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HomeMy WebLinkAbout20010699 Ver 1_Complete File_20010508TO: Mr. Eric Alsmeyer, USACOE Raleigh Field Office FROM: Maryellen Haggard, DOT Permit Coordinator Habitat Conservation Program DATE: May 31, 2001 SUBJECT: NCDOT culvert placement in an unnamed tributary to a tributary to Rich Fork Creek, Davidson County. The North Carolina Department of Transportation (NCDOT) is requesting a concurrence letter from the North Carolina Wildlife Resources Commission (NCWRC) to obtain a 404•permit' from the U.S. Army Corps of Engineers. Biologists on staff with the NCWRC have reviewed the ` proposed improvements and are familiar with habitat values of the project area. These comments are provided in accordance with the provisions of the Fish and Wildlife Coordination Act (48 Stat. 401, as amended; 16 U.S.C. 661-667d) and the Clean Water Act of 1977 (33 U.S.C. 466 et seq.). NCDOT proposes to install a 36' culvert on an intermittent unnamed tributary to Rich Fork Creek in order to construct a new road. This action will impact 80 feet of the unnamed tributary to Rich Fork Creek. The project will not impact trout waters. We will not object to the project as proposed provided that the following conditions are implemented: 1. Disturbance of the stream channel must be limited to only what is necessary to install the culvert. Heavy equipment should be operated from the bank rather than in the stream channel in order to minimize sedimentation and reduce the likelihood of introducing other pollutants into the stream. 2. The 36-inch culvert should be buried below the streambed. The dimension, pattern, and profile of the stream above and below the pipes should not be modified by widening the stream channel or reducing the depth of the stream. All waters should flow without freefalling or damming on either end during low flow conditions to maintain aquatic life passage. 3. Stringent erosion control measures should be installed where soil is disturbed and maintained until project completion. 4. Temporary or permanent herbaceous vegetation should be planted on all bare soil within 15 days of ground disturbing activities to provide long-term erosion control. We encourage NCDOT to utilize onsite vegetation and materials for streambank stabilization, to minimize the use of riprap (or hard stabilization methods) and to maximize the use of native vegetation for stabilization and shade. 5. Work must be accomplished so that wet concrete does not contact stream water. Thank you for the opportunity to review and comment on this project during the early planning stages. If you have any questions regarding these comments, please contact me at (336) 527-1549. cc: Cynthia Van Der Wiele, NCDWQ Diane K. Hampton, NCDOT O?O? W AT ?RQG r Michael F. Easley _ Governor William G. Ross, Jr., Secretary Department of Environment and Natural Resources Kerr T. Stevens Division of Water Quality May 22, 2001 Davidson County DWQ Project No. 010699 -U-1767Y New Road APPROVAL of 401 Water Quality Certification Ms. Diane K. Hampton, P.E., Division Environmental Officer NCDOT Division 9 2125 Cloverdale Avenue Winston-Salem, NC 27103 Dear Ms. Hampton: You have our approval, in accordance with the attached conditions and those listed below, to impact 80 linear feet of an unnamed tributary to Rich Fork Creek for the purpose of constructing -U-1767 New Road in Davidson County. The project should be constructed in accordance with your application dated 3 May 2001. After reviewing your application, we have decided that this fill is covered by General Water Quality Certification No. 3289 corresponding to the U.S. Army Corps of Engineers Nationwide Permit Number 14. 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. 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 which conforms to Chapter 150B of the North Carolina General Statutes to the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh, N.C. 27699-6714. This certification and its conditions are final and binding unless you ask for a hearing. 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) 919-733-1786 (phone), 919-733-6893 (fax), http://h2o.enr.state.nc.us/ncwetlands/ Page 2 of 2 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 919-733-1786. Sincerely, err T. Stevens Attachment cc: Wilmington District Corps of Engineers Corps of Engineers Raleigh Field Office NCDWQ Winston-Salem Regional Office Central Files File Copy 4o y /Ssv Ei) STATE of NORTH CAROLINA DEPARTMENT OF TRANSPORTATION MICHAEL F. EASLEY LYNDO TIPPET GOVERNOR SECRETARY May 3, 2001 SUBJECT: Davidson County - U-1767Y New Road High Point ,- Mr. John Domey NC Division of Water Quality 4401 Reedy Creek Raleigh, NC 27607 Dear Mr. Dorney, d } In an effort to obtain the necessary permits for the subject culvert placement, we are providing a pre-construction notification application with supporting documentation and $200 fee for the placement of a 36-inch pipe in Davidson County. There are no wetlands to be impacted and there will be 80 feet of intermittent stream impacts. We propose to construct a new road to ease existing and future traffic congestion. We believe this project can be accomplished under General Permit number 31. By copy of this letter, we are also seeking approval from the State Historic Preservation Office, the Corps of Engineers, the Fish and Wildlife Service and the NC Wildlife Resources Commission. Therefore, we are submitting the enclosed material to them. If you have any questions, comments or need additional information after reviewing this material, please contact me at (336) 761-2613. Thank you for your cooperation in this matter. Respectfully, Diane K Hampton, P.E. Division Environmental Engineer Enclosures CF: Mr. Pat Ivey, PE., Division Engineer Mr. John Rhyne, E.I.T., Assistant District Engineer File 01 0699 PAYMENT RECEIVED Division of Highways • Division Nine • 2125 Cloverdale Avenue, Winston-Salem, NC 27103 Telephone (336) 761-2613 • Fax (336) 761-2606 • Courier Box 13-12-04 Office Use Only: Form Version April 2001 USACE Action ID No. DWQ No. 01069 9 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: GP-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: ? H. Applicant Information Owner/Applicant Information Name: NC Department of Transportation - Division 9 Mailing Address: 2125 Cloverdale Ave. Winston-Salem, NC 27055 Telephone Number: 336-761-2613 E-mail Address: 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: Diane Hampton, PE, DEO Company Affiliation: NCDOT - Division 9 Mailing Address: 2125 Cloverdale Ave. Winston-Salem NC 27055 Telephone Number: 336-761-2613 Fax Number: 336-761-2606 E-mail Address: dkhampton@dot state nc us Fax Number: 336-761-2606 Page 3 of 12 M. 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: U-1767Y New Road -High Point 2. T.I.P. Project Number (NCDOT Only): N/A 3. Property Identification Number (Tax PIN): N/A 4. Location County: Davidson Nearest Town: High Point Subdivision name (include phase/lot number): N/A Directions to site (include road numbers, landmarks, etc.): Take Hwy 311 south from Winston Salem to High Point Take N Main Street exit turn right and go approx. 0.2 miles to the next left onto Hedgecock Rd Go approx. 0 5 miles and the road will be on the right next to a new soccer complex 5. Site coordinates, if available (UTM or Lat/Long): 36°00' 19.7" N 80°02'30.3" 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: Suburban road site next to soccer complex. 7. Property size (acres): 8. Nearest body of water (stream/river/sound/ocean/lake): Unnamed Tributary to Trib. To Rich Fork Creek 9. River Basin: Yadkin (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.ne.us/admin/mgps /.) Page 4 of 12 10. Describe the purpose of the proposed work: to place culvert for construction of new road. 11. List the type of equipment to be used to construct the project: standard construction equipment including a trackhoe 12. Describe the land use in the vicinity of this project: suburban / city sports complex 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 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. 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 Page 5 of 12 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 Site Number (indicate on ma) Type of Impact* Area of Impact (acres) Located within 100-year Floodplain** (yes/no) Distance to Nearest Stream (linear feet) Type of Wetland*** N/A rn * List each impact separately and identify temporary impacts. impacts include, but are not imutea to: mechanized cteutmg, giauuig, iui, excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both 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 maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or online at htty:/hvtivw.fema.gov. *** 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: Total area of wetland impact proposed: 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? (please scify) 1 Culvert 80 ITT. To Rich Fork Ck 2 Intermittent ==r -ter List each impact separately and identity temporary impacts. impacts include, ouL are not uuuicu to: ?uivelLs WIG .-C-CU 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 ,N-tiv.usgs.gov. Several internet sites also allow direct download and printing of USGS maps (e.g., ww,w.toDoozone.com, www.map_.Ic uest.com, etc.). Cumulative impacts (linear distance in feet) to all streams on site: 80 feet Page 6 of 12 3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any other Water of the U. S. Open Water Impact Site Number (indicate on ma) Type of Impact* Area of Impact (acres) Name of Waterbody (if applicable) Type of Waterbody (lake, pond, estuary, sound, bay, ocean, etc.) N/A * List each impact separately and identify temporary nnpacts. Impacts include, but are not unutea to: 1111, exUavauvu, iucuguiy, flooding, drainage, bulkheads, etc. 4. Pond Creation N/A 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.): 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. The new road is being constructed to relieve existing roads of congestion and traffic due to the newly constructed 1000+ home subdivision nearby and a new soccer complex constructed by the City of High Point The road follows high ground to the maximum extent possible and crosses a small intermittent draw at one point A 36-inch culvert will be placed (partially buried) to allow the flow to pass All efforts to insure erosion control and to minimize the placement of rip rap will be made Natural materials will be used to stabilize the banks where possible. Construction will be completed in a timely fashion to not upset the natural community. Page 7 of 12 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 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 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. N/A Page 8 of 12 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 http://h2o.enr.state.nc.us/Nvrp/index.htm. If use of the NCWRP is proposed, please check the appropriate box on page three and provide the following information: IX. 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): Environmental Documentation (DWQ Only) Does the project involve an expenditure of public funds or the use of public (federal/state/local) land? Yes ® No ? X. 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 (919) 733-5083 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 ? 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 (Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please identify )? Page 9 of 12 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. Zone* Impact (square feet) Multiplier Required Miti tion 1 3 2 1.5 Total * Zone 1 extends out 30 feet perpendicular trom near banr, oI cnannei; Gone / extenas 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. N/A XH. 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 XHI. 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 Page 10 of 12 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). 5- 2 Applicant/Agent's Signature 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 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: (828) 271-4854 Caldwell Haywood McDowell Swain Fax: (828) 271-4858 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: (919) 876-8441 Davidson Guilford Person Warren Fax: (919) 876-5283 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: (252) 975-1616 Chowan Hertford Pasquotank Fax: (252) 975-1399 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: (910) 251-4511 Columbus Moore Sampson Pitt Tyrrell Washington Wayne Union Watauga Yancey Wilson Yadkin *Croatan National Forest Only Page 11 of 12 w LL. uNno?- - - - - abO?iin? 1° -i'- - - I- - - - --------a I i I ? i ?? $ ZI • $I / ?I I ro• 9Z' 60' 11 I O'LO• \ I jFj \ I Z I J H i ` I I ?I / I / I 1 ?I I 1 / I l I ?s. ° / s2 n I ' - I _ I 1 ° m I ? •" I ? /dam nl I I / 0D 1 o_ ?I El N ,It d N/ g ! 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T la ?l m rZI rGI d13 V . 4J f__. • \?, /s?j1111?N3?32-/J 300189 1003 888 6d - L711 9p aouclllV _leoocs -l.uowpold 'oul 'uol-I-oloossd .?ulod U61N 888 bd - L511 4p aoucllly -IOoocs •4-uowpalcJ •oul uoj-Ploossd 4.ulod U61H I??G )11sV3d. 431V0112i80J.bZ ._.. see 6d - Lsu 4p aourllly _leooc? .{ Uowpalcl •oul •uol-ploossd -l-ulod U61H la ' dWJ.Sl 10 .. k. 6 Office Use Only: ® 1 U 6 g onn 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. I. Processing 401 iSSlIED 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: GP-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: ? H. Applicant Information 1. Owner/Applicant Information Name: NC Department of Transportation - Division 9 Mailing Address: 2125 Cloverdale Ave. Winston-Salem NC 27055 Telephone Number: 336-761-2613 E-mail Address: 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: Diane Hampton PE DEO Company Affiliation: NCDOT - Division 9 Mailing Address: 2125 Cloverdale Ave. Winston-Salem NC 27055 Telephone Number: 336-761-2613 Fax Number: 336-761-2606 E-mail Address: dkhampton e dot state nc us Fax Number: 336-761-2606 Page 3 of 12 PAY M -ENT RECEIVED •r . a M. 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: U-1767Y New Road - High Point 2. T.I.P. Project Number (NCDOT Only): N/A 3. Property Identification Number (Tax PIN): N/A 4. Location County: Davidson Nearest Town: High Point Subdivision name (include phase/lot number): N/A Directions to site (include road numbers, landmarks, etc.): Take Hwy 311 south from Winston Salem to High Point Take N Main Street exit turn right and go approx. 0.2 miles to the next left onto Hedgecock Rd Go approx 0.5 miles and the road will be on the right next to a new soccer complex 5. Site coordinates, if available (UTM or Lat/Long): 36°00'19.7" N 80°02'30.3" 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: Suburban road site next to soccer complex. 7. Property size (acres): 8. Nearest body of water (stream/river/sound/ocean/lake): Unnamed Tributary to Trib. To Rich Fork Creek 9. River Basin: Yadkin (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.ne.us/admin/maps/.) Page 4 of 12 10. Describe the purpose of the proposed work: to place culvert for construction of new road. 11. List the type of equipment to be used to construct the project: standard construction equipment includi_ng_ a trackhoe 12. Describe the land use in the vicinity -of this project: suburban/ city sports complex 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 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. 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 Page 5 of 12 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 Site Number (indicate on ma) Type of Impact* Area of Impact (acres) Located within 100-year Floodplain** (es/no) Distance to Nearest Stream (linear feet) Type of Wetland*** N/A * List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mecnamzed clearing, graautg, iui, excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both 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 maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or online at http://utivw.fema.gov. *** 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: Total area of wetland impact proposed: 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? (please sc' ) 1 Culvert 80 UT. To Rich Fork Ck 2 Intermittent List each impact separately and identify temporary impacts. impacts include, out are not arruteu to: culverts and aaavcaatw 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. x * 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 usgs.gov. Several internet sites also allow direct download and printing of USGS maps (e.g., wwtiv.topozone.com, wi%vv.mapdt uest.com, etc.). Cumulative impacts (linear distance in feet) to all streams on site: 80 feet Page 6 of 12 Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any other Water of the U. S. Open Water Impact Site Number (indicate on ma) Type of Impact* Area of Impact (acres) (if Name of applicable) Waterbody Type of Waterbody (lake, pond, estuary, sound, bay, ocean, etc.) N/A * List each impact separately and identify temporary unpacts. impacts mctude, but are not Imutea to: im, excavauon, weuguig, flooding, drainage, bulkheads, etc. 4. Pond Creation N/A 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.): 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. The new road is being constructed to relieve existing; roads of congestion and traffic due to the newly constructed 1000+ home subdivision nearby and a new soccer complex constructed by the Cif of High Point The road follows high ground to the maximum extent possible and crosses a small intermittent draw at one point A 36-inch culvert will be placed (partially buried) to allow the flow to pass All efforts to insure erosion control and to minimize the placement of rip rap will be made Natural materials will be used to stabilize the banks where possible. Construction will be completed in a timely fashion to not upset the natural community. Page 7 of 12 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 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/newetlands/strmgide.html. 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. Page 8 of 12 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 http://h2o.enr.state.nc.us/«-rp/index.litm. 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 (919) 733-5083 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 )? Page 9 of 12 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. Zone* Impact (square feet) Multiplier Required Miti gation 3 2 1.5 Total * Zone 1 extends out 30 feet perpendicular from near bate: of cnannei; Lone G emenus 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. XH. 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 XIII. 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 Page 10 of 12 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). Applicant/Agent's Signature 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 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: (828) 271-4854 Caldwell Haywood McDowell Swain Fax: (828) 271-4858 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: (919) 876-8441 Davidson Guilford Person Warren Fax: (919) 876-5283 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: (252) 975-1616 Chowan Hertford Pasquotank Fax: (252) 975-1399 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: (910) 251-4511 Columbus Moore Sampson Pitt Tyrrell Washington Wayne Union Watauga Yancey Wilson Yadkin *Croatan National Forest Only Page 11 of 12 - ...... ...... ........ - - - - - --? I i i ?I I I -? I - I ez roO G0 eo 11 !•-. ? i ?I ?I I Z i .? I • ? N i ? I I 1 I 1 ? I ?a, nI I i o2 I ? I / /v I I i - at I I ?, / I _Ol ? i I Oln EI' ? I I I? I I, I I I I N _ ? e I I R .1< y? I N o I ? I s, . I / ?I I w z O Q i?Z G" O Qa 1 Q N Z Z O Z Q Q d ? on N U z 0 J 0 C O ?- o z Q Q V o Z O Q g V 0 Q U 0 Z W M? ? ® W Z z -1 w g> p m O Q v w Z Q = c ® O LL f- Z D W U O Z Z Z O Q ? w O N z? m ??o ?- Q FO U- ; 0 a oz= W = z F?- _ (7 Q 4J = W LL p Q O to w z U- 0 H 1 O o e _ ? ^ f e f?rt f ? ? {` lam ??? \ M4` O-A • ??'r ? ti. c;/ --?-??,?? `??' _! f.V-" \ '\\ ? rat..-? 'I'"? '-..-. e ? .? ? ? "0+4:,3:/•^-`?`-`.?. - j'? may, ,._. ??/-? ? v/. LLJ ci L ) =rf? Ly ?•.? i i'? J O 04 a W c) c cl U) DI 15' CMP DI High Point Association, Inc. Pledmont _Soccer Alliance db 1157 - pg 888 DI 24'-CORRUGATED PLASTIC High Point Association, Inc. Pledmont 50CCal- Alliance db 1157 - P9 888 EIP _ 112' 1211 ?Q In N G z z 90' 4 CURVE TAPER w 3 o Z 36o4oir " High Point Association, Inc. R Piedmont Soccer- Alliance El _ db 1157 - pg 888 N87415>5-W I Nr /• "? !\." FOOT BRIDGE CREEK j? q?\ John D.Swartzbaugh & wf Patricia L. db 1081 pg 1276 Sccleo- 601 R 50` \\ ?BRCp EIP \ w iv \ k \ \\\ ?1 /wv wv (D of \ \ / L7 LIGHT DI v \-? ISF OFFICE \ / VP WO VI i \ f N W !Rf FENCe Nag^S6-l6'W t .C Office Use Only: Form Version April 2001 USACE Action ID No. DWQ No. 01 0 6 9 9 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: GP-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: ? H. Applicant Information 1. Owner/Applicant Information Name: NC Department of Transportation - Division 9 Mailing Address: 2125 Cloverdale Ave. Winston-Salem NC 27055 Telephone Number: 336-761-2613 Fax Number: 336-761-2606 E-mail Address: 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: Diane Hampton PE DEO Company Affiliation: NCDOT - Division 9 Mailing Address: 2125 Cloverdale Ave. Winston-Salem, NC 27055 Telephone Number: 336-761-2613 Fax Number: 336-761-2606 E-mail Address: dkhampton e dot state nc us PAYMENT Page 3 of 12 RECEIVED . ik M. 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: U-1767Y New Road - Hi hg Point 2. T.I.P. Project Number (NCDOT Only): N/A 3. Property Identification Number (Tax PIN): N/A 4. Location County: Davidson Nearest Town: High Point Subdivision name (include phase/lot number): N/A Directions to site (include road numbers, landmarks, etc.): Take Hwy 311 south from Winston Salem to High Point Take N Main Street exit turn right and go approx. 0.2 miles to the next left onto Hedgecock Rd Go approx 0 5 miles and the road will be on the right next to a new soccer complex 5. Site coordinates, if available (UTM or Lat/Long): 36°00'19.7" N 80°02'30.3" 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: Suburban road site next to soccer complex. 7. Property size (acres): 8. Nearest body of water (stream/river/sound/ocean/lake): Unnamed Tributary to Trib. To Rich Fork Creek 9. River Basin: Yadkin (Note - this must be one of North Carolina's seventeen designated major river basins. The s/.) River Basin map is available at http://h2o.enr.state.ne.us/admin/map Page 4 of 12 10. Describe the purpose of the proposed work: to place culvert for construction of new road. 11. List the type of equipment to be used to construct the project: standard construction equipment including a trackhoe 12. Describe the land use in the vicinity of this project: suburban / city sports complex 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 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 Page 5 of 12 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 Site Number (indicate on ma) Type of Impact* Area of Impact (acres) Located within 100-year Floodplain** (es/no) Distance to Nearest Stream (linear feet) Type of Wetland*** N/A * List each impact separately and identify temporary impacts. Impacts include, but are not lmuted to: mechanized cleanng, grading, fill; excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both stricture 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 maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or online at httv//wti,.,v.fema.sov. *** 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: Total area of wetland impact proposed: 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? (please sc' ) 1 Culvert 80 UT. To Rich Fork Ck 2 Intermittent d ted List each impact separately and identify temporary impacts. Impacts mclude, but are not lmuted to. culverts an assocra np-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 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 wlvw.usgs.gov. Several intemet sites also allow direct download and printing of USGS maps (e.g., wytiv.topozone.com. Nv,rw.mapquest.com, etc.). Cumulative impacts (linear distance in feet) to all streams on site: 80 feet Page 6 of 12 3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any other Water of the U.S. Open Water Impact Site Number (indicate on ma) Type of Impact* Area of Impact (acres) Name Wate) (if applicable) Type of Waterbody (lake, pond, estuary, sound, bay, ocean, etc.) N/A * List each impact separately and identify temporary impacts. impacts include, but are not ii tea to: um, excavauun, wcugmg, flooding, drainage, bulkheads, etc. 4. Pond Creation N/A 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.): 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. The new road is being constructed to relieve existing roads of congestion and traffic due to the newly constructed 1000+ home subdivision nearby and a new soccer complex constructed by the City of High Point The road follows high ground to the maximum extent possible and crosses a small intermittent draw at one point A 36-inch culvert will be placed (partially buried) to allow the flow to pass All efforts to insure erosion control and to minimize the placement of rip rap will be made Natural materials will be used to stabilize the banks where possible. Construction will be completed in a timely fashion to not upset the natural community. Page 7 of 12 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 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/ncwetiands/strmgide.html. 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. Page 8 of 12 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 http://h2o.enr.state.nc.usl-vv /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 (919) 733-5083 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 (Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please identify )? Page 9 of 12 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. Zone* Impact (square feet) Multiplier Required Mitigation 1 3 2 1.5 Total * Gone 1 extends out 30 teet peipencticutar from near uanx of cnannei; cone /_ exienuzi 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. N/A XH. 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 X1H. 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 Page 10 of 12 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). Applicant/Agent's Signature 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 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: (828) 271-4854 Caldwell Haywood McDowell Swain Fax: (828) 271-4858 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: (919) 876-8441 Davidson Guilford Person Warren Fax: (919) 876-5283 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:. (252) 975-1616 Chowan Hertford Pasquotank Fax: (252) 975-1399 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: (910) 251-4511 Columbus Moore Sampson Pitt Tyrrell Washington Wayne Union Watauga Yancey Wilson Yadkin *Croatan National Forest Only Page 11 of 12 p w LL. ALNno.j_ - adojiin0 ?o - - ---1--- - • - - -•-•--? I i ?I I I 1 i .. I • I i ,\ I I ^ 1 ?I $ zl • $I ? ez• 1 ?I I? m• Vz' 60' I l • I nl F-• ?;?I ?I ?• I I I ? J H 1 ? I d °z • ? I J I i I P . V '. I C 4 ; I / I / ?I I 1 ? I rP• nl I I Pa I - ' I ? 1 I • ' ?I $I i " i t c I ? I I I o m I 1 ?'• ? I n ? ?d5 l I I 1 - of / 0 h S3 I 1y I I I ol• el? ??? I I?eo frhI ? I Ell 01? I I ?. I I I 1? 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"oul 'uol+oloossV 4-ulod L451H ICI dWJ.51 10 ?OM ,of d 888 6d - L911 qP aouc111V -Iea,:?cs +uowPald •oui •uol-?oloossd 4-ulod u61H `` 17 ,,9? _ ?71sd7d a?v?n?ao??6a = -==o ??sod ova la 888 6d - LSII qP aouo111V -18ooc,5 .I.uowpold •ou1 'uo1..?D1Oossd 4-ulod IAH Office Use Only: Form Version April 2001 USACE Action ID No. DWQ No. 010699 If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than leaving the space blank. d 1. Processing" .z? 1. Check all of the approval(s) requested for this project: ® Section 404 Permit *111'- 9nol , 4?- ? Section 10 Permit ® 401 Water Quality Certification ? Riparian or Watershed Buffer Rules 2. Nationwide, Regional or General Permit Number(s) Requested: GP-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: ? H. Applicant Information 1. Owner/Applicant Information Name: NC Department of Transportation - Division 9 Mailing Address: 2125 Cloverdale Ave. Winston-Salem NC 27055 Telephone Number: 336-761-2613 Fax Number:-336-761-2606 E-mail Address: 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: Diane Hampton, PE, DEO Company Affiliation: NCDOT Division 9 Mailing Address: 2125 Cloverdale Ave. Winston-Salem NC 27055 Telephone Number: 336-761-2613 Fax Number: 336-761-2606 E-mail Address: dkhampton@dot state nc us PAYMENT RECE1 VED Page 3 of 12 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: U-1767Y New Road - Hi hg Point 2. T.I.P. Project Number (NCDOT Only): N/A 3. Property Identification Number (Tax PIN): N/A 4. Location County: Davidson Nearest Town: High Point Subdivision name (include phase/lot number): N/A Directions to site (include road numbers, landmarks, etc.): Take Hwy 311 south from Winston Salem to High Point Take N Main Street exit turn right and go approx. 0.2 miles to the next left onto Hedgecock Rd Go approx 0.5 miles and the road will be on the right next to a new soccer complex 5. Site coordinates, if available (UTM or Lat/Long): 36000'19.7"N 80°02'30.3" 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: Suburban road site next to soccer complex. 7. Property size (acres): 8. Nearest body of water (stream/river/sound/ocean/lake): Unnamed Tributary to Trib. To Rich Fork Creek 9. River Basin: Yadkin (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.ne.us/admin/maps/.) Page 4 of 12 10. Describe the purpose of the proposed work: to place culvert for construction of new road. 11. List the type of equipment to be used to construct the project: standard construction equipment including a trackhoe 12. Describe the land use in the vicinity of this project: suburban / city sports complex 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 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. 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 Page 5 of 12 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 Site Number (indicate on ma) Type of Impact* Area of Impact (acres) Located within 100-year Floodplain** (es/no) Distance to Nearest Stream (linear feet) Type of Wetland*** N/A rn * List each impact separately and identify temporary impacts. impacts include, but are not imutea to: mecnamzeu cteatmg, gtauutg, Iu1, excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both 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 maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or online at htty://w-,vw.fema.Rov. *** 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: Total area of wetland impact proposed: 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? (please scify) 1 Culvert 80 UT. To Rich Fork Ck 2 Intermittent * List each impact separately and identity temporary impacts. impacts mciuae, out are nut nnuiCU w. cu1VCILJ c LL aZsVV1"- -F-.may, 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 ww%v.usas.aov. Several intemet sites also allow direct download and printing of USGS maps (e.g., wutiv.topoozone.com, w,\ztiv.mapquest.com, etc.). Cumulative impacts (linear distance in feet) to all streams on site: 80 feet Page 6 of 12 3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any other Water of the U. S. Open Water Impact Site Number (indicate on ma) Type of Impact* Area of Impact (acres) Name Wate) ( applicable) Type of Waterbody (lake, pond, estuary, sound, bay, ocean, etc.) N/A * List each impact separately and identify temporary impacts. Impacts include, but are not limited to: till, excavation, dredging, flooding, drainage, bulkheads, etc. 4. Pond Creation N/A 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.): 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. The new road is being constructed to relieve existing roads of congestion and traffic due to the newly constructed 1000+ home subdivision nearby and a new soccer complex constructed by the City of High Point The road follows high ground to the maximum extent possible and crosses a small intermittent draw at one point A 36-inch culvert will be placed (partially buried) to allow the flow to pass All efforts to insure erosion control and to minimize the placement of rip rap will be made Natural materials will be used to stabilize the banks where possible. Construction will be completed in a timely fashion to not upset the natural community. Page 7 of 12 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 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. 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. Page 8 of 12 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 http://h2o.enr.state.nc.us/-vvm/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 (919) 733-5083 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 (Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please identify )? Page 9 of 12 Yes ? No N 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. Zone* Impact (square feet) Multiplier Required Mitigation 1 3 2 1.5 Total * Zone 1 extends out 30 feet perpendicular from near oamc of cnannei; zone z exienus 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. N/A XH. 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 N Is this an after-the-fact permit application? Yes ? No N Page 10 of 12 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). Applicant/Agent's Signature r 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 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 Cabamzs Graham Madison Stanley Telephone: (828) 271-4854 Caldwell Haywood McDowell Swain Fax: (828) 271-4858 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: (919) 876-8441 Davidson Guilford Person Warren Fax: (919) 876-5283 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: (252) 975-1616 Chowan Hertford Pasquotank Fax: (252) 975-1399 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: (910) 251-4511 Columbus Moore Sampson Pitt Tyrrell Washington Wayne Union Watauga Yancey Wilson Yadkin *Croatan National Forest Only Page 11 of 12 C w uNno:j- _ - - - abojimo - - -- ---?--- ------ - -? 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