20170127 Ver 1_Horsepen_Creek_PCN page 5_20170206

4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individuall list all o en water im acts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number (if applicable) Type of impact Waterbody Area of impact (acres)
Permanent (P) or type
Tempora T
01 Choose one Choose
02
03
04
4f. Total open water impacts
4g. Comments: none
5. Pond or Lake Construction
If ond or lake construction ro osed, then com lete the chart below.
5a. 5b. 5c. 5d. 5e.
Pond ID number Proposed use or Wetland Impacts (acres) Stream Impacts (feet) Upland
purpose of pond (acres)
Flooded Filled Excavated Flooded Filled Excavated
P1 Choose one
P2
5f. Total:
5g. Comments:
5h. Is a dam high hazard permit required? ❑ Yes ❑ No If yes, permit ID no:
5i. Expected pond surFace area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If an im acts re uire miti ation, then ou MUST fill out Section D of this form.
6a. Project is in which protected basin? ❑ Neuse � Tar-Pamlico � Catawba � Randleman ❑X Other: Jordan
6b. 6c. 6d. 6e. 6f. 6g.
Buffer Impact Reason for impact Stream name Buffer Zone 1 Zone 2
number — mitigation impact impact
Permanent (P) or required? (square (square
Tem ora T feet feet
B1 P Road widening, bridge Horse Pen Creek No 5529 3958
B2 T Bridge, culvert removal Horse Pen Creek No 1702 789
B3 P Stormwater pipe outlet Stream 5 No 745 409
B4 P Fill, pipe outlet Stream 6 No 4203 3209
B5 - No
B6 - No
6h. Total Buffer Impacts: 1217s 8365
6i. COmments: g1 and B2 impacts are on either side of the existing culvert / proposed bridge location; B5 and B6 are at other locations along the
project
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