20110048 Ver 1_Application_20110606

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
® 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 impaled.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of jurisdilion
number- Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWO -non-404, other) (acres)
Tem ora
W1 ®P ^ T Fill Bottomland
Hardwood Forest ®Yes
^ No ®Corps
^DWQ 10 Sq. ft.
W2 ®P ^ T FiII Bottomland ®Yes ®Corps 220 Sq. ft.
Hardwood Forest ^ No ^ DWO
W3 ®P ^ T Fill Bottomland ®Yes ®Corps 305 Sq. ft.
Hardwood Forest ^ No ^DWQ
W4 ®P ^ T Fill Bottomland ®Yes ®Corps 395 Sq. ft.
Hardwood forest ^ No ^ DWO
WS ^ P ^ T ^Yes ^ Corps
^ No ^ DWO
W6 ^ P ^ T ^Yes ^ Corps
^ No ^ DWO
2g. Total wetland impacts 930 Sq. Ft.
2h. Comments: 930 Sq. ft.(0.02 Acres) 404 Wetland Impals
3. Stream Impacts
If there are perennial or intermittent stream impacts (inGuding temporary impacts) proposed on the site, then complete this
question for all stream sites impaled.
3a. 3 b. 3c. 3d. 3e. 3f. 3g.
Stream impal Type of impal Stream name Perennial Type of jurisdilion Average Impal
number - (PER) or (Corps - 404, 10 stream length
Permanent (P) or intermittent DWO -non-404, width (linear
Temporary (T) (INS? other) (feet) feet)
S1 ®P ^ T Box Culvert U/T Tyson Marsh ®PER
^ INT ^ Corps
®DWQ 12' 22'
S2 ^ P ®T Box Culvert U/T Tyson Marshh ®PER
^ INT ^ Corps
®DWQ 12' 8'
S3 ^ P ®T Box Culvert U!T Tyson Marsh ®PER
^ INT ^ Corps
®DWQ 12' 8'
S4 ®P ^ T Box Culvert U/T Tyson Marsh ®PER
^ INT ^ Corps
®DWQ 12' 22'
^PER ^ Corps
S5 ^ P ^ T ^ INT ^ DWO
S6 ^ P ^ T ^PER ^ Corps
^ INT ^ DWO
3h. Total stream aad tributary impacts 60 LF
3i. Comments: 60 Linear Feet of Stream Impals 44 Linear Feet Permanent and 16 Linear Feet Temporary Impacts
Page 5 of 11
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