HomeMy WebLinkAboutExcavating & Filling Permit #11-G-08 �� ����
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"�'�`' "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 �� � . � � .
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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 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
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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 $:15,OOd wort1�'of work
associated with the rsmoval a�d installati�n of services have been completed, Therefore
rathar th�n requesting a reductivn on the cun�z�t LUC, Ryland wauld hold vff on any
reductinn requ�sts until site gra�ling for phase I and II are complete later this fall.
If this is ac�eptable, ple,a,s�e confirm with a lette� or emaaL T�anl� you for your assistance
in this matter.
Sincerel�,
THE RYLAND �RUTJF, INC.
�^��� ,
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Land Development Manager, Twin Cites
�'T.�F.�CAT� OI�,II�SL1ItA�TCIG
PItUJI�CT: ,Teffers WAterfront
G'�EtTIC�I[:AT'E�OLD3�' 2: CitynfPriorLeka y -
+�64b DaEeotri Street SE �
PilorLnke, Miistiesota 5S3'1�
� 'Tlie RylAnB C�roup Iac.
_h3�3)ITi�N�IiYS[J12�D: Cityof�PrtorLnke
�'����': Aan Risk Iusnrance Sen�ices West, Inc.
WORi�LRS' COMPJGN$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�
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