2004-06-14 MPCA Storm Sewer Permit
SEH
TRANSMITTAL
To: MPCA
Date:
SEH File No.:
Client No.:
Re: 2004 Prairie Run Improvements, Albertville, MN
We are:
~ Enclosing D Sending under separate cover
1 MPCA Storm Sewer pelmit (NPDES)
1 $400 Check
For your:
~ Information/Records
D Action
Remarks:
D Review and comment
D Distribution
By: Debbie Gilyard
c: Larry Kruse, City of Albertville (w/enc1osure)
Dennis Fehn Gravel & Excavating
Russ Bly, SEH SP (w/enc1osure)
Bob Moberg, SEH SP
Jim Schulz, SEH (w/enc1osure)
djg
u:\a\albev\040900\corr\t-mpca npdes permit-061404.doc
June 14,2004
A-ALBEV 0409.00 32
N/A
D Sending as requested
D Approval
D Revision and resubmittal
1/04
Short Elliott Hendrickson Inc., 1200 25th Avenue South, P.O. Box 1717, St. Cloud, MN 56302-1717
SEH is an equal opportunity employer I www.sehinc.comI320.229.4300 I 800.572.0617 I 320.229.4301 fax
+
This form is for new permit applications only.
Existing permittees must use Application for Permit Transfer/Modification to transfer a permit to one party or Subdivision Registraticm for multiple parties.
:.
National Pollutant Discharge Elimination System (NPDES)/State Disposal System (SDS)
Application for General Storm-water Permit
for Construction Activity (MN R100001)
Minnesota Pollution Control Agency
REM Division, Construction Storm-water Permit Program
520 Lafayette Road North, St. Paul, MN 55155-4194
MPCA use only
W#
Check #
Please refer to the application instructions and the NPDES/SDS General Storm-water Permit for Construction Activity
(MN R100001) as you complete this form. See brackets [ ] for specific permit references.
Call the MPCA Customer Assistance Center at 651-297-2274 or 800-646-6247 (in Minn.) for assistance.
1. Storm-water Pollution Prevention Plan (SWPPP)
a. Has a Storm-water Pollution Prevention Plan been developed for this project and
incorporated into the project's plans and specifications? [part m.A]
b. Are erosion prevention measures addressed in the SWPPP? [part IV.B]
c. Are sediment control measures addressed in the SWPPP? [Part IV.C]
d. Are dewatering and basin draining addressed in the SWPPP? [part IV.D]
e. Are inspections and maintenance addressed in the SWPPP? [part IV .E]
f. Are pollution prevention management measures addressed in the SWPPP? [Part IV.F]
g. Is final stabilization addressed in the SWPPP? [part IV.G]
h. If an environmental review was required, did you incorporate all storm-water related
miti ation measures contained in the review into the SWPPP?
STOP if you responded no to any question above. A SWPPP must be developed prior to submitting a permit application.
Complete the above requirements and check yes before submitting this application. Continue if you responded yes or na
to all uestions above.
A-ALBEV 0409
fXIYes DNo
fXIYes DNo
fXIYes DNo
fXIYes DNo
fXIYes DNo
fXIYes DNo
fXIYes DNo
fXINA Dyes DNo
2. Discharges to Special Waters
Mark NA if no discharges described below will occur.
a. Are all storm-water discharges that may flow from the project to a Special Water that is fXINA DYes DNo
located within 2,000 feet of any project discharge points addressed in the SWPPP to meet
the ermit conditions. in A endix A, Part A-C?
STOP if you responded no. Complete the above requirements and check yes before submitting this application. Continue
if ou res nded es.
3. Additional Application Review
a. Will the project include alternative treatment methods? [part m.C.5]
If yes. this application and the alternative treatment plans must be submitted a minimum of 90 days before construction starts.
b. If yes, are the plans attached?
c. Will the project disturb 50 acres? AND Is there a discharge point within 2000 feet of an impaired or
special water whose discharge may reach an impaired or special water listed in Appendix A of the
permit? [part II.B .1.b ]
If yes, this application and the SWPPP must be submitted a minimum of 30 days before construction starts.
d. If yes, is the SWPPP attached?
4. Application Fee
Is the required $400 Application Fee enclosed?
wq-stnn2-57
100
Dyes f81No
DYes DNo
Dyes fXINo
Dyes DNo
fXIYes
August 2003
f
2004 Prairie Run
5. Project Name
6. Dates of Construction 06/01/04
a. Construction Start Date
06/30/05
b. Estimated Completion Date
7. Project Location
5020 J aSOD Avenue NE, Northwest of Intersection of CSAH 18 and CSAH 19
Site Address Actual location
Albertville
Indicate general location description ifno address is available. Do not use a P.O. Box.
Albertville
City or Township
Albertville
MN 55301-0009
State Zip Code
All cities where construction will occur
Wright
All counties where construction will occur
All townships where construction will occur
8. County Parcel ID # 101500024403, 101500024404,
101500024405, 101034001010
Attach list if necessary
10. Project Map
11. Project Type
12. Cumulative
Impervious
Surface
13. Permanent
Storm-water
Management
14. Receiving
Waters
Name of Water Body
9. Project Size
38 Acres
Number of acres to be disturbed
Is the required 8 Yz x II" United States Geological Survey (USGS) 7.5 minute quad or ~Yes
equivalent map indicating site boundaries attached?
[8J Residential
~CommercialJIndustrial
D Road Construction
D Other_
a. Existing area of impervious surface
o
(to the nearest quarter acre)
b. Post construction area of impervious surface 7.8 (to the nearest quarter acre)
H new impervious surface created by the project is less than one acre, skip to question 14.
What types (check all that apply) of permanent storm-water management will be used if more than one
acre of new impervious surface is created by the project? [Part m. C]
~ Wet Sedimentation Basin 0 Infiltration/Filtration D Regional Ponding
o Alternative Methods (!fusing alternative methods, construction cannot corrunence until receiving approval from the MPCA.)
Identify surface waters within ~ mile of project boundary that will receive storm water from the site or
discharge from permanent storm-water management system. Include waters shown on USGS 7.5 minute
uad or e uivalent and all waters identified in A endix A of the ermit. Add additional a r if needed.
Appendix A
Type (ditch, pond, wetland,lake, stream, river) S ecial water?
Wright County Ditch No.9
Ditch
Dyes IZINo
DYes DNo
DYes DNo
Dyes DNo
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August 2003
)
..
15. Owner
City of Albertville
41-1252624
9766764
Business or Finn Name
Kruse Larry
Last Name First Name
5975 Main Avenue NE, PO Box 9
Mailing Address
Middendorf
Federal Tax ID
State Tax ID
763.497.3384
City Administrator
Title
E-mail
Albertville
City
Telephone (include area code)
~ 55301-0009
State
Zip Code
763.497.3384
John
Alternate Contact Last Name First Name
E-mail
Telephone (include area code)
I certify under penalty oflaw that this document and all attachments were prepared under my direction or supervision in accordance with a system
designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons
who manage this system, or the persons directly responsible for gathering the information, the information is, to the best of my knowledge and belief,
true, accurate and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and
imprisonment for knowing violations.
I also certify under penalty of law that I have read, understood, and accepted all terms and conditions of the NPDESISDS General Storm-water
Permit Construction Activity (MN RI ??oo1) that authorizes storm-water discharges associated with the construction site identified on this form.
~~ ~~ S-17- 041 .
Authorized Signature ~ Date
This Application must be signed by:
· Corporation: a prindpal executive officer of at least the level of vice-president or the duly authorized representative or agent of the executive officer if the
representative or agent is responsible for the overall operation of the facility that is the subject of the permit application.
· Partnership or Sole Proprietorship: a general partner or the proprietor.
· Municipality, State, Federal or Other Public Agency: principal executive officer or ranking elected official.
16. Contractor
IJbt,<<-~ F~&/'~13'i'c,_ ;::~
Business or Finn Name
(9~~
First N e
4{-/~ lrrO
Title
37/3/U
Federal Tax ID State Tax ID
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T . E-mllll . Telephone (mclude area code)
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City r State Zip Code
Sit ~'L Tz. to ~1iUf\-:' ~ .e.d--
E-mail
7b l-~Cf 7 -'2...~ lY
Telephone (include area code)
H/Iv.....
Last Name
tJ-~
J>Q gov z..r~
Mailing Address
t(~f.,-
Alternate Contact Last NlIlDe
)l bif
First NlIlDe
I certify under penalty oflaw that this document and all attachments were prepared under my direction or supervision in accordance with a system
designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons
who manage this system, or the persons directly responsible for gathering the information, the information is, to the best of my knowledge and belief,
true, accurate and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and
imprisonment for knowing violations.
I also certify under penalty of law that I have read, understood, and accepted all terms and conditions of the NPDESISDS General Storm-water
Permit for C nstruction Activity (MN RI 00001) that authorizes storm-water discharges associated with the construction site identified on this form.
12..-0 '{
Authorized Signature Date
This Application must be signed by:
Corporation: a principal executive officer of at least the level of vice-president or the duly authorized representative or agent of the executive officer if the
representative or agent is responsible for the overall operation of the facility that is the subject of the permit application.
· Partnership or Sole Proprietorship: a general partner or the proprietor.
· Municipality, State, Federal or Other Public Agency: principal executive officer or ranking elected official.
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August 2003