192119 11/23/2010 CITY OF CARMEL, INDIANA VENDOR: T361426 Page 1 of 1
0 ONE CIVIC SQUARE INDIANA DEPT OF NATURAL RESOURCRECK AMOUNT: $200.00
CARMEL, INDIANA 46032 201 W RIVERSIDE DR
CLARKSVILLE IN 47129 CHECK NUMBER: 192119
CHECK DATE: 11/23/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4358300 PERMIT 200.00 OTHER FEES LICENSES
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Mail To: Department of Natural Resources Division of Water
402 West Washington Street, Room W264
PERMIT APPLICATION FOR CONSTRUCTION Indianapolis, Indiana 46204 -2641
State Form 42946 (R6 1 2 -05) Telephone Number: (317) 232 -4160
Approved by the State Board of Accounts, 2005 Toll Free: 1- 877 928 -3755
01° Fax Number: (317) 233 -4579
www.IN.gov/dnrlwater
Based on the "Permit Application Assistance Manual I am submitting this application to perform work under:
Application Application Fee
Permit Type Fee Permit Type
IC 14 -26 -2 Lake Preservation Act 100.00 IC 14 -29 -3 Sand and Gravel Permits Act 50.00
IC 14 -26 -5 Lowering of the Ten Acre Lake Act 25.00 IC 14 -29 -4 Construction of Channels Act 100.00
IC 14 -29 -1 Navigable Waterways Act No Fee I lr l f
5,
IC 14 -28 -1 Flood Control Act, (select one of the following)
Excavation, fill, or non residential construction in a floodway 200.00
Residential reconstruction in a floodway, other than the Ohio River floodway
Residential construction, or reconstruction, in the Ohio River floodway 50.00
10.00
PLEASE TYPE OR PRINT
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'1 APPLICANT INFORMATION aG
Name of Applicant Carmel Clay Parks and Recreation Name of Contact Person Mark Weslermeier
Applicant Mailing Address 1411 E. 116' Street Carmel IN 46032
Street, P.O. Box or Rural Route City State ZIP Code
Contact Information: Daytime Tele. (317 )573 -401 Fax (317 )571 -4136 E -mail dress mwestermeier @carmelclayparks.com
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2., ACaENT INFORMATION
Name of Agent JJR, LLC Name of Contact Person Mark O'Leary
Agent Mailing Address 625 Williamson Street Madison W1 53703
Street, P.O. Box or Rural Route City State ZIP Code
Contact Information: Daytime Tele. (608 )327 -4417 Fax (608 )251 -6147 E -mail Address mark.oleary@jjr- us.com
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4 PRt:}PERTY�OWNER•INFORMATION zz F
f
Name of Pr perty Owner Carmel Clay Parks and Recreation Name of Contact Person Mark Westermeier
Property Owner Mailing Address 1411 E. 116th Street Carmel IN 46032
Street, P.O. Box or Rural Route City State ZIP Code
Cont ct Information: Daytime ele. (317 )573 -4017 Fax (317 571 -4136 E -mail Address mwestermeier @carmelclayparks.com
Relationship of applicant to property: N Owner Purchaser Lessee Other
'4 PUBLIC NOTICE {See PermitApplrcat ►onAss�stanee_Manual)�, ��F�� E ST;
Complete and submit SF 52086 titled "Adjacent Property Owners Listing Form N -4: Affirmation of personal service, 1 class mail service, or certified mail
service
5 PR83ECT DESG14I1PTION 51- Description Narrattve' „(See Perm►f Applicatron r4ssrs[ance Manual u
et n
See Attachment 3 -1
6 PROJECT 'OCATION a
o-.� �.P �'r ,t, a��, a: lr., .i ..r.. .r�r. ee" a
6 -1 Location Narrative: (See Permit Application Assistance Manual) Stream /Lake Name:
Carmel Creek in Carmel, Clay Township, Hamilton County, Indiana.
N 1/2, NE 114, Section 1, Township 17 North, Range 3 East, Carmel Quadrangle.
6 -2 Driving Directions: (See Permit Application Assistance Manual)
Project is located south of E. 11$ Street between Westfield Boulevard and Monon Greenway.
6 -3 Special Information: (See Permit Application Assistance Manual)
6-4 Project Location Map: (See Permit Application Assistance Manual)
6 -5 Project Site Map: (See Permit Application Assistance Manual)
..64. ,zT':q �r4 fir} xux. a�b!"�;! n, K a• a ap ay, ova .r
7 DISTURBEDtAREA DRAWING t t r r t jj x yr S r a 1. t 4 ear t 3 a ts i Y
rx xR.'r.A �.,.'r s
7 -1 Drawing Requirements: (See Permit Application Assistance Manual)
n
.8 PROJECT PHOTOGRAPHS ,.'.t
C_ i f ty.1iV nec.§S .x 2 A
8 -1 Images: (See Permit Application Assistance Manual)
8 -2 Photo Orientation Map: (See Permit Application Assistance Manual)
8 -3 Photo Documentation: (See Permit Application Assistance Manual)
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F.S..N a- 4. >t:cm .NN _n w�`.xu,.t..a+�d• t n .J. e -,En .r.e✓ ,t.x,�.. .i .tsn Y•
Department of Natural Resources
Administrative Cause Related Application(s) Early Coordination
ER -15297
Floodplain Analysis/Regulatory Assessment Violation Exemption
Department of Environmental Management
Section 401
Corps of Engineers
Public Notice Section 404 Application Section 10 Application
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10 �t STATEMEt3TaOF AFFIRMATION s 5x t
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1 hereby swear or affirm, under the penalties for perjury, that the information submitted herewith is to the best of my knowledge and belief, true, accurate and
complete. I further certify that I possess the authority to undertake the project. I hereby grant to the Department of Natural Resources, the right to enter the
above d ribed to ion to inspect the work.
f! L
Vgn of Applicant or Authorized Agent (REQUIRED) Date (month, Wy, year)
11 REGULATORYFEES „i� a.� �sr s k
11 -1 Regulatory Fees Submitted: (See Permit Application Assistance Manual)
11 -3 Payment Method: (See Permit Application Assistan Manual)
v `R "`'X R?�,%s K'.de'F'.:�in; 2gF12 Y ,{N d`' n?' Yf._.. N ✓x r T
l2Et�UlREMENT FOR ADDITIONAL INFORMATION AND PERMIT
Application made to and approval granted by the Department of Natural Resources does not in any way relieve the applicant of the necessity of securing
easements or other property rights, permits and approvals from affected property owners and other local, state, and federal agencies.
Audrey Kostrzewa
From: Mark Westermeler
Sent: Tuesday, November 09, 2010 3:26 PM
To: Audrey Kostrzewa; Debra Grisham; Deb Grisham
Subject: Fwd: Permits
Attachments: CarmelStormwaterPermitForm.pdf; ATT24066.htm; IDEM NOI Form.pdf; ATT24067.htm
This one replaces the one I just sent to you.... Mark
Begin forwarded message:
From: "Dave Wolmutt" David.Wolmutt(a,iir- us.com
To: "Mark Westermeier" M Westen neier(a),calmelclayp arks. corn
Ce: "Mike Stirk" Michael.StirkRjjr- us.com "Laura Verden" Laura.Verden a,jjr- us.com
"Mark O'Leary" Mark. OLeary(@i i r-us. com
Subject: Permits
Mark
Just wanted to give you a quick summary of our recent permit submittals for the East Woods
project and request some information to tie up "loose ends
In a nutshell, I am requesting the following:
Signatures on the City of Can Stormwater Permit Application and Notice of Intent
Forms (attached).
A check for 5200 to the Indiana Department of Natural Resources Division of Water for
the Flood Control Act Permit Application
A check for $100 to the Ij diana Department of Environmental Management for the.
SWPPP Notice of Intent application.
The following is the permit status and further explanation:
1. An Application Package for permitting fill in Waters of the Nation under Section 404 has
been submitted to the US Army Corps of Engineers. This application was signed by Mark
O'Leary of our office per your prior authorization. It is our understanding that there is no
application fee, but a fee may be requested at a later date at the discretion of the Corps District
Engineer.
2. The COE Application package is also being submitted to the Indiana Department of
Environmental Management for Section 401 Water Quality Certification for impacts to Waters
of the Nation. Mark O'Leary also signed this application per your authorization. There 1s no fee
associated with this application.
i
3. An Application Package for a Flood Control Act Pennit has been submitted to the Indiana
Department of Natural Resources. This application is for permit coverage for construction in the
Carmel Creek Floodway, including replacement of the culvert. Mark O'Leary signed this
application. There is a $200 permit fee which we have not yet submitted. We are requesting a
check from you (Parks) made out to "Indiana Department of Natural Resources Division of
Water" for this. Either mail this to me and I will forward to IDNR or, depending on time frame,
provide to Mark O'Leary or Mike Stirk.
4. We have completed a report titled "Stormwater Drainage Technical Report and Pollution
Prevention Plan (SWPPP). Per direction of the City, this will be submitted to the Hamilton
County Soil and Water Conservation District for review on behalf of the City (for SWPPP
review) and the City (Drainage review). We are assuming there will be no review fee since this
is essentially a City project. However, we will confirm this. I have attached the City's
Stormwater Permit Application Form, which requires your signature.
5. After approval of the permit application by Hamilton County and the City, we have to
issue a public notice. The City approval, verification of public notice and Notice of Intent form
must be submitted IDEM at least 48 hours before beginning construction. A check for $I00 to
"Indiana Department of Environmental Management" must accompany the Notice of Intent
form. I have attached a copy of the NOI form, which requires your signature.
You will be receiving copies of each of these application packages within the next few days.
Please call if you have any questions.
David Wolmutt, PE
Senior Civil Engineer
JJR
625 Williamson Street
Madison, WI 53703
T 608.327.4446
F 734.780.8969
www.iir-us.com
2
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show, kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
074600 Department of Natural Resources Terms
Division of Water
402 W.Washington St., Room W264
Indianapolis, IN 46204 -2641
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
1119110 Permit Flood Control Act Permit East Woods project 200.00
Total 200.00
1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
20_
Clerk Treasurer
Voucher No I� Warrant No.
�Y l
074600 epartment of Natural Resources Allowed 20
Division of Water
402 W.Washington St., Room W264
Indianapolis, IN 46204 -2641 In Sum of
200.00
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO# or INVOICE NO. ACCT #fTITLE AMOUNT Board Members
Dept
1125 Permit 4358300 200.00 1 hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
18 -Nov 2010
Signature
200.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund