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JHN �� EJ17 �
'WATER RESOURCE PERMIT �.'rrrn►r v�nnu
vae this�rm to notityJapply to t�Ca Minnehaha Cregk Watershed D1strlct(MC ay fell witliln
their jarisdicdcx�.Fill out this fOrtp completely and suhmit with your sita plan,maps,etc.to t�MCWD at:
15320 Minnetonka Blvd.Minnetonka,MN 55345.
Keep a copy fifi�rr your reoorda
YOU MUST OBTAIN ALL RE UIRED AUTHORIZATIflNS BEFORE BEGIlVNINC}WORK.
1.Namc of each praperty own�: Shields,Mtke and Meliasa
Mailing Addrass: 800 Lanewood Ln C�ty; Piymouth State: MN Zip: 55447
Emafi Addres�• Phone: F�•
2.Praporty Uwner Repreaentative Infocmation(not required)(lic�nsed Qontractox,architect,eagineer,etc...)
Business Name: �K Buildera, Inc. Representative Name: ��'Y or Grag Kuperue
Business Address: �2125th Ave Clty; Milaca $�• MN Zip; 56353 �
Emait Address: Idkbuilders�gmail.com,gregQldkhomes.c phone• 61�859086,7832449001 g�;
3.Projcct Address: �9 Minneeonka Highland Rd City: Orono �
State: Mw �;p; 55356 Qtr Soction(s}: Section(s): � Township(s): Rengo(s):
Lot: 3 Block: 2 Subdi�riaion: Minnetonka Highland EstaEes pip� 0611723440007
;
4.Size of project parcel(squaro f�t or scres):42,OBs SF �
Area of di�sturbancs(squara fee�t): Volume of axcavation/fill(cubic yar�cls): '
Area of oxisting impervious aurface• 9,18b Area of proposed imparviousi stuface: 8,773 ;
1.angth of shoreline affected(�Geet): . Waberbody(�t bay if appliQablo): �� �
S.Type of pa�mit being applied for(Check all tfiat apply):
m EROSION CONTROL ❑ WATERHODY CROS3INCi5/STRUCTURES �
❑ FLOODPLAIN ALTERATION ❑ STORMWATER MANA(iEMENT
❑ WBTLAND PROTECTION ❑ APPR�PRIATION3 �
❑ DREUQINC� ❑ ILLICiT DISCHARGE
❑ 3I�IORELINE/STRBAN�ANK STAHII.,IZATION �
6.Projoct purpose(Check all that aPP�3')� �
G� SINdLB FAMILY HOME � MULTI FAMII.Y RESIDBNTIAI,(�rtnaents) �_
C1 ROAD CON3TRUCTION ❑ COMMERCIAL or INSTITUT.[ONAL
Q UTILITIBS ❑ SUBDIYISIONS(ina[udo m�mber of lots)
❑ DREDC�ING ❑ LANDSCAPINC�(pools,berma,�tc.) '
C3 SHORELINE/STREANIDANK 3TASIY.IZATION ❑ 4THER(DFSCRIB�:
'7.NPDE3/SDS Ceneral Stormw�er Fermit Number(if applieable):
8.Wa�srbody recoiving ntaoff from aite:Lake Minn�tonka
9.Projoct Tiutelina: Start Date: March 2017 Completion Dat�•A st 20t7
Permits 12av�bean applIed far:City d County C�MN Pollution Couirol A�ency �DNR �COE 1�
Permits have t�received: City^�Cownty—�MN Pollutlon Control Agency�DNR'�COE—�
By signing below,I hereby request a perniit to a�rthoriLa the activities d�.aaribed herein.I certify that I am familiar wi�MCWD
Ral�end that dta proposed aet[vity will be oonducted in aompliance with these Ruioa.I am familiar with tho infonnation
containecl in thia appltcation and,to the bast of my�owledge and bebtef,all intbrmaHon i�tnu�complete and acctq�ate. I
unde�stand thai pt+nceeding with work befnre atl reqoirod attd�orizations aro obtaiitted may be subject to fiedaral,si�ete and/or loce]
administrativa,civil and/or criminal p�taltiea. t
����—Z-- _ � ���-�� a��i7
Signahu+e of Badi Pnnpedy Ownar ' Date
;;,_:;��� .��1:`1;i1 i:. �'i�i?< � £:�i i '
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EROSION CONTROL SUPPLEMENTAL I NFORMATION FORM
I NSPECTION PLA�1 REQU I REMENTS �,s'� � s;"� � ��� � �� ��
�..
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�. Routina �nspaction�� ` ; �A� � � ��1 j '
, ,
. � ��' �
Qnce every sevan d�ys during actWe conskruCt.ion Ir
� VV I[hin 2`t ho�rs of t�half Inch or morc3 precipl[ak�on � � µ mm
., � _,..., ___ ., .� ..._ ...,.:�.�
2. Cc�mplet[3ci Fi�i�i �nspc3ctlon Reports.
� Reports avaltable within Z4 hours of roquest untll MCWD da[arminos pro�oct Is compleCa CX
stabi Iized
FB!/ure[o subml4 raques[ed Mapect(on Mformatlon w!/I�asWt /n a slta fnspectfon and may bs sutZ/ect to
relmbc��ement for/V/l�W�stflfF[lme.
Who wi ll inspect your-slte regular-ly�
NAME: Matt Blacketter ORGANIZATION: LDK Builders, Inc.
PHONE: 612-886-5963 ALTERNATE PHONE:
EMAI L: blackketter86�hotmail.com
Wnere rs tna cor,�r-ete wesnout io�etior,�
B OFF SITE OR CONTAINED ON TRUCK
� INDICATED ON SITE PLAN (wlth raqulraci imparmaable Iiner)
❑ N/A
WFiat Is thg final stabillzation matf-�od�
�seed, soa�, etc.�: $OC�
6 Mchas of topsoU must be added�replacad pr�lor to fM�l st.�bt/lzatlon
WIII protec.t7vB Eencinp for retained vegFst.atlon be Ins[alled�
9 YES
❑ NOTAPPLICABLE
❑ OTHER(das�,-��)
� certify that � am famll iar wlth tha requir4>mants of�tt�e MCWD Erosion Co�trol flula and that tlie
pro sed activity wlll ba conduct�d fn compllance with this rule.
1/23/17
Slgnatu � of/-1�plic or� uU� rized/-lgent �ate �
MINNEHAHA CREEK
WATER8HED DISTRICT
ou�um of wes4 uu�urr or un
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DATE �/Z cS� I ( � .
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. RECEIVED FROM '� �i
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OFOR RENT ��� �� DOLLAI�$
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ACCOUNT , Q CASH � ��
PAYMEIVT �p � ,� 'CJ�HECK '1'�," S� �S?
� �MONEY �; FROM
BAL.DUE ORDEq TO
_ � �CREOIT � �� �
CARD BY
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By: ____ -
JUL-24-2003 13�46 MINNEHAHA CREEK WATERSHED 6124716682 P.02�03
Permit # - y�
SHORELINE EROSION PROTECT��N — �AST TRACK PERIVIIT
MINNENAHA CREEK WATERSHEO DISTRICT(MCWD)
18202 MINNETONKA BLVD. Ph: 952-471-0590
DEEPNAVEN, MN 55391 Fax: 952-�71-0682
R.ob��a.,..d ckary/
�, reside at �d$ �1'! .�/�s, ,' ��`
(P perty ner) (Street Addre
, �' (�6�)�•s!9/
d�a/I!d �1�►- sPo ( z _ 6�/r/�8'� request approval to install riprap
(��ry) (State) (7.ip) (Phone)
shoreline erosion protection on property described as.�6��wa�a,!/'/,'/�located in
��d (Street address)
. The riprap installation
(Within the City boundaries) (Counry) � (Properry ID# (PID#])
will consist of_ �0 � along the shoreline of��+� , �/jp�cY/r/or�i�»r�_ in full
(�neal feet) (Lake) ' (Bay)
accordance with the Minnehaha Creek Watershed Dist�ict Shoreline Protection Quideline for
riprap plaeement required for iss�ance of a Fast Track General Permit. I have corrtracted with
��(s o�� P/us , ,a � � s�ag� �,., cd.� �M , S � .
c��q
(Name f C pany) (Street address) ( ) (Z�p) (Phone)
, to perform the work who is familiar with the technical
(Bond Numbe�)
requirements and has fulfilled the bonding requirements of the watershed district (ses paqe
two). I have read and understand the requirements of the MCWD relating to Shoreline Erosion
Protection. .
I .. /��/ B� � �O
(Sipnature of Property e � (Oate)
Subscribed and sworn to before me on this�day af 2p(�,
� '
�� ��
Notary P lic pprp�py p���p�
� �b�MIi01�A�till��1.�
• ~ 11
Approved by: Dato Z
,
Distrlbution: _Property Owner _Contractor ,�Municipelity JpNR _Oistrict File
Pa e�' D ��� ���
. �
JU� � 1 2003
JUL-24-2603 13�46 MINNEHAHA CREEK WATERSHED 6124710682 P.03/03
Permit # �3 - 3`'� �
Sandblanket Permit and Sand Source Exhibit Form
FAST TRACK PERMIT
MINNEHAHA CREEK WATERSHED DISTRICT(MCWD)
18202 MiNNETONKA BLVD. Ph: 952-471-0590
DEEPHAVEN, MN 55391 Fax: 952-471-0682
.
I, R� Y � � esid at �o��� " , OaC(j' Q
�P tt Owner) 6•� � (Add�s) (CiIY�
/�ri S 5 S�L , ( /2) L�v�k , ranuest approval to instali a sandblanket on property described
(State�aP) (P el % . ..
as aG�9��1��w:�•►la:lk'l, •�L�:,.=. . . , �ocated in D�PdA/G.��,�_ , en„e ;v
�S et address) (V11Uh1 the Clty boundaries) (Count
on p1i.w�vC�n►+lc�o�. r No� �i�S.�l
{Propeny 10#(PIO�rp (Laks) � �� (Bay)
❑I have contracted with H6 lir,s , �G �oY ,5��
(Name of Co anYl (Slreet address)
�-vr� �/ce� . M� . S3'3S� ,_,(.95�.) �/T3-�6C�9 to install clean sand from the
(ChY� c�Zlp) (Phone)
following source �
(Suppllar) (Address) (City,ap)
�
(Phone)
' ❑ I wili install the sandblanket from the following source ,
csw�w1e�
(Add�ess) � (City,State,Zp) � �� (Phone
)
/ /
My shoreline is lSS feet and ihe dimensions of the proposed sandblanket are: 50 X
d' �r X 1�� . Sandblanket dimensions cannat exceed a length of 50'(or 509��o horeline),
(oop�n) cwidu,)
a width of 10' and a depth of 6". If this prvject requires municipal approval or review, please attach
documentation of the municipal approval with this application.
I understand �at if this application is not c:ompletely filled out, or if I fail to submit the required exhibits, the
applicatio� is incomplete and will be retumed. It will not be reviewed by MCWD staff until complete. By
signing this applicatlon, I a9�ee and understand that the District may enter the property at reasonable hours
to conduct an inspectlon to determine whether the terrns of the permit are being met. I fu►ther understand that
if I violate the terms and conditions of the permit that is issued based upon this appliration, the DisVict shall
conduct a field inspection of the project per MCWD Rule J� provided with this application. I understand the
Dist�ct will charge fees tv cover the actual costs of field inspechons, including investigation of the area
affected by the work, analysis of the work, including the services of legal cmunsel and enginee�s, and any
subsequent monitoring of the work.The DistricYs actual costs are deemed to begin accruing when the District
issues notice vf the violation to permittse. I have read a d n erstand the MCWD Technical Guidellnes for
sandblankets
Q �
( �gnature of Properry er) -� � (Date)
ubscribed and s om to b fore me on this�_d of 2p�.
.
,
'' .,,w,,.nn,wwl� ■ �,g�V F'}: ;.;,,,_.. .... .
�fl���,�,�f� �''�, L�7 LJ�."; r.3 �+:t d:_'. :1 i�i
..
N tary Publi �" ' `�
,,; N01qR1►PlI6��'.1�/I�ORA .��� �. �, �'--',
yrpa�il�6�,1�,�1��111 = ?:��,:
A roved by: Date — '
TOTAL P.03