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, <br /> 9 <br /> �' � .. � ..�� � � <br /> ( ------___--- ------- — -- Cl�1' �c �RONO <br /> Project Name and/or Number: 3010 Somerset Lane,Orono-AE 14671 <br /> PART FOUR: Aquatic Resource Impactl Summary ' <br /> I <br /> � <br /> If your proposed project involves a direct or indirect impact to an aquatic resource (wetland, lake, tributary, etc.) identify each <br /> impact in the table below.Include all anticipated impacts,including those expected to be tempo�ary.Attach an overhead view map, <br /> aerial photo, and/or drawing showing all of the aquatic�esources in the project area and the location�s) of the proposed impacts. <br /> Label each aquatic resource on the map with a reference number or letter and identify the impacts in the following table. <br /> Type of Impatt Duration of County,Major <br /> Aquatic Existing Plant <br /> Aquatic Resource (fill,excavate, Impact Overall Size of Watershed It, <br /> Resource Type Community <br /> ID(as noted on drain,or Permanent(P) Size of Impact2 Aquatic and Bank <br /> (wetland,lake, Type�s)in <br /> overhead view) remove or Temporary Resource 3 Service Area�i <br /> tributary etc.) Impact Area° <br /> vegetation) (T)' of Impact Areas <br /> llf impads are temporary;enter the duration of the impacts in days next to the"T". for example,a project with a temporary access fill that <br /> would be removed after 220 days would be entered"T(220)". <br /> 2lmpacts less than 0.01 acre should be reported in square feet. Impacts 0.01 acre or greater should be reported as acres and rounded to the <br /> nearest 0.01 acre. Tributary impacts must be reported in linear feet of impact and an area of impact by indicating first the linear feet of impact <br /> along the flowline of the stream followed by the area impact in parentheses). For example,a project that impacts 50 feet of a stream that is 6 <br /> feet wide would be reported as 50 ft(300 square feet). <br /> 3This is generally only applicable if you are applying for a de minimis exemption under MN Rules 8420.0420 Subp.8,otherwise enter"N/A". <br /> 'Use Wetland Plants and Plani Community Types of Minnesota and Wisconsin 3rd Ed.as modified in MN Rules 8420.0405 Subp.2. <br /> SRefer to Major Watershed and Bank Service Area maps in 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 requesting a pre-aqplication consultation with the Corps and LGU based on the information you have � <br /> provided. Regulatory entities will not initiate a formal application review if this box is checked. <br /> By signature below, I attest that the information in this application is complete and accurate. I further attest that I possess the <br /> authority to undertake the work described herein. <br /> Signature: Date: �� % � <br /> I hereby authorize to act on my behalf as my agent in the processing of this application and to furnish, upon request, <br /> supplemental information in support of this application. <br /> 'The term"impact"as used in this joint application form is a generic term used for disclosure purposes to identify <br /> activities that may require approval from one or more regulatory agencies. For purposes of this form it is not meant to '� <br /> indicate whether or not those activlties may require mitigation/replacement. <br /> MinnPcnta IntPravPncv WatPr RPcnurcP Annlication Form Februarv 2014 PaQe 4 of 6 <br />