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NA-026620-03B (V.2.02 for MS WORD) 9/17/2007 i~ninnesota Local~5tate/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 }iELP"directs you to important additional information and assistance in Instructions, Page 1. I. LANDOVI'N'ER/APPLICANT CONTACT INFORI\9ATION (See Help I) Name: Greg and Cindy Noble I Phone: 651 292 1667 Complete mailing address: 825 Heinel Drive. Roseville. MN 55113 I A. AUTHORIZED AGENT See Hel ~ 1A Onl~~ tf applicable; an agent is not required) Name: ~' 1 Phone: "'"~ Cotplete mailing address: 2. NAME, TYPE AND SIZE OF PUBLIC WATERS or WETLANDS IJ\41'ACTEll Attach Addttia~al Pro ect Area sheets if needed Name or LD. # of Waters Impacted (if applicable; if known): Lake Owasso '°""°'I (Check all that apply): ~ Lake ^ River ^ Circular 39 Wetland type: ^ 1, ^ 1L, ^ 2, ^ 3, ^ 4, ^ 5, ^ 6, ^ 7, ^ 8 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: ^ l0 to 40 acres ^/ Greater than 40 acres 3. PROJECT LOCATION (Infor•matton can be found oho er taz statement, ro ert title or title insurm~ce): Project street address: 825 Heinel Drive Fire #: N/A City (if a licable : Roseville ~~~~~ '/< Section: SE Section: 02 Township #: 2g '! Range #: 23 County: Ramsey m Lot #: ~ } Block: t Subdivision: Korrcf~ Watershed (name or #) GrassB UTM location: N ~ E Attach a simple site locator map. If needed, include on the map written directions to the site from a known location or landmark, and provide distances from known locations. Label the sheet SITE LOCATOR MAP. 4. TYPE OF PROJECT: Describe the e of ro osed work. Attach TYPE OF PROJECT sheet if needed. Remove existing dock section -install boulder retaining wall. 5. PROJECT PURPOSE, DESCRIPTION AND DIMEN'SION'S: Describe what you plan to do and why it is needed, how you plan to construct the project with dimensions (length, width; depth), area of impact, and when you propose to construct the project. This is the most important part of your application.. See HELP 5 before completing this section; see What To Include on Plans (Instructions, page 1). Attach PROJECT DESCRIPTION sheet. Footprint of project: ~ acres or ~ square feet drained, filled or excavated 6. PROJECT ALTERNATIVES: What alternatives to this proposed project have you considered that would avoid or minimize impacts to wetlands or waters? List at least TWO additional alternatives to your project in Section 5 that avoid wetlands (one of which may be "no build" or "do nothing"), and explain why you chose to pursue the option described in this application over these alternatives. Attach PROJECT ALTERNATIVES sheet if needed. 7. ADJOINING PROPERTY OWNERS: For projects that impact more than 10,000 square feet of water or wetlands, list the complete mailing addresses of adjacent property owners on an attached separate sheet. (See HELP 7) 8. PORTION OF WORK COMPLETED: Is any portion of the work in wetland or water areas already completed? ^ Yes ^No. If yes, describe the completed work on a separate sheet of paper labeled WORK ALREADY COMPLETED. (See HELP 8) 9. STATUS OF OTHER APPROVALS: List any other permits, reviews or approvals related to this proposed project that are either pending or have already been approved or denied on a separate attached sheet. See HELP 9. 10. I am applying for state and local authorization to conduct the work described in this application. I am familiar with the information coy~Yai~ed in this application. To the best of my knowledge and belief, all information in Part 1 is true, complete, and accurate. I possess tYie a>~hority to und~ake the work desc~e~ or I ant acting as the duly authorized agent of the applicant. (Lando~~ner) Date Signature of agent (lfapplicable) Date Thy block must be signed by the person who desires to undertake the proposed activity and has the necessary property rights to do so ]f only the Agent has signed, please attach a separate sheet signed by the landowner, giving necessary authorization to the Agent. 'See Wetland Plants and Plant Communities of Minnesotn and Wisconsin (Eggers and Reerl 1997) as modified by the Board of Water and Soil Resources, United States Army Corps of Engineers. Minnesota Local/State/Federal Application Fonns for Water/Wetland Projects Page I