20010270 Ver 1_Complete File_20010223

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross, Jr., Secretary
Kerr T. Stevens, Director
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•
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IkIA
NC ENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
March 21, 2001
Chatham County
DWQ Project No. 010270
APPROVAL of 401 Water Quality Certification
Mr. William D. Gilmore, P.E., Manager
Planning and Environmental Branch
North Carolina Department of Transportation
1548 Mail Service Center
Raleigh, North Carolina, 27699-1548
Dear Mr. Gilmore:
You have our approval, in accordance with the attached conditions and those listed below, to place fill
material in 130 linear feet of streams for the purpose of replacing Bridge Number 253 on SR 1363 with two
replacement culverts in Chatham County. The project should be constructed in accordance with your
application dated February 23, 2001. After reviewing your application, we have decided that this fill is
covered by General Water Quality Certification Number 3289. This certification corresponds to the
Nationwide Permit Number 14 issued by the Corps of Engineers. In addition, you should acquire any other
federal, state or local permits before you proceed with your project including (but not limited to) Sediment
and Erosion Control, Non-Discharge and Water Supply Watershed regulations. This approval will expire
with the accompanying 404 permit, unless otherwise specified in the Water Quality Certification.
This approval is valid solely for the purpose and design described in your application (unless modified
below). Should your project change, you must notify the DWQ and submit a new application. 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 the conditions. If total wetland fills for this project (now or in the future)
exceed one acre, or of total impacts to streams (now or in the future) exceed 150 linear feet, compensatory
mitigation may be required as described in 15A NCAC 2H .0506 (h) (6) and (7). For this approval to
remain valid, you must adhere to the conditions listed in the attached certification.
1.) Upon completion of the project, the NCDOT shall complete and return the enclosed "Certification of
Completion Form to notify DWQ when all work included in the 401 Certification has been completed.
The responsible party shall complete the attached form and return it to the 401/Wetlands Unit of the
Division of Water Quality upon completion of the project.
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 that conforms to Chapter 150B of the North Carolina General Statutes to the Office of
Administrative Hearings, P.O. Box 27447, Raleigh, N.C. 276 1 1-7447. This certification and its conditions
are final and binding unless you ask for a hearing.
Wetlands/401 Unit 1621 Mail Service Center Raleigh, North Carolina 27699-1 62 1
Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post consumer paper
State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross, Jr., Secretary
Kerr T. Stevens, Director
NC ENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
ROAD CROSSING CERTIFICATION GENERAL CERTIFICATION FOR PROJECTS
ELIGIBLE FOR CORPS OF ENGINEERS NATIONWIDE PERMIT NUMBER 14 (ROAD
CROSSINGS), REGIONAL GENERAL PERMIT 198200031 AND NEUSE/TAR-
PAMLICO/RANDLEMAN BUFFER RULES
This General Certification is issued in conformity with the requirements of Section 401, Public Laws 92-
500 and 95-217 of the United States and subject to the North Carolina Division of Water Quality (DWQ)
Regulations in 15A NCAC 2H, Section .0500 and 15A NCAC 2B .0200 for the discharge of fill material to
waters and wetland areas as described in 33 CFR 330 Appendix A (B) (14) of the Corps of Engineers
regulations (i.e., Nationwide Permit No. 14 and Regional General Permit 198200031) and for the Neuse,
Tar-Pamlico and Randleman Buffer
Rules (15A NCAC 2B .0233,.0259 and .0250). The category of activities shall include any fill activity for
road crossing and is limited to fill less than one-third of an acre. This Certification replaces Water Quality
Certification Number 2177 issued on November 5, 1987, Water Quality Certification Number 2666 issued
on January 21, 1992, Water Quality Certification Number 2732 issued on May 1, 1992 and Water Quality
Certification Number 3103 issued on February 11, 1997. This WQC is rescinded when the Corps of
Engineers re-authorizes Nationwide
Permit 14 or Regional General Permit 198200031 when deemed appropriate by the Director of the DWQ.
The State of North Carolina certifies that the specified category of activity will not violate applicable
portions of Sections 301, 302, 303, 306 and 307 of the Public Laws 92-500 and 95-217 if conducted in
accordance with the conditions hereinafter set forth.
Conditions of Certification:
1. Proposed fill or substantial modification of wetlands or waters (including streams) under this General
Certification requires application to and prior written concurrence from the Division of Water Quality;
2. In accordance with North Carolina General Statute Section 143-215.3D(e), any application for a 401
Water Quality Certification must include the appropriate fee. If a project also requires a CAMA Permit,
one payment to both agencies shall be submitted and will be the higher of the two fees;
3. In accordance with 15A NCAC 2H .0506 (h) compensatory mitigation may be required for impacts to
streams and/or wetlands. In addition, buffer mitigation may be required for any project with Buffer
Rules in effect at the time of application. A determination of buffer, wetland and stream mitigation
requirements shall be made for any Certification for this Nationwide Permit. The most current design
and monitoring protocols from DWQ shall be followed and written plans submitted for DWQ approval
as required in those protocols;
4. For any project involving a stream re-alignment, a stream relocation plan must be included with the 401
application for written DWQ approval. Relocated stream designs should include the same dimensions,
patterns and profiles as the existing channel, to the maximum extent practical. The new channel should
be constructed in the dry and water shall not be turned into the new channel until the banks are
stabilized. Vegetation used for bank stabilization shall be limited to native woody species, and should
include establishment of a 30 foot wide wooded and an adjacent 20 foot wide vegetated buffer on both
sides of the relocated channel to the maximum extent practical. A transitional phase incorporating coir
Wetlands/401 Unit 1621 Mail Service Center Raleigh, North Carolina 27699-1621
Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post consumer paper
State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross, Jr., Secretary
Kerr T. Stevens, Director
N.TV115 •
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
fiber and seedling establishment is allowable. Also, rip-rap may be allowed if it is necessary to maintain
the physical integrity of the stream, but the applicant must provide written justification and any
calculations used to determine the extent of rip-rap coverage requested. If suitable stream mitigation is
not practical on-site, then stream impact will need to be mitigated elsewhere;
Impacts to any stream length in the Neuse, Tar-Pamlico and Randleman River Basins requires written
concurrence from DWQ in accordance with 15A NCAC 213.0233, 15A NCAC 213 .0259 and .0250 and
15A NCAC 2H .0500. New development activities located in the protected 50-foot wide riparian areas
(whether jurisdictional wetlands or not) within the Neuse, Tar-Pamlico and Randleman River Basins
shall be limited to "uses" identified within and constructed in accordance with 15A NCAC 2B .0233,
15A NCAC 2B .0259 and .0250. All new development shall be located, designed, constructed, and
maintained to have minimal disturbance to protect water quality to the maximum extent practicable
through the use of best management practices. Activities listed as "exempt" from these rules do not need
to apply for written concurrence under this Certification;
Placement of culverts and other structures in waters, streams, and wetlands must be placed below the
elevation of the streambed to allow low flow passage of water and aquatic life unless it can be shown to
DWQ that providing passage would be impractical. Design and placement of culverts and other
structures including temporary erosion control measures shall not be conducted in a manner that may
result in dis-equilibrium of wetlands or stream beds or banks, adjacent to or upstream and down stream
of the above structures. The applicant is required to provide evidence that the equilibrium shall be
maintained if requested in writing by DWQ. Additionally, when roadways, causeways or other fill
projects are constructed across FEMA-designated floodways or wetlands, openings such as culverts or
bridges must be provided to maintain the natural hydrology of the system as well as prevent constriction
of the floodway that may result in destabilization of streams or wetlands;
7. If this Certification is used to access building sites, all lots owned by the applicant must be buildable
without additional fill beyond that allowed under other General Certifications. Deed restrictions must be
placed on the remaining wetlands and streams on these lots to restrict future wetland and stream fill.
DWQ shall be sent copies of all deed restrictions applied to these lots;
8. That appropriate sediment and erosion control practices which equal or exceed those outlined in the
most recent version of the "North Carolina Sediment and Erosion Control Planning and Design Manual"
or the "North Carolina Surface Mining Manual" whichever is more appropriate (available from the
Division of Land Resources (DLR) in the DENR Regional or Central Offices) shall be in full
compliance with all specifications governing the proper design, installation and operation and
maintenance of such Best Management Practices in order to assure compliance with the appropriate
turbidity water quality standard;
9. All sediment and erosion control measures placed in wetlands or waters shall be removed and the natural
grade restored within two months after the Division of Land Resources has released the project;
10. Measures shall be taken to prevent live or fresh concrete from coming into contact with waters of the
state until the concrete has hardened;
Wetlands/401 Unit 1621 Mail Service Center Raleigh, North Carolina 27699-1621
Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post consumer paper
State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross, Jr., Secretary
Kerr T. Stevens, Director
1 101?WAA
•
NC ENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
11.This Certification shall be utilized for roads from natural high ground to natural high ground. The
Certification for Nationwide Permit 18 may not be used in conjunction with this Certification to create
high ground for road access;
12. If an environmental document is required, this Certification is not valid until a Finding of No Significant
Impact (FONSI) or Record of Decision (ROD) is issued by the State Clearinghouse. All water quality-
related conditions of the FONSI or ROD shall become conditions of this Certification;
13. That additional site-specific conditions may be added to projects proposed under this Certification in
order to ensure compliance with all applicable water quality and effluent standards;
14. When written concurrence is required, the applicant is required to use the enclosed "Certification of
Completion Form" to notify DWQ when all work included in the 401 Certification has been completed;
15. Concurrence from DWQ that this Certification applies to an individual project shall expire three years
from the date of the cover letter from DWQ or on the same day as the expiration date of the
corresponding Nationwide Permit 14 and Regional General Permit 198200031 whichever is sooner.
Non-compliance with or violation of the conditions herein set forth by a specific fill project may result in
revocation of this Certification for the project and may also result in criminal and/or civil penalties.
The Director of the North Carolina Division of Water Quality may require submission of a formal
application for individual certification for any project in this category of activity, if it is determined that the
project is likely to have a significant adverse effect upon water quality or degrade the waters so that existing
uses of the wetland, stream or downstream waters are precluded.
Public hearings may be held for specific applications or group of applications prior to a Certification
decision if deemed in the public's best interest by the Director of the North Carolina Division of Water
Quality.
Effective date: 1 June 2000
DIVISION OF WATER QUALITY
By
Kerr T. Stevens
Director
WQC # 3289
Wetlands/401 Unit 1621 Mail Service Center Raleigh, North Carolina 27699-1621
Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post consumer paper
State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross, Jr., Secretary
Kerr T. Stevens, Director
DWQ Project No.:
Applicant:
Project Name:
Date of Issuance of 401 Water Quality Certification:
1 ? •
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
County:
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable Buffer
Rules, and any subsequent modifications, the applicant is required to return this certificate to the
401/Wetlands Unit, North Carolina Division of Water Quality, 1621 Mail Service Center, Raleigh, NC,
27699-1621. This form may be returned to DWQ by the applicant, the applicant's authorized agent, or the
project engineer. It is not necessary to send certificates from all of these.
Applicant's Certification
I, , hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to be built
within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the
approved plans and specifications, and other supporting materials.
Signature:
Date:
Agent's Certification
I, , hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to be built
within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the
approved plans and specifications, and other supporting materials.
Signature:
Engineer's Certification
Partial Final
Date:
I, , as a duly registered Professional Engineer in the State
of North Carolina, having been authorized to observe (periodically, weekly, full time) the construction of
the project,for the Permittee hereby state that, to the best of my abilities, due care and diligence was used in
the observation of the construction such that the construction was observed to be built within substantial
compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and
specifications, and other supporting materials.
Signature
Date
Registration No.
Wetlands/401 Unit 1621 Mail Service Center Raleigh, North Carolina 27699-1 62 1
Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post consumer paper
State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross, Jr., Secretary
Kerr T. Stevens, Director
NC ENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
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 Dorney at 919-733-9646.
Sincerely,
Attachment
cc: Wilmington District Corps of Engineers
Corps of Engineers Raleigh Field Office
DWQ Raleigh Regional Office
File Copy
Central Files
c:\ncdot\SR 1363\wgc\010270wgc.doc
rr . *Steves
Wetlands/401 Unit 1621 Mail Service Center Raleigh, North Carolina 27699-1621
Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post consumer paper
r r
0102-70
DWQ ID: CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
rya
1) NOTIFICATION TO THE CORPS OF ENGINEERS -
2) APPLICATION FOR SECTION 401 CERTIFCATION
f 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: JOFL DORNEY. 4401 REEDY CREEK ROAD.
RALEIGH. NC 27607. PLEASE PRINT OR TYPE.
1. OWNER'S NAME: NG 0 0-r
2. MAILING ADDRESS: Po fS v X 0 8 9
SUBDIVISION NAME
CITY: '?;1 L_ ?Eiz G 1 T y STATE: N L ZIP CODE: Z-7 3 44
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE): 13 iZ 1?? c, No • Z,5'3 o&L sr2 13-7 3 0,4 ?rz-= r2
T t?_j g u-'A-2y or: 2oL(&Y 12 a-
3. TELEPHONE NUMBER: (HOME)
(WORK) 919 7,4 Z -- &,49
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
19 iZ 1 L r IJ ist-s o rJ
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR :SERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: 6144-r- NEAREST TOWN: S 1 uE2 Ll Ty rn
zzz rrn
rrn
0 ---i

SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LA NDMARKS, ECT.)
SO 1 73 ov?,z TIZIRwrl4al-I o F 2a?Ic.Y l2ry?j2
6. IMPACTED OR NEAREST STRE.kM/RIVER: IZd?I?Y 2?y ,2
RIVER BASIN: G/4Pe 1=04IZ
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER, (SA),
HIGH QUALITY WATERS (HQW), OUTSTANDING SOURSE WATERS (ORW), WATER _
SUPPLY (WS-I OR WS-II)? YES( ) NO (VIF YES, EXPLAM:
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF E.NVIROMENTAL CONCERN (AEC)? YES ( ) NO (VII")
7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEEPAGE 7 FOR LIST OF
COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION?
8a. HAVE ANY SECTION 404 P RMITS 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):
8b. ARE ADDITIONAL PERMITQUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES( ) NO (\.4 IF YES, DESCRIBE ANTICIPATED WORK:
9a. ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND: D, --
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
/? oNl£
10a. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: _
FLOODING:
DRAINAGE :
EXCAVATION:
OTHER:
TOTAL ACRES TO BE IMPACTED:
10b. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF
RELOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION:
LENGTH BEFORE: N/d FT AFTER: N1/A FT
WIDTH BEFORE (based on normal high water contours): FT
AVERAGE DEPTH BEFORE: FT AFTER: FT
(2) STREAM CHANNEL ItiIP ACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: PLACEMENT OF PIPE IN CHANNEL: ?
CHANNEL EXCAVATION: COONSTRUCTION OF A DA?WFLOODING:
OTHER:
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
DRAINING TO THE POND?
POND SURFACE AREA?
WHAT IS THE EXPECTED
12. DISCTIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMEN'T' TO BE USED? (ATTACH PLANS; 81/2 BY 11 DRAWINGS ONLY)
121F- L/+-(-,E- e; x?57iN e-, z5 ' ls,cig(,?E w/ Z LrM?-;-: s
0 ? 1 ?} Z "x 9 I " G,M P/? . la?avi+--ra 1z. s F? ?t-???-F? i? -rz,
(??? UTl l-I ???I?
13. PURPOSE OF PROPOSED WORK: ?25e I (D&7l-7-
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE ANY MEASURES TAKEN TO MINIMIZE `VETLAND IMPACTS)
N
15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR
NATIONAL MARINE FISHERIES SERIVE REGARDING THE PRESENCE OF ANY FEDERALY
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: _ 6y !_ f Tt"e.4Z
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
ISI LisrnS .
17. DOES THE PROJECT LIVOLVE AN L•. ENDITLRE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? YES ( ?NO ( ) (IF NO, GO TO 16) _
a. IF YES, DOES THE PROJECT REQUIRE PREPERATION OF AN ENVIRONMENTAL
DOCUMENT PURUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT? YES ( ) NO ( ?<
b. IF YES, HAS THE DOCUMENT BEEN REFIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES ( ) NO (
IF ANSWER 17b IS YES, THEN SUBMIT APPROPRIATE DOCUNIENTATIONFROM 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 NUNfBERS 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 PROPOERTY?
IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
g. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WTLANDS 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 _
MANAGEIVfENT PROGRA?NI,
OWNER'S/AGENT'S SIGNATURE DATE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED).
,..?? i iwvV1n1'1 WLV. rCIA -yj°J-(00-0
Jul 20 2CAO 10:58 P.05
PAICE A: INU MNIUM CRITERIA YES NO
1, Is the proposed project listed Asa type which would qualify ?? Q
U a Non-Major Actiou utidcr the Mbimum Criteria?
PART 13; MINllV1UM CRITERIA ExCEftIONS
2. Is the proposed project likely to precipitate significant, foreseeable
alterations inland =0, planacd growth, or dcvclopmenr patterns?
3. Doca the proposcd action divide or disrupt € a established community?
4. Does tho proposcd action bypass an existing cornmunlty7
5. Does the proposed action provide new access to areas containing L7 0,
sianifionnt amounts of exploitable natural resources?
6. Is tho proposcd action likely to have a significant detrimental impact
on air quality?
7. Is the proposed action likely to havo a significant detrimental impact
on ambient noise levels for adjoining areas?
8. Is the proposed action likely to have a significant impact on travel
puUms or traffic volumes?
9, Is the proposed action likely to significantly affect water quality? F ,E'
10. Does the proposed action require the relocation of significant numbers El of poople?
11, Is the project likely to be controversial? 0 21"
12, Will *,e proposed action requiro the use of land owned by the
U. S. Forest Service or the National Park Scrvico?
PART C: COMPLWNCE WNH STATE AND FEDERAL REGULATIONS
Ecological impacts
13. Is a federally protected threatened or endangered species, or its habitat, Q [?
likely to bo inpaetcd by tha proposcd action?
14. Docs the action requlro the p.'acement of fill in waters of the United States? [jam Q
2
III-LIJ 1 1 r,uul.rn,f Lev. rax-yly-(JJ-J5if5 Sul 20 2000 1058 P. C6
r
15. Does the project require the placement of a sigaiflcant amount of 1111 in ? U
high quality or relatively rare wetland ecosyatems, such as mountain bogs
or pine savannahs?
16. Does the project require stream rolocation or chamicl t1unges? ?
17. Is the proposed action located in an Area ofEnviroamental Concern, ?
as defined in the Coastal Area Management Act?
Cultural Regis
lg. Will the project hsrvc an "'effect" on a proparty or site listed on the
National Registcr of Historic Places?
19. Will the proposed action require acquisition of additional right of way
from publicly owned parkland or recreational areas?
Rovicwed by; Date;
Project Flaming Engineer
Project Planning Unit Head

11 E3-,/
If any questions 2 through 12 are answered "yes", the proposed project does not qualify as a
Non-Major Action. A state environmental asmcssment (EA) will be required. For assistance,
contact:
William D. Gilmore, P. B.
Manager, Project Development and Environmental Analysis Branch
F. 0. BOX 25201
Raleigh, NC 27611
[phone]
Fax: [phone]
Questions in Part C are designed to assist the Engineer in-determining whether a permit or
consultation with a state or federal resourCC agency may be required. if any question in part c is
answered "yes", refor to the Environmental Guidance section of this document and contact the
appropriate individual for assistance.
i lk-Lu i + NWURtv'i LGV. r dX • J ly-f JJ-0=) JU 1 21 2WU 10:b8 P. 04
MINIMUM CRITERIA DETE NATION CHECKLIST
The following questions provide direction in determiuina whether a proposed projoct h= only a
minimum potendai for cavironmenml effects. Answer the following questions by checking
either yes or uo. Refer to tho attached auidaace for assistance.
TIP Project No.
State project No. 5.5 z sz.
Project Location: 5P- 13-73
pro joct Description: 1Z?+?c ?t u£- rS2???,rL.
Anticipated Permit or Consultation Requirements: njor IF-
Special Project Information: ?? ??
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' `
RECOMMENDED STRUCTURE.
2 @ 142" X 91".C.S.P.A. w/ HEADWALL
X
PASTURE STA. 10+00
B.O.B. (PK)
X
STA. 9+50
P.O.T. (P K) PASTURE
P
T
X BWF X X X-
SR. 1373 I6' , _

HEADWALL
REQUIRED
STA.10+25.50
E.O.B. (P K)
1 PASTURE
UGC
POLE
L XBB W
? D/L
15,
lml -T
I PASTURE
I STA.10+50
P.O.T. (PK)
X
PED.
N 13'00' W
0
P
IELD
+/- 200'
PP
FIELD
Tj
2P
n
PP
m
?c FIELD
TRIG.
ROCKY RIVER
13.5 0' ? ?--
1 1209'xT'
RCBC
9.1 ( w/ side tapered
1 I 1 Inle t
< 421
00 9+00 1
0+00
FIELD
CLASS I ?fi ?.
RIP RAP 4 Q M
h \j
d °D°CCC ?
ii+nn
i?-+-n(