HomeMy WebLinkAbout2015-01557 (demo) t - � CITY OF ORONO
* 2 0 1 5 — 0 1 5 5 7 *
2750 KELLEY PARKWAY DATE ISSUED: 12/18/2015
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 3185 CASCO CIR
PIN : 20-117-23-43-0057
LEGAL DESC : SPRING PARK
: LOT MB BLOCK MB
PERMIT TYPE : DEMOLITION
PROPERTY TYPE : RESIDENTIAL
COI�ISTRUCTION TYPE : DEMO-PRINCIPAL STRUCTURE
ACTIVITY : 645-SINGLE FAMILY HOUSES(ATT&DET
NOTE:
1. FOUNDATIONS/ALL DEMO DEBRIS TO BE REMOVED FROM GROUND&DISPOSED OF OFF SITE,PER PCA REGULATIONS.
2. WELLS MUST BE ABANDONED.
3. [NSPECTIONS DONE BEFORE BACKFILLING.
NOTE: A 24-48 HOUR NOTICE IS REQUIRED FOR ALL INSPECTIONS. CALL(952)249-4600.
SEWER MUST BE DISCONTINUED AT THE CITY SERVICE BY QUALIFIED CONTRACTOR BEFORE DEMO PERMIT IS ISSUED. CHECK
TO MAKE SURE THIS PERMIT HAS BEEN PULLED BEFORE ISSUING THIS PERMIT.
APPLICANT DEMOLITION-PRINCIPAL STRUCTURE 75.00
STATE SURCHARGE DEMO 1.00
BOLLIG& SONS,INC. TOTAL 76.00
11401 COUNTY ROAD 3 Payment(s)
HOPKINS,MN CREDIT CARD 6881 76.00
(952)938-4433
OWNER
YAFFE,HARRY&BELLE
2300 ARCHERS LA
MINNETONKA, MN 55305-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at an time for due cause.
�y a i►�� ��- o � �� ��,,� ,,�-
Applicant Permitee Signature Date Issued Signature Date
! • �
Christine Mattson
From: Christine Mattson
Sent: Thursday, December 17, 2015 1:21 PM
To: 'Gustafson, Sven'; Harry Yaffe
Cc: 'bolligandsons@msn.com'
Subject: 3185 Casco Circle/#2015-01557
Sven,
The demolition permit for 3185 Casco Circle is ready to be picked up. We are open until 4:30 today or 8 am to 4:30 pm
tomorrow. Please don't hesitate to contact me if you have any questions.
Christine Mattson
Planning Assistant
City of Orono
2750 Kelley Parkway ( Orono � MN � 55356 (physica/addressJ
PO Box 66 � Crystal Bay � MN � 55323-0066 (mailing addressJ
�' 952.249.4620 � g 952.249.4616
�� cmattson@ci.orono.mn.us ; � www.ci.orono.mn.us
Office Hours: Monday- Friday 8 am to 4:30 pm
OUR OFFICE WILL BE CLOSED: Thursday& Friday, December 24& 25, 2015
Friday,lanuary 1, 2016
Monday,January 18, 2016
From: Gustafson, Sven [mailto:Sven@stonewood.com]
Sent:Thursday, December 17, 2015 11:24 AM
To:Christine Mattson <CMattson@ci.orono.mn.us>; Harry Yaffe <Harry.yaffe@belgarde.com>
Subject:Signed escrow agreement
Christine,
I have attached the signed escrow agreement. Please let me know when we will be able to pick up that
demolition permit so we can proceed?
Kind regards,
J. Sven Gustafson
Stonewood, LLC
i
, t , . �
City of Orono FO CIT USE ONLY
/ !�O^/\ P.O.Box 66 Date Received:ly � r Permit# ��—'<` ��
0 ` 2750 Kelley Parkway
i � Crystal Bay,MN 55323 Amount: $ SAC Creclir.
� (952)249�600 �/'��Zj,r.�� ./y� -f-//� �jj�
���
� � + Homeowner(s)Signed: ❑Yes /�
-* : ;
F � Resolutioos(if any)Signed:0 Yes ❑None Required � H�1'�
�-P,�-�`H���� Zonin Disclosure Si ed: ❑Yes ❑None Re uired r�����
� ----- ul�p�� G�p'OVv �h'.Q.l�►'�+ Ye,(,Gtv�. '�7
CITY OF ORONO - DEMOLITION PERMIT
(All permits must be approved by the Building Official and/or Zoning Department)
Job Site / Owner Information:
Type: �Residential ❑ Commercial
Site Address: � � � J C�� C��
Owner. �f�y \�a��� MailingAddress: �J�u /--�rC�l�f� �-l�
City: �l�n�.`�'1 �� Zip: � � j��
Phone: Email:
Contractor/Applicant Information:
Contractor/App.: ����`� � ��n-� Contact Person: ���v ���
Address: I f �N� W I w .� State License#:
City: �t ����5 Zip: .��t'"�5����♦� Expiration Date:
^�,1 � "
Phone: �S�-�� �0- I�� Email: ����� �n =�'`'�� � m�'n� ��e
SPF���' ^^"—"— :SS AGREEMENT
Generallnstructic �, S �
1. You may be ��� ient, sewer, etc.
2. Work must rn b site.
3. A 24-48 hour I� -4600.
4. Sewer must t �� �ctor before demo permit is issued.
Demolitio i by means _ ❑Other ���
Permit(s) ssued: �: i `�r� I � �'�' �;
II ' �
In return for issuan �d owner hereby agrees to:
1. Submit a survE '��� ���' he property. Note which structures are
to be demolish�
2. Submit a surve i control measures in accordance with
Chapter 79, Co
3. Submit a copy � �rshed District (MCWD). The City will
not issue a den ,_, .,�,�� the MCWD or documentation stating
permit(s)are no ���� ����,;�1 I�>• ��
,�
Form Last Updated: July 2015
icnoon
. � , , f
4. Submit a$2,500 escrow and an escrow agreement signed by the property owner(copy attached).
5. Keep all structure(s)enclosed and/or secured until such time as demolition is complete.
6. Keep all demolition debris off adjoining property and/or the public rights-of way unless specific prior
approval is obtained in writing for temporary use thereof.
7. Completely remove foundation(s)from the ground.
8. Completely dispose of all demolition debris off site in accordance with all applicable PCA requirements.
9. Abandon water wells in accordance with State Health Department regulations.
10. Call for an inspection when all debris has been removed, before backfilling.
11. Within 5 working days of superstructure removal, a final inspection shall be requested. The site shall be
left clean and clear of all debris, with any excavation filled with earth level with the adjacent ground
elevation (except when such excavation is to be used as part of a new building and such new building is
actually under construction).
12. Abandon septic systems per Minnesota Rules Chapter 7080. All septic tanks must be pumped, crushed
and filled with native soils. An inspection is required after the tanks are pumped and before the tanks are
crushed and filled.
13. The undersigned owner shall and hereby does indemnify and hold harmless the City of Orono, its agents,
employees and assigns from and against all claims, damages, losses or expenses, including attorney
fees, against the City, its agents, employees and assigns arising out of or resulting from the demolition
described herein as performed by the property owner, his employees, agents, subcontractors or assigns.
' PERMIT TYPE AND FEE CALCULATION
�~ _ �'C�
[�$75.00 — Principal Structure $ � --�
G _
❑ $50.00 —Accessory Structure x (how many)
1. Subtotal of above permit requested $
2. State Surcharge 1.00
3. TOTAL PERMIT FEE (add lines 1-2 above) $
The undersigned herby applies to the City of Orono for issuance of a Demolition Permit, agrees to do
all the work in a 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 Signature: � C Date: �� �
/
Owner's Signature: Date: i�l�� ►ij
Approved By: Date: �Z /
( ilding Official)
2X��� � �
*Zoning Disclosure Required? ❑ YES �NO N� �jQ... �(�►(�y,f�m�
''This must be filled out by Zoning Department—For eit er answer, a Zornng O�cial rhust sign alfapplications.
*Approved By: Date:
(Zoning Official)
Form Last Updated: July 2015
150784
12/15/2015 Hennepin County GIS-Printable Map
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Parcel 20-117-23-43-0025 A-T-B: Torrens Map Scale: 1"= 50 ft. N
��� Print Date: 12/15/2015
� ,
Owner Harry Yaffe&Belle Yaffe Market $714,000
Name: Total: • � �
Parcel 3185 Casco Cir Tax $8,910.54 � �'' �� ��
Address: Orono,MN 55391 Total: (Payable:2015) ��
• e� t�
Pro rt Sale �
� y Seasonal-Residential Rec $1,437,500
Type: PPICe: This map is a compilation of data from various
sources and is fumished "AS IS"with no
Home- Non-Homestead Sale 07/2015 �presentation orwarranty expressed or
stead: Date: imPiied, including fitness of any particular
purpose, merchantability, or the accuracy and
completeness of the information shown.
Parce� 0.31 acres Sale Sale Includes More
Area: 13,602 Sq ft Code: Than One Parcel COPYRIGHT OO HENNEPIN COUNTY 2015
. —...., ��,_r�
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CERTIFICATE OF SURVEY FOR
HARRY YAFFE
IN LOTS 34 & 35, SPRING PARK & VACATED LAKESHORE AVENUE
HENNEPIN COUNTY, MINNESOTA
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'',~� (� �\ s n g ,a�� EXISTING
�c>" �� '�p� '�i � � HOUSE
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� PROPOSED � \ ' �
����� \.\ ..p��y ��\ � , \ \ � \/3195 DECK
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PROPOSED ELEVATIONS PER ARCHITECT : (verify) � �= Q� \ � �HOUSEJ '�952 ��
D'...� � � . ,.
f�3185 �,�', � ��
1) Garage = 95a.o `..� �\ M1o„u \ Qar �'��� \ , ' ��
(A) �,"",s \ �
2) Top of foundation = 95a.3 M1 (E) �� ' � i�
��� 9��5 PAi� / 9hj0 ,. � //
3) Moin floor = 95sS � . 952 �� . . �'�
, � V ..� . ���
S) Basement = eas.s :_'� J 9�e � �
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95 �
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EXISTING � seieecK B�°� \1 � i ' �
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HOUSE � aaoaose � ��
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LEGAL DESCRI�TION OF PREM6ES : (per Certificate of Title No. 1t,c0213) yi �� a4� +,��.,�"�� �� /
i .. 5 p
Lot 35 and the westerly 1/2 of Lot 34; and ,�� �i� � .._- . 3 ��� . g
�.. �S 6 .�0 �P RP
� �pi7� DECk
All of the land lying between the above described property �� i� '";, � �g�.y,
and the shore of Lake Minnetonka on the South, and between i� . " 9,�
the Westerly line of said Lot 35 and the Easterly line of ' � 9 �-��..929.4 CONTOUR
said Westerly 1/2 of soid Lot 34 produced Southerly to - ��t-� � -� LNE (O.H.W.)
said lake shore; - � !� � �p FPP
All in Spring Pork. � '
• : denotes iron marker found � �
(955.3) : denotes existing spot elevation, mean seo level datum � T /� K -�j
1J n
95a.e : denotes proposed spot elevation, mean sea level datum
9ae . denotes existing contour line, mean sea level datum M I N N E T 0 N K A
�—: denotes proposed contour line, mean sea level datum
Bearings shown are based upon an assumed datum.
This survey intends to show the boundories of the above described
property, the location of an existing house and garage, to be �emo�ed, U P P E R L A K E
and the proposed locatlon of a proposed house, driveway, walk and
grades thereon. It does not purport to show any other improvements
or encroachments.
Dn*E� !here0y certify lhot this plan spec'lication or rePort SCUE
�°��"., ,��,��», GRONBERG AND �°a"a'�`am°a d��Y�'�e�ed��d"5�,`�eY'°��de". ,�•_Zo�
- ��,a.a� ASSOCIATES, INC. �na�a.=o,��e 5�0«o,M�,��so,a. o.,E
- "��9q""�ED"�� CONSULTING ENGINEERS, LAND
7-7-15
SURVEYORS, & SITE PLANNERS
aas ivoarH wiuow oaivE 1� �„1��. J0B N0
LONG LAKE,MN.5535fi 75-2698
952-475-4141 Mark 5.Gronber Alinnesota License Num6er 12755
15-2698
t •
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Asbestos Survey and Building
Inspection Report,
3185 Casco Circle
Orono MN
For
Stonewood
Wayzata, MN 55359
nate
S'eptember 21, 2015
Hickey Consultants
Health and Safety Services
' c " ,
Hickey Consultants Occupational Health and 4301 Spruce Way
Environmental Safety Maple Plain,MN 55359
763 479 3214 phone/fax
Hickey Consultants
September 21, 2015
Sven Gustafson
Stonewood
153 East Lake Street
Wayzata, MN 55391
612-462-4000 Office
612-267-2670 Cell
S�'E'll LL,'StO1lCWOOa.C011l
Dear Sven,
This letter and attached documentation reports the results of the Asbestos Inspection and Bulk
sampling performed by Hickey Consultants, in the building located at 3185 Casco Circle, Orono,
MN.
This study is significant in that it identifies asbestos-containing materials and provides guidance
regarding the relative location. When a building is to have demolition of structural supports, the
MPCA (Minnesota Pollution Control Agency) requires that the friable asbestos, Freon, PCB and all,
mercury materials be removed prior to demolition of the structure.
SUMMARY
Building inspections, accompanied by bulk sampling of suspect asbestos-containing materials
(ACM), was conducted at 3185 Casco Circle, Orono, MN. Hickey Consultants performed the
inspection. The ACM inspection covered all areas of the building. The building consisted of a 2
story residential home with a detached garage built in 1905 with a 1648 syuare foot foundation.
No asbestos containing materials were found in the home. Building materials sampled included:
roofing material, tar paper under siding, sheetrock wallboard and joint compound, white spray-on
ceiling material, troweled on ceiling texture, fibrous and mastic like material under the carpet.
Twenty bulk samples were collected and during the building inspection and analyzed for asbestos.
ACM is considered positive with indicating levels of greater than one percent (>1%). The samples
were analyzed and asbestos>1%was not detected in any of the samples.
The thermostats and fluorescent lights must be removed and disposed of properly because of the
mercury concern. The fluorescent light ballasts must be removed because of PCB's concerns. The
refrigerators and air conditioner need to be removed because of Freon concerns. The smoke
detectors need to be removed because of radiation concerns. The city water, electric and gas meters
needs to be disconnected. The microwave, trash compactor, stove, oven, clothes washer and dryer,
water softener, furnace, need to be removed prior to demolition. The extra 12 volt sump pump
batteries in the basement need to be removed because of acid and lead concerns.
1
,
. � �
Current Environmental Protection Agency (EPA) statutes mandate control measures for friable
(easily pulverized) asbestos-containing materials. Non-friable materials (for example, pliable
caulking, floor tile or mastic) do not pose an immediate exposure risk unless they are cut, torn,
sanded or otherwise abraded. Because non-friable materials have the potential to become friable
during certain activities, friable and non-friable materials have been identified in this building.
EPA's Asbestos Hazard Emergency Response Act (AHERA) was used as a guidance document for
bulk sampling procedures, sample analysis, and location selection. An AHERA asbestos trained
building inspector participated in the building inspection.
BULK SAMPLING METHODS
Asbestos bulk sampling was performed, sampling included collection of material samples and
analysis of bulk samples for asbestos percentages utilizing polarized light microscopy(PLM).
A walk-through survey of the home was first conducted to identify homogeneous areas and develop
a bulk sampling and inspection strategy. For each homogeneous area sa�npled, two criteria were
used to determine sample locations:
1) The sample site must be representative of the homogeneous area
2) A random element to prevent bias from entering the results was exercised in sample site
selection
Sampling protocol was as follows. Amended water consisting of water and a surfactant (soap
solution) was misted on the sample site before, during and after the sampling process. This served
to minimize dispersion of the sampled material. Sampling instruments were used to section a
representative sample of material away from building component. Sealed, plastic packs were used
to contain the sample and marked with the sample serial number. Sampling instruments were
cleaned after collecting each sample to prevent cross contamination of subsequent samples.
Inspectors utilized half-face respirators when appropriate, and gloves for adequate personal
protection during sampling activities.
Results for bulk samples collected during the survey are provided in the Asbestos Laboratory
reports attached by: EMSL Analytical, Inc. Bulk samples were analyzed by: EMSL Analytical,
Inc. 14375 23`d Avenue North, Minneapolis, Minnesota 55447, utilizing polarized light microscopy
recommended by method EPA/600/R-93/116 in accordance with federal, state and local laws and
regulations. EMSL Analytical, Inc National Voluntary Laboratory Accreditation Program
(NVLAP) number is 200019-0.
Attached are sample sheets describing; asbestos locations, and the Demolition permit for the
Minnesota Pollution Control Agency. Complete laboratory analysis charts are also included in this
report.
The appliances, fluorescent lights, Ballasts and thermostats can be taken to the Hennepin County
hazardous waste disposal site by the homeowner at 8100 Jefferson highway, Brooklyn Park, or
2
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1400 West 96�' Street in Bloomington. Hennepin country recycle phone number is 612-348-3777 or
go to ������w.hen��epin.us
If you have any questions ar concerns regarding the information in this report, please contact
Hickey Consultants at your convenience.
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Sinccrely, :,,�:. °'•'F :
LEFiIFIC�`ION s' .
�� ^ � / � %� i � • hUMSEp •.� i
G rr�c..�=� : i; S?41 CP t i 2
� Douglas Hickey MI.TC'I .CSP. :; �. :xP�H=s ,:�•'
Certificd Industnal H1�fcnist ' ap�. ,, 6-�-2019 . .
: G '•e"N �eo•' \,2` •�
Salety and}iealth C'onsultant • �t �a►iv�„��:`.•' � `
.A[3IN No.5741.BCSP�o. 1 167� ,��•,�FOWARDH�G'�`F"�.�'�
'••.......�•'
Minnesota Department of Health Asbestos Inspector License Number AI2420
Attachments/Enclosures:
• Asbestos Inspection Survey Results
• Maps of Asbestos Inspection
• Minnesota Pollution Control Agency Notification of Intent to Perform a Demolition
• Map of Recycling Centers
• Pre-Renovation and Demolition Information
• Photo Log
• EMSL Laboratory Results
• Asbestos Inspector Certificate
3
Ins ection Data Sheet �
Room/Area Location Material Description Contains Estimated Units Physical Friable Sample Percent Comments -
Asbestos Amount Condition yes/no Number Asbestos
>1%
Outside Air Conditioner Freon CFC
Disconnect Electricity, Gas, City
Water
Remove from kitchen Stove, oven, trash
compactor, microwave
Remove Refrigerator and air Freon concerns
conditioner
Remove florescent light bulbs 17 bulbs in basement, 2 in
first floor closets, 1 in
second floor master
bedroom closet, 8 in
garage because of Mercury
concerns
Remove florescent light bulb 3 in basement, 1 in second
ballasts floor master closet, 3 in
garage because of PCB
concerns
Remove thermostats Mercury concern
Remove smoke alarms Radiation concern
Remove batteries in basement Battery acid and lead
concern
Remove before demolition Clothes washer& dryer,
hot water heater, water
softener, furnace,
dehumidifier,
RoofofHouse RM1-Shingles No Good No RM1- None
O1-
Shingles
RM1-
O 1-Tar
4
Room/Area Location Material Description Contains Estimated Units Physical Friable Sample Percent Comments '
Asbestos Amount Condition yes/no Number Asbestos -
�l o�o
Roof of Garage RM 1-Shingles No Good No RM 1- None
02-
Shingles
RM1-
02-Tar
Garage and House TP 1-Tar paper under No Good No TP 1-03 None
siding TP1-04
Attic TSI1-Cellulose insulation No Good Yes TSI1-OS None
TSI1-06
Ground Floor SM 1-Sprayed on ceiling No 1400 sqft Good Yes SM 1-07 None
texture SM 1-08
SM 1-09
Basement SM2-Trowled on ceiling No 900 sqft Good Yes SM2-10 None
texture SM2-11
Basement Storage Room SM3-Spraeyd on ceiling No 12 sqft Good Yes SM3-12 None
texture
Basement Laundry Room CT1-Ceiling tile 2'x4' No 224 sqft Good Yes CT1-13 None
CT1-14
Walls and Ceiling SR1-Sheetrock and joint No Good Yes SR1-15 None
compound SR1-16
2" Floor S.W bedroom FT2-Fibrous layer under No 110 sqft Good Yes FT2-17 None
carpet
2" Floor Hallway FT3- Mastic like material No 640 sqft Good Yes FT3-18 None
on wood floor
NAO—No Asbestos Observed
None det—None Detected
Sqft—Square Feet
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��:� �' '"�nn��°t� P°"ut�°n Notification of I ntent to
�- Can#r�l Agency
52dlatayetteRoadNorth Perfarm a Qemolition
St.Paul,b1N 55155 419�
Asbestos Program
Goc Tyipr .Asbes:as a Gzrrvautix�l�menarnent:
Type of notification: ❑ On�ginal ❑ :.rt�ended ❑ Proyect cancellation
Notification must be postrnarked or received ten(10)working days before demditian begins.See Item 5 for emergency
demoliRions_Both start and end dates should be amended in writing as necessary to reflect current project dates_
Demolition Contractor Building Information
hame: Buflding name:
Address AddresslLocaoon:
Ci:y Sta:e.Zip: Ci:y.Sta:e.�ip:
Phone number. County:
Contad name: Phone number:
Phon�numGer. R8e oE blcbg tyrs}: �ize of bldg i,sq kr.
kumber pflbors.includin$basem+en�leveh,s;�
Building Owner Present use ofbl•�g:
f�ame: Prior use of bidg
Address
Ci.ry.Sc�:e,�iF: Dates of demolition or intentional buming:
Phorm�umber. S:ar.date: '�nd date:
Contact name rmi'�cYyy mrn�'ori'}�i'
Phone num6�er.
Note: If there�s >��C linear'Feet or�18C�sqvare fee:of�egulated Asbestos-Containing Material i;�ACti1i in the huii�in�to be
demolished, d must be r�moved by a Iice�nsed asbestos oontrador prior ao demolition.The State of A1h-"�loflye a�fn�ent to
Perform an,4sbestos F,bate�men��rojec^h�:r,�www.pca.sta^.e.mn.us;publicatianstvr-sw4-0E.doc mus E�e use�d;c+notiry for
the asbestos remaval.
Is non(riable ACM prcsent in the structure to be demolished? ❑ Yes ❑yo
Will nonfriabFe ACM be prnsent in the strucOire at the time of demolition? ❑'Yes ❑No
If Yes o�bath ques�ons above,com.ple6E�IterrNs 1-8. If No to Qither question,complete 12ems 3-8.
1. ff ACM will be left in place for tt�e dertwlition indicate the amaunt of Category I andlor Gategory II norrfriable ACM 4eft
in place_
Categc��+I Linear feet Categrsry II Linear�eet
Square feet Square f�ee:
Cubic feet Cubir fee:
Category 1 nonfriable ACM means asbes�os-containmg CateBory 11 nonfiable AGN�mEans any material,e�cck�ding
packings,gaskets,resilient floor cavering,and asphal: Category I nontriable ACAI,con;aining more th,an one
r�firr�producCs containing more than o�e peroent peroe�t Asbestc�s that,when dry,cannoc be crumbled.
asbestos. pulvertzed.or reduoed:o a pawder by h�nd pressure.
Category 1 nonfriable ACM is not allowed to remain C�egory 11 nonfriable ACM is nat allowed to rernain in
in place for demolition iF it is in poor oondition. place for dertioli6on ifi it has a hi�probabiiity af becoming
cn+r�bled,PuNermed,or reduced to a pawtier d�xing
dert►d'Rion,transport or d'isposal`e-9-,traisibe,oernent,
s1aEe roo6ng)_
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��.,i3 Pre-Renovatian and Demolition
�`=-' Minn. R. 7035.0805
Minnesota
Pollutivn
Control 'J'.'a�te•Solid"dJasGe#4 C�? • :+ugust 2U09
Agency
�e ustent oi\iinsi R �03�.OS05 i�• The toltou-ing is n��t a c�lete l�st but
t�esa;,ure that item��preseat in should be used for 1ao�-ledge of tshat t�pe
sntictuses such a°�hazardou� of item�must be reuio:-ed_
u�acerials ar Qther itenis that az•e prat�ikrited
frain being deposited in a IandfilL aze • wi�ed niunicipal sol�d v�aste-
reinoz•ed prior to the conmieucemeat of ��"e. ca:petiae unattach�ed to the
:•eao�-abon oi•deinolitia� aud that those subsrrate_beddiug�_mattresse;.
u�aterials are disposed of or recccled dotlu� swall appliances_food aud
p�aperl�•.Tbis fact=aheet is onl}'iutended to �'�ste
gire�uidaace and is not inteaded as a . household huardaus t�aste-
substitute fa readine tl�sule aud autainoti��e fluids_la�ra aad earden
deteru�ininq its applicabiLR•to your chesnicals.pest coutrol pa�oducts.
resioration ar desnolitioa pro�ect. hotuehold cleauers.gaznt and h4n�e
uuproti�euient pro�ducts
Does the pre-renovation and . �ate�Yals that constitute iadustrial solid
demolition rule apply to my u�aste or hazardous��aste
project? . v�•aste tires
T1�e Pre-Reno��ariou and Desnolition Rule � �����es
applies ta all smutures and persous
eneaged m th�e renot-ation.nwcis�and • merc'un•cantaining itesn�
demoLtion of smuture.or portion of a . batteries
stiuchue.This intlucies reside�ntial homes.
recreat�onal_ �o��_�*�*+�.a�ricultural. • ��h�g-floresceat_high iatensin-.
commerciaL iudush•ial aad other smutwes tn�h pressua�e so3auni m�ercurti'��apor.
of a relatiti�el�,�pe�rinaaeat nanue.The Pre- ���
Renoti�aaan aad Deinolition iule aLso . switches
includes deuwlition bS•biuniug for the
purpose of disposal cmh•ichere it has bt*eu • �stats and suxiilar detices
authorized tn•lau�or for fire trauuug. . detYces associated u^ith heatiaq
sc•steau_air conditioning s���tems_
Items needed to be removed �i�rs and r�n�te5 �
prior to renovation or . dec7ces associatedu*ithelectrical
demolition? s}•stems
Note that all svaterials remo�-ed must be • chlara fluoro carbans(CFCs)
properl�•characterized tested,mauaged. containing items
aad dispased of.reused or rec}�cletl in
accacdwce with applicabte staudard�. ' P°I`•-chlvriaated bihen�;ls(PC'Bs)
coutainiug items
wvw4-07
Minne�.,ota Pollubon Convd C,�enry • S20 Lafayette Rd.N.,S�Paul,MN 55155-419+3 • www.pca.state.mr�.us
6�i-296-�300 • 8{10�57-38fi4 • TTY 651-282-5332 or 800-657-3864 • Available in atterr�ative fom'iats
13
�. ( Y� �
. oils-used oi1 all t��•draul�c oils_aud�ils cc�ntaiutd
iu heariu�oil tSnk.:.pipine. sump: aud u�ap,
. lead-lead pipes.lead sheetu�.flashiag m roof
rents.lead pnrnt that is not,frrmh�adher�ad ro
si�bsn�nt
. electric products-cathode rac tubs(T�'.couiputers}_
cirruit boards
. asb�sto�- products recluired to be reinoc�ed uuder
hiian.R. '011_99?0
. rad�aactire u^aste
. other wateriaLs that u�ay be prohibited from disposal
at the facilin�uueuded to receic•e the renot•atian or
deuiolitian��•a,te
National emission standard for hazardous
air pollutants (NESHAP)
Facilities regulated tm�der�i0 C�'R pt.61.1-t 1 must uotify
the 3�I�nesota Pollution Control a�eac�-{��CA)tea
u•orL-iag da�•s prior ro the stazt date of a reno�atian or
demolition pro�ect.�ill n�aterials regu]ate�uodes�tlie
Pre-Reno�-at�on a4d I?esuol�tion Rule must be resnai•ed
f�•ow the facilit�•t�-o da�-s pnor to the start date that uas
submitted cyn the motification.
Exemptions
(hilc under special circumstassces_such as the smscture
being t�nsafe to enter as determined b�a loca!
�rn-eina�ent authc+ritz-.is it acceptable uot to remoi-e
reQulated itein.before reao�•ation or deuwlirio�
Ho�•eti�er.these items must be remored from tt�e
debris before disposal.Coutac�the:�iPCA at
6S 1-?96-6340 or 1-3U6-b5--v 3&1 aad asl-far the
demolitian staff for fiMh�er Quidance_
Pre-Ren�va�onandDemolrtion • w-sw-407 • August2009 nr���tio►oroliue�o�
Car.rol Aqerxv
Page=
14
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EMSL Lab Results
EMSL Analytical, Inc. E""s�°r°a: �s'sos2s�
— tp75 2xd,4venue I/orm,M.�ne�po�is.�r,55�u7 CusComC�10: HICKSS
P1wndFa�c p63)41C-1922!{783)4s9-4G24 CUStomefPO:
httA:ilwww.E6lSt.cwn munneaodislab�lemsl.com PfD)CC�ID:
aan: Douglas E. Hickey P� (763)479-321<
Hickey Consultants Fax: (763)479-3214
4301 Spruce Way R��.�a: osr�s��sa:ao�
Maple Plain, MN 5b359 A�h�o�: s�»rzo�s
ca�cea: �v�sno�s
Project S1IV091615
Test Report: Asbestos Analysis of Buik Materials via EPA 600/R-931116 Method using
Polarized Light Microscopy
Non-Asbestos Asbestoa
Sample DestripCan /4ppearance :. F�rous 9: Non-Fibrous °� Tv�e
RMI-01-Shingle Roofug Shin�es BrowrUGra�d8ladc 1D% Glass 90% Nan-fitxaus(ofher) None Detecied
���� �Hause d F�g
Garage ���s
RMI-01-T� Roofng Shirqes Bladc 100'6 Non-fibraus(df�) None Oetected
35f306263ooDU on Fiouse 3 NorFFibraus
G� tbmogeneous
RMI-02-Shirgk Roofrg Shinqes BrowrdGraylBladc t596 Glass 85% Non-fibrous(oU�er) None Detetted
35tso62�3ooD2 on Nouse 3 F�breus
Garage Helenpg�s
RMI-02-Tr Roofng Sfiinqes Blndc 100% Non-fibraus(oCier) None Detected
an Nouse 3 Na�Ftrous
351506263�000?A G�.� �qgeneaus
TPI-03 Tar Paper Under B1adc 50% Cdlulose 50% Nan-fibraus(ott�r) None Detected
33t3U6263v003 House 3 Gara9e F�rws
Sidng �pgeneous
TPI-04 Tar Paper Under BFadc 50% Cdlulose 50% Nan-f�xaus(ofher) None Oetecitd
House 3 Garage p�s
sstsOs2�Aooi g;�j ��eaus
TSH-DS Celubs�L�ce Brorm 100% CdlWo�e OX Nan-fibrous(atl�er) None Deteded
Thamo Insulation Fibrous
351506263A003
HOfTMO9Cf1�0U3
TSIt-O6 Cdubae like Brown 100% CellWose 0% Non-fibran(dher) None Detected
Thamo Insulatian Fibr�ous
35fSG62630006
FIOT'�9E11EOU8
��u8) .�.�.� � ..^ �-)t.�'�_
Nicholos Asuncon(ZO) Rachd Traws,Laboralory Managv
w dher approNed signatory
B�ASL maiM'ns f�biliq limipa Oo mst d ardysis.Ths r�part reutes anly Oo Ihe san+pwes rePo'k'd aM may rw[De�xad�oed.e�ept n iulL wirtwut�+uen appiac�l Dy EMSL EMSL beas no
msponsiW ity for vrtiple m�ecuon actNroes ar:uytic�l rnetl�od limi�aoores.Inleryeatian a�d use af/est results are the Rsponsail ity dthe diait This report must nat be use�d by tlie d�ent ro dam
P������P�.or mdasm�mt by M/LAP,NISTa sy apeicy d Ihe 4den1 po�emment. Nonfiade ogancaly bovd maMials present a poblem maYix and tlxmefae EMSL
IECOftY1191��EN[ICdlmOrt Pipf b YI�y515. $iflpQS 1F0l//Ed in QI70d C01166a1 U11K5 OIIIMWKE 11tlpd. E59T22d iCQliCy.P18CISIOf1 71d tflCHiiHy 6ih iY311dbIP 1IP01e 1lQ.IESt.LIf1�F55
icquesied Dr u,r cae+c b�+arg maomass marulaarea w++�m�ropk ta�ers p.e.lmokrrn.�.a��eoad etc.l x ieporoed as d sirg!sanpl.aepaaig kmit is 1x
��Y�M BiASL Md�er�l.Y�e�Nr�e�po6s.Mn PMP�P La6 Code 200D19-0
Initial report from 09l17/2015 1629:17
Test RepaR PLM-728.9 Pri�ted:9�17I2015 429:17 PM �
�n
� s
� i�� .
EMSL Analytical� II1C. EMSLOrder: 351506263
� 14375 23rd Avenue North,Mi�nc�olis,Mn 55447 CUStaf�EiiD: HICKSS
Phone�'Fa�r. {7B3j 448�P22 i(783)449-4924 CllStdlYCfPO:
- http:Nwww.EAlSLcoan minneapdisiab(c�emsl.com P('OjCCtID:
Att": Douglas E. Hickey P�e: (763)479-3214
Hickey Consultants Fax: (763)4T9-3214
4301 Spruce Way Received: 09/16l15 4:4D PM
Maple Plain, MN 55359 Armlysis Date: 9/17l2015
ca�ced: s��sno�s
Project: S4Y091615
Test Report: Asbestos Analysis of Bulk Materials via EPA 600lR-93/116 Method using
Polarized Light Microscopy
Non-Asbestos Aabestos
Sample Description Appearance •,o Fibrous °n Non-Fibrous °h TvDe
SMt-07 Sprayed on Ceiing '.h'hRe 10096 Nm-fibrous(oC�er} P1one Oetected
Te�ure Non-Fibrous
351506263A7D•'
h10fT10gCf1COU3
SMt-08 Sprayed m Cdling White 100% Non-fiixoua(oUiex) lbne Detected
35i5062p�a0D8 Te�dure Non-Fibrous
Homageneous
SM1-05 Spsayed on Cdling White 100X Non-fibrais(aUiet} None Detected
�i�� Te�ure Nor�Fibraus
Fbmogeneous
SM2-10 Tro�wled on CeYng W hite 100% Nm-fitxous(o�er) Mone Detected
Tadwe Non_Fibrous
35150626300f0 �qyeneous
SM21-11 Trowled m Ceing White 70076 Nan-flbraus(alher} None Detected
3515062G3vOf t Te�dure Non-Fibrous
Honwgeneaus
SM3-12 Sprayed m Cdling Wh�e 100�6 Non-fibrous(otlier} Mone Detected
3515P6263fh7f2 Te�ure Nw}Fibrous
Fbrtiogeneous
CT1-13 CeilingTiie2'x4' Gray/WfriBe 50% Cdk�ose 15% PexliQe NoneDetectcd
35f5o62�i0df3 Fibrous 30Ye M�.Wod 596 Non-fibtous Iol�)
F1e�erogeneaus
CT1-14 Ceing Tiie 2'x4' GrayfW hiDe 50% CdkAose 1576 Pexiite None Detected
����� Fi6rous 3D% Mii.Waol 5% Non-fibrous�ofher:D
Helerogeneais
Analyst(s) Ct.._ �. � ����----
NichWes Asuncian(20) Rachd Travis,Latwralory Manager
ar dher approved sgnatory
EASL mantans fatiliy limiled b cost d analpsis.This apat relates any w tlie sartples repw�ed and may rwt be reprod�aed.e�ept n h�l.wllw�R wrqEen app�osl by BASI. EM�beas ra
respmiW iyr far gmpr mlection amieoes ar anal�tii�l metlwd FmitaUorts. kroerpet�im aid use d test rewks ae tl�e iespa�il iry d the dierrt This report m�at rwt be used by thr d Knt Lo dam
qoduc!oamFcamm�Paet,a endaser�ent by NVLAP.NIST v ary a�.y d Ihe kGer�gwanmenL Narfiade aparwcally Eotnd nuileri�ls preserrt a piaElern matrix rd tlierefae EMSL
recarruner�parnHnC ied�etqn pia b analysis. Sartiples rece�d in good oa�30m uYe55 otlierwise naled Estim�ed arxaracy.pleGisqn aW unerta�kyi dam aoilable upm mqJest.UNess
mques�ed Mmr d�e�t e�adng maeenais myw�Fsmr�ed wM multipk tsyers(i.e.�irck.xn.wanboara.etc.)aie mpor�a as a sinpk:ampe.Repve.g ami,is t�.
.iaerples a�yad by B+ISL Malytical.k�c Afineapdis.Mn PMAP Lab Code 2000140
Inifial repatfrom Q9/17/2015 1629:17
Test Repart PLM-7.28.9 Pnn�ed:9J17l2015 429:17 PM Z
�1
, � . �
, f• ,
EMSL Analytical, Inc. eMs�ora� 351506263
— 14375 21r�d 14renue North,Mitneapolis,Mn 554t7 CuStOmCt1D: H IC K55
PlwnelFau {7E3144B4922!(763j M9-4024 CUStpi�PO:
htmJlv.ww.EF45Lcam minneapdisiab(�emsl.00m PfOjCC�ID:
i
Att" Douglas E. Hickey P�e. (763)d79-3214
Hickey Consultants Fau: (763)479-3214
4301 Spruce Way R�a,+oa: oyris��s a:ao a�+
Maple Plain, MN 55359 ^��o��: s,�Tnou
Cdlec6ed= 9/16/2015
Project: SYY097615
Test Report: Asbestos Analysis of Buik Materiais via EPA 6001R-93/116 Method using
Polarized light Microscopy
Non-Asbestos AabeaWs
Sample Description Appearance 9-0 Fibrous "•� Non-Fibrous °: Tvpe
SR1-15 Sheet Rock 8 BrowNWhite 7U96 Ceiluioae 90% Non-filrraus(ofher) None Detected
Jdrrt Canpound Fibrous
3515L6263Un 5
Hebetogeneous
Ths�s a composder resdt d sFieetrock and jt oompard-
SRt-16 Sheet Rock 8, BrowNW hite 1D% CeiWlose 9096 Non-fikxaus{olhex) None Detected
Jarrt Campand F�S
33l306263�OP�6
Fiornogeneous
This ss a campos�oe res�Jt d sheetrnct and jc oompard.
FT2-17 Fibrous Laytxon Brown 10096 Celi�ase 0% Non-fibrws(other} None Detected
VVood Fbor F�rous
33f5G6263�OfJ7'
HORIOgfX1COU3
FT3-18 Mastic like Layer BrowNOrange 70096 Non-Tibraus(dher) None Detected
on Harda'ood Non-Fibruus
ss�saszs3orna
Fbrriogeneous
�P����B��indpded�ardps�s
Anelyst{s) (i._ M_ _�' ��<._-----_
Nicirolns Asuncian(20) Rachd Travis,Laboratory Manager
or aher ap�xnved signetory
�ma�e6 Ga6ility limi�a Co cost d arulysis.This repart Mates arYy to he sa��pies repated and may rat be reproWced.excpt n iulL vrilhaR�rilEen appiwd by B�ASI. BASL bears ra
Rsptrbibiily far grnple ao6ecUon act�es aaWytiral mdlad imimUw6.k�6erpemtim a�d�se d Lest rew16 ae Uee resportslMlay d the dierR. This ieport rtw6t nat be used b�r the dKrN b dam
P����P�'�.ar endosenart by NVLAP,NISTorary apency d 1he kderA pwianment. NorfYi�ie apamcaily bamd ma�riaFs pr�en[a podem rnalrbc ad O�efae EMSL
mcwrxnan�p7rrtremc m�a�on prwor b an�y5is. " s ieoened i�pood ca�66m uiess othe�wise�oleC E59rf�ed acaracy.qecasion and u�nly data a�aiaMe�qm req�est.Uriess
requesled bf'tlhe de�t b�dnp marenYs rt�rhdred w�h muluple la�s I�.e.linofeun.rrallboad etc i ae�ePab�as a sirple sanple.Repavq I�mit is 1X
�P��I�dP BJ15L Ar��Oca�.Yu Afxr�e�pofis.A4i NVLAP L.�Code 2DD019-0
�
Initiai reportfrarn 09l17I2015 1629:17
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��
� � �.
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' OrderZDi 351505263
' Asbestos Chain of Custody �':�SL ti�.�.: . ��., �-;
� rY ,:i��J r.'..; .�.=_ nl�_i';��.'
� �= EMSL Order Number�cab use o��y,_ ;,.,E 4,�,�,5 r�r���:::��
; �- _ // ((�/j�2] ��, �._ �7e�,-i=1:; a�31:,
� tM61 11VA1YtICAI.INC � ....... ..._. ..,.. ...-_..�L.�V✓ ... . . �
...c..•�..-...e..-...�.....a _..__ : ,r r�t •� � �i_�u�.
� EMSL-BIII to; Same , Uift�rent
Compan�r:Nick�Consuttants ; if nni�,�5.^�dio•c�".rpfe+nstnx'iors n�om-�rrls"
� Street:4301 Spruce Way' _� ThtrdParti Hr,�i�rnqu�res w�tten authonratian Irom thirA{:arty
; City: 1Maple Ptain I State/Province:MN Zip:PostN Code:5535Y Country:U5A
� Report To{Name): Douglas E.Hickey Fax#: 763�79�294
' telephone!1� ]63-479-3214 Email Address: dhickeymn��rahoo.com
_ _ __.,__. _. _ __
Pro)oct NamelNumber. SWD91615
_- -- - - _ _ -- -
+ Please Provide Rosutts: �;_I Fax �Errwi! j PurchaseOrder: � U.S.State Sam Iss Takent MN
, .. - - _ _._ ..__._._..a-__.___.�. ..�_ __..__ __. .
_. _. _ . _ .—__ ..
� Turnaround Time(TAT!Options•-Pfoaae Check
„ . . -- - .___ -
� �3 Hour y�,;6 Hour �24 Hour 1❑48 Hour � L; 7T Hour�(� 96 Hour_, i'I Weak �I�2 Wt3Bk
't ot 7f:1rf A�r:!A�fhmuQn 6 hr,'NCase Car d���a^,t�s���.^.C��o'�he;�;i,s�premi�m G/:a:gc lt�r 31!uw T�M ANER11 rN LPA Leve/!I 7R 1 Yo:r wd!Ih;esked fo sryi�
' an aciMonzafror/or�r/cr M�s m�r^e �i�ai s:•s�:�m tiNeA err a(�!d�r7�Y7 wr:h,FMSt S T�rms.3r�(:�nerjRr.�:s b�efeC/!rhe An rcw Pr�Cwrde.
__
� M•Air TEM-Air Q 4�.Shr TAT(AHERA oMy� TEM-UUfi
❑ NiOSH 1400 [� ANE�Zq 40 CF K,Part 763 'hlicrovac-ASTM D 5755
(_ wi dSHA$hr.TWl� Q NiOSH 74R2 I [Wi,^.r. ASTM 7fi480
___ _ _.___._..__ _ _
PLNi-Bulk innortin9 ti t ❑ EPA l ovel It ❑Ca�et Snnication{EPA 60Q;J-93/t67)
�PLM FPA 600rR-93;116(<1�0) � ❑ iS0 1Q312 5y,of1lRockNormicuNta _ _
_ ._ _ _- __
❑P�M EPA NUEI(<1�k) � M-Su ❑PLM CARB 435-A(0.25°k sensitivity)
Pomt Count } ❑TEM EPA N08 ❑PLM CARB 435-8(0.1°o sansiiivity)
❑40Q{<0.25%}0 1000(<0.196) i ❑NYS NOB 198.4(non-friab4e-WY) I ❑TEM CARB 435-B(0.14b sensitiwty)
Po�nt Count w/Grevimetric ' ❑Chatfield SOP ❑TEM CARB 435-C(0.0'.%scsnsitivity►
' ❑400(<0.25°�,}�1000(<0.1%) � ❑TEM Mass Anafysls-EPA 600 sec.2.5 j ;]EPA Protocol(Sart�i-QuanHtaGve)
� ❑ f�YS 198.1(tnaWe in NYj ° TEM-Wats�:FPA 100.7. 1 L;EPA Protocol(Quantitative)
3 Q NYS 198.G 1J08{non-fnaWe-NY) Fibers?10um []Waste []Drinking Other.
i � NIOSH 9002(�1°!0) � All Fibc;r 5i�es L�Waste ❑DrinkirG i :�
�Check For Positive Stop-Clearl Identify Homogenous Group
-- _ _ _.. _.�p. . . --- _... _ .��---
._._-
Sampiers iYame:aouglas Hickey S�np�era Sipeature: :�) r'�
furrw/Area{Airj OatalTime
sa►�� Sampla pescriptiwt HA iF Bulk Sa {ed
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Client Sa►r�ple#isj_ • - - -- Total 0 of Sam�plqs: _ .
. __ _ . _ _._. �
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Relinquished(Client): �� � Dato:-_�_�� Tima:
Racelved(Lab�: OatQ: � ��_I�__ Time: `7�. Yf�
Gomme�tslSpoclal at ctions:
_____.__ _ _ ..� _
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Paqe 1 Of 2
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OrderZD� 351506263 Asbestos Chain of Custody F�.��i �'.:' '-"'. .''.
,�:3�:�.:3' ;.:. r�, :.. ,
= EMSL_Order Number�cab use on►y�: �.�,:�r„�,:, �, ^�y`,5�y,
[Mf.ANALYiiCAL.lNC I_.,..�... .. __. _ ...... . . �{ F'�'�..�^J+� �'Fi;ii[:1��::92:.
�___ Fa.i..�'l�i t}�::5�.;;.t J,
Additionai Pages o/the Charn of Custody are only necessary i(needed lor additional sample informatron
VolumolArea(Ai►) D;�tefTime
Sam le#� Sam I�DeacrF tp iort HA A� Sulk Sampled _
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DATE TIME
CITY OF ORONO CALLED IN �—
INSPECTION OTICE � SCHEDULED
PERMIT NO. ��� COMPLETED �
ADDRESS � ��
OWNER TELEPHONE NO.
CONTRACTOR
'' DESCRIPTION "�'`-/�� �� �����I� �
t�y ❑ FOOTING DEMO-FINAL ❑ SEPTIC FINAL ���rt f
Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLINO
�Q ❑ FOUNDATION WATERPRO ❑ PLUMBING FINAL ❑ TREE REMOVAL
Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS
� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
_ ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL
v ❑ DEMO-SITE ❑ SEPTIC INSTALL
? OMfNEJY�CO1fTRACTOR TO MEET YCU:_YES._NO �
� COMMENTS: � � L �
4
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W ❑VMORK SATISFACTORY`.PFiOCEED ECT COMIPLETE
� ❑CORRECT WORK 3 PROCEED O I E CERTIFl(',ATE OF OCCUPMNCY
W
0 O CORRECT WORK,CALL FOH REINSPECTION TEMPOMRY
V BEFORE COA/ERINO PERMANENT
❑CORRECT UNSAFE CONDITION WRHIN HOURS. p p�.{OTO TAKEN
INSPECTOR WIILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �GTATION ISSUED
❑INSPECTION REW IRED.CALL TO ARRANf3E ACCESS.
Call for the next Mspectfon 24 hours in advance. (952) 249-4800
OwnedContra on site•
Inspector. �
L
Whits CoDrnnspectw's Fil� c.nary CoprfSM�Notic+
� ' MINNEHAHA CREEK � WATERSHED DISTRICT
QUALITY OF WATER "^�^` QUALITY OF LIFE
Pursuant to Minnesota Statutes Chapter 103D, and on the basis of statements
;�•.; ��;;;,nt;,�f„cr��.�� and information contained in the permit application, correspondence, plans,
maps, and all other supporting data submitted by the applicant, and made a part
Watershed District�s hereof by reference, PERMISSION IS HEREBY GRANTED to the applicant
committed to a leadership named below for use and development of land in the Minnehaha Creek
Watershed District. �I� � Q� �
role in protectiny,
improving and manag�ng �ssued to: Belle & Harrv Yaffe Permit No: 15-632
the surface waters and
Location: 3185 Casco Circle Orono
affiliated groundwater
resources within the Purpose: Erosion Control, Sinqle Familv Home
District,inctudingtheir Date of Issuance: 11/24/2015 Date of Ex iration: 11/24/2016
rel�tionships to the By Order of the Board of Managers
ecosystems of which t \ '
\r V ,
they are an irrtegra�part. Tom Dietrich
District Technician
We achieve our mission
through regulation, This permit is not transferable without District approval, and is valid to the date of
expiration. No activity is authorized beyond the expiration date. If the permittee
capital proj���=, requires more time to compiete the project, an application for renewal of the
education,cooperativ��
permit must be received by the District at least 30 days before expiration.
endeavors, and other The applicant is responsible for compliance with all District Rules and for the
action of their representatives, contractors, and employees.
programs based or�
sound sdence, Conditions: Project to be completed as described in plans submitted to the
MCWD office on November 12, 2015 according to the provisions
innovative thinking, an of this permit.
• Properly install and maintain all required erosion control
informed and engaged measures until the disturbed areas are re-stabilized
constituency, ar,d t'r,e • Notify MCWD in writing upon completing installation of
perimeter and sedimentation controls
cost effective use of . When the site is re-stabilized and the MCWD staff has
performed a final inspection, all silt fences must be removed
�uh�ic fi!nds.
(Statement concerning fees for inspections, violations, etc... on following page)
I
15320 Minnetonka Boulevard, Minnetonka, MN 55345 • Office: (952)471-0590• Fax: (952)471-0682 •www.minnehahacreek.org
I
MINNEHAHA CREEK �� WATERSHED DISTRICT
QUALITY OF WATER "'"�'` QUALITY OF LIFE
Inspection/Analvsis/Monitorinq Fees
The Minnehaha Creek
Watershed District is A site inspection and monitoring by District staff will be performed where the
committed to a teader�hip aCtivity involves:
role in protectiny, . a commercial/industrial/multi-family residential development
improving and mar;aging • a single family residential development greater than 5 acres or of any size if
within the Minnehaha Creek subwatershed
the su�face waters and . any alteration of a floodplain or wetland
affiliated groundwater ' dredging within the beds, banks or shores of any protected water or wetland
• a violation
resources within the • any project which in the judgment of the District staff should be inspected
due to project location, scope, or construction techniques
Distrid,including their
relationships to the
In these cases, the applicant shall pay to the District a fee equal to the actual
ecosystems of which costs of field inspection of the work, including investigation of the area affected
by the work, analysis of the work, and any subsequent monitoring of the work,
they are an integrat pa�t. Which in the case of a violation shall be at least $35.
We achieve our mission
through regutation,
Standard Fee Schedule
capital project�,
education,cooperative District professional staff $ 65.51*
District interns $ 40.35*
endeavors, and otheT District clerical staff $ 46.69*
programs based o- Consulting Senior Engineer $ contracted rate
Consulting Engineer/Technician $ contracted rate
sound science, District Counsel $ contracted rate
Application fee $ 10.00
innovative thinki+�y, an Copy costs $ .25 + actual staff time
informed and enyaged Color copy costs � $ 1.00 + actual staff time
constituency,and the
cost effective use ar * Hourly i
pubtic ft�rtris. ,
15320 Minnetonka Boulevard, Minnetonka, MN 55345 � Office: (952)471-0590• Fax: (952)471-0682 •www.minnehahacreek.org
� ' MINNEHAHA CREEK � WATERSHED DISTRICT
QUALITY OF WATER ' QUALITY OF LIFE
Pursuant to Minnesota Statutes Chapter 103D, and on the basis of statements
;���� ��,�,,r,�i,�r,,��:,�r�f�� and information contained in the permit application, correspondence, plans,
maps, and all other supporting data submitted by the applicant, and made a part
Watershed District;5 hereof by reference, PERMISSION IS HEREBY GRANTED to the applicant
committed to a leader�r�;G� named below for use and development of land in the Minnehaha Creek
Watershed District. ��I� ` Q 'r�--�, �
rote in protecting, �7 �
improving and managing Issued to: Belle & Harrv Yaffe Permit No: 15-632
the surface waters and �
Location: 3185 Casco Circle, Orono
affiliated groundwater
resources within the Purpose: Erosion Control, Sinqle Family Home
�istrict,induding their Date of Issuance: 11/24/2015 Date of Ex iration: 11/24/2016
relationships to th� By Order of the Board of Managers
ecosystems of which
� v� ,
they are an integral part. Tom DietrlCh
District Technician
We achieve our mission
through regulation, This permit is not transferable without District approval, and is valid to the date of
expiration. No activity is authorized beyond the expiration date. If the permittee
capital projects, requires more time to complete the project, an application for renewal of the
education, cooperative
permit must be received by the District at least 30 days before expiration.
endeavors,and other The applicant is responsible for compliance with all District Rules and for the
action of their representatives, contractors, and employees.
programs based on
sound science, Conditions: Project to be completed as described in plans submitted to the
MCWD office on November 12, 2015 according to the provisions
innovative thinking, an of this permit.
• Properly install and maintain all required erosion control
informed and eng��e�i measures until the disturbed areas are re-stabilized
constituency,and tr�e • Notify MCWD in writing upon completing installation of
perimeter and sedimentation controls
cost e�ective use of . When the site is re-stabilized and the MCWD staff has
puhtic fi_���ds.
performed a final inspection, all silt fences must be removed
(Statement concerning fees for inspections,',violations, etc... on following page)
15320 Minnetonka Boulevard, Minnetonka, MN 55345 • Office: (952) 471-0590• Fax: (952) 471-0682 •www.minnehahacreek.org
I
MINNEHAHA CREEK WATERSHED DISTRICT
C��M
QUALITY OF WATER "�� QUALITY OF LIFE
Inspection/Anatysis/Monitorinq Fees
Tne Minnei�aha Crec��:
Watershed District.is A site inspection and monitoring by District staff will be performed where the
committed to a leadership aCtivlty involveS:
role in protedinq, . a commercial/industrial/multi-family residential development
improving and mar;aging • a single family residential development greater than 5 acres or of any size if
within the Minnehaha Creek subwatershed
the surface waters and . any alteration of a floodplain or wetland
affiliated groundwater • dredging within the beds, banks or shores of any protected water or wetland
• a violation
resources within the • any project which in the judgment of the District staff should be inspected
due to project location, scope, or construction techniques
District,including their
rel�tionships to tt�e
In these cases, the applicant shall pay to the District a fee equal to the actual
ecosystems of which costs of field inspection of the work, including investigation of the area affected
by the work, analysis of the work, and any subsequent monitoring of the work,
they are an integral part. Which in the case of a violation shall be at least $35.
We achieve our mission
through regulation,
capitat projects, Standard Fee Schedule
education,cooperative District professional staff $ 65.51*
District interns $ 40.35*
endeavors, and other District clerical staff $ 46.69*
programs based on Consulting Senior Engineer $ contracted rate
Consulting Engineer/Technician $ contracted rate
sound science, District Counsel $ contracted rate
Application fee $ 10.00
innovative thinking, an Copy costs $ .25 + actual staff time
informed and engageG Color copy costs $ 1.00 + actual staff time
constituency,and the
cost effective use or * Hourly j
���!ii!�r ft.;r,r1,.
15320 Minnetonka Boulevard, Minnetonka, MN 55345 •Office: (952)471-0590 • Fax: (952)471-0682 •www.minnehahacreek.org