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For Replacement Plans using credits from the State Wetland Bank: Bank Account# Bank Service Area County Credits Approved for Withdrawal(sq.ft.or nearest.01 acre) Replacement Plan Approval Conditions. In addition to any conditions specified by the LGU, the approval of a Wetland Replacement Plan is conditional upon the following: 0 Financial Assurance: For project-specific replacement that is not in-advance, a financial assurance specified by the LGU must be submitted to the LGU in accordance with MN Rule 8420.0522,Subp. 9(List amount and type in LGU Findings). ❑ Deed Recording: For project-specific replacement, evidence must be provided to the LGU that the BWSR "Declaration of Restrictions and Covenants" and "Consent to Replacement Wetland" forms have been filed with the county recorder's office in which the replacement wetland is located. 0 Credit Withdrawal: For replacement consisting of wetland bank credits, confirmation that BWSR has withdrawn the credits from the state wetland bank as specified in the approved replacement plan. Wetlands may not be impacted until all applicable conditions have been met! LGU Authorized Signature: Signing and mailing of this completed form to the appropriate recipients in accordance with 8420.0255, Subp. 5 provides notice that a decision was made by the LGU under the Wetland Conservation Act as specified above. If additional details on the decision exist,they have been provided to the landowner and are available from the LGU upon request. Name Title Brandon Wisner Compliance Officer Date Phone Number and E-mail 12.4- (952)iI 641-4505 I 3//3 bwisner@minnehahacreek.org THIS DECISION ONLY APPLIES TO THE MINNESOTA WETLAND CONSERVATION ACT. Additional approvals or permits from local, state, and federal agencies may be required. Check with all appropriate authorities before commencing work in or near wetlands. Applicants proceed at their own risk if work authorized by this decision is started before the time period for appeal(30 days)has expired.If this decision is reversed or revised under appeal,the applicant may be responsible for restoring or replacing all wetland impacts. This decision is valid for three years from the date of decision unless a longer period is advised by the TEP and specified in this notice of decision. 3.APPEAL OF THIS DECISION Pursuant to MN Rule 8420.0905, any appeal of this decision can only be commenced by mailing a petition for appeal, including applicable fee,within thirty(30)calendar days of the date of the mailing of this Notice to the following as indicated: Check one: Appeal of an LGU staff decision. Send ❑Appeal of LGU governing body decision. Send petition and$0 fee(if applicable)to: petition and$500 filing fee to: Minnehaha Creek Watershed District Executive Director 15320 Minnetonka Blvd Minnesota Board of Water and Soil Resources Minnetonka,MN 55391 520 Lafayette Road North BWSR Forms 7-1-10 Page 2 of 3