3150-PM-BWEW0557 7/2016
    Aquatice Resource Impact Table
    Applicant's Name / Client: ________________________________________
    INSTRUCTIONS:
    DEP / Corps USE ONLY
    leave blank
    , it will be completed by DEP upon permit acknowledgement/issuance/verification.
    leave blank
    , it will be completed by DEP/Corps upon permit acknowledgement/issuance/verification.
    leave blank
    , it will be completed by DEP upon permit acknowledgement/issuance/verification.
    provide the appropriate information based on the details on each impact for the project
    this same unique identifier should be used in all aspect of the permit registration/application package.
    indicate if the structure or activity is impacting a stream or wetland
    select/provide the type of aquatic resource (based on wetland or stream) being impacted;
    Stream:
    select/provide the type of stream being impacted: perennial, intermittent, ephemeral stream or stream floodway
    Wetland:
    select/provide the type of wetland being impacted: PEM, PSS, PFO or POW wetland
    provide the latitude of the aquatic resource impact in decimal degrees
    provide the longitude of the aquatic resource impact in decimal degrees
    select/provide the type of work proposed to impact the resource; aerial, boring, excavation or fill
    provide the name of the stream or wetland (if available)
    provide the Chapter 93 designation for the aquatic resource
    provide the appropriate information based on the aquatic resource impact
    within the Section 404 jurisdictional area
    , list all impacts separately.
    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
    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
    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
    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;
    indicate "n/a" if impact is to a wetland OR if "n/a" indicated above to Corps Impact Type
    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
    provide the appropriate information based on the aquatic resource impact
    within Chapter 105 jurisdictional area
    , list all impacts separately.
    select/provide the type of aquatic resource impact; temporary or permanent.
    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.
    AREA
    provide the square feet area of impacts to wetlands; indicate "n/a" if impact is to a stream
    Date:
    Corps Impact
    Stream
    Impact
    Stream
    Impact
    Stream
    Impact
    Wetland
    Impact
    DEP
    Impact
    Floodway
    Impact
    Wetland
    Impact
    TYPE
    WIDTH
    LENGTH
    AREA
    AREA
    TYPE
    AREA
    AREA
    leave blank
    leave blank
    leave blank
    unique identifier
    being
    impacted
    TYPE
    dd nad83
    dd nad83
    temp / perm
    linear feet
    linear feet
    sqare feet
    square feet
    temp /
    perm
    square feet
    square feet
    Stream 1
    Stream
    Perennial
    41.7710519 -77.1526930 Excavation
    UNT
    CWF
    Temp
    6
    110
    713
    N/A
    Temp 2201
    N/A
    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
    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
    Latitude
    Longitude
    Work
    Proposed /
    Impact Type
    Waters Name
    PA Code
    Chapter 93
    Designation
    Single and
    Complete
    Project
    PADEP
    Permit
    Number
    Structure /
    Activity
    Aquatic
    Resource
    Aquatic Resource
    Crossing
    Number
    Project / Site Name:
    Example Project
    July 1, 2016
    DEP / Corps use only
    Project Information
    Corps / 404
    PADEP / 105
    for Pennsylvania Chapter 105 Water Obstruction and Encroachment application/registration and US Army Corps of Engineers Section 404 application
    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.
    Longitude
    (nad 83)
    :
    Work proposed / impact type:
    Project Information
    Project / Permit Number
    Single and Complete Project Number:
    Crossing Number:
    DEP Permit Number:
    AREA
    provide a unique identifier for each regulated structure and/or activity being proposed, typically a name and number;
    Structure / Activity Identifier:
    Aquatic Resource:
    Aquatic Resource Type:
    Latitude
    (nad 83)
    :
    Waters Name:
    PA Code Chapter 93 Designation:
    Corps / 404 area
    Stream Impact:
    Corps Impact Type:
    PADEP / 105 area
    PADEP Impact Type:
    Floodway Impact:
    Wetland Impact:
    Wetland Impact:

    3150-PM-BWEW0557 7/2016
    Aquatice Resource Impact Table
    Applicant's Name / Client: ________________________________________
    Date:
    Corps Impact
    Stream
    Impact
    Stream
    Impact
    Stream
    Impact
    Wetland
    Impact
    DEP
    Impact
    Floodway
    Impact
    Wetland
    Impact
    TYPE
    WIDTH
    LENGTH
    AREA
    AREA
    TYPE
    AREA
    AREA
    leave blank
    leave blank
    leave blank
    unique identifier
    being
    impacted
    TYPE
    dd nad83
    dd nad83
    temp / perm
    linear feet
    linear feet
    square feet
    square feet
    temp /
    perm
    square feet
    square feet
    PA Code
    Chapter 93
    Designation
    Waters Name
    Work
    Proposed /
    Impact Type
    Aquatic Resource
    Latitude
    Single and
    Complete
    Project
    Project / Site Name:
    PADEP
    Permit
    Number
    Longitude
    Aquatic
    Resource
    Structure /
    Activity
    DEP / Corps use only
    Crossing
    Number
    Project Information
    Corps / 404
    PADEP / 105

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