HomeMy WebLinkAboutExcavating & Grading Permit 16-G-21 "EXHIBIT A" Z r GI— wi
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EXCAVATING & GRADING PERMIT -Rete, _ &# 6'79k'
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Applicant: <C 7` <. .s�,t, to > .. St t J Phone: i 7(` Z 2 "`�
Project/Development Name if Applicable:
Address: 4.1.0).6) i:A..)k),,St .44'
Property Owner: c; x CII, £; Phone:
Address: - :.Lr ;+ -"
Contractor: ic 14 3 t: avd 54 t,,f('. Phone:
Address: 4-y- 17,),,,,,,c, ,i ,ryr( ;.kms :) t,_rrYsL,",t{i,-- tr.PU, 55337
Consultant Engineer/Surveyor: Phone:
Address:
Emergency Contact(24 HR): Phone:
Location of the Property:
Legal Description:
Will the excavation or filling be in a: Watercourse Wetland Upland
Purpose for the proposed excavating or filling'_:( ,, ,,
Estimated start date: `' - 't Completion date:
What is the type of material to be removed or deposited? +‘ r,c
What is the quantity of material to be removed or deposited? ..-
What is the total area disturbed for excavation or filling? / ',,,,
In what manner will the material be removed and/or deposited? f**<
What highway,street or other public-way will material for removal or deposition be hauled or carried? '*-. .:`i •'
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 plan?Yes_ No,`:;'
If yes,explain proposed effect
"EXHIBIT A"
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 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. Effect 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:
A. Applicant must call the Engineering Department for erosion control inspection at (952) 447-9830 prior to earth
moving activities.
B. Maximum 4:1 slopes are allowed in "maintained"areas except approved by City Engineer. Maximum 3:1 slopes
are allowed adjacent natural resources.
C. Slopes greater than or equal to 3:1 shall have approved erosion control Best Management Practices installed
immediately after finished grading.
D. Minimum grade for drainage swales shall be 2%or greater.
E. Removal or depositing of material greater than 400 cubic yards requires a conditional use permit,unless it is part
of a preliminary plat application.
F. 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.
G. Applicant is responsible for all damages to other property or facilities as a result of work covered by this permit.
H. Applicant must call the Engineering Department for final grading inspection at(952)447-9830 prior to release of
grading security.
I. 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
THE CITY OF PRIOR LAKE ENGINEERING DEPARTMENT OR ITS DESIGNATED AGENT.
Applicant: Date 8/31/2016
Property Owner: Date
"EXHIBIT A"
IMPORTANT— BEFORE STARTING WORK
EXCAVATOR AND OPERATOR'S NOTICE
This notice is to inform excavators and operators they must comply with
Sections 216D.03 to 216D.07 of MINNESOTA STATUTES
Call Gopher State One
Call(800)252-1166 or 651-454-0002
Or go to www.Ropherstateonecall.org
Smart Phone: http://mnticketentry.korterraweb.com
FOR CITY USE ONLY
AUTHORIZATION OF PERMIT
Financial Guarantee Amount$ Financial Guarantee Type
(Letter of Credit,Bond or Cash)
Permit Fee$ 2 pa• C70
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 submitte. •rawings. - r
ENGINEERIN OFFICIAL L.�/� Date 0/&//4)
i/r'v- i if.signe y�icial
11 PERMIT EXPIRATION DATE(90 days from approval date) /1 / Planning Dept.Initials
Susan Zick
From: Drew Stillwell <drew@blackstonehardscape.com>
Sent: Wednesday, August 31, 2016 3:30 PM
To: Susan Zick
Subject: RE: Excavating/Grading Permit for 16020 West Ave
Attachments: Permit application.pdf
Original Message
From: Susan Zick [mailto:szick@cityofpriorlake.com]
Sent: Wednesday,August 31, 2016 3:07 PM
To: drew@blackstonehardscape.com
Cc: Dale Stefanisko; Nathan Briese
Subject: Excavating/Grading Permit for 16020 West Ave
I understand you were in this morning to fill out and Excavating &Grading Permit for 16020 West Avenue, Prior Lake,
MN per Dale Stefanisko's instructions.
Unfortunately, when you were in, I was in a meeting so wasn't able to look through your permit application paperwork.
You didn't sign your permit application, so I have attached a copy of the permit application and do need your signature.
Please see the attached. If you could sign and date and then either email it back to me or bring in the signature page
along with a check or cash for$200.00 for the permit application fee, I can then process your permit application.
If you have questions about this, please let me know. My direct dial phone# is shown below.
I will be out of the office tomorrow but back in on Friday.
Thank you in advance for your attention to this.
Susan Zick
Development Services Assistant I City of Prior Lake I Direct: 952.447.9830
1
1'ft{�ir' City of Prior Lake RECEIPT
' 4646 Dakota Street SE
''' Prior Lake MN 55372
rra 952-447-9840
Received Of: Receipt: 6796
Date: 09/06/16
Blackstone Hardscape Inc Customer: Blackstone Hardscape Inc
12400 Beard Ave S
Burnsville MN 55337
Receipt Item Receipt Description GL Number Total
Grading Permit 16-G-21/16020 West Ave
Zoning&Subdivision Fees 200.00
Receipt Total 200.00
TENDERED: Checks 15998 200.00
Total:200.00