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1 <br /> I <br /> I Project Name and/or Number: 3635 Togo Road <br /> PART FOUR: Aquatic Resource Impacts Summary <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 temporary.Attach an overhead view map, <br /> aerial photo,and/or drawing showing all of the aquatic resources in the project area and the location(s)of the proposed impacts. <br /> i <br /> Label each aquatic resource on the map with a reference number or letter and identify the impacts in the following table. <br /> Aquatic Type of Impact Duration of County,Major <br /> Aquatic Resource q (fill,excavate, Impact Overall Size of Existing Plant <br /> Resource Type Community Watershed <br /> overhead <br /> #, <br /> ID rnoted on drain,or Permanent(P) Size of lmpact2 Aquatic and Bank <br /> head view) (wetland,lake, remove or Temporary Resource 3 Type(s)in <br /> tributary etc.) vegetation) (T)1 Impact Area° Service Area# <br /> of Impact Area <br /> 1 <br /> I 'if impacts are temporary;enter the dui " <br /> � P rY, duration of the impacts in days next to the"T . For example,a project with a temporary access fill that <br /> iwould be removed after 220 days would be entered"T(220)". <br /> =Impacts 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 impacts50 feet of a stream that is 6 <br /> feet wide would be reported as 50 ft 300 <br /> Po ( square feet). <br /> Mis 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 Plant Community Types of Minnesota and Wisconsin 3nd 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 /> i <br /> PART FIVE: Applicant Signature <br /> ❑ Check here if you are requesting a pre-aoolication 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 /> B signature below,Y g nature o ,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. i <br /> I <br /> Signature: Z 7 <br /> Date: �— <br /> I hereby authorize to act on my behalf as my agent in the processing of this application and to fumish,upon request, <br /> supplemental information in support of this application. <br /> 'The term"impaL`t"as used in this joint application form is aeneric term used <br /> g 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 activities may require mitigation/replacement. <br /> I� <br />