20010785 Ver 1_Complete File_20010524

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross, Jr., Secretary
Kerr T. Stevens, Director
1 ? •
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
June 15, 2001
Halifax County
DWQ Project No. 010783
APPROVAL OF 401 Water Quality Certification and ADDITIONAL CONDITIONS and Tar-
Pamlico River Buffer Rules
Mr. Jim Trogdon III, P.E., Division Engineer
NCDOT, Division 5
PO Box 3165
Wilson, North Carolina 27893
Dear Mr. Trogdon:
You have our approval, as described in your application dated May 21, 2001, and in accordance with the
attached conditions and those listed below, to place fill material at four sites for a total of 60 linear feet of
streams. The project's purpose is the widening and paving of SR 1609 from NC 48 to the end of the
SR1609 (total length approximately 0.881 miles) in Halifax County. The project should be constructed in
accordance with your application dated May 21, 2001. After reviewing your application, we have decided
that this fill is covered by General Water Quality Certification Number 3289. This certification corresponds
to the Nationwide Permit Number 14 issued by the Corps of Engineers. This approval is also valid for the
Tar-Pamlico River Buffer Rules (15A NCAC 2B .0259). 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. Stormwater shall be directed to sheetflow at nonerosive velocities through the protected stream buffers.
2. Upon completion of the project, the NCDOT shall complete and return the enclosed "Certification of
Completion Form" to notify DWQ when all work included in the 401 Certification has been completed.
The responsible party shall complete the attached form and return it to the 401/Wetlands Unit of the
Division of Water Quality upon completion of the project.
3. All authorized temporary impacts to the Tar-Pamlico Riparian buffers located outside the 115 feet of
culverted stream shall be restored to natural grade and revegetated with native tree species upon
completion of the project construction.
Wetlands/401 Unit 1621 Mail Service Center Raleigh, North Carolina 27699-1621
Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post consumer paper
State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross, Jr., Secretary
Kerr T. Stevens, Director
A
NC ENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RE50URCE5
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. 276 1 1-7447. This certification and its conditions
are final and binding unless you ask for a hearing.
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,
Attachment
cc: Wilmington District Corps of Engineers
Corps of Engineers Raleigh Field Office
DWQ Raleigh Regional Office
File Copy
Central Files
c:\ncdot\SR 1606\wqc\010783wgc.doc
Dy?
ptevens
Wetlands/401 Unit 1621 Mail Service Center Raleigh, North Carolina 27699-1621
Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post consumer paper
State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross, Jr., Secretary
Kerr T. Stevens, Director
DWQ Project No.:
Applicant:
Project Name:
Date of Issuance of 401 Water Quality Certification:
1 ITk?WAA ?
NC ENR
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
40UWetlands Unit, North Carolina Division of Water Quality, 1621 Mail Service Center, Raleigh, NC,
27699-1621. This form may be returned to DWQ by the applicant, the applicant's authorized agent, or the
project engineer. It is not necessary to send certificates from all of these.
Applicant's Certification
I, , hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to be built
within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the
approved plans and specifications, and other supporting materials.
Signature:
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
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 Registration No.
Date
Wetlands/401 Unit 1621 Mail Service Center Raleigh, North Carolina 27699-1621
Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post consumer paper
State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross, Jr., Secretary
Kerr T. Stevens, Director
1 09WAA •
NC ENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
11.This Certification shall be utilized for roads from natural high ground to natural high ground. The
Certification for Nationwide Permit 18 may not be used in conjunction with this Certification to create
high ground for road access;
12. If an environmental document is required, this Certification is not valid until a Finding of No Significant
Impact (FONSI) or Record of Decision (ROD) is issued by the State Clearinghouse. All water quality-
related conditions of the FONSI or ROD shall become conditions of this Certification;
13. That additional site-specific conditions may be added to projects proposed under this Certification in
order to ensure compliance with all applicable water quality and effluent standards;
14. When written concurrence is required, the applicant is required to use the enclosed "Certification of
Completion Form" to notify DWQ when all work included in the 401 Certification has been completed;
15. Concurrence from DWQ that this Certification applies to an individual project shall expire three years
from the date of the cover letter from DWQ or on the same day as the expiration date of the
corresponding Nationwide Permit 14 and Regional General Permit 198200031 whichever is sooner.
Non-compliance with or violation of the conditions herein set forth by a specific fill project may result in
revocation of this Certification for the project and may also result in criminal and/or civil penalties.
The Director of the North Carolina Division of Water Quality may require submission of a formal
application for individual certification for any project in this category of activity, if it is determined that the
project is likely to have a significant adverse effect upon water quality or degrade the waters so that existing
uses of the wetland, stream or downstream waters are precluded.
Public hearings may be held for specific applications or group of applications prior to a Certification
decision if deemed in the public's best interest by the Director of the North Carolina Division of Water
Quality.
Effective date: 1 June 2000
DIVISION OF WATER QUALITY
By
Kerr T. Stevens
Director
WQC # 3289
Wetlands/401 Unit 1621 Mail Service Center Raleigh, North Carolina 27699-1621
Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post consumer paper

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross, Jr., Secretary
Kerr T. Stevens, Director
09W,j
NC ENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
the physical integrity of the stream, but the applicant must provide written justification and any
calculations used to determine the extent of rip-rap coverage requested. If suitable stream mitigation is
not practical on-site, then stream impact will need to be mitigated elsewhere;
Impacts to any stream length in the Neuse, Tar-Pamlico and Randleman River Basins requires written
concurrence from DWQ in accordance with 15A NCAC 213.0233, 15A NCAC 2B .0259 and .0250 and
15A NCAC 2H .0500. New development activities located in the protected 50-foot wide riparian areas
(whether jurisdictional wetlands or not) within the Neuse, Tar-Pamlico and Randleman River Basins
shall be limited to "uses" identified within and constructed in accordance with 15A NCAC 2B .0233,
15A NCAC 213 .0259 and .0250. All new development shall be located, designed, constructed, and
maintained to have minimal disturbance to protect water quality to the maximum extent practicable
through the use of best management practices. Activities listed as "exempt" from these rules do not need
to apply for written concurrence under this Certification;
Placement of culverts and other structures in waters, streams, and wetlands must be placed below the
elevation of the streambed to allow low flow passage of water and aquatic life unless it can be shown to
DWQ that providing passage would be impractical. Design and placement of culverts and other
structures including temporary erosion control measures shall not be conducted in a manner that may
result in dis-equilibrium of wetlands or stream beds or banks, adjacent to or upstream and down stream
of the above structures. The applicant is required to provide evidence that the equilibrium shall be
maintained if requested in writing by DWQ. Additionally, when roadways, causeways or other fill
projects are constructed across FEMA-designated floodways or wetlands, openings such as culverts or
bridges must be provided to maintain the natural hydrology of the system as well as prevent constriction
of the floodway that may result in destabilization of streams or wetlands;
7. If this Certification is used to access building sites, all lots owned by the applicant must be buildable
without additional fill beyond that allowed under other General Certifications. Deed restrictions must be
placed on the remaining wetlands and streams on these lots to restrict future wetland and stream fill.
DWQ shall be sent copies of all deed restrictions applied to these lots;
That appropriate sediment and erosion control practices which equal or exceed those outlined in the
most recent version of the "North Carolina Sediment and Erosion Control Planning and Design Manual"
or the "North Carolina Surface Mining Manual" whichever is more appropriate (available from the
Division of Land Resources (DLR) in the DENR Regional or Central Offices) shall be in full
compliance with all specifications governing the proper design, installation and operation and
maintenance of such Best Management Practices in order to assure compliance with the appropriate
turbidity water quality standard;
9. All sediment and erosion control measures placed in wetlands or waters shall be removed and the natural
grade restored within two months after the Division of Land Resources has released the project;
10. Measures shall be taken to prevent live or fresh concrete from coming into contact with waters of the
state until the concrete has hardened;
Wetlands/401 Unit 1621 Mail Service Center Raleigh, North Carolina 27699-1621
Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post consumer paper
State of North
Carolina
Department Of
and Natural Environment
Division of a' Resources _
Water Quality •
Michael F. Easley, G. Ross Governor
Kerr T. Stevens Jr., Secretary
Director CD
ROAD NORTH CAROLINA DEP
ELIGIB CROSSING CERTIFI ENVIRONMENT
CATION AND NATURARrMENr OF
LE FOR CORPS OF GENERAL
CROSSINGS) R PS OF LGINEE CERTIFICATION RESOURCES
GENERAL p TION?WIDE pERrVIT FOR PROJECTS
PAMLICO?IVD ERMIT 19820003 AND U
This Genera! LEMAN BUFF AD
Certification is issued in confor • BER 14 (RO
500 and 95-217 of the ER RULES NEUS TAR.
Regulations in 1Sq NC United States and subjects o the the requirements of Section 401 Public Laws 92
and wetland 2H, Section .0500 North Carolina Division
regulations areas as and 15A NCAC
(i e "Nationwide p scribed in 33 CFR 330 q 2B .02 °f Water
-Pamlico ermit No 00 Quality (DWQ)
activities and Randleman Buffer 14 and Regional pendix q (B) (14) of the C ge of fill
shall include le Rules General Per material to
TarThis Certification replaces any fill activity (15A NCAC 2B . Permit 198200031) rps of Engineers
places Water y for road crossing 0233' '0259 and . and for the
Quality Certification Qualit g and is ][ 0250). The case Neuse,
issued Number Y Certification noted to fill less than one_ gory of
on May ], 1992 and umber 2666 issued on January 2Number 2177 ' third
u'QC is rescinded , 1992 tssued on November 5 °f an acre.
Permit 14 or Regional when the Corps Quality Certification Number 3103 - 1987
ps of En i Quality Certification Nu 'Water
General Permit 19 neers 1e authorizes Issued on February mber 2732
The State when dee Nationwide 11, 1997.
of North Carolina certifies that the s med a This
Portions of Sections 301 ppropriate by the Director
accordance with the conditions pecified cate of the DWQ. , 302 303, 306 and 307 of the Public Laws °faws activity will not violate
hereinafter set forth. t 9
Conditions of Certification: 2_500 and 95_ applicable
217 if conducted in
1• Proposed fill or substantial
Certification re modification
quires application to and of wetlands or
2• In prior written conct,ers (including streams)
accordance with under this
Water North rrence from the Division of General
Qualit Carolina General Statute Section 143-
Y Certification must include the a Water Quality;
one payment to both agencies shall cl submitted fee. If a .D(e), an
3• In mitted and higher Project also requires tion fora 401
accordance with 15q NC AC be the hi quires a
streams and/or AC 2H .0506 gher of the two fees; CAMA Permit,
Rules in a Wetlands. In addition, (h) c°m
ffect at the time of application. Aensator
requirements shall be nvtigation may mitigation may be re
A Bete may be required for an gect for Impacts to
as and g protocols from D wetland with Buffer minati
required in those ??'Q shall be Nationwide Permit and stream miti
protocols; followed and . The gallon
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be constructed ' existin
stream deli plan must be included
stabilized. Ve in the dry and g channel, to the gns should include the the 401
With
dimensions,
water shall not be turned into the new xtent channel until the same
include establishment getation of used for bank stabilization shall be li practical. The eW channel should
sides of the relocated channeo to?he
fiber and wooded and an ad' to native
Wetlands/401 ide mitt 2 banks are
seedling maxima Jacen 2p woody species, and should
establishment is m extent foot wide vegetated buffer on both
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PPortunity Affirmative Action E FAX Raleigh, North Carolina
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SSVED_ s
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY LYNDO TIPPETT
GOVERNOR SECRETARY
May 21, 2001
U.S. Army Corps of Engineers
Raleigh Regulatory Field Office
6508 Falls of the Neuse Road, Suite 120 y
Raleigh, NC 27609
J
Attention: Mr. Eric Alsmeyer
NCDOT Coordinator
Subject: Secondary road improvements to SR 1609 from NC 48 to end of road in
Halifax County. State Project No. 6.302069T.
The North Carolina Department of Transportation (NCDOT) proposes to upgrade
SR 1609 from NC 48 to the end of the road in Halifax County. SR 1609 is an unpaved
roadway that will be upgraded to a paved roadway. Total project length is 0.881 miles.
Transportation and highway laws of North Carolina (G.S. 136-44.6, 136-44.7,
136-44.7A, 136-44.8, and 136-44.9) require the NCDOT to develop annual work
programs for construction and maintenance of secondary roads. These general statutes
specifically set forth requirements for annual construction and paving of existing unpaved
roads. Paving of these roads is performed in priority order as established by the NCDOT
for each unpaved road within a given county. This number is based on characteristics of
each road, including number of homes, schools, churches, businesses, industries,
recreational facilities, traffic counts, presence of school bus routes, and value as a
thoroughfare. SR 1609 is scheduled for paving in the 2000-2001 Secondary Roads
Construction Program.
Impacts to Waters of the United States
m?
Construction of the project will necessitate impacts to waters of the United States M
in the Tar River Basin. The project crosses one unnamed intermittent tributary to Rocky rn F.
Swamp, as shown in the following table. Total impacts to the stream from construction o -I
include an additional 12 square feet (0.00027 acres) fill in surface water and a total of 60
linear feet existing channel impact at the subject crossing.
Post Office Box 3 165, Wilson, North Carolina 27895-3165
LOCATION EXISTING EXISTING PROPOSED PROPOSED
Station Width in. Length ft. Width in. Length ft.
22+25 24 -. 40 36 48
No impacts to wetlands associated with roadside shoulder and ditch construction
are anticipated due to the subject project.
Waters of the U.S. Mitigation
Avoidance: All wetlands or surface waters not affected by the project will be
protected from unnecessary encroachment. No staging of construction equipment or
storage of construction supplies will be allowed in or near wetlands or surface waters.
N inimization: The side slopes have been steepened to the extent possible at
jurisdictional sites. Strict Enforcement of sedimentation and erosion control Best
Management Practices for the protection of wetlands and surface waters will be enforced
during project construction. Continued coordination will occur with maintenance forces
and the Environmental Officer during construction to minimize impacts to waters of the
U.S. at these sites.
Compensatory Mitigation: Construction of the project will result in no impacts
to waters of the U.S. Impacts have been minimized to the maximum extent possible
during the design process.
Riparian Buffer Impacts
The construction of the project involves a road crossing of a stream that is Ubject
to the Tar-Pamlico Riparian Buffer Rule. Construction impacts at each jurisdictional
crossing are less than 40 linear feet of riparian buffer. Based on the impacts to the riparian
buffer at this site, the crossing is exempt from the Rule. Efforts will be made to minimize
the impacts of any additional storm water by the installation of extra check dams, level
spreaders and vegetated swales wherever possible.
Dewatering
The NCDOT proposes to temporarily dewater the stream during the construction
of the project. This will involve the temporary placement of sandbags, sheet metal
cofferdams, or Class B or Class 2 rip rap covered with filter fabric in the stream channel
approximately 10 feet upstream of the proposed pipe inlet. To maintain water flow during
construction, water upstream of this impervious structure will be temporarily pumped out
and conveyed downstream of the construction activity where it will be allowed to filter
through vegetation before flowing into the stream. The stream will be dewatered for less
than five consecutive working days. This will result in minor temporary impacts to these
surface waters.
Temporary impacts to the stream from this activity will result in the dewatering of a total
of 210 square feet (0.0048 acres) of streambed and approximately 70 linear feet stream
channel for the proposed pipe replacement. The total area of temporary disturbance due
to excavation for pipe replacement will be 48 square feet (0.0011 acres). The sandbags or
riprap covered with filter fabric will be entirely removed after construction.
Regulatory Review
The subject project has been reviewed and concurrence obtained from the State Historic
Preservation Office that there is no effect to any National Register or Study-listed
properties within the subject projects Area of Potential Effects.
The subject project has been reviewed by the Environmental Officer and by the U.S. Fish
and Wildlife Service (USFWS) representative for the presence of listed threatened and
endangered species. The subject project has been determined to have no effect on any
listed threatened or endangered plant or animal species.
Permit Issues
The purpose of this letter is to provide notification under Section 404 Nationwide
Permit (NWP) 14, Linear Transportation Crossings. Notification for the use of this NWP
to the USACE is provided for this project, as a courtesy to the USACE. Also, notification
to the North Carolina Division of Water Quality (NCDWQ) for Section 401 Water Quality
Certificate (WQC) No. 3289 is required for this project. NCDOT will comply with all
conditions associated with this NWP and WQC.
Additionally, the purpose of this letter is to request authorization under a Section
404 NWP 33 to dewater the stream crossings during project construction. The 401 WQC
No. 3114 (which corresponds to NWP 33) does not require written concurrence from the
NCDWQ as NCDOT intends to comply with conditions for the WQC.
Summary
NCDOT proposes to upgrade and pave SR 1609 in Halifax County. Temporary
impacts to the stream from dewatering activity will involve 210 square feet (0.0048 acres)
of streambed and 70 linear feet of stream channel at each crossing. Impacts associated
with the pipe replacement at this project include 12 square feet (0.00027 acres) of
additional fill in surface water and 60 linear feet existing channel impacted. No wetland
impacts are anticipated as a result of the subject project. The project is located in the Tar
River Basin. Impacts at the stream crossing are less than 40 linear feet in the buffer and
are therefore exempt from the Riparian Buffer Rule. The NCDOT asks that the
dewatering of the stream be authorized under a Section 404 NWP 33. The NCDOT will
adhere to all applicable Section 404 NWPs and Section 401 WQCs conditions. If you
have any questions or need additional information, please contact Ms. Robin MLittle at
[phone].
Sincerely,
?.,? f1-0
am
es TroaIII> >
Division Engineer
cc: Mr. David Franklin, USACE,Wilmington
Mr. John Dorney, NCDWQ, Raleigh
Mr. David Cox, NCWRC, Creedmoor
Mr. Garland Pardue, USFWS, Raleigh
Ms. Renee Gledhill-Earley, SHPO, Raleigh '
Mr. Bryant Bunn, P.E., NCDOT Division Maintenance Engineer
Mr. Don Goins, P.E., Chief Engineer, Operations
Office Use Only: nn Form Version April 2001
USACE Action ID No. D`VQ No. 01 1 0 7 8
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: NWP 14, 33
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: ?
II. Applicant Information
Owner/Applicant Information
Name: Mr. James H. Trogdon III P.E Division Engineer
Mailing, Address: North Carolina Department of Transportation /Division 4
P.O. Box 3165
Wilson_ NC 27895-3165
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: jtrogdona,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: Ms. Robin M. Little
Company Affiliation: Division Environmental Officer
Mailing Address: North Carolina Department of Transportation/Division 4
P.O. Box 3165
Wilson, NC 27895-3165
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: rmIittle a dot. state.nc.us
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 detailedsite 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: SR 1609
2. T.I.P. Project Number (NCDOT Only): NA
3. Property Identification Number (Tax PIN): NA
4. Location
County: Halifax Nearest Town: Aurelian Springs
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.): 195 North to Exit 160, west on
NC 561, 7.4 miles to right onto NC 48, 1.8 miles to right onto SR 1609.
5. Site coordinates, if available (UTM orLat/Long): UTM 18 248128E 4023563N
(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 distinctwaterbody.)
6. Describe the existing land use or condition of the site at the time of this application: Rural,
agricultural
7. Property size (acres): NA
8. Nearest body of water (stream/river/sound/ocean/lake): UT to Rocky Swami) (DWQ ID #
28-79-28-(0.3) C NSW
9. River Basin: Tar River
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available athttp://li2o.enr.state.tic.us/admin/maps/.)
10. Describe the purpose of the proposed work: Grading, drainage, base, paving and erosion
control to bring existing gravel road in compliance with standard safety design specifications,
replace culvert.
Page 4 of 12
11. List the type of equipment to be used to construct the project:
Heavy construction equipment ( back hoe, track hoe excavator, dump truck)
12. Describe the land use in the vicinity of this project: Rural residential/agricultural mix.
1V. 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.
NA
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: NA
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
Page 5 of 12
1. Wetland Impacts
Wetland Impact
Site Number
(indicate on nna)
Type of Impact* Area of
Impact
(acres) Located within
100-yearFloodplain**
(yes/no) Distance to
Nearest Stream
(linear feet)
Type of Wetland***
0 no

List each impact separately and identity temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
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://w1«v.fcma.2ov.
*** List a Nvetland 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: NA
Total area of wetland impact proposed: 0
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact Length of AN,cmge Width Perennial or
Site Number Type of Impact* Impact Stream Name** of Stream Intermittent?
(indicate on ma) (linear feet) Before Impact (please secif )
1- STN 22+25 136" RCP 60 UT to Rocky Swamp 3 Intermittent
" List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associatedip-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
NVWNV.11S2S.,0V. Several inter net sites also allow direct download and printing of USGS neaps (e.g., www.topozone.conl
wWNy.m1pqucSt.C0111, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 60
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 Watcrbody
)
(if applicable) Type of Waterbody
(lance, pond, estuary, sound,
bay, ocean, etc.)

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
4. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Page 6 of 12
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.
All wetlands or surface waters not affected by the project will be protected from unnecessary
encroachment. No staging of construction equipment will be allowed in or near wetlands or
waters of the U.S. Strict enforcement of sedimentation and erosion control Best Management
Practices for the protection of wetlands and surface waters will be enforced during Project
construction.
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
Page 7 of 12
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http://l12o.elif*. state.nc.i..ts/ncwetlaiids/strrnC,ide.htmt
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.
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 lntl2://h2o.eiir.state.nc.tis/wro/index.htn,. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information:
Amount of stream mitigation requested (linear feet
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres
Amount of Non-riparian wetland mitigation requested (acres
Amount of Coastal wetland mitigation requested (acres):
IX. Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?
Yes ® No ?
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Pa?,c 8 of 12
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 213 .0233
(Neuse), 15A NCAC 213 .0259 (Tar-Pamlico), 15A NCAC 213 .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ® No ? If you answered "yes", provide the following infortntion:
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 0 3 0
2 0 1.5 0
Total 0 0
Zone 1 extends out 30 feet perpendicular from near bank: of channel; Zone 2 e\tends 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 213 .0242 or.0260.
XI. Stormwater (DWQ Only)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stortnwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
Existing; gavel road surface area will not be widened within riparian buffer Temporary
dewatering and all appropriate best management practices for sediment and erosion control will
be implemented during pipe replacement.
Page 9 of 12
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.
NA
XIII. Violations (DWQ Only)
Is this site in violationof 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).
491cant/Agent's SiAature ?D,te
(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 Mitcliell Union
US Anny Corps of Engineers Avery Clay Jackson Polk Watanga
151 Patton Avenue Buncombe Cleveland Lincoln RoNvan Yancey
Room 208 Burke Gaston Macon Rutherford
Asheville, NC 28801-5006 Cabanas Gmliani Madison Stanley
Telephone: [phone] Caldwell Hay«vood McDo«vell Swain
Fax: [phone] CataiNba Henderson Mecklenburg Transylvania
Raleigh Regulatory Field Office Alamance Durham Johnston Rockingham Wilson
Page 10 of 12
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"ED
STATE O NORTH CAROLINA

DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY LYNDO TIPPETT
GOVERNOR
May 21, 2001
U.S. Army Corps of Engineers
Raleigh Regulatory Field Office
6508 Falls of the Neuse Road, Suite 120
Raleigh, NC 27609
Attention: Mr. Eric Alsmeyer
NCDOT Coordinator
00?
Subject: Secondary road improvements to SR 1609 from NC 48 to end of road in
Halifax County. State Project No. 6.302069T.
The North Carolina Department of Transportation (NCDOT) proposes to upgrade
SR 1609 from NC 48 to the end of the road in Halifax County. SR 1609 is an unpaved
roadway that will be upgraded to a paved roadway. Total project length is 0.881 miles.
Transportation and highway laws of North Carolina (G.S. 136-44.6, 136-44.7,
136-44.7A, 136-44.8, and 136-44.9) require the NCDOT to develop annual work
programs for construction and maintenance of secondary roads. These general statutes
specifically set forth requirements for annual construction and paving of existing unpaved
roads. Paving of these roads is performed in priority order as established by the NCDOT
for each unpaved road within a given county. This number is based on characteristics of
each road, including number of homes, schools, churches, businesses, industries,
recreational facilities, traffic counts, presence of school bus routes, and value as a
thoroughfare. SR 1609 is scheduled for paving in the 2000-2001 Secondary Roads
Construction Program.
Impacts to Waters of the United States
Construction of the project will necessitate impacts to waters of the United States
in the Tar River Basin. The project crosses one unnamed intermittent tributary to Rocky
Swamp, as shown in the following table. Total impacts to the stream from construction
include an additional 12 square feet (0.00027 acres) fill in surface water and a total of 60
linear feet existing channel impact at the subject crossing.
SECRETARY
??
o -i
Post Office Box 3 165, Wilson, North Carolina 27895-3165
LOCATION EXISTING EXISTING PROPOSED PROPOSED
Station Width in. Length ft. Width in. Length ft.
22+25 '24 40 36 48
No impacts to wetlands associated with roadside shoulder and ditch construction
are anticipated due to the subject project.
Waters of the U.S. Mitigation
Avoidance: All wetlands or surface waters not affected by the project will be
protected from unnecessary encroachment. No staging of construction equipment or
storage of construction supplies will be allowed in or near wetlands or surface waters.
Minimization: The side slopes have been steepened to the extent possible at
jurisdictional sites. Strict Enforcement of sedimentation and erosion control Best
Management Practices for the protection of wetlands and surface waters will be enforced
during project construction. Continued coordination will occur with maintenance forces
and the Environmental Officer during construction to minimize impacts to waters of the
U.S. at these sites.
Compensatory Mitigation: Construction of the project will result in no impacts
to waters of the U.S. Impacts have been minimized to the maximum extent possible
during the design process.
Riparian Buffer Impacts
The construction of the project involves a road crossing of a stream that is subject
to the Tar-Pamlico Riparian Buffer Rule. Construction impacts at each jurisdictional
crossing are less than 40 linear feet of riparian buffer. Based on the impacts to the riparian
buffer at this site, the crossing is exempt from the Rule. Efforts will be made to minimize
the impacts of any additional storm water by the installation of extra check dams, level
spreaders and vegetated swales wherever possible.
Dewatering
The NCDOT proposes to temporarily dewater the stream during the construction
of the project. This will involve the temporary placement of sandbags, sheet metal
cofferdams, or Class B or Class 2 rip rap covered with filter fabric in the stream channel
approximately 10 feet upstream of the proposed pipe inlet. To maintain water flow during
construction, water upstream of this impervious structure will be temporarily pumped out
and conveyed downstream of the construction activity where it will be allowed to filter
through vegetation before flowing into the stream. The stream will be dewatered for less
than five consecutive working days. This will result in minor temporary impacts to these
surface waters.
Temporary impacts to the stream from this activity will result in the dewatering of a total
of 210 square feet (0.0048 acres) of streambed and approximately 70 linear feet stream
channel for the proposed pipe replacement. The total area of temporary disturbance due
to excavation for pipe replacement will be 48 square feet (0.0011 acres). Tile sandbags or
riprap covered with filter fabric will be entirely removed after construction.
Regulatory Review
The subject project has been reviewed and concurrence obtained from the State Historic
Preservation Office that there is no effect to any National Register or Study-listed
properties within the subject projects Area of Potential Effects.
The subject project has been reviewed by the Environmental Officer and by the U.S. Fish
and Wildlife Service (USFWS) representative for the presence of listed threatened and
endangered species. The subject project has been determined to have no effect on any
listed threatened or endangered plant or animal species.
Permit Issues
The purpose of this letter is to provide notification under Section 404 Nationwide
Permit (NWP) 14, Linear Transportation Crossings. Notification for the use of this NWP
to the USACE is provided for this project, as a courtesy to the USACE. Also, notification
to the North Carolina Division of Water Quality (NCDWQ) for Section 401 Water Quality
Certificate (WQC) No. 3289 is required for this project. NCDOT will comply with all
conditions associated with this NWP and WQC.
Additionally, the purpose of this letter is to request authorization under a Section
404 NWP 33 to dewater the stream crossings during project construction. The 401 WQC
No. 3114 (which corresponds to NWP 33) does not require written concurrence from the
NCDWQ as NCDOT intends to comply with conditions for the WQC.
Sum?llary
NCDOT proposes to upgrade and pave SR 1609 in Halifax County. Temporary
impacts to the stream from dewatering activity will involve 210 square feet (0.0048 acres)
of streambed and 70 linear feet of stream channel at each crossing. Impacts associated
with the pipe replacement at this project include 12 square feet (0.00027 acres) of
additional fill in surface water and 60 linear feet existing channel impacted. No wetland
impacts are anticipated as a result of the subject project. The project is located in the Tar
River Basin. Impacts at the stream crossing are less than 40 linear feet in the buffer and
are therefore exempt from the Riparian Buffer Rule. The NCDOT asks that the
dewatering of the stream be authorized under a Section 404 NWP 33. The NCDOT will
adhere to all applicable Section 404 NWPs and Section 401 WQCs conditions. If you
have any questions or need additional information, please contact Ms. Robin MLittle at
[phone].
Sincerely,
01
Troad III P.1?.
e
s H. D ,
1am,
Division Engineer
cc: Mr. David Franklin, USACE,Wilmington
Mr. John Dorney, NCDWQ, Raleigh
Mr. David Cox, NCWRC, Creedmoor
Mr. Garland Pardue, USFWS, Raleigh
Ms. Renee Gledhill-Earley, SHPO, Raleigh
Mr. Bryant Bunn, P.E., NCDOT Division Maintenance Engineer
Mr. Don Goins, P.E., Chief Engineer, Operations
Office Use Only: Form Version April 2001
0 77 8 05
USACE Action ID No. DWQ No.
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
1. Processing
Check all of the approval(s) requested for this project:
® Section 404 Permit
? Section 10 Permit
® 401 Water Quality Certification
® Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: NWP 14. 33
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: ?
II. Applicant Information
Owner/Applicant Information
Name: Mr. James H. Trogdon III P.E Division Engineer
Mailing Address: North Carolina Department of Transportation /Division 4
P.O. Box 3165
Wilson NC 27895-3165
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: jtrogdonCa dot.state.ne.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: Ms. Robin M. Little
Company Affiliation: Division Environmental Officer
Mailing Address: North Carolina Department of Transportation/Division 4 _
P.O. Box 3165
Wilson NC 27895-3165
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: [e-mail]. nc us
Pap 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 detailedsite 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: SR 1609
2. T.I.P. Project Number (NCDOT Only): NA
3. Property Identification Number (Tax PIN): NA
4. Location
County: Halifax Nearest Town: Aurelian Spring
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.): 195 North to Exit 160, west on
NC 561, 7.4 miles to right onto NC 48, 1.8 miles to right onto SR 1609.
5. Site coordinates, if available (UTM orLat/Long): UTM 18 248128E 4023563N
(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 distinctwaterbody.)
6. Describe the existing land use or condition of the site at the time of this application: Rural,
agricultural
7. Property size (acres): NA
8. Nearest body of water (stream/river/sound/ocean/lake): UT to Rocky Swamp (DWQ ID #
28-79-28-(0.3) C NSW
9. River Basin: Tar River
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available adittp://h2o.enr.state.ric,.us/admin/maps/.)
10. Describe the purpose of the proposed work: Grading drainage base, paving, and erosion
control to bring existing gravel road in compliance with standard safety design specifications,
replace culvert.
Page 4 of 12
11. List the type of equipment to be used to construct the project:
Heavy construction equipment back hoe, track hoe excavator, dump trick)
12. Describe the land use in the vicinity of this project: Rural residential/agricultural mix.
1V. 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: NA
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
Ngc5of12
1. Wetland Impacts
Wetland Impact
Site Number
(indicate on nna)
Type of Impact* Area of
Impact
(acres) Located within
100-ycarFloodplain**
(es/no) Distance to
Nearest Stream
(linear feet)
Type of Wetland***
0 no

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
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: /iwNv w. fern a.2 ov
*** 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: NA
Total area of wetland impact proposed: 0
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact Length of Average Width Perennial or
Site Number Type of Impact* Impact Stream Name** of Stream Intermittent?
(indicate on ma) (linear feet) Before Impact (please specify)
1- STN 22+25 136" RCP 60 UT to Rocky Swamp 3 Intermittent
" List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associatedip-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 Ur (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
Several intemet sites also allow direct download and printing of USGS maps (e.g., w%vw.topoznne.con?
vvwnv.mapqust.cnnn, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 60
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 Waterbod
(if applicable) y 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, dredging,
flooding, drainage, bullduaads, etc.
4. Pond Creation
if construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Page 6 of 12
Pond to be created in (check all that apply):
Describe the method of construction (e.g.,
draw-down valve or spillway, etc.):
VII.
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:
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.
All wetlands or surface waters not affected by the project will be protected from unnecessary
encroachment. No staring of construction equipment will be allowed in or near wetlands or
waters of the U.S. Strict enforcement of sedimentation and erosion control Best Management
Practices for the protection of wetlands and surface waters will be enforced during project
construction.
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
? uplands ? stream ? wetlands
dam/embankment, excavation, installation of
Page 7 of 12
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http://h2o.enr. sta.te.nc.us/ncwetlatuls/strm?-,i de.htmt
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.
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 clir.st.ite..iic.tis/w!p/indcx.hirn. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information:
Amount of stream mitigation requested (linear feet
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres
Amount of Coastal wetland mitigation requested (acres):
IX. Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?
Yes ® No ?
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Page 8 of 12
Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ® No ? If you answered "yes", provide the following infortntion:
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 0 3 0
2 0 1.5 0
Total 0 0
Lone 1 extenas out su teet pcrpenclicular Irom near bank of channel; Gone 2 extends an
additional 20 feet from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B.0242 or.0260.
XI. Stormwater (DWQ Only)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
Existing gravel road surface area will not be widened within riparian buffer Temporary
dewatering and all appropriate best management practices for sediment and erosion control will
be implemented during pipe replacement.
Page 9 of 12
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.
XIII. Violations (DWQ Only)
Is this site in violationof DWQ Wetland Rules (15A NCAC 211.0500) or any Buffer Rules?
Yes ? No
Is this an after-the-fact permit application?
Yes ? No
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
Ap,f icant/Agent's Sig ture Ddte
(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 Mitclicll Union
US Anny Corps of Engineers Avery Clay Jackson Polk Watauga
151 Patton Avenue Buncombe Cleveland Lincoln Roan Yancey
Room 208 Burke Gaston Macon Rutherford
Asheville, NC 28801-5006 Cabanas Graham Madison Stanley
Telephone: [phone] Caldwell Haywood NlcDoivcll Swain
Fax: [phone] Catawba Henderson Mecklenburg Transylvania
Raleigh Regulatory Field Office Alanimce Durham Johnston Rockingliani Wilson
Page 10 of 12
USDA/NRCS VICINITY MAP
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