20171254 Ver 1_More Info Received_20171101

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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 indivii ually list all open water impacts below.
4a.
Open water
impact number
Permanent(P)or
Temporary T
4b.
Name of waterbody
(if applicable)
4c.
Type of impact
4d.
Waterbody
type
4e.
Area of impact (acres)
01
Choose one
Choose
O2 -
Choose one
Choose
03 -
Choose one
Choose
04 -
Choose one
Choose
4f. Total open water impacts
4g. Comments: No open water Impacts will result from the construction of this project.
5. Pond or Lake Construction
If pond or lake construction proposed, the complete the chart below.
5a.
Pond ID number
5b.
Proposed use or
purpose of pond
5c. 5d.
Wetland Impacts (acres) Stream Impacts (feet)
5e.
Upland
(acres)
Flooded
Filled
Excavated Flooded
Filled
Excavated
P1
Choose one
P2
Choose one
5f: Total:
5g. Comments: No ponds or lakes will be constructed as part of this project.
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 any impacts require mitigation, then you MUST fill out Section D of this form.
6a. Project is in which protected basin?
❑x Neuse j] Tar -Pamlico ❑ Catawba )] Randleman ❑ Other:
6b.
Buffer Impact
number—
Permanent(P)or
Tem ora T)
6c.
Reason for impact
6d.
Stream name
6e.
Buffer
mitigation
required?
6f.
Zone 1
impact
(square
feet).
6g.
Zone 2
impact
(square
feet
B1 P
Road & rip rap stabilization
UT to Smith Creek
No
7,663
3,931
B2 -
Yes/No.
B3 -
Yes/No
B4 -
Yes/No
B5 -
Yes/No
B6
Yes/No
6h. Total Buffer Impacts:
7,663
3,931
6i. Comments:
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