20160064 Ver 1_PCNPage 4 rev 1-15-16_20160115

C. Proposed Impacts Inventory
1. Impacts Summary
1a. Which sections were completed below for your project (check all that apply):
❑ 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. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of impact Type of wetland Forested Type of jurisdiction Area of
number Corps (404,10) or impact
Permanent (P) or DWQ (401, other) (acres)
Tem ora T)
W1 - Choose one Choose one Yes/No -
W2 - Choose one Choose one Yes/No -
W3 - Choose one Choose one Yes/No -
W4 - Choose one Choose one Yes/No -
W5 - Choose one Choose one Yes/No -
W6 - Choose one Choose one Yes/No -
2g. Total Wetland Impacts:
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 (PER) or Type of Average Impact
number intermittent (INT)? jurisdiction stream length
Permanent (P) or width (linear
Temporary (T) (feet) feet)
S1 P � Cu�vert � UT to Burgaw Creek PER � Corps � 10 3
S2 P � Channel restoration � UT to Burgaw Creek PER � Corps � 10 180
S3 P � Stabilization � UT to Burgaw Creek PER � Corps � 10 16
S4 T � Dewatering � UT to Burgaw Creek PER � Corps � 10 30
S5 - Choose one - -
S6 - Choose one - -
3h. Total stream and tributary impacts 229
3i. Comments:
This impact length includes the pipe replacement, as well as the installation of rip rap and backfilling with native material from the site to restore the
stream to its previous conditions. The 180 linear feet of channel restoration on the outiet end also inciudes 26 (f of stabilization. Temprary impacts are
for impervious dikes/dewatering/bypass pumping.
Page 4 of 10
PCN Form — Version 1.4 January 2009