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Minnesota Wetland Conservation Act <br />Application for Certificate of No Loss or Exemption* <br />Greg Gappa, City of Orono <br />Name(s) of Applicant <br />PO Box 66 <br />Street Address <br />,Orono, MN 55323-0066 <br />City, State, Zip Code <br />APPLICANT AND PROJECT LOCATION INFORMATION <br />LGU:Minnehaha Creek Watershed District <br />Project Location: 1/4 __ 1/4 ___ Sfl_Tl l 7NR23W <br />UTM Coordinates: X __ Y __ <br />County Name/Number: Henneping <br />Minor Watershed Name/Number: __ <br />Size of entire wetland:0.12 acre acres <br />Wetland type: Circular 39 _1 __ ; NWI_PE_M_A ___ _ <br />(952)249-4600 <br />Telephone (Day) <br />) <br />(Evening) <br />Check one: [8] < 50%, D 50% -80%, or D > 80% <br />Check one: D Agricultural land (g!Non-ag. land <br />PROPOSED PROJECT DESCRIPTION <br />Describe the nature and purpose of the proposed project:Currently accesses to Big Island as well as internal roads are not <br />contained within plated easements or city owned property. This project will provide a public road for foot traffic and vehicles <br />(typically during ice conditions) to access this island and help eliminate crossing on private property. <br />(attach additional pages if needed) <br />Timetable: proiect will begin on 03/ /04 (mo/day/yr) and will be completed by 05/ /04 <br />The wetland activity at the above site qualifies for the following under the Wetland Conservation Act (WCA) (check one): <br />D No Loss Determination (attach plans) <br />[gl Exemption# De minimis (per MN Rule Chapter 8420.0122) (Note: Applicant is responsible for submitting the <br />proof necessary to show qualification for the exemption claimed.) <br />Description of Exemption Claimed: <br />Project impacts less then 400 square feet of wetland. <br />APPLICANT SIGNATURE <br />The information provided for this determination is truthful and accurate to the best of my knowledge. I ensure that, in draining, <br />excavating, or filling the subject wetland under an exemption noted above; appropriate erosion control measures will be taken to <br />prevent sedimentation of the water; the drain, excavation, or fill will not block fish passage; and the drain, excavation, or fill <br />activity will be conducted in compliance with all other applicable federal, state, and local requirements; including best <br />management practices and water resource protection requirements established under Minnesota Statutes, Chapter 103H. <br />9-;y-4j)~1M <br />3-4 .. 1·14- <br />Page lof3 <br />BWS R_F orm_ W CA_Ex.emption_2(App_for _ Certi f _No _Loss) (April 2003)