Benedictine Application and Plans.pdf

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5. RICE CREEK WATERSHED DISTRICT PERMIT APPLICATION Permit Fee (Check all that apply) Rule C (Stormwater Management Plans): Rule F (Wetland Alteration): Single Lot,Single Family Residential Development 0 Exemption $250 ❑ Home,accessory structure,driveway $150 ❑ <1 acre of mitigation required $875 All Other Development 0 i to 5 acres of mitigation required $1,750 ❑ <1 acre impervious surface $i000 0 >5 to io acres of mitigation required $3,500 ❑ -Ito 2.5 acres impervious surface $2,000 ❑ >io acres of mitigation required $5,250 CI >2.5 to 5 acres impervious surface $3,500 0 Banking Plan $1,750 ❑ >5 acres impervious surface $5,000+$1,000/ac>5* Rule G (Bridge, Culvert Er Utility Crossings): *Capped at$io,000,round down to the nearest whole acre ❑ All projects $Soo Rule D (Erosion Control Plans): Rule I (Drainage Systems): ❑ <2.5 acres of land disturbance $ioo 0 Public Ditch Alteration Plan $Soo O 2.5 to io acres of land disturbance $25o Rule J (Appropriation of Public Waters): ❑ >io acres of land disturbance $Soo ❑ All RCWD regulated appropriations $o Rule E (Floodplain Alteration): Rule L (Variances): ❑ No mitigation required $o ❑ See District Permit Variance Guidance Policy 0 Mitigation required $ioo NOTE: Permit fee is the cumulative total of all individual aspects of a project checked above. Government entities are exempt from permit fees. Total Permit Fee: $ 3,750 Applicant Signature "I understand that,as the permittee, I am legally accountable to ensure compliance with terms and conditions of the permit. I understand that I am not authorized to begin the project until I receive the permit and the permit sign is posted on site. If the project is modified, I will obtain approval by the Rice Creek Watershed District before I continue with the project. I authorize the District,and its agents,employees,officers and contractors,to enter the worksite at all reasonable times until permit closure to inspect the work authorized hereunder,and to take any reasonable action to address existing or threatened discharge of sediments or other pollutants into waters or offsite." "I recognize that as the permittee, I will be responsible for site conditions and permit compliance until the permit is closed or transferred by written RCWD approval to a subsequent property owner. I confirm that the Applicant address stated on the front of this form is the official address to which all notices and correspondence relating to this application are to be addressed, unless the address of an authorized agent appears below. I certify that I have thoroughly read and understand the above information." Signature of landowner Date Print signer's name Benedictine Care Centers Company (if applicable) Title 24 LAND USE APPLICATION: 1101 BLACK OAK DRIVE, NEW BRIGHTON, MN 55112 FEBRUARY 14,2020