20170361 Ver 1_Carteret 63 PCN - Revised Sheet 4_20170719

C. Proposed Impacts Inventory
1. Impacts Summary
1a. Which sections were completed below for your project (check all that apply):
❑X 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 impact Type of wetland Forested Type of jurisdiction Area of
number Corps (404,10) or impact
Permanent (P) or DWQ (401, other) (acres)
Tempora T
W1 P Fill and Excavation Bottomland Hardwood Forest Yes Corps 0.04
�/2 T Hand Clearing Bottomland Hardwood Forest Yes Corps 0.02
�/3 P Fill Bottomland Hardwood Forest Yes Corps 0.01
�/4 T Hand Clearing Bottomland Hardwood Forest Yes Corps 0.01
W5 P Fill and Excavation Bottomland Hardwood Forest Yes Corps 0.02
�/6 - Choose one Choose one Yes/No -
2g. Total Wetland Impacts: 0.1
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 - Choose one - -
$2 - Choose one - -
S3 - Choose one - -
S4 - Choose one - -
S5 - Choose one - -
S6 - Choose one - -
3h. Total stream and tributary impacts
3i. Comments:
Page 4 of 10
PCN Form — Version 1.4 January 2009