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NA-02622—OA <br />Rev. 10/ PERMIT APPLICATION <br />DEPARTMENT OF TO WORK IN PROTECTED WATERS OR WETLANDS <br />nM nMf£ c§I7rlAl (INCLUDING DAM SAFEM <br />NATURAL RESOURCES <br />►►Please read instructions before attempting to complete this application. <br />II. <br />.A)A <br />Ill. <br />V. <br />VII. <br />VIII. <br />IX <br />X. <br />XI. <br />MI. <br />OFFICE USE ON ,Y <br />P.A. N0. <br />MN Dept, of Transportation HNTB /Ross D. Harris <br />(612 )920- 4666Agent <br />Address (Street, RFD, Box Number, City, State. Zip Code) <br />2055 N. Lilac Drive, Golden Valley, MN 55422/6700 France Ave. S., Mpls, MN 55435 Agent <br />LOCATION OF PROPOSED PROJECT (BESURE TO INCLUDE SKETCH SHOWING HOW TOGET TO THE SITE) <br />Government Lots) <br />0SWCD UGC <br />Q W.D. ❑ USCOE <br />Applicant's Name (Last, First, M. 1.) Authorized Agent (if applicable) <br />Telephone Number&areacoce <br />MN Dept, of Transportation HNTB /Ross D. Harris <br />(612 )920- 4666Agent <br />Address (Street, RFD, Box Number, City, State. Zip Code) <br />2055 N. Lilac Drive, Golden Valley, MN 55422/6700 France Ave. S., Mpls, MN 55435 Agent <br />LOCATION OF PROPOSED PROJECT (BESURE TO INCLUDE SKETCH SHOWING HOW TOGET TO THE SITE) <br />Government Lots) <br />Quarter Section(s) <br />Sections) No. <br />Township(s) No. <br />Range(s)No. <br />Lot. Block, Subdivision <br />oka(C)Cham lin <br />(A)SE1 /4 (C)NW1 /4 <br />(A)12 (C )19 <br />A T31N C T1 <br />ON A R21W C <br />5W Auditor's Subdiv <br />Fire No., Box No. or Project Address Anoka— <br />County <br />Protect wiilaffect O Lake. Owetlanoor Kiwatercourse <br />TH 169 C. Mississippi River Champlin <br />Anoka, Hennepin <br />0k owni <br />TYPE OF WORK PROPOSED (CHECK ONE) <br />IV, TYPE OF PROJECT (CHECK ONE) <br />O excavate ❑ repair <br />❑ shoreline ❑ shore - protection ❑ obstruction ❑ dam <br />* fill ❑ remove <br />❑ channel ❑ harbor M bridge 0 other <br />❑ drain O abandon <br />❑ sand blanket ❑ permanent dock O culvert (specify) <br />IS construct M other (specify) <br />❑ riprap ❑ wharf Roadway <br />LT5 install Rehabilitate <br />ESTIMATED PROJECT COST $ mi tempora <br />3.73mil(permane <br />LENGTH OF SHORELINE AFFECTED (IN FEET): <br />) 600 Ft. <br />VOLUME OF MATERIAL FILLED OR EXCAVATED (IN CUBIC YARDS): 5,040 Cy fill; 5, ' , i in oo p 5558 8 C o y ex ro <br />Ccavat <br />BRIEF EXPLANATION OF PROJECT: (EXPLAIN WHAT PROJECT CONSISTS OF AND HOW WORK WILL BE DONE) <br />*Rehab. St. Br. No. 4380 and widen four -TII t. travel lanes to 12 ft, including 8 ft side- <br />walks with concrete barriers, for a total deck width of 80 ft (out -out). Construct 4 -lane <br />temp. br, downstream adjacent to existing br. Add turning lanes at signalized intersection <br />with CSAH 12 in Champlin. Mill & resurface roadway between CSAH 12 & W. River Rd. <br />*Temp Br. & roadway installed first, letting for per.manent Br. 4- 26 -91. <br />PURPOSE OF PROJECT: (Explain why this project is needed) <br />Critically- deficient condition existing bridge (deck slab /support beams); substandard <br />lane widths and driveway approaches, inadequate left -turn lanes at CSAH 12 to accommodate <br />future AADT, and deteriorated roadway surface between CSAH 12 intersection and West River <br />Road (Old TH 252). Br. No. 4380 is on NRHP and must retain significant architectural and <br />aesthetic values with rehabilitation. <br />ENVIRONMENTAL IMPACT (Anticipated changes to the water and related land resources, including unavoidable but detrimental effects) <br />No adverse social or environmental impacts; three businesses displaced. Potential sediment- <br />ation /silt effects. No adverse impacts to recreational water interests. <br />ALTERNATIVES (Other alternatives to the action proposed) <br />Before decision to rehabilitate, three other Br. and roadway alignments were considered. <br />with no Temp. structure also considered, but increased maint. costs & safety hazards woul <br />I hereby make application pursuant to Minnesota Statutes Chapter 105.42 and all supporting rules for a permit to work in or affect the above named protected <br />water(S) in accordance with all supporting maps. plans, and other information submitted with ibis application. The information submitted and statements made <br />concerning this application are true and correct to Me best of my knowledge. <br />STATE OF LJ <br />COUNTY OF <br />Subscribed and sworn to before me this <br />1 .L� Uay of 19 <br />My commission expires �sll:A 0 9� <br />of <br />I° <br />;d <br />Re ab <br />er- <br />sist. <br />Signatur er or Autn rued Agent <br />Date <br />Si Lure of Leasee <br />Date <br />Distribution: <br />White: <br />DNR <br />all Blue: <br />SWCD <br />JAMES O. MURPHY Green: <br />Watershed District <br />NOTALY FU%UC— MIIiQSOIA <br />CARVER COUNTY Goldenrod: <br />City or County <br />My ootnmiuion explret Meta, 26,1991 Pink: <br />Army Corps of Engineers <br />Canary: <br />Applicant <br />