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WCA Permit Application (2) 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) COEMPCA Note: The U.S. Army Corps of Engineers () will forward application forms to the Minnesota Pollution Control Agency () for do not processing if state water quality certification is required from the MPCA. You need to send this application to the MPCA. This application packet includes : Part I: BASIC APPLICATIONCOE APPLICATION The and theto be filled out by all applicants (see Instructions). only for PART II: REPLACEMENT PLAN SUPPLEMENT The to be completed projects that impact wetlands and require a If you’re not sure replacement plan for wetland mitigation. 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 Proceeding with work before all required the status of your application at any time, contact the agencies directly (see Instructions, page 2). 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, If you are a Federal Farm Program participant contact those office(s) directly.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 notrequired. 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 (includingthe 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 1 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 concerningthe 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 ? must Attachments 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) may Attachments also include: Applicant Contact Information (HELP 1) (if additional space was needed) ProjectLocation (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.a complete copy of your application to each of the Keep the original, and mail 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 DNRWaters 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 RegionSouthern 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 55106New Ulm, MN 56073 Phone: 218-755-3973 Phone: 218-327-4416 Phone: 651-772-7910Phone: 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, RegulatoryBranchU.S. COE, Regulatory BranchU.S. COE, Regulatory Branch U.S. COE, Regulatory Branch 10867 E. Gull Lake Drive N.W.Army Corps of Engineers Centre1114 South Oak Street1554 Highway 2, Suite 2 th Street East La Crescent, MN 55947-1338 Two Harbors, MN 55616 Brainerd, MN 56401-9051 190 5 Phone: 218-829-8402 St. Paul, MN 55101-9051 Phone: 507-895-8059Phone: 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 Minnesota Local/State/Federal Application Forms for Water/Wetland Projects Instructions, Page 2 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. (See Help 1) 1. LANDOWNER/APPLICANT CONTACT INFORMATION Mr. Martin Walsh952 466 5252mwalsh@co.carver.mn.us Name: Phone: E-mail: Carver County Parks, 11360 Hwy 212 West, Cologne, MN 55322 Complete mailing address: (See Help 1Aan agent is not required 1A. AUTHORIZED AGENT) (Only if applicable; ) Jeffrey W. Olson763 249 6789jolson@srfconsulting.com Name: Phone: E-mail: 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 Additional Project Area (Attach 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 1 Wetland 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 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 RegionalPark 6900 Hazeltine Boulevard Chanhassen, MN 55331 UnknownChanhassen, MN Fire #: City (if applicable): Various116N23WCarver ¼ Section: Section: 9,4, and 3Township #: Range #: County: NANANA33 Lot #: Block: Subdivision: Watershed (name or #) UTM location: N 4969841.47E453747.80 Attach a simple site locator map. If needed, include on the map written directions to the site from a known location or landmark, and SITE LOCATOR MAP. provide distances from known locations. Label the sheet See Appendix B: Figures 1 and 2. 4.TYPE OF PROJECT: TYPE OFPROJECT Describe the type of proposed work. Attach 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 This is the construct the project with dimensions (length, width, depth), area of impact, and when you propose to construct the project. most important part of your application. See HELP 5 before completing this section; see What To Include on Plans (Instructions, PROJECT DESCRIPTION page 1). Attach sheet. See project description in Appendix A. Footprint of project: acres or square feet drained, filled or excavated. 6. PROJECTALTERNATIVES: What alternatives to this proposed project have you considered that would avoid or minimize impacts TWO to wetlands or waters? List at least 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 HELP 7 mailing addresses of adjacent property owners on an attached separate sheet. (See ) See attached list ofadjacent 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 WORK ALREADY COMPLETEDHELP 8 yes, describe the completed work on a separate sheet of paper labeled . (See ) 9. STATUS OF OTHER APPROVALS:pending List any other permits, reviews or approvals related to this proposed project that are either or have already been approved or denied on a separate attached sheet. See HELP 9. SeeAppendix 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. 1 Wetland Plants and Plant Communities of Minnesota and Wisconsin (Eggers and Reed, 1997) See 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 FORDEPARTMENT OF THE ARMYPERMIT (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 hoursper 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 collectionof 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 CODE3. DATE RECEIVED4. DATE APPLICATION COMPLETED YOU DO NOTNEED TO COMPLETE ITEMS 6-10 and 12-25 in the SHADED AREAS. All non-shadedalso applicants must complete items 5 and 26. If an agent is used, complete items 8 and 11. This optional Federal form is valid only for use when included as part of this entire state application packet. 5. APPLICANT’S NAME8. AUTHORIZED AGENT’S NAME AND TITLE (an agent is not required) Mr. Martin Walsh Jeffrey Olson, Associate Wetland Scientist 6. APPLICANT’S ADDRESSCarver County Parks, 11360 9. AGENT’S ADDRESSOne Carlson Parkway North Suite #150, Minneapolis, MN 55447 Hwy 212 West, Cologne, MN 55322 952-466-5252763-249-6789 7. APPLICANT’S PHONE NO.10. AGENT’S PHONE NO. 11. STATEMENT OF AUTHORIZATIONif applicable; completeonlyif 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 SITE18. NATURE OF ACTIVITY 19. PROJECT PURPOSE20. 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 NOIF 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 amacting as the duly authorized agent of the applicant. 1/31/2011 DateDate Signature of applicant Signature of agent (if any) 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 18 U.S.C. Section 1001 the statement in Block 11 has been filled out and signed. 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 fraudulentstatements 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 (MNRule 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 beeither 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? must Attachments include: If the project includes any wetland banking (complete or partial), include Applicationfor 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) may Attachments 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 Ithe Federal applicationand (Page 1), (Page 2), attachmentsFinal Checklist for Part I as indicated on(Instructions, Page 2). Your application must also include Part II Final Checklist for Part II (Pages 3-5) and additional attachments as indicated on (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 Unitor 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 on than one wetland impact, reference your overhead view (part of Section 5) to this chart by identifying and labeling “first impact” and “second impact” 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 for each separate wetland type within that impact area; identify predominant vegetation and size of impacted area 5) If youdo not have access to some of (Photocopy chart for more impacts, if needed.) this information, call your LGU or SWCD office for assistance. DESCRIPTION OF WETLAND IMPACTS Watershed Wetland impact Watershed Wetland plant Predominant Size of area Existing land use in project and Bank name or community vegetation in impacted area (check all that apply) (as noted on Service 1 number typeimpacted (in acres or overhead view)(if Area wetland areasquare known) feet) BSA 7 20Type 1 (W-20)Poa pratensis0.130 ac Housing (W-20) Commercial Industrial BSA 7 Type 2 (W-22)Poa pratensis0.010 ac Parks/recreation areas W-22) Highways and associated rights-of-way BSA 7 Type 2 (W-8)Phalaris 0.070 ac (W-8) Forested arundinacea Farmsteads/agricultural Vacant lands Public and semi-public BSA 7 Type 1L (W-2)Frax.penn.,, 0.005 ac 20 (W-2) (schools/gov’t facilities) Carex Airports normalis Extractive (gravel aristosa BSA 7 Type 6 (W-5)Salix exigua, 0.070 ac (W-5) pits/quarries) Phalaris Other: arundinacea 1 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 identifymore 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 for each separate wetland type with that impact area. of impacted area TOTALS OF AREA(S) IMPACTED FOR EACH WETLAND TYPE ON CHARTindicate acres or square feet () 1 Wetland plant community type : Shallow open waterDeep marshShallow MarshSedge meadow : : : : Fresh wet meadowWet to wet mesic prairieCalcareous fenOpen bog or coniferous bogShrub carr or alder thicket :0.08 ac: : : :0.07 ac Hardwood swamp or coniferous swampFloodplain forest Seasonally flooded basin : 0.005 ac0.13 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 Wetland Plants and Plant Communities of Minnesota and Wisconsin (Eggers and Reed, 1997) See 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 ACCOMPLISHEDone : Indicate how proposed replacement will be accomplished (check only box below and continue as indicated): SEE Appendix D for proposed credits to be used. A. Wetland banking credits only Application for Withdrawal of Wetland Credits Form Complete 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 Application for Withdrawal of Wetland Credits Form concurrently with submittal of this form. Also, Complete 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, restoredby 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 (suchas 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 DESCRIPTION OF REPLACEMENT ending the project; and 6) a vegetation management plan. Write this description on a separate sheet of paper labeled 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 submit a Wetland Banking surplus wetland credits that you wish to have deposited in the State Wetland Bank for future use? Yes No. If yes, 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. DESCRIPTIONOF 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 on your overhead view; replacement site” and “second replacement site” 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 for each separate wetland type with that lines to indicate each separate wetland type, and identify type(s) of replacement credits and “restored or created” 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 Photocopy chart for more wetland replacements, if needed.) assistance. DESCRIPTION OF REPLACEMENT WETLANDS IdentifyWatershed CountySection, Wetland Type(s) of replacement creditsRestored Wetland name or Plant or (in acres or square feet) Township, replacement numberCommunity created? Range 1 New Wetland Public Value siteTypeIndicate (if known) Credits (NWC)Credits (PVC) Bank Service (R or C as noted on Area overhead view) 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 TOTAL NWCTOTAL PVC wetland type within a given wetland impact area, use the extra dotted lines to indicate each for separate wetland type, and identify predominant vegetation and size of impacted area REQUIRED REPLACEMENT RATIO: each separate wetland type within that impact area. (If known) Wetland plant community type: Shallow open waterDeep marshShallow MarshSedge meadow : : : : Fresh wet meadowWet to wet mesic prairieCalcareous fenOpen bog or coniferous bogShrub carr or alder thicket : : : : : Hardwood swamp or coniferous swampFloodplain forest Seasonally flooded basin : Wetland Plants and Plant Communities of Minnesota and Wisconsin (Eggers and Reed, 1997) * See 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 only 18. ADDITIONAL INFORMATION REQUIRED FOR PROJECT-SPECIFIC REPLACEMENT (Required 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 scaleWhat to Include on Plans of the replacement wetland. Include both overhead view and profile (side view or cross-sectional view). See your application will be considered incomplete. (Instructions, Page 3) for a detailed description of what should be included in these drawings. Without drawings, 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: AND 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; 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 beconsidered for replacement. Part B: Additional assurances all (check 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. Forprojects involving any 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): ApprovedApproved 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 ß°°»²¼·¨ ß Ð»®³·¬ ß¼¼·¬·±²¿´ ×²º±®³¿¬·±² 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 LakeMinnewashta 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 toprovide 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’saccess 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 LakeMinnewashta 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)ExistingProposed Type of Trail/Pathn/aMulti-Use Trail/Path Width 10 feet Trail/Path Surfacingn/aBituminous Design Speed 20 miles per hour Posted (Regulatory) Speed n/a Shoulder Width2 feet minimum Shoulder Surfacingn/aTurf Lead-in Guardrail/Fencingn/a20 feet at bridge approaches Maximum Graden/a5% typical, 8.33% maximum Vertical Clearancen/a10 feet minimum to vegetation Clear Zone n/a2 feet minimum In-slopen/a2:1 max; 3:1 preferred TH 41 Underpass —ExistingProposed From West of TH 41 toEast of TH 41 (Off-Road Facility ) Bridge or Culvert Numbern/aTBD Location (over/under) n/aUnder TH 41 Bridge or Culvert Typen/aBox culvert Design Loading n/an/a Bridge Roadway width, ft n/a12 feet Sidewalk, ftn/an/a Bridge Length, ftn/a72 feet Bridge: Number of Spansn/an/a Skewn/an/a Guardrailn/aYes Bridge Clear Widthn/an/a Vertical Clearancen/a9 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 biking and walking trails, would be lost. Location Alternatives ReviewedAlternative 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 includedmoving 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 projectwill 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. 9. Status of Other Approvals PERMITAGENCYACTION REQUIRED FEDERAL Categorical ExclusionFHWAApproval Section 106Mn/DOT CRUPending Project reviewU.S. Fish and Wildlife ServiceCompleted STATE Section 401 Water Quality MPCAPending 1 Certification NPDES/SDS Construction Site MPCAPending Permit (Phase II) Section 106 (Historic / SHPOPending Archeological) LOCAL Erosion control and stormwater Minnehaha Creek Watershed Pending plans District Erosion control and stormwater Riley Purgatory Bluff Creek Pending plans Watershed District ß°°»²¼·¨ Þ Ú·¹«®» Í¸±®»©±±¼ Ó×ÒÒÛÍÑÌß Ý¿®ª»® Ý±«²¬§ ýûü Ó·²²»¬±²µ¿ É»¬ Ó·¼¼´» Í½¸±±´ Ð®±¶»½¬ Ô±½¿¬·±² Ð®±°±»¼ É»¬ Ð¿®µ·²¹ Î»¬¿·²·²¹ É¿´´ Ô±¬ Ð®±°±»¼ Ð»¼»¬®·¿² Ô¿µ» ýpûü Ë²¼»®°¿ Ó·²²»©¿¸¬¿ Ô¿µ» Ó·²²»©¿¸¬¿ Î»¹·±²¿´ Ð¿®µ ÝßÎÊÛÎ ÝÑËÒÌÇ Ý¸¿²¸¿»² p ðïôðððîôððð Ð®±°±»¼ Ì®¿·´ ß´·¹²³»²¬Ð®±°±»¼ Î»¬¿·²·²¹ É¿´´Û¨·¬·²¹ Ì®¿·´ Ú»»¬ ìÊÍÒ×ÙÈûÊ×Û öÓÕÇÊ× Carver County TH 41 Underpass and Trail Project SP 10-090-30 Carver County, Minnesota ýûü Ó·²²»¬±²µ¿ É»¬ Ó·¼¼´» Í½¸±±´ Ð®±¶»½¬ Ô±½¿¬·±² É»¬ Ð¿®µ·²¹ Ð®±°±»¼ Ð»¼»¬®·¿² Ô±¬ Ð®±°±»¼ Ô¿µ» Î»¬¿·²·²¹ É¿´´ Ë²¼»®°¿ ýpûü Ó·²²»©¿¸¬¿ Ô¿µ» Ó·²²»©¿¸¬¿ Î»¹·±²¿´ Ð¿®µ ÝßÎÊÛÎ ÝÑËÒÌÇ Ý¸¿²¸¿»² p ðïôðððîôððð Ð®±°±»¼ Î»¬¿·²·²¹ É¿´´ Ð®±°±»¼ Ì®¿·´ ß´·¹²³»²¬ Ú»»¬ Excelsior Quadrangle, Minnesota: 7.5 Minute Series Section 4, Range 23, Township 116 ìÊÍÒ×ÙÈðÍÙÛÈÓÍÎçéõé öÓÕÇÊ× ùÛÊÆ×ÊùÍÇÎÈÃèôçÎØ×ÊÌÛÉÉÛÎØèÊÛÓÐìÊÍÒ×ÙÈ éì ùÛÊÆ×ÊùÍÇÎÈÃïÓÎÎ×ÉÍÈÛ