HomeMy WebLinkAboutMCWD permits JUN-10-2004 16�52 FROM TO 9522494616 P.02i07
Minneh�,ha Creek Watershed DistriCt
�Irnproving Quality of Water, Qualiay of Life
F.srablished in 1967
Mail: '
18202 Minnetonka Blvd, Pursuant to Minnesota Statutes Chapter 103D, and on the basis of statements
and information contained in the permit application, correspondence, plans,
Qeephaven,MN 5539i maps, and all other supporting data submitted C�y the applicant, and made a part
Phane;(952)471-0590 hereof by reference, PERMISSION IS HEREBY GRANTED to the applicant
named below for use and development of land in the Minnehaha Creek
Fex:(ss2)a�i-osez Watershed District.
Email: '
Issued to: Haitv McNernev Permit No:03-628
admi n�minnehahecreek.org '
web site: Location: 3�00 Fox Street. Orono
www.minnehahacreek.org purpose: Rule B: Erosion Control
Date of Issuance: 06/09/04 Date of Expiration: 06/09/05
By Order of the Board of Managers
Board of Managers
Pemela 8�xt
Renae Clar �
,lemes Calkins District Technician
Lance Fisher
This permit is not transferable without District appraval, and is valid to the date of
Susan�oetz expiration. No activity is authorized beyond the oxpiration date. If the permittee
Rlchard Miller requires more time to complete the project, an application for renewal of the
Ethe�Sm�th permit must be received by the District at least 30 days before expiration. �
ScottThomas The applicant is responsible for complia�ce with all District Ruies and for the
action of their representatives, contractors, and employees.
Conditions: Project to be completed as described in plans submitted to the
MCWD office on June 8, 2004 according to the provisions of this
permit.
� Properly install and maintain all required MCWD Rule B,
erosion control measures until the disturbed areas are
restabilized
• Silt fence must be orange in color
• Wheh the site is restablilized and the MCWD staff has
performed a final inspection, all silt fences must be removed
(Statement concerning fees for inspections, violations, etc... on reverse)
COMBINED JO1NT NOTIF1CATlON FORM-WATCR RESOURCE APPLICATION r�,,,,i
Use this form to notify/apply to the Minnehaha Creek Watershed District (MCWD),their engineering consultants,the
DNR,and the Hennepin Conservation District of a pro�wsed water/wetland project or work which may f'all within their
jurisdiction.These a�encies should advise you of their jurisdiction or pern�it reyuirements within 10 days. Fill out this
form completely and mail a copy,with plan, maps,etc... to the MCWD, 13202 Minnetonka Blvd.,Deephaven, MN 55391
Keep a copy for your records.
YOU MUST OBTAIN ALL REQUIRED AUTHORIZATIONS BEFORE BEGINNING WORK.
1.Applicant's Name(Last,1=irst,M.1.) Phone No.
�Ntr-n� A� 65� - �{Z- I8'a�
Address(Sh•eet, RFll,Box#,City,St�te,"Lip)
• o0 0 +. o o N .SS S�
2. Location of proposed project(Attach drawing w/directions to site):
COUN�1'Y Q"CR SECTION(s) SECTION(s) TOWNSItlP(s) RANGE(s) Lot,Block,Subdivision
���n���t �f 3 �5 t I 7 �3 eo 5
Ko��. rA�uk�.ss: 3�{0o FaX �, crrY: o�ono
3. LENG"CI I OP SI IORE AFFEC'CEU(in feet): VOLUME OF FILL OR EXCAVA710N(Cubic yards): �/O�11 E
Au�A�A.1-�i)QK H�f'F?J IS Acres.OR Syuare F'eet.
�y o � �?�o ac re s
4. TYP�,OF PERMl1'B�.ING APPLI�,U}�OR: (Check all thnt apply):
�57�0}tMWA�I'ER MANAGEMEN7�PLAN ❑FLO011PLA1N AL�1'ERA�170N ❑WE�I�LAND ALI�ERA7�ION
❑Sl10REL1NE IMI'ROVEMEN7� ❑S�fORM SEWEk OU'I�E'ALLS ❑ EXCAVA�f(ON(llREllG1NG)
a.�RIPRAP a.❑WILDLIF'�
b.�SANDBLANKE7� ❑ICE RIUGE REMOVAL b.❑NAVIGA�I�ION
c.❑It�."i'AININC WALL c.❑BIO�:NGIN��RING
� n � 1 ❑BRIllG�&CULVERT CROSSINGS
or�i�Kt��scKi��> _ �oSian LA�n e
4a. APPLICAN7"S KEPKESEN'I'A71VE:(Licensed Contractor,Engineer,etc...) lnclude name,address&phone nwnber.
Scotf I/�,� pe� �n e �Q �60 /l�7 G�l�� w� �l ,SS3 gY
5. PRO.IEC'i'PURPOSE(why is this project needed-what benefits will it provide'?)
� ,1t�re4s� 'de lu.l��+-a
RCS'�oro�10� o� A�E��1Jc �ct I�'� �o,� wil( GI'e a!o o �„ !o v�
6.AL'CERNA'fIVES(describe any other sites or methods that could be used to achieve the pumose of your project while avoiding or
minimizing water/weNand imp�cts. Attach additional sheets,if needed. _�
N�
7. llA7'ES: Propose�i start of activity: M q�--'�ne Ppo� Yroposed completion: �S a�{{'E r S�o(`�'
{��C'1�lf"i.'? a:0i:'^.iet�t�`:r:)I'n Oi:Fiti�:C:":;:�::3CFiLVil1"� �C' (J✓'�t���
8. NAMES&AllllRESS 'S OF AUJOINING PROP 'RTY O NERS(Attach list if�uore)
/=?�rn k -�v((���F� ��o z -�ox .�� ��r,_v� .r�ti' SS 35Co
9. P�RJv1ffS 1lAV�:H�.�.N R�C�31V�U�OR API'Ll�:ll h'OK(Al FROM: llNR ARMY CORPS Oh'ENGK
_�_COUN"fY��C17Y MN POLLU710N CON'1'ROL AGENCY
l hereby notify tlie recipients of this ti�rm of tlie project proposed herein a�id request 1 be acivised of any pennits or otlier detennin�tioiis
conceniing this project diat 1 must obtain. I understand th�t proceeding with work before all required authorizations�re obtained niay be
subject to Federal, State and/or local administrative,civil and/or criminal penalties.
��✓,� �� D
i�nature of Persor�Pro osin Pro'ect or A ent Date
R���I�I�D
UtL c � �3
1NSTRUCTIONS-PLEASE READ CAREFULLY G17Y UF ORQNO
A copy of this form,with copies of all plans,drawings,etc... should be sent to each agency indicated below.
Please check the appropriate spaces below to show everywhere you are sending this form.Remember to keep a
copy for your records.
✓ The LOCAL GOVERNMENTAL UN1T(LGU)city,county or water management organization
✓ The SO1L&WATER CONSERVATION DISTRICT ✓ HENNEPIN SWCD CARVER SWCD
✓ MINNESOTA DEPARTMENT OF NATURAL RESOURCES (MDNR)Regional Office
'� US ARMY CORPS OF ENGINEERS(ACOE)at: Dept. of the Army,Corps of Engineers, St.Paul
District-ATTN: CO-R, 190 Fifth St. East,St.Paul,MN 55101-1638
Note:T'he above agencies may provide a copy of your completed form to the Minnesota Pollution Control
Agency(MPCA). MPCA water quality issues may apply to your proposed project.
ATTENTION (From USDA):Any activity including drainage,dredging,filling,leveling or other manipulations,
including maintenance,may affect a landuser's eligibility for USDA benefits under the 1985 Food Security Act
as amended.Check with your local USDA office to request and complete Form AD-1026 prior to initiating
activity.
IMPORTANT: Some agencies,including the Corps of Engineers and the MDNR accept this form as a permit
application form.If you wish this form to constitute an application to the Corps and/or MDNR for any necessary
pernuts for your projects please carefully read the following information and sign where indicated.
����������������������������������������������������������������������������������
Application is hereby made for a permit to authorize the activities described herein. 1 certify that I am familiar
with the information contained in this application,and that to the best of my knowledge and belief such
information is true,complete and accurate.l further certify that 1 possess the authority to undertake the proposed
activity or 1 am acting as the duly authorized agent of the applicant.
c� ; � '
���✓�%� ' c�'C �C'�
Signature of Applicant Date Signature of Agent Date
Note: The application must be signed by the person who desired to undertake the proposed activity
(Applicant)or it may be signed by a duly authorize agent if the information requested below is provided.
Agent's Name&Title: ��/� t�R..� �n Cr�dC
Agent's Address: �a �OX �la 7 Wf�''�er�ew/1 /�N �S 3��
Agent's Telephone: ((of2 ) ��g ' q`'�°2�
18 U.S.C. Section 1001 provides that: Whoever,in any manner within the jurisdiction of any department or
agency of the United States knowingly and willfully falsifies,conceals,or covers up by any trick,scheme,or
device a material fact or makes any false, fictitious or fraudulent statements or representations or makes or uses
any false writing document lrnowing same to contain any false,fictitious,or fraudulent statement or entry,shall
be fined not more than$10,000 or imprisoned not more than five years,or both.
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3400 Fox St '
Orono MN �
55356-9775 US
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AUG-22-2001 15�36 MINNEHAHA CREEK �RTERSHED 6124710682 P.02i02
� � __�� �
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�'hl' :��I1�. , ...,
Permit# 00- 3 � ' �. " `. `'-h.
� l
SH�RELINE EROSION PR�TECTION-FAST TRACI�.P�i3AQLT.. _ .__
MINNEHAHAI CREEK WATERSHED DISTRI�CT �
GRAY FRESNWATER CENTER Ph: 471-0590
2500 SHJ�DYWOOD ROOD FAX: 471-0682
EXCEL.SIOR, MN 55331
C �����
I,�Airy �.�1�.ki�.�l� /v�side �t .3y�11�,�ST•
(Property Owner) (Sireet Addvess)
�,p,v�.,�,R� , /)'Jip/. .�$^�, ��T�3��--� equest appro�al to instali
(CNy) (Stat�) (�P) (Phone)
riprap shoreline erosion protiectian on property described as , located in
' r {stTeet�ddressj
���� , �,�l�v.E,�,�n>_,(,�,�"-//�-�� f�.�000„�'The rip rap inst�lla�tion
(Within 1he City bounderies) (County) (PID#) '
will consist of���along the sho�etine of �f i�, ,S,��RS,�? ,�,f-in�full
(hneel teet) � ) ( y)
accordance with the Minnehaha Creek Watershed Di�trict Shoreline Protection Guideline for
�p���B��Ka�OR8b1A�D edg�9suarlce of a Fast Track General Permit. I have corrtracted with
500 West Lake St. , , ,
t � 1 (Adiiress) (Phone), • .
4749454 , to pertomn the work who i�s familiar with the technical requirements
(�ond Number)
and has fulfilled the bonding requirements of the wat�rshed districfi (see reverse). 1 have read
and e tand the requir men of the MCWD relating to Shoreline Erosion Prntection.
- ' �1�1� I
�,y . � (Date)
Subscribed and swom to before me on this f� day of 17 u,L:E�, � � , 200�
Juditll E.Nleam '
� — Not�ry Pu6110-NUnne�om
. He►u►epin Cow►�r
ary Public � � �°o�D°�e1�'�0°'
/�
Approved By: � Date: -
Distr� ution: _Pmperry Ovmer rContractot ,�Municiputiry �DN Dlstriet Filc .
?-2001 15�21 MINNEHAHA CREEK WATERSHED 6124710682 P.02i02
� �. �- `-• �-
.. . , a►33a _,
SA,NDBI.�A�II�'P�RNIIT�&SA1�TD SOURCE .
�BE�'K W�A7�BSHEU DLS'1'RICT -
� . . � T�0 ��
_... ,
1 � ' r � �yt D S�. �w �r„� ss.��,6
Property Owncr .. Addness Ci�y,Stat¢�Zip -'
>r�'" ,�,''�5�'�- �.�.vi✓+ , or P1D# ��/,(�-� 3 5�3��OD.S'
Piwnc Cotu�ly T�vr�Sd�roey Ra�gc (frwa prvperry tex statc�ucntl
own�nd occupy the ahov�e ain,glc iamily residence and�wislt to irtsialt a sandblatsloct on �
Wce��•y
Minnetonka Portable Qredging
`� I h�.ve contracted with � 500 West Lalte S�t at
/ �oefeior, 5533 �� �
- _ to install Glean sa.nd from the foilowirtg sour
city�state�zip phonc
�nt, �l�f44�� e�- �d"�/S __ �A�'I�irc�,G /71 n/. � —��j y/7S r or.
s�p�i�r -- � �ddr�s ptw.0 '
❑ I v�nll install the sandblankc�myself f�rom the follo�wing soume_
supputr
addreas -- � — phono
If this projeet rec{uires muni,ccipal appmvsl or rzview,pleaae attach docutn�entation oE the municipa.l apprc
with this application. My s�oreline is�3o?D feet and�he dimensians of Ehe propose:d sandblanket are:
� (Length) x r.L� (Width) x�� (D�:pthj. Sandblank�:t dimer�sionc earnot exceed a
length of 50' (or S09b of shoreline),a width of I O'and a dcpth of 6". `
I understand that if this applic�tion is not compl,efely hlled out, or if I fai). to submit the rcc{uir�ed exhik
thc applie�tioa is inovmple�c at1d will be returned..IE w�11 aot bG revicwrd by MCWD staff unti,l compl�
By �it�g t�tais applieation, I ag�e and uitc�et�tattd �t the Diatrict may enter tha property at reasona
hw.rs to ooaduct att inspectiozt to detcraaine whethe� the tcrms c�f the permit are being met. I furt
underst�.n,d.-that if [ violate Fhe ternis•and conditions oI'a permi.t that is issacd base,d upoa this applieati
the Disttiot s�iall.'oonduct a fie1�d i�p�n of tlu ptioje�;t per MC1ND Rule j, pravided with this applicati
i undersfat�d t�ie Disi�iet w�I.charg�c f�cs to�wer the ae�tual oosts vf Geld inspcctions,in�ludir�g investiga�
vf t�i,e are�s�ed by the w�orlc,ansl�sis of the work, ineiu�ding tive mervi le.gal oounsel �nd et�,gine
and any subsequent ntoaibocit�g of the worl� Tl�e Distt�ct's ac[uaE casls at+e���c�.d to be�ii� accruing w:
the District issu.es notice af the violation to the permitte�. i have read and understand the MCWD Techn
G � Ii es f db ts.
. ,.
� � � ��6�0/
Date
Subs�ri'bed and sworn to befo� me thas �day of �,f�� � 200 � JOa��'�'�'
�C.I�^ � I�TFUYFtIbI1C-M�1NIi�0i�
• �.»..,,.�.�
�
` , Ily OOnntisson 6�Yee I.a1�
. - �
ary Pablic � ,...,r:,��a�:::.,. � .
- ���... .
Approved and, Acc�pted by Date
�. . . 7t_J�, f\�.� � • T � • •
TOTAL P.02