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Home My WebLink About2005-08-11 MPCA Stormwater Permit for Construction Activity ApplicationThis form is for new permit applications only. Existing lxrmittees must use ,ppliCcrti(rr1 /err Permit Mrrls /er/M(r(11tic atior1 10 transfer a permit to one party 01" Su /)th •isiOrr Re,i,\tr<aticrrr for multiple parties. Minnesota Pollution Control Agency h. c. d. e. f. g- h. 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 A 1/(.\ rr!eonly Check k 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 8()() -646 -- -6247 (in Minn.) for assistance. [ElYes El Yes EYes ZYes EYes El Yes EYes EINA LIjYes Permit Application Prerequisites 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 III.A] Are erosion prevention measures addressed in the SWPPP? [Part IV.B] Are sediment control measures addressed in the SWPPP? [Part IV.C] Are dewatering and basin draining addressed in the SWPPP? [Part IV.D] Are inspections and maintenance addressed in the SWPPP? [Part IV.E] Are pollution prevention management measures addressed in the SWPPP? [Park. IV.F] Is final stabilization addressed in the SWPPP? [Part IV.G] If an environmental review was required, did you incorporate all storm -water related mitigation 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 questions above. �No LNo LNo LJNo LINo LINo LINo LjNo 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 ®NA []Yes LNo located within 2,000 feet of any project discharge points addressed in the SWPPP to meet the ermit conditions in Appendix A, Part A -C? STOP if you responded no. Complete the above requirements and check yes before submitting this application. Continue i if you responded yes. 3. Additional Application Review a. Will the project include alternative treatment methods? [Part III.C.5] If yes, this application and the alternative treatment plans must be submitted a minimum of 90 days before construction starts. h. 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.I .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- strm2 -57 LlYes LIJYes LIYes LlYes EJNo ZYes ZNo E]No ZNo 1 of 3 September 20)3 Construction Activity Information 5. Project Name: Stillwater Motors — Parkingllluilding Expansion 6. Project Location: South of Hwy 36 and West of Hwy 5 Briefly describe where construction activity occurs - Example: Intersection of -45th Street and 1r ing Avenue. Inchide address r Oak Park Heights MN 55082 C or. To rnshhip County Parcel ID # .1rrac•lr list if neressol \- Oak Park Heights All cities where construction will occur Washington County All counties where construction will occur All townships where construction will occur 7. Project Size 8. Project Map 9. Project Type 10. Cumulative Impervious Surface 11. Permanent Storm- water Management 12. Receiving Waters wq- strm2 -57 4.5 Number of acres to be disturbed Is the required 8 1/2 x 1 I United States Geological Survey (USGS) 7.5 minute quad or ElYes equivalent map indicating site boundaries attached? ri Residential ®Commercial /Industrial [❑ Road Construction ❑ Other a. Existing area of impervious surface 2.25 (to the nearest quarter acre) b. Post construction area of impervious surface 3.25 (to the nearest quarter acre) If new impervious surface created by the project is less than one acre, skip to question 12. 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 III. C] El Wet Sedimentation Basin [21 Infiltration/Filtration ❑ Regional Ponding Elil Alternative Methods (If using alternative,nethrods, construction cannot commence until receiving approval fiOnr the ll/IPCA.) ❑ Other Specify reason and list other treatment allowed by Part 111. C Identify surface waters within 1/2 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 quad or equivalent and all waters identified in Appendix A of the permit. Add additional paper if needed. Appendix A special water? Name of Water Body Type (ditch, pond, wetland, lake, stream. river) Ditch LjYes [ZI No LIYes LINo LlYes DNo LjYes LINo 13. Dates of Construction August. 2005 a. Construction Start Date 2 of 3 State file Code November 2005 b. Estimated Completion Date rmr table September 2003 J Responsible Parties 14. Owner Stillwater Motors Business (U 1°1.11 Nam Timm Richard Last Name First mum, 5900 Memorial Ave. N Mailing. Address Erickson Todd Alternate Contact Last Name First Name 15. Contractor Last Name sy Mailing Address / Alternate Contact Last Name First Name wq strm2 - 57 Title I certify under penalty of law 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. 1 am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations. 1 also certify under penalty of law that 1 have read. understood, and accepted all terms and conditions of the NPDES /SDS General Storm -water Permit Construction Activity (MN R100001) that authorizes storm -water discharges associated with the construction site identified on this form. /4Z: Bus ess or Firm Name First Name Title Federal 1 !) s u„,, T.s s 11) 77/- 5 CO 651-439-4333 I�- r11ai1 Stillwater City Date E -mail Date 1041)11011C 1)11011c {irrc lrrd(' area c e MN 55082 City State Zip 2 code terickson @ffe- inc.com 651 --493- --8833 E-mail Telephone (include area code) Authorized Signature This .4pplicatiwt wrist be signed by: • Corporation: a principal executive officer" ()f at least the level of vice-president or the duly otrthor representative e or agent of the e.vecutrve officer if the representative or agent is responsible for the overall operation of the facility that is the ,subject of the permit crlrplrc•atinf. • Partnership or Sole Proprietorship : a general partner or the proprietor • Municipality, State, Federal or Other Public Agency: principal executive officer or ranking elected official. • a3a- Federal Tax ID State Tax ID //e e _47-7 E - Telephone (include area code) i`— SVFP State Zip Code 6:/77 Telephone (include area code) 1 certify under penalty of law 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. 1 am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations. 1 also certify under penalty of law that 1 have read, understood, and accepted all terms and conditions of the NPDES/SDS General Storm -water Permit for Constr tion Activity (MN R l 00001) that authorizes storm -water discharges associated with the construction site identified on this form. Authorized Signature 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: u general partner or the proprietor. • Municipality, State, Federal or Other Public Agency: principal executive officer or ranking elected official. 3 of 3 September 2003 ))*( • • 0. .0 it • • • Z-s • • ;{ • • 1 � oz 7,r 1 • • a' L ; r _r jl I I d rr r"\ i i ....--- ------, -- 6---. , , , ', ,_, ---------------' i -,,-- ('-: i .„ ,,-- -\., _____ ,_ ,_ --\_...„ . ,.., V • MOTORS TO THE MINNESOTA POLLUTION CONTROLA ORDER 520 LAFAYETTE ROAD NORTH ST PAUL MN 55155 4194 OF BUICK • CHEVROLET • JEEP • FAMILY OWNED SINCE 1922 • 5900 Stillwater Boulevard North • P.0. Sox 337 Stillwater, MN 55082 (651) 439 -4333 PAY **FOUR HUNDRED : DOLLARS AND OO /1OO NAME DATE 08/10/05 NUMBER DATE MINNESOTA POLLUTION CONTROL AGENCY APPLICATION FOR GENERAL STORM -WATER PERMIT FOR CONSTRUCTION ACTIVITY (MN R100001) ACCT# AMOUNT CTRL# DESC 72A 400.00 REMITTANCE ADVICE DETACH AND RETAIN STILLWATER MOTOR CO. STILLWATER, MN 55082 Wells Fargo Bank 7 CHECK# 57898 I Stillwater Office i ' 2000 Northwestern Avenue . 04g E Stillwater, MN 55082 . 57898 -,' AUTHORIZED SIGNATURE 08/10/05 AMOUNT STILLWATER MOTOR COMPANY $400.00 NP CHECK NO. 57898 NET AMOUNT $400.00 0