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Home My WebLink About2003-05-21 MNDOT Drainage Permit- LU6 MnmoT TP- 30795-0 (a - ot) 3 �Nt4 MINNE SOTA DEPARTME -N -- .- OF ` g APPLICATION FOR DRAINAGE PIs RNUT � J5 District Pet C-S. TJL RP. (Do NOT COMPLETE THIS S.EC,RrON F0 1- OF1 ICE USE o NLY.) ATTA CH.A SKETCH O F° TBE PROPOSED WORKAAD RE TYGN PD TR UAW 1HGHWAY. SUCII SKETCH SHALL BED RA W7V TO SCALE WREN REQUMED BY THE ENG. NEE.. PRINT GR TYPE APPLICATION. SIG.NEV SPACE PROVIDED. SUBAHT" TO EOC'AL OFFj'CE ( )F DTA DEPARTMENT OF TRANSPORTATION. APPLICANT TELEPHONE ADDRESS (Street, City, Stat zp) V HOC `� } a - _ j L4. AID` K PROPERTY OWNER TELEPHONE ADDRESS (Street, City, State, nip) - PARTY PERFORMING WORK TELEPHONE ADDRESS (street, City, State, Zip) :6414C-1k APPL4-CA- �orv'r LOC TION OF PROPOSED DRAINAGE WORK ' y� �? tY ro ty O a xx wa . c is X UWIZSbilp CouII TYPE OF DRAINAGE ° •Tile Outlet - -Open Ditch AREA TO DE DRAINED a - Parallel Installation ° -other 5 - co/zm 5qvvfz�-_ r Acres LEGAL DESCRIPTION OF PROPERTY (CIRCLE ONE) (SPECIFIC ROAD! INTF RSE+ :7107 d OR LANDMARK) Mile VS-E-W of 7� Y CASING SITE AND TYPE PIPE SIZE AND TYPE WORK TO START ON OR AFTER (Date) 4 ( .1 zoo:s i, We, the undersigned, herewith accept the terms and conditions of the permit req of the Commissioner of Transportation and agree to fully comply therewith to the satisfaction of the Minnesota Department of Transportation. It is agreed that no work in connection with this application will be started until the application is approved and the permit issued. It is further understood that this permit is issued subject to the approval of local city, village or borough authorities having - ,point supervision over said street or highway and subject to applicant's compliance with the rules and regulations of the Minnesota Environmental Quality Board and any other affected governmental agencies. WORK TO BE COMPLETE .9 ON ORB FORE 1 3 all claims for damages, actions or causes of action arising out of th� y work to be done herein and the continuing usage, constructing, reconstructin ttr aunts ininng and using of said drainage facility under this application and pens it for- con struc 7ionn. Dated this By Furthermore, except for negligent acts of the State, its agents and employees, the applicant or his agents or contractor shall assume A liability for, and save the State, its agents and employees, harmless from, any and Signature . . PERMIT NOT VALID UNLESS BEARING SIGNATURE AND NUMBER. AUTHORIZATION OF PERMIT SEE RE'V)W E SIDE FOR GENERAL INFORMA'ION AND REQUIREMENTS It is expressly understood that this permit is conditioned upon replacement or restoration of the trunk highway to its original Co dition or to a sans actory condition. In consideration of the applicant's agreement to - comply in all respects with the regulations of the Commissioner of Transportation covering such oper4ions, permission is hereby granted for the work to be performed as described in the above application, said work to be performed in accordance with sf ceiai fro v sions as hereby stated: SEE ATTACHED SPLCUL PROVISIONS Date All Work o Be Completed By A owed Mn/DOT Signature Date of Autharizec Sign: tore DISTRIBUTION DEPOSIT REQUIREMENTS DEPOSIT ' NFF Original to Area Maintenance Engu = ww'4o Deposit Required Cashier's Check # .Certified Applicant ` -Deposit Required in the Amount of Check # _. _Money Order # Subarea Supervisor Date Deposit Received Roadway Regulations Supervisor Deposit to he returned upon satisfactory completion of all work. DA WORK COMPLETED (The date when the work is completed must be reported to the local mDOT Roadway .Reg w1aatio Supervisor.) t'�l _ day of J�I . 20L/ A e ; 4:� Name -- Print or T e DO NOT WRITE BELOW THIS LINE Page 3 of 3 M -D -03 -688 C,S.8214 (T,,H,5) Denny Hecker The applicant, or their contractor, shall notify Mr. Keith Van Wagner, Mn/DOT Roadway Regulation Supervisor, at 651- 582 -1443 at least 48 hours prior to starting construction so State inspection may be arranged, and for approval of al( highway materials prior to them placement. All work authorized by this permit shall meet Mn/DOT specifications. This permit authorizes the applicant to install a storm sewer on the NE side of Nf;al Ave approximately $00 feet North of 58' St North in the city of yak Park Heights as shown on applicant's plan sheet(s). The applicant shall. provide in -house inspection at all times while working on trunk highway right of way. 4. The applicant shall furnish, install and maintain all required traffic control devices according to the Minnesota Field Manual on Temporary Traffic Control Zane. Layouts dated January 2001 (see web page @ www .dot.state.mn.us /trafficeng /), whip performing the construction authorized by this permit. If the temporary traffic control. zone is to remain in one place for more than 3 days or involves a detour, road closure or a situation where the typical layouts du not apply, the applicant shall prepare a specific Traffic Control Plan for approval by Mn /I)OT prior to start of any construction. All persons while performing authorized work on Mn /DOT Right of Way shall be rf.quized to wear a Mn /DOT approved High Visibility Safety Vest and Soft Capl�Iard I��. ±, Any authorized night work requires all personnel to wear a Mn/DOT approved ful.1 nigh safety suit (pants and jacket). It shall be the responsibility of the applicant to utilize the "Gopher State! ()nc Call" excavation notice system as required under Minnesota Statute Chapter 2116D, 4� hours prior to performing any excavation (Phone 651- 454 -0002 Twin Cities Metro Area _:)r Toil Free 1-800-252-1166). M- D enn y ( T . H , 5) The applicant shall contact the owners of the in -place utilities and make all arran:7ements for their relocation or revisions as required due to the construction authorizred by this permit. No material shah be deposited on the traveled roadway. The applicant shall., be responsible for the maintenance of all drainage structures covered. by this permit. All areas disturbed by the applicant shall, be restored with a minimum of 6" oj' topsoil (according to Mn/DOT Standard Specification 2105 Table 1 Topsoil. Borrow), then sodded or seeded. Seed or sod should be the same as /or compatible with the existing turf cover. If the areas are to be seeded, a Mn/DOT seed mixture comparable to the existing turf along with Type 1 Mulch and Disk Anchoring shall be used accordi:ag to Mn/DOT Specification 2575. The applicant shall perpetuate all. existing drainage. The applicant is required to preserve all existing survey monuments. If Mn /DOT determines that monuments have been disturbed or destroyed during construction activities, the applicant shall accept full responsibility for all costs incurred in the re- establishment of the monuments. It is expressly understood that this permit is issued subject to the app4cant's compliance with the Rules and Regulations of the Minnesota Environmental Quality hoard ( any other affected Governmental Agencies. Winter work shall be considered from Noveraber 1 through April 15, work during this period shall be on a day to day basis at the discretion of the lZoadway lZe�;ulation Supervisor. All work au "thorized by this permit and, the restoration of the State's right of w(ay .shall be satisfactorily completed by 1-1-04. The applicant or his contactor shall notify the permit office at 651 -582 -144.3 for final inspection.