20200248 Ver 2_More Info Received_20230428 (4)

D. Proposed Impacts Inventory
Impacts Summary
❑x Wetlands ❑x Streams - tributaries
la. Where are the impacts associated with your project ❑ Buffers ❑x Open Waters
(check all that apply):
❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, complete this table for each wetland area impacted.
2a.
Site #*
2a1.
Impact
Reason/Type*
2b.
Impact
Duration*
2c.
Wetland Type*
2d.
Wetland Name*
2e.
Forested
?*
2f.
Jurisdiction
Type*
2g.
Impact Area
(ac)*
W1
Road/
Driveway
Crossing
Permanent
Headwater
Forest
W1
Yes
Both
0.165
W2
Other
Temporary
Headwater
Forest
W1
Yes
Both
0.022
W3
Road/
Driveway
Crossing
Permanent
Headwater
Forest
W2
Yes
Both
0.157
W4
Other
Temporary
Headwater
Forest
W2
Yes
Both
0.01
W5
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W6
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W7
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W8
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W9
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W10
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W11
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W12
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W13
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W14
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W15
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
2g1. Total temporary wetland impacts
0.032 ac
2g2. Total permanent wetland impacts
0.322 ac
2g3. Total wetland impacts
0.354 ac
2h. Type(s) of material being discharged and the amount of each type in cubic yards:
Clean Fill Dirt (cubic yards n/a)
Page 9 of 23 PCN Form Version 4.3- April 20, 2022

2i. Comments:
Mitigation is Proposed at a 2:1 Ratio for Wetland Loss = 0.644 WMUs
Page 10 of 23 PCN Form Version 4.3- April 20, 2022

3. Stream Impacts
If there are perennial or intermittent stream/ tributary impacts (including temporary impacts) proposed on the site,
complete this table for all stream/ tributary sites impacted.
** All Perennial or Intermittent streams must be verified by DWR or delegated local government
Site #*
3a
Impact
Reason*
3b.
Impact
Duration*
3c.
Impact
Type*
3d.
Stream Name
3e.
Stream
Type*
3f.
Jurisdiction
Type*
3g.
Stream Width
(avg ft) *
3h.
Impact length
(linear ft)
S1
Road Crossing
Permanent
Crossing/
Culvert
Tributary
Stream 2
Intermittent
Both
3
26
S2
Road Crossing
Permanent
Crossing/
Culvert
Tributary
Sream 1
Intermittent
Both
4
93
S3
Temporary
Construction
Temporary
Other
Tributary
Stream 1
Intermittent
Both
4
25
S4
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S5
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S6
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S7
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S8
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S9
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S10
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S11
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S12
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S13
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S14
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S15
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S16
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S17
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S18
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S19
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S20
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
3i1. Total jurisdictional ditch
impact:
0 linear ft
M. Total permanent stream
impacts:
119 linear ft
36. Total temporary stream
impacts:
25 linear ft
3i4. Total stream and ditch
impacts:
145 linear ft
Page 11 of 23 PCN Form Version 4.3- April 20, 2022

3j. Comments:
Total requested permanent stream loss equals 119 LF & 0.012 acres, as such no stream
mitigation is proposed as it's less than the typical 0.02mitigation threshold.
Stream fill proposed at S1 will result in the relocation of the stream into a roadside ditch. This
stream is a modified natural stream / ditch, that has beenmanipulated and maintained as a
ditch for decades.
Temporary stream impacts proposed at S3 will be restored to original contours and cross
sectional area above and below the proposed culvert. Thisstream has also been ditched and
maintained for decades.
Ditch Impacts are included in Section 4.
Page 12 of 23 PCN Form Version 4.3- April 20, 2022

4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other
open water of the U.S., individually list all open water impacts in the table below.
4a.
4a1.
4b.
4c.
4d.
4e.
4f.
Site #*
Impact Reason
Impact
Waterbody Name*
Activity Type*
Waterbody
Impact area
Duration*
Type*
(ac)*
01
Ditch Fill
Permanent
Ditch #1
Fill
Ditch
0.035
02
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
03
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
04
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
05
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
4g. Total temporary open water impacts
0 ac
4g. Total permanent open water impacts
0.035 ac
4g. Total open water impacts
0.035 ac
4h. Comments:
Ditch1 is a potentially jurisdictional ditch (440 If / 0.035 acres) believed to have an OHWM, but no flow
or stream characteristics and obviously manmadedug along a woods line. The ditch will no longer
serve a drainage purpose post development and filling the ditch should allow groundwater levels to
riseand help maintain or even expand the retained/avoided jurisdictional wetlands within the future
northwest quadrant of the future intersection.
5.
Pond or Lake Construction
If pond or lake construction is proposed, complete
the table below. (*This
does NOT include
offline stormwater
management ponds.)
5a.
5b.
5c.
5d.
5e.
Pond ID
Proposed use or
Wetland Impacts (ac)
Stream
Impacts (ft)
Upland
#
purpose of pond
Impacts (ac)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
P1
Choose one
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
P2
Choose one
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
P3
Choose one
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
5f.
Total
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
5g.
Comments:
Click to enter.
5h.
Is a dam high hazard permit required?
❑ Yes ❑ No
If yes, permit ID no.:
Click to enter
5i.
Expected pond surface area (acres):
Click to enter.
5j.
Size of pond watershed (acres):
Click to enter.
Page 13 of 23 PCN Form Version 4.3- April 20, 2022