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<br />10. WILL THE PROPOSED SEWER PROJECT BE DESIGNED AND CONSTRUCTED AS DESCRIRED IN STANDARD <br />UTILITIES SPECIFICATIONS PREPAREI) BY THE CITY ENGINEERS ASSOCIA nON OF MINNESOT A? l2Jyes Dno <br /> <br />L1. HAS THIS PROJECT BEEN REVIEWED IN A PREVIOUS EA W? Dyes l2Jno <br />fryes. note the name of the project reviewed in the EAW, the responsible govcrnmenL.'l! unit, ilnd the dute of the negative declaration: <br />Nalllc of the Project Reviewed in EA W: Date; <br />Date of the negative declaration: Date: <br />Responsible Governmental Unit: <br /> <br />12. DETERMINATION OF THE NEED FOR AN ENVmONIVIENTAL ASSESSMENT WORKSHEET eEA W): <br />Is the ultimate design now 1'01' the proposed project greater than 1,000,000 gpd? Dyes l2Jno <br />If yes. the preparation of an EA W is mancbtory tbr this project <br /> <br />NO SEWER CONSTRUCTION FOR THE REFERENCED EXTENSION ~lA Y HE UNDERTAKEN UNTIL YOU ARE IN <br />RECEIPT OF THE REQUIRED PERiVIIT(S) ISSUED BY THIS AGENCY AND AS DEFINED BY LAW UNDER <br />MINNESOTA STATE STATUTE 115.07, SUBDIVISION 3. <br /> <br />CERTIFICATION AND SIGNATURE <br /> <br />Federal regulations (Section 309(c)(2) of the Clean Water Act and State regulations (Minn. R. 7001.0070) require <br />the authorized signer to be one of the following: <br />A. For corporation. a principal executive officer of at least the level of vice president; <br />B. For a partnership or sole proprietorship, a general partner or the proprietor, respectively; or <br />C. For a municipality, State, Federal, or other public facility, either a principal executive officer or ranking <br />executive official. <br />D. If the operator of the facility is different than the owner, both the operator and the owner according to <br />items A to C. <br /> <br />"I certify under penalty of law that this document and all attachments were prepared under my directton or supervision in <br />accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information <br />~ubmitted. Based on my inquiry of the person, or persons, who manage the system, or those persons directly responsible <br />for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and <br />complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine <br />and imprisonment." <br /> <br />PRINTED NAM.E <br /> <br />TITLE <br /> <br />AUTHORIZED SIGNATURE <br /> <br />DATE <br /> <br />PRINTED NMvlE <br /> <br />'T'cn;sa Bender <br /> <br />TITLE <br /> <br />Administr;uion <br /> <br />AUTHORIZED S(~:~~~;,;~~~'~~ (V',41) }!/~~~ ~. <br />(AUTHORIZED CITY REPRESENTATIVE) <br /> <br />DATE <br /> <br />p/iz -Sk I <br />- " .. ""/'---- <br /> <br />PRINTED NANIE <br /> <br />Thomas \V" Peterson <br /> <br />Reg No. 16610 <br /> <br />AUTHORIZED SIGNATURE <br /> <br />it1 - <br />. ..'/"'1l1?1J;1:.J <br /> <br />f) /1 <br />'1f.i b -;-- <br />&'[-, ett!1/!.:~ <br />(ENGINEER) <br /> <br />DATE <br /> <br />_t:/t/lj~ I <br /> <br />STATE'L\X IDI; <br /> <br />FEDERAL TAX LD" it <br /> <br />i_pplicatiolls submitted without (m allllwrized sigJ![{tufe, tile required application fee and allac/mumts, will he returned. Please make your check <br />payable to the ,lliunesotll Pollution Control Agency. Send completed permit applia1filw. attachments (including plans and spec(ficatiofls, (f <br />flpplicable) ami dl(~ck to the attention r~f: Sanitary SewtW Extensio1ls at the address listed 011 thl! sccondpage r~ftJw tfullsmittul.!(lnn. <br /> <br />- 2 - <br />