20231276 Ver 1_More Info Received_20231109 (3)

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
❑X Wetlands ❑X 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.
Wetland impact
number
Permanent (P) or
Temporary T
2b.
Type of impact
2c.
Type of wetland
2d.
Forested
2e.
Type of jurisdiction
Corps (404,10) or
DWQ (401, other)
2f.
Area of
impact
(acres)
W1 P
Fill
Headwater Wetland
Yes
Corps
0.002
W2 P
Fill
Headwater Wetland
No
Corps
0.001
W3 P
Fill
Headwater Wetland
No
Corps
0.001
W4 P
Fill
Headwater Wetland
Yes
Corps
0.003
W5
Choose one
Choose one
Yes/No
W6
Choose one
Choose one
Yes/No
2g. Total Wetland Impacts:
0.007
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.
Stream impact
number
Permanent (P) or
Temporary (T)
3b.
Type of impact
3c.
Stream name
3d.
Perennial (PER) or
intermittent (INT)?
3e.
Type of
jurisdiction
3f.
Average
stream
width
(feet)
3g.
Impact
length
(linear
feet)
S1 P
Culvert
Burleson Creek
PER
Corps
2.8
10
S2 T
Culvert
unnamed tributary
PER
Corps
3.1
14
S3 P
Culvert
unnamed tributary
PER
Corps
3.1
4
S4 T
Dewatering
Burleson Creek
PER
Corps
2.8
31
S5 T
Dewatering
unnamed tributary
PER
Corps
4.3
20
S6
Choose one
3h. Total stream and tributary impacts
79
3i. Comments:
Permanent impacts to acres of stream bed (total = 0.004 acres): S1 = 0.002 AC; S3 = 0.002 AC
Temporary impacts to acres of stream bed (total = 0.005 acres): S2 = 0.001 AC; S4 = 0.002 AC; S5 = 0.002 AC
Page 4of10
PCN Form — Version 1.4 January 2009