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DEPARTMENT OF NATURAL RESOURCES ', oaPanma~, o, ! Water Appropriation General Permit Notification Form I Na,ural Resources) General Permit 97-0005 requires that the DNR be notified at least five days before the start of water appropriations. Please fill in the items listed below and fax, mail or email this form to the appropriate Area Hydrologist for the county in which the water appropriation is located. This notification form is only for temporary appropriations authorized by General Permit 97-0005 that total less than 50 million gallons and are completed within one year. Applicant Name: Contact Person or Agent: Knife River Corporation -North Central Holly Brisk Address: 4787 Shadow Wood Drive NE Sauk Rapids MN 56379 Telephone: FAX: 320.529.4241 320.251.001 1 Purpose: ^ Construction Dewatering ^ Hydrostatic Testing of Pipelines or Tanks (Check one or morej ®Landscaping or Dust Control ^ Hydrostatic Testing of Wastewater Ponds Project Description (include depth of wells, dewatering depth, well size, etc): gravel pit -dug pond for the purpose of pulling water for washing aggregate material anddust control on site located on the Ernest Toth gravel site Source of Water and how it will be appropriated: a dug pond(s) located onsite within the property line of the Toth's property which is leased by Knife River, which roan agreement for the purpose of a dug pond for washing aggregate and dust control measures. The site is currently permitted for mining into the water table with the City of Elk River which issued Knife River a Conditional Use Permit in Dec'O5. Legal Description of Point of Taking: (Please include a map) Sherburne County: Quarter Section or Gov. Lot see attached mao, Section 03, Township 33N, Range 26W. Estimated Pumping Rate: Estimated Volume of Water to be Appropriated Start of Pumping (date): End of Pumping (date): (may not exceed 50 million gals): , 250 gpm Approx June 1, 2009 12-31-09 1,000,000 Point of discharge for water: (Please include a map showing the discharge site) Quarter Section or Gov. Lot ,Section ,Township ,Range Name or Description of Receiving Water: Signat~~ f ApplicanC (By signing, I certify the information submitted is true and correYct the best of my knowledge) Date: .f'i 1 ~ n t ~-, 3-30-09 REQUIREMENTS - Please read the conditions below before commencing «ppropriut/opt. The temporary appropriation may commence 5 days after receipt of this form by the Area Hydrologist, or upon verbal approval of the Area Hydrologist, provided that all conditions of General Permit 1997-0005 are satisfied. If a natural resource conflict is expected, the Area Hydrologist will contact the applicant and advise them that the General Pe-mit cannot be used. Please note that a $101 water use fee is required for all projects that exceed 15 million gallons. If the estimated volume sho~~m above exceeds I S million gallons, the applicant will receive an Invoice from the State of Minnesota domandin~ payment of the $101 water use fee. In all cases.. after completion of the project, the enclosed "Report of Water Use" form must be completed and transmitted to the address shown on the form. rAX or mail this form so that it will be received by the appropriate Area Hydrologist at least five days before the