Wetland Project Application
08 -0,
Application No.
Field Office Code
(V.2.02 for MS WORD) 9/17/2007
Iication Form for WaterlWetland Pro'ects
For Internal Use Only
Date Initial Application Received
Date initial Application Deemed Complete
NA-026620-03B
Minnesota Local/State/Federal A
PART I: BASIC APPLICATION
''See HELP" directs you to important additional information and assistance in Instructions, Page I.
1. LANDOWNER/APPLICANT CONTACT INFORMATION (See Help 1)
Name: Eden Trace; Mark Undestad Phone: (952) 361-0722 E-mail:
Completemailingaddress:8156MalloryCourt.Chanhassen.MN 55317
lA. AUTHORIZED AGENT (See Help LA) (Only if applicable; an agent is Ilot required)
Name: MFRA; Todd Ullom Phone: (763) 476-6010 E-mail: tullom@mfra.com
Complete mailing address: 1480028thAveNorth,Suite140,Plymouth,MN 55447
2. NAME, TYPE AND SIZE OF PUBLIC WATERS or WETLANDS IMPACTED (Attach Additional Project Area sheets ifneeded)
Name or ID. # of Waters Impacted (if applicable; if known):
(Check all that apply): 0 Lake 0 River 0 Circular 39 Wetland type: 0 1, OIL, 1812, 0 3, 0 4, 0 5,06,0 7, 0 8
Wetland plant community type1: 0 shallow open water, 0 deep marsh, 0 shallow marsh, 0 sedge meadow, 181 fresh meadow,
o wet to wet-mesic prairie, 0 calcareous fen, 0 open bog or coniferous bog, 0 shrub-carr/alder thicket,
o hardwood swamp or coniferous swamp, 0 floodplain forest, 0 seasonally flooded basin
Indicate size of entire lake or wetland (check one): 0 Less than 10 acres (indicate size: 0 10 to 40 acres 0 Greater than 40 acres
3. PROJECT LOCATION (Information can be found on property tax statement, property title or title insurance):
Project street address: Fire #: City (if applicable): Vadnais Heights
Yo Section: SW Section: 14 Township #: 116N Range #: 23W County: Carver
Lot #: Block: Subdivision: Watershed (name or #) Riley-Purgatory-Bluff UTM location: N E
Attach a simple site locator map. If needed, include on the map written directions to the site from a known location or landmark, and
provide distances from known locations. Label the sheet SITE LOCATOR MAP.
4. TYPE OF PROJECT: Describe the type of proposed work. Attach TYPE OF PROJECT sheet ifneeded.
warehouse development - please see attached site plan
5. PROJECT PURPOSE, DESCRIPTION AND DIMENSIONS: Describe what you plan to do and why it is needed, how you plan to
construct the project with dinlensions (length, width, depth), area of inlpact, and when you propose to construct the project. This is the
most important part of your application. See HELP 5 before completing this section; see What To Include on Plans (Instructions,
page 1). Attach PROJECT DESCRIPTION sheet
The project will involve the construction of a 44,600 SF industrial! office structure and associated parking lots and access roads.
Stormwater ponding for the proposed project will be completed by expanding the neighboring stormwater pond. A 5,668 SF man-made
wetland Qncidental) will be impacted as part of the proposed project.
Footprint of project: 0.13 acres or 5,668 square feet drained, filled or excavated.
6. PROJECT ALTERNATIVES: What alternatives to this proposed project have you considered that would avoid or minimize impacts
to wetlands or waters? List at least TWO additional alternatives to your project in Section 5 that avoid wetlands (one of which may be "no
build" or "do nothing"), and explain why you chose to pursue the option described in this application over these alternatives. Attach
PROJECT ALTERNATIVES sheet if needed.
Not Applicable
7. ADJOINING PROPERTY OWNERS: For projects that inlpact more than 10,000 square feet of water or wetlands, list the complete
mailing addresses of adjacent property owners on an attached separate sheet. (See HELP 7)
8. PORTION OF WORK COMPLETED: Is any portion of the work in wetland or water areas already completed? 0 Yes ONo. If
yes, describe the completed work on a separate sheet of paper labeled WORK ALREADY COMPLETED. (See HELP 8)
9. STATUS OF OTHER APPROVALS: List any other permits, reviews or approvals related to this proposed project that are either pending or
have already been approved or denied on a separate attached sheet. See HELP 9.
10. I am applying for state and local authorization to conduct the work described in this application. I am familiar with the information
contained in this application. To the best of my knowledge and belief, all information in Part I is true, complete, and accurate. I possess
the authority to undertake the work described, or I am acting as the duly authorized agent of the applicant.
~ ~TNh.~~
Signature of applicant (Ewu1urmr!.r)
"3 -L\-a'Q
Date
'..,- ~ '--
Signature of agent (if applicable)
"t- ~- 0 ~
Date
This block must be signed by the person who desires to undertake the proposed activity and has the necessary property rights to do so. If only the Agent has signed.
please attach a separate sheet signed by the landowner, giving necessary autborization to the Agent
ISee Wetland Plants and Plant Communities of Minnesota and WISconsin (Eggers and Reed, 1997) as modified by the Board of Water and Soil Resources,
United States Army Corps of Engineers.
APPLICATION FOR DEPARTMENT OF THE ARMY PERMIT (33 C.FR 325) OM>> ArPROV AL NO. 0710-003 Expires Dee 31. 2004
The public burden for Ibis collection of infurmation is estimated to allel'8ge 10 hOllrs per response, although the m'liority of 8fll'lications should require 5 hours or less. This includes
the time for reviewing inslructions, searching existing data somces, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send
comments rcgmding this bunten estimate or any other aspect oftbis collection of information, including suggestions for reducing tbis burden, to Department of Defense, Washington
Headquarters Service Directorate of Information Operations and Reports, 1215 Jefll:rson Davis Highway, Suite 1204, Arlington, VA 22202-4302; and to lhe Office of Management
and Budget, Paperwork Reduction Project (0710-0003), Washington, DC 20503. Respondents should be aware that notWitbstanding any other provision of1aw, no person shall be
subjeot to any penally for failing to comply with a collection of infonna\ion if it does not display a currently valid OMB control number. Please DO NOT RETURN your form to
either of these addresses. Completed applications must he submitted to the District engineer having jurisdiction over the location of the proposed activity.
PRIVACY ACf STATEMENT: Authorities: RivelS and Harbors Act, Section 10, 33 USC 403; Clean Water Act, Section 404,33 use 1344; Marine Protection, Research and
Sanctuaries Act, 33 USC 1413, Section 103. Principal purpose: Information provided on this furm will be used in evaluating the application fur a pcnnil. Routine uses: This
information may he shared with the Dapartment of Justice and other Federal, state, and local government agencies. Submission of requested infonnalion is vollUllaJ:y; however, if
infunnation is not nrovided. the permit 8IIIllication cannot be evaluated nor can apenn;t he issued.
ITEMS 1 THROUGH 4 TO BE FILLED IN BY THE CORPS
1. APPLICATION NO.
2. FIElD OFFICE CODE
3. DATE RECEIVED
4. DATE APPLICATION COMPLETED
YOU DO NOT NEED TO COMPLETE ITEMS 6-10 and 12-25 in the SHADED AREAS.
AU applicants must complete non-shaded items 5 and 26. If an agent is used, also complete items 8 and 11. This optional Federal form is valid
for use om when included as art of this entire state Iication a.cket
11. STATEMENT OF AUTHORIZATION (if applicable; complete only if authorizing an agent)
I hereby authorize MFRA 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 permit application.
26. Application is hereby made for a permit or permits to authorize the HOrk described in this application, I certify that the information in this
application is complete and accurate. I further certifY that I possess the authority to undertake the work: descnoed herein or am acting as the duly
authorized agent of the applicant.
r(~~ s--3-oCO
Signature of applicant Date Signature of agent (if any) Date
The application must be signed by the person who desires to undertake the propo activity (applicant), or it may be signed by a duly authorized agent if
the statement in Block 11 has been fined out and signed. 18 U.S.C. Section 1001 provides that: Whoever, in my manner within the jurisdiction of my
department or agency of the United States knowingly and willfully falsifies, conceills, or covers up with any trick, scheme, or disguises a material fact or
makes any false, fictitious or ftaudulent statements or representations or makes or U..fes any false writing or document \mowing same to contain any false,
fictitious or fraudulent statements or entry, shall be fined not more than $10,000 or /1llprisoncd not morc than five ycars or both.
ENG FORM 4345, Jul97 EDITION OF FEB 9418 O~SOLETE. (proponent: CECW-OR)
Minnesota LocaVStatelFederal Application Forms for Water/Wetland Projects
Page 2
FOR LGUUSE ONLY:
Determination for Part 1: 0 No WCA Jurisdiction
o Exempt: No. _ (per MN Rule 8420.0122)
o No Loss: _ (A.,B,. . .G, per MN Rule 8420.0220)
o Wetland BOWldary or type
o Replacement required - applicant must complete Part II
COMPLETE THE SECTION BELOW ONLY IF REPLACEMENT IS NOTREOUIRED:
Applitation is (checkoue): 0 Approved OApproved with conditions (conditions attached)
o Denied
Comments/Findings:
LOO official signature
Date
Name and Title
For Agricultural and Drainage exemptions (MN Rule 8420;0122 Subps. 1 and 2B), LGU has received pruuf of recording of restrictions
(per MN Rule 8420.0115):
County where recorded
Date
LOU official signature
Date
Minnesota Local/State/Federal Application Forms for WaterlWetland Projects
Page 3
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