20230468 Ver 1_Revised PCN table_20230518

D. Proposed Impacts Inventory
Impacts Summary
❑N Wetlands ❑ Streams - tributaries
la. Where are the impacts associated with your project ❑ Buffers ❑ 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.
2a1.
2b.
2c.
2d.
2e.
2f.
2g.
Site #*
Impact
Impact
Wetland Name*
Wetland Type*
Forested
Jurisdiction
Impact Area
Reason/Type*
Duration*
?*
Type*
(ac)*
W1
Choose one
Temp/
Click to enter
Choose one
Y/N
Choose one
Click to
Perm
enter
W2
Fill (Incl.
Permanent
WE 1-132
Bottomland
Yes
Both
0.014
Riprap)
Hardwood
Forest
W3
Fill (Incl.
Permanent
WE 1-132
Bottomland
Yes
Both
0.071
Riprap)
Hardwood
Forest
W4
Fill (Incl.
Permanent
WC 1-28
Bottomland
Yes
Both
0.005
Riprap)
Hardwood
Forest
W5
Choose one
Temp/
Click to enter
Choose one
Y/N
Choose one
Click to
Perm
enter
Fill (Incl.
Permanent
WE 1-132
Bottomland
Yes
Both
0.009
W6
Riprap)
Hardwood
Forest
2g1. Total temporary wetland impacts
Click to enter. ac
2g2. Total permanent wetland impacts
0.099 ac
2g3. Total wetland impacts
0.099 ac
2h. Comments:
The wetland impacts are associated with proposed roads that will provide access to the site and the associated grading
limits necessary to bring the roads to grade. Mitigation is not proposed.
Page 9 of 22 PCN Form - Version 1.5, September 2020