20170940 Ver 1_revised_B-4544 PCN_p4_20170818

C. 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)
Tem orar T
Fill/Mechaniz- � Yes � Corps
Site �/2 � P❑ T ed Clearing Riparian � No � pWQ 0.03
Site �/2 � P❑ T Excavation Riparian � Yes � Corps <0.01
❑ No ❑ DWQ
Fill/Mechaniz- � Yes � Corps
Site 2� P❑ T ed Clearing Riparian � No � pWQ 0.15
Fill/Mechaniz- � Yes � Corps
site 2�3 � P❑ T ed Clearing Riparian � No � DWQ 0.02
Fill/Mechaniz- � Yes � Corps
Site 3� P � T ed Clearing Riparian � No ❑ DWQ <0.01
Site 1❑ P❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
0.20
2g. Total wetland impacts Permanent
2h. Comments: See Wetland Permit Impact Summary sheet for details. Hand clearing in riparian wetlands totals 0.04 ac.
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 Average Impact
number - (PER) or jurisdiction stream length (linear
Permanent (P) or intermittent (Corps - 404, 10 width feet)
Temporary (T) (INT)? DWQ — non-404, (feet)
other)
Site 1/2 ❑ P� T Fill Black River � PER � Corps 40 97 If
❑ INT ❑ DWQ
Site 2/3 � P � T Fill Black River � PER � Corps 40 21 If
❑ INT ❑ DWQ
Site 2/3 ❑ P� T Fill Black River � PER � Corps 40 81 If
❑ INT ❑ DWQ
Site ❑ P❑ T ❑ PER ❑ Corps
❑ INT ❑ DWQ
Site ❑ P❑ T ❑ PER ❑ Corps
❑ INT ❑ DWQ
Site ❑ P❑ T ❑ PER ❑ Corps
❑ INT ❑ DWQ
3h. Total stream and tributary impacts 21 If P
178 IfT