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NA-026620-03B (V.2.02 for MS WORD)9/17/2007
<br /> Minnesota Local/State/Federal Application Form for Water/Wetland Projects
<br /> For Internal Use Only
<br /> Application No. Field Office Codc Date Initial Application Received Date initial Application Deemed Complete
<br /> PART I: BASIC APPLICATION
<br /> "Sec HELP"directs you to important additional information and assistance in Instructions,Page 1.
<br /> 1. LANDOWNER/APPLICANT CONTACT INFORMATION(See Help 1)
<br /> Name: Spring Hill Golf Club,Tim Johnson Phone: 612-812-0374 E-mail:timj@spdnghillgc.com
<br /> Complete mailing address:Spring Hill Golf Club,725 County Rd.6,Wayzata,MN 55391
<br /> IA. AUTHORIZED AGENT(See Help IA) (Only if applicable,an agent is not required)
<br /> Name: Kelly Bopray,BES,Inc. Phone: 715-307-4577 E-mail:kbopray@yahoo.com
<br /> Complete mailing address: N7831 920th St.,River Falls,WI 54022
<br /> 2. NAME,TYPE AND SIZE OF PUBLIC WATERS or WETLANDS IMPACTED(Attach Additional Project Area sheets if needed)
<br /> Name or I.D.#of Waters Impacted(if applicable;if known):
<br /> ' (Check all that apply): ❑Lake ❑River ❑Circular 39 Wetland type:❑ 1,❑ IL,❑2,N 3,❑4,❑5,❑6,❑7,❑8
<br /> Wetland plant community type': ❑shallow open water,❑deep marsh,N shallow marsh,❑sedge meadow,N fresh meadow,
<br /> ❑wet to wet-mesic prairie,❑calcareous fen,❑open bog or coniferous bog,❑shrub-carr/alder thicket,
<br /> ❑hardwood swamp or coniferous swamp,❑floodplain forest,❑seasonally flooded basin
<br /> ' Indicate size of entire lake or wetland(check one): N Less than 10 acres(indicate size:5 ac.) ❑ 10 to 40 acres ❑Greater than 40 acres
<br /> 3. PROJECT LOCATION (Information can be found on property tar statement,property title or title insurance):
<br /> Project street address: Fire#: City(if applicable):Orono
<br /> '/,Section:SE Section:26 Township#:I I 8 Range#:23W County:Hennepin
<br /> Lot#: Block: Subdivision: Watershed(name or#)Minnehaha Creek UTM location:N E
<br /> Attach a simple site locator map. if needed,include on the map written directions to the site from a known location or landmark,and
<br /> provide distances from known locations, Label the sheet SITE LOCATOR MAP.
<br /> 4. TYPE OF PROJECT: Describe the type of proposed work. Attach TYPE OF PROJECT sheet if needed.
<br /> See attached narrative.
<br /> ' 5. PROJECT PURPOSE,DESCRIPTION AND DIMENSIONS: Describe what you plan to do and why it is needed,how you plan to
<br /> construct the project with dimensions(length,width,depth),area of impact,and when you propose to construct the project. This is the
<br /> most important part of your application. See HELP 5 before completing this section;see What To Include on Plans(Instructions,
<br /> page 1). Attach PROJECT DESCRIPTION sheet.
<br /> See attached narrative.
<br /> Footprint of project: 0.42 acres or 18,249 square feet drained,filled or excavated.
<br /> 6. PROJECT ALTERNATIVES: What alternatives to this proposed project have you considered that would avoid or minimize impacts
<br /> to wetlands or waters? List at least TWO additional alternatives to your project in Section 5 that avoid wetlands(one of which may be"no
<br /> build"or"do nothing"),and explain why you chose to pursue the option described in this application over these alternatives. Attach
<br /> PROJECT ALTERNATIVES sheet if needed.
<br /> See attached narrative.
<br /> 7. ADJOINING PROPERTY OWNERS: For projects that impact more than 10,000 square feet of water or wetlands,list the complete
<br /> mailing addresses of adjacent property owners on an attached separate sheet. (See HELP 7)
<br /> 8. PORTION OF WORK COMPLETED: Is any portion of the work in wetland or water areas already completed? ❑Yes NNo. If
<br /> yes,describe the completed work on a separate sheet of paper labeled WORK ALREADY COMPLETED. (See HELP 8)
<br /> 9. STATUS OF OTHER APPROVALS: List any other permits,reviews or approvals related to this proposed project that are either pending or
<br /> have already been approved or denied on a separate attached sheet. See HELP 9.
<br /> 10. I amapply'ng for state and local authorization to conduct the work described in this application. I am familiar with the information
<br /> ' contained i t s application. To the best of my knowledge and belief,all information in Part I is true,complete,and accurate. I possess
<br /> the author' undert a work described,or I am acting as the duly authorized agent of the applicant.
<br /> I #Dat
<br /> %/ ( 02
<br /> Signar�ck
<br /> of applicant(Landowner) .Signature f gent( applicable) Date
<br /> This bmust be signed by the person who desires to undertake the proposed activity and has the necessary property rights to do so. If only the Agent has signed,
<br /> pleaseh a separate sheet signed by the landowner,giving necessary authorization to the Agent.
<br /> 'See Welland Plants and Plant Conrmrmities of Minnesota and Wisconsin(Eggers and Reed,1997)as modified by the Board of Water and So it Resources,
<br /> United States Army Corps of Englneers
<br /> Minnesota Local/State/Federal Application Forms for Water/Wetland Projects
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