20200110 Ver 1_Updated Impact Table_20200205

2/5/2020
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.
J
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".
2a1 Reason * M 2b. Impact type* (?)
�p.c. Tyof W. * 2d. W. name * 2e. Forested*
—] � J
2f. Type of
Jurisdicition * M
2g. Impact
arear
rlra�wer
T Headwater Forest
_��
W-10
Yes
Both
0.015
(acres)
Add
2g. Total Temporary Wetland Impact
0.015
2g. Total Permanent Wetland Impact
0.000
2g. Total Wetland Impact
0.015
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".
F]
3a. Reason for impact* (?>
3b.lmpact
type*
3c. Type of impact*
3d. S. name*
3e. Stream
_11
Type*(?)
3f. Type of
Jurisdiction*
3g. S. width*
3h. Impact
length*
S1
Sanitary Sewer Cros
Temporary •
Excavation •
S-1
Perennial •
Both •
IJ
Average (feet)
20
(linear feet)
https://edocs.deq.nc.gov/Forms/Pre-Construction_Notification_Form 6/10

2/5/2020
New Submission
S2
Roadway Crossing
Permanent •
Culvert •
S-1
Perennial •
Both •
I`
Average (feet)
70
(linear feet)
S3
Sanitary Sewer Cros
Temporary •
Excavation •
S-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.
3i. Total jurisdictional ditch impact in square feet:
0
31. Total permanent stream impacts:
70
3i. Total temporary stream impacts:
40
3i. 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.mil/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
la. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
Yes No
https://edocs.deq.nc.gov/Forms/Pre-Construction_Notification_Form 7/10