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i Project Name and/or Number. Wischmeier Property,Orono—AE 14699 <br /> ' PART F�UR: Aquatic Resource Impact15ummary <br /> � If your proposed project involves a direct or indirect impact to an aquatic resource (wetland, lake, tributary, etc.) identify each i <br /> �I impact in the table 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 ihe following table. <br /> ' Type of Impact Duration of County,Major ' <br /> Aquatic Existing Plant <br /> Aquatic Resource (fill,excavate, Impact Overall Size of Watershed#, <br /> Resource Type ! Community <br /> ID{as noted on drain,or Permanent(P) Size of ImpactZ Aquatic and Bank <br /> (wetland,lake, Type(s)in <br /> overhead view) remove or Temporary Resource 3 Service Area# <br /> tributary etc.) 1 Impact Area" <br /> vegetation) �T) of Impact Areas <br /> � <br /> ' <br /> � 'If 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 ' <br /> , would be removed after 220 days would be entered"T(220�". <br /> i 2lmpacts 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 reported in linear feet of impact and an area of impact by indicating first the linear feet of impact <br /> 'I 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 fi <br /> � feet wide would be reported as SO h(300 square feet). <br /> j 3This is generally only applicable if you are applying for a de minimis exemption under MN Rules 8420.0420 Subp.8,otherwise enter"N/A". <br /> ' 'Use Wetland Plants and Ploni Community Types of Minnesota and Wrsconsin 3�d Ed.as modified in MN Rules 8420.0405 Subp.2. <br /> �I SRefer to Major Watershed and Bank Service Area maps in MN Rules 8420.0522 Subp.7. <br /> Ii If any of the above identified impacts have already occurred,identify which impacts they are and the ci�cumstances associated ' <br /> ii with each: I <br /> I . ill <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 II! <br /> iprovided. 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 acwrate. I further attest that I possess the <br /> , <br /> authority to undertake the work described herein. <br /> � �--�' — <br /> Signature: , Date: May 19, 2017 <br /> ' I hereby authorize Anderson Engineering of MN,LlC to act on my behalf as my agent in the processing of this application and to <br /> furnish,upon request,supplemental information in support of this application. <br /> I I <br /> 'The term"impacY'as used in this joint application form is a generic term used for disclosure purposes to identify <br /> activities that may require approval from one or more regulatory agencies. For purposes of this form it is not meant to <br /> ' indicate whether or not those activities may require mitigation/replatement. <br /> I <br /> Minnesota Interagency Water Resource Application Form February 2014 Page 4 of 5 J <br /> �_ _---- — _ — _— --_ _._ _ ----—- -- _ <br />