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Home My WebLink AboutExcavating & Filling Permit #12-G-07 �» ��,. �� PRj�j� � � �. �►r�* "EXHIBIT A" FOR CITY USE ONLY EXCAVATING AND GRADING PERMIT PERnniT # j 2— —a� DATE ��L I ►�,. Applicant: �� , � t Phone # l / Z �7So?�S'6 Project/Development Name if A le: Address: �d-�� s � �''� F'roperty Owner: ��_.� , S �g�'�� Phone # Address: Contractor: � � f✓L��l'L-�" Phone # Address: Consultant Engineer/Surveyor: Phone # Address: _ - Emergency Contact (24 hr): Phone # Location of Property: Legal Description: Will the excavation or filling be in a: Watercourse N a Wetland Upland ��_ Purpose for the proposed excavating or filling: / a ��_ !2,�� f C �� Estimated start date: �/ l� Completion date: ��/�, What is the type of material to be removed or deposited? �c� �.D ��s��7o ✓� What is the quantity of material to be removed or deposited? What is the total area disturbed for excavation or filling? � fC o In what manner will the material be removed and/or deposftec�� e�iC Aa t� What highway, street or other public-way will material for removal or deposition be hauled or carried? �D What, if any, street, avenue, lane, alley, highway, right-of-way, thoroughfare or public ground will be obstructed? ad 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 Ciry of Prior Lake overall storm water management plan? Yes No� If yes, explain proposed effect SUBMISSION REQUIREMENTS: (A) Compteted 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 Dasign ManuxB20Q7 PWDM UPDATB�F:XHI131T A APPLICATION E�R EXCAV Xc [7LLING.dtx: 1 � „L �� rarp � � � "��! "EXHIBIT A" shown including all properly 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 Ciry may incur by reason of doing anything required to be done (H) Public liability insurance CONDITIONS OF APPROVAL: (1) Applicant must cali 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 controi Best Management Practices installed immediately after finished grading. (4) Minimum grade for drainage swales shali be 2% or greater. (5) Removal or depositing of material greater than 400 cubic yards requires a conditional use permit, uniess 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 o�her properry 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 secu rity. (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 ITY OF PRIOR LAKE EN EERING DEPARTMENT OR ITS DESIGNATED AGENT. Applicant: Date Z L Property Owner: G Date FOR CITY USE ONLY AUTHORIZATION OF PERMIT Financial Guarantee Amount $ N � Financial Guarantee Type �(Letter of Credit, Bond, or Cash) Permit Fee $ 2�• � � �d_,»� � P� –.�-�'+- Fc � 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 � Z y � Z Permit is valid if signed by City Official Permit Expiration Date Planning Dept. Initials �� '.� f' Pe.�.�: "t� G:�Admin\PW Design Manual�2�M17 I'WDM UPDATE�EXHIBIT A APPLICATION FOR EXCAV & F[LL[NG.doc , 2 , �, Scott County, MN �� ;� �: F . 3; , :. � �;�' � .� � � r . �� , �y �� ; �.a �� , . 3 s �. � �� F �r : �� ,�G� �. t �: i � � �tt �' � ��. � E' ii � i E � � � � � �#�� "� °�°� � I � � � 11' �� , �� ¥ E ,� �� , ,; � �`" ` � � ��; � �� ,� �� ` � � �� a� e , , "'� ��. � �� ,� . a �" ;4a "� � �" E�Et E�y,'�" � � � � � �� . � ��` � d s w � k �`�� •�' . a «$' s s 1.31. � « E 3 . � :, �� C�„�' � �ri�'i NF'- sra, �� ` mo' � ° � . 3 . � �� . � 'ki, yy }� .. ��.�.t.. �� .�„ ` .� k%:'k� �� . � "� � � �` �� x ` �� # �" k . ¢ yk € Y � � � d �i� � 4 fr "�� "fp "` �� `� � �. ��. b 1� 1 � : i` � ` � � � 8 � 4 � '� i �� x � d � � �� } �h+� F � � �.. f +e � , S` d � � , �� $ g �, ig �„ �. � �� 1 �^ ' a , ',%n �� `�� . � }f »; ' u � . .'��,� � �'.. * �� a � "- sd � ��``�, 'r �. �'�� ) y�e�, � �'1'°' �.� � �` � . � `d � �' �'� 3 �p� � 7 � � �" s ': a � , ,� 7y �"'�i� a . � ,�y�„ �` R � � ,. Cp Y �� , q � . .'� � � � . `�� ° ,� a � � �� *' r � � � � �'� �� a� �*.y�,,, �'�g E � �,� ��a„� �, � �,�� $ # � �i �'t / k � yxf^ . . � 3 �p� { €�:� 2 � �$ � `� .� � ^C� Y '� �- '}� ° �y � � '�� y S , �' � ' F} � : �' � ^ 3� ;� � _tt� � � rr k g - yy� `$1 � .' . � q �� :: � : 9 a � � x� .� a � `� �° � � � �� "�r t � � + .� ,-��. � �.� v,� ' . � � ,«� e �,k . * "q,. ' �'. ° �; � � :`�� `:� G � ,� `� � � « � ` . ,�.�. �" wn �w ��" � � �`; � � � `� � �' y i � � � r � � 1 � � � 9 ' � ; .c� °';�`� �� . ,� F �M� � � . �"^+ tN �. �� 6� : '� t � � � 3 r�k � � -1`t �e e,,.+' ' �� F t� } �M � f .. �`. � ,�µ+ Y ��. a & p . v � .d� 4.':' � ` ��r� t � �* �.y�*-f ;m� � �� °� � � a�b r+��?.. �'s �.'x w. .Y= This drawing is neither a legally recorded map nor a survey and is not Map Scale N intended to be used as one. This drawing is a compilation of records, information, and data located in various city, county, and state offices, and 1 inch = 43 feet other sources affecting the area shown, and is to be used for reference W� E � purposes only. Scott County is not responsible for any inaccuracies herein � contained. If discrepancies are found, please contact the Scott County Map Date s�Ne o�i�e. 8/24/2012 S �� PRI 6694� �� . CITY OF PRIOR LAKE RECEiPT # �" 4646 DAKOTA STREEf S.E. ►—�i x PRIOR LAKE, MN 55372 V LT1 (952) 447-9800, FAX (952) 447-4245 DATE: � 2- �/.G— �INNES��' . . Received of for the purpose of �— � r-- ,,� ��L � �.z �� ' ,,� J �� ' , � ° �:�.�::r:.�:�::� e . e , . �:- . e . . . . : °°.: � Cash � Check �d� �d Invoice # Q ACH � � i ' Total �. �U . � � eceipt Clerk for the City of Prior Lake . ,c