20220142 Ver 1_Updated Impacts Table_20220321

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below
for your project (check all that apply):
❑ Buffers ❑ Open Waters ❑ Pond Construction
X Wetlands X Streams — tributaries
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a.
Wetland impact
number
Permanent (P) or
Temporary (T)
2b.
Type of impact 1
2c.
Type of wetland
2d.
Forested
2e.
Type of jurisdiction
Corps (404,10) or
DWQ (401, other)
2f.
Area of
impact
(acres)
W1 P
Culvert/Retaining Wall
Bottomland Hardwood Forest
Yes
Corps
0.065
W2 T
Construction Access
Bottomland Hardwood Forest
Yes
Corps
0.007
W3 T
Construction Access
Bottomland Hardwood Forest
Yes
Corps
0.001
W4 T
Construction Access
Bottomland Hardwood Forest
Yes
Corps
0.015
W5 -
Choose one
Choose one
Yes/No
-
W6 -
Choose one
Choose one
Yes/No
-
2g. Total Wetland Impacts:
0.088
2h. Comments:
Impacts W2-W4 are associated with access for retaining wall construction.
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.
Stream impact
number
Permanent (P) or
Temporary (T)
3b.
Type of impact
3c.
Stream name
3d.
Perennial (PER) or
intermittent (INT)?
3e.
Type of
jurisdiction
3f.
Average
stream
width
(feet)
3g.
Impact
length
(linear
feet)
S1 P
Culvert
UT Fourmile Branch
PER
Corps
5
71
S2 T
Construction Access
UT Fourmile Branch
PER
Corps
5
20
S3 P
Culvert
Fourmile Branch
PER
Corps
4
16
S4 T
Construction Access
Fourmile Branch
PER
Corps
6
20
S5 -
Choose one
-
-
S6 -
Choose one
-
-
3h. Total stream and tributary impacts
162
3i. Comments:
Streambed Impacts: S1 = 0.009 Ac (71 If); S2 = 0.003 Ac (20 If); S3 = 0.001 Ac (16 If); S4 = 0.004 Ac (20 If)
Total Permanent Streambed Impacts = 0.010 Ac; Total Temporary Streambed Impacts = 0.007 Ac.
Page 4 of 10
PCN Form — Version 1.4 January 2009