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BWSR Forms 11-25-09 Page 2 of 2 3. CONTRACTOR VERIFICATION By signing below, I verify that I have received a signed copy of this form and will be performing the indicated work as described above. Company and Individual Performing Proposed Work (Print) Address Signature Date Phone Number and E-mail Address (Optional) Note: The contractor is responsible for ensuring this form is mailed to the appropriate office when complete. This statement is invalid if any of the above information is not supplied or is inaccurate. Work in violation of this notification requirement is a separate and independent offense from other violations of Minnesota Statutes chapter § 103G and is a misdemeanor punishable by fines up to $1,000 and/or 90 days in jail. The State Department of Natural Resources (DNR) Commissioner also has the authority to require restoration of any work done without the necessary permits or approvals or work that is beyond what was authorized. 4. INFORMATION AND RESOURCES A Wetland Conservation Act (WCA) replacement plan is required for any wetland draining, excavation, or filling activity that is not exempt under Minnesota Rules Chapter 8420.0420. A DNR Waters permit is required for any work in public waters. National wetland inventory maps are available for review at the County Soil and Water Conservation District (SWCD) office and online at http://www.fws.gov/wetlands/Data/Mapper.html. Many wetlands are not identified on the maps but are still restricted from draining, excavating, or filling. If you are unsure the proposed work will affect a wetland, contact your local government unit (LGU) or SWCD for assistance. Public Waters of the State of Minnesota include the channel to the top of the channel bank for watercourses and the basin from the ordinary high water level waterward for public waters (i.e. lakes) and public waters wetlands. Public waters inventory maps are available for review at the County Auditor’s office, DNR Division of Waters regional offices, and online at http://www.dnr.state.mn.us/waters/watermgmt_section/pwi/download.html. General information about public waters, wetlands, and related regulations are available on the DNR website at http://mndnr.gov and the MN Board of Water and Soil Resources (BWSR) website at http://www.bwsr.state.mn.us. 5. WHERE TO SEND THIS NOTIFICATION ➢ For work in public waters (lake, watercourse, or public waters wetland), send this completed form to the DNR Regional Enforcement Office serving the project’s area. See below for DNR regional office information. A map of DNR regions can be found on the DNR website at: http://files.dnr.state.mn.us/aboutdnr/dnr_regions.pdf ➢ For work in any wetland that is not a public waters wetland, send this completed form to the WCA LGU with jurisdiction over the project area. The LGU is usually the County or SWCD, except in urban areas the City is often the LGU. Contact any of these local governments or BWSR for assistance. BWSR also maintains a list of LGUs on its website at: http://www.bwsr.state.mn.us/directories/WCA.pdf. ➢ If it is not known if the wetland is a public waters wetland, send the completed form to both the DNR Regional Enforcement Office and the WCA LGU. Department of Natural Resources Regional Offices Northwest Region: 2115 Birchmont Beach Rd. NE Bemidji, MN 56601 Phone: 218-308-2700 Northeast Region: 1201 E. Hwy. 2 Grand Rapids, MN 55744 Phone: 218-327-4455 Central Region: 1200 Warner Road St. Paul, MN 55106 Phone: 651-259-5800 Southern Region: 261 Hwy. 15 South New Ulm, MN 56073 Phone: 507-359-6000 Keep a copy of this form for your records!