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Home My WebLink AboutExcavating & Filling Permit #11-G-10 Q ,� rRr� x. � � � "EXHIBIT A" FOR CITY USE ONLY EXCAVATING AND GRADING PERMIT PERMIT # DATE Applicant: �1_/LC-1� / �/�� Phone # lQl✓''�v � �so � Project/Develo ment Name if Applicable: Address: � �-- Property Owner: Phone # Address: �� 1 L.�� _ r �� L.. � /�,� �`� � l� Z�Z-�So y Contractor: r �' ��N l i�f= �(1'Owl�' �./1 •w�L��U Phone # n Address: 1'�� 1 �OYN ZUY�� f SP� �i�Go�C.- �/J�l� /� Consultant Engineer/Surveyor: Phone # Address: Emergency Contact (24 hr): Phone # Location of Property: �� ' T / �a�N� �d't�'!"et� Legal Description: Will the excavation or filling be in a: Watercourse Wetland Upland Purpose for the proposed xcavating or filling: �• Estimated start date: � ZL Completion date: l[ What is the type of material to be removed or deposited? Ci�s 5 What is the quantity of material to be removed or deposited? What is the total area disturbed for excavation or filling? ^ llta SY In what manner will the material be removed and/or deposited? What highway, street or other public-way will material for removal or deposition be hauled or carried? What, if any, street, avenue, lane, alley, 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 plan4 Yes No � If yes, explain proposed effect SUBMISSION REQUIREMENTS: (A) Completed appiication 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 Manua112007 PWDM UPDATE�EXEIIBTT A APPLICATION FOR EXCAV & FII.LING.doc ' � 1 � �� "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 �re 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 perrnit, 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 foilowing: DNR, Corps of Engineer, Prior Lake/Spring Lake Watershed District, Scott County, MNlDOT, 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: ��'� MvS'�` �t LGSS �Sh � t w n�tl,r I�e - ��l�L. yb �� r�S � � . 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 SATISFACTI F TH ITY F RIOR LAKE ENGINEERING DEPARTMENT OR ITS DESIGNATED AGENT Applica : � " � Date o �� Property Owner. Date FOR CITY USE ONLY AUTHORIZATION OF PERMIT Financial Guarantee Amount $ �!9•OC� Financial Guarantee Type (Letter of Credit, Bond, or Cash) Permit Fee $ /0�9�D0 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 Date � zL � � � Permit is valid if signed by City Official Permit Expiration Date _ ��" ZZ'/ ( Planning Dept. Initials �� G Wdmin�PW Design Manua1�2007 PWDM UPDATEIEXHBTT A APpLICAI70N FOA EXCAV & PILI,ING.doc � 2 �fC PRI �.j� RECEIPT # 6 41 �� CITY OF PRIOR LAKE 4646 DAKOTA STREET S.E. u � PRIOR LAKE, MN 55372 �� J j � (952) 447-9800, FAX (952) 447-4245 DATE: �INNES�� Received of �� Zru�' �.or.�1,S�c�.�y�.� for the purpose of � YG �. U�,'� Cr�,�� n,.�, �� . )) �( -1 Q — Payme � Cash C y�,�� Check �� G, Q 7 �►we+e� #_� �d' -S � ACH Total $ 3� U � � G�� eceipt Clerk for the City of Prior Lake MANDINEC GROUP LANDSCAPING, INC WELLS FARGO BANK, N.A. GHSS 17201 HORIZONTRAILPH.952-226-1813 www.wellsfargo:com PRIOR LAKE, MN 55372 17-1/s10 �"� t OR ER OF � � IZ �' � ��' � �v _� DOLLARS t MEMO n ,� J�� l.i �' (. �� C�� M , AUTHORIZED SIGNATURE ■