TH101CSAH 61 Permit Application FormMinnesota 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 Ecological
and Water Resources 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 Ecological and Water Resources 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 Ecological and Water Resources 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: 218-308-2620 Phone: 218-327-4416 Phone: 651-259-5845 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
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
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
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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)
First
impact
33-Lower
Minnesota
River
9
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:
Second
impact
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: 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
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.
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.
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
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.
See Attached
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
7
Carver
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
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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-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.
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
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