HomeMy WebLinkAboutExcavating & Filling Permit #10-G-03 �� r�r��
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° � "EXHIBIT A"
FOR CITY USE ONLY
EXCAVATING AND GRADING PERMIT PERMIT#
DATE ,T 2p D
Applicant: �hii�� �i�i+.� t �are.+✓A�"� __ Phone#,Q-��'�36�3'�
ProjecUDevelopment Name if Applicable: /✓�IA
Address: .?6.z39 S,� /.����, a.r 8�✓/� l��� .r1a -s'6 DI'>
Property Owner: /��1�� o� �/Nf �Q k+%�� a Phone # �/.�-�/- �997
Address: /G 9!/ /W us��fa�.✓ .Po�,.� ���br��.r� d/� S�'3'o�-
Contractor: C�Rc� ' %� •� � �reA✓A-fr;,,� Phone # 4Sa-87�-6✓.Y�-
Address: a6 �� l� /f�/4�C'--� y •7S - .ZI!//t P��Nf /"�N SGOl�
Consultant Engineer/Surveyor. iv�i4 Phone #
Address:
Emergency Contact (24 hr): �..� �.an� Phone # 6/i -L8S"=�867
Location of Property: /L 9L l /K ksk-ao�u�.J �oa�
Legai Description:
Will the excavation or filling be in a: Watercourse �.b Wetland tic Upland �D
Purpose for the proposed excavating or filling: ��i t u%//E wo �r� ���/��' �
Estimated start date: S- s-� p Completion date: - - O
What is the type of material to be removed or deposited? �o
What is the quantity of material to be removed or deposited? �'
What is the total area disturbed for excavation or filling? ' �w tsc'
In what manner wiil the material be removed and/or deposited? s,� -f- ��% - �.r� -+ .r3 �.1
What highway, street or other publio-way will material for removal or depos ion be hauled or carried? �1w� �3,��✓� 7o'
What, if any, street, avenue, lane, aliey, highway, right-of-way, thoroughfare or public ground will be obstructed?
IT SHALL BE THE RESPONSIBILITY AND THE BURDEN OF THE APPLICANT TO DEMONSTRATE TO THE SATISFACTION
OF THE CITY ENGINEER FOR THE CITY OF PRIOR LAKE THAT THE PROPOSED EXCAVATION AND/OR FILLING
. COMPLIES WITH THE OVERALL CITY OF PRIOR LAKE STORM WATER MANAGEMENT PLAN. SAID BURDEN SHALL
INCLUDE THE FURNISHING OF A REPORT WITH SUPPORTING CALCULATIONS OF A REGISTERED PROFESSIONAL
ENGINEER.
Will proposed excavation or deposition affect the City of Prior Lake overall storm water management plan? Yes No �
If yes, explain proposed effect N�.►
SUBMISSION RE UIREMENTS:
(A) Completed application form
(B) Map or plat of the proposed filling or excavating showing location and amount of material proposed to be removed or
deposited, with a description of the area
(C) 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 1"=50' or larger. The proposed and original contours shall be
G�Admin�PW Design Meeua1�2001 FWDM UPDATE�EXFIIDTT A APPLICATIOI3 FOR EXCAV & FII.LiNG.doc
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�¢ "EXHIBIT A"
shown including all property within 200' of proposed excavation or deposition and shall be signed by an engineer or
surveyor registered in the State of Minnesota
(D) Erosion control plan
(E) Affect on existing utilities
(F) Application fee
(G) Amount of Letter of Credit, or deposit of monies in a sum sufficient to pay the cost 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
(H) Public liability insurance
CONDITIONS OF APPROVAL:
(1) Applicant must call the Engineering Department for erosion control inspection at (952)447-9830 prior to earth moving
activities.
{2) Maximum 4:1 slopes are allowed in "maintained" areas except approved by City Engineer. Maximum 3:1 slopes are
allowed adjacent naturaf resources.
(3) Slopes greater than or equal to 3:1 shall have approved erosion control Best Management Practices installed
immediately after finished grading.
(4) Minimum grade for drainage swales shall be 2% or greater.
(5) Removal or depositing of material greater than 400 cubic yards requires a conditional use permit, unless it is part of a
preliminary plat application.
(6) Applicant is responsible for obtaining and meeting the conditions outlined by other permitting agencies including but not
limited to the following: DNR, Corps of Engineer, Prior Lake/Spring Lake Watershed District, Scott County, MN/DOT,
MPCA.
(7) Applicant is responsible for all damages to other property or facilities as a result of work covered by this permit.
(8) Applicant must call the Engineering Department for final grading inspection at (952)447-9830 prior to release of grading
security.
(9) Additional Conditions:
THE UNDERSIGNED HEREIN CERTIFY THAT THEY HAVE READ SECTION 706 OF THE CITY CODE AND ACCEPT THE
TERMS AND CONDITIONS TO THE ISSUANCE OF THIS PERMIT AND AGREE TO FULLY COMPLY THEREWITH TO THE
SATISFACTION OF THE CITY OF PRIOR LAKE ENGINEERING DEPARTMENT OR ITS DESIGNATED AGENT.
Applicant: `/oAr �IJE/'�r+t! �. � C:������'����-3 Date 6� a
Property Owner: /y��k�- /kc,��w,Ity Date
FOR CITY USE ONLY
' AUTHORIZATION OF PERMIT
Financial Guarantee Amount $ �DO Financial Guarantee Type (Letter of Credit, Bond, or Cash)
Permit Fee $ .
Liability Insurance provided? Yes❑ No (Insurance Certificate must name the City of Prior Lake as an additional insured party)
In consideration of agreement to comply in all respects with the regulations of the City of Prior Lake covering such operations,
and pursuant to authorization duly given by said City of Prior Lake, permission is hereby granted for the work to be done as
described in the above application and submitted drawings, said work to be done in accordance with this application and
submitted drawings.
ENGINEERING OFFICIAL �i����`"�'�""� Date S_"2 d��v
Permit is valid if signed by City Official
Permit Expiration Date g��D "�Q Planning Dept. Initials
G4ldroin�PW Design Manua1�2007 PWDM UPDATE�EXAIDTT A APPLICATION FOR EXCAV & FII.LING.doc
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