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Owner's Responsible Person: ?e?(y A e.??e -?y el <br />Address: •?9t/S /Z occ "z'?- Ccl u y clad I Z 7 <br />Street or P.O. Box City State Zip Code <br />Phone: (7-7o 570 27/2 (primary) 0781 876 /8Sg (secondary) <br />DESCRIPTION OF DAM AND RESERVOIR <br />Type of Dam - (e.g. Earthfill, Homogeneous) <br />Concrete Gravity Arch <br />Earthf ill V Zoned Homogeneous <br />Rockfill Zoned Impervious Membrane <br />Masonry Other <br />Hazard Classification: I, II, ill, IV <br />STRUCTURAL DATA <br />Dam (Dimensions to nearest tenth of foot, volume to nearest acre-feet or cubic-yard, areas to nearest acre) <br />Jurisdictional Height /_.-7 ft. (Natural surface of ground.to bottom of emergency spillway at longitudinal centerline) <br />Embankment Height ?. O ft. (Jurisdictional height plus emergency spillway freeboard) <br />Structural Height A/A._ ft. (Bottom of cutoff trench to crest of dam at centerline) <br />Crest Length 900. O ft. Crest Width 12. O ft. Crest Elev.6jj.a c, ft., M.S.L., <br />Embankment Volume e4/o ' oo G? C.Y. <br />Maximum Impoundment Capacity 40.. _7 Acre-Feet (to crest of dam) <br />Normal Reservoir Capacity -IM Z Acre-Feet (at high waterline) <br />Reservoir Surface Area .5-12- Acres (at high waterline) <br />U/S Slope: _ a :1, D/S Slope 7- . S :1 <br />Upstream (U)/Downstream (D), Facing Material (Place U or D as appropriate) <br />Concrete Dam , Concrete Facing , Clay , Gabions , Gravel , <br />Handplaced riprap , Masonry Dam , Natural , Planted riprap with bedding <br />riprap with no bedding -4-1 Rock Zone , Soil Cement , Steel , Wood <br />Other? (Describe) <br />Outlet <br />Outlet Diameter: <br /> <br />nches/Feet Type: <br />Comments: <br />Maximum Discharge Capacity: cfs (Reservoir at high waterline) <br />(PAGE 2 OF 3)