20200110 Ver 1_updated impact table_20200203

1 /31 /2020
New Submission
Are any other NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize any part of the proposed project or related activity?
This includes other separate and distant crossing for linear projects that require Department of the Army authorization but don't require pre -construction notification.
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
Wetlands 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.
"W." will be used in the table below to represent the word "wetland".
6
2a1 Reason*(?)
Sanitary Sewer
2b. Impact type* (?)
T
2c. Type of W. *
Fa�est
2d. W. name *
W-6
2e. Forested *
JJurisdicition
Yes • J
2f. Type of
* (?)
Both
2g. Impact
are
0.004
(acres)
w-10
Sanitary Sewer
T
Headwater Forest
—�]
W-10
Yes
—
Both
n
0.015
(acres)
Add
2g. Total Temporary Wetland Impact
0.019
2g. Total Permanent Wetland Impact
0.000
2g. Total Wetland Impact
0.019
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.
"S." will be used in the table below to represent the word "stream".
3a. Reason for impact*(?) 3b.lmpact 3c. Type of impact* 3d. S. name* 3e. Stream 3f. Type of 3g. S. width* 3h. Impact
tvDe* I Tvpe*(?) Jurisdiction* 1 length*
https://edocs.deq.nc.gov/Forms/Pre-Construction_Notification_Form 6/10

1 /31 /2020
New Submission
S1
S2
ISanitary Sewer Cr os Temporary •
,Roadway Crossing Permanent
Excavation •
Culvert •
S-1
S-1
Perennial •
Perennial •
Both •
Both •
I
Average (feet)
I`
Average (feet)
20
(linear feet)
70
(linear feet)
fl
Sanitary Sewer Cros
Temporary
Excavation • ��JS--2—
Perennial •
Both •
I`
Average (feet)
20
(linear feet)
Add another impact
** All Perennial or Intermittent streams must be verified by DWR or delegated local government.
31. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
70
3i. Total temporary stream impacts:
40
31. Total stream and ditch impacts:
110
3j. Comments:
E. Impact Justification and Mitigation
1. Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project: *
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques: *
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for impacts to Waters of the U.S. or Waters of the State?
Yes No
NC Stream Temperature Classification Maps can be found under the Mitigation Concepts tab on the Wilmington District's RIBITS (https://ribits.usace.army.miI/ribits_apex/f?
p=107:27:2734709611497::NO:RP:P27_BUTTON_KEY:O) website.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
*** Recent changes to the stormwater rules have required updates to this section .***
1. Diffuse Flow Plan
https://edocs.deq.nc.gov/Forms/Pre-Construction_Notification_Form 7/10