20200266 Ver 1_(PCN) Form-Revised Page 5_20200422

r Yes r No
Are any other NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize any part of the proposed project or related activity? This
includes other separate and distant crossing for linear projects that require Department of the Army authorization but don't require pre -construction notification.
D. Proposed Impacts Inventory V
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
W Wetlands W Streams -tributaries r Buffers
r Open Waters r Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
"W." will be used in the table below to represent the word "wetland".
F"��
2a1Reason*(?) 2b. Impact type*(?) 2c. Type of W.2d. W. name* 2e.Forested* 2f.Typeof 2g. Impact
Jurisdicition*(?) area*
Road Crossing
P
Bottomland Hardwood Forest
A
Yes
Both
0.085
(acres)
1
Road Crossing
T
Bottomland Hardwood Forest
A
Yes
Both
0.020
(acres)
2g. Total Temporary Wetland Impact
0.020
2g. Total Permanent Wetland Impact
0.085
2g. Total Wetland Impact
0.105
2h. Comments:
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.
"S." will be used in the table below to represent the word "stream".
3a. Reason for impact* (?) 3b.lmpact type * 3c. Type of impact* 3d. S. name * 3e. Stream Type * �3f. Type of 3g. S. width * 3h. Impact
(?) Jurisdiction* length*
Road CrossingPermanent Culvert A Intermittent Both 2 L et)
32 Road Crossing Temporary Culvert A Intermittent Both 2 28
`All Perennial or Intermittent streams must be verified by DWR or deleaated local government.
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
105
31. Total temporary stream impacts:
28
31. Total stream and ditch impacts:
133
3j. Comments:
Stream A is not buffered, as it is not illustrated on the t1SGS topo quad, or the bound soil survey map.
E. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
The road crossing is designed to cross the wetland at the narrowest portion practically possible, while also maintain minimum required lot dimensions.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Prior to construction, tree protection and silt fence will be installed to ensure areas outside of proposed impacts will not be disturbed.