20150955 Ver 2_B-4929 GP31 PCN Rev 09Feb16_20160210

C. Proposed Impacts Inventory
1. Impacts Summary
1a. Which sections were completed below for 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.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of jurisdiction
number — Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ — non-404, other) (acres)
Temporar T
W1 � P❑ T roadway riparian � Yes � Corps 0.01
❑ No ❑ DWQ
roadway, riparian & coastal � Yes � Corps
W2 � P❑ T infiltration basin, 0.16
bridge approach marsh ❑ No ❑ DWQ
W3 � P❑ T roadway riparian � Yes � Corps 0.55
❑ No ❑ DWQ
W4 � P❑ T bridge coastal marsh � Yes � Corps 0.04
� No ❑ DWQ
W4 ❑ P� T bridge coastal marsh � Yes � Corps 0.03
� No ❑ DWQ
W5 � P❑ T pipe outlet coastal marsh � Yes � Corps 0.01
� No ❑ DWQ
pipe outlet ❑ Yes � Corps
W6 � P❑ T coastal marsh <0.01*
cleanout � No ❑ DWQ
pipe outlet ❑ Yes � Corps
W7 � P❑ T coastal marsh <0.01"
cleanout � No ❑ DWQ
0.77 permanent
2g. Total wetland impacts 0.03 temporary
2h. Comments: See attached Permit Drawings and Wetland Permit Impact Summary for additional detail. Overhead power
line relocations will result in <0.01 acre of impacts and 0.41 acre of hand cleaing in riparian and coastal wetlands.
* Sites 6& 7 only include Hand Clearing, totaling 0.01 acre for pipe outlet cleanouts
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3c. Comments:
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached. ❑ Yes
4b. Stream mitigation requested: 0 linear feet
4c. If using stream mitigation, stream temperature: ❑ warm ❑ cool ❑cold
4d. Buffer mitigation requested (DWQ only): 0 square feet
4e. Riparian wetland mitigation requested: 1.44 acres
4f. Non-riparian wetland mitigation requested: 0 acres
4g. Coastal (tidal) wetland mitigation requested: 0.1 acres
4h. Comments: NCDMS Acceptence Letter will be forwarded upon receipt
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires ❑ Yes � No
buffer mitigation?
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
6c. 6d. 6e.
Zone Reason for impact Total impact Multiplier Required mitigation
(square feet) (square feet)
Zone 1 3(2 for Catawba)
Zone 2 1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
6h. Comments:
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