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Minnesota Wetland Conservation Act <br /> ► t .vit/ Exemption Evidence <br /> I do hereby certify that the following statement of evidence or activity is true and may be used as evidence to support <br /> qualification for WCA exemptions. The LGU may require additional affidavits or verification evidence before <br /> making an exemption determination. <br /> Project Location: <br /> SW 17 117 23 Hennepin Orono Part of Lot 7 B110 Townsite of <br /> Langdon Park <br /> Gov.Lot(s) Quarter Section(s) Section(s) Township No. Range No. (County/City/Lot/Block/Subdivision) <br /> Exemption: # <br /> DESCRIPTION OF EVIDENCE FOR EXEMPTION: <br /> The proposed pond is in the location of Wetland 1 as described in the"Wetland Delineation Report"completed by <br /> MFRA on November 18,2003. Wetland 1 is a total of 371 Sq Ft in size and according to the Minnesota Wetland <br /> Conservation Act(WCA)would come under the deminimus exemption and can,therefore,be excavated. It is also <br /> shown on the Certificate of Survey, which is attached. <br /> penalty enalty of perjury,I hereby swear under oath that the information above,made for the purpose of documenting <br /> � <br /> qualification for an exemption from the WCA, is true to the best of my knowledge. <br /> s(,-a/02- <br /> Si a Date Social Sec.No. <br /> ACKNOWLEDGEMENT <br /> The foregoing instrument was subscribed and sworn to before me on: <br /> _(day),J11M (month), (year), by dw-n � <br /> (Notary Stamp or Seal) MEG ANo ry P ETERS �� <br /> Minnesota <br /> M Commission E 'res Jenue 31,2009 S 2005 <br /> Page 1 of 2 <br /> navarrewcaform P <br />