20230549 Ver 1_revised impact table_20230524

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
3a
3b.
3c.
3d.
3e.
3f.
3g.
3h.
Site
Impact Reason*
Impact
Impact
Stream
Stream
Jurisdiction
Stream
Impact
#*
Duration `
Type*
Name
Type*
Type*
Width (avg
length
ft) *
(linear ft) "
S1
Culvert/headwall/endwall
Permanent
Crossing/
SA
Perennial
Both
5
136
Culvert
S2
Riprap Dissipater
Permanent
Fill (Incl.
SA
Perennial
Both
4.7
30
Riprap)
S3
Pump and Sandbags
Temporary
Dewatering
SA
Perennial
Both
5.5
10
S4
Click to enter
Temp/
Choose
Click to
Per/Int
Choose
Click to
Click to
Perm
one
enter
one
enter
enter
S5
Click to enter
Temp/
Choose
Click to
Per/Int
Choose
Click to
Click to
Perm
one
enter
one
enter
enter
S6
Click to enter
Temp/
Choose
Click to
Per/Int
Choose
Click to
Click to
Perm
one
enter
one
enter
enter
S7
Click to enter
Temp/
Choose
Click to
Per/Int
Choose
Click to
Click to
Perm
one
enter
one
enter
enter
S8
Click to enter
Temp/
Choose
Click to
Per/Int
Choose
Click to
Click to
Perm
one
enter
one
enter
enter
S9
Click to enter
Temp/
Choose
Click to
Per/Int
Choose
Click to
Click to
Perm
one
enter
one
enter
enter
S10
Click to enter
Temp/
Choose
Click to
Per/Int
Choose
Click to
Click to
Perm
one
enter
one
enter
enter
S11
Click to enter
Temp/
Choose
Click to
Per/Int
Choose
Click to
Click to
Perm
one
enter
one
enter
enter
S12
Click to enter
Temp/
Choose
Click to
Per/Int
Choose
Click to
Click to
Perm
one
enter
one
enter
enter
S13
Click to enter
Temp/
Choose
Click to
Per/Int
Choose
Click to
Click to
Perm
one
enter
one
enter
enter
S14
Click to enter
Temp/
Choose
Click to
Per/Int
Choose
Click to
Click to
Perm
one
enter
one
enter
enter
S15
Click to enter
Temp/
Choose
Click to
Per/Int
Choose
Click to
Click to
Perm
one
enter
one
enter
enter
S16
Click to enter
Temp/
Choose
Click to
Per/Int
Choose
Click to
Click to
Perm
one
enter
one
enter
enter
S17
Click to enter
Temp/
Choose
Click to
Per/Int
Choose
Click to
Click to
Perm
one
enter
one
enter
enter
S18
Click to enter
Temp/
Choose
Click to
Per/Int
Choose
Click to
Click to
Perm
one
enter
one
enter
enter
S19
Click to enter
Temp/
Choose
Click to
Per/Int
Choose
Click to
Click to
Perm
one
enter
one
enter
enter
Page 10 of 21 PCN Form Version 4.3- April 20, 2022

S20
Click to enter
Temp/
Choose
Click to
Per/Int
Choose
Click to
Click to
Perm
one
enter
one
enter
enter
3i1. Total jurisdictional ditch impact:
0 linear ft
3i2. Total permanent stream impacts:
166 linear ft
36. Total temporary stream impacts:
10 linear ft
34. Total stream and ditch impacts:
176 linear ft
3j.
Comments:
S1 — Stream location 1 includes 136 LF (680 SF) of permanent impact for installation of the culvert/headwalls
and endwalls.
S2 — Stream location 2 includes 30 LF (141 SF) of permanent fill associated with a riprap dissipater downstream
of the culvert. Riprap will be installed flush with the existing stream bed.
S3 — Stream location 3 includes 10 LF (55 SF) of temporary fill for coffer dam and pump located upstream of the
culvert.
Page 11 of 21 PCN Form Version 4.3- April 20, 2022