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Project Name and/or Number: <br />PART FOUR: Aquatic Resource Impact' Summary <br />If your proposed project involves a direct or indirect impact to an aquatic resource (wetland, lake, tributary, etc.) identify each impact n <br />the table below. Include all anticipated impacts, including those expected to be temporary. Attach an overhead view map, aerial photlI , <br />and/or drawing showing all of the aquatic resources in the project area and the location(s) of the proposed impacts. Label each aquatic <br />resource on the map with a reference number or letter and identify the impacts in the following table. <br />Type of Impact <br />Duration of <br />County, Major <br />Aquatic <br />Existing Plant <br />Aquatic Resource <br />(fill, excavate, <br />Impact <br />Overall Size of <br />Watershed #, <br />Resource Type <br />Community <br />ID (as noted on <br />drain, or <br />Permanent (P) <br />Size of Impact' <br />Aquatic <br />and Bank <br />(wetland, lake, <br />s <br />Type(s) in <br />overhead view) <br />remove <br />or Temporary <br />Resource <br />4 <br />Service Area # <br />tributary etc.) <br />1 <br />Impact Area <br />s <br />vegetation) <br />(T) <br />of Impact Area <br />Wetland B <br />wetland <br />fill <br />P <br />0.01 <br />1.61 <br />Type 2 <br />7 <br />Wetland BB <br />wetland <br />excavate <br />P <br />0.24 <br />0.24 <br />Type 2 <br />7 <br />Wetland D/E <br />wetland <br />fill <br />P <br />0.10 <br />1.62 <br />Type 2 <br />7 <br />Wetland F <br />wetland <br />excavate <br />P <br />0.20 <br />0.20 <br />Type2 <br />7 <br />Wetland I <br />wetland <br />excavate <br />P <br />0.29 <br />0.29 <br />Type 2 <br />7 <br />Wetland L <br />wetland <br />fill <br />P <br />0.03 <br />11.34 <br />Type 2 <br />7 <br />Wetland P <br />wetland <br />fill <br />P <br />1 0.04 <br />1.98 <br />1 Type 2 <br />7 <br />TOTALS: <br />1 0.91 <br />17.28 <br />IIf 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 <br />removed after 220 days would be entered "T (220)". <br />2Impacts 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 <br />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 <br />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 <br />reported as 50 ft (300 square feet). <br />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 />4Use Wetland Plants and Plant Community Types of Minnesota and Wisconsin 3rd Ed. as modified in MN Rules 8420.0405 Subp. 2. <br />5Refer 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 with <br />each: <br />1 The term "impact" as used in this joint application form is a generic term used for disclosure purposes to identify activities <br />that may require approval from one or more regulatory agencies. For purposes of this form it is not meant to indicate whether <br />or not those activities may require mitigation/replacement. <br />Minnesota Interagency Water Resource Application Form February 2014 <br />Page 6 of 19 <br />