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HomeMy WebLinkAboutExcavating & Filling Permit #11-G-08 �� ���� :� � � � � :� ; "�'�`' "EXHIBIT A" FOR CITY USE ONLY EXCAVATING AND GRADING PERMIT PERMIT# �t -�, -c� DATE � L�, � � 1 Appiicant: Ryl and Home s Phone # 9 5 2- 2 2 9- 6 0 0 0 Project/Development Name ifApplicable: Jeffers Pond 5th Addition Address: Pointe Pass and Wilds Ridge Property Owner: Ryl and Home s Phone # 9 5 2- 2 2 9- 6 0 0 0 Address: �599 Anagram Drive, Eden Prairie Minnesota 55344 Contractor: North Pine Aggregate Phone# 651-4b4-6802 Address: 14551 Lake Drive, Forest Lake Minnesota 55025 ConsultantEngineer/Surveyor: Pioneer' Engineering Phone# 651-681-1914 Address: 2422 Enterprise Drive, Mendota Heights Minnesota 55120 Emergency Contact (24 hr): Mark S ons t egard Phone # 612 - 3 6 6- 2 9 2 7 LocationofProperty: Outlot D Jeffers Pond 4th Addition Legal Description: Corner of Pointe Pass and Wilds Ridge Will the excavation or filling be in a: Watercourse Wetland Upland X Purpose for the proposed excavating or filling: Grading f or home construCt ion Estimated start date: September l5t , 2 011 Completion date: November lst , 2 011 What is the type of material to be removed or deposited? On s i t e s o i l s What is the quantity of material to be removed or deposited? 12 , 017 CY What is the total area disturbed for excavation or filfing? 5..7 acres In what manner will the material be removed and/or deposited? d�� ckho _ nd � ks What highway, street or other public-way will material for removal or deposition be hauled or carried? n nn o What, if any, street, avenue, lane, alley, highway, right-of-way, thoroughfare or public ground will be obstructed? none 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 ENGfNEER. Will proposed excavation or deposition affect the City of Prior Lake overall storm water management plan? Yes No ?{ If yes, explain proposed effect SUBMISSiON REQUIREMENTS: (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:�.4dmin�PW Design ManuaI�2007 PWDM UPDATE�EXFIIBTf A APPLICATION FOR EXCAV & FILLING.dce �� � . � � . 1 . . �� ����,� �. �.. �4. �r' .� �'�'�"`�' "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 natural 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. (� 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: �,b �-- e— c� �--�--. � N--�S �-�s �... �s�- h� �"•--s � � �e+y1 ��.: a -(.� 6--�..ts.._. ` nc �: �: �� �, • THE UNDERSIGNED HEREIN CERTIFY THAT THEY HAVE READ SECTION 706 OF THE CITY CODE AND ACCEP7 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: � i✓ Date � Property Owner: ,_�,.�� Date FOR CITY USE ONLY AUTHORIZATION OF PERMIT Financial Guarante Amount $� �,'"� �" Financial Guarantee Type � c G (Letter of Credit, Bond, or Cash) Permit Fee $ V Liability Insurance provided? YesO 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 Date � �Zq � � Permit is valid if signed by City Official Permit Expiration Date q � Z� � �� Planning Dept. InitialsSl�N�. G:4ldmin�PW Design Manual�2007 PWDM UPDATE�EXE�Tf A APPLICATION FOR EXCAV & FII.LING.doc 2 A�� °� CERTIFICATE OF LIABILITY INSURANCE 8�25i2oii THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement s. PRODUCER coNTacr Laurie Wanner NAME: Cedarleaf, Cedarleaf & Cedarleaf, II1C. AHC ext: �651)488-6666 p/C No: (651)488-9932 360 Larpenteur Avenue West pooRess:lw@cedarleaf.com $uite 10� PRODUCER U0001561 St . Paul NIId 55113 INSURER S AFFORDING COVERAGE NAIC # INSURED INSURER A;W23t2Z'Il Ndt.10IId1 Mutual Ins . INSURERB:T�lE Builders Grou North Pine Aggregate, II1C. INSURERC: 14551 Lake Drive INSURERD: INSURER E : � Forest Lake NIld 55025 INSURERF: COVERAGES CERTIFICATE NUMBER?�G 2010-11 CERT REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR 7ypE OF INSUflANCE ADDL pOLICY NUMBER MM/DD/VYYY MM/DD/YYYY LIMfTS LTR GENERAL LIABILITV EACH OCCURRENCE $ 1� OOO � OOO X COMMERCIAL GENERAL LIABILITY PREMISES� a occur ence $ lOO � OOO A CLAIMS-MADE X❑OCCUR PP0013167 2/31/201012/31/2011 MEDEXP(Anyoneperson) $ 5�000 PERSONAL & ADV INJURY $ 1� OOO � OOO GENERAL AGGREGATE $ Z� OOO � OOO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2� OOO � OOO POLICY X P E� LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT � (Ea accident) $ 1, ���, ��� X ANY AUTO BODILY INJURY (Per person) $ A ALLOWNEDAUTOS PP0012944 2/31/201012/31/2011 BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS Underinsured mo[orist $ 1� QQO � 000 PIP-Basic $ statutory }[ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ $� OOO� OOO EXCESSLIAB CLAIMS-MADE AGGREGATE $ 5� OOO� OOO DEDUCTIBLE $ A X RETENTION $ 10 000 0010406 2/31/201012/31/2011 $ B WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N E.L. EACH ACCIDENT $ SOO OOO OFFICER/MEMBER EXCLUDED? N� N�A g-0658 /1/2011 1/1/2012 (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ $OO OOO If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ SOO OOO DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 707, Additio�al Remarks Schedule, It more space Is required) Project: Ryland Homes It is agreed and understood that the City of Prior Lake is included as additional insured within the scope of the insureds operation aas respects to General Liability and Umbrella policies CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Of PZ'iOZ' Lake ACCORDANCE WITH THE POLICY PROVISIONS. Prior Lake, NIld AUTHORIZED REPRESENTATIVE Laurie Wanner/I,W � l�C./GZ�,c�,.-,.cJ� ACORD 25 (2009/09) � 1988-2009 ACORD CORPORATION. All rights reserved. INS025 �zoosos> The ACORD name and logo are registered marks of ACORD RY�4Nf� H+�M��� rwia cm�s oivisioN 7548 Anagram Driv� Eden Prairie, MN 55344 852.228.8000 Tel 952.229.6024 Fax www.ryland.com AU�L1St ��, �U11 MC. �.23't'� pd��11�i City Engineer C.i�y af Prior La1ce 4646 �akota �treet SE Prior' Lake, MN 5�� 72 RE: Jeffers Pond 4`h Addition Phase TI Site Grading Surety Dear Mr. Pvppler: With regards the $11,400 securzty required fo� the Phase II grading at deffers Pond 4�' Addition, Ryland requests that it be incoipotatefl �nto the current I,(}C # IS0001�'74 held by the City. The eurrent L+C?C is #'or $1.40,017.00, as off today ap�roximately $:15,OOd wort1�'of work associated with the rsmoval a�d installati�n of services have been completed, Therefore rathar th�n requesting a reductivn on the cun�z�t LUC, Ryland wauld hold vff on any reductinn requ�sts until site gra�ling for phase I and II are complete later this fall. If this is ac�eptable, ple,a,s�e confirm with a lette� or emaaL T�anl� you for your assistance in this matter. Sincerel�, THE RYLAND �RUTJF, INC. �^��� , � ��� s���t���a Land Development Manager, Twin Cites �'T.�F.�CAT� OI�,II�SL1ItA�TCIG PItUJI�CT: ,Teffers WAterfront G'�EtTIC�I[:AT'E�OLD3�' 2: CitynfPriorLeka y - +�64b DaEeotri Street SE � PilorLnke, Miistiesota 5S3'1� � 'Tlie RylAnB C�roup Iac. _h3�3)ITi�N�IiYS[J12�D: Cityof�PrtorLnke �'����': Aan Risk Iusnrance Sen�ices West, Inc. WORi�LRS' COMPJGN$ATIQN; Y'fllicy 1Vo. �� �791885 �tfeefivel?ttta: 06/0I/26I1 L�piraYi�u D7te; Q6/01/2012 Insurn�cc +Compn�'a ACB Ameaic�tn Las�trance Company CQY�.t2AGE- Workers'Campe�uaEion, 5tntutoiy. � � � I�AI3T�.TI'Y: PolieyNo. THIlU00I3 .�fPec!lveDafe: OG/O1/20I1 �x�irntiott�lnte: ����1/2012 Itisnrnuce Catn�ya»y: Aspen Iusurauce UK Ltd {) Claiins tvinde (� Dccqrrence ]�,WiITS: jIVX)t►Imun�� �ac�� occu,�;oe �i,000,00a Da�nge to Rented Preir►ises: $1,UOO Personai & ADV Injury: $I,000,004 General Aggregute; $2,Ofl0,U0D . Products-Co�np10P Agg: $Z,ODU,OQO �orr�rtac:a. �ROV�Fn- bperntiousoFCon4•,lotor: � crtst2 � pa;c � �f a Qperations ofSbb-Gozi[raetor(Conlingat�t}: � Does�ersona[rnjuiylnoludaCinimsRelatedtoE��toyment7 �B" Camp)eted Opet�tfo»slPrudaats: Y� Contractaal i.3ebf])ty (Broad Formr �ES Got�emmental Tn3munity is �Jaived: Y,"� Property Damage Linbitity L�Qtc�tes: Damuge Due ro B(astin� � Damage �oe to ColJapse � . Damego Doe to Undergrotind �acilities � T3road Fot7n Ptopeirty L?ama�e �^ AUT41t!iC)BII,� L7A�f7L�"�''Y: PoIicyNa. CALHQ8G80383 F€i'�'ec�ivcDntn: OG/U�/2011 ��y��iotrDntet OG/01/2012 ins�Tr CnmpnnY ACE American Iusurance Coinpany (3►.� I�Tued A�itos and Non Oti��ed Autos L]MI[�S: [3Yliii�nttun� �Goinbi,ued SistgleLiinit: �1_OOO,R00 each accident Ait� ANY D£.DIJC�TBL�S e�PPLYCABL� T� 730}?�Y INJrTJItY OR �'I�OP�ItTY DANJ[AG� �N ANY OF TS� A.�OyL CUV�T�A.GES: ffsq I1sh Amaunt: $ [Not to exceed �i,D04A0j SF��UI,D ANX l7�' Tii� ABOYL� DT�SC1t�I3�D pOLtC�S I3� CANC�IC.'�D $E�QIt� TiI� �XPiI�ATION bATL TIICR�4T, T.H.� ISSUiNG COMPAI�tIr 1'VILL MA.T.I, THIItTY {3df AAYS WRl'CF,�I� 1YQTiCL� TO �'AL� PARTDCS TO I�VHQM THIS C�RT'II�ICAT,� IS ISSUI;D. Dateci at Los Augefes California a„ July 11. z011' BYc � �c� Au iized Ensas�nce Rep� ut ve C✓I51! I pnge 2 ut' 2 � �N P � _� � �~ _ � : . 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