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• Project Name and/or Number: 649 Ferndale Road,Orono—AE 14636 PART FOUR: Aquatic Resource Impactl Summary If your proposed project involves a direct or indirect impact to an aquatic resource (wetland, lake,tributary, etc.) identify each impact in the table below. Include all antidpated impacts, including those expected to be temporary.Attach an overhead view map, aerial photo, and/or drawing showing all 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 foliowing table. Type of Impact Duration of County,Major Aquatk Existing Plant Aquattc Resource (fitl,excavate, Impact Overall Si�of Watershed li, Resource T ID(as noted on � drain,or Permanent(P) Size of Impad2 Aquatic �Ommunity and Bank (wetiand,lake, Type(s)in overhead view) remove or Temporary Resource 3 Senr(ce Area# tributary etc.) 1 Impact Area4 vegetation) (� of Impact Areas ilf 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 would be removed after 220 days would be entered"T(220�". 2lmpacts less than 0.01 acre shouid 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 of impact by indicating first the linear feet of impact 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 feet wide would be reported as SO ft(300 square feet). sThis is generally only applicabte if you are applying for a de minimis exemption under MN Rules 8420.0420 Subp.8,otherwise enter"N/A". •Use Wetland Pfants and P/ant Community Types of Mlnnesota ond Wisconsln 3�Ed.as modified in MN Rules 8420.0405 Subp.2. SRefer to Major Watershed and Bank 5ervice Area maps In MN Rules 8420.0522 Subp.7. If any of the above identified impacts have already occurred,Identify which impacts they are and the circumstances assoclated with each: PART FIVE: Applicant Signature ❑ Check here if you are requesting a Are-an�liration 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 d ribed rei . Signature: Date:��/�' I hereby authorize Anderson Engineering of MN, LC 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�s a generic term used for disdosure purposes to ideMtfy activities that may requ(re approval from one or more regulatory agencies. For purposes of this form it is not meant to indicate whether or not those activities may requfre mitigatfon/replacement. Minnesota Interagency Water Resource Application Form February 2014 Page 4 of 5