HomeMy WebLinkAboutPermits
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Minnesota Pollution Control Agency
L I..
The Honorable Jack Haugen
Mayor, City of Prior Lake
16200 Eagle Creek Avenue SE
Prior Lake, Min.'1esota 55372-1787
Dear Mayor Haugen:
Enclosed is the Sanitary Sewer Extension Permit Number 46493 for the construction and
operation of a Sanitary Sewer Extension System to be located in Prior Lake, Minnesota.
Please carefully review the Permit, including any Special Conditions, General Conditions
(No. 1-20) and information relative to plans and the Permit Application. If you have any
questions, please contact the Customer Assistance Center at (651) 297-2274, or
800-657-3864.
Sincerely,
~dY~!!&
Metro Unit
Municipal Wastewater Section
Municipal Division
GLE:jeh
Enclosures: Sewer Extension Permit
General Conditions
cc: Frank Boyles, City Manager
Marcus A. Thomas, Bolton & Menk, Inc.
Roger Janzig, Metropolitan Council-Environmental Services
520 Lafayette Rd. N.; Saint Paul, MN 55155-4194; (651) 296-6300 (Voice); (651) 282-5332 (TTY); www.pca.state.mn.us
St. Paul. Brainerd. Detroit Lakes · Duluth · Mankato · Marshall · Rochester · Willmar
Equal Opportunity Employer. Printed on recycled paper containing at least 20 percent fibers from paper recycled by consumers.
Minnesota Pollution Control Agency
PERMIT FOR THE CONSTRUCTION AND OPERATION OF
A DISPOSAL SYSTEM
CITY OF PRIOR LAKE
Scott County
Pursuant to authorization by the Minnesota Pollution Control Agency (MPCA), and in
accordance with the provisions of Minn. Stat. chs. 115 and 116, plans are approved and a
Permit is hereby granted to the above-referenced Permittee for the construction and
operation of a Sanitary Sewer Extension in Prior Lake, Minnesota.
The facilities are further described in the application designated as: "City Project No. 05-
01", which was received at the Agency on April 7, 2005, and proposed by Bolton & Menk,
Inc. The application indicates that the project will include:
. 15 Existing Homes;
. 3 Commercial: a Mall, an Office
Bldg., and a Florist.
It is the Permittee's responsibility to assure compliance with any special conditions and the
general conditions that are required by this Permit. This includes taking all necessary
measures needed to comply, including, but not limited to, the notification of contractors or
others who may be carrying out this work.
PERMIT NUMBER: 46493
2 2
.9f
DATED:
Gary L. Eddy
Metro Unit
Municipal Wastewater Section
Municipal Division
520 Lafayette Rd. N.; Saint Paul, MN 55155-4194; (651) 296-6300 (Voice); (651) 282-5332 (TTY); www.pca.state.mn.us
St. Paul · Brainerd · Detroit Lakes · Duluth · Mankato · Marshall · Rochester · Willmar
Equal Opportunity Employer. Printed on recycled paper containing at least 20 percent fibers from paper recycled by consumers.
16. The Agency, its officers, employees and agency review and comment upon engineering reports
and construction plans and specifications regarding this permit solely for the limited purpose of
determining whether such report, plans and specifications will enable the facilities subject
thereto to reasonably comply with the regulations and criteria ofthe Agency.
17. This permit has not been reviewed by the U.S. Environmental Protection Agency and is not
issued pursuant to Section 402 of the Federal Water Pollution Control Act Amendments of 1972.
18. The plans for this project have been approved with the reservation stated in the attached sheet
entitled "Information Relative to Review of Plans and Permit Applications."
19. The Permittee shall comply with all rules, regulations and requirements of the Minnesota
Environmental Quality Board prior to construction of the proposed project. This permit is not
effective until the Permittee completes all applicable environmental review (Environmental
Assessment Worksheet or Environmental Impact Statement) which may be required for the
project.
20. This permit authorized the Permittee to perform the activities described herein under the
conditions set forth. In issuing this permit, the State/Agency assumes no responsibility for any
damage to permits, property or the environment caused by the activities of the Permittee in the
conduct of its actions, including those activities authorized, directed .or undertaken pursuant to
this permit. To the extent the state/agency may have any liability for the activities of its
employees, that liability is explicitly limited to that provided .in the Torts Claims Act, Minnesota
Statutes 3.736.
---------------- -
Minnesota Pollution Control Agency
Information Relative to Review of Plans and Permit Applications
November 15, 2004
The review of plans and specifications for sewage, industrial waste, or other waste disposal systems
and application for permits is made in accordance with the authority conferred by law (Minn.
Stat. ~ 115.07). Approval of plans and permits is based upon the assumption that the information
provided by the applicant is correct and that all necessary legal requirements have been or will be
satisfied.
Plans for sewage, industrial waste or other waste disposal systems are examined with regard to the
design features with apply to operation and maintenance of the treatment works and sewer system,
the degree of treatment to be provided, the effectiveness and reliability of the system or methods
employed, and compliance with applicable standards systems. The bulletin entitled Recommended
Standards for Wastewater Facilities, 1197 Edition, and supplements thereto, as well as other
information are used in examination of the design, operation and maintenance aspects of the
proposed system.
Sewer plans are recommended for approval on the basis that the system is to collect only domestic
sewage and such industrial or other waste as may have been provided for in the design. Foundation
or footing drains to collect ground water and roof drains or other surface water conduits should not
be connected to the sanitary sewer system. Adequate field supervision and inspection by a qualified
representative of the owner should be provided at all times during construction to assure that the
project is constructed in compliance with the approved plans and specifications.
The Agency assumes no responsibility for the integrity of structures or physical features, or for the
reliability, durability or efficiency of specific items of propriety equipment or material. All
applicable federal, state and local laws, regulations or ordinances must be followed in the design,
location and construction of proposed sewer systems or treatment works.
The Agency reserves the right to withdraw its approval of plans in construction is not undertaken
within a reasonable period after issuan~e of the permit.
Gopher State
651-454-0002
APPLICATION FOR OBSTRUCTION PERMIT
ON COUNTY HIGHWAY RIGHT OF WAY
SCOTT COUNTY PUBLIC WORKS
600 Country Trail East
Jordan,~ 55352-9339
Phone 952-496-8346 Fax 952-496-8365
Permit No.
Traffic Signal Locates
952-496-8346
Permit Fee - $95.00
48 hrs before digging
MUST BE REGISTERED WITH SCOTT COUNTY TO OBTAIN PERMIT
Name of Applicant Address r I r_ I. A- !;g-
I' I I " 2.00 c::a.j e. ~ i!e.r. ve..
\...i+ of Pr\or L", ~e.- Prior l.4\te. MN 55372
Name of Contractor Address Ro
NorJ-l wes+ As "La.H. 'T >'\c I ~5IS+Q..y-c(;G\c..h c,~
n rt ~. ~ ho..b.v.:.e fvtN S5374
Phone 95'1 - 4J.17~" $>32-
le( Fax ~52 - 'fl.{ - 426 Gopher One Call ID#
County Roads Involved
c..sAH 4
SECT.
3"
RANGE
2.2
TWP
115
4 f FrClnk 1,'-'
DNo )aYes
If yes, a traffic plan must be submitted with plans.
(I) (We) the undersigned, hereby apply for a permit from Scott County for the above. (I) (We) understand and accept the
terms and conditions of the regulations of the Commissioner of Transportation and that the approval of the County must
be obtained for issuance of this permit. On completion of the installation, persons doing such work must notify the Scott
County Highway Engineer that work has been completed and is readyJor inspection and acceptance. The applicant shall
also comply with the reguIatioos of all other governm~cies.
S//~ I//s- ~~
Date ' , Applic~gnature ~
!>/I"jos-
Dati I
In accordance with this application an Obstruction Permit is granted to the applicant to place, construct, and "thereafter
maintain" on, or across, or under the Right-of-Way of the above described Right-of-Way and in the location as shown by
the above application with the attached conditions and requirements:
Scott County Ordinance 22, Management or the Public Right-or-Way, Section 119: The excavation, backfilling, patching and
restoration, and all other work performed in the right-of-way shall be done in conformance with Minnesota Rules 7819.1100,
7819.5000 and 7819.5100 and shall conform to MnDOT standard specifications and other applicable local requirements, in so far as
they are not inconsistent with the Minn. Stat. ~ 237.162 and 237.163.
Date
mk-w:\word\pennits\permit fonns\utilitypennicnew _obstruction.doc
SCOTT COUNTY HIGHWAY DEPARTMENT
Public Works Division
600 Country Trial East
Jordan, MN 55352-9339
Phone: 952-496-8346
Fax: 952-496-8365
INSTRUCTIONS FOR COMPLETING APPLICA nON FOR OBSTRUCTION PERMIT
Note: An incomplete application will delay processing.
* Allow up to 2 weeks for processing.
1. Print, in ink only, or type the application. Be sure to sign both this instruction sheet and the application form
at the bottom. Submit the original forms only. Faxed copies will not be accepted.
2. Complete each item on the application. If an item does not apply, print "N.A." in the blank.
3. No work under this application is to be started until the application is approved and the permit is issued.
4. Prior to construction, the permittee shall notify the County Inspector at 952-496-8487 and again after
completion for final inspection and approval by the County Highway Department.
5. No changes or alterations may be made at any time without written permission from the County Highway
Department.
6. It is the responsibility of the contractor to notify Gopher One ~?!_ .~tility locations for any work be4tg
performed within the Scott County right.:.of-way, and obtain all other necessary municipal permits.
\,.
7. Where work on traveled roadways is necessary, traffic must be protected, and the proper signage or
barricades must be placed in accordance with the standards of the Scott County Highway Department.
I, We, have agreed to all requirements and any special provisions included in this instruction sheet. All work
commencing will be done to the satisfaction of the Scott County Highway Department.
Dated:
~I/fplor
/ (
Applicant's SigMture4 f?
mk-w:\word\pennits\pennit fonns\utilitypenniCnew _obstruction. doc
CITY OF PRIOR LAKE. TELEPHONE (952) 447-4230
16200 EAGLE CREEK AVENUE S.E. . PRIOR LAKE, MN 55372-1714
No.062379
'.
Invoice
Date
5/3105
Amount
$95.00
Check #62379
Total $95.00
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PURCHASE ORDER
CITY OF
PRIOR LAKE, MINNESOTA
(952) 447-4230
Fax: 447-4245
NO. OS-617
IMPORTANT. This no. MUST appear on all
packages, packing slips, shipping papers,
invoices & correspondence.
The Center of the Lake Country
INVOICE
TO:
City of. Prior Lake
16200 Eagle Creek Ave. S. E.
Prior Lake, Minnesota 55372
SHIP
TO:
(Same as "Invoice To" unless otherwise noted below)
PURCHASE FROM: SCOTT COUNTY
Scott County Public Works
bUD Country IraII East
Jordan, MN 55352
HIGHWAY D PT.
IMPORTANT
QUOTE THIS ORDER NUMBER ON INVOICE
DATE
QUANTITY DESCRIPTION ... UNIT PRICE TOTAL REMARKS.
Aoolication/Obstruction Permit 95.00
Pro i . #OS-Ol~ 200S Imorovements
,
-....;---. .--. -
..
TOTAL ORDER 9S.00
ORDERED BY: SENG THONGVANH, CIVIL ENG
#501-48358-515
APPROVED BY:
;;t->I/
APPROVED BY:
TO BE USED FOR:
Dept. Acct. #:
DEPARTMENT HEAD
CASH 0 CHARGE 0
REMARKS:
CITY MANAGER
NOTE: The City is not subject to penalty for late
payment on bills.
White. Vendor
Yellow. Receiving
Pink. Accounting & Purchasing
.
E30L. ,-OI'-J & 1'/1 E:I'-J 1<, II'-JC.
Consulting Engineers & Surveyors
12224 NicolletAvenue · Burnsville, MN 55337-1649
Phone (952) 890-0509. FAX (952) 890-8065
May 16, 2005
Darin Holmgren
Scott County Highway Department
Scott County Public Works
600 Country Trail East
Jordan, MN 55352
Re: Scott County Application for Obstruction Permit
Prior Lake City Project No. 05-01
Dear Mr. Holmgren:
Please find enclosed the completed Application for Obstruction Permit on County Highway Right of Way
and the required application fee in the amount of$95.00. This permit has been submitted as directed, as a
result of the detouring required by the work to be performed. Please refer to the Scott County Application
for Utility Permit, dated March 28, 2005.
Since this contract has not yet been executed, the permit will be signed by the Contractor when the project
is let.
Please contact me at (952) 890-0509 if you have any questions or comments.
Sincerely,
BOLTON & MENK, INC.
Kentfid;:~
Design Engineer
Enc.
cc: BMI File
F:'- Civil\PLAK\T1621543\Permits\Scott Co obstr transm.doc
MANKATO, MN · FAIRMONT, MN · SLEEPY EYE, MN · BURNSVILLE, MN · WILLMAR, MN · CHASKA MN · AMES, IA
www.bolton-menk.com
An Eoual Oooortunitv Emolover
os...o/
~ Metropolitan Council
Environmental Services
April 15,2005
Larry Poppler
Assistant City Engineer
City of Prior Lake
16200 Eagle Creek Ave.
Prior Lake, MN 55372-1787
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Re: City Project No. 05-01, Prior Lake
Dear Mr. Poppler:
The Metropolitan Council Environmental Services (MCES) Division has reviewed your application
for a sanitary sewer extension for the above project. This project is in accord with your
comprehensive sewer plan (CSP) and consistent with the Metropolitan Urban Service Area.
The plans submitted with your sanitary sewer extension permit application indicate this project is
near MCES Interceptor (7120) west of Highway 13 and south of Pleasant Street. To insure the
integrity of our interceptor, prior to initiating this project, final plans should be sent to Scott
Dentz, Interceptor Engineering Manager (651-602-4503) at the Metropolitan Council
Environmental Services for review and comment. With this understanding, we will file this project
as part of your CSP and inform the Minnesota Pollution Control Agency that we have no objection
to the installation of these facilities.
If you have any questions or require any additional information, please feel free to call me at 651-
602-1116.
~
Donald S. Bluhm
Manager, Municipal Services Section
Wastewater Services Department
DSB:RWJ:EAS
sood/word/sewer .ext.1tr/priorlake. 041505
cc: Jan Hjellming, MPCA
Bill Moeller, MCES
Scott Dentz, MCES
Metro Info Line 602-1888
www.metrocouncil.org
230 East Fifth Street . St. Paul, Minnesota 55101-1626 · (651) 602-1005 · Fax 602-1138 · TTY 291-0904
An Equal Opportunity Employer
JUN' 1. '7 1GO~
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Mn/OOTTP-1723 (SHORT FORM PERMIT) (4-01)
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District
M
7L')t) /
Pennit #
T.H.
C.S.
APPUCANT
TELEPHONE
ADDRESS (Street, City, State, Zip)
16200 Eagle Creek Ave. S.E.
Prior Lake, MN 55372
ADDRESS (Street, City, State, Zip)
1451 Stagecoach Road
Shakopee, MN 55379
City of Prior Lake
PARTY PERFORMING WORK
(952) 447-9832
TELEPHONE
Northwest Asphalt, Inc.
(952) 445-1003
LOCATION OF PROPOSED WORK
(SPEOFY ROAD INTERSECTION OR LANDMARK)
Highway 13
in Prior Lake
Cityffownship Scott
County 0.3
Miles Northeast of C.S.A.H. 44
SURFACE TO BE DISTURBED (Check Appropriate Boxes)
DRoadway0ShoulderDConcreteDBituminous Ooravel
0TurfonlMother guardrail
METHOD OF INSTALLATION/CONSTRUCTION
NATURE OF WORK Construct conc. sidewalk and ped. ramp, relocate guardrail
behind new walk and ped ramp at SE comer TH 13 & Candy Cove
DEPTH OF EXCAVATION BELOW SURFACE
NUMBER & SIZE OF EXCAVATIONS
12"
WORK TO START ON OR AFTER
1
WORK TO BE COMPLETED ON OR BEFORE
at grade concrete pour with road reconstruct
IS TRAFFIC DETOUR NECESSARY? no
July 1, 2005. November 1, 2005
I, We, the undersigned, herewith accept the terms and conditions of the
permit requirements of the Commissioner of Transportation and agree to
fully comply therewith to the satisfaction of the Minnesota Department of
Transportation. It is agreed that no work in connection with this
application will be started until the application is approved and the permit
issued. It is further understood that this permit is issued subject to the
approval of local city, village or borough authorities having joint
supervision over said street or highway and subject to applicant's
compliance with the rules and regulations of the Minnesota Environmental
Quality Board and any other affected governmental agencies.
(IF YES, TRAFFIC CONTROL PLAN IS REQUIRED)
any and all claims for damages, actions or causes of action arising out of the
work to be done herein and the continuing usage, constructing,
reconstructing, maintaining and using of said utility/miscellaneous work
under this application and permit for construction.
Co I, 'of oS-
Dated
By
LA2..f2'-/
POPPL.~(t....
Name - Print or Type
Furthermore, except for negligent acts of the State, its agents and
employees, the applicant or his agents or contractor shall assume all
liability for, and save the State, its agents and employees, harmless from,
~- >>~
DO NOT WRITE BELOW THIS LINE
PERMIT NOT VALID UNLESS
BEARING SIGNATURE AND NUMBER
AUTHORIZATION OF PERMIT
SEE REVERSE SIDE FOR GENERAL
INFORMATION AND REQUIREMENT
It is expressly understood that this pennit is conditioned upon replacement or restoration of the trunk highway to its original condition or to a satisfactory condition In
consideration of the applicant's agreement to comply in all respects with the regulations of the Commissioner of Transportation covering such operations, permission is
hereby granted for the work to be performed as descnbed in the above application, said work to be performed in accordance with special provisions as hereby stated.
SEE ATTACHED SPECIAL PROVISIONS
/-1- O~
Date All Walk To Be Completed by
c-r ·
~orized Mn/DOT Signature
7-2<[j-oS
Date of Authorized Signature
DISTRIBUTION
Ori. to Area Maintenance Eogineer
pplicant
Subarea Supervisor
Roadway Regulations Supervisor
DEPOSIT REQUIREMENTS
No Deposit Required
o Deposit Required in the Amount of $
Dale Deposit Received
Deposit to be returned upon satisfactory completion of all worlc.
DEPOSIT TYPE
Z>
Cashier's Check #
Certified Check #
Money Order #
Bond #
DATE WORK COMPLETED
oneil to the local Mn/DOT Roadwa R
,
.,
.'
EXPLANATION
This application form shall be used for installations of utility service connections that do not cross the trunk highway roadbeds, for miscellaneous
guys and anchors, imd for performing miscellaneous work on the highway right of way.
Utility applications for overhead and underground installations and extensions thereto shall be made on Form 2525 and submitted to the Utilities
and Agreements Engineer, State Transportation Building for issuance.
PERTINENT REGULATIONS
Safety
I. Where work on or near the traveled roadway is necessary, proper signs, channelizing devices, warning lights, and barricades shall be
erected to protect traffic, employees, and pedestrians. All traffic control devices and methods shall conform to the Minnesota Field
Manual on Temporary Traffic Control Zone Layouts, Minnesota Manual on Uniform Traffic Control Devices (MMUTCD}, Minnesota
Standard Sign Manuals Parts I, 11, and ill and the appropriate provisions of Standard Specification 171 O.
2. Ifwork to be done lies within a municipality or platted town, permission must be obtained from such village, town, or city.
3. Excavations must be cribbed when necessary, depending upon type of soil, in order to prevent cave-ins. All excavations, trenching
and/or jacking and boring pits shall be shored or sloped in accordance with OSHA requirements.
4. No guys or stays or any structure are to be attached to trees on trunk highway right of way.
5. Underground construction must be so constructed as not to harm or unnecessarily destroy the root growth of specimen trees.
PERTINENT REGULATIONS
Roadway
I. Installation of pipe under concrete or bituminous pavements shall be done by jacking or boring or other approved methods.
2. When open trenching or excavating in existing roadways, all subgrade, base, and surfacing materials shall be replaced with
the same type, depth, and density of materials that were removed.
3. All backfill must be placed in 6" or less layers and thoroughly tamped and material must be flush and even with the adjacent surface
when finally in place.
4. If pavement or roadway is damaged, same shall be restored to a condition as good or better than the original condition.
5. All pavements shall be replaced in accordance with State specifications.
6. If settlement occurs or excavation caves in so that replaced materials settle (bituminous mat or concrete base), same shall be restored to a
condition as good or better than the original condition.
7. Unless adequately protected by a traffic barrier, there shall be no work within the clear zone, nor shall pipe materials, equipment or other\::-
objects as determined by the State, be stored within the clear zone as determined by the Department and as defined by the latest edition
of AASHTO's "Guide for Selecting Locations, and Designing Traffic Barriers."
8. No poles, anchors, anchor braces, or other construction shall be placed on the roadway shoulder or within ~e prescribed clear zone.
9. No driving onto highway from ditch or driving on shoulders will be permitted where damage will occur.
10. No foreign material such as dirt, gravel, or bituminous material shall be deposited or left on the road during any construction activities.
LIMITATIONS
1. No liIgs shall be used on equipment traversing road which will damage the road surface.
2. Roadside shall be cleaned up upon completion of all work.
3. If Department of Transportation shall DllIke any improvements or change on all or any part of its right of way upon, over, under, or along
the highway, then and in every case the applicant herein named shall after notice from the Commissioner of'I,'ransportation or
Commissioner's authorized agents proceed to alter, change, vacate, or remove from trunk highway right of way said works necessary to
conform with said changes without cost whatsoever to the State of Minnesota.
4. Drainage on the trunk highway right of way shall be done under Form 30795-02 available at the District! Area Maintenance office.
5. After work on a project is completed said persons doing such work must notify the Area Maintenance Engineer or his authorized
representative in which district the work is being performed that such work has been completed and ready for final inspection and
acceptance by the State of Minnesota.
6. Cutting and trimming o(trees within the right of way and removal of resulting stumps require prior approval of the Area Maintenance
Engineer or his authorized representative.
NOTE: Certified Check or Bond may be required to insure proper restoration of highway surfaces and to cover payment for any
damage to highways or State property. Additionally, any expense incurred by the Minnesota Department of Transportation
above the posted deposit will be assessed against the 'applicant. In the event that the construction has not been started by the
"WORK TO BE COMPLETED ON OR BEFORE" date, this permit becomes nuD and void and deposit refunded.
MnlDOT TP-I723 (SHORT FORM PERMIT) (4-01)
Page 2 of2
M-US-05- 9518
C.S.7001
T.H.13
City of Prior Lake
THIS PERMIT IS SUBJECT TO THE FOLLOWING CONDITIONS:
The applicant, or their contractor, shall notify Mr. Jeff Dierberger, Mn/DOT Roadway
Regulation Inspector, at 651-582-1451 at least 48 hours prior to starting construction so State
inspection may be arranged, and for approval of all highway materials prior to their
placement. All work authorized by this permit shall meet Mn/DOT specifications.
This permit authorizes the applicant to construct sidewalk, ped ramp and relocate the existing
guardrail in the SE comer ofT.H.l3 and Candy Cove in the city of Prior Lake as shown on
applicant's plan sheet.
The applicant shall be responsible for all maintenance of said sidewalk.
The applicant shall provide in-house inspection at all times while working on trunk highway
right of way.
The applicant shall furnish, install and maintain all required traffic control devices according
to the Minnesota Field Manual on Temporary Traffic Control Zone Layouts (January
2004)(see web page @ www.dot.state.mn.us/trafficeng/). while performing the construction
authorized by this permit. Due to the Twin City rush hour restrictions, no work involvin2
interference with or causin2 a distraction to traffic will be allowed from 6:00 AM to
9:00 AM, or from 3:00 PM to 6:00 PM. unless authorized by the MN/DOT Permit
Office at 651-582-1443.
If the temporary traffic control zone is to remain in one place for more than 3 days or involves
a detour, road closure or a situation where the typical layouts do not apply, the applicant shall
prepare a specific Traffic Control Plan for approval by Mn/DOT prior to start of any
construction.
All persons while performing authorized work on Mn/DOT Right of Way shall be required to
wear an Mn/DOT approved High Visibility Safety Vest and Soft Cap/Hard Hat. Any
authorized night work requires all personnel to wear an MnlDOT approved full night safety
suit (pants andjacket).
It shall be the responsibility ofthe applicant to utilize the "Gopher State One Call" excavation
notice system -as required under Minnesota Statute Chapter 216D, 48 hours prior to
performing any excavation (Phone 651-454-0002 Twin Cities Metro Area or Toll Free
1-800-252-1166).
.... ..
'"
M-US-05- 9518
C.S.7001
T .H.13
City of Prior Lake
The applicant shall contact the owners of the in-place utilities and make all arrangements for
their relocation or revisions as required due to the construction authorized by this permit.
No material shall be deposited on the traveled roadway.
All areas disturbed by the applicant shall be restored with a minimum of 6" of topsoil
(according to Mn/DOT Standard Specification 2105 Table 1 Topsoil Borrow), then
sodded or seeded. Seed or sod should be the same as/or compatible with the existing turf
cover. If the areas are to be seeded, a Mn/DOT seed mixture comparable to the ex.:isting
turf along with Type 1 Mulch and Disk Anchoring shall be used according to Mn/DOT
Specification 2575.
All areas disturbed during construction within State right-of-way shall be restored to
original or better condition.
The applicant shall perpetuate all existing drainage.
The applicant is required to preserve all existing survey monuments. IfMn/DOT determines
that monuments have been disturbed or destroyed during construction activities, the applicant
shall accept full responsibility for all costs incurred in the re-establishment of the monuments.
It is expressly understood that this permit is issued subject to the applicant's compliance with
the Rules and Regulations of the Minnesota Environmental Quality Board and any other
affected Governmental Agencies.
Winter work shall be considered :from November 1 through April 15, work during tliisperiod
shall be on a day-to-day basis at the discretion of the Roadway Regulation Supervisor.
All work authorized by this permit and the restoration of the State's right of way shall be
satisfactorily completed by 1-1-06.
The applicant or his contractor shall notify the permit office at 651-582-1443 for fmal
inspection.
--
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MniDOT TP-30795-02 (4-0 I)
MINNESOTA DEPARTMENT OF TRANSPORTATION
APPLICATION FOR DRAINAGE PERMIT
05'-01
(I>
District /)1 Pennit #
e.s. 1 ~t? 7 T.H.
R.P.
(DO NOT COMPLETE THIS SECTION FOR OFFICE USE ONLY)
ATTACH A SKETCH OF THE PROPOSED WORK AND RELATION TO TRUNK HIGHWAY. SUCH SKETCH SHALL BE DRA WN TO
SCALE WHEN REQUIRED BY THE ENGINEER. PRINT OR TYPE APPLICATION. SIGN IN SPACE PROVIDED. SUBMIT TO LOCAL
OFFICE OF THE MINNESOTA DEPARTMENT OF TRANSPORTATION.
APPUCANT TELEPHONE ADDRESS (Street, City, State, Zip)
16200 Eagle Creek Ave. SE
City of Prior Lake (952) 447-9832 Prior Lake, MN 55372
PROPERTY OWNER TELEPHONE ADDRESS (Street, City, State, Zip)
16200 Eagle Creek Ave. SE
City of Prior Lake (952) 447-9832 Prior Lake, MN 55372
PROPERTY OWNER TELEPHONE ADDRESS (Street, City, State, Zip)
LOCATION OF PROPOSED DRAINAGE WORK
(SPECIFY ROAD INTERSECTION OR LANDMARK)
Highway 13 in Prior Lake CityffoWDship Scott County
TYPE OF DRAINAGE DTile Outlet 0 Open Ditch AREA TO BE DRAINED
o Parallel Installation ~ Other Storm sewer outlet 2.33 Acres
LEGAL DESCRIPTION OF PROPERTY WORK TO START ON OR AFTER
0.3 Miles Northeast
I CASING SIZE AND TYPE
N/A
of Intersect. TH 13 & CSAH 44
PIPE SIZE AND TYPE
Intersection of Candy Cove Trail SE & TH 13
May 16, 2005
WORK TO BE COMPLETED ON OR AFTER
November 1. 2005
I, We, the undersigned, herewith accept the terms and conditions of the
permit requirements of the Commissioner of Transportation and agree to
fully comply therewith to the satisfaction of the Minnesota Department of
Transportation. It is agreed that no work in connection with this
application will be started until the application is approved and the permit
issued. It is further understood that this permit is issued subject to the
approval of local city, village or borough authorities having joint
supervision over said street or highway and subject to applicant's
compliance with the rules and regulations of the Minnesota Environmental
Quality Board and any other affected governmental agencies.
Furthermore, except for negligent acts of the State, its agents and
employees, the applicant or his agents or contractor shall assume all
liability for, and save the State, its agents and employees, harmless from,
15" RCP
any and all claims for damages, actions or causes of action arising out of the
work to be done herein and the continuing usage, constructing,
reconstructing, maintaining and using of said drainage facility under
application and permit for construction.
Dated
sllo(f)J
~~T~ :811LAO~ W~I ()I)v~
I J::eI) _ ll;f6- Cbry
Name-PrintorType , -;;; -f"'l~ <....A1t..e
Si~A-~~
By
~
PERMIT NOT VALID UNLESS
BEARING SIGNATURE AND NUMBER
DO NOT WRITE BELOW THIS LINE
SEE REVERSE SIDE FOR GENERAL
INFORMATION AND REQUIREMENT
AUTHORIZATION OF PERMIT
It is expressly understood that this permit is conditioned upon replacement or restoration of the trunk highway to its original condition or to a satisfactory condition.
In consideration of the applicant's agreement to comply in all respects with the regulations of the Commissioner of Transportation covering such operations,
permission is hereby granted for the work to be performed as described in the above application, said work to be performed in accordance with special provisions as
hereby stated:
SEE ATTACHED SPECIAL PROVISIONS
/-/-0 ,
Date All Work To Be Completed by
DISTRIBUTION
OT Signature
7-};z-tJr
Daie of Authorized Signature
DEPOSIT TYPE
Original to Area Maintenance Engineer
Hcant
Subarea Supervisor
Roadway Regulations SupelVisor
DEPOSIT REQUIREMENTS
o Deposit Required .,.
D Deposit Required in the Amount of $ - V ·
Dale Deposit Received
Deposit to be returned upon satisfactory completion of all work.
Cashier's Check #
Certified Check #
Money Order #
Bond #
DATE WORK COMPLETED
"" 't',t
".l
VI,
~~ ~
MINNESOTA LAW REGULATING DRAINAGE WORK
The State-law is.as-[ollows:
160.20 DRAINAGE
Subdivision I. Connecting drains to highway drains.
When the course of natural drainage of any land runs to a highway, the owner of the land shall have the right to enter upon the highway for the purpose of
connecting drain or ditch with -any drain or ditch constructed along or across the highway, but before making the connections, shall first obtain a written
permit for the connection from the road authority having jurisdiction. The connections shall be made in accordance with specifications set forth in the
permits. The road authority shall have power to prescribe and enforce reasonable rules and regulations with reference to the connections. The highway shall
be left in as good condition in every way as it was before the connection was made_
Subd. 3. Installing drain tile along or across highway.
When the course of natural drainage of any land runs to a highway, the owner of the land who has been granted a permit as provided in subdivision 4 may
install drain tile along or across the highway right-of-way along the general course of the natural drainageway, provided further that there will be no diversion
of drainage waters away from the natural receiving drainageway immediately downstream from the highway_ Any installations shall be made in accordance
with specifications set forth in the permit and any rules that apply to the installations. When any installation is made pursuant to this subdivision the highway
shall be left in as good condition in every respect as it was before the installation was made.
Subd. 4. Conditions
(a) A road authority may accept applications for permits for installation of drain-tile along or across the right-of-way under its jurisdiction. The road authority
may adopt reasonable rules for the installations and may require a bond before granting any permit Permits for installation along a highway right-of-way
must ensure that the length of the installation is restricted to the minimum necessary to achieve the desired agricultural benefits. A permit must not allow
open trenches to be left on the right-of-way after installation of the drain tile is completed. A road authority that grants a permit for drain tile installation is
not responsible for any damage to that installation resulting from the action of the authority or any other permittee utilizing the right-of-way.
(b) A person who installs draiit tile along or across a highway right-of-way without obtaining a permit as provided in this section is guilty of a misdemeanor.
(c) The commissioner shall take no action under this section which will result in the loss of any federal aid for highway construction in the state.
(d) For the purpose of this section, "highway" means any highway as defined in section ~ which is located outside the corporate limits of a home rule
charter or statutory city.
SPECIFICATIONS AND PERMIT REQUIREMENTS
I. All construction details shall be entered on Form TP30795-02 or supplemental sheets as required.
2. 'Installations shall be in accordance with Specification 2502 of the Minnesota Standard Specifications for Construction.
3. Where work on or near the traveled roadway is necessary, proper signs, channelizing devices, warning lights, and banicades shall be erected to protect traffic
employees, and pedestrians. All traffic control devices and methods shall conform to the Minnesota Field Manual bn Temporary Traffic Control Zone Layout
Minnesota Manual on Uniform Traffic Control Devices (MMUTCD), Minnesota Standard Sign Manuals Parts I, II, and III and the appropriate provisions of
Standard Specification 1710.
4. Allowable materials for longitudinal installations shall be:
Corrugated metal pipe (Std. Plate 3040)
Reinforced concrete pipe (Std. Plate 3000)
Thermoplastic pipe (Spec. 3245)
5. Connections offield tile to allowable longitudinal installations. shall be made a minimum of three feet beyond the highway right of way line using an
inspection tee. (Std. Plate? 143) .
6. All. c~ings shall be}ack~ or bored.
7. All system installations shall be at a minimum of three feet below existing ground.
8. No installations will be permitted in the shoulder or mslope of the roadway.
9. The owner, his successor or assigns, shall maintain the installation in perpetuity.
10. If drainage work to be done lies within the limits of any city, village or watershed district, permission must be obtained from the local governing authority
involved. If drainage work to be done involves county, judicial, or group drainage systems, permission must also be obtained from the authority involved. If
any drainage is diverted from the owner's property he shall have written approval from the landowners upon whom it is discharged.
II. The applicant shall comply with all rules and regulations of the Minnesota Environmental Quality Board and any other affected governmental agencies.
12. The applicant shall furnish, install and maintain an approved culvert marker post at outlet of drainage tile.
13. The drainage work shall not interfere with any existing utility facilities on the trunk highway right-of-way.
14. Removal of trees or shrubs within the right of way requires prior approval of the Area Maintenance Engineer or his authorized representative.
15. No equipment will be permitted to operate on or across the roadway which will damage the roadway or shoulder surface.
16. Certified Check or Bond may be required to insure proper restoration of highway surfaces and to cover payment for any damage to highways or
State property. Additionally, any expense incurred by the Minnesota Department of Transportation above the posted deposit will be assessed against
the applicant. In the event that the construction has not been started by the "WORK TO BE COMPLETED ON OR BEFORE" date, this permit
becomes null and void and deposit refunded.
17. The State reserves the right to remove or repair, with its own forces but at the expense of the applicant, any tile outlet which is not maintained and causes
damage to adjacent right-of-way. Applicant must obtain a permit to do maintenance work on the drainage system covered by this permit. _
18. If the Minnesota Department of Transportation shall make any improvements or change on all or any part of its right-of-way upon, over, under or along the
trunk highway, then and in every case the applicant herein named shall, after notice from the Commissioner of Transportation or Commissioner's authorized
agents, proceed to alter, change, vacate or remove from trunk highway right-of-way, said works necessary to conform with said changes without cost to the
State of Minnesota
19. After work on a project is completed the applicant must notify the Area Maintenance Engineer or authorized representative that such work has been complete
and is ready for final inspection and acceptance.
20. Issuance of this permit is subject to the provisions of Chapter I03B of the Minnesota Statutes.
MnlDOT TP-30795-02 (4-01)
Page 2 of2
M-D-05-9041
C.S.7001
T.H.13
City of Prior Lake
THIS PERMIT IS SUBJECT TO THE FOLLOWING CONDITIONS:
The applicant, or their contractor, shall notify Mr. Keith Van Wagner, MnlDOT Roadway
Regulation Supervisor, at 651-582-1443 at least 48 hours prior to starting construction so
State inspection may be arranged, and for approval of all highway materials prior to their
placement. All work authorized by this permit shall meet Mn/DOT specifications.
This permit authorizes the applicant to install a 15-inch RCP storm sewer outlet in the SW
quadrant ofT.H.13 & Candy Cove Trail SE in the city of Prior Lake as shown on applicant's
plan sheet(s).
The appliCant shall provide in-house inspection at all times while working on trunk highway
right of way.
The applicant shall furnish, install and maintain all required traffic control devices according
to the Minnesota Field Manual on Temporary Traffic Control Zone Layouts r (January
2004)(see web page @ www.dot.state.mn.us/trafficeng/). while performing the construction
authorized by this permit. Due to the Twin City rush hour restrictions. no workinvolvin2
interference with or causin2 a distraction to traffic will be allowed from 6:00 AM to
9:00 AM. or from 3:00 PM to 6:00 PM. unless authorized bv theMN/DOT Permit
Office at 651-582-1443.
If the temporary traffic control zone is to remain in one place for more than 3 days or involves
a detour, road closure or a situation where the typical layouts do not apply, the applicant shall
prepare a specific Traffic Control Plan for approval by MnlDOT prior to start of any
construction.
All persons while performing authorized work on Mn/DOT Right of Way shall be required to
wear an Mn/DOT approved High Visibility Safety Vest and Soft Cap/Hard Hat. Any
authorized night work requires all personnel to wear an Mn/DOT approved full night safety
suit (pants and jacket).
It shall be the responsibility of the applicant to utilize the "Gopher State One Call" excavation
notice system as required under Minnesota Statute Chapter 216D, 48 hours prior to
performing any excavation (Phone 651-454-0002 Twin Cities Metro Area or Toll Free
1-800-252-1166).
M-D-05-9041
C.S.7001
T .H.13
City of Prior Lake
The applicant shall contact the owners of the in-place utilities and make all arrangements for
their relocation or revisions as required due to the construction authorized by this permit.
No material shall be deposited on the traveled roadway.
All areas disturbed by the applicant shall be restored with a minimum of 6" of topsoil
(according to MnJDOT Standard Specification 2105 Table 1 Topsoil Borrow), then
sodded or seeded. Seed or sod should be the same as/or compatible with the existing turf
cover. If the areas are to be seeded, a MnJDOT seed mixture comparable to the existing
turf along with Type 1 Mulch and Disk Anchoring shall be used according to MnJDOT
Specification 2575.
All areas disturbed during construction within State right-of-way shall be restored to
original or better condition.
The applicant shall perpetuate all existing drainage.
,
,,- \'
The applicant is required to preserve all existing survey monuments. IfMnJDOTdetermines
that monuments have been disturbed or destroyed during construction activities, the applicant
shall accept full responsibility for all costs incurred in the re-establishment of the monuments.
It is expressly understood that this permit is issued subject to the applicant's compliance with
the Rules and Regulations of the Minnesota Environmental Quality Board and any other
affected Governmental Agencies.
Winter work shall be considered from November 1 through April 15, work during this period
shall be on a day-to-day basis at the discretion of the Roadway Regulation Supervisor.
All work authorized by this permit and the restoration of the State's right of way shall be
satisfactorily completed by 1-1-06.
The applicant or his contractor shall notify the permit office at 651-582-1443 for final
inspection.
,..~ ~li'i~~~n~;':;;:-~i.ii~~'<<'>_'~L:.....",_.:~.......,.. '.~""""'''"';''''''~'.___.''''''_'.''''''''
I SEE SHEET 17 I
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'1}\.. B... o LTO N. '. &. M. . ENK, INC.
e--..c...,... _ ........
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CANDY COVE TRAIL SE
I HEREBY CERTIfY THAT THIS PLAN, REVISION NO.
SPECIFICATION. . OR REPORT. WAS
PREPARED BY ME OR UNDER . lit DIRECT
~~g~'~~(;~~~SIOn:..' ~~~LY PlAN BY: DESIGN BY:
~5~. WS.OF. THE..... STATE OF" '. LSKWL.
'-17f7~~~-..c.., C:Ell .IM~;~
~ )'/oIAR<WU.. ..'. 'THO/oIAS. P.E. AS MT 1M 00\1[:
00\TE: L/l..~IX.NO,: .' 214l1l1 . .'
DESCRlPTlON
o~ -Of
Gopher State
651-454-0002
APPLICATION FOR OBSTRUCTION PERMIT
ON COUNTY HIGHWAY RIGHT OF WAY
SCOTT COUNTY PUBLIC WORKS
600 Country Trail East
Jordan, MN 55352-9339
Phone 952-496-8346 Fax 952-496-8365
Traffic Signal Locates
952-496-8346
Permit No. CJ/ ~
Permit Fee - $95.00
48 hrs before digging
MUST BE REGISTERED WITH SCOTT COUNTY TO OBTAIN PERMIT
Name of Applicant Address r I /"_ I. A ~6"
b I '''1.00 C:O~ e '--I<ee.t:. ve
()~ rr\or LOI~e..- Prior ~\te. MN 55372
^.J. I :r~!~;J ~~d~~SS <5~cCX\c-h ~
Norf~ west tiSr\~lt. , ho..kD e..e MN 5537'l
Phone t.t52 - 4117 - 't f32.
le( Fax ct 52 - "ILl - I.f 2' Gopher One Call ID#
Nature of Work
~tortn ~~we("
RANGE
22.
TWP
115
4+ FrtA""'I~
DNo paVes
If yes, a traffic plan must be submitted with plans.
(I) (We) the undersigned, hereby apply for a permit from Scott County for the above. (I) (We) understand and accept the
terms and conditions of the regulations of the Commissioner of Transportation and that the approval of the County must
be obtained for issuance of this permit. On completion of the installation, persons doing such work must notify the Scott
County Highway Engineer that work has been completed and is ready for inspection and acceptance. The applicant shall
also comply with the regulations of all other gOVenun~cies.
sl/~/~s- ~:1-
Date ' , Applic~gnature ~
l>Jj~/~~-
Dat! I
In accordance with this application an Obstruction Permit is granted to the applicant to place, construct, and "thereafter
maintain" on, or across, or under the Right-of-Way of the above described Right-of-Way and in the location as shown by
the above application with the attached conditions and requirements:
Scott County Ordinance 22, Management of the Public Right-of-Way, Section 119: The excavation, backfilling, patching and
restoration, and all other work performed in the right-of-way shall be done in conformance . Minnesota Rules 7819.1100,
7819.5000 and 78 I 9'.S1 09 and shall Gonform to MnDOT standard specificatio other app . local requirements, in so far as
they are not inconsistent with the Minn. stat. ~ 237.162 and 237.163.
Date
mk -w:\word\permits\permit fonns\utilitypennit....Jiew _obstruction.doc
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~'
SCOTT COUNTY HIGHWAY DEPARTMENT
Public Works Division
600 Country Trial East
Jordan, MN 55352-9339
Phone: 952-496-8346
Fax: 952-496-8365
INSTRUCTIONS FOR COMPLETING APPLICATION FOR OBSTRUCTION PERMIT
Note: An incomplete application will delay processing.
* Allow up to 2 weeks for processing.
1. Print, in ink only, or type the application. Be sure to sign both this instruction sheet and the application form
at the bottom. Submit the original forms only. Faxed copies will not be accepted.
2. Complete each item on the application. If an item does not apply, print "N.A." in the blank.
3. No work under this application is to be started until the application is approved and the permit is issued.
4. Prior to construction, the permittee shall notify the County Inspector at 952-496-8487 and again after
completion for final inspection and approval by the County Highway Department.
5. No changes or alterations may be made at any time without written permission from the County Highway
Department.
6. It is the responsibility of the contractor to notify Gopher One for utility locations for any work being
performed within the Scott County right-of-way, and obtain all other necessary municipal permits.
7. Where work on traveled roadways is necessary, traffic must be protected, and the proper signage or
barricades must be placed in accordance with the standards of the Scott County Highway Department.
I, We, have agreed to all requirements and any special provisions included in this instruction sheet. All work
commencing will be done to the satisfaction of the Scott County Highway Department.
Dated:
~!tfp loS-
t (
Applicant's SignahJre4 ~
mk-w:\word\pennits\pennit fonns\utilityp,ennicnew_obstruction.doc
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Minnesota Department of Transportation
~
MAY I 2 2005
...J..
<
Transportation Building
395 John Ireland Boulevard
Saint Paul, Minnesota 55155-1899
By
651-296-8655
MailStop 678
May 10, 2005
MR LARRY POPPLER
ASST CITY ENGINEER
CITY OF PRIOR LAKE
16200 EAGLE CREEK AVE. S.E.
PRIOR LAKE, MN 55372
In Reply Refer To: Your Reference. CITYPROJ # 05-01
C.S.7001 (T.H.13) SCOTT County
CANDY COVE TRAIL AND FRANKLIN TRAIL IN CITY OF PRIOR LAKE
CITY OF PRIOR LAKE
Permit No. M-UL-2005-8917
DEAR MR LARRY POPPLER
A permit has been prepared based on your application dated March 25, 2005 for
installation of a 8" SANITARY SEWER & 8" WATERMAIN at the above referenced location.
However, you have NO AUTHORITY TO ACT UNDER THIS PERMIT until you have received it.
The permit has been forwarded to MR. KEITH VANWAGNER, ROADWAY REGULATIONS SUPERVISOR,
at 1500 W CO RD B2 , ROSEVILLE, MN, 55113-3174 telephone number 651-582-1443. You MUST
obtain it from him/her at his/her office and discuss with the person named in the
Special provisions any rules, regulations, or special provisions which may require
explanation before any work is performed on your project, or it may be sent to you if
arrangements have been made with this office.
Said permit or a copy thereof shall be provided to your construction forces or your
contractor to assure that the installat:;ion will be made in accc.rdance "lith the Rules
and Regulations, the special Provisions, and the Sketches contained in the Permit.
This Permit must be in the possession of your contractor while working on the highway
right of way.
Sincerely, / ~ ' ~
c::; 4~AI-uK/b -_c:;; ~
CC:
PATRICK HUGHES, D.E., ROSEVILLE
SUE MULVIHILL, A.D.E.M., ROSEVILLE
L. LEITNER, C.O. PERMITS
Marilyn Remer, P.E.
utilities Engineer
~
An equal opportunity employer
. ,
Page 4
STATE OF MINNESOTA
DEPARTMENT OF TRANSPORTATION
Utility Permit
Reference: Control Section 7001
T.H. 13
Attn: MR LARRY POPPLER
ASST CITY ENGINEER
In accordance with Minnesota Statues Section 161.45,
Minnesota Rules Section 8810, and this application
a Utility Permit for construction is granted to:
CITY OF PRIOR LAKE
to place, construct and thereafter maintain a:
8" SANITARY SEWER, "
8" WA TERMAIN
on or across, the right of way of Trunk Highway No. .13 in the location shown on the sketch
which is a part of the application, or in a location specified by the Department of Transportation in the attached Special
Provisions.
Recommended for approval:
/J1 ? 1J(';
DistricUDivision Representative
Dated
~ (I) ).ojs-
s-c;-- OS-
(Date)
Commissioner of Transportation
Transportation Building
St. Paul, Minnesota 55155-1899
Approved by:
.~ /-J:;:~
J Utilities Engineer
Division Engineer
Federal Highway Administration
(Date)
Permit No. M
UL
2005 __~ 9_~
COPIES:
Utilities Engineer
Applicant
District Engineer
Pat Hughes - Metro
Assistant District Engineer
Maintenance
Sue Mulvihill- Metro
Amount of Surety Bond Required
~
Project engineer
"
.' "
proVISIOns of the permit. If a check' is furnished, any moneys
remaining over and above such expense shall be returned to the
applicant.
Subp. 6. Uabllity. Except for the negligent acts of the state, its
agents, and employees, the utility shall assume all liability for, and
save the state, its agents and employees, harmless from, any and all
claims for damages, actions, or causes of action arising out of the
work to be done herein and the continuing uses by the utility,
including but not limited to the placing, constructing, reconstructing,
maintaining, and using of said utility under this application and permit
for construction.
Subp. 7 No easement. The work permit or permit for construdion as
issued does not in any way imply an easement on private property.
statutory authority: MS 1161.45
8810.3400 STANDARDS FOR WORK CONDUCTED UNDER
PERMIT.
Subpart 1. Trees, brush, and vegetation. At the time of construction
of the utility and at the times of subsequent maintenance, prior
approval shall be obtained from the distrid engineer or his authorized
representative for the cutting and trimming of trees within the trunk
highway right-of-way. Wherever trees are cut the resulting stumps
shaH be removed unless otherwise provided in the special provisions
of the permit for construction. Any holes caused by stump removal
shall be backfilled, the area leveled, and all materials associated
therewith disposed of outside the trunk highway right-of-way. The
utility shall advise the distrid engineer or his authorized
representative at least 48 hours in advance of its intent to start
lIJ clearing and grubbing operations so that the proper supervision can
:r: be provided.
(.)
I-
,~ Burning or disking operations and/or the use of chemicals to control
lIJ or kill trees, brush, and other vegetation is prohibited without prior
l}l approval from the assistant distrid engineer, maintenance.
o
..J
~ Subp. 2. Waterways. All waterways and lines of drainage shall
W remain operative.
Subp. 3. Topsoil and sod. Wherever topsoil and sod are disturbed
they shall be replaced and maintained satisfactorily until the turf is
established.
Subp. 4. Existing utility facilities. The utility facility and installation
shall not interfere with any existing utility facilities on the trunk
highway right-of-way.
Subp. 5. Warning devices. When necessary, barricades, warning
devices and flagmen shall be provided by the utility during all phases
of their construdion and maintenance operations on the trunk
highway right-of-way.
Subp. 6. Restoration to original condition. Upon completion of an
installation, the utility shall restore the trunk highway right-of-way to
its original condition. The utility shall then notify the office of the
assistant distrid engineer, maintenance, or projed engineer of the
completion of the work so that inspedion can be made to determine
its acceptability.
Subp. 7. Conformity. The installations shall be made in conformity
with all applicable laws, rules, and codes covering said installations.
All installations shaD be made in conformity with rules of
governmental agencies for the protection of the public
Statutory Authority: MS 1161.45
8810.3500 AERIAL UNES.
There shaH be only a single pole line on the trunk highway right-of-way
on either side of the center line thereof, unless otherwise authorized in
the special provisions of the permit for construction.
, .
P~ge 3
.-
Longitudinal installations on noninterstate trunk highways shall
normally be located in the outer five feet of the right-of-way. At
crossings of the noninterstate trunk highway, poles shall be placed at
a minimum of 30 feet from the shoulder lines of the through roadbeds
unless right-of-way widths are prohibitive to such location. Unless
dearly indicated on the permit for construction sketch, the location of
all brace poles, anchors, and anchor poles within the limits of the
trunk highway right-of-way shall be approved by the distrid engineer
or his authorized representative prior to &dual installation. In those
instances in which a utility is issued a permit or permits for
construction on both sides of the trunk highway right-of-way in a
given area such permit is conditioned upon the utility subsequently
providing joint use to other utiUties upon reasonable terms mutually
agreeable to the utilities.
Statutory AuthorIty: MS 1161.45
8810.3600 UNDERGROUND UNES.
All crossings of the roadbeds of the trunk highway shall be made by
boring inside a casing or carrier pipe, or by jacking, unless this
procedure is modified in the special provisions of the permit for
construction. The auger shall not lead the casing or carrier pipe by
more than one inch. Open trenching shaD be restricted to the area
from five feet beyond shoulder to the right-of-Way Une except as
modified in the special provisions of the permit for construction.
When pipes with bells and flanges are installed, the crossings of the
roadbeds of trunk highway shaH be made by boring inside a conduit,
as provided in the preceding paragraph, of jacking a conduit of
sufficient diameter to permit threading the carrier pipe through it.
All voids caused by jacking or boring shall be filled by pressure
grouting. The grout material shall consist of a sand-cement slurry of
at least two sacks of cement per cubic yard and a minimum of water
to assure satisfactory placement. The underground utilities shall be
so installed as virtually to preclude any necessity for disturbing the
roadbeds to perform maintenance operations.
Underground installations shall be accomplished without damaging
or destroying the principal root strudure of specimen trees.
Statutory Authority: MS 1161.45
NOTE:
As used in Minnesota Rules, Utilities Equipment, part 8810.3100
Definitions, Subpart 1, interstate highways shall include all Interstate
Highways and Federal Aid Freeways.
May 10, 20
m [f 1.;~ r.~:;~ n fli.7 rem
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MAY 1 3 2;05~!J
~
UT20050273
CERTIFICATE OF COMPLETION OF UTILITY INSTALLATION
FOR THE STATE OF MINNESOTA, DEPARTMENT OF TRANSPORTATION
TO: KEITH VANWAGNER
ROADWAY REGULATIONS SUPERVISOR
1500 W CO RD B2
P.O. Box
ROSEVILLE, MN 55113-3174
Telephone No. 651-582-1443
I hereby certify that
has completed
LAKE Company as
M-UL-2005-8917,
PRIOR LAKE.
Utility - Municipality - Contractor - Owner
installation of 8" SANITARY SEWER & 8" WATERMAIN for CITY OF PRIOR
described in and in accordance with Trunk Highway Permit No.
C.S.7001, T.H.13, at CANDY COVE TRAIL AND FRANKLIN TRAIL IN CITY OF
Dated
day of
20
utility - Municipality - Contractor - Owner
By
The work covered by the permit has been
satisfactorily completed.
Date
Assistant
Engineer,
District
Maintenance
For utility Permits Only:
Bond Number in the amount of $ will remain in effect a minimum
period of year(s) from the date of completion of the utility installation,
at which time the bond will be released if in the opinion of the Area Maintenance
Engineer the installation is satisfactory.
Where approved changes are made in the installation contrary to the application
sketches, 2 copies of "as built" sketches must be submitted with the signed
certificates.
THE CONTRACTOR IMMEDIATELY ON COMPLETION OF THE INSTALLATION SHALL SIGN AND RETURN
TWO COPIES OF THE CERTIFICATE OF UTILITY INSTALLATION TO THE ASSISTANT DISTRICT
ENGINEER, MAINTENANCE AT THE ADDRESS NOTED ABOVE.
Mn/DOT TP-02525-03 7-00
Pa 1
STATE OF MINNESOTA
DEPARTMENT OF TRANSPORTATION
)-z.-7~3
SUBMIT 1 (ONE)
COMPLETED FORM
WITH 4 (FOUR) SETS OF
SKETCHES TO:
APPLICATION FOR UTILITY PERMIT ON
TRUNK HIGHWAY RIGHT OF WAY UtilitlesEngineer-MS678
Minnesota Department of Transportation
INSTRUCTIONS 1. Complete only page one (no photocopies) Transportation Building
TO 2. Sign completed form . 395 John Ireland Blvd.
APPLICANT 3. Include 4 four sets of sketches Sl Paul, MN 55155-1899
County Scott T.H. No. 13 SEC. 36 TWP..11L RGE. 22 Company Project No. City ProJ.#05-01
New Facility!!2l Replacement Facility Cityff ownship Prior Lake
Application is hereby made for permission to place, construct and thereafter maintain a
Sanitary sewer and appurtenances & stonn sewer and appurtenaces
from: south side of intersection of TH 13 and Candy Cove Trail
to: south side of intersection of TH 13 and Franklin Trail
40 feet from center line on the South
I. AERIAL CONSTRUCTION (Check appropriate box)
o Single pole 0 Other
o H-Frame
o Single pole & H-Frame
o Steel tower
Existin Ie line
Voltage
o Open wire
o Cable
o Not Applicable
Number of ConductorS
along
Agreement No.
State Pro eel No.
Trunk Highway No. 13
side of the trunk highway as shown on the attached sketch
LIGHTING
Mounting Height
Mast Arm Length
Type of Lamp
Watts
Poles Not Appl
Size of Conductors
Minimum height of conductor:
ft. along highway
ft. at crossings over highway
II. UNDERGROUND CONSTRUCTION
Direct Buried Sanitary Sewer and Stonn Sewer
Voltage Number of Conductors-Type
CONDUIT TYPE PVC-sanitary RCP-storm
o Steel pipe . 0 Plastic Max. Oper. Pres. DIP-sanitary
Wall thickness per specs per specs
o Multiple tile Type Grade SDR 35 '-
o Clay tile Class 5
~ Sectional concrete Size 8- 15-
t/ Ductice Iron Depth 15' and 12' at (Jrade
o Other Number 2 1
METHOD OF INSTALLING UNDER ROADBEDS Not Applicable
III. EXTENT & LOCATION OF TREE TRIMMING ANDIOR CLEARING:
East and west boulevards of Can Cove Trail, south of TH 13
IV.
Work to start on or after May 1, 2005
and to be completed on or before November 1,2005
V. The applicant, in carrying on all of the work mentioned above or referred to in its
application and in the Permit for construction issued therefore, shall strictly conform to
the tenns of the Permit, and the Rules of the State of Minnesota as set forth in
Minnesota Rules 1983 as of July 31, 1983 together with the Special Provisions. all of
which are made a part hereof. The applicant specifically agrees to be bound hereby.
The applicant shall also comply with the regulations of all other governmental
agencies for the protection of the public. The work shall be accomplished in a manner
that YJiIl not be detrimental to the highway and that will safeguard the public.
.~
Will Facility be attached to a bridge?
No --
Size of Conductors, Cable Depth
CASING Not Applicable
Wall thickness
Grade
Class
Size
Applicant City of Prior Lake
Name of UtiHty making application
Address 16200 Eagle Creek Ave. S.E.
City
State
Prior Lake
MN
Zip 55372
T I hon (952) 447-9832
eep e
By Larry Poppler Asst. City Engineer
Name (Print or Type) TiBe
t?c...-
Dated "3 ( a S"" / <) S- Signed
Pursuant to Minnesota StaMes, Section 161.45, the following Rules have been promulgated by the Co missioner of Transportation (see reverse side).
,.
. '-.I
MINNESOTA RULES
1983
Adopted as of July 31,1983
UTILITIES EQUIPMENT
8810.3100 DEFINITIONS.
Subpart 1. Interstate highways. Under this order 'nterstate highways.
shan mean all trunk highways which are a part of the interstate system.
Subp. 2. Nonlnterstate highway. Under this order .noninterstate
highways. shall mean aU trunk highways which are not a part of the
Interstate system.
Subp. 3. Trunk highways. Under this order ~nk highways. shaD
mean ail trunk highway including those which are a part of the interstate
system. .
Subp. 4. UtIlity. Under this order .utility" shaD mean and include aU
privately, publicly, or cooperatively owned communication lines and
facilities, any systems, lines, and facilities for the distribution and
transmission of electrical energy, oil, gas, water, sewer, steam, and
other pipe lines, 'railways, ditches, flumes, or other structures which
under the laws of this state or the ordinance of any viHage or city may
be COnstructed, placed, or maintained across, along or on trunk
highway right..of-way. Dependent upon the meaning intended in the
CO(ltext, .utility" shaD also mean the utility company, inclusive of any
wholly owned subsidiary.
Statutory Authority: MS t161.45
8810.3200 PURPOSE AND SCOPE.
Subpart 1. Purpose. The purpose of parts 8810.3100 to 8810.3600 is
to carry out the mandate of the legislature and to effectuate that
mandate as set forth in the laws of Minnesota .1959, chapter 500,
article II, section 45 (Minnesota Statutes, section 161.45) with reference
to the placing, constructing, reconstructing, and maintaining of utilities
across, along, upon or under the right..of-way of trunk highways.
Subp. 2. Scope. The scope of parts 8810.3100 to 8810.3600 is
confined within the framework of and consistent with the laws of
Minnesota 1959, chapter 500, article II, section 45.
Statutory Authority: MS t161.45
8810.3300 PERMITS.
Subpart 1. Construction. Except as otherwise permitted, utility
construction and relocation on trunk highway right..of-way shall not be
commenced until an application for a permit for construction, has been
made and such permit granted. The permit for construction sketch shall
show the location of the proposed utility with reference to pertinent
features such as the right..of-way lines, curb lines, trunk highway center
line, etc. A copy of the sketch shall be provided for each copy of such
permit. Prints of trunk highway right..of-way maps available upon
request from the Road Plans Information Office, Department of
Trans~rtation Building, Saint Paul, Minnesota 55155.
Subp. 2. Maintenance. The utility shall obtain a work permit from the
office of the assistant district engineer, maintenance, prior to performing
service and maintenance operations on the interstate highways and
shaH also obtain a work permit prior to performing service and
maintenance operations on the noninterstate highways when such
operations require opening and disturbing the surface of the right..of-
way thereof. In all other instances the utility shall notify the office of the
assistant district engineer, maintenance, prior to performing service and
maintenance operations on the non interstate highways which interfere
with the normal flow of traffic thereon. However, the company may
perform service and maintenance operations on the trunk highways
including opening and disturbing the surface of the right..of-way without
a work permit in those instances where an emergency exists that is
dangerous to the life or
Page 2
'"
safety of the public and which requires immediate repair. The utility
upon knowledge of such an emergency shall immediately notify the
State Patrol Division. The utility shall take all necessary and reasonable
safety measures to protect the traveling public and shall cooperate fully
with the State Patrol Division to that end. The utility in such an event
will request a work permit from the office of the assistant district
engineer, maintenance, not later than the second working day
thereafter when a work pannit would ordinarily have been required but
for the emergency.
Subp. 3. Orders to make improvements. If at any time the state of
Minnesota, acting through its commissioner of transportation, shaM
deem it necessary to make any improvements or changes on all or any
part of the right..of-way of trunk highway which affect a utility located on
trunk highway right-of-way, then and in such event, the owner of the
utility shall within 15 days after written notice from the commissioner of
transportation or his duly authoriZed agent, proceed to alter, change,
vacate, or remove said utility from the trunk highway right..of-way so as
to conform to said trunk highway changes and as directed by the
commissioner of transportation. Such work shaH be done without any
cost whatsoever to the state of Minnesota except as otherwise provided
by law or agreement and shall be completed within the date specified in
said written notice, which date shaU be reasonable under the
circumstances. The utility shall assume all liability arid save the state of
Minnesota harmless from any and all claims of damage of any nature
whatsoever occasioned by reason .of not having removed said utility
within the time specified in said notice. Notwithstanding the provisions
of parts 8810.3100 to 8810.3600, the state may reimburse a
municipality for the cost of the first relocation of a municipally owned
utility located within the limits of a municipal street at the time that the
street was taken over by the State as a trunk highway, when such
reloca~ is required by construction or reconstruction of the trunk
highway.
Subp. 4. Along interstate highways. Utilities along interstate
highways shall be located outside the controJ.of-access lines except as
outlined below. Where the control..of-access lines coincide with the
right..of-way lines, the utilities shall generally be located on private
property. Where the control..of-access lines and right..of-way lines do
not coincide, utilities may in general be located in the area between
them. All utilities shall be serviced and maintained without access from
the ramps, loops, and through traffic roadbeds. Utilities may be
serviced from frontage roads and roads other than another interstate
highway which cross either over or under the interstate highway. At
aerial crossings of an interstate highway, supporting poles may be
located on interstate highway right-of-way if they are a minimum of 30
feet beyond the shoulders of all through traffic roadbeds; however, in
no event shall they be located in a median unless its width is 80 feet or
more. Manholes and other points of access to underground crossings
may be permitted on the interstate highway right..of-way only when
located outside the shoulders of the through traffic roadbeds, loops, or
ramps. The restrictions of this subpart shall not apply to utility lines
which service facilities required for operating the interstate highway.
There may be extreme cases where, under strictly controlled
conditions, a utility may be permitted inside the control-of-access lines
along an interstate highway. In each case there must be a showing that
any other utility location is extremely difficult and unreasonably costly to
the utility consumer, that the installation on the right..of-way of the
interstate highway will not adversely affect the design, construction,
stability, traffic safety, or operation of the interstate highway and that
the utility can be serviced without access from through traffic roadbeds,
loops, or ramps.
Subp. 5. Deposit, bond, or undertaking. The commissioner of
transportation may require the utility, or its contractor, to furnish a
deposit in the form of a certified check, a surety bond or corporate
undertaking in favor of the state of Minnesota, commissioner of
transportation, for any expense incurred by the state in the 'repairing of
damage to any portion of the trunk highway right..of-way caused by
work performed under a work permit or a permit for construction,
including any out of the ordinary engineering supervision and inspection
expense provided by the state. In those instances wherein a deposit is
required, the amount of the deposit shall be specified in the special
SPECIAL PROVISIONS: UT20050273
PAGE 1
This permit is issued to CITY OF PRIOR LAKE for an 8 inch sanitary sewer on TH 13 as
follows:
STATION
TO
STATION
DISTANCE FROM CENTERLINE
878+95
40 feet east to the East R/W line
868+10
868+30
40 feet east to the East R/W line
together with an 8 inch watermain as follows:
868+95
65 feet to 75 feet
as shown on the attached sketch(es) provided the installation does not affect existing
signs, lights and markings. (CANDY COVE TRAIL AND FRANKLIN TRAIL IN CITY OF PRIOR
LAKE )
The installation authorized in this permit will be inspected by MR. KEITH VANWAGNER,
ROADWAY REGULATIONS SUPERVISOR, 1500 W CO RD B2, ROSEVILLE, MN, 55113-3174, telephone
number 651-582-1443. The applicant or its contractor shall notify him/her at least two
days prior to starting the installation. He/she shall approve all highway materials
prior to placement, and the total installation must meet with his/her satisfaction.
The applicant shall provide in-house inspection at all times while on trunk highway
right of way.
The proposed installation shall be field staked by the applicant as to location and
elevation, and the same shall be approved by the State's inspector prior to the start
of the installation.
Two-way traffic shall be maintained at all times.
No material shall be deposited on the traveled roadway.
No above ground valve or regulator shall be placed on the highway right of way.
It shall be the responsibility of the applicant to utilize the "Gopher State One Call"
excavation notice system as required under Minnesota Statute Chapter 216D, 48 hours
prior to performing any excavation (phone 651-454-0002 Twin Cities Metro Area or Toll
Free 1-800-252-1166) .
The applicant shall coordinate the proposed installation with the existing facilities
of others in the area.
All excavations, trenching and/or jacking and boring pits shall be sheeted and/or
shored as per OSHA Requirements. No unsheeted trench shall be left open overnight.
SPECIAL PROVISIONS: UT200S0273
PAGE 2
A detailed plan shall be submitted to, and approved by, the Assistant District Engineer
- Maintenance for any dewatering or pumping operations.
All installation procedures for Plastic pipe shall be in accordance with ASTM-D-2774
(Pressure pipe) or ASTM-D-2321 (Non-Pressure Pipe) .
Material removed from the trench shall be used for backfilling, insofar as it is
suitable. No rock shall be replaced in the trench, but shall be removed from the site
by the applicant. Backfilling shall consist of approved material and shall be tamped
mechanically (maximum 12 inch layers) to secure satisfactory compaction. The shoulders
and roadways disturbed by these operations shall be repaired immediately with suitable
and approved material, such replacement to conform to existing grades. Drainage and
slopes shall be satisfactorily restored. The applicant must restore any settlement.
All base and surface courses damaged during trenching operations shall be restored in a
condition as good or better than before operations began. If replaced material
settles, it shall be restored to its original condition by the applicant.
All entrances shall be satisfactorily restored by the applicant.
All curb or sidewalk disturbed shall be satisfactorily restored by the applicant.
All plants or trees removed or damaged shall be replaced in kind by the applicant.
All tree trimming or clearing shall have prior approval of the Assistant District
Engineer - Maintenance.
All elm, oak and pine timber, stumps, roots and debris, together with the bark and
byproducts with adhering bark of elm tree origin shall be disposed of according to
Minnesota state and local law.
All wounds. to oak trees located on projects south of the 46 degree parallel shall be
avoided during April, May and June in order to prevent the spread of oak wilt. If it
is necessary to complete utility work near oak trees during those months; any resulting
wounds, including exposed root ends, shall be immediately treated with an asphaltic
base wound dressing.
All specimen trees and other plants that are designated to remain shall be protected
against damage by fencing when necessary. Temporary fencing shall be placed prior to
starting any utility work. No material shall be stored, or any construction operation
carried on inside the dripline of any tree except as designated by the Assistant
District Engineer-Maintenance. Fencing shall remain in its original position until all
work is completed or until designated for removal by the Assistant District
Engineer-Maintenance.
Specimen tree roots exposed and damaged shall immediately be cut off cleanly inside the
damaged area. Topsoil shall be immediately placed over the exposed area.
All drainage structures removed or damaged shall be restored by the applicant to as
SPECIAL PROVISIONS: UT20050273
PAGE 3
good or better condition than before operations began.
All drainage tile lines shall be located and staked as to location and elevation. Any
damage to tile lines caused by the construction operations shall be repaired by the
applicant.
It is expressly understood that this permit is issued subject to the applicant's
compliance with the rules and regulations of the Minnesota Environmental Quality Board
and any other affected governmental agencies.
Unless adequately protected by a traffic barrier, there shall be no work within the
clear zone, nor shall pipe materials, equipment and other objects as determined by the
State, be stored within the clear zone as determined by the Department and as defined
by the latest edition of AASHTO'S "ROADSIDE DESIGN GUIDE" (2002) . If portable concrete
jersey barriers are required they shall be placed in accordance with The 2001 Minnesota
Manual on Uniform Traffic Control Devices" Portable Concrete Barrier Placement and End
Treatments" Figure 6f-6 (Sheets 1 and 2) .
The applicant shall furnish, install and maintain all required traffic control devices
according to the "Minnesota Field Manual on Temporary Traffic Control Zone Layouts"
(January 2004) (see website @ http://www.dot.state.mn.us/trafficeng/). while performing
the construction authorized by this permit.
If the temporary traffic control zone is to remain in one place for more than 3 days or
involves a detour, road closure or a situation where the typical layouts do not apply,
the applicant shall prepare a specific Traffic Control Plan for approval by Mn/DOT
prior to start of any construction.
The applicant is required to preserve all existing survey monuments. If Mn/DOT
determines that monuments have been disturbed or destroyed during construction
activities, the applicant shall accept full responsibility for all costs incurred in
the re-establishment of the monuments.
Within 30 days upon completion of the installation, the applicant must furnish to the
Assistant District Engineer-Maintenance the Certificate of Completion Form (furnished
with permit) and a set of "AS-BUILT" plans as stated on the Certificate of Completion.
Work during the period of November 1 through April 15 shall be considered as winter
work and shall be done on a day to day basis at the discretion of the Assistant
District Engineer - Maintenance.
No work which will restrict or interfere with traffic shall be performed between 12:00
Noon on the day preceding and 6:30 A.M. on the day following any consecutive
combination of a Saturday, Sunday, and a Legal Holiday without the written permission
of the Assistant District Engineer - Maintenance.
Conditions may require temporary measures to control erosion and sedimentation.
Installation of temporary erosion measures shall be carried out concurrently with the
operation or as soon thereafter as practicable. Temporary erosion controls are
SPECIAL PROVISIONS: UT20050273
PAGE 4
short-lived devices such as straw bale structures, silt curtains, sediment traps or
other means to temporarily protect the overall work prior to restoration of the
worksite. The Assistant District Engineer - Maintenance will decide when these measures
are required according to Section 2573 of the Standard Specifications for Highway
Construction of the Minnesota Department of Transportation, dated SEPT. 5, 2000.
All areas disturbed by the applicant shall be restored with a minimum of 6" of topsoil
(according to Mn/DOT Standard Specification 2105 Table 1 Topsoil Borrow), then sodded
or seeded. Seed or sod shall be the same as/or compatible with the existing turf cover.
If the areas are to be seeded, a Mn/DOT Seed mixture comparable to the existing turf
along with Type 1 Mulch and Disk Anchoring shall be used according to Mn/DOT
specification 2575.
The applicant or its
amount of $ rlJ
Transportation. T
contractor shall furnish a certified check or surety bond in the
, in favor of the State of Minnesota, Commissioner of
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o~ l'R.IO<1i CITY OF PRIOR LAKE FRANKLIN TRAIL SE
aW~ ENGINEERING DEPARTMENT SANITARY SEWER
16200 EAGLE CREEK AVE. S.E. AND WATERMAIN
~~~() PRIOR LAKE. UN 55372
PH:952/447-9830 FAX:952/447-4263 CITY PROJ. NO. 05-01
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I HEREBY CERTIFY THAT THIS PlAN,
SPECIFICATION, OR REPORT WAS
PREPARED BY ME OR UNDER MY DIRECT
SUPERVISION AND THAT I AM A DULY
UCENSED PROFESSIONAl. ENGINEER
UNDER THE LAWS OF THE STATE or
IiUNNESOTA.
REVISION NO.
DESCRIPTION
PlAN BY: OESlGN BY:
LS ICUL
CHECKED BY: PROJ. NO.
MAl' "121543
AS BULl BY: DATE:
MARCUS A. THOMAS. P.E.
DATE: UC.NO.: 2&4l19
E30L. ,-Of'J & 1'-/1 ~ I'J I< ,
Consulting Engineers & Surveyors
1515 East Highway 13 · Burnsville. MN 55337-2917
Phone (952) 890-0509. FAX (952) 890-8065
II'JC.
March 28, 2005
Darin Holmgren
Scott County Highway Department
Scott County Public Works
600 Country Trail East
Jordan, MN 55352
Re: Scott County Application for Utility Permit
Prior Lake City Project No. 05-0 I
Dear Mr. Holmgren:
Please find enclosed the completed Application for Utility Permit on County Highway Right of Way. I
have also enclosed two hal~-size copies of the traffic control plan, two half-size plan sheets of the work to
be performed within the County Right of Way on Candy Cove Trail and Franklin Trail, two copies of
Layout 32 from the MMUTCD, and the required application fee in the amount of$95.00.
Also included is a work zone speed limit documentation form, since the traffic control plan will reduce
the speed limit on CSAH 44 from 45 mph to 30 mph.
Since this contract has not yet been executed, the permit will be signed by the Contractor when the project
is let.
Please contact me at (952) 890-0509 if you have any questions or comments.
Sincerely,
BOLTON & MENK, INe.
t.
Kent Louwagie, E.!. T.
Design Engineer
Enc.
cc: BMI File
F:~CiviI\PLAK\T1621543\Pennits\Scott Co transm.doc
MANKATO, MN · FAIRMONT, MN · SLEEPY EYE, MN · BURNSVILLE, MN . WILLMAR, MN · CHASKA, MN · AMES, IA
www.bolton-menk.com
An Equal Opportunitv Emp/over
Gopher State
651-454-0002
APPLICATION FOR UTILITY PERMIT
ON COUNTY HIGHWAY RIGHT OF WAY
SCOTT COUNTY PUBLIC WORKS
600 Country Trail East
Jordan,~ 55352-9339
Phone 952-496-8346 Fax 952-496-8365
Traffic Signal Locates
952-496-8346
Permit No.
Permit Fee - $95.00
48 hrs before digging
CSAH/CR
MUST BE REGISTERED WITH SCOTT COUNTY TO OBTAIN PERMIT 4L{
Name of Applicant Address It A S Phone '152 - "~7 ~ '18..32-
C 1~'1 o~ P r i or LAke.. I b 200 E~ Ie. Cr~~ ve. E" Fax 't52 - qll7 - 42h3
Prior LAke MN 55372 Reg. #
Name of'Contractor Address Phone
Fax
Reg. #
Contact Person Phone '52 - "I1.{7- '8.121
Lt:vr~ Poobl~ r Fax "52. - 4'" - 1./263 Gopher One Call 1D#
( , I
2tf)5
roved.)
County Roads Involved
C~A'" '-Il./
SECT.
A ,., 4'1
8" b,P q. SZ Wc;Jd~;i"\ ,,+ Fr~kl;"
Will Detouring of Traffic be Necessary? 0 No Yes
If yes, a traffic plan must be submitted with plans along
with an Obstruction Permit Application. -
?J6
RANGE
Z2
TWP
115
Attach Detailed Site Drawing Showin All Dimensions from Ri ht-of-Way and Existing 1m rovements.
(I) (We) the undersigned, hereby apply for a permit from Scott County for the above. (1) (We) understand and accept the
terms and conditions of the regulations of the Commissioner of Transportation and that the approval of the County must
be obtained for issuance of this permit. On completion of the installation, persons doing such work must notify the Scott
County Highway Engineer that work has been completed and is read)'"-for inspection and acceptance. The applicant shall
also comply with the regulations of all other governmental agencies.
']I]c!-~ ~~
Date ~ ignature
Date Contractor's Signature
FOR OFFICE USE ONLY
In accordance with this application a Utility Permit is granted to the applicant to place, construct, and "thereafter
maintain" on, or across, or under the Right-of-Way of the above described Right-of-Way and in the location as shown by
the above application with the attached conditions and requirements:
Scott County Ordinance 22, Management ofthe Public Right-or-Way, Section 119: The excavation, backfilling, patching and
restoration, and all other work performed in the right-of-way shall be done in conformance with Minnesota Rules 7819.1100,
7819.5000 and 7819,'5100 and shall conform to MnDOT standard specifications and other applicable local requirements, in so
far as they are not inconsistent with the Minn. Stat. S 237.162 and 237.163.
Date Authorized Signature for Scott County Highway Department
mk-w:\word\permits\permit forms\utilitypermicnew _utility .doc
SCOTT COUNTY HIGHWAY DEPARTMENT
Public Works Division
600 Country Trial East
Jordan, MN 55352-9339
Phone: 952-496-8346
Fax: 952-496-8365
INSTRUCTIONS FOR COMPLETING APPLICATION FOR UTILITY PERMIT
Note: An incomplete application will delay processing.
* Allow up to 2 weeks for processing.
1. Print, in ink only, or type the application. Be sure to sign both this instruction sheet and the application form at the
bottom. Submit the original forms only. Faxed copies will not be accepted.
2. Complete each item on the application. If an item does not apply, print "N.A." in the blank.
3. No work under this application is to be started until the application is approved and the permit is issued.
4. It is the responsibility of the contractor to notify Gopher One for utility locations for any work being performed
within the Scott County right-of-way, and obtain all other necessary municipal permits.
5. No foreign material such as dirt, gravel, or bituminous material shall be left or deposited on the roadway during the
installation of utilities.
6. Prior to construction, the permittee shall notify the County Inspector at 952-496-8487 and again after completion for
final inspection and approval'by the County Highway Department.
7. No changes or alterations may be made at any time without written permISSIOn from the County Highway
Department.
8. The area will need to be mulched and seeded and any necessary erosion control installed after the work has been
completed.
9. In the event that the construction has not been started within one year of the permit approval date, this permit
becomes null and void.
I, We, have agreed to all requirements and any special provisions included in this instruction sheet. All work
commencing will be done to the satisfaction of the Scott County Highway Department.
Dated:
'3/30/0 -=>
I
Applicant's Sign.turOp R...
mk-w:\word\permits\permit forms\utilitypermicnew _utility.doc
WORK ZONE SPEED LIMIT DOCUMENTATION FORM
Road
Name
Road
Authorit
Existing
Seed Limit
C.$.A',tI.
Sc.o++
45
44
Coun+
Control
Section
Posted Work Zone
Speed Limit
30
Whereas it is necessary to perform maintenance/construction roadwork in a safe and efficient
manner, therefore, the following changes in maximum speed limits shall be made to the
described roadway sections. Changes authorized herein are in accordance with Minnesota
Highway Traffic Regulation Act, Minnesota Statutes Chapter 169.14, Subd. Sd.
LOCATION t",h!rsed-;on of MN TIf 13 I"f.ersec./-ior. J h'.st.. Po,,,/- RooJ
FROM G\.,.,d . CS A H Ll4 TO ~""a CSA H Ll4
Signature
Time/Date Installed Signature
Time/Date Removed
LOCATION
FROM
TO
Signature
Time/Date Installed Signature
Time/Date Removed
'-
LOCATION
FROM
TO
Signature
Time/Date Installed Signature
Time/Date Removed
LOCATION
FROM
TO
Signature
Time/Date . Installed Signature
Time/Date Removed
Use fixed physical features such as intersections and bridges or the distance from these features
to describe from/to locations. Reference Points (mileposts) may be used if accurately identified.
DO NOT USE signs, poles, barricades, or temporary devices.
Stationary
~.
..
r=
JO
if
Spacing of
Channelizing Buffer
Devices Space
(0).. . (B)
meters :Jeet meters
10 25
10 50
15 85
15 100
15 165
NOTES:
1. For nighttime and Intermediate
Term operations, Type A flashers
are required on advance warning
signs unless PCMS's and flashing
arrowboards are used.
* - Required for speeds
greater than 40 mph.
. - Channelizing Device.
Cones or tubular
markers may be used
only for daytime
operations
- Channelizing device.
A"
.
.
r=m.
+-.
+-'Y.
+- .6,..T
1 ....
'5 ~.'7 -:. - OPTIONAL~
.;. _ ~ _ :.. _ _se~ ~te.! ~
DOUBLE LANE CLOSURE
MULTI-LANE UNDIVIDED ROAD
6K-41
Layout - 32
January, 2004
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C.S.A.H. 44
TRAFFIC CONTROL PLAN
STAGE 2
CITY PROJ. NO. 05-01
H:\PIAlC\T1121543\p1ofta\21li43_.... 03-21-200& .:04 pm
I HEREBY CERTIfY THAT THIS PlAN,
SPECIFICATION, OR REPORT WAS
PREPARED BY ME OR UNDER MY DIRECT
SUPERVISION ANO THAT I AM A DULY
lICENSED PROFESSIONAl ENGINEER
UNDER THE LAWS OF THE STATE OF
MINNESOTA.
"'BOLTON ... MENI<, INC.
e--. EntII- . ..........
-... -.... ILEIPf M.... _...
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REVISION NO.
DESCRIPTION
MARCUS A. THOMAS, p.r.
DATE: REG.NO.' 26499
PlAN BY: DESIGN BY:
LS KlolL
CHECKED BY: PROJ. NO.
MAT T1li21543
AS BUIlT BY: DATE:
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MARCUS A. THOMAS. P.E.
DATE: REG.NO.' 26499
PlAN BY: DESIGN BY:
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CHECKED BY: PROJ. NO.
MAT T162154J
AS BUILT BY: DATE:
1t\Pl.AK\T1S21li4l\p_\2t54.5l1WFJC.dw9 03-21-2005 5:14 pm
I HEREBY CERTIfY THAT THIS PlAN.
SPECIfiCATION. OR REPORT WAS
PREPARED Il'r ME OR UNDER MY DIRECT
SUPERVISION AND THAT I AM A DULY
UCENSED PROFESSIONAL ENGINEER
UNOER THE LAWS OF THE STATE OF
MINNESOTA.
C.S.A.H. 44
TRAFFIC CONTROL PLAN
STAGE 3
CITY PROJ. NO. 05-01
REVISION NO.
", .I;-\.f>~C;~.;:;mT,;~.il<~.f.f:v'-",.,,:" -:,'~;- .
DESCRIPTION
E30L. TOI'J & ~ E: I'J J< ,
Consulting Engineers & Surveyors
1515 East Highway 13 · Burnsville, MN 55337-2917
Phone (952) 890-0509. FAX (952) 890-8065
II'JC.
March 28, 2005
Minnesota Pollution Control Agency
ATTN: Sanitary Sewer Extensions, REM, Metro
520 Lafayette Road
S1. Paul, MN 55155-4194
Re: City Project No. 05-01
Prior Lake, MN
To Whom It May Concern:
Please fmd enclosed a permit application, a design certification form, one copy of the construction plans,
a Hudson map showing the project location, and the application fee in the amount of $240.00 for the
above referenced project. The project will be completed in accordance with the City Engineers
Association of Minnesota, Standard Utilities Specifications.
Please contact me at (952) 890-0509 if you have any questions or need additional information.
Sincerely,
BOLTON & MENK, INC.
Kent Louwagie, E.!. T.
Design Engineer
....
Ene.
cc: Roger Janzig, MCES
BMI File
F:\.. Civil\PLAK\T1621543\Permits\MPCA transm.doc
MANKATO, MN · FAIRMONT. MN · SLEEPY EYE, MN · BURNSVILLE, MN · WILLMAR MN · CHASKA, MN · AMES, IA
www.bolton-menk.com
An Eaual Oaoortunltv Em%ver
~
-~
Minnesota
Pollution
Control
Agency
PERMIT APPLICATION and TRANSMITTAL FORM/or
SANITARY SEWER EXTENSIONS
AND/OR CHANGES
NEW process for 2002!
COMPLETE APPliCATION BY PRINTING OR TYPING. PLEAsE MAKE A PHOTOCOPY FOR YOUR RECORDS.
1. Title of Project (plans and Specs): City Project No. 05-01
Developer/Owner: City of Prior Lake
Developer/Owner Address: 16200 Eagle Creek Ave SE
City: Prior Lake State: MN
Zip: 55372-1714
2. Permittee:
Contact person:
City of Prior Lake
Larry Poppler, P.E.
Scott
(952) 447-9832
County:
Title: Assistant City Engineer
Phone: (952) 447-4230
Phone:
3. Wastewater Treatment Facility (WWTF): Blue Lake
Is the proposed sewer project in accord with the City or District Comprehensive Sewer Plan? [8] Yes 0 No
4. Specification of Current WWTF
1) Average wet weather design flow (A WW)
2) Annual average daily flow (past 12 months)
3) Average design flow (if A WW not available)
4) Annual average influent CBOD5 (past 12 months)
42
27.72
32
226
MGD
MGD
MGD
mgIL
MGD
5. Estimated Flow Increase Initial Project: 0 MGD
Basis for estimate:. Reconstruction and re-routing of existing utilities
Ultimate: 0
6. Estimated BOD 5 Increase Initial Project: 0 #/day
Basis for estimate: Reconstruction and re-routing of existing utilities
Ultimate: 0
#/day
7. Location of Proposed Project:
Township
Township #: 115N
City: Prior Lake
Address (or nearest intersection):
Facility is located in the
of
quarter of the SW
Scott
Range #:
22
quarter of section 36
County
East or West: W
State: ~MN Zip: 55372
MN Trunk Highway 13 and County State Aid Highway 44 - See attached Hudson map
8. Nature of Area to be Served by the Proposed Project
Residential: Number of New Homes: 0 Number of Existing Homes: 15
CommerciallIndustrial (Describe): 3 - A mall, an office buildin2, and a florist
Other (Describe):
9. Technical Agent or Consulting Engineer: Marcus A. Thomas, P.E. Title: Project Engineer
Name of firm or organization: Bolton & Menk, Inc
Mailing Address: 1515 East Highway 13, Burnsville, MN 55337-2917
Phone: (952) 890-0509 Fax: (952) 890-8065
10. Has the project been reviewed in a previous Environmental Assessment Worksheet (EA W)? 0 Yes [8] No
If yes, note the name of the project reviewed in the EA W, the responsible governmental unit, and the date of the negative declaration:
Name of the Project Reviewed in EA W: Date:
Responsible Governmental Unit: Date:
Date of the negative declaration:
11. Determination for the need of an EA W:
Is the ultimate design flow for the proposed project greater than 1,000,000 gpd? 0 Yes [8] No
If yes, the preparation of an EA W is mandatory for this project.
Permit Application and Transmittal Form for
Sanitary Sewer Extensions and/or Changes (wq-wwprm7-15)
Page 1 of2
MAY 03
CERTIFICATION AND SIGNATURE
Federal regulations (Section 309(c)(2) of the Clean Water Act and State regulations (Minn. R. 7001.0070) require the authorized
signer to be one of the following:
A. For corporation, a principal executive officer of at least the level of vice president;
B. For a partnership or sole proprietorship, a general partner or the proprietor, respectively; or
C. For a municipality, State, Federal, or other public facility, either a principal executive officer or ranking executive
official.
D. If the operator of the facility is different than the owner, both the operator and the owner according to items A to C.
"I certify under penalty of law that this document and all applicable design documents were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based
on my inquiry of the person, or persons, who manage the system, or those persons directly responsible for gathering the information, the
information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant
penalties for submitting false information, including the possibility of fine and imprisonment."
PRINTED NAME
TITLE
AUTHORIZED SIGNATURE
DATE
PRINTED NAME
Larry P. Poppler, P.E.
~r2
~ (AUTHORIZED CITY REPRESENTATIVE)
TITLE
Assistant City Engineer
DATE '3 I? I / 0 S-
AUTHORIZED SIGNATURE
PRINTED NAME Marcus A. Thomas, P .E. Reg No. 26499
AUTHORIZED SIGNATURE -'j./ll (,t.,(.~. 14 7l{;."'t-i t{..L- DATE V It (OS-
(ENGINEER)
STATE TAX 1.0. #
FEDERAL TAXI.D. #
REMEMBER!
...
· DO NOT submit plans and specifications with this application unless required!
You must first complete the form and checklist titled: Design Certification for Sanitary Sewer Extension Plans and Specifications
to determine if plans and specifications need to be submitted.
· No project construction may begin until you are in receipt of the required permit(s) issued by the MPCA and as defined by law under
Minn. Stat. g 115.07, subd.3.
· The project information packet you submit must contain ALL of the following items or it will be immediately returned:
1. This completed and properly signed Application Form.
2. The completed form and checklist titled: Design Certification for Sanitary Sewer Extension Plans and Specifications.
3. Plans and specifications (ONLY ifrequired).
4. The required application fee ($240). Please make your check payable to the Minnesota Pollution Control Agency.
· Forms are available on the MPCA's web site at: www.pca.state.mn.us. You can also contact the MPCA's Customer Assistance
Center at (651) 297-2274 (Metro or outside MN) or toll free at (800) 646-6247 to request forms or ask questions.
· Send the project information packet to: Minnesota Pollution Control Agency, 520 Lafayette Road, St. Paul, Minnesota, 55155-4194
ATTN: Sanitary Sewer Extensions, REM, Metro.
Permit Application and Transmittal Form for
Sanitary Sewer Extensions and/or Changes (wq-wwprm7-15)
Page 2 of 2
MAY 03
~
--
Minnesota
Pollution
Control
Agency
Design Certification for Sanitary Sewer
Extension Plans and Specifications
MPCA USE ONLY
Application Number
SE# I
Fast Track? YES
NO
Permittee:
City of Prior Lake
Title of Plans and S ecifications:
Location of Project ma'or intersection: Intersection ofT.H. 13 & C.S.A.H. 44
All sanitary sewer extensions shall be designed according to the latest version of the following
recommendations, specifications, and guidelines (specific MPCA guidelines take precedence over other
documents):
Recommended Standards for Wastewater Facilities, Great Lakes - Upper Mississippi River
Board of State and Provincial Public Health and Environmental Managers. (Ten States
Standards)
Standard Utilities Specification, City Engineers Association of Minnesota.
Design Flow and Loading Determination Guidelines, Minnesota Pollution Control Agency
Fast Track Review Process
· Answer questions no. 1-44 below
· If both questions no. 23 and 46 are answered YES or NA:
. sign the Fast Track Certification Statement if applicable;,>-
. attach this completed form to the Sanitary Sewer Extension Permit Application; and
. do not submit plans and specifications (plans and specifications for some projects may be
required to be submitted for review as part of a random audit to verify compliance
with applicable standards).
Detailed Review Process (This process may require additional time for completion)
· Answer questions no. 1-44 below
· If either question no. 23 or 46 are answered NO:
. do not sign the certification statement below;
. sign the Statement for Detailed Review;
. attach a copy of this completed form to the Sanitary Sewer Extension Permit Application;
. provide justification for not following the specified recommendations; and
. submit plans and specifications for review and approval.
Design Certification for Sanitary Sewer Extension
Plans and Specifications Form (wq-wwprm7-13)
Page 1 of4
JUL 02
Design Flow:
1. What is the er ca ita er da desi flow? 100
2. If the design flow is less than 100 gallons per person per day, is the total based on an analysis of actual existing per
ca ita flow to the treatment facili ?
3. What is the desi eakin factor?
Sewer Pipe:
Yes No NA
~ 0
~ 0 0
~ 0
o 0 ~
0 0 ~ 9.
0 0 ~ 10.
0 0 ~ 11.
~ 0 12.
~ 0 0 13.
~
o
o
~
5. Are all sewers desi ed without an overflow or b ass oint?
6. Are all vi sewers at least 8 inches diameter? Answer NA onl if there are no sewers
7. Are all sewers sufficiently deep to receive wastewater from basements and to prevent freezing or
is insulation rovided for sewers that are not laced at a de th to revent freezin ?
8. If there are sewers that cross or enter any water body, has the Department of Natural Resources
been contacted to determine if they will require a permit for construction? (Answer NA only if
there are no sewers located in a water bod ?
Do the design plans and specification contain specific size and location requirements for reaction
blocking or pipe restraint to withstand water hammer and other cyclic reversal of stresses
associated with lift station 0 eration? Answer NA onl if there are no res sure sewers)
Is there an air relief valve shown at all high points in force mains? (Answer NA only if there are
no ressure sewers
Are grinder pumps or other solids removal equipment included for any force main that is less than
4 inches in diameter? Answer NA onl if there is no ressure sewer
Are all sewers designed with mean velocities when flowing full, of at least 2.0 feet per second,
based on Mannin 's formula usin and "n" value ofO.013?
Is the slope of 8-inch diameter gravity sewer at least 0.40%; IO-inch diameter sewer at least
0.28%; 12-inch diameter sewer at least 0.22%; 14-inch diameter sewer at least 0.17%; IS-inch
diameter sewer at least 0.15%; 16-inch diameter sewer at least 0.14%; and IS-inch diameter sewer
at least 0.I2%? The pipe diameter and slope shall be selected to obtain the greatest practical
velocities to minimize settling problems. Oversizing sewers to achieve flatter slopes should not be
done. If proposed slopes are less than those listed above, what is the depth of flow and velocity of
flow at the average wet weather flow and peak hourly wet weather flow for affected pipe sections?
A WW flow (mgd) = Depth of flow = (ft.) Velocity = (ips)
PHWWflow (mgd)= Depth of flow = (ft.) Velocity= (ips)
If sewer grades are less than those listed above, sedimentation problems, frequent sewer maintenance, and
backups may result. All sewers with a slope less than the minimums listed above be cleaned at least once
per year to ensure problems to not develop and to develop a site specific maintenance interval. (Answer
N/A onl ifno avi sewer.)
Are individual service connections to the sewer designed to be water tight and do not protrude into
the sewer?
Are all gravity and pressure sewer pipes and water supply pipe separated horizontally by at least
10 feet and vertically by at least 1.5 feet when crossing?
~ For gravity sewers only, if it is not practical to maintain a 10 feet horizontal separation, is
water main in a separate trench or on an undisturbed earth shelf located on one side of the sewer
and at an elevation so the bottom of the water main is at least 18 inches above the top of the
sewer?
o For gravity sewers only, if it is impossible to obtain the proper horizontal and vertical
separations, are both water and sewer pipe constructed of slip-on or mechanical joint pipe
com I in with ublic water su I desi and construction standards?
14.
15.
Design Certification for Sanitary Sewer Extension
Plans and Specifications Form (wq-wwprm7-13)
Page 2 of4
JUL 02
Sewer Pipe (Continued):
~ No NA
[8J D D
[8J D D
[8J D D
[8J D D
o 0 [8J
[8J D 0
o [8J
o [8J D
Lift Stations:
Yes No NA
D [8J
D D
0 0
D D D
o
o D
D
D
D
D
D
D
o
D
D
o 0
D
D
D
D
D
o
D
D
D
D
D
o D
0.0
o
16. Are all manholes at least 48 inches in diameter? Answer NA onl if there are no manholes.
17. Are all manholes constructed to revent surface water run off from enterin throu the cover?
18. Are drop manholes used at locations where the sewer pipe enters the manhole at an elevation of 24
inches or more above the manhole invert? (Answer NA only if sewer pipes enter at an elevation
less than 24 inches
19. Is the spacing between manholes 400 feet or less or if the spacing is greater than 400 feet, do
operation and maintenance personnel have access to adequate cleaning equipment that can
accommodate the s acin ? (Answer NA onl if all ressure sewer.)
20. Will a leakage test be performed to demonstrate watertightness of the sewer pipes?
What test method will be used?
21. Will a deflection test be performed on all plastic gravity sewer after the pipe has been in place for
at least 30-da s? Answer NA onl iftelevisin or other method is used instead.
22. Will sewer line televisin be erformed? Answer onl as YES or NA
23. Have uestions #5 throu #22 been answered as YES or NA?
Does the ro' ect include an work on a lift station? If NO, 0 to uestion No. 46 and answer NA
24. Will the lift station be full 0 erational and accessible durin a 25 ear flood?
25. Will the lift station structural, electrical and mechanical equipment be protected from physical
dama e durin at 100 ear flood?
26. Where high ground water conditions are anticipated, has the buoyancy of the lift station structure
been considered and adequate provisions made to protect the structures? (Answer NA only ifhigh
ound water conditions are not antici ated.)
27. Are wet wells and dry wells completely separated and common walls are gas tight? (Answer NA
onl if no d well is included
28. Are multiple pumps provided such that with any unit out of service, the remaining units have
ca aci to handle the desi eak hourI wet weather flow?
29. Are all urn s ca able of assin s heres of at 3 inches in diameter?
30. Are all urn suction and dischar eo enin s at least 4 inches in diameter?
31. Are all electrical components in raw wastewater wet wells in compliance with National Electrical
Code re uirements for Class I Grou D, Division 1 locations?
32. There are no b ass or overflow i es from the wet well?
33. Are suitable shutoff and check valves laced on the dischar e line of each
34. Are check valves located between the shutoff valve and the urn ?
35. Are check valves placed in the horizontal position, except ball valves which may be placed
vertically?
36. Are shutoff and check valves for submersible pump lift stations located in a separate valve pit? If a
se arate valve it is not rovided, are all valves easil accessible for maintenance?
37. If a drain line is provided between a valve pit or dry well and a wet well, is the drain line equipped
with a gas and water tight valve or extended below the low water level in the wet well to prevent
en of hazardous cases to the valve it? Answer NA onl if a drain line is not included
38. If continuous wet well ventilation is provided, are at least 12 complete air changes per hour
rovides? Answer NA onl if submersible urn lift station
39. If intermittent wet well ventilation is provided, are at least 30 complete air changes per hour
rovided? (Answer NA onl if submersible urn lift station
Design Certification for Sanitary Sewer Extension
Plans and Specifications Form (wq-wwprm7-13)
Page 3 of4
JUL 02
Lift Stations (Continued):
Yes No NA
o 0 40.
o 0 41.
o
o
o
o
o
o
o
o
42.
43.
If continuous dry well ventilation is provided, are at least 6 complete air changes per hour
rovided? Answer NA onl if submersible urn lift station
If intermittent dry well ventilation is provided, are at least 30 complete air changes per hour for 10
minutes and 6 complete air changes per hour thereafter provided? (Answer NA only if submersible
urn lift station
Are rovisions for flow measurement rovided? T e:
Are a sufficient number of running time meters provided to record when each pump is running and
when multi Ie urn s are runnin at the same time?
Is an appropriate alarm system provided to indicate power failure, pump failure, unauthorized
en , or other malfunction? T e of alarm:
Are provisions included for emergency operation to prevent the bypassing or backup of sewage?
Emergency pumping capability may be accomplished by connection to at least two independent
utility substations, or by provision of portable or in-place electrical generation, or by portable
um in e ui ment? T e:
Have uestions #24 throu #46 been answered as YES or NA?
o
o
44.
45.
46.
o
o
~
Fast Track Certification Statement (Do not submit plans and specifications)
"I have answered Checklist items No. 23 and No. 46 above as YES or NA and hereby certify that the design plans and
specifications for this project, to the best of my knowledge, conform to the requirements listed above. I am aware that
there are significant penalties for submitting false information, including the possibility of fine and imprisonment.
I hereby certify that this plan, specification, or report was prepared by me or under my direct supervision and that I am a
duly Licensed Professional Engineer under the laws of the state of Minnesota.
Signature:
Date:
Address:
Typed or Printed Name:
Registration Number:
Phone Number:
'-
Statement for Detailed Review (Plans and specifications must be submitted)
"I have answered NO to Checklist item No. 23 or No. 46 because the design does not conform with all of requirements in
the above listed standards, specifications, and guidelines"
Signature: ~tU~A- A- t ~&4A.- Date: 'III/or
List of standards, specifications, and 2uideline not complied with (attach additional paJZ;es if needed):
Section Number Justification for variation
Question 15 At north end of Candy Cove Trail, the existing horizontal separation is approximately
7'. Reconstruction of sanitary sewer at the same line and grade will not allow a new
alignment in order to develop the required 10' separation. Watermain will not be
reconstructed, but will be at least 18" above new sewer.
Design Certification for Sanitary Sewer Extension
Plans and Specifications Form (wq-wwprm7-13)
Page 4 of 4
JUL 02
@HMC 1999 C
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UT20050273
CERTIFICATE OF COMPLETION OF UTILITY INSTALLATION
FOR THE STATE OF MINNESOTA, DEPARTMENT OF TRANSPORTATION
May 10, 2005
TO: KEITH VANWAGNER
ROADWAY REGULATIONS SUPERVISOR
1500 W CO RD B2
P.O. Box
ROSEVILLE, MN 55113-3174
Telephone No. 651-5a2-1443
I hereby certify that
has completed
LAKE Company as
M-UL-2005-a917,
PRIOR LAKE.
utility - Municipality - Contractor - Owner
installation of a" SANITARY SEWER & a" WATERMAIN for CITY OF PRIOR
described in and in accordance with Trunk Highway Permit No.
C.S.7001, T.H.13, at CANDY COVE TRAIL AND FRANKLIN TRAIL IN CITY OF
Dated
day of
20
utility - Municipality - Contractor - Owner
By
The work covered by the permit has been
satisfactorily completed.
Date
Assistant
Engineer,
District
Maintenance
For Utility Permits Only:
Bond Number in the amount of $ will remain in effect a minimum
period of year(s) from the date of completion of the utility installation,
at which time the bond will be released if in the opinion of the Area Maintenance
Engineer the installation is satisfactory.
Where approved changes are made in the installation
sketches, 2 copies of "as built" sketches must
certificates.
contrary to the application
be submitted with the signed
THE CONTRACTOR IMMEDIATELY ON COMPLETION OF THE INSTALLATION SHALL SIGN AND RETURN
TWO COPIES OF THE CERTIFICATE OF UTILITY INSTALLATION TO THE ASSISTANT DISTRICT
ENGINEER, MAINTENANCE AT THE ADDRESS NOTED ABOVE.
05-0\
Mn/DOT TP-02525-o3 (7-0m Pace 1
STATE OF MINNESOTA SUBMIT 1 (ONE)
DEPARTMENT OF TRANSPORTATION COMPLETED FORM
WITH 4 (FOUR) SETS OF
APPLICATION FOR UTILITY PERMIT ON SKETCHES TO:
TRUNK HIGHWAY RIGHT OF WAY Utilities Engineer - MS 678
INSTRUCTIONS 1. Complete only page one (no photocopies) Minnesota Department of Transportation
Transportation Building
TO 2. Sign completed form 395 John Ireland Blvd.
APPLICANT 3. Include 4 (four) sets of sketches St. Paul, MN 55155-1899
County Scott T.H. No. 13 SEC. .1!.TWP.115 RGE.~ Company Project No. City Proj.#05-01
DNew Facility~Replacement Facility Agreement No.
CityfTownship Prior Lake State Proiect No.
Application is hereby made for permission to place, construct and thereafter maintain a
Sanitary sewer and appurtenances & storm sewer and appurtenaces along Trunk Highway No. 13
from: south side of intersection of TH 13 and Candy Cove Trail
to: south side of intersection of TH 13 and Franklin Trail
40 feet from center line on the South side of the trunk highway as shown on the attached sketch
I. AERIAL CONSTRUCTION (Check appropriate box) LIGHTING
D Single pole D Other D Open wire Mounting Height
D H-Frame D Cable Mast Arm Length
D Single pole & H-Frame D Not Applicable Type of Lamp
D Steel tower Watts
n Existina Dole line Poles Not Applicable
Voltage I Number of ConductorS Size of Conductors
Minimum height of conductor: ft. along highway ft. at crossings over highway
II. UNDERGROUND CONSTRUCTION Will Facility be attached to a bridge?
Direct Buried Sanitary Sewer and Storm Sewer No
Voltage I Number of Conductors-Type Size of Conductors, Cable I Depth
CONDUIT TYPE PVC-sanitary RCP-storm CASING Not Applicable
D Steel pipe ~ Plastic Max. Oper. Pres. DIP-sanitary
Wall thickness per specs per specs
o Multiple tile Type Grade SDR 35
o Clay tile Class 5 Wall thickness
~ Sectional concrete Size B" 15" Grade
~ Ductice Iron Depth 15' and 12' at grade Class
o Other Number 2 1 Size
METHOD OF INSTALLING UNDER ROADBEDS Not Applicable
III. EXTENT & LOCATION OF TREE TRIMMING ANDIOR CLEARING:
East and west boulevards of Candv Cove Trail, south of TH 13
IV. Applicant City of Prior Lake
Work to start on or after May 1, 2005
Name of Utility making application
and to be completed on or before November 1, 2005 16200 Eagle Creek Ave. S.E.
Address
V. The applicant, in carrying on all of the work mentioned above or referred to in its Prior Lake
application and in the Permit for construction issued therefore, shall strictly conform to City
the terms of the Permit, and the Rules of the State of Minnesota as set forth in MN Zip 55372
Minnesota Rules 1983 as of July 31, 1983 together with the Special Provisions, all of State
which are made a part hereof. The applicant specifically agrees to be bound hereby.
The applicant shall also comply with the regulations of all other governmental Telephone (952) 447-9B32
agencies for the protection of the public. The work shall be accomplished in a manner
that will not be detrimental to the highway and that will safeguard the public. Larry Poppler Asst. City Engineer
By
~~rType) litie
Dated "3(~r;/oS- Signed f?c--
, S'
Pursuant to Minnesota Statutes Section 161.45 the followin Rules have been romul ated b the Col'1'l'"missioner of Trans rtation see reverse side .
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3
I HEREBY CERTIFY THAT THIS PLAN.
SPECIFlCAOON. OR REPORT WAS
PREPARED BY ME OR UNDER MY DIRECT
SUPERVISION AND THAT I NA A DULY
UCENSED PROFESSIONAL ENGINEER
UNDER THE LAWS OF THE STATE OF
MINNESOTA.
ell
"'BOL. TON ... MENt<. INC.
~ ~ II ........
_... _... _Dr.... -...
-..L'" -... -."
REVISION NO.
DESCRIPTION
CANDY COVE TRAIL SE
.~
"'\l
CITY PROJ. NO. 05-01
MARCUS A. THOMAS. P.E.
DATE: UC.NO.: 26499
PLAN BY: DESIGN BY:
LS KMl
CHECKED BY: PROJ. NO.
MAT T16211143
AS BULl BY: DATE:
STREET AND STORM SEWER
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