Minnesota Wetland Projects Application
NA-026620-03B
Minnesota Local/State/Federal A
For Internal Use Only
Date Initial A lication Received
(V.2.02 for MS WORD) 10/29/04
lication Form for Water/Wetland Pro'ects
A lication No.
Field Office Code
Date initial A
PART I: BASIC APPLICATION
1. LANDOWNER/APPLICANT CONTACT INFORMATION
Name: Mr. Tim Erhart Phone: (952) 368-3434 Fax: (952) 368-4877
Complete mailing address: 9611 MeadowlarkLane.Chanhassen.MN55317.Chanhassen.MN 55317
IA. AUTHORIZED AGENT (Only if applicable; an agent is not required)
Name: Phone:
Complete mailing address:
2. NAME, TYPE AND SIZE OF PUBLIC WATERS or WETLANDS IMPACTED (Attach Additional Project Area sheets if needed)
Name or LD. # of Waters Impacted (if applicable; if known): See Table Below
(Check all that apply): OLake DRiver [8]Wetland type 0 lOlL 02 03 04 05 0 6 07 0 8 See Table Below
Indicate size of entire lake or wetland (check one): See Table Below [8] Less than 10 acres (indicate size: ) 010 to 40 acres 0
Greater than 40 acres
Wetland Proposed Prop osed
Basin Size Type Wetland Topographic Drainage
10 (sq. ft.) (Circ. Type Dominant Vegetation Setting Area
39) (Coward in) Fill. Excav. Fill Excav. (:I: acres)
(sa. ft.) (sa. ft.) (acres) (acres)
A 25,174 4 PEMH Reed canary grass 15,568 9,606 0.36 0.22 Isolated 9.2
B 5,791 1/2 PEMNB Spike rush spp. 207 0 0.005 0 Tributary 3.4
Total 30,965 15,775 9,606 0.36 0.22
Drainage areas are approximate and were estimated usmg surveyed two-foot contour data.
3. PROJECT LOCATION (Information can be found on property tax statement, property title or title insurance):
Project street address: Fire #: NA City (if applicable): Chanhassen
y, Section: NE '!. Section: 26 Township #: 116N Range #: 23W County: Carver
Lot #: Block: Subdivision: Watershed (name or #) Mississippi River - Shakopee (#33)
Attach a simple site locator map. Ifneeded, include on the map written directions to the site from a known location or landmark, and
provide distances from known locations. Label the sheet SITE LOCATOR MAP.
4. TYPE OF PROJECT: Describe the type of proposed work. Attach TYPE OF PROJECT sheet if needed.
See Attached Narrative
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. Attach
PROJECT DESCRIPTION sheet.
See Attached Narrative
Footprint of project: acres or square feet drained, filled or excavated.
See Table above
6. PROJECT AL TERNA TIVES: 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 Attached Narrative
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.
Available Upon Reauest
Westwood Professional Services, Inc. (952) 937-5150
Page 1
Minnesota Local/State/Federal Application Forms for Waterl\Netland Projects
8. PORTION OF WORK COMPLETED: Is any portion of the work in wetland or water areas already completed? DYes l8lNo. If
yes, describe the completed work on a separate sheet of paper labeled WORK ALREADY COMPLETED.
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.
NA Conditional Use Permit e County
e Plat Approval e Town/City
e Zoning Variance NA SHPO
e NPDES e EAW/EIS/AUAR
NA State Disposal System Permit NA Groundwater Appropriation Permit
e Watershed District Permit NA Hazardous Waste Site
NA Feedlot Permit Other:
(Enter e if Pending, ~ if already been approved, Q if denied, or NA if not required)
10. I am applying for state and local authorization to conduct the work described in this application. I am familiar with the information
contain in this application. To the best of my knowledge and belief, all information in Part I is true, complete, and accurate. I possess
the a ority to undertake the work described, or I am acting as the duly authorized agent of the applicant.
~
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.
Westwood Professional Services, Inc. (952) 937-5150
Page 2
Minnesota Local/State/Federal Application Forms for Water/Wetland Projects
APPLICA nON FOR DEPARTMENT OF THE ARMY PERMIT (33 CFR 325) OMS APPROVAL NO. 0710-003 Expires Dee 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 ofInformation 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 oflaw, no person shall be
subject to any penalty for failing to comply with a collection of information ifit 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
I. 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 II, This optional Federal form is valid
for use only when included as art of this entire state a lication packet.
5. APPLICANT'S NAME 8. AUTHORIZED AGENT'S NAME AND TITLE (an agent is not required)
Mr. Tim Erhart
6. APPLICANT'S ADDRESS Q
111 AA
7, APPLICANT'S PHONE NO. I
11. STATEMENT OF AUTHORIZA TlON (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 W A TERBODY; IF KNOWN (if applicable) PROJECT STREET ADDRESS (if applicable)
"
IS. LOCATION OF PROJECT
16. OTHER LOCATION DESCRIPTIONS, IF KNOWN (see instructions)
17. DIRECTIONS TO THE SITE 18. J
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 OTHERWA TERS 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 APPROV ALSIDENIALS FEDERAL, STATE OR LOCAL AGENCIES FOR
WORK DESCRIBED IN THIS APPLICATION.
Westwood Professional Services, Inc. (952) 937-5150 Page 3
Minnesota Local/State/Federal Application Forms for WaterlWetland Projects
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)
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 II has been filled out and signed. 18 V.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)
Westwood Professional Services, Inc. (952) 937-5150
Page 4
Minnesota Local/State/Federal Application Forms for WaterlWetland Projects
FOR LGU USE ONLY:
Determination for Part 1:
D No WCA Jurisdiction
D Exempt: No. _ (per MN Rule 8420.0122)
D No Loss: _ (A,B,. . .G, per MN Rule 8420.0220)
D Replacement required - applicant must complete Part II
COMPLETE THE SECTION BELOW ONLY IF REPLACEMENT IS NOT REOUlRED:
Application is (check one): D Approved DApproved with conditions (conditions attached)
D 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
Westwood Professional Services, Inc. (952) 937-5150
Page 5
Minnesota Local/State/Federal Application Fonns for WaterlWetland Projects
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, ifneeded.)
DESCRIPTION OF WETLAND IMPACTS
County, Prot osed Pro osed
Watershed Section, Wetland Dominant Vegetation
Wetland Impact Name or # Township, Type Fill Excav. Fill Excav.
Basin 10 Range (Circ. 39) (sa. ft.) (sa. ft.) (acres) (acres)
A Mississippi Sec. 26, 4 Reed canary grass 15,568 9,606 0.36 0.22
River - T116N,
Shakopee R23W
(#33)
B Mississippi Sec. 26, 1/2 Spikerush Sp. 207 0 0.005 0
River - T116N,
Shakopee R23W
(#33)
Total 15,175 9,606 0.36 0.22
Existing land use in project area: See Attached Narrative
'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 with that impact area.
TOTALS OF AREA(S) IMPACTED FOR EACH WETLAND TYPE ON CHART (indicate acres 0 or square feet ~)
Type:
I: 207 S.F. lL: 2:
3: 25.174 S.F. 4:_5:_6:_7:_8:_ R:_
12. SPECIAL CONSIDERATIONS: Are you aware of any special considerations that apply to either the impact site(s) or the replacement site(s)? 0 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 ofa lake or 300 feet ofa river.
All wetland impact areas are within the Shoreland Impact Zone.
14. HOW PROPOSED REPLACEMENT WILL BE ACCOMPLISHED: Indicate how proposed replacement will be accomplished (check only one box below
and continue as indicated):
D A. Wetland banking 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.rnn.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.
o C. A Combination of wetland banking and project-specific replacement
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.rnn.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: I) 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 Narrative
Westwood Professional Services, Inc. (952) 937-5150
Page 6
Minnesota Local/State/Federal Application Forms for WaterlWetland Projects
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? 0 Yes 181 No. If yes, submit a Wetland Banking
Application directly to your LGU. 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: I) 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, ifneeded.)
New Public
Wetland Value
Wetland County, Wetland Credits Credits Restored
Watershed Section, (NWC) (PVC) Topographic General
Wetland Basin ID Size Type or
(Acres) Name or # Township, (Circ. 39) (Square (Square Setting Location Created?
Range Feet) Feet)
Below Above
902.5 902.5
M-1 0.83 Mississippi Sec. 26, 2/3 36,104 0 Tributary Surrounding Created
River - T116N, Wetland B with
Shakopee R23W ditch
(#33) berm
Pond 1: 0.41 Mississippi Sec. 26, N/A 0 17,903 N/A Near Created
PVC Credits River - T116N, Wetland A
Shakopee R23W
(#33)
M-1: Upland Buffer 0.46 Mississippi Sec. 26, N/A 0 20,018 N/A Surrounding Created
PVC River - T116N, Wetland B
Shakopee R23W
(#33)
Totals 1.43 36,104 37,921
DESCRIPTION OF REPLACEMENT WETLANDS
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:
181 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.
181 For created replacement wetlands, include additional soils information (if available) that indicates the capability of the site to produce and maintain wetland
characteristics. See Attached Narrative
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 1 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. 1 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):
181 The wetland will be replaced before or concurrent with the actual draining or filling of a wetland.
o An irrevocable bank letter of credit, performance bond, or other acceptable security has been provided to guarantee successful completion of the wetland replacement.
o The wetland losses will be replaced via withdrawal from an account in the State Wetland Bank.
Westwood Professional Services, Inc. (952) 937-5150
Page 7
#
Minnesota Local/State/Federal Application Forms for Water/\Netland Projects
.. '
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 proo f such recording to the LGU.
*.;;, ~
Date
FOR LGU USE ONLY
Replacement plan is (check one): D Approved
DApproved with conditions (conditions attached)
D Denied
LGU official signature
Date
LGU has received 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
Westwood Professional Services, Inc. (952) 937-5150
Page 8