HomeMy WebLinkAboutExcavating & Filling Permit #03-G-13 V�/L�/VJ luV1V 1J:JO rAA U1L44/4LUJ V11Y VP rn1Un Lhn� L�/�UVG
EXHIBIT "B"
TO
PRIOR LAKE PUBLIC WORKS DESlGN MANUAL
APPLICATION FOR EXCAVATINGlFILLING PERMIT
Permit No. r���� 3 Date "� �� 3
AppIICr3flt: � h u�� c1>.> <• � �� t� w a k u r. "� or S i �• �. K � �'ll� i\ti �..�L �; �1� , Phone #`/ S Z (, —� 1.� �>
Address: 2:i3 �s S i C �, y- r r c� � AI � ��r ��"'�- La � /'i n) S S' {-}_ Z -
Property0wner. S K Me o� S �� ��vc- e Phone#
Address:
Contractor, r� w� t� �� c�` KYVS. , 1 �C. - C_�v l Phone# � - 3 Z�� - r� � 4
Address: i3� X z c� P� ;�.s �a„ ;;� �-,i�t s� z�� 1-a c��,
Consultant Engineer/Surveyor � v� ff (`1 � ,,. E""� Phone # `� i z - C� � �. - � �:� � �;
Address: ! 1 0� i-{ ��e_! -1 �� �i c, �_, C' h a � 1-c c� �7 �! s S 3 1
Location of Property: S�� �_ �(. � �( �'J I i C t1��- �` c� � 1
Legal Descripti�n:
Will the excavation or filling be in a: Watercourse 1U v WeUand � t' � Upland �1 ��-' S
Purpose forthe proposed excavating orfilling: fZ< <.v.� c-� F.,.� -� c1�_? �-�- C ��v� � C-�. _
Estimated start date: � � ' } — � 5 Completion date: � ` �'- � �
What is the rype of matenal to be removed or deposited? C 1-� � �� S c> > �
In what manner will tlne material be removed and/or deposited?
What highway, sFreel: or ofher public way will material for removal or deposition be hauled or carried? --
What, if any, street, �jvenue, lane, alley, highway, right-of-way, thoroughfare or public ground will be obstructed? .D n c�:� �• l'a .�� N. ��
IT SNALL BE THE RESPONSIBILIN AND THE BURDEN OF THE APPLICANT TO DEMONSTRATE TO THE SATISFACTION
OF THE CITY ENCyINEER FOR THE CITY OF PRIOR LAKE THAT THE PROPOSED EXCAVATION AND/OR F{LLING
C�MPLIES WITH THE OVERALL CITY OF PR10R LP,KE STORM WATER MANAGEMENT PLAN. SAID BURDEN SHALL
INCLUDE THE FURNISHING OF A REPORT WITH SUPPORTING CALCULATIONS OF A REGISTERED PROFESSIONAL
ENGINEER
Wil( proposed excavation or depositi�n affect the City Of Prior Lake overall storm water management plan? Yes ` No _
If yes, sh�w proposed effect ��--� C �� E� rl �i �- �l
SUBMISSION REQl11REMENTS:
(A) Campleted application form (B) Completed legal descripfion (C) Map or plat of the proposed filling or excavating showing location and amount of
material proposed to be removed of deposited, with a description of the area (D) The depth or heights to which such removal or deposition is proposed
ibroughout the area and the proposed angle of all slopes to be shown on a 2' contour map at a scale of 1"=50' or largec The proposed and original
contours shall be shown including all property wllhin 150' of proposed axcavation or deposition and shall be signed by an engineer or surveyor registered
in the State of Minnesot�a (E) Erosion conlrol plan (F) Affect on existing utilities (G) Protection of site by erection of suitable fence, guard or barricede (H)
Application fee (q Amounts Letter of Credik or deposit of monies in a sum sufficient to pay the cost of restoring a site. The extra orciinary costs of
repairing, highways, stre�ets or oiher public ways along designated routes of trevel and to pay such expenses as lhe City may incur by reason of doing
anything required to be cfone (J) Public liability insurance.
o' � � �/
Amount of bond Letter of Credit ����. �`�'' or deposii of money liability insurance provided
Pertnit fe� Z�1 °� •�C �Signature of Applicant �• Date 9� Z-� '
Permit Deposit City Enginee� � Date � a j 7 f v�
rmit s va sig City Engineer
G1P.dmin\FORMS\EXHIDR' B,MPLiCATION FOR EXCAV & FILLING.dx
IRREVOCABLE LETTER OF CREDIT
No: 3-2003
Date: September 25, 2002
TO: City of Prior Lake
16200 Eagle Creek Avenue
Prior Lake, MN 55372-1715 SEP 2 9 2��3 I I'
ATT: Susan McDermott � � ��
Dear Ms. McDermott:
We hereby issue, for the account of Shakopee Mdewakanton Sioux Community and in
your favor, our Irrevocable Letter of Credit in the amount of $325,000.00 (Three Hundred
twenty-five thousand and no/100 dollars), available to you by your draft drawn on sight on the
undersigned Federal Credit Union.
The draft must:
a). Bear the clause "Drawn under Letter of Credit No. 3-2003, dated September 25, 2003
of South Metro Federal Credit Union, reference Conditional Use Permit to Allow filling
and excavation on property located on the North side of Co. Road 82 and West of Mystic
Lake Casino (Mystic Lake Golf Club).
b). Be signed by the Mayor or City Manager of the City of Prior Lake.
c). Be presented for payment at 15045 Mystic Lake Drive, Prior Lake, MN 55372, on or
before 4:00 p.m. on September 25, 2004.
This Letter of Credit shall automatically renew for successive one-year terms
unless, at least forty-five (45) days prior to the next annual renewal date (which shall be
September 30th of each year), the Credit Union delivers written notice to the Prior Lake
City Manager that it intends to modify the terms of, or cancel, this Letter of Credit.
Written notice is effective if sent by certified mail, postage prepaid, and deposited in the
U.S. Mail, at least forty-five (45) days prior to the next annual renewal date addressed as
follows: Prior Lake City Manager, Prior Lake City Hall, 16200 Eagle Creek Avenue,
Prior Lake, MN 55372-1714, and is actually received by the City Manager at least forty-
five (45) days prior to the renewal date.
This Letter of Credit sets forth in full our understanding which shall not in any
way be modified, amended, amplified or limited hy reference to any document,
instrument, or agreement, whether or not referred to herein.
This Letter of Credit is not assignable. This is not a Notation Letter of Credit.
More than one draw may be made under this Letter of Credit.
This Letter of Credit shall be governed by the most recent revision of the
Uniform Customs and Practice for pocumentary Credits, International Chamber of
Commerce Publication No. 400.
We hereby agree that a draft drawn under and in compliance with this Letter of
Credit shall be duly honored upon presentation.
By: � � � `� � �
J � �
B. Don Crofut, ``
Its President
South Metro Federal Credit Union
.
IRREVOCABLE LETTER OF CREDIT
No: 1-2003
Date: August 4, 2003
TO: City of Prior Lake
16200 Eagle Creek Avenue
Prior Lake, MN 55372-1715
Dear Sir or Madam:
We hereby issue, for the account of Shakopee Mdewakanton Sioux Community and in
your favor, our Irrevocable Letter of Credit in the amount of $260,000.00 (Two-hundred-sixty
thousand and no/100 dollars), available to you by your draft drawn on sight on the undersigned
Federal Credit Union.
The draft must:
a). Bear the clause "Drawn under Letter of Credit Na 1-2003, dated August 4, 2003 of
South Metro Federal Credit Union;
b). Be signed by the Mayor or City Manager of the City of Prior Lake.
c). Be presented for payment at 15045 Mystic Lake Drive, Prior Lake, MN 55372, on or
before 4:00 p.m. on August 4, 2004.
This Letter of Credit shall automatically renew for successive one-year terms
unless, at least forty-five (45) days prior to the next annual renewal date (which shall be
August 30 of each year), the Credit Union delivers written notice to the Prior Lake City
Manager that it intends to modify the terms of, ar cancel, this Letter of Credit. Written
notice is effective if sent by certified mail, postage prepaid, and deposited in the U.S.
Mail, at least forty-five (45) days prior to the next annual renewal date addressed as
follows: Prior Lake City Manager, Prior Lake City Hall, 16200 Eagle Creek Avenue,
Priar Lake, MN 55372-1714, and is actually received by the City Manager at least forty-
five (45) days prior to the renewal date.
This Letter of Credit sets forth in fu11 our understanding which shall not in any
way be modified, amended, amplified or limited by reference to any document,
instrument, or agreement, whether or not referred to herein.
This Letter of Credit is not assignable. This is not a Notation Letter of Credit.
More than one draw may be made under this Letter of Credit.
This Letter of Credit shall be governed by the most recent revision of the
Uniform Customs and Practice for pocumentary Credits, International Chamber of
Commerce Publication No. 400.
We hereby agree that a draft drawn under and in compliance with this Letter of
Credit shall be duly honared upon presentation.
,
By:
B. Don Crofut,
Its President
South Metro Federal Credit Union
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PRIp�
� ,�. C q v Engineering Department
r i�i�i�
� �' City of Prior Lake
V �' 16200 Eagle Creek Avenue S.E.
Prior Lake, MN 55372
'�IN2vESO�� ' , .
DA7E: Monday, September 29,
2003
Number of Pages including cover sheet: 2
TO: Angie FROM: Larry Poppler, Ass't City Engineer
PHONE: 952-49G-6136 PHONE: (952) 447-9832
FAX: 952-49�-6180 FAX: 952 447�263
CC:
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❑ Urgent � For your review Reply ASAP Please Comment
Angie,
Attached is the grading permit application. Please review the submission requirements section and include necessary
information. Please also include copies of all permits you have gotten for this project. The amount or soil excavated or filled
and the acreage disturbed will be used to calculate the fees and letter of credit. lf you have any ques6ons or concerns please
call me at 952-447-9832.
Larry Poppler
� This form is for new permit applications only.
Lxisting permittees must use Applicntior7 foi� Per•mit Transfer/Modif:catiaz to transfer a permit to one party or Subdirisio�� RegistratiorT for multiple parties.
� National Pollutant Discharge Elimination System (NPDES)/State Disposal System (SDS) , ,�pCA use o,:/p ;
�.....
Application for General Storm-water Permit ;
""'�" for Construction Activity (MN R100001)
Minnesota rD # ;
PollutlOn Minnesota Pollution Control Agency
COtltPOl REM Division, Construction Storm-water Permit Program cite�� �;
Agency 520 Lafayette Road North, St. Paul, MN 55155-4194
Please refer to the application instructions and the NPDES/SDS General Storm-�vater Permit for Const►•uction Activity
(MN R100001) as you complete this form. See brackets [] for specific permit references.
Call the MPCA Customer Assistance Center at 651-297-2274 or 800-646-6247 (in Minn.) for assistance.
Permit Application Prerequisites'
1. Storm-water Pollution Prevention Plan (SWPPP)
a. Has a Storm-water Pollution Prevention Plan been developed far this project and �Yes ❑No
incorporated into the project's plans and specifications? [Part III.A]
b. Are erosion prevention measures addressed in the SWPPP? [Part N.B] �Yes ❑No
c. Are sediment control measures addressed in the SWPPP? [Part N.C] �Yes ❑No
d. Are dewatering and basin draining addressed in the SWPPP? [Part N.D] �Yes ❑No
e. Are inspections and maintenance addressed in the SWPPP? [Part IV.E] �Yes ❑No
f. Are pollution prevention management measures addressed in the SWPPP? [Part N.F) �Yes ❑No
g. Is final stabilization addressed in the SWPPP? [Part IV.G] �Yes ❑No
h. If an environmental review was required, did you incorporate all stonn-water related �NA ❑Yes ❑No
mitigation measures contained in the review into the SWPPP?
STnP if you responded no to any question above. A SWPPP must be developed prior to submitting a permit application.
Complete the aUove requirements and check yes before submitting this application. Continue if you responded yes or na
to all questions above.
2. Discharges to Special Waters
Mark NA if no discharges described below will occur.
a. Are all storn7-water discharges that may flow from the project to a Special Water that is �NA ❑Yes ❑No
located within 2,000 feet of any project discharge points addressed in the SWPPP to meet
the pernlit conditions in A endi� A, Part A-C?
5TOP if you responded no. Complete the above requirements and check yes Uefore submitting this application. Continue
if you res onded ves.
3. Additional Application Review
a. Will the project include alternative treatment methods? [Part III.C.S] ❑Yes �No
If yes, this application ai�d the alternative treahnent plans must be submiYted a minimum of 90 days before construction starts.
b. If yes, are the plans attached? ❑Yes ❑No
c. Will the project disturb 50 acres? AND Is there a discharge point within 2000 feet of ai7 iiz�paired or �yes �No
special water whose discharge may reach an impaired or special water listed in Appendix A of the
perniit? [Part II.B.l.b]
If yes, this application and the S WPPP must be submitted a minimum of 30 days before construction starts.
d. If yes, is the SWPPP attached? ❑Yes ❑No
4. Application Fee Is the required $400 Application Fee enclosed? �Yes
wq-strm2-57 1 of 3 September 2003
Construction Activity Information
5. Project Name Mystic Lake Golf Course
6. Project Location
15451 NW Howard Lake Road
Briefly describe where construction acti��ity occurs - Example: Intersection of 4�th Sh�eet and Iiviii� Avenue. Include ndrlress rfnvailaG/e
Shakopee, MN MN 55379
Ciry or Township State Zip Code
See Attached
County Parcel ID # Attach list if iiecessary
Shakopee, Prior Lake
All cities where construction will occur
SCOtt COUI]ty
All counties where construction will occur All townships where consh•uction will occur
7. Project Size 153.75
NumUer of acres to be disturbed
8. Project Map Is the required 8%z x 11" United States Geological Survey (USGS) 7.5 minute quad or �Yes
equivalent map indicating site boundaries attached?
9. Project Type ❑ Residential �ConunerciaUIndustrial ❑ Road Constniction
❑ Other
10. Cumulative a. Existing area of impervious surface 18.7 acres (to the nearest quarter acre)
Impervious
Surface b. Post constniction area of impervious surface 8.8 acres (to the nearest quarter acre)
If new impervious surface created by the prolect is less than �ne acre_ skin tr► n��P�t��., ia
11. Permanent What types (check all that apply) of pennanent stoni�-water management will be used if more thai� one
Storm-water acre of new impervious surface is created by the project? [Part IIL C]
Management
❑ Wet Sedimentation Basin ❑ Infiltratioi�/Filtration ❑ Regional Ponding
❑. MetIlOCIS (Iju.ring altei�rsative n:e//iods, co�2stracetion cnnnot comnzerzce until receivrng npprovnl fi�oi�r �he MPCA.)
❑ �tlleT'
Specify reason and list other treatment allowed bv Part III. C
12. Receiving ldentify surface waters within Yz mile of project boundary that will receive storm water from tl�e site or
Waters discharge from pernlanent stonn-water management system. Include «�aters shown on USGS 7.5 minute
quad or eGuivalent and all waters identified in Appendix A of the pernut. Add additional pa er if needed.
Name of Water Bod � , Appendix A
3 1'3 pC (ditcl�, pond, wetland, ]ake, stream, river)
s ecial water?
DNR Public Water #70-80P Wetland ❑Yes �No
❑Yes ❑No
❑Yes ❑No
❑Yes ❑No
13. Dates of Construction 10/7/2003 07/O1/2005
a. Construction Start Date b. Estimated Completion Date
wq-strm2-57 2 of 3 September 2003
Responsible Parties
�
14. Owner
Shakopee Mdewakanton Sioux Community 41-0989737 6190686
Business or Fiim Name Federal Tax ID State Tax ID
Rudnicki William Tribal Administer Land c�.ccs�ndc.or� 952-496-6145
Last Name First Name Title E-mail Telephone (incicrde aren code)
2330 Sioux Trail NW Prior Lake MN 55372
Mailing Address City State Zip Code
E1lisoi7 Stanley Landnccsmdc.or
g 952-496-6158
Alteroate Contact Last Name First Naine E-mail Telephone (iiiclude nrea code�
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system
designed to assure that qualified personne] properly gather and evaluate the information subnvtted. Based on my inquiry of the person or persons
who manage this system, or the persons directly responsible for gathering the information, the infonnation is, to the best of my knowledge and be]ief,
true, accurate and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and
imprisonment for knowing violations.
I also certify under penalty of law that I have read, understood, and accepted all terms and conditions of the NPDES/SDS General Storm-water
Permit Construction Activity (MN R100001) that authorizes storm-water discharges associated with the construction site identified on this form.
. . �� 9 2 a3
Authorized Sio ature Date
This Applicatio�z must Ge signed Gy:
• Corporation: n principal executive o�cer ojat leas[ the leve! of vice preside�u or the duly m�thorized representative or agent of the executive officer if dre
represenlative or agent is responsiGle for the overnll operation of the facilitp that is the suGject of the permit application.
• Parbrersleip or Sole Proprietorsl�ip: a general pnriner or the proprietor.
• Muiricrpality, State, Federal or Ot/ier Pisb[ic Agency: principa/ esecutive officer or rnnking elected officinl.
15. Contractor
Duininck BrotherIncorporated 41-1552F54 zce�4n�
Business or Firm Name Federal Tax ID State Tax ID
Munkvold Dave GolfManager Dave@dbigolf.com 1-800-328-8949
Last Name First Name Tide E-mail Telepl�one (include m•en code)
P.O. Box 208 Prinsburg MN 56281-0208
Mailino Address City State Zip Code
Judd Duininck Judd Judd@biggolf 320-978-6011
Alternate Contact Last Name Fiist Name E-mai] Telephone (include area code)
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system
designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on nry inquiry of the person or persons
who manage tl�is system, or the persons directly responsible far gathering the information, the information is, to the best of my knowledge and belief,
true, accurate and complete. I am aware Yhat there are significant penalties for submitting false information, including the possibility of fine and
imprisonment for knowing violations.
I also certify under penalty of law that I have read, understood, and accepted all terms and conditions of the NPDES/SDS Gener Storm-water
Permit for Construction Act� y(MI�' R100001) that-authorizes st � n- ater discharges associated with the construction site identified on this form.
• � •`%"%"'' i %�� / ,/ 1 ,._ / ��f , /,� ! � - / ^ /� .' ''�`y y !`; '''
. . ... . �' . . �� / cT� •����,�.�' r•.
• / �.�
�=�t �onzed S��uature � � � � � Date
This Application niust Ge sigr:erl b��: .. �
• Corporatio�:: a princi'pal esecutii�e officer ofat least tlie lerel of i�ice pr or d�e dttl)' mtthorired represe�ttntive o�� age�at of1lie elecutive ofjicer rftlte
representntive or ngent is resparsiGle for the overall operntio» of the facilit�� t/ta/ is tl:e suGject of the permit npplicatiare.
• Partnership or Sole Proprietorslrrp: n gei�ern/ pm7ner or t/te proprielor.
• M�uiicipa[it��, Siate, Federal or Other Public Agenc�•: principn! esecutn�e officer or ranking elected official.
wq-stnn2-57 3 of 3 September 2003
Southern Parcels For Mystic Lake Golf Club
Parcel ID# 259330082
Owner: Menden, Jeffrey C
Address: 2495 154 St. NW
City/State/Zip: Shakopee, MN 55379
Parcel ID# 259330062
Owner: Sakuma, Shun
Address: 15730 Howard Lake Road NW
City/State/Zip: Shakopee, MN 55379
Parcel ID# 259330061
Owner: Sakuma, Yeiko
Address: 15730 Howard Lake Road NW
City/State/Zip: Shakopee, MN 55379
Parcel ID# 259330070
Owner: Scott County Hwy Engineer
Address: 600 Country Trail E
City/State/Zip: Jordan, MN 55352
Parcel ID# 259320160
Owner: MGH Family Ltd Partnership
Address: 7510 Cahill Rd.
City/State/Zip: Edina, MN 55439
Parcel ID# 252040010
Owner: Beneke, Brad
Address: 15290 Howard Lake Road NW
City/State/Zip: Shakopee, MN 55379
Parcel ID# 252040020
Ov��ner: Beneke, Brad
Address: 15290 Howard Lake Road NW
City/State/Zip: Shakopee, MN 55379
Parcel ID# 252040021
Owner: Schiffman, John C& Kathleen
Address: 15220 Howard Lake Road NW
City/State/Zip: Shakopee, MN 55379
Parcel ID# 252040050
Owner: Manthey, Mark
Address: 15210 Howard Lake Road
City/State/Zip: Shakopee, MN 55379
Western Parcels For Mystic Lake Golf Club
Parcel ID# 259320083
Owner: Hatch, Mark B
Address: 9 4thve. N, nit 105
City,�State/Zip: Minneapolis, MN 55407
Pai ID# 259320080
Owner: Geiser, Albert L
Address: 1843 Hillcrest Ave.
City/State/Zip: St. Paul, MN 55116
Parcel ID# 259320121
Owner: Kreuser, Joseph G& Lisa
Address: 15271 Howard Lake Road NW
City/State/Zip: Shakopee, MN 55379
Parcel ID# 259320070
Owner: Heitz, James G& Kelly L
Address: 15215 Howard Lake Road NW
City/State/Zip: Shakopee, MN 55379
Parcel ID# 259320060
Owner: Skraba, Dennis J& Joyce C
Address: 200 Derrick Dr.
City/State/Zip: Inno, 29063
Parcel ID# 279290040
Owner: Skraba, Dennis J& Joyce C
Address: 200 Deirick Dr.
City/State/Zip: Irmo, 29063
Parcel ID# 279290060
Cwi�er: P�lomiens, Keruletl� & Dolores
Address: 90 Manville
City/State/Zip: Pittsburg, 94565
Inforniation found at the following website:
w�-��.co.scott.mn.us/�is/imspa�e htm
�. � Mystic Lake Golf Course Project
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Project Boundary �
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- � ,.
Prior Lake
Latitude 44 43' 43" Project Location:
Longitude 093 28' S7" 15451 NW Howard Lake Road
Net reduction in impervious surface
Net reduction in 2, 10 and 100 year peak flow
Scott County Roads
i v __j SMSC owned Contact Information:
Shakopee Mdewakanton Sioux Community
Q Construction Area William Rudnicki
952-496-614
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500 250 0 500 1,000 1,500 2,000 ��'' �".�
Meters � t � � �
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This Form Replaces Form 3510-9 (8-98) Form Approved OMB Nos. 2040-0188 and 2040-0211 i
Refer to the Following Pages for Instructions _ �
' United States Environmental Protection Agency '
NPDES ,' t1 Washington, DC 20460
Form i��/ Notice of Intent {NOI) for Storm Water Discharges Associated with
Const ruction Activit Under an NPDES G Permit
Submission of this Notice of Intent (NOI) constitutes notice that the party identified in Section II of this form requests authorization to
�discharge pursuant to the NPDES Construction General Permit (CGP) permit number identified in Section I of this form. Submission
of this NOI also constitutes notice that the party identified in Section II of this form meets the eligibility requirements of the CGP for thei
project identified in Section III of this form. Permit coverage is required prior to commencement of construction activity until you are
eligible to terminate coverage as detailed in the CGP. To obtain authorization, you must submit a complete and accurate NOI form. '
Refer to the instructions at the end of this form.
L.PermiY Number
, MN,R1,0!0'OiOI� '
_ I _ �_�
I ';II. Operator Information
'Nar„e: Sh,a;ko�pee Md wakain�t�o�n; Sioux Comm '
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IRS Employer ldentification Number (EIN): I411J - i Q,' g,8lgl �] i
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Mailing Address: ;
aI( �'� i
Street: I2I3I3I�I � I��"`I I I I I I! I I I I i � ,
City PIrl�lplr �� I I I I I I I i I� I '' I State:� �N ZipCode: J I I
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Pho�e: � 9 5, 2- � 4� 9 6- I 61_l14 �5! Fax (optional) 9 ,51Z �_4! �_� -� 8191��61 �
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_E-mail (nntinnall I�IC����iC �� ��UJa . I��rI�: � � �� I � � I �'' i! I I � i �
_ : _ � _.__ , � __�_ .__� � � �- —' --'- '__�_...._:_ � � � 1 i _. ;_ : �i ;
i
�N: Project/Site Information ���� 3 ..,
Project/SiteName:l��yIS��1Cl 1 "�I}�� IGl�lllf� I _�O I `_I1�SIel I I I I I I I �
I I I i
Project StreeULocation: I ll _�`�_14I.5; l ) ..._C �� �-? � W..`�1 r l�...... I ..__1 R� a�C� I....1---� - �-' j
� � , i
c�t LS� a ikjo �p � e I I i'_� I' I I � I I i I � 1 I�_! scate: ��� Zip Code: � 5' 5 3 7 9_
�� I I I I___1_..1.--I-- i
County or similar government subdivision: I s� CIOIt�t� ,�CIOiU�I� �� ', , I, �; I I
_..__,. _._._...... i
Latitude/Longitude (Use one of three possible formats, and specify method) �
I
Latitude 1. 44� 43• 43• N(degrees, minutes, seconds) Longitude 1. 0 57 "' W(degrees, minutes, seconds)
2. _ _� _ _ _ " N (degrees, minutes, decimal) 2. _ _ _�_ _ _ ' W (degrees, minutes, decimal}
3. _ _ _ _ _ _<> N (decimal) 3. _ _ _ _ _ _ _� W (decimal) ,
Method: ✓� U.S.G.S. topographic map �; EPAweb site (� GPS �t�, Other. ,
• If you used a U.S.G.S. topographic map, what was the scale: 1: 2 4 , � � � '
Project Located in Indian country? � Yes �� No ,
If so, name of Reservation or if not part of a Reservation, put "Not Applicable°:
Shakopee Mdewkanton Sioux Community ����
iEstimated Project Start Date , oI / 0 ' �, / j�� 0 ��I Estimated Project Completion Date: � 7 '',' / O I 1 j /�� O� �
� � � __ ,
Month Date Year Month Date Year
1i5 3; 7 5;
Estimated Area to be Disturbed (to the nearest quarter acre): I I I : . I;
_... __ _.._
I
_.— __.. _......
__ i
EPA Form 3510-9 (Rev. 6/03)
.
.
�N_. SWPPP lnform�t6�n
Has the SWPPP been prepared in advance of filing this NOI? ;✓.' Yes ,�. No
Location of SWPPP for viewing: !✓' Address in Section II ~; Address in Section III � I Other
�
If Other. SWPPP Street: � I� I I I I I I I I( I I 4 I I I I I I I I I I I I I I I I I I
��Y:�1III IIIIIII IIIIIIIIIII IIII
State: W Zip Code: �� - ��
SWPPP Contact Information (if different than that in Section II):
Name: �1 � � � I � � � �� � I � � � � � � I � � � � � I � � � � � I
Phone: �� - �.� - �J Fax (optional): �J - WJ - �J
E-mail (optiona�: � I � I I � � I I � I I I I_� � � � I I I I�� I I( I I I
V. Discharge Information
Identify the name(s) of waterbodies to which you discharge. DNR Pub 1 i c Wa te r # 7 �— 8 � P
Is this discharge consistent with the assumptions and requirements of applicabie EPA approved or established TMDL(s)? � �
,... �-----�
✓; Yes No
VI. Endangered Species Information
Under which criterion of the permft have you satisfied your ESA eligibility obligations?
'✓. A _._ B a__ ` � ,-___, D �_._ : E r_._^ F
• ii yw seiect cnterion r, proviae permit iracK�ng numper ot operator under wnich you are certitying eligibility:
� I I I
Vlt. Certification Information
I certify under penalty of law that this document and all attachments 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. 1 am aware that there are significant
penalties for submitting false information, including the possibitity of fine and imprisonment for knowing violations.
PrintName: William Rudnicki
___._......__.___..�__.._._...__...____.__..__�_._.__...___.w._..__.__.._.._���_____.....�_...__._.__.__..�...___..__._..______........---_______.._. __._---.,___..�_
PrintTitle: Tr'ib31 Administrator
_ . . ._._..._� _._.__,..__ _ _.......__._� _.____..._.____�_...__
�.__�._�__�.�.__.�.._ _ - �._____�_...�.._..____..._____....._..____
Signature: VV ��^�`�ti
_ _. __ __ _.__ __. __
_ � r __ ___.______._ �___. _ _
Date: _ �� ... .__.._� ._._ _____,___.__r_.._ ._. __. ___., __ ___.__._�_.___.__.._�
EPA Form 3510-9 (Rev. 6/Q3)
��I EMORA ND UM
TO: Larry Poppler, Assistant City Engineer
FROM: Cynthia Kirchoff, Planner
DATE: October 7, 2003
RE: Grading Permit for Mystic Lake Golf Club
Upon review of the above referenced grading permit, the planning department
offers the following comments:
1. Excavation and grading must be performed pursuant to the approved
plans.
2. Install tree protection fencing at the drip line of all preserved trees to
protect the root system prior to the commencement of grading on the
site.
3. Submit a letter of credit in the amount of 125 percent of the estimated
cost to furnish and plant replacement trees.
4. Gravel clean up as a result of spills or general transportation of gravel
on any public road shall be the responsibility of the applicant.
5. Watering for dust control shall be done on an as needed basis or within
24 hours written notice from the City. Such notice shall be transmitted
by facsimile to the applicant. Dust control includes the entire project
area and is not limited to roadways. Water for dust control shall be
provided from an off-site source.
6. The CUP is valid for one year, but is revocable at any time for
noncompliance with any condition contained herein. At the expiration
of its one (1) year term, the property owner may make application to
the City to renew the CUP. The initial approval of this CUP does not
create any right, in law or equity, to the renewal thereof. Any renewal
of the CUP is subject to City Council approval and is to include any
information as requested by City staff or the City Council that would aid
the City Council in determining whether the excavation activities
conducted pursuant to this CUP created any adverse impacts to the
health, safety or welfare of the City or its residents.
Thank you for the opportunity to comment. If you have any questions, please
contact me.
.>
�a �;: — 8 `r_�03
Memorandum
To: Bill Rudnicki, SMSC
From: B. Don Crofut
Date: 8/4/2003
RE: Lone Pine Golf Course Disturbed Area - Letter of Credit-City of Prior Lake,
Mlv
Please find attached Irrevocable Letter of Credit 1-2003 in the amount of
$260,000.00. The LOC is issued in favor of the City of Prior Lake, Minnesota for
the account of the Shakopee Mdewakanton Sioux Community.
Please forward the Irrevocable Letter of Credit as requested by the City of Prior
Lake.
If you have any questions regarding this matter, please advise.
Attachments:
SMSC LOC 1-2003
BDC: aa
South Metro Federal Credit Union
15045 Mystic Lake Drive
Prior Lake, MN 55372
952-445-0888 ext. 16
1