HomeMy WebLinkAboutExcavating & Filling Permit
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CITY OF PRIOR LAKE
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Permit No.
APPLICATION FOR
EXCAVATING/FILLING PERMIT
rJ9& - /3
Date
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447-4230
Applicant
Address:
_~mZ;5
,- 51att S
:SAfYJ€.
Phone # i/'1tJ -Y.::l(/~
1..,1<, (nl/), 5'S"?7~
Property Owner:
Phone #
Address:
Contractor:
L'5 Am (
Phone #
Address:
Consultant Engineer/Surveyor {/AIJa l'j .s(JRIJ~ .'l,NG, Phone # <(1./7-dl570
Address: I &'4> 70 FRIJNkl../I\J TIe. S \ E. PRiOR kk. mI.). 55~7~
Location of Property: tJHJf) ~IUD of lJ/3l...~ CllZlJ..{.. (w~si") 8'1 <!-R:."t~~ F=R6M sflc!ll\)"- ,,~
Legal Description: S~t. I'tj-rnc..H~D - 7AII...€NOoF "Of$. ~-,4 I>M ;If,<j.VPc.. STIl<<T.si
IINO,':'IL END 0':; At/iS <S;'- 1$J..1(.1.2.,./f,uo LJI4C. s,,<<-rrr /
Will the excavation or tilling be in a: Watercourse tb SG 16L{ Wetland Upland V
Purpose for the proposed excavating or tilling: ()(~AuATI~i'\J - POiS.:pG"'t \~~RA<.TlotV Or:: Cfo<-/
I-II('JI WA-ri~ PlAfJ.I<.) FI/.,/.,INf>. - 1'0 "-o~PJ..< I( C" 5" /.. 'ME R.oc.Jr: fJRrJl~IJY IIAJO
Co IV T~() i.... € ~ 0 S , 0 I\J
Estimated start date: F~lJ.. 0 f' \ ~ <i ~
Completion date:
What is the type of material to be removed or deposited: C A 5' J../ m (. RtK4:::
O.f{'"
In what manner will the material be removed and/or deposited? .s kID hO A O~ ~
SfRI~" "'~ AP
What highway, street, or other public way will material for removal or depositation be hauled or carried? lu:JIJ tlll",,- ~ Ill.
What, if any, street, avenue, lane, alley, highway, right of way, thoroughfare or public ground will be obstructed? NdN'f.
IT SHALL. BE THE RESPONSIBILITY AND THE BURDEN OF THE APPUCANT TO DEMONSTRATE TO THE SATISFACTION OF THE crrv
ENGINEER FOR THE CITY OF PRIOR LAKE THAT THE PROPOSED EXCA V A T10N AND/OR FILUNG COMPUES WITH THE OVERALL crrv
OF PRIOR LAKE STORM WATER MANAGEMENT PLAN. SAID BURDEN SHALL INCLUDE THE FURNISHING OF A REPORT WITH SUPPORT-
ING CALCULATIONS OF A REGISTERED PROFESSIONAL ENGINEER.
Will proposed excavation or depositon affect the City of Prior Lake overall storm water management plan? Yes _ No ~f
yes, show proposed effect.
SUBMISSION REQUIREMENTS:
(A) Completed application fonn (B) Completed legal description (C) Map or pial of the proposed filling or excavating showing location and amount of material
proposed to be removed of deposited. with a descriplion of the area (D) The depth or heights to which such removal or deposition is proposed throughout the
area and the proposed angle of all slopes to be shown on a 2' contour map at a scale of I" = SO' or larger: The proposed and origirial contours shall be shown in-
cluding all property within ISO' of proposed excavation or deposition and shall be signed by an engineer or surveyor registered in the State of W.jl1llelOla .(E)
Erosion control plan (F) Affect on existing utililies (G) Protection of site by erection of suitable fence, guard or barricade (H) Application fee (I) Bond. letter of
credit. or deposit of monies in a sum sufficient to pay the cosl of restoring a site. The extra ordinary costs of repairing. highways. streets or other public ways
along designated routes of travel and to pay such expenses as the City may incur by reason of doing anything required to be done (J) Public liability insurance.
Amount of bond Letter of credit, or de sit of money ~ty insurance provided
4f v' ~lte41 477- 1? /' #-
Permit fee '"\':>0 ~ Signature ofapplican VlJEJ' C / / / / U~ Date - q
Permit deposit City Engineer tJ . Date t I '1'1
Permit IS valid if signed by City Engineer.
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December 14, 1998
Mr. James Mickley
3124 Spring Lake Road
Prior Lake, MN 55372
SUBJECT:
APPLICA nON FOR EXCA VA TING/FILLING PERMIT
3124 SPRING LAKE ROAD
Dear Mr. Mickley:
We have reviewed the subject permit application. The following items are required prior to
issuance of the permit:
1. You must contact Pat Lynch at the DNR prior to the movement of any material.
associated with this project to ensure compliance with DNR guidelines.
2. Silt fence must be installed at the bottom of the unstable slope prior to placing Class
5.
3. Silt fence must be installed at the excavation area that is to be restored to the original
904 elevation.
4. The unstable slope, as shown on the attached drawing, must be stabilized prior to
placing Class 5 on the path.
5. Submit the required $50.00 application fee.
If you have any questions, call me at 447-9832.
Sincerely,
~~~tf-
Sue McDermott, P.E.
Assistant City Engineer
CITY OF PRIOR LAKE
c: Steve Horseman, Zoning Administrator
Pat Lynch, DNR
16200 Eagle Creek Ave. S.E., Prior Lake, Minnesota 55372-1714 / Ph. (612) 447-4230 / Fax (612) 447-4245
G:\LE1TERSISUE98\MICKLEY.DOC
AN EQUAL OPPORTUNITY EMPLOYER
.. H _. H H _ _ _ H P P _ _ _ P _ H .- - - -
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GR.AOl0G ~ER.f'f\rr REVIEW - 3'"AI17E5 /l1tcXJ....E V
.L . Le.i c.ht:y
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) n -The. mo~t.
1 Owner Trlu.,5t contact. tie. DDF\ lert L.Yfl~) prior to .r~Op1~
o~ a.f\'/ rY\Qtef\o.\ a.SSOCICL-tecL with thl~ proje.c:t to ensu~ Cornp)ia/lC12.
with 0 DR ~,^\J.e..\\ne.s.
2) Silt te.nCl2. rn lA~t be.. 1115 ta\ t eJ Qt tf.e botto m o~ the.. IAn s toY e.
slope. p6er -ID pJro~ Cla~s b.
2>) Un~ta.b\e s)ope } ct:s S~OWfl on J\QM)~) neeJs to be. skb-/tCect
prior- to p\O-C~(lj Class 5 on the. pa-th.
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JOB # LOCATION
Minnesota
Asphalt
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WILLIAM R. ENGELHARDT ASSOCIATES, INC.
Col'ts4ltll't'j 21't'jll'tee'lS
MD 52'1107 HAZELTINE BOULEVARD
CHASKA, MINNESOTA 55318-1008
(612) 448-8838
December 29, 1998
RECElveo
DEe J 0 1998
CITY OF PRIOR LAKE
City of Prior Lake
Attn: Mr. Lani Leichty, P.E.
16200 Eagle Creek Avenue S.B.
Prior Lake, MN. 55372
RE: Mickley Property
Unauthorized Fill
Dear Mr. Leichty:
Please find enclosed a notification form and plan for the above referenced project. The work
shown on the plan was completed in 1997. The DNR has notified Mr. Mickley that the
activities completed required a permit. We are in the process of contacting all involved agencies
to obtain permits for work already completed.
Please review the plan and notify Mr. Mickley with any City requirements to bring the activities
into compliance.
Sincerely,
WILLIAM R. ENGELHARDT ASSOCIATES, INC.
~-
Stephen A. Albrecht
SAA/las
enc.
NMm20-0} LOCAL - STATE - . ~OERAl WATER RESOURCE PROJECT NOTI CATION / ApPLICATION FORM
.. Use this form to notify/apply to the U.S. Army Corps of Engineers, the Minnesota Department of Natural Resources, and your local Government Unit
of a proposed water/wetland oroJect or work which may fall within their jurisdiction. These agencies should advise you of their jUrisdiction or permit
requirements within 45 days. Some LGU's may also require submission of their own application forms. Fill out this form completely and mall a copy,
with plans, maps, etc. to each of the agencies listed on the reverse of the form. Keep a copy for your records. YOU MUST OBTAIN All REQUIRED
AUTHORIZATIONS BEFORE BEGINNING WORK.
AGENCY USE ONLY: lGU NUMBER:
MDNR NUMBER:
CORPS NUMBER:
I. Applicant's Name (Last, First, M.I.) Authorized Agent, if any Area Code, Telephone
Mickley, James C. William R. Engelhardt Associates, Inc. (612 440-2688
Addre>;s (Street, RFD, Box Number, City, State, Zip Code)
3124 Spring Lake Road S.W., Prior Lake, MN. 55372
II. LocatIOn of proposed prolect (attach drawinQ shOWing how to get to site)
COUNTY QUARTER SECTION(s) SECTIONS(s) No. TOWNSHIP(s) No. RANGE(s) No. Lot, Block, Subdivision
Scott 3 T1l4 R22W 5& 6 28 Sprinq Lake
FIRE No., BOX No., OR PROJECT ADDRESS NAME OF WATERBODY AFFECTED and NUMBER (IF KNOWN) Township
Prior Lake 72P
III. ESTIMATED PROJECT COST: $2,000.00 LENGTH OF SHORE AFFECTED (in feet): 80 feet
IV. VOLUME OF FILL OR EXCAVATION (Cubic Yards): (NOTE: You may substitute dimensions)
AREA FILLED OR EXCAVATED IS Acres, OR 600 Square Feet
V. TYPE OF WORK AND AREA (CHECK ALL THAT APPLY): o ACCESS PATH o BRIDGE o CULVERT o DAM !
o CONSTRUCT o DRAIN o EXCAVATE o DOCK }€ RIPRAP o SANDBLANKET
~ FILL o REMOVE o REPAIR
21 LAKE 21 SHORELINE o WATERWAY o WETLAND
OTHER (DESCRIBE):
WETLAND TYPE(S) AND ACREAGE(S) PROPOSED TO BE FILLED/DRAINED:
Attach applicable drawings, plans, and ASCS crop photos. Include a description of any proposed compensatory mitigation. Important: Identify
any disposal and borrow areas. Describe the work below: how it would be done; what equipment would be used.
VI. PROJECT PURPOSE (why is this project needednwhat benefits will it provide?):
To stabilize the shoreline and prevent further "washouts" caused by the stonn sewer discharge
VII. AL TERNA TIVES (deSCribe any other sites or methods that could be used to achieve the purpose of your project while avoiding or minimizing
wetland/water Impacts: Attach additional sheets, if needed).
Not do any stabilization or repairs and allow further erosion or shoreline.
VIII. DATES: Proposed start of activity: Proposed completion:
Riprap and filling done in 1997 per plan.
(Identify any completed work on an attached drawing)
IX. ADJOINING PROPERTY OWNERS (Attach list if more than two)
Name Address City State Zip
Available upon request
x. PERMITS have been received (enter an 8) or already applied for (enter an ~) from: A DNR A ARMY CORPS OF ENGINEERS COUNTY
-
-A TOWN/CITY JL WATERSHED DISTRICT - MN POLLUTION CONTROL AGENCY
Has an archaeological survey of the project site been done? If so, by whom:
I hereby notify the recipients of this form of the project proposed herein and request that I be advised of any permits or other determinations concerning
this project that I must obtain. I understand that proceeding with work before all required authorizations are obtained may subject me to Federal, State,
and/or local administrative, civil and/or criminal penalties.
DATE:
< <-< PLEASE CAREFUllY READ AND COMPLETE BACK OF FORM> > >
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INSTRUCTIONS--PLEASE READ CAREFULLY
A copy of this form, with copies of all plans, drawings, etc., should be sent to each agency indicated below. Please check the
appropriate spaces below to show everywhere you are sending this form. Remember to keep a copy for your records.
x
LOCAL GOVERNMENT UNIT (LGU): city, county, or watershed management organization.
Specify the LGU to which you are sending the form:
The local SOil AND WATER CONSERVATION DISTRICT (SWCD) for the project.
Specify the county SWCD:
x
WATERSHED DISTRICT (if one exists for the project area).
Specify the Watershed District: Prior Lake-Spring Lake
~
MINNESOTA DEPARTMENT OF NATURAL RESOURCES (MDNR) regional office
-X-
U.S. ARMY CORPS OF ENGINEERS (CORPS). Send the CORPS copy to:
Department of the Army, Corps of Engineers, St. Paul District,
ATTN: CO-R, 190 Fifth Street East, St. Paul, MN 55101-1638
Note: The above agencies may provide a copy of your completed form to the Minnesota Pollution Control Agency (MPCA).
MPCA water quality rules may apply to your proposed project.
ATTENTION (FROM USDA): Any activity including drainage, dredging, filling, leveling or other manipulations, including
maintenance, may affect a landuser's eligibility for USDA benefits under the 1985 Food Security Act as amended. Check with
your local USDA office to request and complete Form AD-1 026 prior to initiating activity.
IMPORTANT: Some agencies, including the Corps of Engineers and the MDNR accept this form as a permit application form. If
you wish this form to constitute an application to the Corps and/or MDNR for any necessary permits for your project please
carefully read the following information and sign where indicated.
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxXXXXXXXXXX
Application is hereby made for a permit or permits to authorize the activities described herein. I certify that I am familiar with
the information contained in this application, and that to the best of my knowledge and belief such information is true,
complete, and accurate. I further certify that I possess the authority to undertake the proposed activities or I am acting as the
duly authorized agent of th~?Jicant.
j9./.?;'f' J C /J.l: Zl::e.<
Signature of Applicant
12/29/98
Date
Signature of Agent
Date
Note: The applica on must be signed by the person who desires to undertake the pi oposed activity (applicant) or it
may be signed by a duly authorized agent if the information requested below is provided.
Agent's address:
Agent's Name and title: Steve Albrecht, William R. Enqelhardt Associates, Inc.
MD 52, 1007 Hazeltine Boulevard, Suite 480
Chaska, MN. 55318
Agent's telephone: (612 ) 448-8838
18 U.S.C. Section 1001 provides that: Whoever, in any manner within the jurisdiction of any department or agency of The United States
knowingly and willfully falsifies, conceals, or covers up by any trick, scheme, or device a material fact or makes any false, fictitious or
fraudulent statements or representations or makes or uses any false writing or document knowing same to contain any false, fictitious, or
fraudulent statement or entry, shall be fined not more than $10,000 or imprisoned not more than five years, or both.
SEE ATTACHMENT ABOUT MDNR PERMIT FEES
This information is available in an
altemative format upon request.
o Printed on Recycled Paper
Contains 10% postconsuner waste
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SKETCH PREPARED FOR:
JAMES MICKLEY
3124 SPRING LAKE ROAD S.W.
PRIOR LAKE, MN. 55372
Valley Surveying Co., RA.
SUITE 120-C, 16670 FRANKLIN TRAIL
FRANKLIN TRAIL OFFICE CONDOMINIUM
PRIOR LAKE, MINNESOTA 55372
TELEPHONE (612) 447-2570
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Survey of the August 29, 1984, shore 1 ine and 904 elevation and the November 6,
1997, shoreline and new 90<1 elevation on Lots 5 and 6, Block 28, Spdn9 Lake
Townsite, Scott County, Minnesota.
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SCALE-
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o Denotes 1/2 inch l( 14 inch iron
monument Sft and marked by
License No. 10la.3
. Denotes Iron monument found
It Denotes P. K. Nail set
FILE No
5390
BOOK 204
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