01-20-2009 Planning Commission Packet

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/ � 18. ADDITTONAL INFORMATION REQUIRED FOR PROJECI'-SPECIFIC REPLACEMENT(Required only if you marked Box B or Box C in Section 14): ' For projects involving at least some project-specific replacement,include the following additional information: ❑Two drawings to scale of the replacement weUand. Include both overhead view and profile(side view or cross-sectional view). See What to Include on Plans (Instructions,Page 3)for a detailed description of what should be included in these drawings. Without drawings,your application will be considered incomplete. ❑For created replacement wetlands,include additional soils information(if available)that indicates the capability of the site to produce and maintain wetland characterisrics. Note 1: For replacement weUands located on pipeline easements,you need to receive endorsement of your project from both the easement holder and the Minnesota Department of Public Safety's Office of Pipeline Safety. Before start of construction,the owner of any utilities must be notified. The landowner or contractor is responsible for giving this notice by calling"Gopher Stafe One-Call"at 652�54-0002(Twin Ci6es Metro Area)or 1-800-252-1166(all other locations). Note 2: For eatensive or complex projects supplementary information may be requested at a later dated from one or more of the responding agencies. Such information may include(but not be limited to)the following: topographic map,water table map,soil borings,depth soundings,aerial photographs, environmental assessment and/or engineering reports. 19. SIGNED AFFIRMATION: • FOR PROJECTS INVOLVDVG REPLACEMEIVT BY WETLAND BANHING ONLY. To the best of my knowledge and belief,all information in Part II is true, complete and accurate;and I affirm that the wetland losses will be replaced via withdrawal from an account in the State Wefland Bank. FOR PROJECTS INVOLVIlVG ETTIiER PROJECT-SPECIFIC REPLACEMENT ONLY OR A COMBINATION OF WETLAND SANKIlVG AND PROJEGT-SPECIFIC REPLACEMENT: , � Part A: The replacement wetland. I affirm thatthe replacement wetland was not: . Previously restored or created under a prior approved replacement plan or permit;AND Drained or filled under an exemption during the previous 10 yeazs;AND Restored with financial assistance from public conservation programs;AND Restored using private funds,other than landowner funds,un]ess the funds are paid back with interest to the individual or organization that funded the restoration;and the individual or organization notifies the local govemment unit in writing that the restored wetland may be considered for replacement Part B: AddiNonal assurances(check all that apply): � �The wedand will be replaced before or concurrent with the actual draining or filling of a wetland. �An urevocable bank letter of credit,performance bond,or other acceptable security has been provided to guarantee successful completion of the weUand replacement ❑The wetland losses will be replaced via withdrawal from an account in the State WeUand Bank. Part C. For projects involving any project-specific replacement: Within 30 days of either receiving approval ofthis applicadon or beginning work on the project,I ill recorS the Declaration of Restrictions and Covenants on the deed for the properiy on which the replacement weUand(s)will be located;and I will at the same time ,su mit proof of such recording to the LGU. To e b t of my ledge an belief,all informafion in Part II is true,comp]ete and accurate;and I�rm all statements in Part A and C,as well as ch ed surance()' P B. x � � 1�-�� . Si�ture or applrcant ar agent Date FOR LGU USE ONLY Replacement pian is(check one): ❑Approved ❑Approved with conditions(conditions attached) ❑Denied LGU o�cial srgnature Date LGU has receive evidence of Ntle and proof of recording of Declazation of Restrictions and Covenants for Replacement WeUand: County where recorded Date Document#assigned by recorder LGU o�cial signature Date Minnesota LocaUState/Federal Application Forms for Water/Wetland Projects • Page 6