20190143 Ver 1_PCN Edits - 4.17.2019_20190417

4/17/2019
Resume Submission
Are any other NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize any part of the proposed project or related activity?
This includes other separate and distant crossing for linear projects that require Department of the Army authorization but don't require pre -construction notification.
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
F�1' Wetlands v Streams -tributaries v 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.
"W." will be used in the table below to represent the word "wetland".
2a. Site #* (?)
2a1 Reason * (?)
2b. Impact type* (?)
2c. Type of W.*
2d. W. name*
2e. Forested*
2f. Type of
Jurisdicition*(?)
2g. Impact
area
3h. Impact
length*
Stream Crossing
P •l�[Riv.rine,
Swamp Forest •
�FF=h
Yes •
Both •
0.400
(acres)
Add
2g. Total Temporary Wetland Impact
0.000
2g. Total Permanent Wetland Impact
0.400
2g. Total Wetland Impact
0.400
2h. Comments:
This impact is for the installation of a culvert for a road to cross the West Price Creek.
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this question for all stream
sites impacted.
"S." will be used in the table below to represent the word "stream".
Add another impact
https://edocs.deq.nc.gov/Forms/form/resume/216/19561 6/11
3a. Reason for impact* (?)
3b.lmpact
type
3c. Type of impact*
3d. S. name*
3e. Stream
Type(?)
[3f. Type of
urisdiction*
3gSwidth*
3h. Impact
length*
fl
Stream crossing for i
Permanent
culvert
est Price Creek
Perennial
Both
1"
Average (feet)
60
(linear feet)
Add another impact
https://edocs.deq.nc.gov/Forms/form/resume/216/19561 6/11

4/17/2019
Resume Submission
** All Perennial or Intermittent streams must be verified by DWR or delegated local government.
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
60
3i. Total temporary stream impacts:
0
3i. Total stream and ditch impacts:
60
3j. Comments:
Culvert will be buried 1 foot.
6. Buffer Impacts (for DWR)
If project will impact a protected riparian buffer, then complete the chart below. Individually list all buffer impacts below.
6a. Project is in which protect basin(s)? *
Check all that apply.
L Neuse Tar -Pamlico
D Catawba Randleman
D Goose Creek ✓ Jordan Lake
D Other
6b. Impact Type* (')r(IC).
d. Stream name*
6e. Buffer mitigation required?
6f. Zone 1 impact*
6g. Zone 2
impact*
Stream crossing for road
P
est Price Cre�:::]F-s
2,967
5,009
(square feet)
(square feet)
Add another impact
6h. Total buffer impacts:
Zone 1 Zone 2
Total Temporary impacts: 0.00 0.00
Zone 1 Zone 2
Total Permanent impacts: 2,967.00 5,009.00
Zone 1 Zone 2
Total combined buffer impacts: 2,967.00 5,009.00
6i. Comments:
https://edocs.deq.nc.gov/Forms/form/resume/216/19561 7/11

4/17/2019 Resume Submission
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
Click the upload button or drag and drop files here to attach document
Upload
File must be PDF
E. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:"
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for impacts to Waters of the U.S. or Waters of the State?
Yes No
INC Stream Temperature Classification Maps can be found under the Mitigation Concepts tab on the Wilmington District's RIBITS (https:Hribits.usace.army.mii/ribits_apex/f?
p=107:27:2734709611497::NO:RP:P27_BUTTON_KEY:O) website.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
*** Recent changes to the stormwater rules have required updates to this section .***
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
Yes No
For a list of options to meet the diffuse flow requirements, click here
(https://files.nc.gov/ncdeq/Water%20Quality/Surface%20Water%20Protection/401 /Buffer%20CIarification°/`20Memos/Options%20for%20Meeting%20Diffuse%20FIow%20Provisions%20(
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?
Yes No
Comments:
G. Supplementary Information
https://edocs.deq.nc.gov/Forms/form/resume/216/19561 8/11