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  A B C D E F G H I J K L M N O P Q R S T U V W X AA AB AC
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for Pennsylvania Chapter 105 Water Obstruction and Encroachment application/registration and US Army Corps of Engineers Section 404 application
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4 INSTRUCTIONS:          
5 Please begin to complete the Aquatic Resource Impact Table by including the Applicant's Name / Client (upper right of the page) for each page. Also, complete the Project / Site Name (upper left of the page) and the date of application/registration package submission (upper right, under Applicant's Name / Client). Then complete one row of data for each regulated (DEP Chapter 105 and Corps Section 404) structure or activity and type of impact for the proposed project based on the instructions for each column below; add additional worksheets if needed. Provide completed Aquatic Resource Impact Table with Chapter 105 Water Obsruction and Encroachment application/registration; DO NOT submit instructions (page 1) for this table.          
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7 Project / Permit Number DEP / Corps USE ONLY          
8 DEP Permit Number: DEP Permit Number:leave blank, it will be completed by DEP upon permit acknowledgement/issuance/verification.          
9 Single and Complete Project Number: Single and Complete Project Number:leave blank, it will be completed by DEP/Corps upon permit acknowledgement/issuance/verification.          
10 Crossing Number: Crossing Number:leave blank, it will be completed by DEP upon permit acknowledgement/issuance/verification.          
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12 Project Information provide the appropriate information based on the details on each impact for the project          
13 Structure / Activity Identifier: provide a unique identifier for each regulated structure and/or activity being proposed, typically a name and number;          
14 this same unique identifier should be used in all aspect of the permit registration/application package.          
15 Aquatic Resource: indicate if the structure or activity is impacting a stream or wetland          
16 Aquatic Resource Type: select/provide the type of aquatic resource (based on wetland or stream) being impacted;          
17 Stream: select/provide the type of stream being impacted: perennial, intermittent, ephemeral stream or stream floodway          
18 Wetland: select/provide the type of wetland being impacted: PEM, PSS, PFO or POW wetland          
19 Latitude (nad 83): provide the latitude of the aquatic resource impact in decimal degrees          
20 Longitude (nad 83): provide the longitude of the aquatic resource impact in decimal degrees          
21 Work proposed / impact type: select/provide the type of work proposed to impact the resource; aerial, boring, excavation or fill          
22 Waters Name: provide the name of the stream or wetland (if available)          
23 PA Code Chapter 93 Designation: provide the Chapter 93 designation for the aquatic resource          
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25 Corps / 404 area provide the appropriate information based on the aquatic resource impact within the Section 404 jurisdictional area, list all impacts separately.          
26 Corps Impact Type: select/provide the type of aquatic resource impact; temporary, permanent or n/a; indicate "n/a" if you are not proposing any work in, over, or under waters and/or wetlands          
27 Stream Impact: WIDTH provide the linear feet, measuring from top of bank to top of bank, of transverse and/or full channel fill stream impacts; indicate "n/a" if impact is to a wetland OR if "n/a" to Corps Impact Type          
28 LENGTH provide the linear feet, measuring down the center line of stream, of transverse and/or full channel fill stream impacts; indicate "n/a" if impact is to a wetland OR if "n/a" to Corps Impact Type          
29 AREA provide the square feet area of direct and indirect/secondary stream impact; dewatering or fill placed in stream channel such as rip rap or fish habitat;          
30 indicate "n/a" if impact is to a wetland OR if "n/a" indicated above to Corps Impact Type          
31 Wetland Impact: AREA provide the square feet area of impacts to wetlands; indicate "n/a" if impact is to a stream OR if "n/a" to Corps Impact Type          
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33 PADEP / 105 area provide the appropriate information based on the aquatic resource impact within Chapter 105 jurisdictional area, list all impacts separately.          
34 PADEP Impact Type: select/provide the type of aquatic resource impact; temporary or permanent.          
35 Floodway Impact: AREA provide the square feet area of direct and indirect/secondary 100-year floodway impact, inlcuding watercourse; indicate "n/a" if impact is to a wetland.          
36 Wetland Impact: AREA provide the square feet area of impacts to wetlands; indicate "n/a" if impact is to a stream          
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38 Project / Site Name: Example Project Date: July 1, 2016        
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40 DEP / Corps use only Project Information Corps / 404 PADEP / 105        
41 PADEP Permit Number Single and Complete Project Number Crossing Number Structure / Activity Aquatic Resource Aquatic Resource Latitude Longitude Work Proposed / Impact Type Waters Name PA Code Chapter 93 Designation Corps Impact Stream Impact Floodway Impact Total Water impact Stream Impact Stream Impact Wetland Impact DEP Impact Floodway Impact total water impact Stream Impact Wetland Impact Resource Wetland Stream  
42 TYPE WIDTH WIDTH WIDTH LENGTH AREA AREA TYPE AREA AREA TYPE AREA Wetland Palustrine Forested (PFO) Perennial
43 leave blank leave blank leave blank unique identifier being impacted TYPE dd nad83 dd nad83 temp / perm linear feet feet feet linear feet sqare feet square feet temp / perm square feet area square feet Stream Palustrine Scrub Shrub (PSS) Ephemeral
44 Stream 1 Stream Perennial 41.7710519 -77.1526930 Excavation UNT CWF Temp 6 110 713 N/A Temp 2201 N/A   Paulstine Emergent (PEM) Intermittent
45 Wetland 1 Wetland Paulstine Emergent (PEM) 42.6895100 -76.1539500 Boring WETLAND OTHER N/A N/A N/A N/A N/A Perm N/A 300   Palustrine Open Water (POW) Floodway
46 Wetland 2 Wetland Paulstine Emergent (PEM) 42.7026800 -76.1546200 Fill WETLAND OTHER Perm N/A N/A N/A 83 Perm N/A 83        
47 Project / Site Name:       Date:        
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49 DEP / Corps use only Project Information Corps / 404 PADEP / 105        
50 PADEP Permit Number Single and Complete Project Number Crossing Number Structure / Activity Aquatic Resource Aquatic Resource Latitude Longitude Work Proposed / Impact Type Waters Name PA Code Chapter 93 Designation Corps Impact Stream Impact Floodway Impact Total Water impact Stream Impact Stream Impact Wetland Impact DEP Impact Floodway Impact total water impact Stream Impact Wetland Impact        
51 TYPE WIDTH WIDTH WIDTH LENGTH AREA AREA TYPE AREA AREA TYPE AREA        
52 leave blank leave blank leave blank unique identifier being impacted TYPE dd nad83 dd nad83 temp / perm linear feet feet feet linear feet square feet square feet temp / perm square feet area square feet        
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  A B C D
1 Wetland Perennial Aerial Temp
2 Stream Intermittent Boring Perm
3   Ephemeral Excavation N/A
4   Floodway Fill  
5   Palustrine forested (PFO)    
6   Palustrine scrub shrub (PSS)  
7   Palustrine emergent (PEM)  
8   Palustrine open water (POW)  

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  B C D
1        
2        
3 Resource Wetland Stream  
4 Wetland Palustrine Forested (PFO) Perennial  
5 Stream Palustrine Scrub shrub Ephemeral
6 Paulstine emergent (PEM) Intermittent
7 Palustrine Open Water (POW) Floodway  

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