20001476 Ver 1_Complete File_20001116

? #,?rnr ? ? 20(10
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
JAMES B. HUNT JR. P.O. BOX 25201, RALEIGH, N.C. 27611-5201 DAVID McCOY
GOvERNOR SECRETARY
November 14, 2000
U. S. Army Corps of Engineers
Raleigh Regulatory Field Office
6508 Falls of the Neuse Road, Suite 120
Raleigh, NC 27609
Attention: Mr. Eric Alsmeyer
NCDOT Coordinator
Subject: Replacement of arch pipe on Horse Creek on SR 1177 in Franklin County.
The North Carolina Department of Transportation (NCDOT) plans to replace the
existing 60-foot long, 112" x 75" arch pipe on Horse Creek on SR 1177 in Franklin
County (Sheet 1 of 1). The existing inlet is perched and has been determined to be
undersized. The proposed replacement structure i,s a - l" arch pipe
with a headwall at the inlet. The amount of rip rap placed at the outlet will not exceed the
existing amount of rip rap. The replacement pipe, if practicable and possible, will be
buried a foot below the existing substrate.
Horse Creek is a blue-line stream located in the Neuse River Basin (DWQ Index
No. 27-17-(0.3)). In-stream and in-buffer activity will be minimized during construction.
Impacts to the riparian buffer will be less than 0.1 acre. Work that can be done manually
instead of with machinery will be conducted to the extent possible and practicable.
The construction of the project is authorized under a Section 404 Nationwide
Permit (NWP) 3 for the replacement of a structure. Notification for the use of this NWP
to the U. S. Army Corps of Engineers (USACE) is not required for this project. The
purpose of this letter is to request authorization under a Section 404 Nationwide Permit
33 to dewater the stream during project construction.
The 401 Water Quality Certification (WQC) No. 3290 (which corresponds to
NWP 3) does not typically require written concurrence from the North Carolina Division
of Water Quality (NCDWQ) as NCDOT intends to comply with general conditions for
this certification. Condition No. 8 states that impacts to any stream length in the Tar-
Pamlico River Basin requires written concurrence from NCDWQ. The road crossing
will impact equal or less than 40 linear feet of riparian buffer and is exempt; therefore,
2
the NCDOT does not need to apply for written concurrence under WQC No. 3290. The
401 WQC No. 3114 (which corresponds to NWP 33) does not require written notification
from the NCDWQ as NCDOT intends to comply with general conditions for this
certification. The construction of this project involves a road crossing of a stream that is
subject to the Tar-Pamlico River Basin riparian buffer rules. However, the road crossing
will impact equal or less than 40 linear feet of riparian buffer and is exempt. A courtesy
copy of the permit application is supplied to NCDWQ.
In summary, NCDOT proposes to replace the existing arch pipe on Horse Creek
with a larger arch pipe. The NCDOT asks that this work be authorized under a Section
404 Nationwide Permit 33. The NCDOT will adhere to all applicable Section 404 NWPs
and Section 401 WQCs conditions. A pre-construction notification is attached with this
request. If you have any questions or need additional information, please contact me at
[phone].
Sincerely,
Christopher A. Mtir ay, P.W.S.
Environmental Officer
cc: Mr. David Franklin, USACE, Wilmington
Mr. John Dorney, NCDWQ, Raleigh
Mr. David Cox, NCWRC, Creedmoor
Mr. Garland Pardue, USFWS, Raleigh
Mr. Jon Nance, P.E., NCDOT Division Engineer, Durham
Mr. Ricky Greene, P.E., NCDOT Division Construction Engineer, Durham
Mr. Scott Capps, NCDOT District Engineer, Henderson
IN
661476
DWQ ID: CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #) 33
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 OF 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 MUST BE SENT TO THE NC DIVISION OF WATER QUALITY,
ATTN: JOHN DORNEY, 4401 REEDY CREEK ROAD, RALEIGH, NC
27607. PLEASE PRINT OR TYPE.
1. OWNER'S NAME: North Carolina Dept. of Transportation, Division 5
2. MAILING ADDRESS: 2512 N. Duke Street
SUBDIVISION NAME
CITY: Durham STATE: NC ZIP CODE: 27704
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
SR 1177 (Nothin am Road), Franklin County
3. TELEPHONE NUMBER: (HOME) (WORK) [phone]
4. IF APPLICABLE: AGENTS NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
Christopher A. Murray, Division 5 Environmental Officer
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP
OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: Franklin - NEAREST TOWN: Youn sville
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.) SR 1177, Nottingham
Road
6. IMPACTED OR NEAREST STREAM/RIVER: Horse Creek RIVER BASIN: Neuse
7. (a) IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER, (SA),
HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-II)? YES ? NO ® IF YES, EXPLAIN:
(b) IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES ? NO
(c) 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?
8. (a) HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT? YES ? NO ® IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND
ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION):
(b) ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
YES ? NO ® IF YES, DESCRIBE ANTICIPATED WORK:
9. (a) ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND:
(b) ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
0.0 acres
10. (a) NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: EXCAVATION:
FLOODING: OTHER :
DRAINAGE : TOTAL ACRES TO BE IMPACTED: 0.0 acres
(b) (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED,
PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION:
LENGTH BEFORE: See Cover Letter FT AFTER: FT
WIDTH BEFORE (based on normal high water contours): FT
AVERAGE DEPTH BEFORE: FT AFTER: FT
(b) (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: Dewaterine of Stream and replacement of pipe in channel.
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
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; 81/2 BY 11 DRAWINGS ONLY)
Replacement of pipe on Horse Creek on SR 1177 and dewaterine of stream.
13. PURPOSE OF PROPOSED WORK: Replacement of pipe on Horse Creek and dewaterine of stream.
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS)
No impacts to wetlands.
15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR
NATIONAL MARINE FISHERIES SERVICE 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:
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) 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 OF THE USE OF PUBLIC
(STATE) LAND? YES ® NO ? (IF NO, GO TO 16)
(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
(b) IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES E] NO ?
IF ANSWER 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE STATE
CLEARINGHOUSE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, 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 OF 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 STREAM (INTERMITTENT AND PERMANENT) ON THE PROPERTY MUST BE SHOWN ON
THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET OF 1 INCH EQUALS 100 FEET
OF THEIR EQUIVALENT.
(b) IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE IMPACTED BY
PRODUCT.
(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 USE OF SURROUNDING PROPERTY? Forested, single family, residential.
(f) IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE US MAY NOT BE IMPACTED PRIOR TO:
1. ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
2. EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF WATER QUALITY
CERTIFICATION, AND
3. (IN THE TWENTY 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.
OWNER'S/AGENT'S S?MNATURE DATE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED).
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Horse Creek
North C
_ arolina Dept. of Transportation
Division 5 --
Horse Creek on SR 1177 (Nottingham Rd)
Franklin
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0014 76
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
JAMES B. HUNT JR. P.O. BOX 25201, RALEIGH, N.C. 27611-5201 DAVID McCOY
GOVERNOR SECRETARY"
November 14, 2000
U. S. Army Corps of Engineers
Raleigh Regulatory Field Office
6508 Falls of the Neuse Road, Suite 120
Raleigh, NC 27609
Attention: Mr. Eric Alsmeyer
NCDOT Coordinator
Subject: Replacement of arch pipe on Horse Creek on SR 1177 in Franklin County.
The North Carolina Department of Transportation (NCDOT) plans to replace the
existing 60-foot long, 112" x 75" arch pipe on Horse Creek on SR 1177 in Franklin
County (Sheet 1 of 1). The existing inlet is perched and has been determined to be
undersized. The proposed replacement structure is a 60-foot long, 142" x 91" arch pipe
with a headwall at the inlet. The amount of rip rap placed at the outlet will not exceed the
existing amount of rip rap. The replacement pipe, if practicable and possible, will be
buried a foot below the existing substrate.
Horse Creek is a blue-line stream located in the Neuse River Basin (DWQ Index
No. 27-17-(0.3)). In-stream and in-buffer activity will be minimized during construction.
Impacts to the riparian buffer will be less than 0.1 acre. Work that can be done manually
instead of with machinery will be conducted to the extent possible and practicable.
The construction of the project is authorized under a Section 404 Nationwide
Permit (NWP) 3 for the replacement of a structure. Notification for the use of this NWP
to the U. S. Army Corps of Engineers (USACE) is not required for this project. The
purpose of this letter is to request authorization under a Section 404 Nationwide Permit
33 to dewater the stream during project construction.
The 401 Water Quality Certification (WQC) No. 3290 (which corresponds to
NWP 3) does not typically require written concurrence from the North Carolina Division
of Water Quality (NCDWQ) as NCDOT intends to comply with general conditions for
this certification. Condition No. 8 states that impacts to any stream length in the Tar-
Pamlico River Basin requires written concurrence from NCDWQ. The road crossing
will impact equal or less than 40 linear feet of riparian buffer and is exempt; therefore,
the NCDOT does not need to apply for written concurrence under WQC No. 3290. The
401 WQC No. 3114 (which corresponds to NWP 33) does not require written notification
from the NCDWQ as NCDOT intends to comply with general conditions for this
certification. The construction of this project involves a road crossing of a stream that is
subject to the Tar-Pamlico River Basin riparian buffer rules. However, the road crossing
will impact equal or less than 40 linear feet of riparian buffer and is exempt. A courtesy
copy of the permit application is supplied to NCDWQ.
In summary, NCDOT proposes to replace the existing arch pipe on Horse Creek
with a larger arch pipe. The NCDOT asks that this work be authorized under a Section
404 Nationwide Permit 33. The NCDOT will adhere to all applicable Section 404 NWPs
and Section 401 WQCs conditions. A pre-construction notification is attached with this
request. If you have any questions or need additional information, please contact me at
[phone].
Sincerely,
?614t7
Christopher A. M, r ay, P.W.S.
Environmental Officer
cc: Mr. David Franklin, USACE, Wilmington
Mr. John Dorney, NCDWQ, Raleigh
Mr. David Cox, NCWRC, Creedmoor
Mr. Garland Pardue, USFWS, Raleigh
Mr. Jon Nance, P.E., NCDOT Division Engineer, Durham
Mr. Ricky Greene, P.E., NCDOT Division Construction Engineer, Durham
Mr. Scott Capps, NCDOT District Engineer, Henderson
r
00 A 47 ro
DWQ ID: CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #) 33
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 OF 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 MUST BE SENT TO THE NC DIVISION OF WATER QUALITY,
ATTN: JOHN DORNEY, 4401 REEDY CREEK ROAD, RALEIGH, NC
27607. PLEASE PRINT OR TYPE.
1. OWNER'S NAME: North Carolina Dept. of Transportation, Division 5
2. MAILING ADDRESS: 2512 N. Duke Street
SUBDIVISION NAME
CITY: Durham STATE: NC ZIP CODE: 27704
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
SR 1177 (Nothingham Road), Franklin County
3. TELEPHONE NUMBER: (HOME) (WORK) [phone]
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
Christopher A. Murray. Division 5 Environmental Officer
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP
OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: Franklin - NEAREST TOWN: Youn sville
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.) SR 1177, Nottingham
Road
6. IMPACTED OR NEAREST STREAM/RIVER: Horse Creek RIVER BASIN: Neuse
7. (a) IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER, (SA),
HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-11)? YES ? NO ® IF YES, EXPLAIN:
(b) IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES ? NO
(c) 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?
8. (a) HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT? YES ? NO ® IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND
ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION):
(b) ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
YES ? NO ® IF YES, DESCRIBE ANTICIPATED WORK:
9. (a) ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND:
(b) ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
0.0 acres
10. (a) NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: EXCAVATION:
FLOODING: OTHER :
DRAINAGE : TOTAL ACRES TO BE IMPACTED: 0.0 acres
(b) (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED,
PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION:
LENGTH BEFORE: See Cover Letter FT AFTER: FT
WIDTH BEFORE (based on normal high water contours): FT
AVERAGE DEPTH BEFORE: FT AFTER: FT
(b) (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: Dewaterin¢ of Stream and replacement of pipe in channel.
It. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
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; 81/2 BY 11 DRAWINGS ONLY)
Replacement of pipe on Horse Creek on SR 1177 and dewaterina of stream.
13. PURPOSE OF PROPOSED WORK: Replacement of pipe on Horse Creek and dewatering of stream.
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS)
No impacts to wetlands.
15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR
NATIONAL MARINE FISHERIES SERVICE 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:
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) 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 OF THE USE OF PUBLIC
(STATE) LAND? YES ® NO ? (IF NO, GO TO 16)
(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
(b) IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES ? NO ?
IF ANSWER 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE STATE
CLEARINGHOUSE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, 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 OF 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 STREAM (INTERMITTENT AND PERMANENT) ON THE PROPERTY MUST BE SHOWN ON
THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET OF 1 INCH EQUALS 100 FEET
OF THEIR EQUIVALENT.
(b) IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE IMPACTED BY
PRODUCT.
(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 USE OF SURROUNDING PROPERTY? Forested, single family, residential.
(f) IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE US MAY NOT BE IMPACTED PRIOR TO:
1. ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
2. EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF WATER QUALITY
CERTIFICATION, AND
3. (IN THE TWENTY 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.
OWNER'S/AGENT'S 918NATURE DATE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED).
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_ North Carolina Dept. of Transportation
Division 5 ---
Horse Creek on SR 1177 (Nottingham Rd.)
Franklin County
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