Dellneation reports-2011-2013 - Laserfiche WebLink

Home Browse Search

1.2 Form r r WATER RESOURCEPERA�iIT APPLIC'AT'ION—COMBINED JOINT NOTIFICATION FOR11I ' Use this form to notify/apply to the Miunellaha Creek Watershed DiMict(NICWD).their engineering consultants.and the DNTR of a proposed projector work which may fall within their jurisdiction.These agencies should advise you of their jurisdiction or pennit requirements within 10 days.Fill out this fornn completely and mail with your site plan.naps.etc...to the MONM. 18202 Minnetonka Boulevard,Deephaven,TAN 51191,Keep a copy for Your records. YOU MUST OBTAIN ALL REQUIRED AUTHORIZATIONS BEFORE BEGINNING WORK. 1.Property O-,vnerName (First.Last): Pring Hill Golf Club,Tim Johnson Mailing Address:715 County Road 6 City:Wayzata State:MN Zip:55391 Entail Address:timj@springhillgc.com Plnone:612-812-0374 Fax: 2.Location of proposed project(Attach neap with directions to site): Project Address: City:Orono County:Hennepin Qtr Sectiorn(s):SE Section(s): 26 Town-ship(s): 118 Range(s): 23 ' Lot: Block: Subdivision: PID: 3. Size of site: Area of disturbance: 18,249 square feet, or 0.42 acres Volume of excavation(or fill): cubic yards Length of shoreline affected: feet Area of existing impervious surface: Area of proposed inn elvious surface: 4. Type of permit being applied for(Check all that apply): El EROSION CONTROL El WETLAND ALTERATION STORMWATER MANAGE1,1ENT ❑Vl'ATERBODY CROSSING FLOODPLAIN ALTERATION ❑SHORELINE/STREAIv1BANK EvIPROVEMENTS Q DREDGING OTHER(DESCRIBE): 5.Project Purpose(Check all that apply): SINGLE FAMILY HOME ❑MULTI FAMILY RESIDENTIAL HOUSING(apartments,etc. COMMERCIAL CONSTRUCTION ❑INSTITUTIONAL CONSTRUCTION(churches, schools,etc.) ' ❑ ROAD CONSTRUCTION ❑SUBDIVISIONS(include munber of lots) ® UTILITIES ❑LANDSCAPING(pools.berms,etc.) DREDGING ❑SHORELINE STABILIZATION(lakescaping,bioengineering) ' ❑x OTHER(DESCRIBE): 6.NPDES/SDS General Stonnnwater Permit number(if applicable): 7.Alternatives(Describe any other sites or inrethods that could be used to avoid or lnininnize impacts to water ' bodies to achieve tine project purposed.Attach additional sheet if needed.) see attached narrative 8. Project Tinneline: Start Date:fall 2013 Com letion Date:spring 2014 9.Applicants Representative (Licensed contractor,engineer,etc...) Business Nauue:Bopray Environmental Services, LLC Representative Nauie:Kelly Bopray, PSS,CWD Business Address:N7831 920th St Cin.:River Falls State:Wl Zip:54022 Entail Address: kjbopray@yahoo.com Phone:715-307-4577 Fax: 10.Names and addresses of adjoining property owners(Attach list if necessary): see a0aehed Appendix E Permits have been applied: City_ l C'oulnty_EL MN Pollution Control Agency_Q_DNR COED Pennits have been received:City ❑ County ❑ MN Pollution Control Agency ❑ DNR ❑ COE I hereby notify ne recipients of this form of the project proposed herein and request I be advised of any pervrits or other detervrivation co cervine this project that I must obtain.I understand that proceeding with work before all required authorizations are obtained na a subject to Federal.State and/or local administrative.civil and/or criminal penalties.. Z 7 lv Signa of Property Owner Date Pagel of 2