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Home My WebLink About20150686 Ver 1_Application_20150901C. 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) Utility Line El Yes ® Corps W1 E] P ®T I II Non - riparian 0.028 nsta anon ® No ® DWQ W2 ❑ P ®T Utility Line Installation Non - riparian El Yes ® No ® Corps ® DWQ 0.003 W3 ❑ P ®T Utility Line Installation Riparian El Yes ® No ® Corps ® DWQ 0.022 W4 ❑ P ®T Utility Line Installation Non - riparian El Yes ® No ® Corps ® DWQ 0.013 W5 ❑ P ®T Utility Line Installation Non - riparian El Yes ® No ® Corps ® DWQ 0.024 W5A ❑ P ® T Utility Line Riparian ® Yes ® Corps 0.011 Installation ❑ No ® DWQ W6 ❑ P ® T Utility Line Installation Non - riparian El Yes ® No ® Corps ® DWQ 0.007 W7 ❑ P ®T Utility Line Installation Non - riparian El Yes ® No ® Corps ® DWQ 0.004 W8 ❑ P ®T Utility Line Installation Non - riparian El Yes ® No ® Corps ® DWQ 0.023 W9 ❑ P ®T Utility Line Installation Non - riparian ❑ Yes ® No ® Corps ® DWQ 0.011 W10 ❑ P ®T Utility Line Installation Non - riparian ❑ Yes ® No ® Corps ® DWQ 0.003 W11 ❑ P ®T Utility Line Installation Non - riparian ❑ Yes ® No ® Corps ® DWQ 0.008 W12 ❑ P ®T Utility Line Installation Non - riparian ❑ Yes ® No ® Corps ® DWQ 0.001 W13 ❑ P ® T Utility Line Installation Non - riparian ❑ Yes ® No ® Corps ® DWQ 0.176 W14 ❑ P ®T Utility Line Installation Non - riparian ❑ Yes ® No ® Corps ® DWQ 0.005 W15 ❑ P ®T Utility Line Installation Non - riparian ❑ Yes ® No ® Corps ® DWQ 0.010 W16 ❑ P ® T Utility Line Installation Non - riparian El Yes ® No ® Corps ® DWQ 0.010 W17 ❑ P ®T Utility Line Installation Non - riparian ❑ Yes ® No ® Corps ® DWQ 0.005 W18 ❑ P ® T Utility Line Installation Non - riparian ❑ Yes ® No ® Corps ® DWQ 0.003 W19 ❑ P ® T Utility Line Non - riparian ❑ Yes ® Corps 0.028 Page 5 of 13 PCN Form — Version 1.3 December 10, 2008 Version Installation ® No ® DWQ W20 ❑ P ®T Utility Line Non - riparian ❑ Yes ® Corps 0.017 Installation ® No ® DWQ 2g. Total wetland impacts 0.412 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 Utility Line NSA ❑ PER ® Corps 5 8 Installation ® INT ® DWQ S2 ❑ P ®T Utility Line Mill Run ® PER ® Corps 10 8 Installation ❑ INT ® DWQ S3 ❑ P ® T Utility Line NSA ❑ PER ® Corps 5 11 Installation ® INT ® DWQ S4 ❑ P ®T Utility Line NSA ❑ PER ® Corps 5 9 Installation ® INT ® DWQ 3h. Total stream and tributary impacts 36 3i. Comments: Page 6 of 13