W912ES22R0001-0004 RRS MNDNR Contractor Resp Form 18Nov21.pdf

BWSR Forms 07-13-17 Page 1 of 2

Landowner Statement and Contractor Responsibility For Work in Wetlands or Public Waters

MN Statutes Sections 103G.2212 and 103G.241 stipulate that an agent or employee of another may not:

1) drain, excavate, or fill a wetland, wholly or partially; or

2) construct, reconstruct, remove, or make any change in any reservoir, dam, or the course, current, or cross-section of any public water;

unless the agent or employee has obtained a signed statement from the property owner stating that any permit or wetland replacement plan required for the work has been obtained, or that a permit or replacement plan is not required; AND this statement is mailed to the appropriate office with jurisdiction over the wetland or public water prior to initiating the work (see next page for information on where to send this notification).

This form is a notification only and is not an application or authorization for any activities described in it.

1. PROJECT INFORMATION

Project will affect (check all that apply):

Lake, Watercourse, or Public Waters Wetland Non-Public Waters Wetland Wetland of Unknown Jurisdiction

Address or description of project location (attach map if necessary):

Legal address WP35 - Red River Control Structure (South of Moorhead, MN along the Red River)

County Clay

Gov’t Lot(s)

Quarter Section(s)

SE

Section(s)

Township(s) 137N

Range(s) 48W

Lot, Block, Subd.

Description of proposed work (include sketch and/or attach additional pages if needed):

Work Package (WP) 35 - Red River Structure includes the construction of a river control structure which will function to regulate the flow during operation of the Flood Diversion Project. To construct this structure, work within the Red River includes bank shaping and grading, construction of coffer dams, and embankment to divert the flow of the Red River through the Red River Structure that will be constructed off-channel.

2. LANDOWNER STATEMENT

I certify that, as the owner of the property listed on this form (check one):

I have obtained all permits or approvals required to perform the work described above.

No permits or approvals are required for this work.

Property Owner (Print Name) Kris Bakkegard (Director of Engineering)

Address 207 4th Street North, Suite A Fargo, ND 58102

Signature

Date

Phone Number and E-mail Address (Optional) 701.660.0912 bakkegardk@fmdiversion.gov

3. CONTRACTOR VERIFICATION

11/10/2021

BWSR Forms 07-13-17 Page 2 of 2

By signing below, I verify that I have received a signed copy of this form and will be performing the indicated work as described above.

Company and Individual Performing Proposed Work (Print)

Address

Signature

Date

Phone Number and E-mail Address (Optional)

Note: The contractor is responsible for ensuring this form is mailed to the appropriate office when complete.

This statement is invalid if any of the above information is not supplied or is inaccurate. Work in violation of this notification requirement is a separate and independent offense from other violations of Minnesota Statutes chapter § 103G and is a misdemeanor punishable by fines up to $1,000 and/or 90 days in jail. The State Department of Natural Resources (DNR) Commissioner also has the authority to require restoration of any work done without the necessary permits or approvals or work that is beyond what was authorized.

4. INFORMATION AND RESOURCES

A Wetland Conservation Act (WCA) replacement plan is required for any wetland draining, excavation, or filling activity that is not exempt under Minnesota Rules Chapter 8420.0420. A DNR Waters permit is required for any work in public waters.

National wetland inventory maps are available for review at the County Soil and Water Conservation District (SWCD) office and online at http://www.fws.gov/wetlands/Data/Mapper.html. Many wetlands are not identified on the maps but are still restricted from draining, excavating, or filling. If you are unsure the proposed work will affect a wetland, contact your local government unit (LGU) or SWCD for assistance.

Public Waters of the State of Minnesota include the channel to the top of the channel bank for watercourses and the basin from the ordinary high water level waterward for public waters (i.e. lakes) and public waters wetlands. Public waters inventory maps are available for review at the County Auditor’s office, DNR Division of Waters regional offices, and online at http://www.dnr.state.mn.us/waters/watermgmt_section/pwi/download.html.

General information about public waters, wetlands, and related regulations are available on the DNR website at http://mndnr.gov and the MN Board of Water and Soil Resources (BWSR) website at http://www.bwsr.state.mn.us.

5. WHERE TO SEND THIS NOTIFICATION

For work in public waters (lake, watercourse, or public waters wetland), send this completed form to the DNR

Regional Enforcement Office serving the project’s area. See below for DNR regional office information. A map of DNR regions can be found on the DNR website at: http://files.dnr.state.mn.us/aboutdnr/dnr_regions.pdf

For work in any wetland that is not a public waters wetland, send this completed form to the WCA LGU with jurisdiction over the project area. The LGU is usually the County or SWCD, except in urban areas the City is often the LGU. Contact any of these local governments or BWSR for assistance. BWSR also maintains a list of LGUs on its website at: http://www.bwsr.state.mn.us/directories/WCA.pdf.

If it is not known if the wetland is a public waters wetland, send the completed form to both the DNR Regional Enforcement Office and the WCA LGU.

Department of Natural Resources Regional Offices Northwest Region:

2115 Birchmont Beach Rd.

NE

Bemidji, MN 56601 Phone: 218-308-2700

Northeast Region:

1201 E. Hwy. 2 Grand Rapids, MN 55744 Phone: 218-327-4455

Central Region:

1200 Warner Road St. Paul, MN 55106 Phone: 651-259-5800

Southern Region:

21371 State Highway 15 New Ulm, MN 56073 Phone: 507-359-6000

Keep a copy of this form for your records!

http://www.fws.gov/wetlands/Data/Mapper.html http://www.dnr.state.mn.us/waters/watermgmt_section/pwi/download.html http://mndnr.gov/ http://www.bwsr.state.mn.us/ http://files.dnr.state.mn.us/aboutdnr/dnr_regions.pdf http://www.bwsr.state.mn.us/directories/WCA.pdf

Landowner Statement and Contractor Responsibility