2003-04-16 Landowner Statement Form
Contractor Responsibility
and
LANDOWNER STATEMENT FORM
Pursuant to Minnesota Statutes Chapter 103G .2212 an agent or employee of another may not drain,
fill or excavate a wetland, wholly or partially, unless the agent or employee has obtained a signed
statement from the property owner stating that the wetland replacement plan required for the work
has been. obtained, or that a replacement plan is not required; AND mailed a copy of the statement
to the local government unit (LGU) with jurisdiction over the wetland.
A violation of Minnesota Statutes 103G.2212 to 103G.237 is a misdemeanor punishable by up
to a X700 fine and 90 days in jail.
A replacement plan is required for any wetland filling, draining, or excavation that is not exempt
underMinnesota Rules Chapter 8420.0122.
National wetland inventory maps are available for review at County Soil and Water Conservation
District (SWCD) offices. Many wetlands may not be identified on the maps but are still restricted
from filling, draining; or excavating. Contact the LGU or SWCD office far assistance. Call the
Board of Water and Soil Resources at 651-296-3767 for LGU or SWCD location information.
Property Owner Name cPC Partners, L.P.
Address 103 Eisenhower Parkway, Roseland, NJ Phone (973)228-6111..
07068
Work Site Location: a~t,e,-tvi > > e Premi,~ 0 tlets
(address or property 6500 Labeaux Avenue, NE
location description) Albertville, MN 55301
Contractor Name: (by company and individual) e7o Builders, Inc. /Brent p. Krause
~~lddress 2958 N. Cleveland Ave., Roseville, MN Phone 651-634-406
55113
Description of Work: The protect will provide four new outlet mall buildings and associated
parking for the Cit}.r of!AlbemTille. This «jork involves the filling of 1~ 6~7 sq ft of eXistin Type
1 PEMA and Type 2 PEMB wetland which will be replaced at a 2~ 1 ratio by 27 274 sq ft of new
wetland creation.
This form is continued on the backside.
i
I certify that, as the owner of the property listed on this form, I have contacted the local government
unit and the person listed on this form, and that. a WCA replacement plan:
X has been obtained, or
is not required,
for the work described and at the location listed on this form.
Property Owner Name
Signature
~ Contractor Owner Name
Signature
. Kr
Local Government Unit (LGU): City of Albertville
Date ` lGIU 3
Date January 28 , 2003
Address 5975 Main Avenue; P.O. Box 9' Albertville MN 55301 Phone (763} 497-3384
LGU Person Contacted: Todd Udvil; of SEH City of Albertville Wetland Consultant• 3535
Vadnais Center Drive• St. Paul MN 55110-5196• (651) 490-2000
This statement is invalid if anv of the above information is not supplied or is inaccurate
keep a copy of this form for your records, and send
the original copy to the Local Government Unit.
CPG Partners, L.,P.
JOrin K. ICle2ri
Senior Vice President
Real Estate
W:\ALLFORMS\Contractors Responsibility Form.doc