04-23-2003 Council Agenda - Laserfiche WebLink

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7. Does the MS4 have a process to evaluate discharges which may adversely affect properties listed or eligible for listing in the National Register of Historic Places or affecting known or discovered archeological sites? See Part IX of the Guidance Manual for Small Municipal Separate Storm Sewer Systems (MSds) for further information. Yes ONO If you answered "No" to Item 5, 6, or 7, briefly explain how the MS4 will come into compliance with the requirements of Appendix C. Owner or Operator Certification: This person must be duly authorized to sign the application (mayor, designated public works director, president of the university, etc.). I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons, who manage the system, or those persons directly responsible for gathering the infoinlation, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete (Minn. R. 7001.0070). I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment (Minn. R. 7001.0540). Authorized Signature Date Schroeder Greg Public Works Director Last Name First Name Official notices will be sent to person indicated here. 515 Little Canada Road Title Mailing Address Little Canada MN 55117 City State Zip Code 651. 766.4049 greg. schroeder @ci.little - canada.mn.us Telephone (include area code) E -Mail Address MPCA MS4 Storm Water Permit Application 6of8 11- 02/06/03