HomeMy WebLinkAboutNotice of Termination / Permit Modification FormMittnesotaPollution 6Vot~ce of Termination/
' ~ ~'~_ ~ ~. Control Agency
520 Lafayette Road North Permit Modification Form
St Paul, MN 55155-4194
NPDES Constrtaction Stormwater Permi# ProSram
Transfer or terminate your National Pollutant Discharge ENrrdnation System (NPDES} Construction Stormwater hermit. Allowable
changes are pemtit lerrrrinsrtion and permit transfer for all or a portion of the site. This bun n~olaces the Notice of Termination
(NOT), Penult Transfer, Permit Modification, and Sutxtiviaion Registration forms used under the farrrrer pemtit.
Instrudtions for this form are located on the In6emet at http://www.pca.state.mn.us/publications/wq-strm2-60i.pdf.
Form will bs invalid and returned to sender unless the checkbox associated with the applicable actions Is checloed and the
corresponding signature is provided iri section A-t, A 2, A-3, and or A~1.
Please submit to: Constwtlon 8tormwater Permit Program
Minnesota Pollutlon Control Agency
520 Lafayette Road North
St. Paul, Minnesota 55155.4184
Existing Permit Identification
a. Current permit lD: CQl>D 2 ¢ ~ 4 / or SUBOO - - - - -
b. Project name: Columbia Hei hts Public Safe Center
Projea bcation: 1125 41a Avenue NE
Columbia Height MN 135421
BrieBj- describe (ha oorrab~Norr actrlARy occurs (farexampple: MtersecUbrr ~45Nr St. end Arre.). Includb address A-avaiEl9aWe.
Select option 1, 2, or 3
1. Dice oti Terrlnination (NOT)1br entire site aY existin8 owner
Select this option when a project has achieved final stabilization with existing owner / contractor and no part of the site ~
being transferred to a new owner and ell oonstrudton activity is complete.
c. ® Notice of Termination for entire wistir~ permitted site or a subdivided site. (Current owner and contractor must sign under
the 'Cumerrt" Owner and 'CurreM° Contracfiar sections respectively).
Check above boot and sign section A-1 and A-2 on page 2.
Z. Transfer of entire site to never owner or contracttor (TransYer/iYiodificatlon)
Select this option if the enEh~e efts (~ by fire ID above) has either a new owner andior reeve general conMESCtor.
Check all the booaes below that apply.
d ^ New Owner for entire existing permitted site. f. ^ Current Owner for entire existing permitted site.
s. ^ New Contractor for entire existing pennirted site. g. ^ Cun~ent Contractor for entire existing permitted site.
Check above box(es) and sign section A-3 and A-4 pie 3 and or check abrnre box(es) and sign section A-t and A-2 page 2
8otir 'iCtrrront" anti 'WeNr' Parties »wst sign b`r/s IF?rm (prelfsrred), however, aepa-ate ibrms are acceptable.
S. Transfer o¢ a portion of a site to a new owner or contractor (Subdtvislon)
Select the option If a portion of a site (permitted under tl~e iD above} has either a new owner andfor new general
contractor. Check the boxes below ttrat apply,
h, Describe ~e portion of the site being transferred: Lot Block
Project Iocation/address:
City, State, and Zip:
EkampJ`: 3W quadrant of 48th Street acrd bvrng Avs~nua or Lola 1-47 of bMc~c 2a. inducts Nat araddreasss y are~p/s pr Inq~ a ~p
i. ^ New Owner for portion of existing site. k. ^ Cumerd Owner of the portion to be transferred.
J. ^ New Contractor for portion of wasting ails. i. ^ Current Contractor of tics portion to be transferred.
Gheck above box(es) and sin section A-3 and A-4 page 3 and or check above box(es) and sign section A 1 and A-2 page 2
Both °Current° and '9Vew" Parties must sign this ibrm (prrrfsr-ed), hoaasver, separate Dorms are acceptable.
www.pca.state.mn.us 651-296-6300 800-657-3ttW TiY 651-282.5332 or 80b•657.3864 AvaNatde in attemative formats
wiq•strmT-60 7/20/04
Ploge f of 3
Current Ov-lner Authorized Si;nature (A 1 j
BusinesslFirm name: City of Columbia Hekahts. MN
Last name: Fehst First reams: Walt Title:
E-mail address:
Telephone: _ X783) 708-3600 Ext.
Mailing address: 590 40s' Avenue NE
City: Columbia tfeiahts State: MN Zip code: 55421
Alternate contact:
Last name: Hansen Fkst name: fCsyin Title:
E-mail address: kevin.hansen columb~helohts mn us Telephone: _('783) 7t16-3800 Ext.
I certify under penalty of law that this document and all attachments were prepaned under my direction or supervision in accordance
with a system designed to assure that qualified personnel properly gather and evaluate the iettomtaflon submitted. Based on my
Inquiry of the person or persons who manage this system, or the persons direc8ly responsible forgathering the information, the
infomrafion is, b the treat of my knowledge and belief, true. accurate and complete. l am aware that there are slgNfrcant penalties
for submiaing false information, including the possibility of floe and imprisonment for knowing violations.
I also certify under penalty of Isar that I have read, understood, and aocepfed all terms and ~nditions of the National Pollutant
Discharge Elimination System (NPDES)/Stete Disposal System (SDS) General Stom~vuater Permit Construction Activity (MN
R100001) that authorizes stornwetter disctearges aesocaeted with the ocnntruction site identified on ihis form.
Authorized signaturo:
Date:
This AppPicatmn m~atbe slgrred by.• CorPoradon: a prlndpa/execuNere officer ofatleast die level of vlce~residerd or the duly-
authorized represenladue~ or agent of the executive officer if the represerrtathne or agerrt -s responsible for the overnll operation of
the Hratls the subject the pemddf applkMtlon. Partrtarah~ orSole Prop~orshfp: a general parbrer orthe prop-letor.
AAsnlclpallty, State, Fgalsral or Other Public ggency: prlncJpaf executive officer or ranking elected oti9clal.
Current Contractor Authorized Signature (A-Z)
BuslnesslFirm name: Landwehr Constnection. Ire.
last rmme: Dambroten First name: Gres~g Title: Project Manager
E-mail address: grestgd®landwehrconstruction.com Telephone: _(320) 252-1494 Ext.
Mailing address: PO Box 1088
City: St. Cloud Stab: MN
Altemab contact:
Last Hams:
E-mail address:
Zip code: 58302
Title:
Telephone: ( ) Ext.
I certify under penalty of law fleet this document aril ail attachments were prepared under my direedion ~ supervision in ac:oordance
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 dinsctly responsible for gathering the information, the
information is, fo the best of my knowledge and be8ef, true, accur~e, and complete. I am aware that there are significant panellise
for submlttir~ false information, including the possibi~ty of fins and Imprisonment for knowing violations.
I also certify under penalty of law that I leave read, understood, and accepted ail terms and conditions of the National Pollutant
Discharge Elimination System (NPDESNState Disposal Sysbm (SDS) General Stornwater Pemnit Constnxflon Activity (MN
R100001) that authorizes storpmn-ata~ischarge~ assge~ated wish the oonstrudion site IdeMlfled on this form.
Authorized signature: ~~1~~ _ ~- Date:
This AppBcation must be signed byr ~orpora8ton: a prtnapaf executive otlfcer of at least the level of vi'cey~residerrt or the duly
authorized repreeseMadw or agent of dre exeouMne olAcer if the representative or agent is responsible for the ousted operadvn of
the la~dity drat /s the srrbJect of the perm-Y spplrcation. P~uvrarshlp w So/s Proprletbrahlp: a general pardner or the proprietor.
A~Iun/clpelHy, Scats, Federal or Other PlrblM Aslency: primtipal executive ol9kaer or rar~ldirrg eledeai oflldal.
First name:
www.pca.state.mn.us 651.196-6300 800.657.3864 TTY 651-?.81.5332 or 800-657-3864 Available to altemattve formats
wq-strm2-60 • 7/20/09 ~ ] o f 3
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National Weather Service - Cl~+nate Data ,,~ Page 1 of 3
y ~ C71M1` V
~~ ~ °~ ~r~~, C~
Select Other Date ~]
These data are preliminary and have not undergone final quality control by the
National Climatic Data Center (NCDC). Therefore, these data are subject to revision.
Final and certified climate data can be accessed at the NCDC -
http://www.ncdc.noaa.gov.
Climate Report
000
CDUS43 KMPX 240710
CLIMSP
CLIMATE REPORT
NATIONAL WEATHER SERVICE CHANHASSEN MN
139 AM CDT WED SEP 24 2008
...THE TWIN CITIES MN CLIMATE SUMMARY FOR SEPTEMBER 23 2008...
CLIMATE NORMAL PERIOD 1971'TO 2000
CLIMATE RECORD PERIOD 1871 TO 2008
WEATHER ITEM OBSERVED TIME RECORD YEAR NORMAL DEPARTURE LAST
VALUE (LST) VALUE VALUE FROM YEAR
NORMAL
..................................................................
TEMPERATURE (F)
YESTERDAY
MAXIMUM 81 225 PM 90 1937 68 13 85
18 91
MINIMUM 64 441 PM 30 1983 48 16 54
AVERAGE 73 58 15 70
PRECIPITATION (IN)
YESTERDAY 0.61 1.20 1977 0.08 0.53 0.00
MONTH TO DATE 1.75 2.16 -0.41 4.28
SINCE SEP 1 1.75 2.16 -0.41 4.28
SINCE JAN 1 18.10 23.83 -5.73 27.36
SNOWFALL (IN)
YESTERDAY 0.0 T 1928 0.0 0.0 0.0
1942
1995
http://www.weather.gov/climate/getclimate.php?wfo--mpx 9/24/2008
National Weather Service - Climate Data
MONTH TO DATE
SINCE SEP 1
SINCE JUL 1
SNOW DEPTH
DEGREE DAYS
HEATING
YESTERDAY
MONTH TO DATE
SINCE SEP 1
SINCE JUL 1
0.0
0.0
0.0
0
0.0
0.0
0.0
0.0
0.0
0.0
0 8 -~ 8 0
65 115 -50 80
65 115 -50 80
65 142 -77 90
Page 2 of 3
0.0
0.0
0.0
COOLING
YESTERDAY 8 1 7 5
MONTH TO DATE 55 49 6 98
SINCE SEP 1 55 49 6 98
SINCE JAN 1
................ 773
................ 689
................. 84
....... 1026
..........
WIND (MPH)
HIGHEST WIND SPEED
HIGHEST GUST SPEED
AVERAGE WIND SPEED
SKY COVER
POSSIBLE SUNSHINE MM
AVERAGE SKY COVER 0.9
33 HIGHEST WIND DIRECTION
41 HIGHEST GUST DIRECTION
13.3
WEATHER CONDITIONS
THE FOLLOWING WEATHER WAS RECORDED YESTERDAY.
THUNDERSTORM
HEAVY RAIN
RAIN
LIGHT RAIN
FOG
HAZE
RELATIVE HUMIDITY (PERCENT)
HIGHEST 87 500 PM
LOWEST 54 300 PM
AVERAGE 71
THE TWIN CITIES MN CLIMATE NORMALS FOR TODAY
http://www.weather.gov/climate/getclimate.php?wfo--mpx
W (270)
W (260)
9/24/2008
National Weather Service -Climate Data
NORMAL
MAXIMUM TEMPERATURE (F) 68
MINIMUM TEMPERATURE (F) 48
SUNRISE AND SUNSET
SEPTEMBER 24 2008.....SUNRISE
SEPTEMBER 25 2008.....SUNRISE
RECORD YEAR
89 1935
31 2000
Page 3 of 3
703 AM CDT SUNSET 706 PM CDT
704 AM CDT SUNSET 704 PM CDT
- INDICATES NEGATIVE NUMBERS.
R INDICATES RECORD WAS SET OR TIED.
MM INDICATES DATA IS MISSING.
T INDICATES TRRCE AMOUNT.
The U.S. Naval Observatory (USNO) computes astronomical data. Therefore, the NWS does
not record, certify, or authenticate astronomical data. Computed times of sunrise, sunset,
moonrise, moonset; and twilight, moon phases and other astronomical data are available
from USNO's Astronomical Applications Department (http://aa.usno.navy.mil). See
http://aa.usno.naw.mil/faq/docs/lawyers.php for information on using these data for legal
purposes.
http://www.weather.gov/climate/getclimate.php?wfo=mpx
9/24/2008
n
Owner:
General Contractor:
City of Columbia Heights, MN
Landwehr Construction., Inc.
Project Name: Columbia Heights Public Safety Cente CSW
Identification Number: 000026341 ~ ~ Au ust 22 2008
Date Issued
If you have questions regarding the storm water program for construction activity, please access
the MPCA's storm.water site at http://www:pca.state.mn.us/water/stormwater/index.html, or~call
the MPCA's Customer Assistance Center_at 651-297-2274 or toll free at 800-646-6247.
The Construction site identified below is covered under the National Pollutant Discharge ~ i
"~ Elimination System General Permit (MNR100001) and is authorized by the Minnesota
Pollution Control Agency to discharge storm water associated with construction activities.