20100312 Ver 1_Application_20100609

C. Proposed Impacts Inventory
1. Impacts Summary
1a. Which sections were completed below for your project (check all that apply):
Z Wetlands ❑ Streams - tributaries
Buffers
❑ Open Waters ❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on
the site, then complete this question
for each wetland area impacted.
2&
2b.
2c.
2d.
2e.
2f.
Wetland impact
Type of jurisdiction
number -
Type of impact
Type of wetland
Forested
(Corps - 404, 10
Area of impact
Permanent (P) or
(if known)
DWQ - non-404, other)
(acres)
Temporary (T)
W1 nPnT
Yes
❑ No
❑ Corps
❑ DWQ
0 Sq. Ft.
W2 E]PE]T
❑ Yes
❑ No
❑ Corps
❑ DWQ
0 Sq. Ft
W3 EIPEIT
❑ Yes
❑ No
[:1 Corps
[--] DWQ
OSq. Ft.
W4 nPnT
❑ Yes
❑ Corps
[-] No
❑ DWQ
W5nPnT
❑ Yes
❑ Corps
[:1 No
[-] DWQ
W6 ❑ P f-1 T
❑ Yes
❑ Corps
❑ No
❑ DWQ
2g. Total wetland impacts
0 Sq- Ft.
2h. Comments: No 404 Wetland Impacts
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a.
3b.
3c.
3d.
3e.
3f.
3g.
Stream impact
Type of impact
Stream name
Perennial
Type of jurisdiction
Average
Impact
number -
(PER) or
(Corps - 404, 10
stream
length
Permanent (P) or
intermittent
D - non-404,
width
(linear
Temporary (T)
(INT)?
other)
(feet)
feet)
S1 ZPnT
Fill
Un-Named
Tributary of Brice's
PER
El INT
0 Corps
0 DWQ
12"
36'
Creek
S2 E]PnT
❑ PER
❑ Corps
[:1 INT
❑ DWQ
S3 nPnT
[:1 PER
F1 Corps
❑ INT
[:] DWQ
S4 [:] P ❑ T
[-] PER
❑ Corps
❑ INT
❑ DWQ
S5 [:1 P ❑ T
❑ PER
f-1 Corps
El INT
[:1 DWQ
S6 E]PnT
❑ PER
❑ INT
3h. Total stream and tributary impacts
36 LF
3i. Comments: 36 Linear Feet of Stream Impacts
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