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--- ---- -- <br /> . j <br /> ProjecC Name and/or Number: I <br /> ; PART FQUR: Aquatic Resource impact� Summary , <br /> �# <br /> � !f your proposed project invohres a direct or indired impad to an aquatic resource (wetland, lake,tributary,etc.)idenYify each I <br /> impact in the tabte below. include ati aniicipated impacts, including those expected to be temporary.Attach an overhead view <br /> map, aerial phoYo,and/or drawing showing all of the aquatic resources ln the project area and the location(5)of the proposed <br /> impacts.label each aquatic resource on tt►e map with a reference number or letter and identify the impatts in the following table. <br /> Type of Impact Duration of County,Major <br /> A uatic <br /> Aquatic Resource Resource Type ����'excavate, Impad Overa��Sue°f �pmm nii� w�tershed k' <br /> ID(as noted on drain,or Permanent{P) Size of Impact� Aquattc � and Bank <br /> (wetland,lake, Type(s}in <br /> overhead view} remove or Temporary Resource� Service Area# <br /> tributary ett.) Impad Area° <br /> vegetation) 1T)I of Impact Areas <br /> ( TBD <br /> �If impacts are temporary;enter the duration of the impacts in days nent to the"T". For exampte,a project with a temporary access filf thai <br /> would be removed after 220 days wouid be e�tered"T{220)". <br /> 2tmpacts less than 0.01 acre should be reportad in square feet. Impacts 0.01 acre or greater should be reported as acres and rounded to the <br /> nearest 0.01 a�re. Tributary impacts musc be reported in finear feet of impact and an area of impact by indicating first the Gnear feet of impact <br /> along the flowiine af the siream followed by the area impa�t in parentheses). For example,a proJect that Impatts 50 feet of a stream that Is 6 <br /> feet wide would be reported as 50 ft(300 square feet). <br /> ?7'his is generally only applicable if you are apptying for a de minimis exemption under MN Rules 5420.0420 Subp.8,otherwise enter"N/A", <br /> 'Use Wetland Plants and Plnnt Community Types of Minnesoto and Wismnsirt 3b Ed.as modified in MN Rules 8420.0405 Subp.2. <br /> SRefer to Major Watershed and Bank Service Area maps i�MN Rules 8420.0522 Subp.7. <br /> If any of the above identified impacts have already occurred,identify which impacts they are and the circumstances associated <br /> with each: <br /> � <br /> PART FiVE: Applicant Signature <br /> ❑ Check here if you are requesiing a ere-apalication consultation with the Corps and LGU based on the information you have <br /> provided. Regulatory entities will not initfate a`ormai application revlew if ihis box is checked. <br /> ( ' <br /> By signature below,I attest that the information in this appfication is complete and accurate. I furtfier attest that 1 possess the j <br /> authority to undertake the worlc described herein. <br /> � <br /> Signature: � � � Date: �J✓�_,�"Uj`3! � <br /> ; �� ��� ��,�..cc,� � ' - C����h- <br /> � I hereby authorize Bopray Environmentat 5ervices LLC to act on my behalf as my agent in the proress(ng of this applicatfon and to <br /> fumfsh,upon request,supplemental information tn support of this applicaclon. <br /> 'The teYm"impaCt"as used in this joint apptication fprm 15 a gene�ic term used for disclosure purposes to identify <br /> activities that may require approva!from one or more regulatory agendes. for purpases of thls forrn it Es not meanL to <br /> i�dicate whether or not those acNvities may require mitigation/replacement. <br /> Minnesota Interagency Water Resource Application Form Fe6ruary 2014 Page 4 of 11 i <br />