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,,vA,0262iJrOl LOCAL - StATE - FEDERAL WATER RESOURCE PROJECT NOTIFICATION I ApPLICATION FORM .Use this form to notify/apply to the U.S. Army Corps of Engineers, the Minnesota Department of Natural Resources, and your Local Governmen~pit of a proposed water/wetland project or work which may fall within their jurisdiction. These agencies should advise you of their jurisdiction or permit requirements within 45 days. Some LGU's may also require submission of their own application forms. Fill out this form completely and mail a copy, with plans, maps, etc. to each of the agencies listed on the reverse of the form. Keep a copy for your records. YOU MUST OBTAIN ALL REQU.lRED AUTHORIZATIONS BEFORE BEGINNING WORK. AGENCY USE ONLY: LGU NUMBER: MDNR NUMBER: 2t11J / -' t Of / CORPS NUMBER: I. Appiicant's Name ILast, First, M.I.} Authorized Agent, if any Area Code, Telephone Midland Hills Country Club Steve Boggs 1351) 631-1545 Address (Street, RFD. Box Number, City, State, Zip Code) 2001 Fulham Street St. Paul, MN 55113 II. Location of proposed project (attach drawinq showing how to get to site) COUNTY QUARTER SECTION(s) SECTIONS(s) N017 TOWNSHIP(s) No. RANGE(s) No. Lot, Block, Subdivision Ramsev S.E. 1/4 of N. W . 1/4 of N.E. 1/4 29 ?:i .. , ., FIRE No.. BOX No., OR PROJECT ADDRESS NAME OF WA TERBODY AFFECTED and NUMBER (IF KNOWN) 2001 "F'lllhJ:lm - W",l ch T,J:lkp III. ESTIMA TED PROJECT COST: $ )0 .00 LENGTH OF SHORE AFFECTED (in feet): "1 /1/1 0:'0 00 IV. VOLUME OF FILL OR EXCAVATION (Cubic Yards): (NOTE: You may substitute dimensions) AREA FILLED OR EXCAVATED IS 36 yards Acres, OR Square Feet V. TYPE OF WORK AND AREA (CHECK ALL. THAT APPLY): o ACCESS PATH o BRIDGE o CULVERT o DAM o CONSTRUCT o DRAIN o EXCAVATE o DOCK o RIPRAP o SANDBLANKET IX FILL o REMOVE o REPAIR o LAKE ~ SHORELINE o WATERWAY o WETLAND OTHER (DESCRIBE): WETLAND TYPE(S) AND ACREAGE(S) PROPOSED TO BE FILLED/DRAINED: Wal~h T.akp ~ J:I('jE'S Attach applicable drawings, plans, and ASCS crop photos. Include a description of any proposed compensatory mitigation. Important: Identify any disposal and borrow areas. Describe the work below: how it would be done; what equipment would be used. VI. PROJECT PURPOSE (why is this project needed--what benefits will it provide?): Two projects withli1 one body of water. Install a improved pump station and repair the eroded shore line. ( Details attachpd ) VII. AL TERNA TIVES (describe any other sites or methods that could be used to achieve the purpose of your project while avoiding or minimizing wetland/water impacts: Attach additional sheets, if needed). No other alternatives could be used to achieve the purpose of these two projects. Tney are to improve the current impact of the lake. VIII. DATES: Proposed start of activity: Proposed completion: A~ri~ J-~ 2001 June 15, 2001 (Identify any completed work on an ttac e r'awlng) IX. ADJOINING PROPERTY OWNERS (Attach list if more than two) Name Address City State Zip Attached x. PERMITS have been received (enter an .8.) or already applied for (enter an ~) from:. DNR ARMY CORPS OF ENGINEERS COUNTY ! - - - - TOWN/CITY - WATERSHED DISTRICT - MN POLLUTION CONTROL AGENCY Has an archaeological survey of the project site been done? No If so, by whom: I hereby notify the recipients of this form of the project proposed herein and request that I be advised of any permits or other determinations concerning this project that I must obtain. I understand that proceeding with work before all required authorizations are obtained may subject me to Federal, State, ,.dlo. 10~1 '~' 0;'" '"dlO:~1 p'~"." DATE J /Q ~ I 5;g."", of P."o. P"~'" .. Ag." /~ l < < < PLEASE CAREFULL V READ AND COMPLETE BACK OF FORM> > >