HomeMy WebLinkAboutMCWD permit +� - • .
MINNEHAHA CREEK WATERSHED DISTRICT
QUALITY OF WATER QUALITY OF LIFE
Pursuant to Minnesota Statutes Chapter 103D, and on the basis of statements
and information contained in the permit application, correspondence, plans,
The Minnehaha Creek maps, and all other supporting data submitted by the applicant, and made a part
Watershed Disirictis hereof by reference, PERMISSION IS HEREBY GRANTED to the applicant
named below for use and development of land in the Minnehaha Creek
committed to a leadership Watershed District. �
rote in protecting,
improving and managing Issued to: Carter Ohrt Permit No: 13-161
the surface waters and Location: 475 Oxford Rd. Orono
affitiated groundwater purpose: Erosion Control, Wetland Protection-Single Familv Home
resources within the
Date of Issuance: 6/24/2013 Date of Ex iration: 6/24/2014
District,includir}g their
retationsh;ps to the By Order of the Board of Managers
ecosystems of which '�✓�- �"'
Brandon Wisner
they are an integrat part. District Technician
We achieve our mission This permit is not transfe�able without District approval, and is valid to the date of
through regu(ation, expiration. No activity is authorized beyond the expiration date. If the permittee
' requires more time to compiete the project, an application for renewal of the
capital projects, permit must be received by the District at least 30 days before expiration.
education,cooperative The applicant is responsible for compliance with all District Rules and for the
= endeavors,and other action of their representatives, contractors, and employees.
programs based on Conditions: Project to be completed as described in plans submitted to the
- sound science, MCWD office on June 19, 2013 according to the provisions of this
- permit.
innovative thinking,an • Properly install and maintain all required erosion control
measures until the disturbed areas are re-stabilized
infurmed and engaged . 1Nhen the site is re-stabilized and the MCWD staff has
� constituency,and the performed a final inspection, all silt fences must be removed
3
cost effective use of
public funds. (Statement conceming fees for inspections, violations, etc... on following page)
18202 Minnet�nka Boulev�ard,Deephaven,MN 55391•Office: (952)471-0590�Fax:(952)471-0682•www.minnehahacreek.org
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MINNEHAHA CREEK � WATERSHED DISTRICT
QUALITY OF WATER QUALITY OF LIFE
Insqection/Analvsis/Monitorins� Fess
The Minnehaha Creek A site inspection and monitoring by District staff will be perFormed where the
Watershed District is activity involves:
committed to a leadership • a commercialrndustrial/multi-family residential development
� a single family residential development greater than 5 acres or of any size if
role in protecting, within the Minnehaha Creek subwatershed
improving and managing • any alteration of a floodplain or wetland
• dredging within the beds, banks or shores of any protected water or wetland
the surface waters and . a violation
affitiated groundwater • any project which in the judgment of the District staff s.hould be inspected due
to project location, scope, or construction techniques
resources within the
District,including their In these cases, the applicant shall pay to the District a fee equal to the actual
relationships to the �sts 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,
ecosystems of which which in the case of a violation shail be at least$35.
they are an ir�tegral part
We achieve our mission
Standard Fee Schedule
through regulation,
District professional staff $ 55.79*
capital projectr, District intems $ 34.24*
education,cooperative District clerical staff $ 50.40*
Consulting Senior Engineer $contracted rate
endeavors,and other Consulting Engineer/Technician $contracted rate
programs based on District Counsel $contracted rate
Application fee $ 10.00
sound science, Copy costs $ .25 +aCtu81 steff time
Color copy costs $ 1.00+actual staff time
innovafire thinking,an Audio tapes � $ 20.00 each
Watershed Plan (Paper) $ cost of production
informed and engaged Watershed Plan CD $ 10.00 each
� constituency,and the CIP $ 10.00 each
� cost effefive use of
pubtic funds. * HOUPIy
18202 Minnetonka Boulev�arcl,Deephaven,MN 55391�O�ce: (952)471-0590�Fax:(952)471-0682•www minnehahacreek.org
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Print Form
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WATER RESOURCE PERMIT APPLICATION—COMBINED JOINT NOTIFICATION FORM
Use this form to notify/apply to the Minnehaha Creek Watershed District(MCWD),their engineering consultants,and the DNR of a
proposed project or work which may fall widun their jurisdiction. These agencies should advise you of theu jurisdiction or permit
requirements within 10 days.Fill out tlus form completely and mail with your site plar►,maps,etc...to the MCWD, 18202 Minnetonka
Boulevard,Deephaven,MN 55391.Keep a copy for your records.
YOU MUST OBTAIN ALL REQUIRED AUTHORIZATIONS BEFORE BEGINNING WORK.
1.Property Owner Name(First,Last): " '""
. � . . ddr-ess: � �1���f}l�-B�$_-- ---�tate: --�' '" -- —__
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Email Addre�s: Phone: Fax:
2.Location of proposed project(Attach map with directions to site):
Project Address: �7� Q}t.�=a�� ;�,� City:
County: ��i� Qtr Section(s): Secrion(s): Township(s): Range(s):
Lot: 2 Block: Subdivision: S.'7�tlWS �Ab�/% PID:
3.Size of site: �1',3fp '- Area of disturbance: square feet, or acres
Volume of excavation(or fill): cubic yards Length of shoreline affected: c� feet
Area of existing impervious surface: Area of proposed impervious surface:
4.Type of permit being applied for(Check all that apply}:
� EROSION CONTROL �WETLAND ALTERATION
� STORMWATER MANAGEMENT �WATERBODY CROSSING
� FLOODPLAIN ALTERATION 0 SHORELINE/STREAMBANK IMPROVEMENTS
� DREDGING
� O'TI�R ES CRIBE):
5.Project Purpose(Check a11 that apply):
� SINGLE FAMII.,Y HOME �MiILTI FAMII,Y RESIDENTIAL HOUSING(apartments,etc.
COMNIERCIAL CONSTRUCTION �INSTIT'UTIONAL CONSTRUCTION(churches, schools, etc.)
� ROAD CONSTRUCTION �SUBDIVISIONS(include number of lots)
� UTII.,ITIES �LANDSCAPING(pools,berms,etc.)
0 DREDGING ❑SHORELINE STABILIZATION(lakescaping,bioengineering)
� OTI-�R(DESCRIBE):
6.NPDES/SDS General Stormwater Permit number(if licable):
7.Alternatives(Describe any other sites or meti�ods that could be used to avoid or minixnize impacts to water
bodies to achieve die project purposed.Attach additional sheet if needed.)
8.Pro'ect Timeline: Start Date: � Completion Date: • fC. ' �
9.Applicants Representative(Licensed contractor, engineer, etc...)
Business Name:�,�j"�� � �j�j. ��G, Representative Name: • ` �
Business Address: �0'73 f�/�rZ.i�9 ° JJ
• � City: ldq/�i L��. State:A�.t� Zip: "'��'' r`
Email Address:-� He flunrrct r Phone: Z - �S- �" Fa�c: 9sZ-�75'-b"7'78 -
10.Names and addresses of adjoining property owners(Attach list if necessary):
cw •� `�A-��. s�� ,rfr�/ Z5'
� � c.,` S ' �
Permits have been applied: City�County � MN Pollution Control Agency_�DNR�_COE�_
Permits have been received:Ci � County � MN Pollution Control A ency � DNR � COE
I hereby notify the recipients of this form of die project proposed herein and request I be advised of any permits or other
determinations concerning dus project that I rnust obtain.I understand that proceeding with work before all required authorizations
are obtain ay b subject er ,3tate and/or local administrative,civil and/or criminai pe�ialties.
5-c�''- (3
Si a e ofPr e er Date
Page 1 of 2
1NSTRUCTIONS-PLEASE READ CAREFULLY
A copy of this form,with copies of all plans,drawings,etc... may need to be s�t to an ag�cy indicated below...Please check
the appropriate spaces below to show everywlrere you are s�ding this form Remember to keep a copy for yourrecords.
� MINNESOTA POLLLTTION CONTROL AGEIVCY(MPCA)for NPDES phase II permit
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0 The LOCAL GOVERNMENTAL iJNIT(LGU), aty,county or water management organization
�MINNESOTA DEPARTMENT OF NAT'LTRAL RESOURCES(MDNR)Regional Office
� US ARMY CORPS OF ENGINEERS(ACOE)at Dept.ofthe Army,Corps of Engineers,St.Paul District
ATTN:CQ-R, 190 Fifth St.East,St.Paul,MN 55101-1638
Note:The above Agencies may provide a copy of your completed form to the Minnesota Pollution Control Age�cy(MPCA).
MPCA water quality requirements may apply to your proposed projec�t.
ATTENTION Gfrom USDAI:Any activity including drainage,dredging,filling,leveling or other manipulations,including
mainteaiance,may affect a land user's eligibility for USDA b�efits under the 1985 Food Security Act as am�ded. Check with
your local USDA office to request and complete Form AD-1026 prior to initiating activity.
Application is hereby made for a permit to authonze the activities described herein.I certify that I am familiar with MCWD
Rules and that the proposed activity will be conducted in compliance with these Rutes. I am familiaz with tiie information
contained in this application and,to the best of my knowledge and belie�a11 information is true,cornplete and accurate. I
further certify that I possess the authority to undertake ti�e proposed activity or I am acting as the duly authorized agent of the
applicant.
� 5� `�,� � �
Signature of Apl ' ant(Property Owner} Date Signature of Ag Date
NOTE:The application must be signed by the property owner where the propos�i activity is to occur.The application may be
signed by a duly authorize�i agent if a letter bearing the original signature of the properiy owner is submitted staring that the
agent noted in the pernvt application is the authorized agent of the landowner for all matters relating to the permit.Please
provide authonzed agent information below:
Ag�t's Name&Title: �dl?�9S j�3,�'/�jtip - ��,�f'� 7S;�L'�f( ,L�JL1+�/��,
Ag�t°S Ada��s: 20`73 ��7�6� �L-v°� (.v e "�1'1/�lb L��' t, �� ���SJ�'
�
Agea�t's Telephone: �Z �7�- �7�
18 U.S.C.Seciion 1001 provides thai:Whoever,in any manner within jurisdiction of any departm�t or ag�cy of the United
States knowingly and willfully falsifies,conceals or covers up by arry trick,scheme,or device A material fact or makes any
false,fictitious or fraudulent statements or representations or makes or uses any false writing documart lrnowing same to
contain any false,fictitious,or fraudul�t statement or entry,shall be fined not more than$10,000 or imprisoned not more than
five years,or both.
Page 2 of 2
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Erosion Control Supptemental Information
Final Stabilization will be provided with(seed,sod, etc): ��3� oR- 5�-�
and 6 inches of topsoil will be added/replaced prior to final stabilization.
Concrete Washout: Location of concrete washout
❑Not Applicable ❑Off site ❑ Indicated on site plans ❑Other(description):
Vegetation: Protective fencing will be installed as necessary so as to exclude all fill and equipment
from the drip line or critical root zone,whichever is greater, of all vegetarion to Ue retained.
�Yes �Not Applicable �Other(description):
Inspections:An erosion control inspection plan is required for a11 projects disturbing 1/4 acre or
greater.The inspection requirements are as follows:
1) The individual identified as being responsible for implementing the erosion control
plan musi routinely inspect the construction srte once every seven days during active
construction and it�ithin 24 hours after a rainfall event greater than 0.5 inches in 24
hours.
2) r111 inspections and maintenance conducted during construction must be recorded in
writing and these records must be retained�vith the erosion control plan and made
available at the District's request within 24 hours.Records of each inspection and
maintenance activity shall include:
i. Date and time of inspections;
ii. Name of person conducting inspections;
iii. Findings of inspections, including recommendations for corrective actions;
iv. Corrective actions taken(including dates, times and parry completing
maintenance activities);and
v. Date and amount of all rainfall events greater than 0.5 inches in 24 hours.
Provide the following information for the primary individual responsible for implementing the erosion
control plan:
�T"�Yi� �Gt�f
Name T�GLR-dlQ S �?GC'��I�i(n P���?��
Organization (� C� •r
Phone l/.+�Z-68 5�- ��� 3 Alternate Phone
Email
I certify that I am familiar with the requirements of the MCWD Erosion Control Rule and that the
proposed activity will be conducted in compliance with this rule.
.J'�v-'/.�
Signature of licant or Authorized Agent Date
5�?S c�c���� �,
Project Address