20141106 Ver 1_Craven 124 PCN pg5 Revised_20141120

C. Proposed Impacts Inventory
1. Impacts Summary
1a. Which sections were completed below for your project (check all that apply):
❑ Wetlands ❑X Streams — tributaries ❑X 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.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of impact Type of wetland Forested Type of jurisdiction Area of
number Corps (404,10) or impact
Permanent (P) or DWQ (401, other) (acres)
Tempora T
W1 - Choose one Choose one Yes/No -
�/2 - Choose one Choose one Yes/No -
�/3 - Choose one Choose one Yes/No -
�/4 - Choose one Choose one Yes/No -
�/5 - Choose one Choose one Yes/No -
�/6 - Choose one Choose one Yes/No -
2g. Total Wetland Impacts:
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.
3a. 3b. 3c. 3d. 3e. 3f. 3g.
Stream impact Type of impact Stream name Perennial (PER) or Type of Average Impact
number intermittent (INT)? jurisdiction stream length
Permanent (P) or width (linear
Temporary (T) (feet) feet)
S1 - Choose one - -
S2 P Culvert Mills Branch PER Corps 5 59
S3 P Channel Improvments Mills Branch PER Corps 5 59
S4 T Culvert Mills Branch PER Corps 5 11
S5 T Culvert Mills Branch PER Corps 5 11
S6 - Choose one - -
3h. Total stream and tributary impacts 140
3i. Comments:
S4 is temporary impact for S2; S5 is temporary impact for S3
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PCN Form — Version 1.4 January 2009