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Home My WebLink About2003-05-22 BRAA Ltr to MPCABonestroG MEM Rosene Anderlik & Associates Engineers & Architects May 22, 2003 Attention: Sanitary Sewer Extension Department Minnesota Pollution Control Agency 520 Lafayette Road St. Paul, Minnesota 55155 -4194 Re: Sanitary Sewer Extension Permit Application McKean Square Utility & Street Improvements Project City of Oak Park Heights File No. 55-03-129 We are transmitting the following for the aforementioned project: (1) copy (1) copy and Bonestroo, Rosene, Anderlik and Associates, inc. sfirmative Action /Equal Opportunity Employer and Employee Owned . Principals: Otto G. Bonestroo, P.E. • Marvin L. Sorvala, P.E. • Glenn R. Cook, P.E. • Robert G. Schunicht, P.E. • Jerry A. Bourdon, P.E. • Mark A. Hanson, P.E. Senior Consultants: Robert W. Rosene. P.E. • Joseph C. Anderlik, PE. • Richard E. Turner, P.E. • Susan M. Eberlin, C.P.A. Associate Principals: Keith A. Gordon, P.E. • Robert R. Pfefferle, P.E. • Richard W. Foster, P.E. • David 0. Loskota, RE. • Michael T. Rautmann, P.E. • Ted K. Field, P.E. ■ Kenneth R Anderson, P.E. • Mark R. Rolfs, P.E. • David A. Bonestroo, M.B • Sidney P. Williamson, P.E., L.S. • Agnes M. Ring, M.B.A. • Allan Rick Schmidt. P.E. • Thomas W. Peterson, RE. • James R. Maiand, RE. • Miles B. Jensen, P.E. • L. Phillip Gravel III, P.E. • Daniel J. Edgerton, P.E. • Ismael Martinez, RE. • Thomas A. Syfko, P.E. • , Sheldon J. Johnson • Dale A. Grove, RE. • Thomas A. Roushar, RE. • Robert J. Devery, P.E. Offices: St. Pau!, St. Cloud, Rochester and Willmar, MN • Milwaukee, WI • Chicago, IL Website: www,banestroo.com Design Certification Form Permit Application and Transmittal For Permit application fee of $240.00 Please review, comment upon and approve these plans and specifications. The proposed sanitary sewer extension conforms to the Municipality's Comprehensive Sewer Plan, which has been submitted to the Metropolitan Council Environmental Services (MCES) for approval. By copy of this letter, we are transmitting one copy of the Transmittal Form, one copy of the Design Certification for Sanitary Sewer Extension Plans and Specification Form to the Metropolitan Council Environmental Services. Sincerely, BONESTROO, ROSENE, ANDERLIK & ASSOCIATES, INC. / I, It ' e. Laurie A. Elmstrand cc: Roger Danzig, MCES w /permit application sheets Eric Johnson, City of Oak Park Heights Karen Erickson, Bonestroo Bonestroo Job File 2335 West Highway 36 m St. Paul, MN 55113 g 651-636-4600 g Fax: 651 - 636 -1311 C2) PERMIT APrL,ICATION and TRANSMITTAL FvadVl for Minnesota SANITARY SEWER EXTENSIONS Pollution Control Agency AND /OR CHANGES NEW process for 2002! COMPLETE APPLICATION BY PRINTING OR TYPING. PLEASE MAKE A PHOTOCOPY FOR YOUR RECORDS. 1. Title of Project (Plans and Specs): McKean Square Utility and Street Improvements Developer /Owner: City of Oak Park Heights Developer /Owner Address: 14168 Oak Park Blvd, PO Box 2007 City: Oak Park Heights State: M Zip: 55082-3007 2. Permittee: City of Oak Park Heights County: Washington 3. Wastewater Treatment Facility (WWTF): Flow to Stillwater Is the proposed sewer project in accord with the City or District Comprehensive Sewer Plan? 4. Specification of Current WWTF 1) Average wet weather design flow (AWW) 2) Annual average daily flow (past 12 months) 3) Average design flow (if AWW not available) 4) Annual average influent CBOD5 (past 12 months) Basis for estimate: SF, Du lei, tri lex at 200 allunitlda , Inde endent livin 1001 allu 'stimated BOD 5 Increase Initial Project: 79 # /day Basis for estimate: total number of units x 0.51 lbs /day /unit 8. Nature of Area to be Served by the Proposed Project Residential: Number of New Homes: 77 Commercialllndustrial (Describe): Other (Describe): 78 Units - Independent living 9. Technical Agent or Consulting Engineer: Karen S. Erickson Name of firm or organization: Bonestroo, Rosene, Anderlik & Associates, Inc. Mailing Address: 2335 West Hgihway 36, St Paul MN 55113 Phone: _651) 636 -4600 Name of the Project Reviewed in EAW: Responsible Governmental Unit: Date of the negative declaration: Number of Existing Homes: 11. Determination for the need of an EAW: Is the ultimate design flow for the proposed project greater than 1,000,000 gpd? El Yes No 5, the preparation of an EAW is mandatory for this project. [E] Yes ❑ No Ultimate: 302 56 Title: Project En inee Fax: (651) 636-1311 MPCA:USE ONLY Application Number Month... Check # Date. Received a Year Date: Date: Phone: (651) 439 -4439 Contact person: Jay Johnson- Public Works Dir. Title: Phone: (651) 439-4439 5. Estimated Flow Increase Initial Project: 0.023 MGD Ultimate: 0,09 MGD # /day MGD MGD MGD mg/L 7. Location of Proposed Project : Facility is located in the SE quarter of the NW quarter of section 5 Township of Wash County Township #: 29 Range #: 20 East or West: East City: Oak Park Hei :hts State: MN Zip: 55082-2007 Address (or nearest intersection): 10. Has the project been reviewed in a previous Environmental Assessment Worksheet (EAW)? 0 Yes ® No If yes, note the name of the project reviewed in the EAW, the responsible governmental unit, and the date of the negative declaration: Permit Application and Transmittal Form for Page 1 of 2 JAN 02 Sanitary Sewer Extensions and/or Changes (sewer- ext- application02.doc) CERTIFICATION AND SIGNATURE .ederal regulations (Section 309(c)(2) of the Clean Water Act and State regulations (Minn. R. 7001.0070) require the authorized er to be one of the following: A. For corporation, a principal executive officer of at least the level of vice president; B. For a partnership or sole proprietorship, a general partner or the proprietor, respectively; or C. For a municipality, State, Federal, or other public facility, either a principal executive officer or ranking executive official. D. if the operator of the facility is different than the owner, both the operator and the owner according to items A to C. "I certify under penalty of law that this document and all applicable design documents were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person, or persons, who manage the system, or those persons directly responsible for gathering the information, the information submitted 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." PRINTED NAME AUTHORIZED SIGNATURE PRINTED NAME AUTHORIZED SIGNATURE PRINTED NAME &UTHORIZED SIGNATURE Karen S. Erickson STATE TAX I.D. # 7983042 -000 REMEMBER! (AUTHORIZED CITY REPRESENTATIVE) TITLE TITLE (ENGINEER) DATE DATE Reg No. 25428 FEDERAL TAX I.D. # 41- 0941681 DATE 4 57.- e DO NOT submit plans and specifications with this application unless required! You must first complete the form and checklist titled: Certification for Sanity Sewer Extension Plans and S ecifications to determine if plans and specifications need to be submitted. • No project construction may begin until you are in receipt of the required permit(s) issued by the MPCA and as defined by law under Minn. Stat. § 115.07, subd.3. • The project information packet you submit must contain ALL of the following items or it will be immediately returned: 1. This completed and properly signed Application Form. 2. The completed form and checklist titled: Desi n Certification for Sanity Server Extension Plans and S ecifications. 1 Plans and specifications (ONLY if required). 4. The required application fee ($240). Please make your check payable to the Minnesota Pollution Control Agency. • Forms are available on the MPCA's web site at: www.pca.state.mn.us. You can also contact the MPCA's Customer Assistance Center at (651) 297 -2274 (Metro or outside MN) or toll free at (800) 646 -6247 to request forms or ask questions. Send the project information packet to: Minnesota Pollution Control Agency, 520 Lafayette Road, St. Paul, Minnesota, 55155 -4194 ATTN: Sanitary Sewer Extensions, REM, Metro. Permit Application and Transmittal Form for Page 2 of 2 JAN 02 Sanitary Sewer Extensions and/or Changes (sewer- ext- application02.doc) Pern ittee: City of oak Park Hex hts Title of Plans and Specifications: McKean Square Utility and Street Improvements Location of Project (major intersection): Year All sanitary sewer extensions shall be recommendations, specifications, and documents) : Recommended Standards for Board of State and Provincial Standards) Standard Utilities Specification, Design Flow and Loading Determination designed guidelines Wastewater Public according to the latest version of the following (specific MPCA guidelines take precedence over other Facilities, Great Lakes -- Upper Mississippi River Health and Environmental Managers. (Ten States City Engineers Association of Minnesota. Guidelines, Minnesota Pollution Control Agency MPCA USE ONLY Application Number SE# Date Received Month Day • Year Fast Track? YES NO Minnesota Pollution Control Agency Design Certification for Sanitary Sewer Extension Plans and Specifications Past Track Review Process • Answer questions no. 1-44 below • If both questions no. 23 and 46 are answered YES or NA: • sign the Fast Track Certification Statement if applicable; • attach this completed form to the Sanitary Sewer Extension Permit Application; and • do not submit plans and specifications (plans and specifications for some projects may be required to be submitted for review as part of a random audit to verify compliance with applicable standards). Detailed Review Process This .rocess ma re wire additional time for corn. . letion Answer questions no. 1 -44 below If either question no. 23 or 46 are answered NO: • do not sign the certification statement below; • sign the Statement for Detailed Review; • attach a copy of this completed form to the Sanitary Sewer Extension Permit Application; • provide justification for not following the specified recommendations; and • submit plans and specifications for review and approval. Design Certification for Sanitary Sewer Extension Page 1 of 6 JAN 02 Plans and Specifications Form (design- cert- san- sewer.doc) Design Flow: 1. What is the per capita per day design flow? 100 gal /cap /day Is the design flow greater than 75 gallons per person per day? Yes 4. What is the • eak hourly wet weather flow desi • eakin ; factor? 3.5 Sewer Pipe: Yes No NA • ❑ 5. Are all sewers designed without an overflow or bypass point? 1Z El El El Ei 71 El E C IZ C C [I] no pressure sewers) the sewer? ;'A x 1 . If the design flow is less than 100 gallons per person per day, is the total based on an analysis of actual existing per capita flow to the treatment facility? (Answer NA only if the per capita flow is 100 gallons per persons per day or more.) What is the per capita design flow? NA Lil 6. Are all gravity sewers at least 8 inches diameter? (Answer NA only if there are no gravity sewers) 7. Are all sewers sufficiently deep to receive wastewater from basements and to prevent freezing or is insulation provided for sewers that are not placed at a depth to prevent freezing? . If there are sewers that cross or enter any water body, has the Department of Natural Resources been contacted to determine if they will require a permit for construction? (Answer NA only if there are no sewers located in a water body? . Do the design plans and specification contain specific size and location requirements for reaction blocking or pipe restraint to withstand water hammer and other cyclic reversal of stresses associated with lift station operation? (Answer NA only if there are no gravity' sewers) C 10. Is there an air relief valve shown at all high points in force mains? (Answer NA only if there are � C • 11. Are grinder pumps or other solids removal equipment included for any force main that is less than 4 inches in diameter? (Answer NA only if there is no pressure sewer) 12. Are all sewers designed with mean velocities when flowing full, of at least 2.0 feet per second, based on Manning's formula using and "n" value of 0.013? 13. Is the slope of 8-inch diameter gravity sewer at least 0.40 %; 10 -inch diameter sewer at least 0.28 %; 12 -inch diameter sewer at least 0.22 %; 14-inch diameter sewer at least 0.17 %; 15 --inch diameter sewer at least 0.15 %; 16 -inch diameter sewer at least 0.14 %; and 18 -inch diameter sewer at least 0.12 %? The pipe diameter and slope shall be selected to obtain the greatest practical velocities to minimize settling problems. Oversizing sewers to achieve flatter slopes should not be done. If proposed slopes are less than those listed above, what is the depth of flow and velocity of flow at the average wet weather flow and peak hourly wet weather flow for affected pipe sections? AWW flow (mgd) = Depth of flow = (ft.) Velocity = (fps) PHWW flow (mgd) = . Depth of flow = (ft.) Velocity = (fps) If sewer grades are less than those listed above, sedimentation problems, frequent sewer maintenance, and backups may result. All sewers with a slope less than the minimums listed above be cleaned at least once per year to ensure problems to not develop and to develop a site specific maintenance interval. C 14. Are individual service connections to the sewer designed to be water tight and do not protrude into 15. Are all sewer pipes and water supply pipes separated horizontally by at least 10 feet and vertically by at least 1.5 feet? El ❑ IT 16. Are all manholes at least 48 inches in diameter? (Answer NA only if there are no manholes.) C 17. Are all manholes constructed to prevent surface water run off from entering through the cover? • 18. Are drop manholes used at locations where the sewer pipe enters the manhole at an elevation of 24 inches or more above the manhole invert? (Answer NA only if sewer pipes enter at an elevation less than 24 inches) Design Certification for Sanitary Sewer Extension Page 2 of 6 JAN 02 Plans and Specifications Form (design- cert- san- sewer.doc) n LI Lik14,L4 61V1 f.LAA4l .....4i11LV11L4iLVV l ,..1.i. W.LLLIVI ALL.; ■ L L.LLVVVLI L4• L44.4V41 414.4 .,1 L1VL.4111A1C ►1,11.iLt.J111Viiii LAALi1 VL1.1.1 accommodate the spacing? EI ® E L ❑ ❑] 20. 21. Will a leakage test be performed to demonstrate watertightness of the sewer and manholes? What test method will be used? Will a deflection test be performed on all plastic gravity sewer after the pipe has been in place for at least 30-days? El FT L:I 22. Will sewer line televising be performed? (Answer only as YES or NA) El El ❑ 23. Have questions #5 through #22 been answered as YES or NA? Lift Stations: 31 Yes No NA Does the project include any work on a lift station? ((LINO, go to question No. 46 and answer NA) ll Z i::i • ❑ 24. Will the lift station be fully operational and accessible during a 25 year flood? LI LI 25. Will the lift station structural, electrical and mechanical equipment be protected from physical damage during at 100 year flood? ii:i ❑ LI 26. Where high ground water conditions are anticipated, has the buoyancy of the lift station structure been considered and adequate provisions made to protect the structures? (Answer NA only if high ground water conditions are not anticipated.) ri [1 ❑ 27. Are wet wells and dry wells completely separated and common walls are gas tight? (Answer NA only if no dry well is included) LI LI 28. Are multiple pumps provided such that with any unit out of service, the remaining units have capacity to handle the design peak hourly wet weather flow? n LI 30. Are all pump suction and discharge openings at least 4 inches in diameter? Ell ❑ 31. Are all electrical components in raw wastewater wet wells in compliance with National Electrical Code requirements for Class 1 Group D, Division 1 locations? ri ❑ 32. There are no bypass or overflow pipes from the wet well? LI LI 31 Are suitable shutoff and check valves placed on the discharge line of each pump? LI ❑ 34. Are check valves located between the shutoff valve and the pump? ❑ LI 35. Are check valves placed in the horizontal position, except ball valves which may be placed vertically? ❑] ❑ 36. Are shutoff and check valves for submersible pump lift stations located in a separate valve pit? If a separate valve pit is not provided, are all valves easily accessible for maintenance? L:I ❑ i::i 37. If a drain line is provided between a valve pit or dry well and a wet well, is the drain line equipped with a gas and water tight valve or extended below the low water level in the wet well to prevent entry of hazardous cases to the valve pit? (Answer NA only if a drain line is not included) T fl 38. If continuous wet well ventilation is provided, are at least 12 complete air changes per hour provides? (Answer NA only if submersible pump lift station) ❑ ❑ L 39. If intermittent wet well ventilation is provided, are at least 30 complete air changes per hour provided? (Answer NA only if submersible pump lift station) E ❑ 40. If continuous dry well ventilation is provided, are at least 6 complete air changes per hour rovided? Answer NA onl if sub mersible urn lift station) n Lil ❑ 41. If intermittent dry well ventilation is provided, are at least 30 complete air changes per hour for 1 r it rilitPe nr-tri C'rIrr1111PtP air rhan r,Pr hn71r fhPrPaffPr nrnvir1PrA9 (Answer NA nri1V if c11hniersiNt. Sewer Pipe (Continued): Yes No NA ❑ 19. Is the spacing between manholes 400 feet or less or if the spacing is greater than 400 feet, do 29. Are all humps ca able of passing spheres of at 3 inches in diameter? Design Certification for Sanitary Sewer Extension Plans and Specifications Form (design- cert- san- sewer,doc) pump lift station) Page 3 of 6 JAN 02 Lift Stations (Continued Yes No NA E 42. Are provisions for flow measurement provided? Type: 1 ❑ C ❑ 43. Are a sufficient number of running time meters provided to record when each pump is running and when multiple pumps are running at the same time? LI 44. Is an appropriate alarm system provided to indicate power failure, pump failure, unauthorized entry, or other malfunction? Type of alarm: 45. Are provisions included for emergency operation to prevent the bypassing or backup of sewage? Emergency pumping capability may be accomplished by connection to at least two independent utility substations, or by provision of portable or in -place electrical generation, or by portable pumping equipment? Type: n C 46. Have questions #24 through #46 been answered as YES or NA? Design Certification for Sanitary Sewer Extension Page 4 of 6 JAN 02 Plans and Specifications Form (design-cert-san-sewer.doc) signature: Date: List of standards, specifications, Section Number and guideline not complied with (attach additional pages if n.eeded): Justification for variation Fast Track Certification Statement (Do not submit plans and specifications) "I have answered Checklist items No. 23 and No. 46 above as YES or NA and I hereby certify under penalty of ,w that the design plans and specifications for this project conform to all of the requirements listed above. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment. I hereby certify that this plan, specification, or report was prepared by me or under my direct supervision and that I am a duly Licensed Professional En :ineer under the laws of the state of Minnesota. R Signature: itAbo Date: Address: 2335 west Hwy 36, St Paul MN 55113 Statement for Detailed Review (Plans and specifications must be submitted) Typed or Printed Name: Karen S. Erickson Registration Number: 25428 Phone Number: (651) 604 -4788 "I have answered NO to Checklist item No. 23 or No. 46 because the design does not conform with all of requirements in the above listed standards, specifications, and guidelines" Design Certification for Sanitary Sewer Extension Plans and Specifications Form (design- cert- san- sewer.doc) Page 5 of 6 JAN 02 5-14-03 55-03-129 CITY 7 OAK PK HL'1 ,AMNIC P,..„„ANIMMW@N.N.W7= ... 240400 11e, � onestroo; ��ose , ssoc ates � Inc::; X33.5 ::W Highway. St. Paul, MN 55113 Pa r 5-15-03 erll *' *. ** *. * *: * *: * * *.* *• *. *: ** 53 060 ,`''Y ; - . IE MP CA ORDER 520 Lafayette Road North OF St. Paul, N s55155-4194 PLEASE DETACH THIS PORTION AND RETAIN FOR YOUR RECORDS. Elbe State 'Bank ENERAL ACCOUNT �:.Pau :.M 5510 240.00 �i uu.dre DATE 2003 II1 5 30 6❑IIm 1 :0 9 60007 5 Si: 08 5 or CHECI .N.C: }: M 53060• °liars 240.00 *****• 240.00 • Bonestroo MEM Rosene In Anderlik & Associates Engineers &Architects May 22 2003 Mr. Brian Noma Minnesota Department of Health Division of Environmental Health Section of Drinking Water Protection 121 East Seventh Place, Suite 220 St. Paul, MN 55101 (2) copies (2) copies (l) original and the Very truly yours, dziz Laurie A. Elmstrand Bonestroo, Rosene, Anderlilc and Associates, Inc. is rmative Action /Equal Opportunity Employer and Employee Owned Principals: Otto G. Bonestroo, RE. • Marvin L. Sorvala, PE.. Glenn R. Cook, P.E. • Robert G. Schunicht, P.E. • Jerry A. Bourdon, RE. • Mark A. Hanson, P.E. Senior Consultants: Robert W. Rosene, P.E. • Joseph C. Anderlik, P.E. • Richard E. Turner, P.E. • Susan M. Eberlln, C. Associate Principals: Keith A. Gordon, P.E. • Robert R. Pfefferie, P.E. • Richard W. Poster, P.E. • David 0. Loskota, P.L. Michael T. Rautmann, P.E. • Ted K. Field, P.E. • Kenneth P. Anderson, P.E. • Mark R. Roffs, P.E. • David A. Bonestroo, M.B.A. Sidney P. Williamson, P.E., .L.S.. Agnes M. Ring, M.B,A. • Allan Rick Schmidt, P.E. • Thomas W. Peterson, RE. • James R. Maland, P.E. • Miles B. Jensen, P.E. • L. Phillip Gravel III, RE. • Daniel J. Edgerton. P.E. • Ismael Martinez, P.E. • Thomas A. Syfko, P.E. • Sheldon J. Johnson • Dale A. Grove, P.E. • Thomas A. Roushar. P.E. • Robert J. Devery, RE. Offices: St. Paul, St. Cloud, Rochester and Willmar, MN • Milwaukee, WI • Chicago, IL Website: www.bonestroo.com Re: Health. Permit Application McKean Square Utility and Street Improvements Project City of Oak Park Heights File No. 55 -03 -129 We are transmitting the following for the project noted above. Please review, comment upon, and approve these plans and specifications: Plans Specifications Plan Review Fee Form #56 Permit Application Fee ($150) Upon approval, please forward the approved 'set of plans to: City of Oak Park Heights, Attention: Eric Johnson 14168 Oak Park Blvd, Oak Park Heights MN 55082 -3007 A copy of any correspondence may be directed to Karen Erickson of our office. BONESTROO, ROSENE, ANDElLIK & ASSOCIATES, INC. 0( d."2, cc: Eric Johnson, City of Oak Park Heights Karen Erickson, Bonestroo Bonestroo Job File 2335 West Highway 36 u St. Paul, MN 55113 u 651 - &36--4600 u Fax: 651- 636 -1311 Environmental Health Services Section 121 East Seventh Place, Suite 220 P.O. Box 64975 `. Paul, Minnesota 55164 -0975 X511215 -0836 Minnesota Relay Service (Greater MN) 1/800/627-3529 Minnesota Relay Service (Metro) 297 -5353 PLAN REVIEW FEE SHEET 2 sets of plans are required. If submitting plans via U.S. Mail, please use the above address. If submitting p lans via a courier service, etc., mail to the following address: Minnesota Department of Health Engineering Unit --- Plan Review 121 East Seventh Place, Suite 220 St. Paul, MN 55101 This application must be completed and fee submitted before the plans will be reviewed. "X" PROJECT TYPE (S) AND PILL IN TOTAL. FEE S IJ B MITTED . [X] Watermains [ ] Well [ 1 Pumphouse 1 Chemical Feed Treatment Plant (new) Treatment Plant (renovation) [ ] Storage (installation) [ ] Storage (coating) [ I Booster Station Total Fee Submitted AVAVVAVL\VAVL\VAVAVAVWAVAVAVAVLVAVL\VLWL\VAVAVA PLEASE TYPE OR PRINT THE FOLLOWING RE UIlZED INFORMATION. Is this a Drinking water revolving fund loan project? _.... Yes X No Name of Project: Project Location: Owner's Name: Owner's Address: abmitter's Name: Submitter's Address : Submitter's Telephone Number: 651 - 636 -4600 Office Use Only Plan No. Fee Deposit No. Deposit Date $ 150.00 Fees are additive for multiple $ 250.00 project types included on $ 150.00 one set of plans. $ 150.00 $1,000.00 $ 250.00 $ 300.00 $ 100.00 $ 150.00 150.00 Payable to Minnesota Department of Health McKean Square Utility and Street Improvements Oak Park Heights MN City of Oak Park Heights 14168 Oak Park Blvd, Oak Park Heights MN 55082 -3007 Bonestroo, Rosene, Anderlik & Associates, Inc. 2335 West Highway 36, St. Paul, MN 55113 . . „ . . ...... . . .. „ . ... 5714-03 55-03-129 CITY Bonestroo Rose & Associates Inc 1. 2335 West Highway 1 1 St. Paul', MN 551 • 5-15-03 53057 Mi'm 150.00 PLEASE DETACH THIS PORTION AND RETAIN FOR YOUR RECORDS. 9 D Ay • E MN Department of Health ri ORDER 121 East. Seventh Place 1 OF #220 L St. Paul, MN 55101 OAK PK HGT st Paul MN 55104-6338 GE NERALACCOUNT .:;. , mNflm@ NVOOE AMOUNT 53057 1:0 oEi SS? LP • 150.00 • 960 lars a HECK NO. 3 057' 0 • . • • 150.00 150.00 5••• *****150:,0 cents:, • , cf