Wetland Protection Land Use Assessment Form
Complete this assessment to evaluate how a proposed or existing land use may affect wetlands. Please provide detailed and accurate information for each section.
Project Name
*
Project Location (Address or Coordinates)
*
Type of Land Use
*
Please Select
Agriculture
Residential Development
Commercial/Industrial Development
Transportation/Infrastructure
Recreational Use
Conservation/Restoration
Other
Is there a wetland present within or adjacent to the project area?
*
Yes
No
Unknown
Describe the scope of the proposed or existing project.
*
Potential Impacts on Wetlands
*
Rows
None
Minor
Moderate
Significant
Vegetation Loss
1
2
3
4
Water Quality
5
6
7
8
Hydrology Alteration
9
10
11
12
Wildlife Habitat
13
14
15
16
Public Access
17
18
19
20
Planned Mitigation Measures (if any)
Buffer establishment
Stormwater management
Wetland restoration/enhancement
Erosion control
Invasive species management
Other
Overall Risk Level to Wetlands
*
Low
Moderate
High
Rate the adequacy of proposed mitigation measures
1
2
3
4
5
Reviewer Assessment and Recommendations
*
Submit Assessment
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