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<br />~ <br />~..1" <br /> <br />TRANSl\tlITT AL FORNI <br /> <br /> <br />MPCAUSEDMlM <br />licatlon fI;l:tlmoer <br /> <br />-innesota Pollution <br />Control Agency <br /> <br />COMPLETE APPLICA TIOt...,' BY PlWVTlNG OR 71'P1NG. Pl_E~4SE MAKE A PHOTOCOPY [lOR YOUR RECORDS. <br /> <br /> <br /> <br />}i"l~(OILF'J;}f'INm' <br /> <br /> <br />Facility Owner 0 and/or Operator [8j (Public Entity. City or Busine~s Firm legally responsible for facility operation) <br />[see l\Ilinn. R. 700 1.0050] <br />Permittee Name: City of Centerville <br />l'vlailing Address: 1880 Main Street <br />State: MN Zip: 55038-9794 <br /> <br />Phone: <br /> <br />(651)429-3232 FAX: <br />City: Centerville <br />Public (gJ ; Private 0 <br /> <br />Type of ownership <br /> <br />Facility Loeation No Post Office Boxes allowed. Actual physical location of facility -- rHust use actual street or <br />highway address (or Section/fownshiplRange coordinates). If'applying for (l permit that can cover rnOT<< thall one .'lite <br />(e.g. aggregate and/or hot mix a,vphalt operations),wrire NA. <br />Facility Name: Pheasantrvlarsh Uitlity & Street Improvements Phase I <br />Location Address: <br />Facility is located in the <br />of Anoka <br />City: CenterviUe <br />[s the facility located on triballand'.l <br /> <br />Phone: <br /> <br />SE <br /> <br />quarter of the SW <br />county. Township # <br />State: <br />[gJ <br /> <br />quarter of section 23 township <br />31 Range #')} East [gJ <br />MN Zip: 55038-9794 <br />If yes, apply to EPA Region V, John Coletti; (312) 886-6]06. <br /> <br />3J <br /> <br />\Vest <br /> <br />o <br /> <br />Dyes <br />no <br /> <br />~chnical Agent or Con..o;;ulting Engineer Thomas Peterson <br />Name of firm or organization: Bonestroo, Rosene, Andedik & Associates, ]oe. <br />Mailing Address: 2335 \tV'est Highway 36 <br />City: Sf Paul State: MN <br />Contact Person (Operator, Plant Manager, City Official): Jim ivfarch <br /> <br />Title: Engineer <br />.. <br /> <br />Phone: <br />Zip: <br /> <br />(65 I )636-4600 <br />55113 <br />Title: Adlninistrator <br /> <br />APPLICA11)t~!lN INFORMATION <br /> <br />J{e:lson forA,tmlication (checlUllLthat zU1clY2: <br /> <br />o Expiration of existing pennit (reissue) <br />~ Nevv permit/facility <br /> <br />Dtvfodification to existing pennit <br />o Land Application Site Approval <br /> <br />o Agency request <br />o ()ther. please specify <br /> <br />IY~9f i\p{?lication (check all that aill2b:J <br /> <br />o ~hmicipal ; 0 Industrial; 0 Stornlw,uer / D Dredge ! 0 Pretreatment! 0 Feedlot /0 Water Treatment Plant ; <br />IZJ S.mitary Sewer; 0 Biosolids! D Aquaculture <br /> <br />Have you ever applied for, or do you currently have a National Pollutant Discharge Elimination Systern (NPDES) or State <br />Disposal System (SDS)permit for this facility? Dyes Ono <br />If yes. please list permit nurnber(s) <br /> <br />. "une on existing permit <br /> <br />Prill.ted rJ(l recycled paper ('1m/Dining alle(1sI10S~fJlbersfruHj Fore!" rVc)'ct'nJ by ctmsultUtrs <br />Page t <br /> <br />lransrnlltillimll FEB 98 <br />