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Project Name and/or Number: SER#2014-030-03—185 Old Crystal Bay Road S,Orono PART THREE: General Project/Site Information If this application is related to a delineation approval,exemption determination,jurisdictional determination,or other correspondence submitted prior to this application then describe that here and provide the Corps of Engineers project number. Describe the project that is being proposed,the project purpose and need,and schedule for implementation and completion.The project description must fully describe the nature and scope of the proposed activity including a description of all project elements that effect aquatic resources(wetland, lake,tributary,etc.)and must also include plans and cross section or profile drawings showing the location,character,and dimensions of all proposed activities and aquatic resource impacts. The owner wants to know where the approved edge is located before starting the planning process.As soon as approval is received they will move forward with their project. PART FOUR: Aquatic Resource Impact' Summary If your proposed project involves a direct or indirect impact to an aquatic resource (wetland, lake, tributary, etc.) identify each impact in the table below. Include all anticipated impacts, including those expected to be temporary. Attach an overhead view map, aerial photo, and/or drawing showing all of the aquatic resources in the project area and the location(s) of the proposed impacts. Label each aquatic resource on the map with a reference number or letter and identify the impacts in the following table. Aquatic Type of Impact Duration of Existing Plant County,Major Aquatic Resource Overall Size of Watershed#, Resource Type (fill,excavate, Impact Z Community ID(as noted on Size of Impact Aquatic and Bank Service (wetland,lake, drain,or remove Permanent(P)or s Type(s)in Impact overhead view) 1 Resource 4 Area#of Impact tributary etc.) vegetation) Temporary(T) Area Areas llf 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 would be removed after 220 days would be entered"T(220)". 2Impacts 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 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 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 feet wide would be reported as 50 ft(300 sq/ft). ;This is generally only applicable if you are applying for a de minimis exemption under MN Rules 8420.0420 Subp.8,otherwise enter"N/A". 4Use Wetland Plants and Plant Community Types of Minnesota and Wisconsin 3rd Ed.as modified in MN Rules 8420.0405 Subp.2. SRefer to Major Watershed and Bank Service Area maps in MN Rules 8420.0522 Subp.7. If any of the above identified impacts have already occurred,identify which impacts they are and the circumstances associated with each: PART FIVE: Applicant Signature ❑ Check here if you are requesting a pre-application consultation with the Corps and LGU based on the information you have provided. Regulatory entities will not initiate a formal application review if this box is checked. By signature below, I attest that the information in this application is complete and accurate. I further attest that I possess the authority to undertake the work described herein. Signature: `r�� Date: October 22, 2014 1 hereby authorize Svoboda Ecological Resources to act on my behalf as my agent in the processing of this application and to furnish,upon request,supplemental information in support of this application. 1 The term"impact"as used in this joint application form is a generic term used for disclosure purposes to identify activities that may require approval from one or more regulatory agencies. For purposes of this form it is not meant to indicate whether or not those activities may require mitigation/replacement.