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Project Name and/or Number: North Shore Meadows, LLC <br /> Describe the project that is being proposed,the project purpose and need,and schedule for implementation and completion.The <br /> project description must fully describe the nature and scope of the proposed activity including a description of all project elements <br /> that effect aquatic resources(wetland, lake,tributary,etc.)and must also include plans and cross section or profile drawings <br /> showing the location,character,and dimensions of all proposed activities and aquatic resource impacts. <br /> The applicant is proposing to build a 120 foot by 60 foot building pad for the future construction of a sport court and/or cold <br /> storage structure located on a private residence in the City of Orono.Construction activities will include importing fill,grading of <br /> the earthen building pad,and road access to driveway.Total land disturbance will be up to 14,000 s.f.of cutting and filling. Future <br /> construction on the building pad will consist of a sport court surface with amenities,and/or a cold storage building. Please refer to <br /> the attached site plan (Sheet 2).Construction and installation of these elements will permanently impact one Type 1 wetland, <br /> totaling 0.022 acres(958 sq.ft.)of wetland fill. <br /> PART FOUR: Aquatic Resource Impact' 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 /> Label each aquatic resource on the map with a reference number or letter and identify the impacts in the following table. <br /> Type of Impact Duration of County,Major <br /> Aquatic Existing Plant <br /> Aquatic Resource (fill,excavate, Impact Overall Size of Watershed#, <br /> Resource Type Community <br /> ID(as noted on drain,or Permanent(P) Size of Impact' Aquatic and Bank <br /> (wetland, lake, Type(s)in <br /> overhead view) remove or Temporary Resource 3 Service Area# <br /> tributary etc.) Impact Area4 <br /> vegetation) (T)1 of Impact Areas <br /> Wetland E Wetland Fill P 0.022 Acres N/A Seasonally Hennepin,WS <br /> (958 S.F.) Flooded Basin #20, BSA#7 <br /> TOTAL: 0.022 Acres(958 S.F.) <br /> 'If impacts 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 /> zlmpacts 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 /> 4Use Wetland Plants and Plant Community Types of Minnesota and Wisconsin 3rd Ed.as modified in MN Rules 8420.0405 Subp.2. <br /> 'Refer 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 /> No impacts have occurred to date. <br /> 1 The term"impact"as used in this joint application form is a generic term used for disclosure purposes to identify activities <br /> that may require approval from one or more regulatory agencies. For purposes of this form it is not meant to indicate <br /> whether or not those activities may require mitigation/replacement. <br />