United States Department of Agriculturesd-Cpa-61

UNITED STATES DEPARTMENT OF AGRICULTURESD-CPA-61

NATURAL RESOURCES CONSERVATION SERVICEREV. 04/09

united states army corps of engineers (usace) clean water act

notification of proposed activity

Owner/Operator:County: Legal Description:

Address:Telephone:

Description of proposed activity (size of the subject area, type of activity, any special concerns):

1.Are there any Food Security Act (FSA) identified wetlands associated with the subject area? Yes No

Will the proposed activity affect any wetlands? Yes No

Do any wetland easements exist in the subject area? Yes No

Identity of the easement holder

What is the wetland hydrogeomorphology (HGM) type?Pothole Floodplain Slope/Groundwater

2.Is NRCS providing any technical or financial assistance for the proposed activity? Yes No

3.What is the wetland effect determination for the proposed activity?

Expedited or HGM Minimal Effect Determination Yes No

Minimal Effect with Conditions (attach Minimal Effect Agreement) Yes No

Wetland Mitigation (attach mitigation plan) Yes No

4.Are there any cultural resources present in the subject area? Yes No

(ARMS, National or State Register database search and/or consultation concerns.)

5.Endangered and Threatened Species: Are federal or state listed endangeredor threatened species, candidatespecies, or state special concern species ortheir habitat present, or does the subject area have ahigh potential to support one of these species and the proposed activity would adversely impact the species or habitat? (This includes those areas in the Natural Heritage Database reported as used or occupied by anendangered or threatened species in thelast10 years.) Yes No

6.Is there a designated wild, scenic, or recreationalriver segment or a designated natural area in or adjacent to the subject area? Yes No

All requests for a CWA evaluation must have a clearly marked map of the subject area identified with any official or certified Food Security Act (FSA) wetland determinations and the wetland boundaries delineated. Attach the map and any other appropriate documentation to the request and mail to:

U.S. Army Corps of Engineers

South Dakota Regulatory Office

28563 Powerhouse Road, Room 118

Pierre, SD 57501

(605)224-8531

NOTE: Determinations, delineations, or exemptions made for the Wetland Conservation (WC) provisions of the 1985 FSA may not meet the requirements of other local, state or federal wetland protection laws. This form serves only as USACE notification for proposed activities. It does not grant the landowner any USACE permit or provide an official determination that a permit is not required for the proposed activity. It is the responsibility of the landowner/producer to contact the USACE to find out if additional information/or a permit application is required prior to beginning the proposed activity.

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NRCS EvaluatorTitleDate