20171239 Ver 1_More Info Received_20171219 (10)

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1. 201 I
4. Open Water Impacts D Q- A ER RESQMIR IN
If there are proposed impacts to I rI u anes, sounds, the Atlantic Ocean, or any other open water of
the U.S. then indiv dually 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
02 -
Choose one
Choose
03 -
Choose one
Choose
04 -
Choose one
Choose
4f. Total open water impacts
4g. Comments:
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. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
(acres)
Flooded Filled
Excavated Flooded
I Filled
Excavated
P1
Choose one
P2
Choose one
5f. Total:
5g. Comments: No ponds are proposed.
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?
❑ Neuse ❑ Tar -Pamlico ❑ Catawba ❑ Randleman ❑X Other: Jordan Lake
6b.
Buffer Impact
number-
Permanent (P) or
Temporary 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
Sewer main installation
Stream 1 UTA of New Hope Creek
Yes
385
56
B2 T
Sewer main installation
Stream 1 UTA of New Hope Creek
No
3,661.93
2,527.24
B3 T
Sewer main installation
Stream 2 UTA of New Hope Creek
No
1,714.53
1,576.83
B4 T
Sewer main installation
Stream 3 UTA of New Hope Creek
No
1,789.36
1,084
B5 T
Sewer main installation
Stream 4 New Hope Creek
No
4,186.86
3,101.56
B6
No
6h. Total Buffer Impacts:
11,737.68
8,345.63
61. Comments: The project is within an existing maintained sewer easement, no trees will he cut. However, a square foot comminutar box is
required as partof the sewer. Ms. Jennifer Burdette DWR Buffer Coordinated approved the box in this location via phone 11/30/17.
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