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� Project Name and/or Number: Modern Construction of Minnesota,Inc. -AE 14280 P�4RT FOUR: Aquatic Resource lmpactl Summary if your proposed project i�volves a direct or indirect impact to an aquatic resource (wetland, lake, tributary, etc.) identify each impact in the table below. �nclude ail anticlpated 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 impa�ts.Label each aquatic resource on the map with a reference number or letter and identify the impacts in the following table. Type of Impad Duration of County,Major Aquatic Existing Plant Aquatic Resource (fiil,excavate, Impact Overall Size of Watershed#, Resource T e ID(as noted on yp drain,or Permanent(P) Size of Impact� pqu�� mmunity and Bank (wetland,lake, T e s in overhead vi�w) remove or Temporary Resource 3 yp t � 4 Service Area# tributary etc.) Im act Area vegetation) {T)1 P of Impact Area '!f 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)". �Impads less than 0.01 acre should be reported in square feet. Impads 0.01 acre or greater should be reported as acres and rounded to the nearest 0.�1 acre. Tributary impacts must be reported in Ilnear feet of impact and an area of impad by indicating first the linear feet of impact along the flowline of the stream followed by the area impact in parentheses). For example,a projed that impacts 50 feet of a stream ihat is 6 feet wide would be reported as 50 ft(300 square feet). ' 3This is generally only applicable if you are applying for a de minimis exemption under MN Rules 8420.0420 Subp.8,otherwise enter"N/A". ; •Use Wetland Plants and Plont Community Types of Minnesotv and Wisconsin 3b Ed.as modified in MN Rules 8420.0405 Subp.2. SRefer to Major Watershed and eank Service Area maps in MN Rules 8420.0522 S�bp.7. If any of the above identified impacts have already occurred,identify which impacts ihey are and the circumstances associated w(th each: PART FIVE: Appticant Signature ❑ Check here if you are requesting a pre-aaplication consultation with the Corps and LGU based on the infarmation you have provided. Regulatory entities wiil not initiate a formal application review if this box is checked. 8y signature below,i attest that the information in this application is complete and accurate. I further attest that I possess the authority to und ke the worlc described herein. Signature: / Date: �'� � � �� I hereby horize Mderson Enginee�ing of MN,LiC to act on my behalf as my agent in the processing of ihis application and to furnish,upon request,supplemental information in support of this application. 1 The term"impact"as used in this jo(ni appllcation form is a generic term used for dtsclosure purposes to ident�fy adivities that may require approval from one or more regulatory agencies. For purposes of this form It is not meant to indirate whether or not those attivities may require mitigation/replacement. Minnesota Interagency Water Resource Application Form February 3014 Page 4 of 5