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Construction Activity Information <br />5. Project Name <br />6. Project Location <br />Briefly describe where constrtic tion acIit i I y occurs - Example: Intersection of,imh Street and Iii ine Avenue. /nchicle uddr ess i/'uruiluhle <br />MN <br />City or Township Slate Zip Code <br />County Parcel ID h +Mach list i� a c ca'surr <br />All cities taficrc consn'uclion Will occur <br />All counties where construction will occur <br />7. Project Size <br />Number of acres to be disturbed <br />All townships where COnSiftIC6011 will occur <br />8. Project Map Is the required 8 '/i x 1 1" United States Geological Survey (USGS) 7.5 minute quad or []Yes <br />equivalent map indicating site boundaries attached'? <br />9. Project Type ❑ Residential ❑Commercial/Industrial ❑ Road Construction <br />❑ Other <br />10. Cumulative <br />Impervious <br />Surface <br />11. Permanent <br />Stormwater <br />Management <br />12. Receiving <br />Waters <br />a. Existing area of impervious surface (to the nearest quarter acre) <br />b. Post construction area of impervious surface (to the nearest quarter acre) <br />If new impervious surface created by the project is less than one acre, skip to question 12. <br />What types (check all that apply) of permanent stormwater management will be used if more than one <br />acre of new impervious surface is created by the project? [Part 111. Q <br />❑ Wet Sedimentation Basin ❑ Infiltration/Filtration ❑ Regional Ponding <br />❑ Alternative Methods (Ifusing allernotive methods, construction cannot Commence until receiving approval from the MPCA.) <br />❑ Other (Specily reason and list other treatment allowed by Part III, C') <br />Identify surface waters within '/ mile of project boundary that will receive storm water from the site or <br />discharge from permanent Stonnwater management system. Include waters shown on USGS 7.5 minute <br />quad or equivalent, all Special Waters identified in Appendix A of the permit and/or any impaired waters <br />(To find Special or Impaired Waters, use the Special and Impaired Waters Search tool at <br />www.pea.state.iinn.us/water/stormwater/stormwater-c.litml). Use additional paper if necessary. <br />Name of Water Body <br />Type (ditch. pond. %vetland, lake. steam. <br />river) <br />Special Water? <br />(See stormwater <br />Permit Appendix A) <br />Impaired <br />Water? <br />❑Yes ❑No <br />❑Yes [-]No <br />❑Yes [:]No <br />❑Yes ❑No <br />❑Yes ❑No <br />[-]Yes ❑No <br />❑Yes []No <br />❑Yes ❑No <br />13. Dates of Construction / / <br />a. Consu-uction Start Date <br />b. Estimated Completion Date <br />wti-strm2-57 2 of3 Revised 4/06 <br />