19980323 Ver 1_Complete File_19980413

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
1 • •
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND N.QuRAL RESOURCES
April 27, 1998
Stokes County
DWQ Project # 980323
APPROVAL of 401 Water Quality Certification
Mr. M.C. Shaffner
NC DOT
2125 Cloverdale Avenue
Winston-Salem NC 27103
Dear Mr. Shaffner:
You have our approval, in accordance with the attached conditions and those listed below, s for the
purpose of widening SR 1721 in Dillard, as you described in your application dated April 13, 1998. After
reviewing your application, we have decided that this impact is covered by General Water Quality
Certification Number 3100. This Certification allows you to use Nationwide Permit Number 031 when it is
issued by the Corps of Engineers. In addition, you should get any other federal, state or local permits before
you go ahead with your project including (but not limited to) Sediment and Erosion Control, Coastal
Stormwater, Non-Discharge and Water Supply Watershed regulations. This approval will expire when the
accompanying 404 or CAMA permit expires unless otherwise specified in the General Certification.
This approval is only valid for the purpose and design that you described in your application except as
modified below. If you change your project, you must notify us and you may be required to send us a new
application for a new certification. If the property is sold, the new owner must be given a copy of this
Certification and approval letter and is thereby responsible for complying with all conditions. If total
wetland fills for this project (now or in the future) exceed one acre, compensatory mitigation may be required
as described in 15A NCAC 2H .0506 (h) (6) and (7). For this approval to be valid, you must follow the
conditions listed in the attached certification.
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing.
You must act within 60 days of the date that you receive this letter. To ask for a hearing, send a written
petition conforming to Chapter 150B of the North Carolina General Statutes to the Office of Administrative
Hearings, P.O. Box 27447, Raleigh, N.C. 27611-7447. This certification and its conditions are final and
binding unless you ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water
Act. If you have any questions, please telephone John Domey at 919-733-1786.
qsttn'Howar y
, Jr. P
Attachment
cc: Wilmington District Corps of Engineers
Corps of Engineers Raleigh Field Office
Winston-Salem DWQ Regional Office
Mr. John Domey
Central Files
980323.1tr
Division of Water Quality • Non-Discharge Branch
4401 Reedy Creek Rd., Raleigh, NC 27607 Telephone [phone] FAX M 733-9959
An Equal Opportunity Affirmative Action Employer • 50% recycled/10% post consumer paper
e a? 5UT[
STATE of NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
JAMES B. HUNT JR. E. NOMS TOLSON
GOVERNOR SECRETARY
April 8, 1998 ?' ?7 (S ?? l?
Stokes County - SR 1721 Jr 3 ia?3 !fill?
1
SUBJECT: Drainage Permits -Division of Water Quality
IVATEEIANDS GROUP
-_j
Mr. John Dorney Attn: Cindy Bell R UAtIIYSECTIp1J
Water Quality Planning
Division of Water Quality
NC DEHNR
4401 Reedy Creek Road
Raleigh, NC 27607
Dcar Cindy Bell,
In an effort to obtain the necessary drainage permits, we are providing a package of design plans for
the paving of Lemmons Road (SR 1721) in Stokes County. In order to pave Lemmons Road it will be
necessary to replace, add, and/or extend the drainage pipes on this road.
By copy of this letter, we are also seeking approval from the NC Wildlife Resources Commission
and the US Army Corps of Engineer and submitting the enclosed material to them.
If you have any questions, comments or need additional information after reviewing this material,
please contact our office at [phone]. Thank you for your cooperation in this matter.
Respectfully,
M.C. Shaffner
District Enginccr
MCS:Iaj
Enclosures
c: Mr. D.B. Waters, Division Engineer
Mr. David Spainhour, Stokes County Maintenance Enginccr
File
Division of Highways • Division Nine • District Two • 2125 Cloverdale Avenue, Winston-Salem, NC 27103
Telephone [phone] • Fax [phone] • Courier Box 13-12-04
DEM ID:
_% Li CORPS ACTION ID:

NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #) :
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFICATION
3) COORDINATION WITH THE NC DIVISION COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE
FIELD OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN (7)
COPIES SHOULD BE SENT TO THE N. C. DIVISION OF ENVIRONMENTAL MANAGEMENT (SEE
AGENCY ADDRESSES SHEET). PLEASE PRINT.
1. OWNERS NAME:
2. MAILING ADDRES?
NC DEPARTMENT OF TRANSPORTATION
2125 CLOVERDALE AVENUE, WINSTON-SALEM NC 27103
SUBDIVISION NAME
CITY: STATE: ZIP CODE:
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
3. TELEPHONE NUMBER (HOME): (WORK) :
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICAL, ADDRESS,
PHONE NUMBER: M.C SHAFFNER
2125 CLOVERDALE AVENUE
WINSTON-SALEM, NC 27103 [phone]
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: STOKES NEAREST TOWN OR CITY: DILLARD
SPECIFIC LOCATION (INCLUDING ROAD
NUMBERS, LANDMARKS, ETC.): FROM DILLARD NC, TAKE SR 1722 SOUTH
APPROXIMATELY 2.8 MILES TO SR 172 1.
6. IMPACTED OR NEAREST STREAM/RIVER: DAN RIVER
i RIVER BASIN: ROANOKE RIVER BASIN
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER (SA),
HIGH QYALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-II)? YES ® NO E] IF YES, EXPLAIN: OUR PROJECT IS
WITHIN A WATER SUPPLY WATERSHED PROTECTED AREA.
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES ? NO
7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF
COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION? N/A
8a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROPERTY? YES ? NO ® IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS
PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION):
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES ? NO ® IF YES, DESCRIBE ANTICIPATED WORK:
9a. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: N/A
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
N/A
Wa. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
N/A
FILLING: 0
FLOODING: 0
DRAINAGE: 0
EXCAVATION:
OTHER: 0
0
TOTAL ACRES TO BE IMPACTED: 0
10b. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED,
PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION):
LENGTH BEFORE: FT. AFTER: FT.
WIDTH BEFORE (based on normal high water contours): FT.
WIDTH AFTER: FT.
AVERAGE DEPTH BEFORE: FT. AFTER: FT.
11
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION ? PLACEMENT OF PIPE IN CHANNEL ?
CHANNEL EXCAVATION ? CONSTRUCTION OF A DAM/FLOODING ?
OTHER ? EXPLAIN:
IF CONTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
2
DRAINING TO THE POND?
WHAT IS THE EXPECTED POND SURFACE
AREA?
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF
MECHANICAL EQUIPMENT TO BE USED (ATTACH PLANS: 8 1/2" X 11" DRAWINGS
ONLY): GRADE, BASE, PAVE LEMMONS ROAD (SR 1721) IN STOKES COUNTY
13. PURPOSE OF PROPOSED WORK: TO IMPROVE ROAD CONDITIOINS
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT
IN WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND
IMPACTS): THIS ROAD WILL BE STABILIZED IN THE UPCOMING MONTHS
(FISCAL YEAR 1998-1999) BECAUSE OF SAFETY FACTORS. THE CAREFUL WORK OF
THE NCDOT FORCES WILL MINIMIZE IMPACTS TO WETLAND AND/OR TROUT
STREAMS.
15. YOU ARE REQUIRED TO CONTACT THE U. S. FISH AND WILDLIFE SERVICE (USFWS)
AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) (SEE AGENCY ADDRESSES
SHEET) REGARDING THE PRESENCE OF ANY FEDERALLY LISTED OR PROPOSED FOR
LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT IN THE
PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE
CONTACTED: (ATTACH RESPONSES FROM THESE
AGENCIES.)
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) (SEE AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC
PROPERTIES IN THE PERMIT AREA WHICH MAY BE AFFECTED BY THE PROPOSED
PROJECT. DATE CONTACTED:
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF
PUBLIC (STATE) LAND?
YES ? NO ® (IF NO, GO TO 18)
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT?
YES ? NO ?
3
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH
• CAROLINA DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE?
YES ? NO ?
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE
STATE CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT
REGARDING COMPLIANCE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY
ACT.
QUESTIONS REGARDING THE STAE CLEARINGHOUSE REV1EIV PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 6VEST JONES STREED, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF
PROPOSED ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL
INTO WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES AND
PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26, 29,
AND 38). ALL STREAMS (INTERMITTENT AND PERMANENT) ON THE PROPERTY
MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE I INCH EQUALS 50 FEET
OR 1 INCH EQUALS 100 FEET OR THEIR EQUIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE
IMPACTED BY PROJECT.
c. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA
SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
d. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
e. WHAT IS LAND US OF SURROUNDING PROPERTY? N/A
I. It AYYLIUABI-h, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? N/A
g. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE. WETLANDS OR IVATERS OF THE U. S. MAY NOT BE IMPACTED PRIOR TO:
1. ISSUANCE OF A SECTON 404 CORPS OF ENGINEERS PERMMIT,
2. EITHER THE ISSUANCE OR WAIVER OFA 401 DIVISION OF ENVIRONMENTAL
MANAGEMENT (IVATER QUALITY) CERTIFICATION, AND
4
3. (IN THE TIVENTY COASTAL COUNTIES ONLY), A LETTER FROM THE NORTH
CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED ACTIVITY IS
CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT PROGRAM.
//la
OWNER'S/AGENT SIGNA'
7'D -l'5
DATE
(AGENT'S SIGNATURE VALID ONLY IF AUTHORIZATION LETTER FROM THE OWNER IS PROVIDED (I 8g.))
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PROPOSED DRAINAGE CROSS LINE TREATMENT
ALONG:LEMMONS ROAD SR:1721 STOKES COUNTY
LOCATED: FROM DILLARD, NC TAKE SR. 1722 SOUTH APPROX. 2.8 MILES TO SR.1721

STATION EXISTING
DESCRIPTION
LGTH/DIAM/TYPE REPLACEMENT
DESCRIPTION
LGTH/DIAM/TYPE
SECTION TYPE
LEFT/RIGHT

COVER
SKEW
(APPROX)
13+00 44'-18" RCP RETAIN FILL/FILL MIN 1' 40°
33+75 40'-18" RCP 44'-18" RCP FILL/FILL MIN 1' 90°
47+00 NONE 40'-18" RCP FILL/FILL MIN 1' 90°

MWA 02/27/1998
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A' DEM ID: CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT
PRE-CONSTRUCTION NOTIFICAT TON APPL,IC TION
UIA4 '
FOR NATIONWIDE PERMITS THAT REQUIRE: t APR 13 198
4VETL%;4DS
1) NOTIFICATION TO THE CORPS OF ENGINEERS --= = -- -
2) APPLICATION FOR SECTION 401 CERTIFICATION
3) COORDINATION WITH THE NC DIVISION COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE
FIELD OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN (7)
COPIES SHOULD BE SENT TO THE N. C. DIVISION OF ENVIRONMENTAL MANAGEMENT (SEE
AGENCY ADDRESSES SHEET). PLEASE PRINT.
1. OWNERS NAME: NC DEPARTMENT OF TRANSPORTATION
2. MAILING ADDRESS: 2125 CLOVERDALE AVENUE, WINSTON-SALEM NC 27103
SUBDIVISION NAME
CITY: STATE: ZIP CODE:
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
3. TELEPHONE NUMBER (HOME): (WORK) :
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICAL, ADDRESS,
PHONE NUMBER: M.C SHAFFNER
2125 CLOVERDALE AVENUE
WINSTON-SALEM, NC 27103 [phone]
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: STOKES NEAREST TOWN OR CITY: DILLARD
SPECIFIC LOCATION (INCLUDING ROAD
NUMBERS, LANDMARKS, ETC.): FROM DILLARD NC, TAKE SR 1722 SOUTH
APPROXIMATELY 2.8 MILES TO SR 172 1.
6. IMPACTED OR NEAREST STREAM/RIVER:
RIVER BASIN: ROANOKE RIVER BASIN
7a.
DAN RIVER
IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER (SA),
HIGH QYALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-II)? YES ® NO E] IF YES, EXPLAIN: OUR PROJECT IS
WITHIN A WATER SUPPLY WATERSHED PROTECTED AREA.
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES ? NO
7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF
COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION? N/A
8a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROPERTY? YES ? NO ® IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS
PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION):
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES ? NO ® IF YES, DESCRIBE ANTICIPATED WORK:
9a. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: N/A
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
N/A
10a. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
N/A
FILLING: 0
FLOODING: 0
OTHER: 0
DRAINAGE: 0 TOTAL ACRES TO BE IMPACTED: 0
10b. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED,
PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION):
LENGTH BEFORE: FT. AFTER: FT.
11
WIDTH BEFORE (based on normal high water contours):
WIDTH AFTER: FT.
AVERAGE DEPTH BEFORE:
FT. AFTER:
FT.
FT.
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION ? PLACEMENT OF PIPE IN CHANNEL ?
CHANNEL EXCAVATION ? CONSTRUCTION OF A DAM/FLOODING ?
OTHER ? EXPLAIN:
IF CONTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
EXCAVATION: 0
2
A DRAINING TO THE POND?
WHAT IS THE EXPECTED POND SURFACE
AREA?
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF
MECHANICAL EQUIPMENT TO BE USED (ATTACH PLANS: 8 1/2" X 11" DRAWINGS
ONLY): GRADE, BASE, PAVE LEMMONS ROAD (SR 1721) IN STOKES COUNTY
13. PURPOSE OF PROPOSED WORK: TO IMPROVE ROAD CONDITIOINS
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT
IN WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND
IMPACTS): THIS ROAD WILL BE STABILIZED IN THE UPCOMING MONTHS
(FISCAL YEAR 1998-1999) BECAUSE OF SAFETY FACTORS. THE CAREFUL WORK OF
THE NCDOT FORCES WILL MINIMIZE IMPACTS TO WETLAND AND/OR TROUT
STREAMS.
15. YOU ARE REQUIRED TO CONTACT THE U. S. FISH AND WILDLIFE SERVICE (USFWS)
AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) (SEE AGENCY ADDRESSES
SHEET) REGARDING THE PRESENCE OF ANY FEDERALLY LISTED OR PROPOSED FOR
LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT IN THE
PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE
CONTACTED: (ATTACH RESPONSES FROM THESE
AGENCIES.)
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) (SEE AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC
PROPERTIES IN THE PERMIT AREA WHICH MAY BE AFFECTED BY THE PROPOSED
PROJECT. DATE CONTACTED:
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF
PUBLIC (STATE) LAND?
YES E] NO ® (IF NO, GO TO 18)
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT?
YES ? NO ?
3
A . . . b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE?
YES ? NO ?
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE
STATE CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT
REGARDING COMPLIANCE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY
ACT.
QUESTIONS REGARDING THE STAE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREED, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF
PROPOSED ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL
INTO WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES AND
PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26, 29,
AND 38). ALL STREAMS (INTERMITTENT AND PERMANENT) ON THE PROPERTY
MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET
OR 1 INCH EQUALS 100 FEET OR THEIR EQUIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE
IMPACTED BY PROJECT.
c. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA
SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
d. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
e. WHAT IS LAND US OF SURROUNDING PROPERTY? N/A
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? N/A
g. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE. WETLANDS OR WATERS OF THE U. S. MAY NOT BE IMPACTED PRIOR TO:
1. ISSUANCE OF A SECTON 404 CORPS OF ENGINEERS PERMIT,
2. EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF ENVIRONMENTAL
MANAGEMENT (1VATER QUALITY) CERTIFICATION, AND
4
3. (IN THE TIVENTY COASTAL COUNTIES ONLY), A LETTER FROM THE NORTH
CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED ACTIVITY IS
CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT PROGRAM.
Z-/ 0 -?g
OWNER'S/AGENT SIGNA'
DATE
(AGENT'S SIGNATURE VALID ONLY IF AUTHORIZATION LETTER FROM THE OWNER IS PROVIDED (18g.))

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PROPOSED DRAINAGE CROSS LINE TREATMENT
ALONG:LEMMONS ROAD SR:1721 STOKES COUNTY
LOCATED: FROM DILLARD, NC TAKE SR. 1722 SOUTH APPROX. 2.8 MILES TO SR.1721

STATION EXISTING
DESCRIPTION
LGTH/DIAM/TYPE REPLACEMENT
DESCRIPTION
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SECTION TYPE
LEFT/RIGHT
COVER
=
((AAPPROX)

13+00 44'-18" RCP RETAIN FILL/FILL MIN
l" 40°
E
33+75 40'-18" RCP 44'-18" RCP FILL/FILL MIN 90°

47+00 NONE 40'-18" RCP FILL/FILL MIN 1' 90°

MWA 02/27/19 98

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