20141190 Ver 1_Updated Impact Table for PCN_20141218

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 impacted.
2a.
2b.
2c.
2d.
2e.
2f.
Wetland impact
Type of jurisdiction
number —
Type of impact
Type of wetland
Forested
(Corps - 404, 10
Area of impact
Permanent (P) or
(if known)
DWQ — non -404, other)
(acres)
Temporary T
W1 ® P ❑ T
Impact #2 - Fill
shrub /scrub
® Yes
❑ No
® Corps
® DWQ
0.006
W2 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W3 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W4 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W5 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
2g. Total wetland impacts
0.006
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
Type of jurisdiction
Average
Impact
number -
(PER) or
(Corps - 404, 10
stream
length
Permanent (P) or
intermittent
DWQ — non -404,
width
(linear
Temporary (T)
(INT)?
other)
(feet)
feet)
S1 ®P ❑ T
Impact #1 -
UT Crab Creek
® PER
® Corps
3
40
Culvert
❑ INT
® DWQ
S2 ❑ P ®T
Impact #1 —
UT Crab Creek
® PER
® Corps
3
5
Culvert Installation
❑ INT
® DWQ
S3 ®P ❑ T
Impact #3 —
UT Crab Creek
® PER
® Corps
3
17
Culvert
❑ INT
® DWQ
S4 ❑ P ® T
Impact #4 —
UT Crab Creek
® PER
® Corps
3
5
Culvert Installation
❑ INT
® DWQ
S5 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
3h. Total stream and tributary impacts
67
3i. Comments: Impacts include 57 linear feet of permanent impact and 10 linear feet of temporary impact. An existing 40 -foot
culvert will be replaced and lengthened at the site.
Page 5 of 11
PCN Form — Version 1.3 December 10, 2008 Version