20011090 Ver 1_Complete File_20010716

r State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality ? FAA
ILF! •
Michael F. Easley, Governor
William G. Ross, Jr., Secretary NORTH CAROLINA DEPARTMENT OF
Gregory J. Thorpe, Ph.D., Acting Director 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 contact John Hennessy at 919-733-5694, or Deborah Sawyer at 252-
946-6481.
Sincerely,
1?-

c:\ncdot\SR 1133\wqc\011088wgc.doc
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
1 1TkWT;WAA •
Michael F. Easley, Governor NC ENR
William G. Ross, Jr., Secretary NORTH CAROLINA DEPARTMENT OF
Gregory J. Thorpe, Ph.D., Acting Director ENVIRONMENT AND NATURAL RESOURCES
August 1, 2001
Camden County
DWQ Project No. 011088
APPROVAL for 401Water Quality Certification
Mr. Don R. Conner, P.E. Division Engineer
NCDOT, Division 1
PO Box 850
Edenton, NC 27932
Dear Mr. Conner:
You have our approval, as described in your application dated July 12, 2001 and in accordance with the
attached conditions and those listed below, to place fill material in 0.0429 acres of wetlands and 10 linear,;
feet of streams: for the purpose of paving and widen ng SR 1133 in Camdeti County. The projea should be:
constructed to accordance with your application dated July 12, 2001. After reviewing your application,.we.
have decided. that this fill is covered by General Water. Quality Certification Number 3106. This
certification corresponds to the Nationwide Permit Number 18 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 when the accompanying 404 permit expires unless otherwise
specified in the General 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). ). This approval shall
expire with the corresponding Nationwide Permit expires or as otherwise provided in the General
Certification. For this approval to be valid, you must follow the conditions listed in the attached
certification and any additional conditions listed below.
1.) Upon completion of the project, the NCDOT shall complete and return 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, which conforms to Chapter 150B of the North Carolina General Statutes to the Office of
Administrative Hearings, P.O. Box 27447, Raleigh, N.C. 27611-7447. This certification and its conditions
are final and binding unless you ask for a hearing.
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
e??
Michael F. Easley, Governor NC ENR
William G. Ross, Jr., Secretary NORTH CARouNA DEPARTMENT OF
Gregory J. Thorpe, Ph.D., Acting Director ENVIRONMENT AND NATURAL RESOURCES
GENERAL CERTIFICATION FOR PROJECTS ELIGIBLE
FOR CORPS OF ENGINEERS
NATIONWIDE PERMIT NUMBER 18 (MINOR DISCHARGES)
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
Regulations in 15A NCAC 2H, Section .0500 and 15A NCAC 213 .0200 for the discharge of fill material to
navigable waters and adjacent wetland areas tributary to interstate waters or navigable waters of the United
States (i.e., isolated wetlands) as described in 33 CFR 330 Appendix A (B) (18). This certification replaces
Water Quality Certification Number 2669 issued on January 21, 1992 and Water Quality Certification '
Number 2733 issued on May 1, 1992. This WQC is rescinded when the Corps of Engineers reauthorize
Nationwide Permit 18 or when deemed appropriate by the Director of 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. Activities authorized by this Nationwide Permit require written concurrence from the Division of
Water Quality;
2. That appropriate sediment and erosion control practices which equal or exceed those outlined in the
most recent edition of the "North Carolina Erosion and Sediment Control Planning and Design
Manual" or the "North Carolina Surface Mining Manual" (available from the Division of Land
Resources in the DEHNR Regional or Central Offices) are utilized to prevent violations of the
appropriate turbidity water quality standard (50 NTUs in streams and rivers not designated trout
waters by DWQ; 25 NTUs in all saltwater classes, and all lakes and reservoirs; and 10 NTUs in trout
waters);
3. All sediment and erosion control measures placed in wetlands or waters shall be removed and the
natural grade restored after the Division of Land Resources has released the project;
4. If an environmental document is required, this Certification is not valid until a FONSI or ROD is
issued by the State Clearinghouse;
5. This Certification shall not be used in conjunction with the Certification for Nationwide Permit 14 to
create high ground for road access;
6. Deed restrictions must be placed on all remaining wetlands on the parcel after appropriate use of this
and other Certifications. DWQ shall be sent copies of all deed restrictions applied to this parcel. If
this condition is not met, written DWQ approval is needed to utilize this General Certification (and
Nationwide Permit);
Wetlands/401 Unit 1621 Mail Service Center Raleigh, North Carolina 27699-1621
Telephone [phone] FAX [phone]
An Equal Opportunity Affumative 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 NCDENR
William G. Ross, Jr., Secretary NORTH CAROLINA DEPARTMENT OF
Gregory J. Thorpe, Ph.D., Acting Director ENVIRONMENT AND NATURAL RESOURCES
7. Measures shall be taken to prevent live or fresh concrete from coming into contact with waters of the
state until the concrete has hardened;
8. Concurrence from DWQ that this Certification applies to an individual project shall expire three
years from the date of the cover letter from DWQ.
Non-compliance with or violation of the conditions herein set forth by a specific fill project shall 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 or downstream waters are precluded.
Public. hearings maybe 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: 11 February 1997.
DIVISION OF WATER QUALITY
By
A. Preston Howard, Jr. P.E. Director
WQC # 3106
Wetlands/401 Unit 1621 Mail Service Center Raleigh, North Carolina 27699-1621
Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/l0% 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
Gregory J. Thorpe, Ph.D., Acting Director
DWQ Project No.:
Applicant:
Project Name:
Date of Issuance of 401 Water Quality Certification:
4 •
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
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:
Agent's Certification
Date:
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 27699-1621
Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post consumer paper
Fit Copy K-
Wi
J :16
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY LYNDO TIPPETT
GOVERNOR SECRETARY
401 ASS
UE?
July 12, 2001
Washington Regulatory Field Office
US Army Corps of Engineers
Post Office Box 1000 0 1 10 9 0
Washington, NC 27889-1000
ATTENTION: Mr. Mike Bell, NCDOT Coordinator
SUBJECT: Request for Authorization of Road shoulder stabilization on SR 1217 in
Gates County under a Nationwide 18 Permit
The North Carolina Department of Transportation is planning increase the
pavement SR 1217 in Gates County, an already paved road, from 16 to 20 feet for safety
reasons. Shoulders will not be increased for the length of the project where it crosses
wetlands. Two pipes on this road will need to be replaced at an unnamed intermittent
tributary to the Hackley Swamp crossing. Although the pipe length will not be increased,
pipe diameter will be increased 12 inches to allow for pipe burial as a condition of
USACE nationwide permits for animal migration. Rip-rap will be placed around both
pipes road shoulder stabilization which will impact approximately 0.003 acres of
wetlands.
The NC DOT requests that this project be authorized under a NW 18 and DWQ
water quality certification. I have included a vicinity map, a PCN application form, a plat
and profile drawing, and a check to cover permitting fees. Please call me if you have any
questions.
Sincerely,
Don Conner, PE ?o
Division Engineer-Division One
Kristen Shacochis U
Division Environmental Officer
P.O. Box 850, Edenton, NC 27932 - Phone: [phone] Fax: [phone]
Cc: Mr. Tom McCartney, USFWS
Mr. DaNid Cox, NCWRC
Ms. Sarah Winslow, NCDNIF
Mr. Ron Sechler. NMFS
Mr. John Hennessy, NCDWQ
Ms. Gretchen Byrum, NCDOT
P.O. Box 850. Edenton, IBC 27932 - Phone: [phone] Fax: [phone]
Office Use Only: 011090 Form Version April 2001
USACE Action ID No. DWQ No.
If any particular item is not applicable to this project. please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
1. Processing
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: 18
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: 7
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: El
II. Applicant Information
1. Owner/Applicant Information
Name: Kristen Shacochis, NC DOT Environmental Officer
Mailing Address: P.O. Box 850 Edenton NC 27932
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: Kshacochis .,dot.state.nc.us
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory authority for the owner/applicant.)
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
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 MRCS 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: SR 1217 Gates
2. T.I.P. Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN):
4. Location
County: Gates Nearest Town: Gatesville
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.):
5. Site coordinates, if available (UTM or Lat/Long): N 36 28.940 W 76 47.526
(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:
rural
7. Property size (acres): Ni
8. Nearest body of water (stream/ fiver; sound/ocean/lake): Tributary to the Hacklgy Swamp
9. River Basin: Chowan
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http:. Wo.enr.state.nc.us/admin/maps/.)
Page 4 of 1'
10. Describe the purpose of the proposed work: To replace two 54-inch corrugated aluminum
pipes with two 66-inch x 51" x50' aluminum pipes. Add Class A rip-rap around pipes to
stabilize shoulder of road.
11. List the tvpe of equipment to be used to construct the project: bulldozer, dump trucks, front
end loader
12. Describe the land use in the Vicinity of this project: rural
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same 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.
none
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: none
VI. Proposed Impacts to Waters of the United StatesiWaters 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 `II 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
Noe 5 of 12
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
1. Wetland Impacts
Wetland Impact
Site Number
(indicate on map)
Type of Impact* Area of
Impact
(acres) Located nithin
100-year Floodplain**
(yes/no) Distance to
Nearest Stream Type of Wetland***
(linear feet)
1 & 2 Rip rap 0.003 Yep ? linear feet Forested wetland

I

List each impact separately and identify temporary impact-. Impacts include. but are not limited to: mecnanizea cieanng, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separatehy 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://www.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 Type of Impact*
(indicate on map) i Length of
Impact Stream Name**
(linear feet) Average Width
of Stream
Before Impact Perennial or
Intermittent?
(please specify)

1 & 2 Rip rap Tributary- of Hacklev
20 feet
Swamp
11 feet
Intermittent

i
I
i
I
* List each impact separately and identity temporary impacts. impacts tnciuue, out are not iimited to: culverts anu associateu np-rap,
dams (separately list impacts due to both srructure and i ooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap. crib wall, g:bions. etc.). excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint --or both the original and relocated streams must be included.
** Stream names can be found on USGS topographic snaps. If a stream has no name, list as LT (unnamed tributary) to the nearest
downstream named stream into which it .lows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.usgs.gov. Several intemet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.mapquest.com, etc.).
Page 6 of 12
Cumulative impacts (linear distance in feet) to all streams on site: 20 feet x 5 feet (100
square feet
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 map)
Type of Impact* Area of
Impact
(acres)
Name Waterbody
( applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.)

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, areagmg,
flooding, drainage, bulkheads, etc.
3. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): F] uplands E] 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 pavement of this road is to be widened from 16 feet across to 20 feet wide for safety
reasons In order to avoid wetlands only the will be increased fill will not be placed
within the wetlands for road shoulders. The old deteriorating pipes are to be replaced with pipes
the same length Each pipe will be 5.5 feet wider due to the condition requiring the pipes to be
buried a foot The only impact to wetlands and streams is the placement of Class A rip-rap
around the pipes for shoreline stabilization resulting in an increase of 0.003 acres of wetland
impacts
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
httl)://h2o.enr.state.nc.us/ncwetlands/strm,ide.htTnl.
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/wrp/index.htrn. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
IX. Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?
Yes No
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes E] 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 F-1 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
Page 9 of 12
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 )?
Yes F-1 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 i Required
i Multiplier
(square feet) Mitigation
1 3
2 1.5
Total
Lone 1 extenos out SU teet perpenatcular :rom near oanx of cnannei: cone _ extenus 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 watersy and wetlands
downstream from the property.
XII. 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.
Pase 10 of 12
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
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g.. draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
No constraints on this project.

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 Union
US Army Corps of Engineers Avery Clay Jackson Polk Watauga
151 Patton Avenue Buncombe Cleveland Lincoln Rowan Yancey
Room 208 Burke Gaston Macon Rutherford
Asheville, NC 28801-5006 Cabatrus Graham Madison Stanley
Telephone: [phone] Caldwell Haywood McDowell Swain
Fax: [phone] Catawba Henderson Mecklenburg Transylvania
Raleigh Regulatory Field Office Alamance Durham Johnston Rockingham Wilson
US Army Corps Of Engineers Alleghany Edgecombe Lee Stokes Yadkin
6508 Falls of the Neuse Road Ashe Franklin Nash Surry
Suite 120 Caswell Forsyth Northampton Vance
NC 27615
Raleigh Chatham Granville Orange Wake
,
Telephone: [phone] Davidson Guilford Person Warren
Fax: [phone] Davie Halifax Randolph Wilkes
Washington Regulatory Field Office Beaufort Currituck Jones Pitt
US Army Corps Of Engineers Bertie Dare Lenoir Tyrrell
Post Office Box 1000 Camden Gates Martin Washington
Washington, NC 27889-1000 Carteret* Green Pamlico Wayne
Page 11 of 12
Telephone: [phone] Chowan Hertford Pasquotaak
Fax: [phone] Craven Hvde Perquimans *Croatan National Forest Only
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fax: [phone] Cumberland :yew Hanover Scotland
US Fish and Wildlife Service /'\ational Marine Fisheries Service
US Fish and Wildlife Service US Fish and Wildlife Servic, National Marine Fisheries Service
Raleigh Field Office Asheville Field Office Habitat Conservation Division
Post Office Box 33726 160 Zillicoa Street Pivers Island
Raleigh, NC 27636-3726 Asheville, NC 23801 Beaufort, NC 28516
Telephone: [phone] Telephone: [phone] Telephone: [phone]
North Carolina State Agencies
Division of Water Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Telephone: [phone]
Fax: [phone]
Division of Water Quality
Wetlands Restoration Program
1619 Mail Service Center
Raleigh, NC 27699-1619
Telephone: [phone]
Fax: [phone]
State Historic Preservation Office
Department Of Cultural Resources
4617 Mail Service Center
Raleigh. NC 27699-4617
Telephone: [phone]
Fax: [phone]
CAMA and NC Coastal Counties
Division of Coastal Management Beaufort Chowan Hertford Pasquotank
1638 Mail Service Center Bertie Craven Hyde Pender
Raleigh, NC 27699-1638 Bruns-Mck Currituck New Hanover Perquimans
Telephone: [phone] Camden Dare Onslow Tyrrell
Fax: [phone] Carteret Gates Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator Alleghany Caldwell Watauga
3855 Idlewild Road Ashe Mitchell Wilkes
Kernersville, NC 27284-9180 Avery Stokes
Telephone: [phone] Burke Suzry
Mountain Region Coordinator Buncombe Henderson Polk
20830 Great Smoky Mtn. Expressway Cherokee Jackson Rutherford
Waynesville, NC 28786 Clay Macon Swain
Telephone: [phone] Graham Madison Transylvania
Fax: [phone] Haywood McDowell Yancey
Page 12 of 12

!- 414
} ?
t

-- .. ?? ^?• i`? ir-, fir. x.31'-.

f y a Gl' ° ? ? __- -

z
0
F
Q?

aQ
zap
-? z

a a x

U
z
Z L
Z '' a N ,;

Q U
??FOti
A
U?IAav?
J B Parter J 3 Parter
500 Rooks Rd 5C0 Rooks Rd
Gates, NC 27937 r ' Gates, NC 27937
}

?
-
pro e o 9I o o©o
2?;,,5 GdrS IXSD ?

$X 12-17
i ;
?r ; s7 3'?
1

9"j got;

I I
M H Buck I i Roger Lare
210 Mallory Buck Rd -'wy 37
NC 27937
mates
Gates, NC 27937 ,

NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
DM ION OF HIGHWAY
COUNTY: aTe3
PROJECT: 5R t zf 7 Jam'
S,
a/ A
,
-
1
J
DATE:
SUBJECT: Plan&X-sec SCALE:
SHEET: j of 3 _ ?0
14, 2 f 1"e3 66x 5-1 x r01
ie

To Re-.,A,
ko,,S klev

?rop'we ?1•ss
A?,o 91P
IF INCORRECT RETURN TO
NC DEPARTMENT OF TRANSPORTATION
DIVISION 0jQEEICEw.--_r.__r_,_.___-.,_,
--- X :492-7977
WARRANT NO. 7606
DATE 07/11/2001
INVOICE NUMBER INVOICE DATE INVOICE AMOUNT Nk .. ; NET AMOUNT
0711151213 07/11/2001 $200.00 $200.00
7 ,
t'u 4?