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<br />. <br /> <br />State of Minnesota <br /> <br />. <br /> <br />Notice of Intent (NOI) <br /> <br />For Storm Water Discharges Associated With Construction Activities <br />Under A National Pollutant Discharge Elimination System <br />(NPDES) General Permit <br /> <br />Submission of this Notice of Intent is notice that the owner/operator identified on this form intends to <br />be authorized by a NPD ES permit issued for storm water discharges associated with construction activity <br />in the S tate of Minnesota. <br /> <br />.. I. Owner/Operator Information <br /> <br />I <br /> <br />Narne:--=cht ~1tluV1d ~F=::rJ~' <br />Address: 6;1{) Ie, ~ .vev ~.;J, ~ \ <br />/ <br /> <br />Telephone: (~l~) Gll-b ~4- <br /> <br />City: _r,(l~ \etIJ ) <br />I <br /> <br />Slate: <br /> <br />M I ~ Vlaofci. <br /> <br />Zip: <br /> <br />~~ <br /> <br />II. Construction Site Information <br /> <br />.:( <br /> <br />1. Location of construction activity (provide a description of where the construction activity is taking place, include <br />address, ifa~ailabl~): B% '5~ JJ ~V t\t toH1 At'€- - ctcUviJ<l-lJ-- ~Jtt:J~ b0 <br /> <br />as<Stcl1td <br />- i) <br />2. If the cOnstruction activity includes roadways provide the name of-the roadway and indicate the length of roadway <br />under construction: te.- (I t.Vt ~fyLle, h,l'Y\ ({~ (a f.-h ~/fy ~Gt tv 60 L- i P, <br />V ) <br /> <br />3. Indicate all Cities, Counties, Townships where construction activity is occurring: IJ-etU J?vlP(C<io<<. <br />u <br /> <br />4. Project start date: Completion date: ,:h-t'l /194- <br />( / <br />S. Descri~ whe~e stonn wa 'r from the const;Ucti~?. site dischar~e: to (for ex~ple, s.torm sewer, w~ter body, <br />retenoon basm, etc.): "$ /tYyn SlU-tl'f fd c..1k1 ((t~~t/U1' t?lr1Li! aC'vc~ sfv-a:r . <br />J I <br />6. (Area to be) diswrbed 1.!i At., 7. Does the site currtr elntlly ~ave Y{ckes 0 No;gr <br />in acres : _ an erosion con 0 pan. 01,. - , -- . 1-1/11 / <br />I~HtJ ';/' .. YP-<-- <br /> <br />ill. Certification <br /> <br /> <br />"I certify under penalty of law that this document and all attaclunenlS were prepared under my direction or supervision in accordance with <br />a system designed to assure that qualified persormel properly gather and evaluate the information submitted. Based on my inquiry of the <br />person. or persons, who manage the system. or those persons directly responsible for gathering the information. the information submitted <br />is. 10 the best of my knowledge and belief. true. accurate. and complete." (Minnesota Rule 7001.0070) <br /> <br />Printed Name: 170llALD ^ :J'~Sb1 Title (Manager, CEO, etc.): ~101ti 1)~f/lt6{f 1i'13v~ <br /> <br /> <br />Authorized Signature: J!Jtn~Lt<t'--- Date: 9,lM/ f'7- <br /> <br /> <br />Submit 10: MPCA. Water Quality Division. Industrial Section. 520 Lafayette Road North. St. Paul. Minnesota 55155-4194 <br /> <br />Form PQOO641 7192 <br />