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Wisconsin Natural Heritage Inventory <br /> Endangered Resources Impact Review Request <br /> Form 1700-047(R 08/08) Page 2 of 2 <br /> b x <br /> Provide a detailed description of the habitat types and current land use within the proposed project area(e.g.,50%in active agriculture <br /> currently corn,20%floodplain forest, 15%industrial area, 10%hardwood swamp dominated by black ash,5%fallow field-in active <br /> agriculture until one year ago). (attach additional information if necessary) <br /> 98%Fallow Field <br /> 2%grassy lawn/manicured areas <br /> List any waterbodies such as rivers,intermittent streams, lakes,or wetlands that are within or near the proposed project area. List any <br /> known or suspected impacts to these waterbodies as a result of the project. For point source discharges into waterbodies please <br /> indicate the discharge location. <br /> None near the project area-closest water body is an unnamed tributary to Badfish Creek,located approximately three-quarters of a <br /> mile to the southeast;no impacts to any water bodies is anticipated as part of this project. <br /> List any reports that have been prepared to describe the habitat that will be affected by the proposed project(e.g.,wetland delineation, <br /> habitat reconnaissance surveys, rare species surveys,etc.). <br /> Edge Consulting obtained the wetland map from the Wisconsin DNR Surface Water Data Viewer-no wetlands were depicted <br /> within the vicinity of the proposed project;the subject site appears to have no suitable habitat for the six(6)listed species for Dane <br /> County-US Fish and Wildlife Service does not require correspondence for"NO EFFECT"determinations <br /> List all other endangered resources or NHI impact reviews that have been submitted or conducted for a different phase,portion,or <br /> other alternatives(s)relating to the proposed project. List ER log#and date(e.g.,00-132 and 2/10/2002)or any other correspondence. <br /> Permit,License or Approval Issuing Agency,Program or Municipality Contact Person Application Status <br /> ❑ will be applying for <br /> ❑ have applied for <br /> ❑ have received <br /> ❑ will be applying for <br /> ❑ have applied for <br /> ❑ have received <br /> ❑ will be applying for <br /> ❑ have applied for <br /> ❑ have received <br /> . s SSA ; y <br /> , rrii,',p. �:�� �"aa•.::;, s. im... � <br /> I am the owner,authorized representative of the owner or utility representative of the property which is the subject of this review request.To the best of <br /> my knowledge the information above is complete and accurate.I understand that the specific location of endangered resources is sensitive information <br /> and will use the material provided solely for analysis and review of the above project. I agree to not include exact locations of endangered resources in <br /> any publicly disseminated documents. I agree to contact the Bureau of Endangered Resources prior to publishing any information provided by the <br /> Wisconsin Natural Heritage Inventory and to credit the Bureau of Endangered Resources as the source of the material. <br /> I also agree to pay,within 30 days of receipt of an invoice for NHI information,the fees charged by the Department.There is a charge of$20/hour(with a <br /> minimum fee of$60)for non-DNR requesters.(For more information on the fee structure and billing exemptions,refer to NR 29,Wis.Adm.Code.) <br /> Applicant Signature Date Signed Applicant Name(please print) <br /> Tracy L. Drunasky <br />