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Project Name and/ot Number: Modern Construction of Minnesota, Inc. -AE 14280 <br /> PaRT FOUR: Aquatic Resource impact15ummary <br /> If your p�oposed project involves a direct or indirect impact to an aquatic resource (wetland, lake, tributary, etc.) identify each <br /> impact in the table below. Include ail anticipated impacts, including those expected to be temporary. Attach an overhead view <br /> map, aerial photo, and/or drawing showing all of the aquatic resources in the project area and the location(s) of the proposed <br /> impacts.label each aquatic resource on the map with a reference number or letter and identify the impacts in the following table. <br /> Type of Impad Duration of County,Major <br /> Aquatic Existing Plant <br /> Aquatic Resource (fill,excavate, Impact Overall Size of Watershed#, <br /> Resource Type Communl <br /> ID(as noted on drain,or Permanent(P) Size of impact� Aquatic � and Bank <br /> (wetland,lake, <br /> overhead view) remove or Temporary Rewurce 3 Type(s)in �ryjce A�ea# <br /> tributary etc.) Im act Area" <br /> vegetation) (T)' p of Impact Areas <br /> 11#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 <br /> would be removed after 220 days would be entered"T(220)". <br /> =Impacts less than 0.01 acre should be reported in square feet. Impacts 0.01 acre or greater should be reported as acres and rounded to the <br /> nearest 0.01 acre. Tributary impacts must be reported in linear feet of impact and an area of impact by indicating first the linear feet of impact <br /> along the flowline of the stream followed by the area impact in parentheses). For example,a project that impacts SO feet of a stream that is 6 <br /> feet wide would be reported as 50 ft(300 square feet). <br /> 3This is generally only appticable if you are applying for a de minimis exemption under MN Rules 8420.0420 Subp.8,otherwise enter"N/A". <br /> j 'Use Wetland Planfs and Plant Community Types of Minnesoia and Wisconsin 3rd Ed.as modified in MN Rutes 8420.0405 Subp.2. <br /> I SRefer to Major Watershed and 6ank Service Area maps in MN Ruies 8420.0522 Subp.7. <br /> � <br /> ' If any of the above idenfified impacts have already occurred,identify which impacts they are and the circumstances associated <br /> with each: <br /> PART FtVE: Applicant Signature <br /> ❑ Check here if you are requesting a pre-aaplication consultation with the Corps and LGU based on the information you have <br /> provided. Regulatory entities will not initiate a formai application review if this box is checked. <br /> By signature below,1 attest that the information in this application is complete and accurate. I further attest that I possess the <br /> authority to und ake the work described herein. <br /> Signature: Date: y'"� �� ��' <br /> I hereby horize Anderson Engineering of MN,LLC to act on my behalf as my agent in the processing of this application and to <br /> furnish, upon request,supplemental information in support of this application. <br /> 1 The term"impact"as used in this joint application form is a generic term used for disclosure purposes to identify <br /> adivities that may require approvai from one or more regulatory agencies. Fo�purposes of this form it is not mea�t to <br /> indicate whether or not those activities may require mitigation/replacement. <br /> Minnesota Interagency Water Resource Application Fo�m February 2014 Page 4 of 5 <br />