at least 4 hours Automatic Siphon Maximum water depth above hole bottom during tests 6 inches Time Time Depth Drop in H20 Perc Rate 10:29 10:44 6" 2.7 5.5 10:47 11:02 6" 2.6 5.7 11:03 11:18 6" 2.5 6 AVERAGE PERC. 5.8 Loas of Soil Borinqs License#810 Location or Project: 440 Big Island Borings made by: Rusty Olson's Soil and Perc testing 6/27l01 Classification System: AASHO ; USDS•USDS-SCS X ; Unified ; Other Auger used (check two): Hand_X_, or Power , Flight, or Bucket_X_ Boring Number_1_Surface elevation_100.3_ Mottled Soil at_,1.5_feet 0"-8" Dark brown loam 10yr3/2 H2d present at_X 8"-18" Brown loam 10yr4/4 18"-24" Rusty brown loam 10yr5/4 24"-38" Rusty brown loam to ctay loam 10yr5/4 Boring Number_2_Surface elevation_98.8_ Mottled Soil at_2.0_feet 0-8" Dark brown loam 10yr3/2 H20 present at_X 8"-24" Brown sandy loam 10yr4/4 24"-36" Rusty brown loam to cfay loam 10yr514 Boring Number_3_Surface Elevation_10d_3_ Mottled Soil at_1.9_feet 0-8" Daric brown loam 10yr3/2 H20 present at�x_ 8"-22" Brown loam 10yr4/4 22"-36"Rusty brown loam to clay loam 10yr5/4 � � � . PUMP SELECTION PROCEDURE 1. �Determine pump capacity: A. Gravity distribution L Minin�um required discharge is 10 ��ii� 2. Maximum stiggested discharge is 45 ��m. For other establishments at least 10% greater than tl�e �vater supply rate, but no faster than the rate at which effluent ��ill flo�� out of the dis'rribution device. B. Pressure distribution See pressure distr�ibutio�2 wor�k sheet From A or B Selected pump capacity: / � gpm 2. Determine pump head requirements: A. Elevation difference bet��een pump and point of discharge? soil treatment system &point of discharge � I feet a��a`��_a� B. Special head re�uirement? (See tigiire nt right - Special Head Requirements) total pipe length � feet 2A.elevation inlet ` *` difference C. Calculate Friction loss pipe .: ------- -;� 1. Select pipe diameter o�. in `� .. .. ............... ... , - ------------ ------ ,,� �---------------- 2. Enter Figure E-q��ith g-pm (lA or B) and pipe diameter (C7.). Read friction loss in feet per 100 feet from Figure E-9 Special Head Requirements Friction Loss = • .�'3 ft/100ft of pipe Gravity Distribution 0 ft 3. Determine total pipe length from pump discharge to soil rreatment Pressure Distribution S ft discharge point. Estimate by adding 25 percent to pipe length for fitting loss. Total pipe length times 125 = equivalent pipe length rE-9: Friction Loss in Plastic Pipe �f�_feet x 1.?� _ �_fe�t � Per 100 feet 4. Calctilate total friction loss b�� mtiitiplying friction loss (C2! nominal in it/100 t't bv the equ;valent pipe length (C3) and c�i�'ide bv ll)U. pipe diameter _ , -� 3 ` " flow rote 1.5° 2" 3" _ __ tti�1(l�ft x �CU =10G = __ � f� pm D. T�c�tal head recuired :s lhe st._m ef ele��ation diH�rence (A), s}:�rcial 20� 2.47 �'0.7 0.11 � he�d requiremcnt� (�), an;7 total frict�on ]oss (C4` 2� 3J3 1.11 0.16 --L� f h ' I'" 5.23 1•.55 0.23 --- ---`----'}t -- --�----r t =:. �v�� 3� 6.96 2.06 0.30 TOId� 1?E'3c�: -- _.L--`-- ;�et 4C 8.91 2.64 0.39 , ...-...�..._._......_._._._,� - ------- ----- R �47 1 1.07 3.28 0.48 �i3. Puri�p se��c�ct�c��t ; - �; ; '��; 13.40 3.99 0.58 I � 4.76 OJO �� . �.� , , ,�� . ,� �I� �- '�� '.r��i�. f�r ��1 1��f �_� _��rz� �� 5.60 0.82 Fi . _... '___ , . � \ ... ' .. . fi`f'f i?j il)f�ll �Zl'�l:j „��-,,. �� , , f�� :� i,- r� a� 0�5 , , �'� --- - _ _ _ _ _-- -_ -----------------' � ---- 44 1.09 __..__..�Y.....�__....__..�....w�,..._. _.__.__ _---- ---' ___ _, :n� � .,i� ;�, , rii �� , .in�] I�,t�. -- ^I i . �/ i : . . ,� � � _- , _�- � , �.; ,_ ,, . � : .. � ��,<<, , . � „ . , � � ` . , , _ -� --- ------ „�. _____ � ' ' PRESSURE DISTRIBUTION SYSTEM Geotextile fabric � 12 �. 1. Select number of perforated laterals v Uarter inch erforations s aced�3' 9"of rock 2. Select perforation spacing = � ft Perf Sizing 3/16"- 1/4" 3. Since perforations should not be placed closer than 1 foot to Perf Spacing 1.5�-s� the edge of the rock layer (see diagram), subtract 2 feet from the rock layer length. E-4: Maximum allowable number of 1/4-inch perforations �� per lateral to guarantee<10�discharge vanation Rock la er len th � Y g -2 ft =�_ft pertoration spacing 4. Determizie the number of spaces between perforations. teet 1 inch 1.25 inch 1.5 inch 2.0 inch Divide the length (3)by perforation spacing (2) and round �iown to nearest whole ntunber. 2.5 8 14 18 28 Perforation spacing= c�� ft- � ft=�_spaces 3.0 8 13 17 26 5. Number of perforations is equal to one plus the number of 3.3 � �2 �6 25 4.0 1 11 15 23 perforation spaces(4). Check figure E-4 to assure the number of 5.0 6 10 14 22 perforations per lateral guarantees <10% discharge variation. / SPaces + 1 = L�5" PerforaHons/lateral E-6: Perforation Discharge in gpm 6. A. Total number of perforations = perforations per lateral (5) perforation diameter times number of laterals (1) head inches (feet) 3/16 7/32 1/4 �_perfs/latx ? lat= r; �--i perforations 1.Oa 0.42 0.56 0.74 B. Calculate the square footage per perforation. b Should be 6-10 sqft/perf. Does not apply to at-grades. 2•0 0.59 0.80 1.04 Rock bed area = rock width (tt) x rock length (ft) 5.0 0.94 1.26 1.65 '� ft x �� ft = ��'� sqft a Use 1.0 foot for single-famity homes. Square foot per perforation = Rock bed area =number of perfs (6) b Use 2.0 feet for an �� ei�. a 5� sqft= �� perfs =1�sqft/perf MANIfOLO IOCATED AT ENO OF PRESSURE qSTPIBUTION SYSTEM 7. Determuze required flow rate by multiplying the total number of perforations (6A) by flow per perforation (see figure E-6) �K .� �_perfs x � ?'� gpm/perfs = � gpm � 8. If laterals are connected to header pipe as shown on upper ,,�,��'" � �,� �,.^��, example, to select minimum required lateral diameter;enter �M,�""" figure E-4 with perforation spacing (2) and number of perforations ��` per lateral (5) Select minimum diameter for UrOUT 0� K�IOnnTEO�iPf LaTEn��S!OR perforated lateral -_j_ inches. ""`5=,�`o�s�a�e��o« w�a�.o a�u .� 9. If perforated lateral system is attached to manifold pipe near �.�.,�.,,.�„p��o,.. ^` EM S�n�wt[� �wrh.!� �- AK��r� � the center, lower diagram, perforated lateral length (3) and °"w °��"" � r W.;,,ao n number of perforations per lateral (5) will be approximately one K��;,«�,«.�.�.,�� half of that in step 8. Using these values, select minirnum '° '�" - ._,�.��;��„�,�, diameter for perforated lateral = �_ inches. � � b. ,a„` �„irto Y�Mn . \ `�M d � .� �� I hereby certify that I have completed this work in accordance with applicable ordinances, rules and laws. � . �___ �-� ;: " _ (signattue) -- �� _(license �) __(date) � MOUND SLOPE WIDTH & LENGTH Landslope > 1% slope J. (landslope greater than 1%) o��r� Downslope absorption width = absorption width (F) o;' bo�o ooe°o � 6"Topso❑ �unus rock layer width (D2) __,_. ��Sand-f� ' �; ft- /o ft = /v ft pareHon h R<=�M��,g�Y« _'_._, UpsbpeWdlhF1G2d) Rock H'Idlh(D2) �"^�sbpeM'idN(N2i) Calculate mound size " 7 PSLOPE Depth of clean sand fill at upslope edge of qbsorytionWidflh-Sand(F� ,�ck layer = 3 ft minus the distance to restricting layer (C1) � ft- l�S ft= /.-� ft Mound height at the upslope edge of rock D-34: SLOPE MULTIPLIER TABLE :yer = depth of clean sand for separation (G2a) �.�,d UPSLOPE DOWNSLOPE Slo e multipliers for various multipliers for various t upslope edge plus depth of rock layer (1 ft) �� slope ntios slope ratios (us depth of cover (1 ft) 3:1 4:1 5:] 6_1 7:1 B:1 3:1 4:1 5:7 6:1 7:1 � ft + 1ft+ lft = 3-S ft o s.o a.o s.o �o �.o s.o s.o a.o s.o 6.0 �.o Upslope berm multiplier based on land slope 1 2.91 3.85 4.�6 s.� b.s� �.4� 3.09 a.�� s.z6 b.� �.ss - f y (see figure D-34) 2 2•83 3.70 4.54 536 6.19 6.90 3.19 4.35 5.56 6.82 8•14 Upslope width - berm multiplier (G2c) times 3 2.75 3.57 4.35 S.OS 5.79 6.45 3.30 4.59 5.88 7.32 B•86 4 2.68 3.45 4.17 4� 5.46 6.06 3.41 4.76 6.25 7.89 9.72 aslope mound height (G2b): 5 2.61 3.33 4.00 4b2 5.19 5.71 3.53 5.00 6.67 8S7 10.77 �� x a.�� ft = �_ ft 6 2. 3.23 3.85 4.41 4.93 5.41 3.66 5.26 7.14 9.38 12.07 . �OWNSLOPE 7 2.48 3.12 3.70 4�3 4.70 5.13 3.80 5.56 7.69 10.34 13.73 Drop in elevation = rock layer width (D2) times 8 2.42 3.03 3.57 4A5 4.49 4.88 3.95 5.88 8.33 1154 15.91 -�rcent landslope (C5) = 100 9 2.36 2.94 3.45 3_90 4.30 4.65 4.11 6.25 9.09 ]3.04 18.92 '%� ft X �j %= 1�� _ ' � ft 10 2.31 2.86 3.33 3.75 9.12 4.44 4.29 6.b7 ]0.00 ]5.00 2333 Downslope mound height= depth of clean n 2.26 2.78 3.29 3.61 3.95 4.26 �.48 7.14 ]l.11 77.65 30.4: nd for slope difference (G2e) at downslope � �1 2.�0 3.12 3.49 3.80 4.08 4.69 7.69 12.50 21.43 43.75 �ck edge plus the mound height at the _�slope edge of rock layer (G2b) �?.�' ft + - L ft = `�- � ft Downslope berm multiplier based on percent land slop ScE �s�;,„ ��?, (oG (see figure D-34) � '��`�� . - Downslope width = downslope multiplier - vPS,oPe Width(G2d) f� ;2g) times downslope mound height (G2� ! _,:,(�G X�`.�_lt = /� �t � � Rock 8ed Upslope Width(G2d) ��! m Upslope Width C2d Width(D2) ft Select the greater of Gl and G2h as the � " Length(D3) �wnslope width: �� ft a ��nslope Width(G2i) f� Total mound width is the sum of upslope Abso�ph�n W;dwcF,�y idth (G2d) width plus rock layer width �2) plus downslope width (G2i) Total Length(G2k) f� �_ ft + � ft + �ft = � ft Total mound length is the sum of upslope width (G2d) ��s rock layer length (D3) plus upslope width (G2d) ft + �`r ft + 9 ft = �_ feet -- as ' =�� ss' Final Dimensions: ��' ��-; x �i� 4�..f„ .:y �� :t�reby certify that ] have completed this work in accordance with applicable ord:nances, rules and laws. i% --^�%"�-- .- �/ - %; - ' ` �/ ---- (signature) �"�� (licen«� = _ _. __ _(date) ' � � MOL�NI� DESIGN WORK SHEET (For Flows u to 1200 d) A. Average Design FLOW A-l: Estimoted Sewage Flows in Gallons per Day num er o Estimated �J gpd (see figure A-1) bedrooms Closs i Clau II Class III Closs IV or measured x 1.5 (safety factor) = gpd 2 300 225 �eo � 3 450 300 218 of the 4 600 375 256 values B. SEPTIC TANK Capacity 5 750 450 294 in the 6 900 525 332 Class I, �-/Uoo allons (see ure G1) � �� 3�0 ��, or u� g �$ 8 1200 675 408 columns. C. SOILS (refer to site evaluation) C-l: Se ticTaokCa acities('m albns) liquid capaciry Number of Minimum Liquid Liquid capaciry with W��disposal& 1. Depth to restricting layer = �.S feet B�i00� �P�'ry S�age disposal lift iaside 2. Depth of percolation tests = /,v feet z o�iess �so >>u �Soo 3. Texture /,..�a•�-� 3 or 4 �000 �s� z000 5 w 6 1500 2250 300p Percolation rate � mpi �,8 or 9 Z000 3000 4. Soil loading rate �� gpd/sqft(see figure D-33) 5. Percent land slope �� % D. ROCK LAYER DIMENSIONS 1. Multiply average design flow (A) by 0.83 to obtain required rock layer area. � gpd x 0.83 sqft/gpd = �s� sqft 2. Deternvne rock layer width = 0.83 sqft/gpd x linear Loading Rate (LLR 0.83 sqft�gpd x a �pd/sqft = �v ft Mound LLR 3. Length of rock layer = area =width = sv sqft (D1) = !v ft (D2) _ �-�" ft < 120 M PI < � 2 E. ROCK VOLUME > 120 M PI < b 1. Multiply rock area (Dl) by rock depth of 1 ft to get cubic feet of rock ��v sqft x 1 ft = a� cuft 2. Divide cuft by 27 cuft/cuyd to get cubic yards a� cuft = 27 cuyd/cuft = /o cuyd 3. Multiply cubic yards by 1.4 to get weight of rock in tons /U cuyd x 1.4 ton/cuyd = �`� tons D-33: Absorption Width Sizing Table II i F. SEWAGE ABSORPTION WIDTH PcrcoletionRa�c �d;�gRe« in Minutcs{xr Soil Tcxturc Gallons Absorpuon Inch {xr dsY per Ralio � MPf uarc foai Fastcr than 5 Coaru Sand 1.20 �� Mcdium Sand Absorption width equals absorption ratio (See Figure D-33) LoemySand times rock layer width (D2) ,b��3o Loam o.� _ Z� 31 to 45 Sill Loam 0.50 2,40 n ( � 46�0 60 Sandy(7ay OAS 2.6% � )( � 1 t - 0'� Et Silly Clay Lonm 61�o I20 Siity Clay 0.24 5.00 Sandy Clay CI� ._.. ..__--. . SI�wcr than 120' ---- -—�— i •Srs�rn�dolpnea br N«wds nu.�rK«ncr o�rcrlomucxa 1 . �y �._ , ------ : :,,.;` _ ', � ; � � ,t r� ��ov G i s ot l . �� Iin 'V r)JJD )l/G7 �)�<`��9 UC)9 ) �JIIII � �� • � ,;;;,�1 �, � �� t IK > , I� 21 /. u�f ini :.r. �;«c� � � f,:�NHbt (iI9) � � � , , - —�-- �� l'�� ?J /�r�'a IT� N N NOl�(V rd;��,:. --- - ��r o � ; _ _ ��C�� ;Z-� �---'-- � ----�--. �-=—�<.k 1---t�-r�y n ' ' i'� ',��:,, � � �r� � �,;- � '= a' /� �ro�ls�Y� � \ . . �� J/� I s� 17i i ? an P�no�6�apun 1 C e ��aUJ �� :' S�;�-�o � , �o Q /�� o=Hs I -Q ��lr � ,'"� ��Na.;�'s .R5� ��--i � ��ueurpip ie�o'I '� OBOL =a�dey� ,�, \ <h��`_" �;-- ' -,�M �w�'_`y P�,�� '�o'�^u°d o�<'��v�yr �VI �p �esb, /�"�;� a,,��1 � i �w o� ��n��sum �q ot y u��s1.s � _��oN F i+ /�w � � y�,�� 'sb� \� � - '--'' �r"y � . � .t,� �S�W �8� � �F v, .- ��r� - 1 �� s?�L_. �4' . f�..-�i�y-�v.?�d� ��^ F � . Sbu�og �!�� F,s i�„ { :�o�s sis�l uo±l�p�rad B �� / ��.� ;sE. `-- :7na��s '�ny �7oSessd�,y . h -;Z _ =} � o �,s �,i , .;� ' < Y� �� / �wai ; y. ,w��:��` a�Sa,riid I S 1�} i ' h �' S ;�o�d , � a s6 0,7•G�'7/-/17� . � r /�+c>c i _'C`: -;C�4 :�,�/�� W�l5J,S c/?'>o,�m y d 3 I ��. U r � v , � I . � I w ahrir J �l i .L � i 110W / I �\-i �� (� _ ?Srnt^ i�1'•��' pas�' �'�� I � I I I I i � � �i� , I � � i I � � � � _ _ ___ __ _ _ . _-- _ . _ _ -_ - - _ _ ------------- • r '� ` -, �i ' — —_ ,a .___.—.._. _______ . c � 1 � � •.. —�IrSB-_ �\ — — -- �- ";o� � T . . �'� �K�o �;�' ;'J�o-� -� r/oa, � IJ'� � ,�:�__� .'n �_ .6 — �'f / �� ,L �o� v-,7 � 'F - � rn..<c ctr-r,n.i Y7Fk' __ I I HauSE �� * ew�a.: f.w+. _ ��I au.r.�ald. W�efl�t fl10df�; . . � Slfit �r_��r �s c � '2�,/ :_ • 3--f ss o, _ �;oa_ , SOIL BORING ELEVATtONS - ,, , 9$0 � o,. ,c..+cr n� t THIi EL-.�3 .I~++K -�� '� �`Srntr A�n..sr at t..�e to THl2 EL_qF 6 ee�.� t..T s.c.,� w�.�...� .e.. o�..., TH,/1 EL -_ � qa.a' TM.,u E�..-_ - TM.,rs�..-_ �t.ss Q.-_ . Sf33 too. z �ET-BACKS System mcttt be: Tan �d 'from propetty 16nes � � •rrom w�eus �'from bldqs. �.�ams cv+cr�iu nFSK�N•M�UND �+tattnetrt at+�a PK¢�•d��_� �O� T�eatrn�nt anea - ' from Wces,_ 7YPE��/ .��.��P�R��tNtlJtnch (QastQtt.t3�.R• ♦ Trcatment arca�' trom proPertY Ilnes :��y x.0 s�.Rlg�t.��st}.R.of cna�nt ana (�t o rt.�■a�rt.k rt��" . �c, • rron, w�e t�s �iJop�ntt� 3 to 1 x�ttatflhts�R x 7az R t:wn ar�ea r,aede� -- tnuudns r or rnck abo,ro f �o ' f� bldfls. ' C,ltsn t+odc nesdtd–a.=�sR-R trstt[ttant area x l ' e . � cv.lLJ 2T� /a cu.Yds- 3!<'to 21f2"dii., P Pa) P��k �=. to o(I 6"�i cu. Avera e sand de th .-,�'i, � from trres tkat�sand(UI baluw rock !D/ fo�trt b a c h f i � cu.y ds.app�x-��Ps J�� ✓;,, ��- 0 P .1�� Coats�vr�st� YCs.iPProx. . s�r►�Y ,a G�.%!�. N u r�b e�dtanks re qulneQ � . tst tank/vrx�y a L,2nd tu�k /r��%fl a J. m i ntm�ms p(us pumP�fl chamber I % . � a� * �eM ctorafls of 1 6 0 fla l B R s� W�- ♦ p i p o b a c k d r z i n a fl e— p�npinfl Chambet upattf�►–Z6%ot da.(ty stwage tio�yn of�yaL � 9 dka. I t(n.R nooda d 2. al. i i o( 1�a11f00[irt.R of � 'dla. strPPh'P�RQ. �n- ne*Ced �� , i qal + mu►Ifo�L flalJ100 Iin_ft of a� P P�, --Z — fl — �ctQeC._'�`!pal. (plus area fo� c Date:7 /al k�� , Ph. 612�98-a290 � tortsdupj�Y ;� P�PI�s+ min. •'pU c� �al.up. pROPER7Y OF:�tii�� Tl�`o? ��L_��___ Rusty Olson's oil and Percolatlon TascJnp � 0{stttbt�ot� P�P��'__ .:z-:i'�-�-.—._� I- ratlOns ?Iy " t rt `r' 1.y ,'; � �... � �v cu. rto � =-��;o �',r T;�,,,v�� — �:i��a ay: i�r 1 �,e_..----�� i pump stzt_hP- iPumpab{� upac.tty ��-�qil � cytks/dayl ��o o i-{ENI-� C� � ---- � � � ��s� �� :,� .� ,s� - -"'' , _?�� ;�. , PERMIT �I�Y O F O RO N O Permit ►vumber: 2750 Kelley Parkway - PO Box 66 Po334o Crystal Bay, Minnesota 55323 Permit Type: Accessory Structures (612) 249-4600 Date Issued: i2iti2oo SITE ADDRESS: 440 Big Island EXCELSIOR,MN 55331 P ID: 23-117-23-32-0071 DESCRIPTION: UBC occupancy U1 Construction Type VN Proposed Use: Buildin Census Code 328 Permit Class: g Permit Type: Accessory Structures Permit Sub-type(s): Shed DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: FEE SUMMARY: PermitFee: $ 9�25 Valuation: $ 4,000.00 dj'� IC�-r� Qx� • (��j- I� State Surcharge Fee: $ 2.00 TOTAL FEE: $ 162.43 APPLICANT: PETE THORKELSON OWNER: W L&P A THORKELSON 4851 DAWNVIEW TERRACE 440 BIG ISLAND MINNEAPOLIS, MN 55422 EXCELSIOR MN 55331 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. �^ � � 4�AlL �D< <.{� �� -�-�_ ��'��c ��r�c�� APPLI ANT PERMITEE SIGNA�E ISSUED BY SIGNATURG Copies: City,Applicant,Assessar, Finance Page 1 � �'otal Fee: $ %(�,,� �� Date Received: '�� ` ��`'` �'`�1 � ` �-�`� ��'��-' • Entered By: -T'W ; Permit#: �� >��— ��"�`/ � ��,(k ,�( �r;i�� ' �,i j �� = _��l � '` �� CITY OF ORONO - BUI�DING PERNIIT APPLICATION All information must be submitted in full before plan review will be started. (please print all information) � --------------------------------------------------------------------------------------------------------------- THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR JOB SITE ADDRESS: y�{1�,,�/ -1-�'�-°`��"� � ZIP: - NAl�IE OF OWNER: �//�+�/rtq ��',�'�� {�d/'0�'�'�.,.`�.�,r�HONE: (home) �,�a=i��`�86 (work) MAILING ADDRESS: ��/�awn V iG�1/��=CITY: GS_ ZIP: �`f y,2�, CO\"TRACTOR: O1 Q I�e,. PH01V�:_ CO`�TACT PERSON: NIOBILE/PAGER: NL4II.I�i 1G ADDRESS: CITY: Z�: ST�T'E LICENSE: # P�„�� ` ARCHIT'ECT/ENGINEER: /) 0/�1�., PHO ��, -� w��P S �IAII,ING ADDRESS: CITY: NA.`IE: REGISTRA7 �'�D l�`'sS � � �,,,��s � TYPE OF WORK: New Addition Acces: ► Move Remodel/Alteration Land Alteration PROPOSED WORK(describe in detai�: /oZ � � � s C��'G� �/�� U� l.v� f�1 C L� c�c� /O ' C� ' 4f�h , c�,. �,�� ca.� C r7 i"4r7'�: STORIES: �_ SQ. FEET OF EACH FLOOR: ��/ NO. OF BEDROOMS: Q � GARAGE STALLS: ATT. DET. ESTlI�IATED CONSTRUCTION VALUATION (excluding land): $ � C �� I hereby apply for a buildin�pernut and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City and with the State Building Code; that I understand this is not a permit and work is not to start without a permit; and that the work win be in accordance with the approved plan. APPLICA1tiT'S SIGNATURE: ��r�� DATE: I I -- �� - � �; � �tTT� �.t.. �r- _�... NOTE! Parade of Homes events require separate permit approval by Police Department and City Council 60 days prior to the event. Non permitted events will not be allowed. 5 � Sec.13.04 RIGHTS OF SUB,JECTS OF DATA � ' ' Subd. 1. Type of data. The righcs of individual on whom the data is stored or to be stored shall be as set forth in this secdon. Subd.2. Information required to be given individual. ?.n individual azked to supply private or confidentiai data conceming himself shall be informed of: (a)the purpose and intended use of the requested data within the collecdng state agency,polirical subdivision,or statewide ryscem;(b)whether he may refuse or is legally required to supply the requested data; (c)any Imown consequence arising from his supplying or refusing to supply private or confidenaa!dara;and(d)the idenary of other persons or endues authorized by sra[e or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investigadve data, pursuant to secdon 13.82, subdivision 5, to a law enforcement officer. 'Ilie_c_ommissioner of revenue mav olace the noace reauired under this subdivision in the individual income taz or orooercv tax refvnd instrucrions instead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as pubiic,private or confidential. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the data without any char;e to him and, if he desires,shall be informed of the content and meanin�of that data. After an individual has been shown the private data and informed of its meaning, the data need not be disclosed co him for six months thereafrer unless a dispute or acaon purnant to this secoon is pending or addirional data on the individual has been collected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority may require the requesring person to pay the actual costs of making,certifying,and compiling the copies. Thz responsible authority shall comply immediately,if possible,with any request made pursuant to this subdivision, or within five days of the date of the request,excluding Saturdays,Sundays and legal holidays, if immediate compliance is not possible. If he cannot compiy wi[h the request wirhin that time, he shall so inform the individual, and may have an addidonal five days within which to comply with the request, excluding Saturdays,Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contes[the accuracy or completeness of public or privare data concerning himself. To ezercue this right,an individual shall nodfy in writing the responsible auchoriry describing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correce the data found to be inaccurate or incomplete and attempt to notify past recipiena of inaccurate or incomplete data,including recipiencs named by the individual;or(b)nodfy the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determinaaon of the responsible authoriry may be appealed pursuant to the provisions of the adminis�ative procedure act relating ro contesced cases. DATA PRIVACY ADVISORY In accordance with N1.S. 13.04, Subd. 2, "Rights of subjects of data", we would like to inform you that your request for a permit or license from the City of Orono or any of its departments may require you to furnish certain private or confidential information. You are notified that: 1. The information you furnish will be used to determine your qualification for the permit or license requested. 2. You may refuse to supply data, but refusal may require that the City deny the permit or license. 3. The information may be shared with other local, state or federal agencies to the extent necessary to process the pemut or license. 4. If your requested pernut or license requires Council action to approve, some information may become public. �. You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself. 6. Your full name is required to process this application or permit. First Middle Last Address Ciry State Zip Phone I understand my rights as stated above. Signamre 6 � CHEC� OFF LIST FOR ISSUA��'CE OF PERtiIITS : FOR OFFICE USE ONL,Y � . ADDRESS OR LEGAL: y� � �r�, �s c..g.v►'� PID: DESCRIPTION OF�ORK: 5��,�� . ZOti�'G REVIE��% BY: ,,,_ _ DATE APPROVED: / z -i �c�o BUILDI�'G REY�� BY: DATE APPROYID: c z� � =c� FEES TO BE CH.4RGED: biisc. Fees Calculated By: pEgIVIIT Yes ✓' No :� pL�,N REVIEW Yes v No SEWEEZ C0�INECTION _ STATE SURCHARGE Yes v- No WATERCONNECTION I'�i,'VESTIGATION FEE Yes No PARK FEE SAC Yes No SITEINSPECTTON Number of SAC�Units OTHER (specify) ZO�T-.V G CHJ�CK LIST zoni.ng Dis�icr. 2 S Fire Department: l,or�� L��.:. Post Office: �U N s� School District: �� Lot Area: Sq.fr. �-t�3��31 Acres I . �Z Widch I i2�'Z-�=�v c�.2 Depth Surve; Sub.Litted: Yes No Da[e of Survey: Proposed Setbacks: � 1^2u�. R,,��'r-�c-wA�� F.oe[(La.ke): 2 3 Ri;ht Side: �1 S' Rear (Street): i 0�' �' Left Side: ��-�8 Adjacent Structures: `-�� o�r (�°��Vetland: N �a � • BuLdin� Hei�hr. Def. H�c. �•�� Pea.�Hgt. -' Lot Covera�e: N �f} Gradin�: Scaff Approval Date: �l�r4 By: — Council Approval Da[e: - Septic: Staff Approval Da�e: /J�t� By: - Zoaing File: � Ze.Z-1 Resolution: � Resolutioa Date: ll-1'�-C�O . Shoreland District: u�,s Av�. Setback: p.1c Btufi Se�back: ,.� I/�T L,o[Co�'era�e: E��? Proposed Hardcover: 0-7�' 75-250' �,`� 2�0-500' 500-IOQO' Hardcover Vari�ce Required: Yes No_�� Dat� oF Council Aoproval: gE�iAR�;.,S (in house): 7 . BUII,DING REVIEW CHECK LIST usc: v - 1 - co�vs�xuc�ov�E: �i r� Sq Foocage $ Per Sq Ftg Sasement z = lst F1oor z = 2nd Floor z = Garage z = x = TOTAL Estimated Construction Value: $ �i (�c�o �= InspectiorLs Required: ��ork Requiring Separate Permits: Site Plumbing ' Fire Hardcover Removai Mechanical Water Connection Foocin� Septic Sewer Connec[ion Framin� Fireplace Lawn Irrigation Insulation (Masonry) O[her Wall Board � (Mfg.) Well (State Permit) oL Final — �o.�C. ��'L�� Grading/Filling Eteccrical (State Permit) Other P°' RE��IARKS (I�i 1 HOUSE): � REVIEW BY OTHERS: � DATE: Access: Ezistin� New Access Approvai: Date By: RE�'L4RKS (TO BE NOTED ON PERMI'1�: 8 Total Fee: $ Date Received: Entered By: Permit#: � CITY OF ORONO - BUII..DING PERMIT APPLICATION All informatioa must be s�bmitted in full before plan review will be started. , (please print all information) THE APPLICA.I`'T IS: (circle one) OWNER 4R CONTRACTOR JOB SiT'E ADDRESS: 440 Big Island Z�. 55323 NANiE OF OWNEB: Willmar Thorkelson 612-588-2486 PHONE: (home) (work) NiAIL�IG ADDRESS: 4851 Dawnview Terrace C�; Golden a ey Zg�; CO1VT'RACTOR• Peter Thorkelson (builder) pAO�. 612-588-2486 � CONTACT PERS4N: MOBTLE/PAGER: MAII,Il�'G ADDRE.SS: CITY: Z�: STATE LiCENSE: # (Building was designed and constructed by Peter Thorkelson.) ARCHITECT/ENGINEER: PHO�IE:. MAILING ADDRESS: CITY: ZIP: � NAIVIE: REGISTRA►TION# TYPE OF WORK: New Addition Accessory Structure X Move RemodeUAlteration Land Alteration PRUPOSED WURK(describe tn detai�: Construct shed (24 x 12) for storage of garden equipment. Shed to include screene si ing porc . o in en e or residence. No utilities or services will be connected to or used in conjunction with structure. STORg'.S: � SQ.FEET OFEACH FLOOR: 2$$ (building has one room) NO. OF BEDROOI�fS: � GARAGE STALLS: ATT. DET. � � approx $3,800.00 ESTLI�IATED COYSTRUCTION VALUATION(excIuding lan�: $ . I hereby apply for a bniiding pemut and I acknowledge that the information above is cornplete and accurate; that the work will be in conformance with the ordinances and codes of the City and with the State Building Code; that I understand this is not a permit and work is not to start without a permit; and that the work will be in accordance with the approved plan. APPLICANT'S SIGNATLTRE: tvll ,�-L��--`��`DATE: �^ '�" � � NOTEI Parade of Homes events require separate permit approvaI by Police Department and City Councit 60 days prior to the event. Non permitted events tivill not be altowed. �