MN wetland conservation act/Notice of Decision/2016

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Project Name and/or Number: Stephen Kennedy—AE 14310 PART FOUR: Aquatic Resource Impact15ummary If your proposed project involves a direct or indirect impact to an aquatic resource (wetland, lake, tributary, etc.j identify each impact in the tabie belaw. Include all anticipated impacts, including those expected to be temporary. Attach an overhead view map, aerial photo, and/or drawing showing a11 of the aquatic resources in the project area and the location(s) of the proposed impacts. Label each aquatic resource on the map with a reference number or letter and identify the impacts in the foilowing table. Type of Impact Duration of County,Major Aquatic Existing Plant Aquatic Resource (fill,excavate, Impact Overell Size of Watershed#, Resource T e ID(as noted on � drain,or Permanent(P) Size of ImpactZ Aquatic Community and Bank overhead view �Wetland,lake, remove or Tem ora Resource 3 Type(s)in � tributary etc.) P ry Impact Area° Service Area# vegetation) (T) of Impact Area 'If impacts are temporary;enter the duration of the impacts in days next to the'T". For example,a projed with a temporary access fiil that would be removed after 220 days would be entered"T(220)". Zlmpacts 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 � nearest 0.01 acre. Tributary impacts must be reported in linear feet of impact and an area ot impact by indicating first the linear feet of impact along the flowiine of the stream followed by the area impatt in parentheses). For example,a project that Impacts 50 feet of a stream that is 6 feet wide would be reported as 50 ft(300 square feet). 3T'his is generally only applicable if you are applying for a de minimis exemption under MN Rules 8420.0420 5ubp.8,otherwise enter"N/A". °Use Wetland Plants and Plant Community Types of Minnesota and Wisconsin 3`d Ed.as modified in MN Rules 8420.0405 Su6p.2. SRefer to Major Watershed and Bank Service Area maps in MN Rules 8420.0522 Subp.7. If any of the above identified impacts have a(ready occurred,identify which impacts they are and the circumstances associated with each: PART FIVE: Applicant Signature ❑ Check here if you are requesting a pre-aaplication consultation with the Corps and LGU based on the information you have provided. Regulatory entities will not initiate a formal application review if this box is checked. By signature below,I attest that the information in this application is complete and accurate. I further attest that I possess the authority to undertake the work described herein. Signature: � Date: ��/� �z0�� I hereby authorize Anderson Engineering of M ,LLC to act on my behalf as my agent in the processing of this application and to furnish,upon request,supplemental information in support of this application. 1 The term"impact"as used in this joint application form is a generic term used for disciosure purposes to identify activities that may require approval from one or more regulatory agencies. for purposes of this form it is not meant to indicate whether or not those activities may require mitigation/replacement. Minnesota Interagency Water Resource Application Form�ebruary 2014 Page 4 of 5