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ProJect Name and/or Number. <br /> PART FOUR: Aquatic Resource Impacti Summary <br /> If your proposed project invoh►es a direct or indirect impact to an aquatic re3ource (wedand, lake,trlbutary, etc_) iderrtify each <br /> impact In the table below. lnclude aN anticipated impacts, induding those expected to be temporary.A#tach an overhead�ew <br /> map, aeriai phota, and/or drawing sfiowing all of the aqt�at�c resources In the proJect area and the locatlon(s) of the proposed <br /> impacts.I.abel each aquatic resour�ce on the map wttf�a reference number or letter and iderstify the impacts En the following table. <br /> Aquatic �e af Imp�t Duratiw�of County,Major <br /> A uatk Resourc� Impact Overall Size af ���� Watershed#, <br /> q (fill,excavate, <br /> Resaurce Type Commun <br /> ID(as noted on drafn,or Permanent{P) Size o�F I�fpact2 Aquatic and Bank <br /> overhead view) �Wetiand lake <br /> � ' remove or Temporary ���3 �YP�s)in ��ice Arca# <br /> tributary etc.) im Area4 <br /> vegetation� (Tj1 � of lmpact Areas <br /> llf fmpacts are�emporary;erner the duratbn of the tmpacts in days next Lo the'T'. For example,a pro]ect with a temporary acoess fl11 tf�at <br /> would be rerrwved after 220 days would be er�red"T(2?Ar. <br /> �lmpacls leas tfian 0.01 acre should be reponed in square feet. lmpacts 0,01 acre or gre�t�er should be�ported as aaes and rounded bo tt�e <br /> nearest 0.01 acre. 1'ributary Impatts must be reported in iinear feet of impad and an area of impact by Indkating flrst the lin�r feet of lmpact <br /> along the flowli�e af the stream folbwed by tt�e ar�ee impacrt in par�entheses). For exampie,a pro)ect that tmpacts Sp feet of a stream that Is 6 <br /> feet wide would be reporDed as 50 ft(300 square feet}. <br /> 3T'hls Is generslly onfy applicable if you are applytng tor a de minlmfs exemptlon under MN Rules 842QAd20 Subp.8,otherwise erKer"N/A". <br /> 'Use WeNand Ala�rts and Piont f�rnmunity Types of Mi»nesata o»d Wlsconsln 3'd Ed.as modffied in MN Rules 8420.0405 Subp.2. <br /> jReferto MaJor Watershed and 8ank Service Area maps in MN Rules 842Q.0522 Subp.7. <br /> tf any of the above iderttified impacts have alreatiy ocarred,iderrtify which impads they are and the cirwmstances associated <br /> with each: <br /> PART FIVE: Appficant Signature <br /> ❑ Check here if you are requesdrig a ore-analication coruultatlon with tt�e Corps and LGU based an the fnformaUon yau have <br /> provided. Regulatory errtities wt11 not initiate a formal appl4cat�on review if this box is checkeci. <br /> � <br /> By S'tgnature below,I attest that tfie information in thls application is camplete and accurate. I furtfier attest that I possess t�e <br /> authortty to undeftake the war�k descxibed herefn. <br /> Sfgnatu re: Date: <br /> i hereby authorize Bopray Emrlronmerrtal Seevices LLC to act on my behalf as my agent in the prooessing of this appliption and to <br /> � fumish,upon request,wpplemeMa!information in support of this applJcatlon. <br /> ( <br /> 1 <br /> � 1 The term"Impacr'as ussd ln thls joint application form is a generic term used for dtsdasure purposes to Identif�l <br /> adivitles that may require appcaval from one or more regulatory a�encies. For purposes of thls form it Is not meant to <br /> indlcate whether or not thpse activRies may require mitigation/reptaoen�ent <br /> Minnesota Interagency Water Resource Application Forrn February 2014 Page 4 of 11 � <br />