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<br /> NA-026620-03B (V.2.02 for MS WORD)9/17/2007
<br /> Minnesota Local/State/Federal A lication Form for Water/Wetland Pro'ects
<br /> For Internal Use Only
<br /> Application No. Field Office Code Date Inifial Application Received Date initial Appiication Deemed Complete
<br /> PART 1: BASIC APPLICATION
<br /> "See HELP"directs you to important additional information and assistance in Instructions,Page 1.
<br /> 1. LANDOWNER/APPLICANT CONTACT INFORMATION(See Help I) •
<br /> Name: Wayzata Country Club; Bob Distel Phone: 952-475-9761 � E-mail:
<br /> . Complete mailing address:200 Wayzata Bivd.West,�Wayzata, MN 55391
<br /> ' lA. AUTIiORIZED AGENT(See He/p lA) (Only if applicable;an agent is i:ot required)
<br /> Name: MFRA;Todd Ullom Phone: 763-259-6015 E-mail:tuliom@mfra.com
<br /> Complete mailing address: 14800 28�'Avenue N,Suite 140, Plymouth, MN 55447
<br /> 2. NAME,TYPE AND SIZE OF PUBLIC WATERS or WETLANDS IMPACTED(Attach Additional Project Area sheets if needed)
<br /> Name or I.D.#of Waters Impacted(if applicable;if lrnown):
<br /> (Check all that apply): ❑Lake ❑River ❑Circular 39 Wetland type:❑ 1,❑ 1L,�2,�3,�4,�5,0 6,�7,0 8
<br /> Wetland plant community typel: ❑shallow open water,�deep marsh,�shallow marsh,❑sedge meadow, �fresh meadow,
<br /> ❑wet to wet-mesic prairie, 0 calcareous fen,�open bog or coniferous bog,�shrub-carr/alder thicket, •
<br /> ❑hardwood swamp or coniferous swamp,0 floodplain forest,❑seasonally flooded basin
<br /> Indicate size of entire lake or wetland(check one): �Less than 10 acres(indicate size:+/-0.7 Ac) ❑ 10 to 40 acres ❑Greater than 40
<br /> acres
<br /> 3. PROJECT LOCATION (Information can be found on property tax statement,property title or title insurance):
<br /> Project street address:200 Wayzata Blvd.West,Wayzata, MN 55391 Fire#:
<br /> City(if applicable): Orono .
<br /> '/<Section:S1/2 Section:36 Township#:118N Range#:23W County:Hennepin
<br /> Lot#: Block: Subdivision: Watershed(name or#)#20 UTM location:N E
<br /> Attach a simple site locator map. If needed,include on the map written d'uections to the site from a lrnown location or landmazk,and
<br /> provide distances from laiown locations. Label the sheet SITE LOCATOR MAP.
<br /> 4. TYPE OF PROJECT: Describe the type of proposed work Aitach TYPE OFPROJECT sheet if needed.
<br /> Construction of a pond within existing golf course. Pond will be constructed via excavation of existing drainage ditch and installation of
<br /> weir. Mitigafion of wetland impacts will be provided on-site in two locations as illustrated on attached plan sheets.
<br /> 5. PROJECT PiTRPOSE,DESCRIPTION AND DIMENSIONS: Describe what you plan to do and why it is needed,how you plan to
<br /> construct the project with dimensions(length,width,depth),area of impact,and when you propose to construct the project This is the
<br /> most important part of your application. See HELP 5 before completing this section;see What To Include on Plans(Instructions,
<br /> page 1). Attach PROJECT DESCRIPTION shee�
<br /> The purpose of the proposed project is fo construct a stormwater pond within an existing draiange ditch on the subject property.The
<br /> stormwater pond will provide additional treatment of stormwater generated by the golf course and neighboring properties pcior to
<br /> entering Lake Minnetonka,subsequently improving surFace water quality of downstream water bodies.Wetland mitigation will be
<br /> provided on-site. •
<br /> Footprint of project: 0.59 acres or 25,704 square feet drained,filled or excavated.
<br /> 6. PROJECT ALTERNATIVES: What aitematives to this proposed project have you considered that would avoid or minimize impacts
<br /> to wetlands or waters? List at least TWO additional altematives to your project in Section 5 that avoid wetlands(one of which may be"no
<br /> build"or"do nothing"),and explain why you chose to pursue the option described in this application over these altematives. Attach
<br /> PROJECT ALTERNATIVES sheet if needed.
<br /> please see atthached narrafive .
<br /> 7. ADJOINING PROPERTY OWNERS: For projects that impact more than 10,000 square feet of water or wetlands,list the complete
<br /> mailing addresses of adjacent property owners on an attached separate sheet (See HELP 7)
<br /> 8. P TION OF WORK COMPLETED: Is any portion of the work in wetland or water areas already completed? ❑Yes �No. If
<br /> yes, e cribe the completed work on a separate sheet of paper labeled WORK ALREADY COMPLETED. (See HELP 8)
<br /> 9. �T TUS OF THER APPROVALS: List any other permits,reviews or approvals related to this proposed project that aze either pending or
<br /> have a eady bee pproved or denied on a separate atEached sheet See HELP 9.
<br /> 10. I applyin f state and local suthorization to conduct the work described in this application. I am familiar with the information
<br /> con d in this a pli tion. To the best of my knowledge and belief,all inforruation in Part I is true,complete,and accurate. I possess
<br /> the � rity to n ert e th wo k described,or I am acting as the duly authorized agent of the applicant
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<br /> Signature of applicant(Landowner) Date Signature of agent(if applicable) Date
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