WCA Permit Application
Minnesota Local/State/Federal Application Forms for Water/Wetland Projects Instructions, Page 1 NA-026620-03B (V.2.02 for MS WORD) 9/17/2007 Minnesota Local/State/Federal Application
Forms for Water/Wetland Projects USE THIS APPLICATION FOR ANY PROJECT AFFECTING A LAKE, RIVER, STREAM OR WETLAND, INCLUDING: Local Government Unit Approval Pursuant to Minnesota Wetlands
Conservation Act (WCA) Minnesota Department of Natural Resources (DNR) Permit to Work in Public Waters Department of the Army Permit (33 CFR 325) Note: The U.S. Army Corps of Engineers
(COE) will forward application forms to the Minnesota Pollution Control Agency (MPCA) for processing if state water quality certification is required from the MPCA. You do not need to
send this application to the MPCA. This application packet includes : Part I: The BASIC APPLICATION and the COE APPLICATION to be filled out by all applicants (see Instructions). PART
II: The REPLACEMENT PLAN SUPPLEMENT to be completed only for projects that impact wetlands and require a replacement plan for wetland mitigation. If you’re not sure whether your project
requires a replacement plan, call your Local Government Unit (LGU) or Soil and Water Conservation District (SWCD) office for guidance. Do not proceed with your project until you have
received all required approvals from your LGU, the DNR and the COE. If you wish to confirm the status of your application at any time, contact the agencies directly (see Instructions,
page 2). Proceeding with work before all required authorizations are obtained may result in fines or other penalties, and may include a requirement to restore the project site to original
condition. If you have questions or need assistance with filling out these forms, contact your local SWCD office, your LGU, your Area DNR Waters office, or your COE field office (see
Instructions, page 2). If you believe that your project may be subject to watershed district, local zoning, or any other local regulations besides those of your LGU, contact those office(s)
directly. If you are a Federal Farm Program participant and your project affects a wetland or water body on agricultural land, your eligibility for USDA benefits may be affected. Contact
a Natural Resources Conservation Service office for further information. A QUICK LOOK AT THE PROJECT APPLICATION PROCESS Electronic files: Forms can be downloaded and filled out using
Microsoft Word. Your input will be restricted to fill-in fields where users can enter text or check boxes. These areas appear gray on the screen, but not on the printed document. Send
copies of these completed application forms to your LGU, your Area DNR Waters office, and your COE regulatory office. Any of the agencies may make initial contact with you to: a) inform
you that it has no jurisdiction over your project; b) request additional information needed; or c) inform you of applicable fees. When your application is considered complete and appropriate
fees have been received (if requested) it will be distributed for appropriate review. Following agencies’ reviews, you will be informed if it has been approved, approved with changes
or conditions, withdrawn, or denied. For information about state laws, rules and regulations that direct this process go to the web site www.revisor.leg.state.mn.us. For information
on U.S. Army Corps of Engineers regulations go to the web site www.mvp.usace.army.mil. Instructions for Part I HELP 1: Every applicant must fill out Section 1. The applicant is the person,
agency, company, corporation, or other organization that owns, leases, or holds other legal rights to the land where the project is located. Indicate names of multiple applicants on
a separate sheet. HELP 1A: Fill out Section 1A only if you have designated an authorized agent. An authorized agent may be an attorney, builder, consultant, contractor, engineer, or
any other person or organization designated by the applicant to represent him/her in this process. An agent is not required. HELP 5: Purpose, description and dimensions of project: State
briefly (in a sentence or two) what you propose to do and why it is needed. Also, describe whether your project will involve any of the following: -Construction of structures, filling,
draining, dewatering, removing, excavating or repair. -Construction of an access path, bridge, culvert, dam, ditch, dock, driveway, riprap, road, sand blanket, shore protection, or tile
line. -Construction of any structures on fill, piles or a float-supported platform. If so, describe. -Dredging or discharging (placing fill material) into a wetland or other water body
(including the temporary placement of material). If so, explain the specific purpose of the placement of the material (such as erosion control) and indicate how it will be done (such
as with a backhoe or dragline). If dredged material is to be discharged on an upland site, identify the location of the site.
Minnesota Local/State/Federal Application Forms for Water/Wetland Projects Instructions, Page 2 Include an overhead view drawing showing the work to be undertaken and its relative location
on the property. Show items such as property boundaries or lot dimensions; location and extent of shoreline, wetlands and water; location and dimensions and footprint of the proposed
project, structure or activity (include length, width, elevation and other measurements as appropriate); points of reference such as existing homes, structures, docks or landscape features;
indication of north; and location of spoil and disposal sites (if applicable). Hand drawn, computer generated or professionally prepared drawings are acceptable, as long as they contain
all necessary information clearly, accurately, and in adequate detail. Please include specific dimensions whenever possible. You may also include photos, if you wish. Paper copies should
be limited to maximum dimensions of 11” by 17”. Computer files should be viewable in a PDF format; contact the agency for other usable formats. HELP 7: For information regarding adjacent
landowners, contact the tax assessor where the project is to be developed. HELP 8: If any part of the work has already been completed, describe the area already developed. Include a
description of structures completed; any dredged or fill material already discharged (including type of material and volume in cubic yards); acres or square feet filled (if a wetland
or other water body); and whether the work was done under an existing permit (if so identify the authorization, if possible). HELP 9: Other permits, reviews or approval related to the
project may include the following: conditional use permit; plat approval; zoning variance; National Pollutant Discharge Elimination System permit; state disposal system permit (includes
dredged material disposal); watershed district/watershed management organization permit (stormwater, erosion, floodplain); environmental assessment worksheet/environmental impact statement;
hazardous waste site; feedlot permit; groundwater appropriation permit; or county/township driveway/road permit. Are you aware of any archeological or cultural resource determinations
or surveys completed concerning the project or replacement site by the State Historic Preservation Office (SHPO) or others? If yes, please explain on a separate sheet or attach a copy
of any determinations or surveys. Final Checklists (Part I) Have you completed all of Part I (Page 1), plus the Federal application (Page 2)? Did you (and your agent, if applicable)
sign Section 10 on page 1? Have you signed the Application for the Department of the Army Permit (Page 2) to seek Federal authorization of your project? Have you included the necessary
attachments for Part I? Attachments must include: Site Locator Map (Section 3) Type of Project (Section 4) (if additional space was needed) Overhead View of Project (Section 5 and HELP
5) Project Purpose, Description and Dimensions (Section 5) (if additional space was needed) Attachments may also include: Applicant Contact Information (HELP 1) (if additional space
was needed) Project Location (Section 3) (if additional space was needed) Project Alternatives (Section 6) (if additional space was needed) Photographs Adjoining Property Owners (Section
7) (if additional space was needed) Work Already Completed Section (Section 8) (if you answered YES) State Historic Preservation Office determination or survey Submitting Your Application
Make three copies of the entire application and all attachments. Keep the original, and mail a complete copy of your application to each of the local, state, and Federal entities listed
below. Be sure to include Part I and all attachments with each application. LOCAL: Send to the appropriate Local Government Unit (LGU). If necessary, contact your county Soil and Water
Conservation District (SWCD) office or visit the Board of Water and Soil Resources (BWSR) web site (www.bwsr.state.mn.us) to determine the appropriate LGU. STATE: Send to your Area DNR
Waters office, attention Area Hydrologist. If necessary, contact your county Soil and Water Conservation District (SWCD) office or visit the DNR website (www.dnr.state.mn.us) to locate
the Area Hydrologist for your location, or contact a Regional DNR office: NW Region: NE Region: Central Region: Southern Region: 2115 Birchmont Beach Road N.E. 1201 East Highway 2 1200
Warner Road 261 Highway 15 South Bemidji, MN 56601 Grand Rapids, MN 55744 St. Paul, MN 55106 New Ulm, MN 56073 Phone: 218-755-3973 Phone: 218-327-4416 Phone: 651-772-7910 Phone: 507
359-6053 FEDERAL: Send to the appropriate U.S. Army Corps of Engineers regulatory field office: Brainerd: St. Paul: La Crescent: Two Harbors: U.S. COE, Regulatory Branch U.S. COE, Regulatory
Branch U.S. COE, Regulatory Branch U.S. COE, Regulatory Branch 10867 E. Gull Lake Drive N.W. Army Corps of Engineers Centre 1114 South Oak Street 1554 Highway 2, Suite 2 Brainerd, MN
56401-9051 190 5th Street East La Crescent, MN 55947-1338 Two Harbors, MN 55616 Phone: 218-829-8402 St. Paul, MN 55101-9051 Phone: 507-895-8059 Phone: 218-834-6630 Phone: 651-290-5375
WEB SITES: BWSR: www.bwsr.state.mn.us U.S. ACOE: www.mvp.usace.army.mil DNR: www.dnr.state.mn.us MPCA: www.pca.state.mn.us
NA-026620-03B (V.2.02 for MS WORD) 9/17/2007 Minnesota Local/State/Federal Application Form for Water/Wetland Projects For Internal Use Only Application No. Field Office Code Date Initial
Application Received Date initial Application Deemed Complete PART I: BASIC APPLICATION “See HELP” directs you to important additional information and assistance in Instructions, Page
1. 1. LANDOWNER/APPLICANT CONTACT INFORMATION (See Help 1) Name: Mr. Martin Walsh Phone: 952 466 5252 E-mail: mwalsh@co.carver.mn.us Complete mailing address: Carver County Parks, 11360
Hwy 212 West, Cologne, MN 55322 1A. AUTHORIZED AGENT (See Help 1A) (Only if applicable; an agent is not required) Name: Jeffrey W. Olson Phone: 763 249 6789 E-mail: jolson@srfconsulting.com
Complete mailing address: SRF Consulting Group, Inc. One Carlson parkway, Suite 150 Plymouth, MN 55447-4443 2. NAME, TYPE AND SIZE OF PUBLIC WATERS or WETLANDS IMPACTED (Attach Additional
Project Area sheets if needed) Name or I.D. # of Waters Impacted (if applicable; if known): Lake Minnewashta, 32W (Figure 4) (Check all that apply): Lake River Circular 39 Wetland type:
1, 1L, 2, 3, 4, 5, 6, 7, 8 Wetland plant community type1: shallow open water, deep marsh, shallow marsh, sedge meadow, fresh meadow, wet to wet-mesic prairie, calcareous fen, open bog
or coniferous bog, shrub-carr/alder thicket, hardwood swamp or coniferous swamp, floodplain forest, seasonally flooded basin Indicate size of entire lake or wetland (check one): Less
than 10 acres (indicate size: ) 10 to 40 acres Greater than 40 acres 3. PROJECT LOCATION (Information can be found on property tax statement, property title or title insurance): Project
street address: Lake Minnewashta Regional Park 6900 Hazeltine Boulevard Chanhassen, MN 55331 Fire #: Unknown City (if applicable): Chanhassen, MN ¼ Section: Various Section: 9,4, and
3 Township #: 116N Range #: 23W County: Carver Lot #: NA Block: NA Subdivision: NA Watershed (name or #) 33 UTM location: N 4969841.47 E 453747.80 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. See Appendix
B: Figures 1 and 2. 4. TYPE OF PROJECT: Describe the type of proposed work. Attach TYPE OF PROJECT sheet if needed. Regional Multi-Use Recreational Trail 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 dimensions (length, width, depth), area of impact, 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. See project description in Appendix A. Footprint of project: acres or 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. See Appendix A 7. ADJOINING PROPERTY OWNERS: For projects that impact 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)
See attached list of adjacent property owners (Appendix A). 8. PORTION OF WORK COMPLETED: Is any portion of the work in wetland or water areas already completed? Yes No. 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. See Appendix A. 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. 1/31/11 Signature of applicant
(Landowner) Date Signature of agent (if applicable) 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 authorization to the Agent. 1See 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. Minnesota Local/State/Federal Application
Forms for Water/Wetland Projects Page 1
APPLICATION FOR DEPARTMENT OF THE ARMY PERMIT (33 CFR 325) OMB APPROVAL NO. 0710-003 Expires Dec 31, 2004 The public burden for this collection of information is estimated to average
10 hours per response, although the majority of applications should require 5 hours or less. This includes the time for reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Service Directorate of Information Operations and Reports, 1215 Jefferson Davis Highway,
Suite 1204, Arlington, VA 22202-4302; and to the Office of Management and Budget, Paperwork Reduction Project (0710-0003), Washington, DC 20503. Respondents should be aware that notwithstanding
any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information 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 be submitted to the District engineer having jurisdiction over the location of the proposed activity.
PRIVACY ACT STATEMENT: Authorities: Rivers and Harbors Act, Section 10, 33 USC 403; Clean Water Act, Section 404, 33 USC 1344; Marine Protection, Research and Sanctuaries Act, 33 USC
1413, Section 103. Principal purpose: Information provided on this form will be used in evaluating the application for a permit. Routine uses: This information may be shared with the
Department of Justice and other Federal, state, and local government agencies. Submission of requested information is voluntary; however, if information is not provided, the permit application
cannot be evaluated nor can a permit be 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. All 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 only when included as part of this entire state application packet. 5. APPLICANT’S NAME Mr. Martin Walsh 8. AUTHORIZED AGENT’S NAME AND TITLE (an
agent is not required) Jeffrey Olson, Associate Wetland Scientist 6. APPLICANT’S ADDRESS Carver County Parks, 11360 Hwy 212 West, Cologne, MN 55322 9. AGENT’S ADDRESS One Carlson Parkway
North Suite #150, Minneapolis, MN 55447 7. APPLICANT’S PHONE NO. 952-466-5252 10. AGENT’S PHONE NO. 763-249-6789 11. STATEMENT OF AUTHORIZATION (if applicable; complete only if authorizing
an agent) I hereby authorize 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.
APPLICANT”S SIGNATURE: DATE: 12. PROJECT NAME OR TITLE (see instructions) 13. NAME OF WATERBODY, IF KNOWN (if applicable) 14. PROJECT STREET ADDRESS (if applicable) 15. LOCATION OF PROJECT
16. OTHER LOCATION DESCRIPTIONS, IF KNOWN (see instructions) 17. DIRECTIONS TO THE SITE 18. NATURE OF ACTIVITY 19. PROJECT PURPOSE 20. REASON(S) FOR DISCHARGE 21. TYPES OF MATERIAL BEING
DISCHARGED AND THE AMOUNT OF EACH TYPE IN CUBIC YARDS 22. SURFACE AREA IN ACRES OF WETLANDS OR OTHER WATERS FILLED 23. IS ANY PORTION OF THE WORK ALREADY COMPLETE? YES NO IF YES, DESCRIBE
COMPLETED WORK. 24. ADDRESSES OF ADJOINING PROPERTY OWNERS, 25. LIST OF OTHER CERTIFICATIONS OR APPROVALS/DENIALS RECEIVED FROM OTHER FEDERAL, STATE OR LOCAL AGENCIES FOR WORK DESCRIBED
IN THIS APPLICATION. 26. Application is hereby made for a permit or permits to authorize the work 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 described herein or am acting as the duly authorized agent of the applicant. Signature of
applicant Date Signature of agent (if any) 1/31/2011 Date The application must be signed by the person who desires to undertake the proposed activity (applicant), or it may be signed
by a duly authorized agent if the statement in Block 11 has been filled out and signed. 18 U.S.C. Section 1001 provides that: Whoever, in any manner within the jurisdiction of any department
or agency of the United States knowingly and willfully falsifies, conceals, or covers up with any trick, scheme, or disguises a material fact or makes any false, fictitious or fraudulent
statements or representations or makes or uses any false writing or document knowing same to contain any false, fictitious or fraudulent statements or entry, shall be fined not more
than $10,000 or imprisoned not more than five years or both. ENG FORM 4345, Jul 97 EDITION OF FEB 94 IS OBSOLETE. (Proponent: CECW-OR)
Minnesota Local/State/Federal Application Forms for Water/Wetland Projects Page 2
FOR LGU USE ONLY: Determination for Part 1: No WCA Jurisdiction Exempt: No. ____ (per MN Rule 8420.0122) No Loss: ____ (A,B,. . .G, per MN Rule 8420.0220) Wetland Boundary or type Replacement
required – applicant must complete Part II COMPLETE THE SECTION BELOW ONLY IF REPLACEMENT IS NOT REQUIRED: Application is (check one): Approved Approved with conditions (conditions attached)
Denied Comments/Findings: _______________________________________________________________________________________________________ LGU official signature Date _________________________________
Name and Title For Agricultural and Drainage exemptions (MN Rule 8420.0122 Subps. 1 and 2B), LGU has received proof of recording of restrictions (per MN Rule 8420.0115): County where
recorded Date Document # assigned by recorder LGU official signature Date Minnesota Local/State/Federal Application Forms for Water/Wetland Projects Page 3
Instructions For Part II Complete those portions of Part II: Replacement Plan Supplement for which information is readily available (such as location, existing land use, size of impact
area, etc.) A person certified in wetland delineation must determine items pertaining to specific wetland impacts (wetland type, predominant vegetation, watershed name, etc.) Contact
the local soil and water conservation district (SWCD) office for further information on obtaining such items. What to Include on Plans Detailed overhead views of replacement site(s)
(Part II), as well as profile view(s) of replacement site(s) (Part II), may be either hand drawn, computer generated or professionally prepared, as long as they contain all necessary
information clearly, accurately, and in adequate detail. Please include specific dimensions whenever possible. You may also include photos, if you wish. Overhead views of Part II replacement
site(s) should include the following items that pertain to your project: Property boundaries and/or lot dimensions. Location and extent of shoreline, wetlands and water. Location and
dimensions of proposed project, structure or activity. Include length, width, elevation and other measurements as appropriate. Points of reference (such as existing homes, structures,
docks or landscape features). Location of inlet and outlet structures. Indication of north. Location of spoil and disposal sites (if applicable). Areas of wetland and upland plants established.
Profile views (side or cross-sectional views) should include the following items that pertain to your project: Location and dimensions of proposed project, structure or activity. Include
elevation, depth, soil profile, side slope and other measurements as appropriate. Proposed water level elevation. Final Checklists Part II: Replacement Plan Supplement Have you completed
all of Part II (pages 3-5)? Did you (or your agent) sign Section 19 on page 5? Have you included the necessary attachments for Part II? Attachments must include: If the project includes
any wetland banking (complete or partial), include Application for Withdrawal of Wetland Credits Form (Section 14) If the project includes any project-specific replacements (complete
or partial), include: Description of Replacement Wetland(s) Construction (Section 15) Copy of vegetation management plan (Section 15) Scale drawing of overhead view or replacement wetland
(Section 18) Scale drawing of profile view of replacement wetland (Section 18) Attachments may also include: Additional description of Wetland Impact Charts (Section 11) (if additional
space was needed) Additional Description of Replacement Wetlands charts (Section 17) (if additional space was needed) Additional soils information for created replacement wetland(s)
(Section 18) (if available) Note: To deposit surplus wetland credits in the State Wetland Bank, submit a Wetland Banking Application directly to your LGU (Section 16). Preparing Your
Application for Mailing To apply for both state and Federal authorization, your application must include Part I (Page 1), the Federal application (Page 2), and attachments as indicated
on Final Checklist for Part I (Instructions, Page 2). Your application must also include Part II (Pages 3-5) and additional attachments as indicated on Final Checklist for Part II (above).
Make three copies of the entire application and all attachments. Keep the original, and mail the three copies to the appropriate local, state, and Federal agencies (see Instructions
for Part I for addresses). Minnesota Local/State/Federal Application Forms for Water/Wetland Projects Instructions Page 3
PART II: REPLACEMENT PLAN SUPPLEMENT For assistance in completing Part II, contact your Local Government Unit or a professional consultant 11. DESCRIPTION OF WETLAND IMPACTS: Complete
the chart below: 1) Use one row of boxes for each wetland impact; 2) If your project has more than one wetland impact, reference your overhead view (part of Section 5) to this chart
by identifying and labeling “first impact” and “second impact” on your overhead view; 3) If you are identifying only one wetland type within a given wetland impact area, use the first
dotted line and leave the others blank; 4) If you have chosen to identify more than one wetland type within a given wetland impact area, use the extra dotted lines to indicate each wetland
type, and identify predominant vegetation and size of impacted area for each separate wetland type within that impact area; 5) If you do not have access to some of this information,
call your LGU or SWCD office for assistance. (Photocopy chart for more impacts, if needed.) DESCRIPTION OF WETLAND IMPACTS Wetland impact (as noted on overhead view) Watershed name or
number (if known) Watershed and Bank Service Area Wetland plant community type1 Predominant vegetation in impacted wetland area Size of area impacted (in acres or square feet) Existing
land use in project area (check all that apply) (W-20) W-22) (W-8) 20 BSA 7 Type 1 (W-20) Poa pratensis 0.130 ac Housing Commercial Industrial Parks/recreation areas Highways and associated
rights-of-way Forested Farmsteads/agricultural Vacant lands Public and semi-public (schools/gov’t facilities) Airports Extractive (gravel pits/quarries) Other: BSA 7 Type 2 (W-22) Poa
pratensis 0.010 ac BSA 7 Type 2 (W-8) Phalaris arundinacea 0.070 ac (W-2) (W-5) 20 BSA 7 Type 1L (W-2) Frax.penn.,, Carex normalis aristosa 0.005 ac BSA 7 Type 6 (W-5) Salix exigua,
Phalaris arundinacea 0.070 ac 1If you are identifying only one wetland type within a given wetland impact area, use the first dotted line and leave the others blank. If you have chosen
to identify more than one wetland type within a given wetland impact area, use the extra dotted lines to indicate each separate wetland type, and identify predominant vegetation and
size of impacted area for each separate wetland type with that impact area. TOTALS OF AREA(S) IMPACTED FOR EACH WETLAND TYPE ON CHART (indicate acres or square feet ) Wetland plant community
type 1: Shallow open water: Deep marsh: Shallow Marsh: Sedge meadow: Fresh wet meadow: 0.08 ac Wet to wet mesic prairie: Calcareous fen: Open bog or coniferous bog: Shrub carr or alder
thicket: 0.07 ac Hardwood swamp or coniferous swamp: Floodplain forest 0.005 ac Seasonally flooded basin 0.13 ac 12. SPECIAL CONSIDERATIONS: Are you aware of any special considerations
that apply to either the impact site(s) or the replacement site(s)? Yes No (Examples: the presence of endangered species, special fish and wildlife resources, sensitive surface waters,
or waste disposal site.) If YES, list and describe briefly. None. 13. SHORELAND IMPACT ZONE: Please identify each wetland impact site noted in Section 15 that is within 1000 feet of
a lake or 300 feet of a river. All impacts are within 1,000 ft of a lake. 1 See 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. Minnesota Local/State/Federal Application Forms for Water/Wetland Projects Page 4
14. HOW PROPOSED REPLACEMENT WILL BE ACCOMPLISHED: Indicate how proposed replacement will be accomplished (check only one box below and continue as indicated): A. Wetland banking credits
only SEE Appendix D for proposed credits to be used. Complete Application for Withdrawal
of Wetland Credits Form and include with your application. Copies of this form are available from your LGU, or download a copy from www.bwsr.state.mn.us Skip to Section 19, page 6 (You
do not need to complete Sections 15-18). B. Project-specific replacement only Continue with Section 15 below. C. A Combination of wetland banking and project-specific replacement. If
using project specific replacement that will result in surplus wetland credits that you propose to deposit in the state wetland bank for future use, then you must submit a wetland banking
application directly to your LGU before or concurrently with submittal of this form. Also, Complete Application for Withdrawal of Wetland Credits Form and include with your application.
Copies of this form and the wetland banking application is available from your LGU, or download a copy from www.bwsr.state.mn.us Continue with Section 15 below. 15. DESCRIPTION OF REPLACEMENT
WETLAND(S) CONSTRUCTION (Complete this section only if you marked Box B or Box C in Section 14 above): Describe in detail how replacement wetland(s) will be constructed. If several methods
will be used, describe each method. Details should include the following: 1) type of construction (such as excavated in upland, restored by tile break, restored by ditch block or revegetated);
2) type, size and specifications of outlet structures; 3) elevations relative to Mean Sea Level or established benchmarks or key features (such as sill, emergency overflow or structure
height); 4) what best management practices will be implemented to prevent erosions or site degradation; 5) proposed timetable for starting and ending the project; and 6) a vegetation
management plan. Write this description on a separate sheet of paper labeled DESCRIPTION OF REPLACEMENT WETLAND CONSTRUCTION. 16. SURPLUS WETLAND CREDITS: If using project-specific replacement
(Box B or Box C in Section 14 above), will the replacement result in any surplus wetland credits that you wish to have deposited in the State Wetland Bank for future use? Yes No. If
yes, submit a Wetland Banking Application directly to your LGU before or concurrently with submittal of this form. Copies are available from your LGU, or download a copy from www.bwsr.state.mn.us
17. DESCRIPTION OF REPLACEMENT WETLANDS: Complete the chart below: 1) Use one row of boxes for each wetland replacement site; 2) If your project has more that one wetland replacement
site, reference your overhead view (part of Section 5) to this chart by identifying and labeling “first replacement site” and “second replacement site” on your overhead view; 3) If you
are identifying only one wetland type within a given replacement site, use the first dotted line(s) and leave the others blank; 4) If you have chosen to identify more than one wetland
type in a given replacement site, use the extra dotted lines to indicate each separate wetland type, and identify type(s) of replacement credits and “restored or created” for each separate
wetland type with that replacement site; 5) If you do not have access to some of the information, or if you do not know your replacement ratio, call your LGU or SWCD office for assistance.
Photocopy chart for more wetland replacements, if needed.) DESCRIPTION OF REPLACEMENT WETLANDS Identify Wetland replacement site (as noted on overhead view) Watershed name or number
(if known) Bank Service Area County Section, Township, Range Wetland Plant Community Type1 Type(s) of replacement credits (in acres or square feet) Restored or created? Indicate R or
C New Wetland Credits (NWC) Public Value Credits (PVC) Name of First replacement site Name of Second replacement site If you are identifying only one wetland type within a given wetland
impact area, use the first dotted line and leave the others blank. If you have chosen to identify more than one wetland type within a given wetland impact area, use the extra dotted
lines to indicate each separate wetland type, and identify predominant vegetation and size of impacted area for each separate wetland type within that impact area. TOTAL NWC TOTAL PVC
REQUIRED REPLACEMENT RATIO: (If known) Wetland plant community type: Shallow open water: Deep marsh: Shallow Marsh: Sedge meadow: Fresh wet meadow: Wet to wet mesic prairie: Calcareous
fen: Open bog or coniferous bog: Shrub carr or alder thicket: Hardwood swamp or coniferous swamp: Floodplain forest Seasonally flooded basin * See 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. Minnesota Local/State/Federal Application
Forms for Water/Wetland Projects Page 5
18. ADDITIONAL INFORMATION REQUIRED FOR PROJECT-SPECIFIC REPLACEMENT (Required only if you marked Box B or Box C in Section 14): For projects involving at least some project-specific
replacement, include the following additional information: Two drawings to scale of the replacement wetland. Include both overhead view and profile (side view or cross-sectional view).
See What to Include on Plans (Instructions, Page 3) for a detailed description of what should be included in these drawings. Without drawings, your application will be considered incomplete.
For created replacement wetlands, include additional soils information (if available) that indicates the capability of the site to produce and maintain wetland characteristics. Note
1: For replacement wetlands located on pipeline easements, you need to receive endorsement of your project from both the easement holder and the Minnesota Department of Public Safety’s
Office of Pipeline Safety. Before start of construction, the owner of any utilities must be notified. The landowner or contractor is responsible for giving this notice by calling “Gopher
State One-Call” at 652–454-0002 (Twin Cities Metro Area) or 1-800-252-1166 (all other locations). Note 2: For extensive or complex projects supplementary information may be requested
at a later dated from one or more of the responding agencies. Such information may include (but not be limited to) the following: topographic map, water table map, soil borings, depth
soundings, aerial photographs, environmental assessment and/or engineering reports. 19. SIGNED AFFIRMATION: FOR PROJECTS INVOLVING REPLACEMENT BY WETLAND BANKING ONLY. To the best of
my knowledge and belief, all information in Part II is true, complete and accurate; and I affirm that the wetland losses will be replaced via withdrawal from an account in the State
Wetland Bank. FOR PROJECTS INVOLVING EITHER PROJECT-SPECIFIC REPLACEMENT ONLY OR A COMBINATION OF WETLAND BANKING AND PROJECT-SPECIFIC REPLACEMENT: Part A: The replacement wetland. I
affirm that the replacement wetland was not: Previously restored or created under a prior approved replacement plan or permit; AND Drained or filled under an exemption during the previous
10 years; AND Restored with financial assistance from public conservation programs; AND Restored using private funds, other than landowner funds, unless the funds are paid back with
interest to the individual or organization that funded the restoration; and the individual or organization notifies the local government unit in writing that the restored wetland may
be considered for replacement. Part B: Additional assurances (check all that apply): The wetland will be replaced before or concurrent with the actual draining or filling of a wetland.
An irrevocable bank letter of credit, performance bond, or other acceptable security has been provided to guarantee successful completion of the wetland replacement. The wetland losses
will be replaced via withdrawal from an account in the State Wetland Bank. Part C. For projects involving any project-project-specific replacement: Within 30 days of either receiving
approval of this application or beginning work on the project, I will record the Declaration of Restrictions and Covenants on the deed for the property on which the replacement wetland(s)
will be located; and I will at the same time submit proof of such recording to the LGU. To the best of my knowledge and belief, all information in Part II is true, complete and accurate;
and I affirm all statements in Part A and C, as well as checked assurance(s) in Part B. 1/31/11 Signature or applicant or agent Date FOR LGU USE ONLY Replacement plan is (check one):
Approved Approved with conditions (conditions attached) Denied LGU official signature Date LGU has receive evidence of title and proof of recording of Declaration of Restrictions and
Covenants for Replacement Wetland: County where recorded Date Document # assigned by recorder LGU official signature Date Minnesota Local/State/Federal Application Forms for Water/Wetland
Projects Page 6
Appendix A Permit Additional Information
Appendix A Permit Addendum 5. Project Purpose, Description and Dimensions Project Purpose The project purpose is to provide a safe grade-separated pedestrian/bicycle link between Lake
Minnewashta Regional Park and the City of Chanhassen. The project will develop paved off-road multi-use trails within the park and along the east side of TH 41 to provide linkages between
residential neighborhoods, employment centers, and recreational opportunities. The project will complete key elements and links in the Carver County and City of Chanhassen transportation
system that will improve safety and convenience for bicyclists and pedestrians. The benefit of this link will extend to the region’s proposed continuous trail system, which is intended
to provide residents and recreationalist’s access and safe travel between residential areas, employment centers, and schools, as well as access and safe travel to Lake Minnewashta Regional
Park. Description and Summary of Proposed Improvements The project will construct a pedestrian/bicycle underpass at TH 41, just north of Ches Mar Drive, and 10-foot bituminous off-road
multi-use trails extending from the west parking lot in Lake Minnewashta Regional Park to the east side of TH 41 and along the east side of TH 41 from the proposed underpass location
south to Longacres Drive and from the proposed underpass location north to Minnetonka West Middle School. Design Elements and Dimensions Trail (Off-Road Facility) Existing Proposed Type
of Trail/Path n/a Multi-Use Trail/Path Width 10 feet Trail/Path Surfacing n/a Bituminous Design Speed 20 miles per hour Posted (Regulatory) Speed n/a Shoulder Width 2 feet minimum Shoulder
Surfacing n/a Turf Lead-in Guardrail/Fencing n/a 20 feet at bridge approaches Maximum Grade n/a 5% typical, 8.33% maximum
Vertical Clearance n/a 10 feet minimum to vegetation Clear Zone n/a 2 feet minimum In-slope n/a 2:1 max; 3:1 preferred TH 41 Underpass — From West of TH 41 to East of TH 41 (Off-Road
Facility) Existing Proposed Bridge or Culvert Number n/a TBD Location (over/under) n/a Under TH 41 Bridge or Culvert Type n/a Box culvert Design Loading n/a n/a Bridge Roadway width,
ft n/a 12 feet Sidewalk, ft n/a n/a Bridge Length, ft n/a 72 feet Bridge: Number of Spans n/a n/a Skew n/a n/a Guardrail n/a Yes Bridge Clear Width n/a n/a Vertical Clearance n/a 9 feet
10 inches 6. Project Alternatives No-Build Alternative The No Build Alternative would result in the underpass and trails not being constructed. Without the underpass and trails, plans
by the County and the City would not be implemented and the barrier for pedestrians and bicyclists wanting to access to the park would remain. Recreational and active transportation
opportunities, including connections to the network of existing City and regional trails as well as safe safe biking and walking trails, would be lost.
Location Alternatives Reviewed Alternative A trail on the west side of TH 41 was considered based on suggestions received during the June 3, 2010 public open house. The perceived benefits
of an alignment to the west of TH 41 included the use of an existing service road and avoidance of impacts to existing vegetation. This option was investigated and dismissed from further
consideration because the west side alignment would require two underpasses in locations with steep slopes and the extensive grading needed to install the culverts would cause impacts
to utilities and would greatly increase project cost. Preferred Alternative The Preferred Alternative includes construction of a pedestrian/bicycle underpass at TH 41, just north of
Ches Mar Drive, and 10-foot bituminous off-road multi-use trails extending from the west parking lot in Lake Minnewashta Regional Park to the east side of TH 41 and along the east side
of TH 41 from the proposed underpass location south to Longacres Drive and from the proposed underpass location north to Chaska Road. Preferred Alternative Wetland Impact Avoidance Complete
avoidance of wetland impacts was not possible with the preferred alternative. Preferred Alternative Wetland Impact Minimization Impacts to wetlands were minimized through a variety of
measures, which included moving the trail alignment, steeping side slopes and use of retaining walls. Specific instances include the following bulleted list: • Retaining walls were used
to reduce impacts to wetlands W-4 and W-5. • The trail alignment was moved to avoid all impacts to wetlands W-12 and W-13. • Trail embankment side slopes were steepened where practicable.
• The trail was kept as low as possible on the landscape to avoid additional footprint impacts. Preferred Alternative Wetland Mitigation Wetland impacts that are a result of the trail
project will be mitigated for using a 2:1 ratio. Mitigation will be accomplished through the use of wetland banking credits. See Permit Item #14 for additional information.
7. Adjoining Property Owners PIN BLDG_NUM STREETNAME STREETTPE ZIP ZIP4 TAX_NAME TAX_ADD_L1 TAX_ADD_L2 019-254530310 7260 HILLSDALE CT CT 55317 7548 AHMAD SHALABI 7260 HILLSDALE CT CHANHASSEN,
MN 55317-7548 019-250041300 CARVER COUNTY 600 4TH ST E CHASKA, MN 55318-2102 019-250091000 CARVER COUNTY 600 4TH ST E CHASKA, MN 55318-2102 019-253490510 6814 HIGHOVER DR DR 55317 7568
CHRISTOPHER C FITCH & 6814 HIGHOVER DR CHANHASSEN, MN 55317-7568 019-253370080 55317 CITY OF CHANHASSEN PO BOX 147 CHANHASSEN, MN 55317-0147 019-253480020 7001 HIGHOVER DR DR 55317 7572
CITY OF CHANHASSEN PO BOX 147 CHANHASSEN, MN 55317-0147 019-253490550 CITY OF CHANHASSEN PO BOX 147 CHANHASSEN, MN 55317-0147 019-250091800 7205 HAZELTINE BLVD BLVD 55331 8036 DAVID
J & STEPHANIE L SEWARD 7205 HAZELTINE BLVD EXCELSIOR, MN 55331-8036 019-253490010 2450 LAKE LUCY RD RD 55317 6707 E JEROME CARLSON PO BOX 554 WAYZATA, MN 55391-0554 019-251100100 6300
CHASKA RD RD 55331 8825 GEORGE & BEULAH G BAER 6300 CHASKA RD EXCELSIOR, MN 55331-8825 019-253370010 7030 HIGHOVER DR DR 55317 HURRELL LLC 7460 BENT BOW TRL CHANHASSEN, MN 55317-6400
019-250033000 6421 HAZELTINE BLVD BLVD 55331 8000 IND SCHOOL DIST 276 261 SCHOOL AVE EXCELSIOR, MN 55331-1987 019-254590050 6390 MELODY LN LN 55331 6402 JOHN T & ANNE C CARTER 6390 MELODY
LN EXCELSIOR, MN 55331-6402 019-253490470 6872 HIGHOVER DR DR 55317 7568 JOSEPH P THULL & 6872 HIGHOVER DR CHANHASSEN, MN 55317-7568 019-253490530 6800 HIGHOVER DR DR 55317 7568 KRISTOPHER
M GRIESE & 6800 HIGHOVER DR CHANHASSEN, MN 55317-7568 019-254530420 LONGACRES HOMEOWNERS ASSN INC PO BOX 542 CHANHASSEN, MN 55317-0542 019-253490380 7014 HIGHOVER DR DR 55317 7572 MARK
BERSON 7014 HIGHOVER DR CHANHASSEN, MN 55317-7572 019-253490520 6810 HIGHOVER DR DR 55317 7568 MARY A BENTLEY 6810 HIGHOVER DR CHANHASSEN, MN 55317-7568 019-253490490 6842 HIGHOVER DR
DR 55317 7568 PATRICK J & LISA M MCNULTY 6842 HIGHOVER DR CHANHASSEN, MN 55317-7568 019-253490480 6856 HIGHOVER DR DR 55317 7568 PHONG M LUONG & 6856 HIGHOVER DR CHANHASSEN, MN 55317-7568
019-250091900 7305 HAZELTINE BLVD BLVD 55331 8038 THOMAS J DOLL & PO BOX 148 EXCELSIOR, MN 55331-0148 019-253490500 6818 HIGHOVER DR DR 55317 7568 WILLIAM D & MARY D HAWORTH 6818 HIGHOVER
DR CHANHASSEN, MN 55317-7568 019-254530300 7250 HILLSDALE CT CT 55317 7548 WILLIAM RYAN HURT & 7250 HILLSDALE CT CHANHASSEN, MN 55317-7548 019-253360040 2585 HIGHCREST CIR CIR 55317
YOBERRY FARMS LLC 2575 HIGHCREST CIR CHANHASSEN, MN 55317-4708
9. Status of Other Approvals PERMIT AGENCY ACTION REQUIRED FEDERAL Categorical Exclusion FHWA Approval Section 106 Mn/DOT CRU Pending Project review U.S. Fish and Wildlife Service Completed
STATE Section 401 Water Quality Certification1 MPCA Pending NPDES/SDS Construction Site Permit (Phase II) MPCA Pending Section 106 (Historic /Archeological) SHPO Pending LOCAL Erosion
control and stormwater plans Minnehaha Creek Watershed District Pending Erosion control and stormwater plans Riley Purgatory Bluff Creek Watershed District Pending
Appendix B Figures
Lake Minnewashta Regional Park Lake Minnewashta ?ÌA@?«A@CARVER COUNTY S h o r e w o o dC h a n h a s s e n Minnetonka West Middle School Proposed Retaining Walls Brinker St Washita Bay
Rd Landings Dr M-588 Dogwood Ave Longacres Dr Shore Dr MNTH 41 Sandpiper Ave Walnut Cv Lake Lucy Rd Melody Hill St Galpin Blvd MNTH 7 Murray Hill Rd Harrison Hill Tr Tanagers La M-354
Dartmouth Dr W 78th St Cypress Dr Ridgeview Way M-591 Moccasin Tr Highover Dr Hazeltine Blvd Orchard La Firetree Ave Fawn Hill Rd Ches Mar Farm Rd M-589 Bentbow Tr Century Tr Elmtree
Ave Lake Harrison Rd Gunflint Tr Hunter Dr M-590 Tanadoona Dr Eureka Rd Strawberry La Grant Lorenz Rd Harding La Smithtown Rd Minnetonka Dr Smith Town Rd Timber La Academy Ave Yellowstone
Tr Wood Dr Tee Tr Glencoe Rd Shorewood Oak Dr Star La Eureka Ave Oak St Club La Mann La N oble Rd Country Club Rd Gillette Cv Wedgewood Dr Chaska Rd Meadow La Park St Eureka Way Riviera
La Shorewood La Park La Lake Linden Dr Manitou Rd Wild Rose La Oak Leaf Tr Seamans Dr Echo Rd Figure 1 J:\Maps\7068\mxd\figure1.mxd Project Area Carver County TH 41 Underpass and Trail
Project SP 10-090-30 Carver County, Minnesota MINNESOTA Carver County Project Location West Parking Lot 0 1,000 2,000 ° Feet Proposed Pedestrian Underpass Proposed Trail Alignment Proposed
Retaining Wall Existing Trail
Lake Minnewashta Regional Park Lake Minnewashta ?ÌA@?«A@CARVER COUNTY Minnetonka West Middle School Chanhassen " Project Location Washita Bay Rd M-588 Dogwood Ave Century Blvd Longacres
Dr Manchester Rd Melody Hill St Vasserman Tr Shore Dr Sandpiper Ave Walnut Cv Lake Lucy Rd MNTH 7 Brinker St Murray Hill Rd Harrison Hill Tr Tanagers La M-354 Dartmouth Dr Wind Dr 65th
St W Galpin Blvd Cypress Dr M-591 Pinehurst Dr Moccasin Tr Brenden Ct Highover Dr Crestview Dr Hazeltine Blvd Orchard La Ridgeview Way Firetree Ave Fawn Hill Rd Majestic Way Hummingbird
Rd Crimson Bay Rd Arboretum Village Cir Ches Mar Farm Rd M-589 Bentbow Tr Century Tr MNTH 41 W 78th St Elmtree Ave Lake Harrison Rd Gunflint Tr Hunter Dr Prairie Flower Blvd M-590 Tanadoona
Dr Arboretum Blvd Minnetonka Dr Academy Ave Yellowstone Tr Wood Dr Tee Tr Glencoe Rd Shorewood Oak Dr Smithtown Rd Country Club Rd Eureka Ave Club La Mann La Chaska Rd Park St Riviera
La Park La Mary Lake Tr Lake Linden Dr Oak Leaf Tr Echo Rd Seamans Dr Figure 2 J:\Maps\7068\7068\mxd\figure2.mxd Project Location -USGS Carver County TH 41 Underpass and Trail Project
West Parking Lot Proposed Pedestrian Underpass Excelsior Quadrangle, Minnesota: 7.5 Minute Series Section 4, Range 23, Township 116 SP 10-090-30 Carver County, Minnesota ° 0 1,000 2,000Feet
Proposed Retaining Walls Proposed Trail Alignment Proposed Retaining Wall
M-558 M-588 Dogwood Ave Wood Duck La 63rd St W Longacres Dr Fox Cir Forest Cir Manchester Rd Melody Hill St Shore Dr Sandpiper Ave Crestview Dr M-578 Melody Cir Greenbriar Ave M-592
Pheasant Dr Lake Lucy Ct Tanagers Pt Crestview Cir Stellar Cir Arrowhead La Moccasin Tr Topaz Dr Murray Hill Rd Hillsdale Ct Highover Tr M-354 Dartmouth Dr Hunter Dr Hickory Ave 65th
St W Saphire La Piper Ridge La Manor Rd N Pinehurst Dr Lake Lucy La Orchard La Firetree Ave Hummingbird Rd Ches Mar Farm Rd Lake Harrison Rd Tanadoona Dr Chaska Rd Washita Bay Rd Landings
Dr Cardinal Dr Ruby La Oriole Ave Lucy La 64th Cir Ringneck Dr Fawn Hill Rd Tanagers La Cypress Dr M-591 Brenden Ct Highover Dr Bentbow Tr M-589 Elmtree Ave Gunflint Tr M-590 ST117 Lake
Lucy Rd ?A7 ?A41 019-256900010 019-250041100 019-258420120 019-250720230 019-254170470 019-258990100 019-258040010 019-250092600 019-252160050 019-252160010 019-256900030 019-250091000
019-256900020 019-258990150 019-258970330 019-250100200 019-250611020 019-254170450 019-250083200 019-250083320 019-250033000 019-250041300 019-250040100 019-250041200 019-257940020
019-250083310 Figure 3 J:\Maps\7068\mxd\7068_wetlands_parcels.mxd Parcel Locations Carver County TH41 Underpass and Trail Project Carver County, Minnesota 0 500 1,000 Feet ± Project
Location Delineated Wetland Boundaries Construction Limits Carver County Parcels Selected Carver County Parcels
Chaska Rd Wood Duck La M-558 M-588 M-228 Maple Dr Dogwood Ave Leslee Cv Hickory Ave Forest Ave Longacres Dr Fox Cir Kings Rd Manchester Rd Moccasin Tr Melody Hill St Shore Dr Stratford
Rdg Crestview Dr 64th Cir Wind Dr M-578 Tristan Dr Melody Cir Red Cedar Point Ave W 77th St Greenbriar Ave M-592 Meadow La Tanagers Pt Lake Ridge Rd Brinker St Stellar Cir Kirkwood Dr
Arrowhead La Wilts ey La Topaz Dr Murray Hill Rd Hillsdale Ct M-354 Dartmouth Dr S Cedar Pt Hunter Dr Strawberry La Park La 65th St W Piper Ridge La Manor Rd N Glendale Dr Pinehurst
Dr Pipewood Rd Lake Lucy La Crestview Dr Orchard La Firetree Ave Majestic Way Hummingbird Rd Ches Mar Farm Rd Aster Tr Elmtree Ave Lake Harrison Rd Tanadoona Dr Oak Leaf Tr Ruby La Fawn
Hill Rd Lucy La Pipewood La Bentbow Tr Tanagers La Cardinal Dr Church Rd Cypress Dr M-591 Landings Dr Brenden Ct Highover Dr M-589 Gunflint Tr M-590 62nd St W ST117 Minnewashta Pkwy
Lake Lucy Rd ?A7 ?A41 Figure 4 J:\Maps\7068\mxd\7068_wetlands_PWI.mxd Public Waters Inventory Locations Locations Carver County TH41 Underpass and Trail Project Carver County, Minnesota
0 500 1,000 Feet ± Project Location Delineated Wetland Boundaries Construction Limits
Figure 4A LEGEND WETLAND CONSTRUCTION LIMITS 0 100 200 WETLAND IMPACT scale in feet { PARK TRAIL LAKE MINNEWASHTA WETLAND 20 IMPACTED AREA = 0.13 ACRES WETLAND 21 NO IMPACT 100 105 110
115 Consulting Group, Inc. h:\projects\7068\hi-mu\graphics\7068_gr01.dgn Job # 12/8/2010 Wetland Impacts Carver County TH 41 Underpass and Trail Project Carver County, Minnesota
Figure 4B LEGEND WETLAND CONSTRUCTION LIMITS WETLAND IMPACT 0 100 200 scale in feet 88 7 11 8 10 7 12 89 87 88 87 87 8 7 87 89 7 11 7 12 9 12 1010 105 19 11 1511 109 AREA I NO IMPACT
WETLAND 13 NO IMPACT WETLAND 12 { PARK TRAIL 120 125 130 135 140 145 5 Consulting Group, Inc. h:\projects\7068\hi-mu\graphics\7068_gr02.dgn Job # 12/8/2010 Wetland Impacts Carver County
TH 41 Underpass and Trail Project Carver County, Minnesota
Figure 4C LEGEND WETLAND CONSTRUCTION LIMITS WETLAND IMPACT 0 100 200 scale in feet { PARK TRAIL WETLAND 11 NO IMPACT WETLAND 22 IMPACTED AREA = 0.01 ACRESWETLAND 10 NO IMPACT WETLAND
9 NO IMPACT AREA J 625 325 145 150 155 160 Consulting Group, Inc. h:\projects\7068\hi-mu\graphics\7068_gr03.dgn Job # 12/8/2010 Wetland Impacts Carver County TH 41 Underpass and Trail
Project Carver County, Minnesota
Figure 4D LEGEND WETLAND CONSTRUCTION LIMITS WETLAND IMPACT 0 100 200 scale in feet IMPACTED AREA = 0.07 ACRES WETLAND 8 AREA B AREA C WETLAND 2 IMPACTED AREA = 0.005 ACRES { T.H. 41
TRAIL 605 610 615 620 305 310 315 320 165 170 Consulting Group, Inc. h:\projects\7068\hi-mu\graphics\7068_gr04.dgn Job # 12/8/2010 Wetland Impacts Carver County TH 41 Underpass and Trail
Project Carver County, Minnesota
Figure 4E LEGEND WETLAND CONSTRUCTION LIMITS WETLAND IMPACT 0 100 200 scale in feet AREA B { T.H. 41 TRAIL 625 630 635 640 325 330 335 340 160 170 341 Consulting Group, Inc. h:\projects\7068\hi-mu\gr
aphics\7068_gr05.dgn Job # 12/8/2010 Wetland Impacts Carver County TH 41 Underpass and Trail Project Carver County, Minnesota
Figure 4F LEGEND WETLAND CONSTRUCTION LIMITS WETLAND IMPACT 0 100 200 scale in feet WETLAND 4 NO IMPACTS WETLAND 5 IMPACTED AREA = 0.07 ACRES AREA G { T.H. 41 TRAIL 640 645 650 655 340
345 350 355 341 343 342 348 349 350 351 352 353 354 347 Consulting Group, Inc. h:\projects\7068\hi-mu\graphics\7068_gr06.dgn Job # 12/8/2010 Wetland Impacts Carver County TH 41 Underpass
and Trail Project Carver County, Minnesota
LEGEND WETLAND CONSTRUCTION LIMITS WETLAND IMPACT Figure 4G 0 100 200 scale in feet AREA G STORM POND AREA H AREA K NO IMPACTS WETLAND 7 { T.H. 41 TRAIL 660 665 670 675 360 365 370 Consulting
Group, Inc. h:\projects\7068\hi-mu\graphics\7068_gr07.dgn Job # 12/8/2010 Wetland Impacts Carver County TH 41 Underpass and Trail Project Carver County, Minnesota
Appendix C Soils Maps
Hazeltine Blvd Ches Mar Dr Lake Lucy Rd Chaska Rd Murray Hill Rd Highover Dr Orchard Ln Manchester Dr Brenden Ct Oriole Ave 64th St Maple St Melody Hill Rd Forest Ave Forest Cir Minneawashta
Regional Park Rd Hig hove r Trl Lake Linden Dr KC YB KE2 MK KE2 L41C2 KB2 ND3 YD KD KB HM KC2 KB KD KB KC KD2 KB KD2 GL KC2 KC2 KD2 KD2 KC HM KC TC HM MP HM KB KD C W TB KC2 HM KB KD2
KC2 NE3 GL KC2 KE2 ND3 KE2 NE3 NE3 KE2 L22E KE2 TC U3B KE2 L24A U1A KD2 L36A L22D2 PM KC2 KC 453600 453600 453800 453800 454000 454000 454200 454200 454400 454400 454600 454600 4969600
4969600 4969800 4969800 4970000 4970000 4970200 4970200 4970400 4970400 4970600 4970600 4970800 4970800 4971000 4971000 4971200 4971200 0 300 600 1,200 1,800 Feet 0 50 100 200 300Meters
44° 53' 35'' 93° 34' 26'' 44° 52' 41'' 93° 34' 26'' 44° 52' 41'' 44° 53' 34'' 93° 35' 22'' 93° 35' 22'' Map Scale: 1:7,840 if printed on A size (8.5" x 11") sheet. Soil Map—Carver County,
Minnesota, and Hennepin County, Minnesota (TH 41 Trail (North)) Natural Resources Conservation Service Web Soil Survey National Cooperative Soil Survey 10/26/2010 Page 1 of 4
MAP LEGEND MAP INFORMATION Area of Interest (AOI) Area of Interest (AOI) Soils Soil Map Units Special Point Features Blowout Borrow Pit Clay Spot Closed Depression Gravel Pit Gravelly
Spot Landfill Lava Flow Marsh or swamp Mine or Quarry Miscellaneous Water Perennial Water Rock Outcrop Saline Spot Sandy Spot Severely Eroded Spot Sinkhole Slide or Slip Sodic Spot Spoil
Area Stony Spot Very Stony Spot Wet Spot Other Special Line Features Gully Short Steep Slope Other Political Features Cities Water Features Oceans Streams and Canals Transportation Rails
Interstate Highways US Routes Major Roads Local Roads Map Scale: 1:7,840 if printed on A size (8.5" × 11") sheet. The soil surveys that comprise your AOI were mapped at 1:12,000. Please
rely on the bar scale on each map sheet for accurate map measurements. Source of Map: Natural Resources Conservation Service Web Soil Survey URL: http://websoilsurvey.nrcs.usda.gov Coordinate
System: UTM Zone 15N NAD83 This product is generated from the USDA-NRCS certified data data as of the version date(s) listed below. Soil Survey Area: Carver County, Minnesota Survey
Area Data: Version 8, Aug 2, 2010 Soil Survey Area: Hennepin County, Minnesota Survey Area Data: Version 7, Aug 2, 2010 Your area of interest (AOI) includes more than one soil survey
area. These survey areas may have been mapped at different scales, with a different land use in mind, at different times, or at different levels of detail. This may result in map unit
symbols, soil properties, and interpretations that do not completely agree across soil survey area boundaries. Date(s) aerial images were photographed: 7/18/2003 The orthophoto or other
base map on which the soil lines were compiled and digitized probably differs from the background imagery displayed on these maps. As a result, some minor shifting of map unit boundaries
may be evident. Soil Map–Carver County, Minnesota, and Hennepin County, Minnesota (TH 41 Trail (North)) Natural Resources Conservation Service Web Soil Survey National Cooperative Soil
Survey 10/26/2010 Page 2 of 4
Map Unit LegendCarver County, Minnesota (MN019) Map Unit Symbol Map Unit Name Acres in AOI Percent of AOI CW Cordova-Webster complex 1.6 0.8% GL Glencoe clay loam 3.2 1.6% HM Hamel loam
10.8 5.5% KB Kilkenny-Lester loams, 2 to 6 percent slopes 14.2 7.3% KB2 Lester-Kilkenny loams, 2 to 6 percent slopes, eroded 7.1 3.7% KC Lester-Kilkenny loams, 6 to 12 percent slopes
40.6 20.8% KC2 Lester-Kilkenny loams, 6 to 12 percent slopes, eroded 14.5 7.4% KD Lester-Kilkenny loams, 12 to 18 percent slopes 8.3 4.2% KD2 Lester-Kilkenny loams, 12 to 18 percent
slopes, eroded 13.8 7.1% KE2 Lester-Kilkenny loams, 18 to 25 percent slopes, eroded 29.5 15.1% MK Houghton and Muskego soils 7.7 4.0% MP Klossner and Muskego soils, ponded 1.8 0.9% ND3
Lester-Kilkenny clay loams, 12 to 18 percent
slopes, severely eroded 6.7 3.4% NE3 Lester-Kilkenny clay loams, 18 to 25 percent slopes, severely eroded 3.2 1.6% PM Klossner muck 0.1 0.0% TB Terril loam, 0 to 6 percent slopes 1.2
0.6% TC Terril loam, 6 to 12 percent slopes 2.7 1.4% YB Rasset-Lester-Kilkenny complex, 2 to 6 percent slopes 12.2 6.2% YD Rasset-Lester-Kilkenny complex, 12 to 18 percent slopes 3.9
2.0% Subtotals for Soil Survey Area 183.1 93.7% Totals for Area of Interest 195.4 100.0% Hennepin County, Minnesota (MN053) Map Unit Symbol Map Unit Name Acres in AOI Percent of AOI
L22D2 Lester loam, morainic, 12 to 18 percent slopes, eroded 0.2 0.1% L22E Lester loam, morainic, 18 to 25 percent slopes 0.6 0.3% L24A Glencoe loam, depressional, 0 to 1 percent slopes
0.3 0.2% L36A Hamel, overwash-Hamel complex, 1 to 4 percent slopes 0.1 0.1% L41C2 Lester-Kilkenny complex, 6 to 12 percent slopes, eroded 10.5 5.4% U1A Urban land-Udorthents, wet substratum,
complex, 0 to 2 percent slopes 0.2 0.1% U3B Udorthents (cut and fill land), 0 to 6 percent slopes 0.4 0.2% Subtotals for Soil Survey Area 12.3 6.3% Totals for Area of Interest 195.4
100.0% Soil Map–Carver County, Minnesota, and Hennepin County, Minnesota TH 41 Trail (North) Natural Resources Conservation Service Web Soil Survey National Cooperative Soil Survey 10/26/2010
Page 3 of 4
Soil Map–Carver County, Minnesota, and Hennepin County, Minnesota TH 41 Trail (North) Natural Resources Conservation Service Web Soil Survey National Cooperative Soil Survey 10/26/2010
Page 4 of 4
Hazeltine Blvd Longacres Dr Ches Mar Dr Highover Dr Bent Bow Trl Moccasin Trl Minneawashta Regional Park Rd Hunter Dr Highover Ct Hillsdale Ct Hig hove r Trl Ches Mar Farm Rd Gunflint
Trl Highove r Way Harrison Hill Trl Southern Ct KB TB KC2 ND3 KC KE2 KC2 KB HM HM KE2 KC2 KB2 KC NC3 CW MK KB KB KB W KD KE2 TB KD2 KB NE3 LA HM KD NE3 KC2 TB NE3 KD2 KD CO HM KE2 HM
KC2 NE3 KC KB NE3 KB KD2 KD2 KD PM KC2 KB2 TB HM KC KD2 EX MK KC KB2 KB ND3 KD2 KB ND3 KE2 KCKE2 KD KE2 NC3 453100 453100 453200 453200 453300 453300 453400 453400 453500 453500 453600
453600 453700 453700 453800 453800 453900 453900 454000 454000 4968700 4968700 4968800 4968800 4968900 4968900 4969000 4969000 4969100 4969100 4969200 4969200 4969300 4969300 4969400
4969400 4969500 4969500 4969600 4969600 4969700 4969700 4969800 4969800 4969900 4969900 4970000 4970000 0 200 400 800 1,200 Feet 0 50 100 200 300Meters 44° 52' 55'' 93° 34' 52'' 44°
52' 11'' 93° 34' 51'' 44° 52' 11'' 44° 52' 55'' 93° 35' 37'' 93° 35' 38'' Map Scale: 1:6,470 if printed on A size (8.5" x 11") sheet. Soil Map—Carver County, Minnesota (TH41Trail (South)
Soils) Natural Resources Conservation Service Web Soil Survey National Cooperative Soil Survey 10/26/2010 Page 1 of 3
MAP LEGEND MAP INFORMATION Area of Interest (AOI) Area of Interest (AOI) Soils Soil Map Units Special Point Features Blowout Borrow Pit Clay Spot Closed Depression Gravel Pit Gravelly
Spot Landfill Lava Flow Marsh or swamp Mine or Quarry Miscellaneous Water Perennial Water Rock Outcrop Saline Spot Sandy Spot Severely Eroded Spot Sinkhole Slide or Slip Sodic Spot Spoil
Area Stony Spot Very Stony Spot Wet Spot Other Special Line Features Gully Short Steep Slope Other Political Features Cities Water Features Oceans Streams and Canals Transportation Rails
Interstate Highways US Routes Major Roads Local Roads Map Scale: 1:6,470 if printed on A size (8.5" × 11") sheet. The soil surveys that comprise your AOI were mapped at 1:12,000. Please
rely on the bar scale on each map sheet for accurate map measurements. Source of Map: Natural Resources Conservation Service Web Soil Survey URL: http://websoilsurvey.nrcs.usda.gov Coordinate
System: UTM Zone 15N NAD83 This product is generated from the USDA-NRCS certified data data as of the version date(s) listed below. Soil Survey Area: Carver County, Minnesota Survey
Area Data: Version 8, Aug 2, 2010 Date(s) aerial images were photographed: 7/18/2003 The orthophoto or other base map on which the soil lines were compiled and digitized probably differs
from the background imagery displayed on these maps. As a result, some minor shifting of map unit boundaries may be evident. Soil Map–Carver County, Minnesota (TH41Trail (South) Soils)
Natural Resources Conservation Service Web Soil Survey National Cooperative Soil Survey 10/26/2010 Page 2 of 3
Map Unit LegendCarver County, Minnesota (MN019) Map Unit Symbol Map Unit Name Acres in AOI Percent of AOI CO Cordova clay loam 2.0 0.8% CW Cordova-Webster complex 4.3 1.8% EX Essexville
sandy loam 0.9 0.4% HM Hamel loam 20.4 8.4% KB Kilkenny-Lester loams, 2 to 6 percent slopes 37.2 15.3% KB2 Lester-Kilkenny loams, 2 to 6 percent slopes, eroded 9.0 3.7% KC Lester-Kilkenny
loams, 6 to 12 percent slopes 18.3 7.5% KC2 Lester-Kilkenny loams, 6 to 12 percent slopes, eroded 40.8 16.8% KD Lester-Kilkenny loams, 12 to 18 percent slopes 8.7 3.6% KD2 Lester-Kilkenny
loams, 12 to 18 percent slopes, eroded 11.5 4.7% KE2 Lester-Kilkenny loams, 18 to 25 percent slopes, eroded 25.7 10.6% LA Le Sueur-Lester loams, 1 to 4 percent slopes 2.2 0.9% MK Houghton
and Muskego soils 4.7 1.9% NC3 Lester-Kilkenny clay loams, 6 to 12 percent slopes, severely eroded 6.0 2.5% ND3 Lester-Kilkenny clay loams, 12 to 18 percent slopes, severely eroded 16.3
6.7% NE3 Lester-Kilkenny clay loams, 18 to 25 percent slopes, severely eroded 12.8 5.3% PM Klossner muck 1.3 0.5% TB Terril loam, 0 to 6 percent slopes 18.5 7.6% W Water 2.4 1.0% Totals
for Area of Interest 243.1 100.0% Soil Map–Carver County, Minnesota TH41Trail (South) Soils Natural Resources Conservation Service Web Soil Survey National Cooperative Soil Survey 10/26/2010
Page 3 of 3
Hazeltine Blvd Ches Mar Dr Highover Dr Minneawashta Region al Park Rd Lake Lucy Rd Longacres Dr Harrison Hill Trl Highover Ct Highover Trl Ches Mar Farm Rd W W KC KE2 EX HM KC2 KD KC
KC TB MP KD KD2 KB TB MK HM KC2 HM KE2 MP KC ND3 MK KC2 EX KD2 ND3 KC2 NE3 MP KB2 KE2 KB KD HM KC KB KB TB KD2 LA KD2 PM KB TB KD2 KD TC KE2 KE2 GL KB TB HM KC KD KC2 KD2 KE2 MK HM KE2
NC3 KB KD EX KD2 KD KC2 KC KB2 KE2 TB EX ND3 HM HM KC ND3 HM EX KB KB GL KB2 KE2 KD2 MP KC2 NE3 MK HM KD2 NC3 PM KC NE3 NE3 KC MK HM 452200 452200 452400 452400 452600 452600 452800
452800 453000 453000 453200 453200 453400 453400 453600 453600 453800 453800 454000 454000 4969200 4969200 4969400 4969400 4969600 4969600 4969800 4969800 4970000 4970000 4970200 4970200
4970400 4970400 0 500 1,000 2,000 3,000 Feet 0 100 200 400 600Meters 44° 53' 11'' 93° 34' 48'' 44° 52' 25'' 93° 34' 48'' 44° 52' 24'' 44° 53' 11'' 93° 36' 26'' 93° 36' 27'' Map Scale:
1:10,300 if printed on A size (8.5" x 11") sheet. Soil Map—Carver County, Minnesota (TH 41 Trail (West) Soils) Natural Resources Conservation Service Web Soil Survey National Cooperative
Soil Survey 10/26/2010 Page 1 of 3
MAP LEGEND MAP INFORMATION Area of Interest (AOI) Area of Interest (AOI) Soils Soil Map Units Special Point Features Blowout Borrow Pit Clay Spot Closed Depression Gravel Pit Gravelly
Spot Landfill Lava Flow Marsh or swamp Mine or Quarry Miscellaneous Water Perennial Water Rock Outcrop Saline Spot Sandy Spot Severely Eroded Spot Sinkhole Slide or Slip Sodic Spot Spoil
Area Stony Spot Very Stony Spot Wet Spot Other Special Line Features Gully Short Steep Slope Other Political Features Cities Water Features Oceans Streams and Canals Transportation Rails
Interstate Highways US Routes Major Roads Local Roads Map Scale: 1:10,300 if printed on A size (8.5" × 11") sheet. The soil surveys that comprise your AOI were mapped at 1:12,000. Please
rely on the bar scale on each map sheet for accurate map measurements. Source of Map: Natural Resources Conservation Service Web Soil Survey URL: http://websoilsurvey.nrcs.usda.gov Coordinate
System: UTM Zone 15N NAD83 This product is generated from the USDA-NRCS certified data as of the version date(s) listed below. Soil Survey Area: Carver County, Minnesota Survey Area
Data: Version 8, Aug 2, 2010 Date(s) aerial images were photographed: 7/18/2003 The orthophoto or other base map on which the soil lines were compiled and digitized probably differs
from the background imagery displayed on these maps. As a result, some minor shifting of map unit boundaries may be evident. Soil Map–Carver County, Minnesota (TH 41 Trail (West) Soils)
Natural Resources Conservation Service Web Soil Survey National Cooperative Soil Survey 10/26/2010 Page 2 of 3
Map Unit LegendCarver County, Minnesota (MN019) Map Unit Symbol Map Unit Name Acres in AOI Percent of AOI EX Essexville sandy loam 24.8 5.3% GL Glencoe clay loam 3.5 0.7% HM Hamel loam
38.9 8.3% KB Kilkenny-Lester loams, 2 to 6 percent slopes 27.6 5.9% KB2 Lester-Kilkenny loams, 2 to 6 percent slopes, eroded 8.3 1.8% KC Lester-Kilkenny loams, 6 to 12 percent slopes
57.3 12.1% KC2 Lester-Kilkenny loams, 6 to 12 percent slopes, eroded 41.5 8.8% KD Lester-Kilkenny loams, 12 to 18 percent slopes 29.4 6.2% KD2 Lester-Kilkenny loams, 12 to 18 percent
slopes, eroded 32.4 6.9% KE2 Lester-Kilkenny loams, 18 to 25 percent slopes, eroded 51.4 10.9% LA Le Sueur-Lester loams, 1 to 4 percent slopes 2.4 0.5% MK Houghton and Muskego soils
13.8 2.9% MP Klossner and Muskego soils, ponded 19.5 4.1% NC3 Lester-Kilkenny clay loams, 6 to 12 percent slopes, severely eroded 2.6 0.6% ND3 Lester-Kilkenny clay loams, 12 to 18 percent
slopes, severely eroded 14.0 3.0% NE3 Lester-Kilkenny clay loams, 18 to 25 percent slopes, severely eroded 6.7 1.4% PM Klossner muck 3.1 0.7% TB Terril loam, 0 to 6 percent slopes 23.8
5.0% TC Terril loam, 6 to 12 percent slopes 2.2 0.5% W Water 68.3 14.5% Totals for Area of Interest 471.6 100.0% Soil Map–Carver County, Minnesota TH 41 Trail (West) Soils Natural Resources
Conservation Service Web Soil Survey National Cooperative Soil Survey 10/26/2010 Page 3 of 3
Appendix D Proposed Wetland Credits
Page 1 of 2 BWSR Form: wca-bank-05-withdrawal.doc Revised 6/1/2010 APPLICATION FOR WITHDRAWAL OF WETLAND CREDITS FROM THE MINNESOTA WETLAND BANK Return Original to BWSR – Transaction
may not be processed without original signatures 1. PROPOSED USER OF CREDITS Name(s) Carver County Address: 600 East Fourth Street Chaska, MN 55318 City State ZIP Day Phone (952)466-5252
Other Phone (952)466-5250 5. CREDITS PROPOSED TO BE WITHDRAWN FROM ACCOUNT NO. Credit Sub-Group1 Acres withdrawn Wetland Type2 Wetland Plant Community3 Cost (per acre) E .58 SWC Upland
buffer $20000 [pick one] [Pick One] [Pick One] Totals: 1 acre = 43,560 sq. ft. Fee Total (Total cost x 0.065 = $ 754 1Letters signify credit sub-groups, which represent wetland areas
with different wetland characteristics. 2Circular 39 types: 1, 1L, 2, 3, 4, 5, 6, 7, 8, R, U (for Upland Buffer). ³Wetland plant community type: shallow open water, deep marsh, shallow
marsh, sedge meadow, fresh meadow, wet to wet-mesic prairie, calcareous fen, open bog or coniferous coniferous bog, shrub-carr/alder thicket, hardwood swamp or coniferous swamp, floodplain
forest, seasonally flooded basin, or upland buffer. See 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. 2. Impact Site Information County Carver Major Wtrshd No.20 Bank Service Area 7 Location: ¼ ¼ Sec 3,4, Twp.116N, Rge 23W Size of
Wetland Impact: .285 acres Wetland Types2 Impacted: Fresh wet meadow, floodplain forest, seasonally flooded basin, shrub carr Wetland Plant Communities impacted3: 1, 1L, 2, 6 Required
Replacement Ratio: 2:1 WCA /local /COE Amount to be replaced using Bank Credits:0.57 Amount replaced on site: 0 Project Name: TH 41 Trail Project S.P. 10-090-03 Att h l t l if dditi
l d t il i d d 4. Regulating Authority(ies) Approving the Use of Wetland Bank Credits Replacement Plan approved by (check all that apply): Local WCA LGU: (Print agency name) Local Permit
# U.S. Army Corps of Engineers: Permit # MN Dept. of Natural Resources: Permit # Natural Resources Conservation Service: Permit # Other authority involved: 3. OWNER /SELLER OF CREDITS
Account No. 1048 Watershed No. 19 County: Carver Bank Service Area 7 Name of Seller: Paul Nesvold, Silas Tesch Tim Nesvold (Name of Authorized Representative) ________________________________________
__ (Signature of Seller/Authorized Representative) Enclosed 6.5% transaction fee, payable to “Board of Water & Soil Resources.”
Page 2 of 2 BWSR Form: wca-bank-05-withdrawal.doc Revised 6/1/2010 6. CERTIFICATION OF USER OF WETLAND CREDITS The proposed user of credits hereby certifies that he/she: a) either owns
the subject wetland credits or has entered into an agreement to purchase said credits, subject to the approval of all applicable regulatory authorities and b) has filed appropriate plans,
specifications and application forms with all applicable regulatory authorities that describe the wetland or water resource impacts for which the subject wetland credits will be utilized
for mitigation purposes. Authorized Signature of Proposed User of Credits PRINT Name Date 7. REGULATORY AUTHORITY APPROVAL(S) The following authorized representatives of the regulatory
authority (ies) identified on page 1 of this application hereby certify that they have: a) verified that the subject wetland credits are deposited in the account of the owner /seller,
b) approved a wetland replacement plan or other water resource impact under their jurisdiction, and c) approved the proposed use of the wetland bank credits described herein. PRINT Name
of WCA LGU Official Signature of Authorized WCA LGU Official Date PRINT Name of Other Regulatory Official (if any) Signature of Other Authorized Official Date Agency Address of Other
Regulatory Official 9. BWSR APPROVAL AND DEBITING OF ACCOUNT I hereby certify that the credits have been properly debited from the subject account, effective the date of signature. ,
Authorized Signature Date Upon approval by BWSR, a copy of this instrument will be mailed to the user of the credits, all regulatory authorities involved, the account holder and the
Board Conservationist. A letter will also be sent to the account holder acknowledging the debit and new account balance. IMPORTANT REMINDERS 1. The Owner /Seller of the credits is responsible
for submittal of this form, containing original signatures, to the BWSR Wetland Bank Administrator so the affected account can be properly debited. 2. No impacts to any wetland or other
water resource may commence until the credits have been debited from the Minnesota Wetland Mitigation Bank and a copy of this approval has been mailed to the regulatory authority(ies),
the account holder and the user of the credits. 3. It is a criminal offense for a seller of wetland credits to sell credits more than one time. It is the responsibility of the account
holder to report any credit sales that are not noted on the most current official BWSR account balance. 8. CERTIFICATION OF OWNER /SELLER OF CREDITS I am the holder of the aforementioned
account in the State of Minnesota Wetland Mitigation Bank and hereby certify that: 1) the credits described in this application have either been sold to the user of credits or I will
use them to mitigate wetland impacts for my own project, 2) I have received payment in full from the buyer (if applicable), 3) the credits have not been sold or used in any way to mitigate
wetland losses other than for the project and location identified in the project site information block on the previous page, 4) the subject wetland credits should be withdrawn my account,
5) I will not have a negative balance of credits after the subject credits are debited from my account, and 6) the Annual Fee for this account has been paid (or will be with an enclosed
check). , Authorized Signature of Owner /Seller of Credits DateMail to: Bank Coordinator, Board of Water & Soil Resources 520 Lafayette Road North St. Paul, MN 55155