20011091 Ver 1_Complete File_20010716

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
i7kTWA •
1
T
NC ENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
August 1, 2001
Halifax County
DWQ Project No. 011091
APPROVAL of 401 Water Quality Certification
Mr. James G. Trogdon, P.E., Division Engineer
NCDOT, Division 4
PO Box 3165
Wilson, NC 27893
Dear Mr. Trogdon:
You have our approval, in accordance with the attached conditions and those listed below, to place fill
material in .054 acres of wetlands and 60 linear feet of streams for the purpose of widening and paving SR
1227 in Halifax County. The project should be constructed in accordance with your application dated July
5, 2001. After reviewing your application, we have decided that this fill is covered by General Water
Quality Certification Number 3289. This certification corresponds to the Nationwide Permit Number 14,
issued by the Corps of Engineers. In addition, you should acquire any other federal, state or local permits
before you proceed with your project including (but not limited to) Sediment and Erosion Control, Non-
Discharge and Water Supply Watershed regulations. This approval will expire with the accompanying 404
permit, unless otherwise specified in the Water Quality Certification.
This approval is valid solely for the purpose and design described in your application (unless modified
below). Should your project change, you must notify the DWQ and submit a new application. If the
property is sold, the new owner must be given a copy of this Certification and approval letter, and is thereby
responsible for complying with all the conditions. If total wetland fills for this project (now or in the future)
exceed one acre, or of total impacts to streams (now or in the future) exceed 150 linear feet, compensatory
mitigation may be required as described in 15A NCAC 2H.0506 (h) (6) and (7). For this approval to
remain valid, you must adhere to the conditions listed in the attached certification.
1.) Upon completion of the project, the NCDOT shall complete and return the enclosed "Certification of
Completion Form" to notify DWQ when all work included in the 401 Certification has been completed.
The responsible party shall complete the attached form and return it to the 401/Wetlands Unit of the
Division of Water Quality upon completion of the project.
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing.
You must act within 60 days of the date that you receive this letter. To ask for a hearing, send a written
petition that conforms to Chapter 150B of the North Carolina General Statutes to the Office of
Administrative Hearings, P.O. Box 27447, Raleigh, N.C. 276 1 1-7447. This certification and its conditions
are final and binding unless you ask for a hearing.
Wetlands/401 Unit 1650 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
Gregory J. Thorpe, Ph.D., Acting Director
4 00
OWN"
NC ENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
ROAD CROSSING CERTIFICATION GENERAL CERTIFICATION FOR PROJECTS
ELIGIBLE FOR CORPS OF ENGINEERS NATIONWIDE PERMIT NUMBER 14 (ROAD
CROSSINGS), REGIONAL GENERAL PERMIT 198200031 AND NEUSE/TAR-
PAMLICO/RANDLEMAN BUFFER RULES
This General Certification is issued in conformity with the requirements of Section 401, Public Laws 92-
500 and 95-217 of the United States and subject to the North Carolina Division of Water Quality (DWQ)
Regulations in 15A NCAC 2H, Section.0500 and 15A NCAC 2B .0200 for the discharge of fill material to
waters and wetland areas as described in 33 CFR 330 Appendix A (B) (14) of the Corps of Engineers
regulations (i.e., Nationwide Permit No. 14 and Regional General Permit 198200031) and for the Neuse,
Tar-Pamlico and Randleman Buffer
Rules (15A NCAC 2B .0233,.0259 and .0250). The category of activities shall include any fill activity for
road crossing and is limited to fill less than one-third of an acre. This Certification replaces Water Quality
Certification Number 2177 issued on November 5, 1987, Water Quality Certification Number 2666 issued
on January 21, 1992, Water Quality Certification Number 2732 issued on May 1, 1992 and Water Quality
Certification Number 3103 issued on February 11, 1997. This WQC is rescinded when the Corps of
Engineers re-authorizes Nationwide
Permit 14 or Regional General Permit 198200031 when deemed appropriate by the Director of the DWQ.
The State of North Carolina certifies that the specified category of activity will not violate applicable; .
portions of Sections 301, 302, 303, 306 and 307 of the Public Laws 92-500 and 95-217 if conducted in
accordance with the conditions hereinafter set forth.
Conditions of Certification:
1. Proposed fill or substantial modification of wetlands or waters (including streams) under this General
Certification requires application to and prior written concurrence from the Division of Water Quality;
2. In accordance with North Carolina General Statute Section 143-215.3D(e), any application for a 401
Water Quality Certification must include the appropriate fee. If a project also requires a CAMA Permit,
one payment to both agencies shall be submitted and will be the higher of the two fees;
3. In accordance with 15A NCAC 2H.0506 (h) compensatory mitigation may be required for impacts to
streams and/or wetlands. In addition, buffer mitigation may be required for any project with Buffer
Rules in effect at the time of application. A determination of buffer, wetland and stream mitigation
requirements shall be made for any Certification for this Nationwide Permit. The most current design
and monitoring protocols from DWQ shall be followed and written plans submitted for DWQ approval
as required in those protocols;
4. For any project involving a stream re-alignment, a stream relocation plan must be included with the 401
application for written DWQ approval. Relocated stream designs should include the same dimensions,
patterns and profiles as the existing channel, to the maximum extent practical. The new channel should
be constructed in the dry and water shall not be turned into the new channel until the banks are
stabilized. Vegetation used for bank stabilization shall be limited to native woody species, and should
include establishment of a 30 foot wide wooded and an adjacent 20 foot wide vegetated buffer on both
sides of the relocated channel to the maximum extent practical. A transitional phase incorporating coir

Wetlands/401 Unit 1650 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 CAROLINA DEPARTMENT OF
Gregory J. Thorpe, Ph.D., Acting Director ENVIRONMENT AND NATURAL RESOURCES
fiber and seedling establishment is allowable. Also, rip-rap may be allowed if it is necessary to maintain
the physical integrity of the stream, but the applicant must provide written justification and any
calculations used to determine the extent of rip-rap coverage requested. If suitable stream mitigation is
not practical on-site, then stream impact will need to be mitigated elsewhere;
5. Impacts to any stream length in the Neuse, Tar-Pamlico and Randleman River Basins requires written
concurrence from DWQ in accordance with 15A NCAC 2B.0233, 15A NCAC 213 .0259 and .0250 and
15A NCAC 2H.0500. New development activities located in the protected 50-foot wide riparian areas
(whether jurisdictional wetlands or not) within the Neuse, Tar-Pamlico and Randleman River Basins
shall be limited to "uses" identified within and constructed in accordance with 15A NCAC 2B .0233,
15A NCAC 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;
6. Placement of culverts and other structures in waters, streams, and wetlands must be placed below the'
elevation of the streambed to allow low flow passage of water and aquatic life unless it can be shown to
DWQ that providing passage would be impractical. Design and placement of culverts and other
structures including temporary erosion control measures shall not be conducted in a manner that may
result in dis-equilibrium of wetlands or stream beds or banks, adjacent to or upstream and down stream
of the above structures. The applicant is required to provide evidence that the equilibrium shall be
maintained if requested in writing by DWQ. Additionally, when roadways, causeways or other fill
projects are constructed across FEMA-designated floodways or wetlands, openings such as culverts or
bridges must be provided to maintain the natural hydrology of the system as well as prevent constriction
of the floodway that may result in destabilization of streams or wetlands;
7. If this Certification is used to access building sites, all lots owned by the applicant must be buildable
without additional fill beyond that allowed under other General Certifications. Deed restrictions must be
placed on the remaining wetlands and streams on these lots to restrict future wetland and stream fill.
DWQ shall be sent copies of all deed restrictions applied to these lots;
8. That appropriate sediment and erosion control practices which equal or exceed those outlined in the
most recent version of the "North Carolina Sediment and Erosion Control Planning and Design Manual"
or the "North Carolina Surface Mining Manual" whichever is more appropriate (available from the
Division of Land Resources (DLR) in the DENR Regional or Central Offices) shall be in full
compliance with all specifications governing the proper design, installation and operation and
maintenance of such Best Management Practices in order to assure compliance with the appropriate
turbidity water quality standard;
9. All sediment and erosion control measures placed in wetlands or waters shall be removed and the natural
grade restored within two months after the Division of Land Resources has released the project;
10. Measures shall be taken to prevent live or fresh concrete from coming into contact with waters of the
state until the concrete has hardened;
Wetlands/401 Unit 1650 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 •
A-ft
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
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 1650 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 1TkW,"!;VAJ
and Natural Resources
Division of Water Quality
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
DWQ Project No.:
County:
Applicant:
Project Name:
Date of Issuance of 401 Water Quality Certification:
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable Buffer
Rules, and any subsequent modifications, the applicant is required to return this certificate to the
401/Wetlands Unit, North Carolina Division of Water Quality, 1621 Mail Service Center, Raleigh, NC,
27699-1621. This form may be returned to DWQ by the applicant, the applicant's authorized agent, or the
project engineer. It is not necessary to send certificates from all of these.
Applicant's Certification
I, , hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to be -built
within substantial compliance and, intent of the 401 Water Quality Certification and Buffer Rules, the
approved plans and specifications, and other supporting materials.
Signature:
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 1650 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
4 00
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
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.
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 1227\wgc\011091 wqc.doc
rpe, Ph.D
c kigirector
Wetlands/401 Unit 1650 Mail Service Center Raleigh, North Carolina 27699-1621
Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/] 0% post consumer paper
e?RNEo
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY LYNDO TIPPETT
GOVERNOR
SECRETARY
July 5, 2001
U. S. Army Corps of Engineers
Raleigh Regulatory Field Office f _
6508 Falls of the Neuse Road, Suite 120 J?
Raleigh, NC 27609
Fr??
Attention: Mr. Eric Alsmeyer SS'(/
NCDOT Coordinator ?v
Subject: Secondary road improvements to SR 1227 (Spell Branch Road) from SR
1226 (Bellamy Lake Road) to NC 481 in Halifax County. State Project No.
6.302062T.
The North Carolina Department of Transportation (NCDOT) proposes to upgrade
SR 1227 (Spell Branch Road) from SR 1226 (Bellamy Lake Road) to NC 481 in Halifax
County. SR 1227 is an unpaved roadway that will be upgraded to a paved roadway.
Total project length is 0.81 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. Spell Branch Road is scheduled for paving in the 2000-2001 Secondary
Roads Construction Program.
Impacts to Waters of the United States
Post Office Box 3165, Wilson, North Carolina 27895-3165
rn
C)
si r';
Construction of the project will necessitate impacts to waters of the United States
in the Tar River Basin. The proposed road ctirrently crosses an unnamed perennial
tributary to Rocky Swamp with a 46-inch diameter corrugated metal pipe (CMP), and one
intermittent tributary to Rocky Swamp with a 24-inch diameter CMP. Impacts to the
stream from construction include minimal impacts due to the pipe replacements of
approximately 1032 square feet of stream channel (0.02 ac.).
LOCATION EXISTING EXISTING PROPOSED PROPOSED
Station Width in. Length ft. Width in. Length ft.
66+25 46 40 2 @ 87 x 63 60
81+25 18 44 24 44
The proposed road project impacts approximately 0.05 acres, with 5 feet of
minimal widening necessary to upgrade the existing road to current standard safety design
specifications. Wetlands were observed adjacent to the existing roadside ditches, on both
sides of the existing road, from Station 64+00 to Station 66+85.
Waters of the U.S. Mitigation
Avoidance: Minimal ditch work will be performed within the wetland area
identified between Station 64+00 to Station 66+85. 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. Sedimentation and erosion control Best Management Practices for the
protection of wetlands and surface waters will be strictly 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 0.05 acres of
impacts to waters of the U.S., therefore no compensatory mitigation is required at this
time. 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 Rules. 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 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 1365 square feet (0.03 acres) of streambed and approximately 70 linear feet stream
channel at each jurisdictional crossing. 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. (See attached Concurrence
Form.)
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 request authorization under Section 404
Nationwide Permit (NWT) 14, Linear Transportation Crossings for the secondary road
improvements. Notification for the use of NWP 14 to the USACE is required due to the
proposed 0.05 acres of wetland impacts associated with this project. 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 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 1227 in Halifax County. Temporary
impacts to the stream from dewatering activity will involve 1365 square feet (0.03acres) of
streambed and approximately 70 linear feet of stream channel. Impacts associated with
the pipe replacement at this project include approximately 1032 sqaure feet (0.02 acres)
fill in surface waters and minimal temporary impacts to the existing channel.
Approximately 0.054 acres of 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 Tar/Pamlico
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 M. Little at [phone].
Sincerely,
J es H. Ti of , II, P.E.
Di i ion Engineer
cc: Mr. David Franklin, USACE, Wil ngton
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., Division Maintenance Engineer
Mr. Andy Mills, District Engineer
Mr. Franz Enders, Assistant District Engineer
Mr. Don Goins, P.E., Chief Engineer, Operations
Office Use Only: Form Version April 2001
USACE Action ID No. DWQ No. f ~?
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
1. Processing
1. Check all of the approval(s) requested for this project:
® Section 404 Permit
? Section 10 Permit
® 401 Water Quality Certification
® Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: NWP 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: F-1
II. Applicant Information
1. Owner/Applicant Information
Name: Mr. James H. Trogdon III P.E. Division Enzineer
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: ltrogdon a, dot.state.nc.us
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory authority for the owner/applicant.)
Name: Ms. Robin M. Little
Company Affiliation: Division Environmental Officer
Mailin; 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: rmlittlendot.state.ne.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 1227 Spell Branch Road
2. T.I.P. Project Number (NCDOT Only): State Project No. 6.302062T
3. Property Identification Number (Tax PIN): NA
4. Location
County: Halifax Nearest Town: Glenview
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.): 195 North to Exit 154, west on
NC 481, approx. 2 miles to left (south) onto SR 1227.
Site coordinates, if available (UTM or Lat/Long): UTM 18 248326E 4005550N -
RINGWOOD quad
(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,
residential/agricultural mix.
7. Property size (acres):,
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://ii2o.enr.st ite.ne.tis/admin/maps`.)
Page 4 of 12
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.
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.
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
V. Future Project Plans
Are any additional permit requests anticipated for this project in the future? If so, describe the
anticipated work, and provide justification for the exclusion of this work from the current
application: 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 ma)
Type of Impact* Area of
Impact
acres Located witlun
100-year Floodplain**
(es/no) Distance to
Nearest Stream
(linear feet
Type of Wetland***
Stn 64+00-66+85 Fill/cxcavation 0.054 no 36 -238 Forested wetland/bcaver

List each impact separately and idyntily temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditclung/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified Uuough the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available tlu-ough the FEMA Map Service Center at 1-800-358-9616, or
online at bttp: //wwAv. fem a. g<w
*`* List a xvctland 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: 0.054 acres
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact Length of ,,2 Average Width PerenmW or
Site Number Type of Impact* Im t Stream Name** of Stream Intennittent?
(indicate on ma) (li ear fc t) Before Impact (please secif )
STN 66+25 2 @ 87x63 CMP 60 UT to Rocky Swamp 13.25 Perennial
List each impact separately and identify tenlperafy impacts. Impacts include, but are not limited to: culverts and associatedip-rap,
dams (separately list impacts due to both stricture 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 topograpluc maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into wluch it flows. USGS maps are available tlurough the USGS at 1-800-358-9616, or online at
w1Nw.use5.2ov. Several internet sites also allow direct download and printing of USGS maps (e.g., «%iAv.topozonc.conj
wwlv.In apqucst.com, etc.).
2
Cumulative impacts (linear distance in feet) to all streams on site: j
Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S.
Open Water Impact
Site Number
(indicate on ma)
Type of Impact* Area of
Impact
(acres) Name of Waterbody
(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.)

* List each impact separately and identify temporary mnpacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulldteads, etc.
4. Pond Creation
Page 6 of 12
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
All wetlands or surface waters not affected b? the project will be protected from unnecessary
encroachment. No staging of constriction 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
Page 7 of 12
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http:://h2Q_enf, State _nc,us/ncwetlands/strmQide,html
Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
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.ric.us/wn)%index.htrr?. 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 N
Page 8 of 12
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ® No ? If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet Multiplier Required
Mitigation
1 930 3 0
2 0 1.5 0
Total 0 0
* Zone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or.0260.
XI. Stormwater (DWQ Only)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
Page 9 of 12
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.
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.
XHL 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).

Applic4fit
(A gent's s
s Signa
12 b
Date
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 Amy Corps of Engineers Avery Clay Jackson Polk Watauga
151 Patton Avenue Buncombe Cleveland Lincoln Rowan Yancey
Room 208 Burke Gaston Macon Rutherford
Page 10 of 12
- 1 ? ? O ?R N 1210
\. ? 1001 a ?.
48
I 1306 ICAO c
1001 1610 C-d. ` ^ \
/ •\ / '
/Au.lbn /,-\ ......\ 1 1516
1 307 _?I Y yo o, ,6' ? i / \ 1613 n a
lzlo .3
r .` \ \ loot 1 1643 1613 '\1617
t 13J8 •\ / •\ •?• 1612•
?.J) Iro0 I lwy \ 1613 1 /
1610 1o c \
1,134 1 4 H •\ / 1310 ',\ ::' /" 1 t •1 1
N S
'•' .? AhL. \ 1 \ J I ' Iml q . Oerlh.pl00 ,\ 1613 164 1612
1 9
o
i A x310 ? / 1601 i '=-'••-'•? If;?•?,• R" V
\?• \^• 1615 `1 1?1
w C J
1311312
\ 1 1 I ICM `61616vs•J
1
\.
1 4 CA)
•* ti
, 316 1314 / _ / _ 1604 1 '
y
r 6 ? 1313 A ,?•, ' I' ?? 1 J
•.1 1 1 „i ^? / \ 17) 1615 I
?1 rKJI /• ICAt n 7 /
'ty / / / y \ 1? 1 4 IC43 n 1 IGy
1312
'1 / 41 'B 1' L0 Mw1hMl4 2 J Y IX'6e 1.\
1315 1317 M4d1y.:14 \ .? :f% I( 2N IUS
376 1
••.?J..J ? \ jir9 4 ?•-\ ?''?? 1212 '``?C` ? ^'\
1372 Ir 1237
1 121
,ie '•`.- / 1213 t216° \ % r o ?;i ry•
Mdlfrw -
3 \ / 3 Ip) I.
/ n 1_oi
/ 1000 1211 3 V J Ic,--,5
/' / R °' 12• \ 'Y b1u11 "1 •brly ••\ 129
l P \ /"?.
?- 132'7 13,6 •5 n 12i3 1333 L - _ . ?• 95
X1 7 123 124 /• I vo `., y,•
1002 tI \
?• 1 w. 448 1214 r , 1 1 1216 ! 1 oc2
1 1335 \1a •\ 1217 \ -_ '? ^_ '-•
- • `1/ . 1222
? ? 1327 ` I 1214 /• Y 1u„?_, \ ?\ „ /•• 1
1214 `I I r 1219 ..
1J3<'\ I M3 127 -
1, „ i? A a \
1337 `
•\ !• 1218 1 ,\ 3
1 1216 481
'•
173 t` . •\ / :c!i -..? 141 y=?ti 1 7 ` .,,4, -
.4 ••( 1 I ' Wh),. 004 - \ 1 u...,..e, •l
?•\. \ 1321 \. 1339 `•??\ ® •\ 12)
\ ??'? •\ ?\4 ' M I r 134, ,? •, ? ???? ?r'? /.r 4 127n ?
1 ?. •\ 1338 , I `A ? ? ? / ,S
/ .. - I 1338 ? LV 1'2'7
1-4/
/ Iw ?. 17 G1w.d.. \ ? e j •I /• '. 131) i 1338 I4 ` ??'.
1 0
27 a7'.?• ?.. /• 1742 y d `d -.6\`..
? 1340 m ? . i' ?'? / • ?- 301
1227
?. a 1 1 N2 I \
134
H
I
C U
"SITE VICINITY MAP"
SCALE 1?° Z fu 1 L ES
F1a??FAx e ?ca? nt?P ,use c- y!5/cr -
o
USGS gUAD MAP " _, yelY
SCALE 1= 20©O' ^
N ?? Tr raj
USDA/NRCS SOIL SURVEY
COUNTY A c.1 rA SHEET # C 13
' ''
1
1
I
/
t .
O.J. SMITI
W; DB E
'-
? ? j 8X2X2
i 65
?III? III?III?III?III?I
1
1
i l
FARMS INC. t (?
I PG 4 t? f? WILLIAM F. D
DB 565
EXISTING 46' MET L PIPE 2 PRO OSED 60'x87'x63'CMPA
W/HEADWALL 7)
1 PROP RW
!f-fff-ilf-
II IIIII I III IIIIII IIL;JIIIL;lIIIII IIIIIIIII II II
I I SR 1227 i o.
?. .?1.-.- __
"" III ?III?III ? III?III ? II II III III III ?III?III ?III?III?III ? III?III III ? ? _ -I
J II
PROP RtW
. ? , ex2x2 ? ? i
06 ? t ! 7
J w RIPARIAN BUFFER ZONE
i
4ILLIAM F. DICKENS HEIRS
z t i DB 565 PG 43
t
sc-A LE 1 11 -- S-0
DATA FORM
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Delineation Manual)
Project/Site: &Z 1207 Date: G ?!S ?D 1
Applicant/Owner: _ALe DU i - D?? County: HALIFAX
Investigator: 266 ? N M LITTLE State: -NC-
Do Normal Circumstances exist on the site? a No Community ID:
Is the site significantly disturbed (Atypical Situation)? a Transect ID:
Is the area a potential Problem Area? es Plot ID:
If needed, a lain on reverse.
VEGETATION
Dominant Plant Species Stratum Indicator Dominant Plant Species Stratum Indicator
1. . 2.1 X VO rd- a
2. Ac&v- ru rkw%
3. U
a. ?L?a [-r I (Ln4e
5.L'7'--Si
EA C,
J t-
12. --
13.
6 H _i5 15-L 14.
7. h a S?•
8. ?i1L_ 15. _
16.

Percent of Dominant Species that are OBL, FACW or FAC !?
(excluding FAC- . 160 / 0
Remarks:
HYDROLOGY
_ Recorded Data (Describe in Remarks):
- Stream, Lake, or Tide Gauge
_ Aerial Photographs
Other
M_Recorded Data Available Wetland Hydrology Indicators:
Primary Indicators:
inundated
Saturated in Upper 12 Inches
_ Water Lrbrks
Drift Lines
_
_ Sediment Deposits
Field Observations: _ Drainage Patterns in Wetlands
Socc dary Indicators (2 or more required):
Depth of Surface Water. (in.) r Oxidized Root Channels in Upper 12 Inches
Water-Stained Leaves
Depth to Free Water in Pit: (in.) Local Sol Survey Data

Depth to Saturated Soil: < (in.) _/FAC-Neutral Test
- Other (Explain in Remarks)
Remarks:
11
B2 Appendix B Blank and Example Data Forms
SOILS
Map /hit Name 5 O f
(Series and Phase ??l N ???.? L Q sL &d
Drainage Class: Poo r Ais 1
Field Observations
Taxonomy T A ?\MY /?
(Subgroup): A. u L7r Confirm Mapped Type? es No
Profile Descrioticm
Depth Matrix Color
(inches) Horizon (Mu
ns
on Moi
st)) (
Mottle Colors Mottle Abundance/ Texture, Concretions,
Munsell Moist) Size/Contrast Structure, otc.
un
?
?j
0-(o A
T
`
loas" 4;
; rte
Alp -jO Jo,_ 7 50;? Safi MC-1 ?K
Hydric Soil Indicators:
_ Histosol _ Concretions
Histic Epipedon _ Hgh Organic Content in Surface Layer in Sandy Soils
Sulfidic Odor - prganic Streaking in Sandy Soils
_ Aquic Moisture Regime ? isted on Local Hydric Soils List
_ Reducing Conddions
leyed or LoH.Chroma Colors isted on National Hydric Soils List
_ Other (Explain in Remarks)
Remarks:
WETLAND DETERMINATION
Hydrophylic Vegetation Prosenl? Ye No (Circle) (Circle)
Wetland Hydrology Present? a No
Hydric Soils Present? R No Is this Sampling Point Within a Wetland? Ye No
Remarks:
Approved by HQUSACE 3/92
Appendix B Blank and Example Data Forms B3
DATA FORM
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Delineation Manual)
Project/Site: S IZ I ?X1-7 Date: r0 J$
C9
Applicant/Owner: NC.DbT - DI V County: 14A 4-4 ?/ac)C
_
Investigator: _Rot31N eA. LITTLE State:
Do Normal Circumstances exist on the site? No Community ID:
Is the site significantly disturbed (Atypical Situation)? Yes Transect ID:
Is the area a potential Problem Area? Yes Plot ID:
If needed, explain on reverse.
VEGETATION
Dominant Plan S tie-
s
Stratum Indicator Dominant Plant Species Stratum Indicat
?
-
1. IY?LLS f'? _? Piker or
s._
2._ A . A 10.
3. ?"! tr 0 FA L 11.

4. t? ?'A&M + '
5.?? _ 1 ?Wl Yf /d0 . - FA-C, _ _
12.
13.
6. SVKI 1 r © ??-
t`
1 14.
c
7 _L
_TI
` /?7 M?+h J_ N, 01
a. AIL, LL- FAC,
15.
16.
Percent of Dominant Species that are OBL, FACW or FAC
(excluding FAC- .
Remarks:
L
HYDROLOGY
_ Recorded Data (Describe in Remarks):
Stream, Lako, or ride Gauge
- Aerial Photographs
?- Other

No Recorded Data Available
let_ Wetland Hydrology Indicators:
Primary Indicators:
_ inundated
_ Saturated in Upper 12 Inches

-Water Marks
Drift Lines
_
_ Sediment Deposits
Field Observations: _ Drainage Patterns in Wetlands
Secondary Indicators (2 or more requi ed):
Depth of Surface Water. (in.) _ Oxidu:ed Rod Channels in Upper 12 Inches
Water-Stained Leaves
Depth to Free Water in Pit: (in.) Local Sol Survey Data
FAC-Neutral Test
Depth to Saturated Soil: f ('n.) _ Other (E)plain in Remarks)
Remarks:
B2 Appendix B Blank and Example Data Forms
SOILS
Map Wit Name
G rn p OY i a/ InI C-d o W ec;
J*fAJ
I I
J
(Series and Phase
Phase,):- c
DrainageClass: ' ?
Field Observations
Taxonomy (Subgroup): Confirm Mapped Type? Yes No
Profile Descriotion:
Depth Matrix Color
(inches) Horimn (Mansell Moist)
Mottle Colors Mottle Abundance/ Texture, Concretions,
(Munsell Moist) SimfContrast Structure, etc.
n-q _A Loa m
-A-{ I oYf S/u 3?G? Vy?
Hydric Soil Indicators:
_ Hstosol _ Concretions
Hstic Epipedon _ Hgh Organic Content in Surface Layer in Sandy Soils
- Sulfdic Odor _ Organic Streaking in Sandy Soils
- Aquic Mosture Regime _ Listed on Local Hydric Soils List
_ Reducing Conditions _ Listed on National Hydric Soils List
- Gleyed or Lo*Chroma Colors _ Other (Explain in Remarks)
Remarks:
WETLAND DETERMINATION
Hydrophylio Vegetation Present? Y. (Circle) (Circle)
Wetland Hydrology Present? Yes
Hydric Soils Present? Yes
is this Sampling Point Within a Wcdand? Yes

Remarks:
Approved by HQUSACE 3152
Appendix B Blank and Example Data Forms B3
NCDOT/P&E ERRNCH Fax:[phone] May 23 '01 16:22 i'.U2
Counry: Halifax NCDOT Division # 4 District 4 1
CONCURRENCE FORM FOR PROPERTIES NOT ELIGIBLE FOR THE NATIONAL.
REGISTER OF HISTORIC PLACES,
FOR STATE FUNDED'SECQNDARY ROAD PROJECTS ONLY
Project Description: Pave and Widen Halifax SR 1227 from NC 481 South .81 miles to SR 1226.
On May 17, 2001, representatives of the
Ll North Carolina Department of Transportation (NCDOT)
? North Carolina State Historic Preservation Office (HPO)
Other
Reviewed the subject project at
as coping meeting
photograph review session/consuhation .
other -.---
All parties present agreed
There are no properties over fifty years old within' theproject's Federal Permit Site's (or Sites') area (or
areas) of potential effects (APE).:...
There are no properties less than fifty years old that. are considered to meet Criterion Consideration G
within the project's Federal Permit.Sife's (or sites.') area (or areas)of potential effects.
There amproperties over-fifty years'old (list attached). within the project's Federal Permit Site's (or Sites')
area (or areas) of potential effects,.but based on the historical information available and the photographs of
each property, properties identified as? are considered not eligible for the National Register and
no further evaluation is necessary.
There are no National Register or Study-Listed properties located within the secondary road project's area
of potential effects.
There are no historic properties affected by t " project. NOTE: NX--166 (SL)and KY-167 (Surveyed) are
out of the AP ojproj L
Signed:
Representative, CD Date
43/0?,_
Representative, HPO .1 VJ
State Historic Preservation Officer
Date
A/
If a survey report is prepared, a final copy of this form and the attached list will be included.