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Project Name and/or Number: Stephen Kennedy—AE 14310 <br /> PART FOUR: Aquatic Resource Impact15ummary <br /> If your proposed project involves a direct or indirect impact to an aquatic resource (wetland, lake, tributary, etc.) identify each <br /> impact in the tabte below. Include all 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 Impact Duration of County,Major <br /> Aquatit Existing Plant <br /> Aquatic Resource (fill,excavate, Impact Overall Size of Watershed# <br /> Resource Type 2 Community ' I <br /> ID(as noted on drain,or Permanent(P} Size of Impact Aquatic and Bank <br /> overhead view) �wetland,lake, remove or Tem ora Resource 3 Type{s)in <br /> trihutary etc.) P ry 4 Service Area# <br /> vegetatian) (T)' Impact Area of Impact Areas <br /> 'If impacts are temporary;enter the duration of the impacts in days next to the'T". For example,a proJect wlth 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 repotted 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 50 feet of a stream that is 6 <br /> feet wide would be reported as 50 ft{300 square feet). <br /> 3T'his is generally only applicable if you are applying for a de minimis exemption under MN Ru(es 8420.0420 Subp.8,otherwise enter"N/A". <br /> 4Use Wetlond Plonts and Plant Community Types of Minnesoto and Wrsconsln 3`d Ed.as modified in MN Rules 8420.0405 Subp.2. <br /> SRefer to Major Watershed and Bank Service Area maps in MN Rules 8420.0522 Subp.7. <br /> If any of the above identified impacts have already occurred,identify which impacts they are and the circumstances associated <br /> with each: <br /> PART FIVE: Applicant Signature <br /> ❑ Check here if you are requesting a pre-application consultation with the Corps and LGU based on the information you have <br /> provided. Regulatory entities will not initiate a formal application review if this box is checked. <br /> By signature below,I attest that the information in this application is complete and accurate. I further attest that I possess the <br /> authoriry to undertake the work described herein. <br /> Signature: C1 Date: � /� .Z�/G <br /> I hereby authorize Anderson Engineering of M ,LLC to act on my behalf as my agent in the processing of this application and to <br /> furnish,upon request,supplementa)information in support ofthis application. <br /> 'The term"impact"as used in this joint application form is a generic term used for disclosure purposes Lo identify <br /> activities that may require approval from one or more regulatory agencies. For purposes of thfs form it is not meant to <br /> indicate whether or not those adivities may require mftigation/replacement. <br /> Minnesota Interagency Water Resource Application Form February 2014 Page 4 of 5 <br />