EXAMPLE STANDARD WETLAND AND OTHER WATER TABLES: Include impact tables if wetlands are identified in Sections 75, 76, or 77 regardless of being impacted.

Wetland Impact Table
Wetland Number	Location	Wetland Feature	USACE Jurisdictional Wetlands1	Wetland Impacts Acre(s)	USFWS Easement Impacts Acre(s)	Wetland Mitigation
Mitigation Required	USACE/11990 Bank	11990 Bank	USFWS Bank	Onsite
Temp.	Perm.	Temp.	Perm.	EO 11990	USACE	USFWS	Location	Acre(s)	Location	Acre(s)	Location	Acre(s)	Mitigation Location; Ratio	Acre(s)	Constructed Site #	Constructed Size Acre(s)
1	Sec.19, T146N, R95W	Artificial	Yes	1	0.6	N	Y	N	Site 1; (1:1)	0.5	Site 1	0.50
Site 2; (1:1)	0.1
2	Sec. 6, T146N, R95W	Natural	Yes	0.5	0.02	0.03	0.3	Y	N	Y	Vollrath 16/17 11990	0.02	Vollrath 15/21 USFWS Easement	0.3
3	Sec.6, T146N, R95W	Artificial	No	0.05	0.2	N	N	N	Site 2	0.20
4	Sec.30, T146N, R95W	Natural	No	0.05	0.07	Y	N	N	Site 3; (1:1)	0.07	Site 3	0.07
5	Sec.30, T146N, R95W	Artificial	No	1	1	N	N	N
6a	Sec.27, T146N, R95W	Natural	Yes	0.05	0.11	Y	Y	N	Site 4; (1:1)	0.11	Site 4	0.11
2.65	2	0.03	0.3	0	0.02	0.3	0.78	0.88

Other Waters Impact Table
Other Waters	Other Water Mitigation
Number	Location	Type	Size	Feature	USACE Jurisdictional1	Impacts to Other Waters	Mitigation Required	Mitigation Location; ratio	Method
Acre(s)	Linear Feet	Acre(s) Temp Perm	Linear Feet Temp Perm	EO 11990	USACE	USFWS
OW 6b	Sec.19, T146N, R95W	Tributary	0.30	124	Natural	Yes	0.14	0.00	27.00	0.00	N	N	N	NA	NA
OW7	Sec. 6, T146N, R95W	Deepwater	0.12	NA	Natural	Yes	0.00	0.06	0.00	0.00	N	N	N	NA	NA
OW8	Sec.6, T146N, R95W	Tributary	0.90	500	Natural	Yes	0.20	0.10	200.00	330.00	N	Y	N	onsite 0.1 at Site 2; (1:1)	Wetland creation
OW9	Sec.30, T146N, R95W	Named Stream	0.40	300	Natural	Yes	0.07	0.07	75.00	75.00	Y	Y	N	NA	60" pipe lowered 1'
OW10	Sec.19, T146N, R95W	Named Stream	1.50	150	Natural	Yes	0.07	0.22	60.00	420.00	Y	Y	N	on site	Box culvert and riprap lowered 1'
OW11	Sec.30, T146N, R95W	Tributary	0.20	42	Natural	Yes	0.00	0.00	0.00	0.00	N	N	N	NA	NA
Totals	3.42	1116	0.48	0.45	362.00	825.00

Include these footnotes underneath one impact table (wetland or other water)

1 A wetland Jurisdictional Determination was issued by the USACE on x/xx/xxxx; NWO-xxxx-xxxx-BIS.
2 1199 Mitigation requirements - All impacts to natural wetlands (natural/jurisdictional and natural/non-jurisdictional), regardless of size, as well as impacts greater than 0.10 acre to wetlands require mitigation. USACE Mitigation Requirements – All jurisdictional impacts greater than 0.10 acre to each resource (cumulative. eg 1a ,1b,1c..etc.) requires mitigation. Other Water impact greater than 300 linear feet requires mitigation.
3 All artificial/non-jurisdictional, deep water (impacts greater than 6.6 feet), Other Waters less than 300 linear feet (determined by the USACE on a case by case), and temporary impacts do not require mitigation.

Impact Summary Table	Mitigation Summary Table
Permanent Impact Summary	Temporary Impacts and additional information	Location	Onsite Acre(s)	11990 Bank Acre(s)	USACE/11990 Bank Acre(s)	USFWS Bank Acre(s)
Wetland Type	Total (Acres)	Wetland Type	Total (Acres/Lf)	USACE Only	Onsite	0.7
Natural/JD	0.13	Temporary JD	1.55	EO 11990 Only	Onsite and Vollrath16/17	0.07	0.02
Natural/Non-JD	0.07	Non-JD Temporary	1.10	USACE/11990	Onsite	0.11
Artificial/JD	0.60	Permanent JD > 0.10	0.71	USFWS	Vollrath 15/21 UFWS Easement	0.3
Artificial /Non-JD	1.20	Permanent OW	0.45 ac/825 ft.	Total	0.88	0.02	0	0.3
Total	2.00	Temporary OW	0.48/362