20170782 Ver 1_Updated Impact Table_20171117

C. Proposed Impacts Inventory
1. Impacts Summary
la. Which sections were completed below for your project (check all that apply):
X 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 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 X P ❑ T
#4 Road/fill
❑ Yes
X Corps
.001
X No
X DWQ
W2 X P ❑ T
#5 Road/fill
ENYoes
X CW
.008
W3 E] P ❑ T
El Yes
❑ Corps
❑ No
❑ DWQ
W4 El P F-1 T
El Yes
El Corps
❑ No
❑ DWQ
El Yes
El Corps
W5 ❑ P FIT
❑ No
❑ DWQ
W6 ❑ P ❑ T
El Yes
El Corps
❑ No
❑ DWQ
2g. Total wetland impacts
.009
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
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)
S1 X P F-1 T
Culvert
UT to North Glade
X PER
X Corps
2
60
Prong
ElINT
X DWQ
S2 X P F1 T
Culvert
UT to North Glade
X PER
X Corps
2
20
Prong
[-]INT
X DWQ
S3 X P ❑ T
Culvert
North Glade Prong
X PER
X Corps
X DWQ
4
20
S4 El P F-1 T
E] PER
El Corps
[I INT
❑ DWQ
S5 El ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S6 El P F1 T
El PER
E] Corps
❑ INT
❑ DWQ
3h. Total stream and tributary impacts
100
Comments:
age 5 of 11
PCN Form — Version 1(3 December 10, 2008 Version