20231421 Ver 1_Sharon Dubec FDR_20231018

Site ID:
EVENT:
Report Date: Local Sponsor Name:
Investigator(s):
Obtain and transmit digital photos of the watershed impairment with this form.
LOCATION:
Location/Address: Drainage Name:
Longitude Decimal
Degrees
County:
Latitude Decimal
Degrees
BACKGROUND:
Describe the damage at this location as a consequence of the natural disaster event:
Describe the Watershed Impairment:
How does the watershed impairment currently impair the watershed’s hydrologic or ecological functions?
How does the watershed impairment currently create an imminent or immediate threat1 to life, property2, or health?
What is the evidence that there has not been an ongoing watershed problem at this site, and that the impairment suddenly
arises as a result of the natural disaster event?
Summarize what will be protected from damage by the proposed work:
Private Property:
Business Property:
Public Property, including public buildings, infrastructure and utilities:
1The potential for a threat to life, health, or property may be at the site, upstream of the site, or downstream of the site (e.g., sedimentation deposited
downstream, flooding upstream, etc.).
2Property is considered any artificial structure permanently affixed to the land such as, but not limited to, houses, buildings, roads, utilities,
structures, dams, etc. Standing timber, orchards, growing crops, other agronomic crops, etc. are not considered property under the EWP Program.
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•creates a potential for loss of life.
•has interfered with access to a medical facility.
•impairment has interfered with normal operation of public infrastructure or public services.
•raises a public safety risk?
Are any special environmental circumstances likely to occur (or known to occur) at, or close to this location, such as:
EVENT:
RANKING:
What is likely to happen if the damage is left untreated?
Has any loss of life been caused by this watershed impairment?
Explain if and how this watershed impairment:
Present (P), Not Present (NP), May Potentially Have an Effect (MPHE)
Special Environmental Concern (SEC) P NP MPHE Comments
●Clean Air Act
●Clean Water Act / Waters of the U.S.
●Coastal Zone Management
Coral Reefs
●Cultural Resources / Historic Properties
●Endangered and Threatened Species
Environmental Justice
●Essential Fish Habitat
Floodplain Management
Invasive Species
●Migratory Birds/Bald and Golden Eagle Protection Act
Natural Areas
Prime and Unique Farmlands
Riparian Area
Scenic Beauty
●Wetlands
●Wild and Scenic Rivers
NC Only- National Food Security Act (HEL/WC)
NC Only- Hazardous Materials
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SCREENING for PRELIMINARY EWP ELIGIBILITY
There has been an unusual event that h as caused watershed impairment (blockage or channel
migration)that is causing an immediate or imminent threat to life, public health, and
property including houses, buildings, structures, roads, utilities.
The threat to life and property significantly exceeds that which existed prior to the
impairment.
Recovery measures would be for runoff retardation or soil erosion prevention.
EWP funds have NOT been utilized twice within the past TEN years to repair damage (as
opposed to removing storm debris) at the exact location.
The damages are NOT considered typical O&M activities.
The damaged area is NOT part of a pre-existing or ongoing problem.
EWP Funds will NOT be used to repair, rebuild or maintain private or public
transportation facilities, utilities or similar facilities.
The site is NOT on Federal Land.
NOTE: If any of the responses are FALSE, then the initial
determination is that the site is NOT eligible. Sites that may be
eligible will undergo further review by NRCS before a final
eligibility decision is made.
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SKETCH of DAMAGE:
Engineering Cost Estimate for Repair Measures
Description of Proposed Recovery Measure (including mitigation measures)
Practices/Components Estimated Qty. Units
Description of Alternative Recovery Measure (including mitigation measures)
Practices/Components Estimated Qty. Units
Calculated Cost
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Unit Cost
Unit Cost Calculated Cost
Proposed Recovery Measure Total Costs (including mitigation measures):
Alternative Recovery Measure Total Costs (including mitigation measures):
Description of Picture 1:
Description of Picture 2:
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Description of Picture 3:
Description of Picture 4:
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Description of Picture 5:
Description of Picture 6:
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Description of Picture 7:
Description of Picture 8:
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