20220546 Ver 1_Updated Impact Statement_20220630

C. Proposed Impacts Inventory
1. Impacts Summary
la. 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
2c.
Type of wetland
2d.
Forested
2e.
Type of jurisdiction
Corps (404,10) or
DWQ (401, other)
2f.
Area of
impact
(acres)
W1 T
Excavation
Headwater Wetland
Yes
Corps
0.01967
W2 T
Excavation
Headwater Wetland
Yes
Corps
0.01033
W3 P
Culvert
Headwater Wetland
Yes
Corps
0.12389
W4 P
Culvert
Headwater Wetland
No
Corps
0.05112
W5 P
Culvert
Headwater Wetland
Yes
Corps
0.04497
W6 -
Choose one
Choose one
Yes/No
-
2g. Total Wetland Impacts:
0.42701
2h. Comments:
W4 is a combined impact for roadway Impact for 2 and 3. I Combined both acreages to make the .05112. as one impact just. See plan detail both
sides of the exsisitng road are being impacted. We are also removing and exsiting road but did not list as impact. See impact site map plan sheet.
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
Killets Creek
PER
DWQ
2.5
80
S2 P
Culvert
Killets Creek
PER
DWQ
2.5
76
S3 P
Culvert
Killets Creek
PER
DWQ
2
116
S4 -
Choose one
-
-
S5 -
Choose one
-
-
S6 -
Choose one
-
-
3h. Total stream and tributary impacts
272
3i. Comments:
Existing Rd will be removed and returned to grade 1371sgft and 18.40ft will be restored back to grade and re vegetated with native wood -stem plants.
Page 4 of 10
PCN Form - Version 1.4 January 2009