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HomeMy WebLinkAboutExcavating & Grading Permit 14-G-9 EEL r i x "EXHIBIT A" FOR CITY USE ONLY EXCAVATING AND GRADING PERMIT PERMIT# ly-b--07 1 DATE 6-27-Iy - Applicant: ., "'� Ptaone# t 1 -o7 i Prolect/Develo ment Name i Applicable: ir A�$ T .t 0 w r .€ t l w Address: ::; + �,' PropertyOwner • �c.r;- iN,_c`, Phone# b `53 —{ 7 1 Address: ' ' ; s__'._. " '1_ S- 3 to, 7 . .� Contractor: ` ' .,[►,...:rf IX- ' ' Phone# 6'52~." a-°1+2 1-1 Address:....J_' : ._.„ 22_00".."..„,{ , r 1 , t r ,. „ J 7t _ Consultant Engineer/Surveyor: -.. Phoned Address: Emergency Contact(24 hr): Phone# Location of Property. / t --i--AA-) k_ lit S.....,?,..„.. 112,.....,,t Kik) , -- Legal Description: f Will the excavation or tilling be in a: Watercourse 1449 Wetland Upland Purpose for the proposed excavating or filling: r ��11 ' , " ' Estimated start date: mpletion date: I d -- What is the type of materialto e removed or deposited ' 1,....A, What is the quantity of material to be removed or deposite ? L. _.__ What is the total area disturbed for excavation or filling?_ t In what manner will the material be removed andfor deposited? L7 What highway,street or other public-way will material for removal or deposition he ha led or carried? 41.41M1=411,____ J) '1 Oart'nat,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 SHALT. 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 Xr 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 0' all slopes to be shown on a 2'contour map at a scale of '=5t)'or larger. The proposed and original contours shall be &,.„gd,nalvii' d_n6.t?UUF7IIIYDMUPDA1i5FXHMO'AAPP€ICATION$©fi£LCAV&FILiYGxdio? a I , ..7. ,:„.' 1 \-, .-,'• ' `*"... -!:''''-•.' "EXHIBIT A" shown including ail 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, (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. ,, i , (9) Additional Conditions: '-i• Cii( .. c.)) ( I S heli).teci rra Ark )0 F -5eei &4e1/ rywilA O."- 11 a 5teif byt-- lertk,'"1a i r 4, t-- 1. ._, „ 1 eftk_ et i THE UNDERSIGNED HEREIN CERTIFY THAT THEY HAVE READ SECTION 706 OF THE CITY CODE AND ACCEPT THE TERMS AND CONDITIONS TO THE SSUANCE OF THIS PERMIT AND AGREE TO FULLY COMPLY THEREWITH TO THE SATISFACTIOA 0:I 1- -ITY/F P .10R LAKE ENGINEERING DEPARTMENT OR ITS DESIGNATED AGENT. Applicant: / i pjpDate I 6) .47 / V i Property Owner: t,'' : _ L., Date V2,7-1--1-----/ FOR USE ONLY AUTHORIZATION OF PERMIT Financial Guarantee Amount$ Financial Guarantee Type (Letter of Credit,Bond,or Cash) Permit Fee$ ZOC.7-0 Liability Insurance provided?Et YesEl No(Insurance Certificate must name the City of Prior Lake as an additional insured party) In consideration of agreement to comply in ail 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. Ayr ENGINEERING OFFICIAL ____ • . Date 6--Z 74 Y . ., t--- • Permit i ,alid if igned by City Official Permit Expiration Date JO iy 11. 2()iy Planning Dept. Initials • 0\AJminl'W 1)*Ign 11.1rox,,1.2007 i'WDN11.-PDA tE,kixti:Bri-A APPI(CATION RJR Es:nv.,.,a NI I,ING ex, 2 rf3L •i /I ... _...... Form 17L(edb)tll)) Durmaeol Msasgcateat Systemowl-NocII MINNESOTA DC+PAR MINT OF TEANSPORTATION District M 1 rami,w y S•-•lq- 67-32.1 APPLICATION FOR MISCELLANEOUS WORK ON � 0 TRUNK HIGHWAY RIGH'1'O&WAY os 0( A►MW1 a t (THIS SECTION FOR AL,DOTOFFICE USE ONLY) ATTACH A SKETCH OF THE PROPOSED WORK AIWA AND RELATION TO TRUNKfAGIIiVAY. SUBMIT TO DISTRICT PERRIIT OFFICE OFM17VNESO7A DEPARTMeN7'OPThANSPORTATI4N APPLICANT TELEPHONE ADDRESS(Street,City,State,Zip) Velishek Auto Sales,Inc. 952-447-2237 16661 Hwy 13 S Prior Lake.MN 55372 PARTY PERFORMING WORK TELEPHONE ADDRESS(Street,City,BMW,Zip) Mark's Bobcat Service,Inc. 95:1-447-6771 19805 Mushtown Rd.Prior Lake,MN 55372 LOCATION OF PROPOSED WORK (citrrfmauhp) (owes) (Dirtans+o) (1d.S.r w) SPECIFIC ROAD INTERsIiCrION OR LANDMARK 13 Prior Lake Scott .10 South Hwy 13&Franklin Trail Highwayin Mites of WILL THIS FACILITY BE WITHIN TRIBAL LANDS? ❑Yes II Nu IF YES.WHICH ONE? NATURE OF WORK Closure of the•dlreeLdrivewav access from Hwy.13 SURFACE TO BE DISTURBED (Check Apptupriute Iioxut) ❑ Roadway •Shoulder 0 Concrete •Bituminous ❑(Travel Q Turf Only 0 Other(explain) ——— _ w. __.. --DEPTH OF EXCAVATION BELOW NUMBER&SIZE OF EXCAVA'T'IONS METHOD OF INSrALLATION/CONSTRUCIION SIJUPACE 30 x 60 Backhoe&Bobcat -- 4 feet WORK TO START ON OR AFTER WORK TO AE COMPLETED BY 15 TRAFFIC DETOUR NECESSARY? ■ Yes No June let 2014 July 2014 IF YES,TRAFFIC CONTROL PLAN IS REQUIRED,) APPLICANT'S ACCEPTANCE,WAIVER AND INDEMNIFICATION The undersigned applicant hereby agrees to comply with applicable statutes,rules,and the aluudard conditions and special provisions of(lrls permit.The applicant understands and agrees that nu work in conueeliun with lila alapllcallou will bestarted until the application hat been approved and(be peradrissucd. The applicant is aware of clrcumalauCes or hazards that may arise while peri raring the work associated with this application that could result in injury,lou.damage or death,and the applicant ttssunres the risk dutch elreuatstauci s,daugers mud hazards,whether reasonably foreseeable or not The applicant also understands that this permit may also be subject CO the approval of local road authorities hawing juin!supervision over said street or highway,and may be enb ect to applicant's compliance with the rules aid reguhalioue of the Minnesota Envlromneutxi Quality Board aadfor any other affected Boveramilial agencies. The undersigned applicant expressly agrees that except for negligent acts of the Slate,its agents and employees,the applicaut or his/her agents or contractor shall assume all Iieblhty for,mid save the State,its agents mid employees,harmless from any and all claims for damages,actions or causes of action arising out of the work to be done la connection with this ippltcalioa and permit. NAME AND TITLE EMAIL ADDRESS Tim Velishek,Vice President tvelishek(ginlegra.net • DATE O` ` / _ SIGNATURE DO NOT WRITE BELOW THIS LINE _ PERMIT NOT VALID UNLESS SULi',hRING4UTNOR1ZEDMnDOTSICNAT UREANDPL'RMITNUMBIER AUWHoitt'LATION ON PERMIT It Is expressly understood that this permit is cuuditioued upon ret(oration of the trunk highway right-of-way to its original condiiiou or to a satisfactory condition. lin consideration of the applicant's agreement to comply In all respes to with the applicable laws and the conditions of the Commissioner ofTruutporlation pertaining 10 this permit,permission Is hereby granted for the work to he perlbrased us described in the above application,said work to be performed iu Accordance with the following standard conditions and special provisions: SEE ATTACHED STANDARD CONDITIONS AND SPECIAL PROVISIONS Date All ark To No Completed BY �.:; _u 'r Del•of danced Si; use DISTRIBUIlON D POSITIUf PI 7rENTS _POSITTYPE Original to Arm Muin ternence Fitgiaeer r No Deposit Requital Cashiers Check a Applicant 0 Deposit Requited in the Amount ofS Certified Check II — Subarea Supctvisor Dale Deposit Received_ Money Orders — Roadway Regulations Supervisor Sc remised apa.aofeauory coutyfe/ba glair work Bond it DATE WORK cOMIPLETED (Madata wl,Or rye tvark Irraorupleled mast be reported to the MnDOT DubhPanda Ol/l Page I oft Z0/Z0 39Vd S3-NS Olfld >i3HSI13A 00bZ0bbZ5E LT:0T tTOZ/0E/50