20230747 Ver 1_More Info Received_20230726 (2)

7/19/23, 12:41 PM
Corps AID Number:
Example: SAW-2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
6. Future Project Plans
6a. Is this a phased project?*
OYes ONo
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):
O Wetlands Q Streams -tributaries O Buffers
O Open Waters O Pond Construction
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
type*
Type *M
Jurisdiction*
length*
S1
Roadway Crossin,
Permanent
Culvert
Unnamed Tributar
Perennial
Both
3
100
Average (feet)
Qinearfeet)
S2
Roadway Crossirn
Permanent]Culvert
Unnamed Tributar
Both
Average (feet)
(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
https://edocs.deq.nc.gov/Forms/Pre-Construction_Notification_Form 6/10