20150621 Ver 2_More Info Received_20160929

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
❑X Wetlands Strea X — tributaries Buffers Open \Qters PQd Construction X❑
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 T
Excavation
Non -Tidal Freshwater Marsh
No
Corps
0.004
W2 P
Excavation
Non -Tidal Freshwater Marsh
No
Corps
0.05
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:
0.054
2h. Comments:
Temporary impacts from utilities installation. Permanent impacts to W2 resulting from pond construction.
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
UT to Ross Creek (S01)
PER
Corps
3
20
S2 P
Culvert
UT to Ross Creek (S01)
PER
Corps
3
22
S3 T
Cofferdam
UT to Ross Creek (S01)
PER
Corps
3
15
S4 -
Choose one
S5 -
Choose one
-
S6 -
Choose one
3h. Total stream and tributary impacts
57
3i. Comments:
Page 4 of 10
PCN Form — Version 1.4 January 2009