20111881 Ver 2_More Info Received_20170818

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C. Proposed Impacts Inventory
1. Impacts Summary
1a. 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)
Temporary(T)
W1 ❑ P ❑T
El Yes El Corps
❑ No ❑ DWQ
W2 ❑ P❑T
Oyes ❑ Corps
0 N ❑ DWQ
W3 ❑ P ❑T ❑Yes ❑ Corps
❑ No ❑ DWQ
W4 ❑ P ❑T
El Yes El Corps
❑ No ❑ DWQ
W5 ❑ P ❑T
ID yes ❑ Corps
❑ No ❑ DWQ
W6 ❑ P ❑T
ID yes El Corps
❑ No ❑ DWQ
2g.Total wetland impacts
2h. Comments:There are no wetland impacts associated with this project
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 jurisdiction Average Impact
number- (PER)or (Corps-404, 10 stream length
Permanent(P)or intermittent DWQ—non-404, width (linear
Temporary(T) (INT)? other) (feet) feet)
Impact 1; Map 1 Utility Crossing Water Fork ® PER ® Corps 12 60
❑ P®T ��Yjr ❑ INT ® DWQ
Impact 2; Map 1 ® PER ® Corps
UtilityCrossingUT to Water Fork 4 45
❑ P®T ❑ INT ® DWQ
Impact 3; Map 2 i 0 PER ® Corps
ID P®T 7J Utility Crossing Water Fork DINT ® DWQ 12 50
3h.Total stream an tributary impacts 155
3i.Comments: Linear/ afootage of temporary impacts includes the footprints of coffer dams to be used during utility installation
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PCN Form—Version 1.3 December 10, 2008 Version