20170620 Ver 1_More Info Received_20170629

it csoi b198117 : &5
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 individually list all open water impacts 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
Temporary(T)
O1 - Choose one Choose
02 - Choose one Choose
03 - Choose one Choose
04 - Choose one Choose
4f.Total open water impacts 0
4g. Comments:
5. Pond or Lake Construction
If pond or lake construction proposed,then complete 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 Choose one
5f.Total:
5g. Comments:
5h. Is a dam high hazard permit required? 0 Yes 0 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 any impacts require mitigation,then you MUST fill out Section D of this form.
6a. Project is in which protected basin? ❑X Neuse 0 Tar-Pamlico 0 Catawba 0 Randleman ❑Other:
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
Temporary(T) feet) feet)
B1 P BMP Bypass Ch rip rap UT Williams Creek No 620
82 T BMP bypass channel Pipe UT Williams Creek No 413
83 - Yes/No
B4 - Yes/No
B5 - Yes/No
B6 - Yes/No
6h.Total Buffer Impacts: 620 413
6i.Comments:
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