20011468 Ver 1_Complete File_20011005

. 2!
Office Use Only: Form Version April 2001
DWQ No.
USACE Action ID No.
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
1. Processing
1. Check all of the approval(s) requested for this project:
® Section 404 Permit
? Section 10 Permit
? 401 Water Quality Certification
? Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s)Requested:NWP #3
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here:
4. If payment into the North Carolina. Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ?
H. Applicant Information
1. Owner/Applicant Information
Name: T R Gibson, P E /NCDOT/Div 6/Division Engineer
Mailing Address: P.O. Box 1150
Fayetteville, NC 28302
Telephone Number: 910-486-1493 Fax Number: 910-486-1959
E-mail Address: t2ibson(a)dot.state.nc us
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory authority for the owner/applicant.)
Name: same as above
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 1 of 9
•h
III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: Bridge #2 Bladen County
2. T.I.P. Project Number (NCDOT Only): B-3411
3. Property Identification Number (Tax PIN):
4. Location
County: Bladen Nearest Town: Tar Heel
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): 0.75 mile southwest of NC 87
and SR-1104.
5. Site coordinates, if available (UTM or Lat/Long): 34.43°N 78.47°W
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Describe the existing land use or condition of the site at the time of this application:
Highway application - Existing Bridge
7. Property size (acres): Less than 1.0 Ac.
8. Nearest body of water (stream/river/sound/ocean/lake): Goodman Swamp
9. River Basin: Lumber River
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/mUs/.)
10. Describe the purpose of the proposed work: Replace structurally deficient bridge with
Page 2 of 9
A new brid e.
11. List the type of equipment to be used to construct the project: Trackhoe Excavator
& Truck Crane
12. Describe the land use in the vicinity of this project: Rural
IV. Prior Project History
if jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdiNfision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
N/A
V. Future Project Plans
Are any additional permit requests anticipated for this project in the future? If so, describe the
anticipated work, and provide justification for the exclusion of this work from the current
application: N/A
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
1. Wetland Impacts
Wetland Impact Type of Impact* Imp act 100- eartFlood lain** Na esstt Stream Type of Wetland***
Site Number
Page 3 of 9
indicate on ma acres es/no linear feet
N/A
Igo
* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing grading fill,
.L ...7 11.....7:
excavation, flooding, ditching/drainage, etc. ror Gams, separately 115L 1111p"ib uuc Lv L vU.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at httr)://www.femagov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property: 0 ac
Total area of wetland impact proposed: 0 ac
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact
Site Number
indicate on ma
Type of Impact* Length of
Impact
linear feet
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
leasespecify)..__
Crossing #1 Bridge OLF Goodman Swamp 22 Ft. Perennial

_ ?_ L_.. 7: ..a .,. .7. e.w.. ...7 ennia4wj rir?ran
* List each impact separately and identity temporary unpacLs. Unp-LS IIIUIUUV, UUL lu,. 11VL 1-.. w. vwa. v.• -.»-?- --r -r
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.usas.oov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.mayauest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: OLF
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S.
Open Water Im act Type of Im act* Area of Name of Waterbod Type of Waterbod
Page 4 of 9
Site Number
indicate on ma Impact
acres (if applicable) (lake, pond, estuary, sound,
bay, ocean, etc.
N/A

1' mrt ' ed fill cavatio Bred 'ng
* List each impact separately and identify temporary impacts. Impacts include, but are not ? to. , ex n, gt,
flooding, drainage, bulkheads, etc.
4. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): N/A
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
Propose to replace an existing 3 span timber and concrete bridge (52.9 OAL) with a 2 span
reinforced concrete and steel bridge (90.0 OAL) Proposed bridge will increase flow
characteristics while reducing existing impacts to the waterway.
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
Page 5 of 9
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http://h2o.enr.state.nc.us/ncwetlands/strmgide.html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offshe), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
Mitigation not re uired.
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP) with the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants
Page 6 of 9
will be notified early in the review process by the 401/Wetlands Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at hiLtp://li2o.enr.state.nc.g5/,"/index.htm. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
IX. Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?
Yes ® No ?
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No
X. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify-,)?
Yes ? No ® If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Page 7 of 9
*
Zone Impact
(square feet
Multiplier Required
Mitigation
1 3
2 1.5
Total
* Zone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or.0260.
XI. Stormwater (DWQ Only)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
Erosion and sedimentation plan shall be incorporated into the construction sequence.
X11. Sewage Disposal (DWQ Only)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
N/A
XM. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No
Is this an after-the-fact permit application?
Yes ? No
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
Page 8 of -9
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
None

Applican Ngent's Signature /Dat'e
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
US Army Corps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Cherokee Iredell Mitchell
US Army Corps of Engineers Avery Clay Jackson Polk
151 Patton Avenue Buncombe Cleveland Lincoln Rowan
Room 208 Burke Gaston Macon Rutherford
Asheville, NC 28801-5006 Cabarrus Graham Madison Stanley
Telephone: [phone] Caldwell Haywood McDowell Swain
Fax: [phone] Catawba Henderson Mecklenburg Transylvania
Raleigh Regulatory Field Office Alamance Durham Johnston Rockingham
US Army Corps Of Engineers Alleghany Edgecombe Lee Stokes
6508 Falls of the Neuse Road Ashe Franklin Nash Surry
Suite 120 Caswell Forsyth Northampton Vance
Raleigh, NC 27615 Chatham Granville Orange Wake
Telephone: [phone] Davidson Guilford Person Warren
Fax: [phone] Davie Halifax Randolph Wilkes
Washington Regulatory Field Office Beaufort Currituck Jones
US Army Corps Of Engineers Bertie Dare Lenoir
Post Office Box 1000 Camden Gates Martin
Washington, NC 27889-1000 Carteret* Green Pamlico
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fax: [phone] Cumberland New Hanover Scotland
Pitt
Tyrrell
Washington
Wayne
Union
Watauga
Yancey
Wilson
Yadkin
*Croatan National Forest Only
Page 9 of 10
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CYPRESS & HARDWOOD SWAMP
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STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY.
GovERNoR
NCDENR Division of Water Quality
Robert Ridings
2321 Crabtree Blvd.
Suite 250
Raleigh, NC 27604-2260
LYNDO TIPPETT
SECRETARY
OCTOBER 15, 2001
L _
`i
IJU? L„JI
RE: NCDENR WQC 3290 / USACE NWP#3
DWQ# 011466 - Bridge #151 Replacement Columbus County (B-3146)
DWQ# 011469 - Bridge #1 Replacement - Columbus County (B-3439)
DWQ# 011468 - Bridge #2 Replacement - Bladen County (B3411)
DWQ# 011467 - Bridge #197 Replacement - Robeson County (B-3367)
Dear Mr.Ridings:
Enclosed, please find two courtesy copies for bridge replacement projects within Division 6. The
projects will be completed in compliance with NCDENR Division of Water Quality General
Certification 3290 and USACE Nationwide Permit #3.
The PCN's for these projects were mailed by Division 6 Bridge Maintenance Department to
NCDENR for review under USACE NWP#31. Richard Spencer of the USACE has determined
that the projects will be permitted as NWP#3. Please disregard all previous notifications
pertaining to the above referenced projects.
If you should have any questions or comments regarding this notification, please feel free to
contact me.
cc: Richard Spencer, USACE
L.L. Upole, P.E.
Sincerely,
James . Rerko, PWS
Division 6 Environmental Officer
P. O. Box 1150, Fayetteville, NC 28302-1150 -Telephone [phone] -Fax [phone]
0 0 WArFRQG
r
o ?
low
Michael F. Easley
Governor.
William G. Ross, Jr., Secretary
Department of Environment and Natural Resources
Gregory Thorpe
Division of Water Quality
October 10, 2001
DWQ# 011466
DWQ# 011467
DWQ# 011468
DWQ# 011469
TIP # B-3146
TIP # B-3367
TIP # B-3411
TIP# B-3439
L. L. Upole, Jr. P. E.
Division Bridge Maintenance Engineer
P. O. 1150
Fayetteville, NC 28302
Dear Mr. Upole:
On October 05, 2001, your applications for 401 Water Quality Certifications for projects in
Bladen, Columbus, and Robeson Counties were received by the N.C. Division of Water Quality.
Please note that beginning January 1, 1999, the N.C. General Assembly passed legislation requiring
payment of a fee for all 401 applications. Your applications are being put on hold since no payment
was received with the packages. The.fee for applications is $200 for projects impacting less than an
acre of wetland and less than 150 linear feet of streams.. For projects impacting one or more acres of
wetland or 150 or more feet of streams, the fee is $475. In order for DWQ to review and process your
request, you must send a check in the appropriate amount made payable to the N.C. Division of
Water Quality. Please refer it to DWQ Project #011466, DWQ Project # 011467, DWQ Project #
011468 and DWQ Project # 011469.
Please call me at 919-733-1786 or visit our web site at http://h2o.enr.state.nc.us/ncwetlands if
you have any questions regarding this fee.
cc: Central Files
File Copy
Since y,
Robert Ridings
North Carolina Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
010 711 1'70C /ni.nne\ 010 7R7 8001 /inv\ I.Hn•//1.^fn on. nlnia nn „n/nn...n?ln n.iw/
v 4
„a STA7E o
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY LYNDO TIPPETT
GOVERNOR SECRETARY
Division of Environmental Management
John Hennessey, WQ Certification Unit
P. O. Box 29535
Raleigh, N. C. 27626-0535
Dear Mr. Hennessey:
Bridge Maintenance Unit
P. O. Box 1150
Fayetteville, N. C. 28302
September 17, 2001
®''46
Please find two (2) copies of the Pre-Construction Notification (PCN) application form for Water Quality Certification
Permits for your info. on this project.
If you have any questions or comments, please call me at 910-829-6345.
Thank you for your assistance in this matter.
Sincerely
?/_/ A.1'wc
L. L. Upole, Jr, P.E.
Division Bridge Maintenance Engineer
Attachments

P. O. Box 1150 - Fayetteville, N. C. 28302 - PHONE: [phone] - FAX: [phone]
Ado
nu,..
S"TAT1" OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
M ICJ IAEL F. EASLEY LYNDO TIPPETT
GOV F.RNOiZ SECRETARY
Bridge Maintenance Unit
P. O. Box 1150 .
Fayetteville, N. C. 28302
September 12, 2001
USACOF
Mr. Richard Spencer
Wilmington Regulatory Field Office
P O. Box 1890
Wilmington, N. C. 28402-1890
RI-'F: 131aden County Bridge Number 2 Replacement (TIP 13-341 1)
LOCATION: SR-10(14 (')vcrGoodman Swamp
Dear Mr. Spencer
We are providing herewith an application package and copies of N.C. Department of Transportation
Hydraulic-, Unit sketches (plan and profile) as a part of a project involving the replacement of an existing
bridge with a new bridge. The project should be let to contract in 2002.
'Io our knowledge, no wetlands are involved and total fill in water is expected to be less than 0.01 acre. This bridge is
not located in a high quality water area.
please review this material, and if additional information is needed, please contact our office.
'I hank you for your cooperation and assistance in this matter.
Sincerely
L. L. Upole, Jr, P.E.
Division Bridge Maintenance Engineer
Attachments
CC: T. R. Gibson, P.E. Division F,ngincer
John Ilennessey -DWQ-ZCopies W/Attachments
Mrs. Renee Gledhill-Earlcy State Historic Preservation Officer
Mike Crocker-US Fish & Wildlife Service.
Jim Rerko-Division Environmental Officer
P.O. BoxI 150-Fayetteville, NC 28302-11hone: (910-829-6345) Pax: (910-829-6348)
Z_ ?lAd c-N Lou, Ti
Of
Pre-Construction Notification (PCN) Application Form
For Section 404 and/or Section 10 Nationwide, Regional and General Permits, Section: 401
General Water Quality Certifications, and Riparian Buffer and Watershed Buffer Rules
This form is to he also(/ (Or projects, (111,11!fi)r any cif ilae!.S Arrray Corps of Engineers' (USAGE)
Nationwide. Regional or General Permits as required by Section 404 of the Clean Water Act and/or
Section 10 of tlae Rivers and Harbors Act, and for the North Carolina Division of Water Quality's
(DWQ) associated General 401 Water Quality Certifications. This form is also to be used for any
project requiring approval under any Riparian Suffer Rulc.s implemented by the N.C. Division of Water
Quality. This form should not be used if you are requesting an individual 404 Pen-nit or Individual 401
Water Quality Certification. The USAGE lndividU al Pea`talit application forni is available online at
l?tt??:i;%???s«.5?a? tts?cc. Gtra135 rlal.ncll?at3c1<.?1't??t-att ?3I'p_1?t3,at.
The USAGE is the lead regulatory agency. To review the requirements for the use of Nationwide,
Regional or General permits, and to determine which perallit applies to your project, please go to the
USAGE websitc at latap:;?'?'?« »? ti?aw.te, lc c.:at?tlly.ralil wCt1;!(ldS!'N,I;tour.litin, or contact one of the field
offices listed at the end of this applications. The website also lists the responsible project manager for
cacti county in North Carolina yaw] provides ta(h.litidnal inf'ortnation regarding the identification and
regulation of vvetlamds and waters of'the t_',.5,
The DWQ issues a corresponding Certification ((ia nervl or Iridividwd), and cannot tell the applicant
which 401 Certification will apply Mild Ow -104 Permit type h,:is been determined by the USACE.
Applicants are encouraged to visa 1)W(„)'.; 401 /Wetlarlds Unit website at
}alt? !la?o cr}3.?t 3tc.t.ac .a(s/n(,l ct( asa.t,s t,+.l rem, Ikolil, curnor.t rV(1U1rc^.raa(Mts for the 401 Water Quality
Certification 1'ropraml and to d tcrmi; c "Olx:th",-r or 11ol 1?,!parvm Butfer Dales, are applicable. The
applicant is also adviscil to reel the 1,1111 t(=Xf R,,f'tla (K+.nf:€a] Certification ((JO trIatching the specific 404
Permit requeste(l. ltl ',0111e C ISCS, v?t-Olcn %q')p'oval figs' some (xeneral ("c.,oki ication is not required,
provided that the applicant adheres to all c.on,_Htions of the (.,( Applicants lacking access to the internet
should contact DWQ's Ce astral 0lfi ce in t?aleigh at ('31 fit) 7 3-1 ;'?l(i.
Trout Waters Coordialation t?r?tii<11 c•otmiinatlon with the North Carolina Wildlife Resources
Commission (NIMR.C) is also reclalircrl for pro-leds occurring in any of North Carolina's twenty-five
counties that contain trout waters, lit such c.tscs, the applicant should contact the appropriate NCWRC
regional coorditlator (list("d by co!-ante oil the 1?)st page cif dais application).
LAMA Coortlltl,:at(tatl If the prc't{'c=t occurs ie1 any of 1dt?sth C?arcalina`s twenty coastal counties (listed on
the last page of this application) the: tatiplic!Mtshould also contact: the North Carolina Division.of Coastal
Management (DCM) at [phone]. DCM will determine whether or not the project involves a
designated Area of Environmental Concern, in which case DCM will act as the lead permitting agency.
In such cases. DCM will require a Coastal Area Management Act (CAMA) Permit and will coordinate
the 404/401 Permits.
USACE Permits - Submit one copy of this form, along with supporting narratives, maps, data forms,
photos, etc. to the applicable USACE Regulatory Field Office (addresses are listed at the end of this
application). Upon receipt of an application, the USACE will determine if the application is complete as
soon as possible, not to exceed 30 days. This PCN form is designed for the convenience of the applicant
to address information needs for all USACE Nationwide, Regional or General permits, as well as
information required for State authorizations, certifications, and coordination. Fully providing the
information requested on this form will result in a complete application for any of the USACE
Nationwide, Regional or General permits. To review the minimum amount of information that must be
provided for a complete PCN for each USACE Nationwide pennit, see Condition 13, 65 Fed.Reg. 12893
(March 9, 2000), available at htti)://www.saw.usace.ani-iy.inil/wetlands/nwpfinalFedRe-g.pd.f
Processing times vary by permit and begin once the application has been determined to be complete.
Please contact the appropriate regulatory field office for specific answers to permit processing periods.
401 Water Quality Certification or Buffer Rules - All information is required unless otherwise stated
as optional. Incomplete applications will be returned. Submit seven collated copies of all USACE
Permit materials to the Division of Water Quality, 401/Wetlands Unit, 1650 Mail Service Center,
Raleigh, NC, 27699-1650. If written approval is required or specifically requested for a 401
Certification, then a non-refundable application fee is required. In brief, if project impacts include less
than one acre of cumulative wetland/water impacts and less than 150 feet cumulative impacts to
streams, then a fee of $200 is required. If either of these thresholds is exceeded, then a fee of $475 is
required. A check made out to the North Carolina Division of Water Quality, with the specific name of
the project or applicant identified, should be stapled to the front of the application package. For more
information, see the DWQ website at http:/Ih2o.elinr.state.nc.us/ncwetlands/fees.httnl. The fee must be
attached with the application unless the applicant is a federal agency in which case the check may be
issued from a separate office. In such cases, the project must be identifiable on the U.S. Treasury check
so that it can be credited to the appropriate project. If written approval is sought solely for Buffer Rules,
the application fee does not apply, and the applicant should clearly state (in a cover letter) that only
Buffer Rule approval is sought in writing. Wetlands or waters of the U.S. may not be impacted prior to
issuance or waiver of a Section 401 Water Quality Certification. Upon receipt of a complete application
for a 401 Certification, the Division of Water Quality has 60 days to prepare a written response to the
applicant. This may include a 401 Certification, an on-hold letter pending receipt of additional
requested information, or denial.
Page 2 of 12
Office Use Only: 011466 Fonn Version April 2001
USACE Action ID No. DWQ No.
if any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
1. Processing
Check all of the approval(s) requested for this project:
? Section 404 Permit
? Section 10 Permit
? 401 Water Quality Certification
? Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: 31
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ?
11. Applicant Information
1. Owner/Applicant Information
Name: Taggs, yc u r ?Q;?. ?; v, E.#6-,e
Mailing Address: OT(3o? iiSo
rrAyE1Y6v,Il9,, Nf Z83oZ
Telephone Number: 9/0-06-/y 93 Fax Number: 91o-W(o -/959
E-mail Address: t_Ji410„ i e do T. srwrd . NC. us
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory authority for the owner/applicant.)
Name: SAME: 145 ABavE
Company Affiliation:
Mailing Address:
Telephone Number: _^. Fax Number:
E-mail Address:
Page 3 of 12
Ill. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly detincd. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than II by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: 6 /9A v 6-,vTy eEp1Ae elyr OF,6,e;4ge #Z
2. T.I.P. Project Number (NCDOT Only): C/3 - 3Y /I
3. Property Identification Number (Tax PIN): N04
4. Location
County:_ &a,pfN _ Nearest Town: A9 MCEd
Subdivision name (include phase/lot number): A114
Directions to site (include road numbers, landiriarks, etc.): , 75 A9 i _fou?N oxs T
OP Nf $ 7 oN se ioo y
LAT. L oNg.
5. Site coordinates, if available (UTM or Lat/Long): /.3q,43 78. 17
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Describe the existinland use or condition of the site at the time of this application:
LI. _ L ...,., Ar,Joc
7. Property size (acres): LE.s.s I iexa
g. Nearest body of water (strcainn/river/sound/ocean/lake):6rdo o~,v .Sw4en D
9. River Basin: ,um BfK
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at llitti)://li2o.enr.statc_.tic,us/admin/mates/.)
10. Dcrs?cribe t,lhe purpose of the proposed work: ae/,% 7ieycTa? QeF64NT
L '4 V9
Page 4 of 12
1 1. List the type of equipment to be used to construct the project: 7-szae,_aCRow7o[
A nir71ANE
12. Describe the land use in the vicinity of this project: 4 teg
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USAGE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued- for prior segments of the same T.I.P. project, along with
construction schedules.
rte lA
V. Future Project Plans
Are any additional permit requests anticipated for this project in the future? If so, describe the
anticipated work, and provide justification for the exclusion of this work from the current
application:
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intennittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation fortns should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
1. Wetland Impacts
Wetland Impact Area of Located within Distance to
Site Number Type of Impact* Impact 100-year Floodplain** Nearest Stream Type of Wetland***
(indicate on map) _ -- -- --(acres) --- (yes/no linear feet
Page 5 of 12
- -.? ----- ---t. 1 A..4:4, ,•t" In n--tc mrhvte hr.t nre not limited to- mechanized clearine. aradine. fill,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to troth structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain Wraps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at 111t1 j:, feina.g lv.
*** List a wetland type that best describes wetland to be impacted (e.g., fresh waterisaItwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property: O
Total area of wetland impact proposed: O
2. Stream Impacts, including all intermittent and perennial. streams
Stream Impact
Site Number
(indicate on ntap) ~ ^
Type of Impact* Length of
Impact
linear feet
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
leasespecify)

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc, If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USES topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the tJSGS at 1-800-358-9616, or online at
w%vw_u5gs ety. Several internet sites also allow direct download and printing of USGS maps (e.g., www.tonozone,com,
wMILllia??c3ucs.t ccnn, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: O
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S.
Open Water Impact Area of Name of Waterbody Type of Waterbody
Site Number "type of Impact* Impact (if applicable) (lake, pond, estuary, sound,
indicate on ma) acres bay, ocean, etc.
Page 6 of 12

* List each impact separately and identity temporary impacts. impacts include, but are not minted to: nm, excavauon, ureuguig,
flooding, drainage, bulkheads, etc.
4. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): N/!+
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VIL` Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 1,50 linear feet of total impacts to perennial
streams.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
Page 7 of 12
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
fimctions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
htt ://h2o.enr.state.nc.us/ncwetIands/strtnaide.htm 1.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
/t'/ a
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP) with the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants
will be notified early in the review process by the 401/Wetlands Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at httu::11?2c _enrstate.ne.us/mMJndex.htm. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the 1Ollowing infonmation:
Amount of stream mitigation requested (linear feet)o
.Page 8 of 12
Amount ol'buffer mitigation requested (square feet): O
Amount of Riparian wetland mitigation requested (acres): 4
Amount of Non-riparian wetland mitigation requested (acres): d
Amount of Coastal wetland mitigation requested (acres): o
IX. Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?
Yes ® No ?
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No N
X. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC` 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 213 .0250 (Randleman' Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ? No ® If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Z.one* Impact
s ware feet) Multiplier Required
Mitigation
1 3
2
-
--- 1.5
--
-
Total ---- --
* Zone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
• ,?
Page 9 of 12
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or.0260.
X1. Storrnwater (DWQ Only)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss storrnwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
X11. Sewage Disposal (DWQ Only)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
N/A
X11I. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 211.0500) or any Buffer Rules?
Yes ? No
Is this an after-the-fact permit application?
Yes ? No
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
No n/E
Page 10 of 12
f(
ZG
Applicant/Agent's Signi Cure Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
US Army Corps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Cherokee lredell Mitchell Union
US Army Corps of Engineers Avery Clay Jackson Polk Watauga
151 Patton Avenue Buncombe Cleveland Lincoln Rowan Yancey
Room 208 Burke Gaston Macon Rutherford
Asheville, NC 28801-5006 Cabarnrs Graham Madison Stanley
Telephone: [phone] Caldwell Ilaywood McDowell Swain
Fax: [phone] Catawba Henderson Mecklenburg "Transylvania
Raleigh Regulatory Field Office Alamance Durham Johnston Rockingham Wilson
US Army Corps Of Engineers Allegh my Edgecombe Lee Stokes Yadkin
6508 Falls of the Neuse Road Ashe Franklin Nash Surry
Suite 120 Caswell Forsyth Northampton Vance
Raleigh, NC 27615 Chatham Granville Orange Wake
Telephone: [phone] Davidson Guilford Person Warren
Fax: [phone] Davie Halifax Randolph Wilkes
Washington Regulatory Field Office Beaulbrt Currituck Jones Pitt
US Army Corps Of Engineers Bertie Dare Lenoir Tyrrell
Post Office Box 1000 Camden Gates Martin Washington
Washington, NC 27889-1000 Carteret* Green Pamlico Wayne
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans *Croatan National Forest Only
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fax: [phone] Cumberland New Hanover Scotland
US Fis
US Fish and Wildlife Service
Raleigh Field Office
Post Office Box 33726
Raleigh, NC 27636-3726
'T'elephone: [phone]
h and Wildlife Service / National N:
US Fish and Wildlife Service
Asheville Field Office
160 Zillicoa Street
Asheville, NC 28801
Telephone: [phone]
I arine Fisheries Service
National Marine Fisheries Service
Habitat Conservation Division
Pivers Island
Beaufort, NC 28516
Telephone: [phone]
North Carolina State Agencies
Division of Water Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Telephone: [phone]
Fax: [phone]
Division of' Water Quality
Wetlands Restoration Program
1619 Mail Set-vice Center
Raleigh, NC 27699-1619
Telephone: [phone]
Fax: [phone]
Pale I I of 1,
;.
State Historic Preservation Office
Department Of Cultural Resources
4617 Mail Service Center
Raleigh, NC 27699-4617
Telephone: [phone]
Fax: [phone]
• r
CAMA and NC Coastal Counties
Division of Coastal Management Beaufort Chowan I Iertfurd Pasquotank
1638 Mail Service Center Bertie Craven Hyde Pender
Raleigh. NC 27699-1639 Brunswick Currituck New Hanover Perquimans
Telephone: [phone] Camden Dare Onslow Tyrrell
Fax: [phone] Carteret Gates Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator
3855 Idlewild Road
Kernersville, NC 2784-9180
Telephone: [phone]
Mountain Region Coordinator
20830 Great Smoky Mtn. Expressway
Waynesville, NC 28786
Telephone: [phone]
Fax: [phone]
Allcghany Caldwell
Ashe Mitchell
Avery Stokes
Burke Sucry
Buncombe Henderson
Cherokee Jackson
Clay Macon
Graham Madison
Haywood McDowell
Watauga
Wilkes
Polk
Rutherford
Swain
Transvivania
Yancey
Page 12 of I2
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