20010619 Ver 1_Complete File_20010425

O?OF WA 7F9pG Michael F. Easley
Governor
UJ r William G. Ross, Jr., Secretary
Department of Environment and Natural Resources
Kerr T. Stevens
Division of Water Quality
April 27, 2001
Iredell County
DWQ Project No. 010619
Pipe on SR 1825, 1000ft. north of SR 1813
APPROVAL of 401 Water Quality Certification
Ms. Trish Simon, Environmental Officer
NCDOT Division 12
P.O. Box 47
Shelby, NC 28151-0047
Dear Ms. Simon:
You have our approval, in accordance with the attached conditions, to temporarily impact 30 linear feet
and permanently impact 30 linear feet of an unnamed tributary to Long Branch for the purpose of
replacing a pipe on SR 1825 in Iredell County. The project should be constructed in accordance with
your application dated April 19, 2001 (received 25 April 2001). After reviewing your application, we
have decided that this fill is covered by General Water Quality Certification No. 3289 corresponding to
the U.S. Army Corps of Engineers Nationwide Permit Number 14. In addition, you should acquire any
other federal, state or local permits before you proceed with your project including (but not limited to)
Sediment and Erosion Control, Non-Discharge and Water Supply Watershed regulations. This approval
will expire with the accompanying 404 permit unless otherwise specified in the Water Quality
Certification.
This approval is valid solely for the purpose and design described in your application (unless modified
below). Should your project change, you must notify the DWQ and submit a new application. If the
property is sold, the new owner must be given a copy of this Certification and approval letter, and is
thereby responsible for complying with all the conditions. If total wetland fills for this project (now or in
the future) exceed one acre, or of total impacts to streams (now or in the future) exceed 150 linear feet,
compensatory mitigation may be required as described in 15A NCAC 2H.0506 (h) (6) and (7). For this
approval to be valid, you must follow the conditions listed in the attached certification.
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory
hearing. You must act within 60 days of the date that you receive this letter. To ask for a
hearing, send a written petition which conforms to Chapter 150B of the North Carolina General
Statutes to the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh, N.C.
27699-6714. This certification and its conditions are final and binding unless you ask for a
hearing.
North Carolina Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
919-733-1786 (phone), 919-733-6893 (fax), http://h2o.enr.state.nc.us/ncwetlands/
Page 2 of 2 _
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water
Act. If you have any questions, please telephone John Dorney at 919-733-1786.
Sincerely,
Stevens
Attachment
cc: Wilmington District Corps of Engineers '
Corps of Engineers Asheville Field Office
NCDWQ Mooresville Regional Office
Central Files
r -?
STATE._
h "C
A
d •401 ?SSUF?.
STATE of NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY P.O. Box 25201, RALEIGH, N.C. 27611-5201 LYNDO TIPPETT
GOVERNOR SECRETARY
P.O. BOX 47, 1710 East Marion Street
Shelby, N. C. 28151-0047
April 19, 2001
Mr. Steve Lund, Project Manager - NCDOT Projects
US Army Corp of Engineers r!
Asheville Regulatory Field Office
151 Patton Avenue, Room 143 ri=d
Asheville, N. C. 28891-5006 'i
Dear Mr. Lund:
The North Carolina Department of Transportation, Division of Highways, proposes the following
project for your issuance of a Section 404 Permit. We believe this project can be accomplished
under NWP #14, Road Crossing.
COUNTY: Iredell
LOCATION: Pipe on SR 1825, 1000 ft. north of SR 1813
STREAM: Unnamed tributary to Long Branch
PROJECT DESCRIPTION: The replacement of an existing 60' long, 60" CMP with a 70'
long, 70" CMP with a concrete headwall and associated rip-rap for stabilization on less than 1/4
acre of NCDOT right of way. The pipe will be placed below existing streambed elevation. A site
location map and a sketch of planned activities are attached.
It is proposed that the watercourse will be managed during construction by the utilizing sand-filled
burlap bags to block the stream approximately 15 feet beyond the upstream and downstream of the
proposed pipe. A pump will be used to divert the water across the road through a flexible pipe.
There are no wetlands; however, the stream is classified "WS-III" waters. Enclosed is a NCDOT
Hazardous Spill Basin checklist documenting the roadway and water quality criteria for this project.
Proper erosion and sedimentation control measures will be implemented during the project
construction.
A review of the Natural Heritage information for the threatened (T/SA -Threatened due to
similarity of appearance) species listed for Iredell County, the bog turtle (Clenunys muhlenbergii),
did not reveal any known sites in the vicinity of the proposed project. I have conducted a survey
for the bog turtle in the project area on April 16, 2001. None were observed. It was determined
that neither the bog turtle nor suitable habitat was located in the proposed project area. No
significant effect on this species is anticipated. A review of the National Register of Historic Places
was also conducted. No sites listed on the National Register will be affected by the proposed
project.
By copy of this letter, we are asking Edward L. Ingle, Area Roadside Environmental Engineer to
comment on the above project. By copy of this letter, we are also requesting concurrence from
the Wildlife Resources Commission, U.S. Fish & Wildlife Service, and the State Historic
Preservation Office.
By copy of this letter, I am forwarding seven (7) copies of the application package to John Dorney,
NCDENR, Division of Water Quality, 401/Wetland Unit for review. A $200.00 check is enclosed
for application processing.
Your earliest consideration for this request would be greatly appreciated. Should you have any
questions, please call me at 704-480-9020.
Sincerely,

Trish Simon
Division 12 Environmental Officer
Enclosures
cc: Mr. Michael L. Holder, P.E., Division Engineer
Mr. Dan Holderman, P.E. , Division Bridge Engineer
Mr. Ed Ingle, Area Roadside Environmental Engineer
Mr. Ron Linville, WRC
Mr. Brian Cole, USF & WS
Ms. Renee Gledhill-Earley, SHPO
Mr. John Dorney, DENR,DWQ,401/Wetlands Unit
File

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vJ
0? \N A
Pre-Construction Notification (PCN) Application Form
QG

For Section 404 and/or Section 10 Nationwide, Regional and General Permits, Section 401
General Water Quality Certifications, and Riparian Buffer and Watershed Buffer Rules
This form is to be used for projects qualifying for any of the U.S. Army Corps of Engineers' (USACE)
Nationwide, Regional or General Permits as required by Section 404 of the Clean Water Act and/or
Section 10 of the Rivers and Harbors Act, and for the North Carolina Division of Water Quality's
(DWQ) associated General 401 Water Quality Certifications. This form is also to be used for any
project requiring approval under any Riparian Buffer Rules implemented by the N.C. Division of Water
Quality. This form should not be used if you are requesting an Individual 404 Permit or Individual 401
Water Quality Certification. The USACE Individual Permit application form is available online at
littp://www.saw.usace.army.mi]/wet]ands/Perm app.htm.
The USACE is the lead regulatory agency. To review the requirements for the use of Nationwide,
Regional or General permits, and to determine which permit applies to your project, please go to the
USACE website at http://www.saw.usace.army.niiI/wetlands/re.tour.htm, or contact one of the field
offices listed at the end of this application. The website also lists the responsible project manager for
each county in North Carolina and provides additional information regarding the identification and
regulation of wetlands and waters of the U. S.
The DWQ issues a corresponding Certification (General or Individual), and cannot tell the applicant
which 401 Certification will apply until the 404 Permit type has been determined by the USACE.
Applicants are encouraged to visit DWQ's 401/Wetlands Unit website at
http://h2o.enr.state.ne.us/newetlands to read about current requirements for the 401 Water Quality
Certification Program and to determine whether or not Riparian Buffer Rules are applicable. The
applicant is also advised to read the full text of the General Certification (GC) matching the specific 404
Permit requested. In some cases, written approval for some General Certifications is not required,
provided that the applicant adheres to all conditions of the GC. Applicants lacking access to the internet
should contact DWQ's Central Office in Raleigh at [phone].
Trout Waters Coordination - Special coordination with the North Carolina Wildlife Resources
Commission (NCWRC) is also required for projects occurring in any of North Carolina's twenty-five
counties that contain trout waters. In such cases, the applicant should contact the appropriate NCWRC
regional coordinator (listed by county on the last page of this application).
Page 1 of 12
CAMA Coordination - If the project occurs in any of North Carolina's twenty coastal counties (listed on
the last ,page of this application) the applicant should also contact the North Carolina Division of Coastal
Management (DCM) at [phone]. DCM will determine whether or not the project involves a
designated Area of Environmental Concern, in which case DCM will act as the lead permitting agency.
In such cases, DCM will require a Coastal Area Management Act (CAMA) Permit and will coordinate
the 404/401 Permits.
USACE Permits - Submit one copy of this form, along with supporting narratives, maps, data forms,
photos, etc. to the applicable USACE Regulatory Field Office (addresses are listed at the end of this
application). Upon receipt of an application, the USACE will determine if the application is complete as
soon as possible, not to exceed 30 days. This PCN form is designed for the convenience of the applicant
to address information needs for all USACE Nationwide, Regional or General permits, as well as
information required for State authorizations, certifications, and coordination. Fully providing the
information requested on this form will result in a complete application for any of the USACE
Nationwide, Regional or General permits. To review the minimum amount of information that must be
provided for a complete PCN for each USACE Nationwide permit, see Condition 13, 65 Fed.Reg. 12893
(March 9, 2000), available at http://xvww.saw.usace.army.niil/wetlands/nwpfinalFedReg.pdf.
Processing times vary by permit and begin once the application has been determined to be complete.
Please contact the appropriate regulatory field office for specific answers to permit processing periods.
401 Water Quality Certification or Buffer Rules - All information is required unless otherwise stated
as optional. Incomplete applications will be returned. Submit seven collated copies of all USACE
Permit materials to the Division of Water Quality, 401/Wetlands Unit, 1650 Mail Service Center,
Raleigh, NC, 27699-1650. If written approval is required or specifically requested for a 401
Certification, then a non-refundable application fee is required. In brief, if project impacts include less
than one acre of cumulative wetland/water impacts and less than 150 feet cumulative impacts to
streams, then a fee of $200 is required. If either of these thresholds is exceeded, then a fee of $475 is
required. A check made out to the North Carolina Division of Water Quality, with the specific name of
the project or applicant identified, should be stapled to the front of the application package. For more
information, see the DWQ website at littp://h2o.ehnr.state.nc.us/ncwet]ands/fees.htmi. The fee must be
attached with the application unless the applicant is a federal agency in which case the check may be
issued from a separate office. In such cases, the project must be identifiable on the U.S. Treasury check
so that it can be credited to the appropriate project. If written approval is sought solely for Buffer Rules,
the application fee does not apply, and the applicant should clearly state (in a cover letter) that only
Buffer Rule approval is sought in writing. Wetlands or waters of the U.S. may not be impacted prior to
issuance or waiver of a Section 401 Water Quality Certification. Upon receipt of a complete application
for a 401 Certification, the Division of Water Quality has 60 days to prepare a written response to the
applicant. This may include a 401 Certification, an on-hold letter pending receipt of additional
requested information, or denial.
Page 2 of 12
Office Use Only: Form Version April 2001
USACE Action ID No. DWQ No. .?
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
1. Processing
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: Nationwide 14
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ?
H. Applicant Information
1. Owner/Applicant Information
Name: N.C. Department of Transportation
Mailing Address: P.O. Box 47
Shelby, North Carolina 28151
Telephone Number: 704-480-9020 Fax Number: 704-480-5401
E-mail Address:
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory authority for the owner/applicant.)
Name: Trish Simon
Company Affiliation: N.C.Department of Transportation
Mailing Address: P.O. Box 47
Shelby, North Carolina 28151
Telephone Number: 704-480-9044 Fax Number: 704-480-5401
E-mail Address: tsimon(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 detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: Pipe Replacement on SR 1825, 1000 ft. north of SR 1813
2. T.I.P. Project Number (NCDOT Only): N/A
3. Property Identification Number (Tax PIN):
4. Location
County: Iredell Nearest Town: Houstonville
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): Take Highway 901 West from
Harmony. Turn right onto SR 1832 and proceed approximately 3 miles to SR 1813. Turn
left onto SR 1813 and proceed 0.5 miles, turn right onto SR 1825 and proceed 1000 ft to site.
5. Site coordinates, if available (UTM or Lat/Long): 36°02'42N/80°48'19W
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Describe the existing land use or condition of the site at the time of this application: Pine
crossing on a partially paved secondary road
7. Property size (acres): '/4 acre (NCDOT right of way)
8. Nearest body of water (stream/river/sound/ocean/lake): Unnamed tributary to Long Branch
9. River Basin: Yadkin
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/maps/.)
Page 4 of 12
10. Describe the purpose of the proposed work: Replace and extend a deteriorated and
structurally deficient 60" CMP with a new 72" CMP to provide and adequate and safe
roadway section for the travelling public.
11. List the type of equipment to be used to construct the project: A trackhoe will be used for
excavating and riprap work.
12. Describe the land use in the vicinity of this project: The surrounding area is mostly wooded
with some residential land.
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: SR 1825 is a partially paved road. There are no other stream crossings on the
existing unpaved road alignment, therefore, no future permit requests are anticipated..
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 NO WETLAND IMPACTS
Wetland Impact
Site Number
(indicate on ma
Type of Impact* Area of
Impact
(acres Located within
100-year Floodplain**
ves/no Distance to
Nearest Stream
ear feet
Type of Wetland***

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.
s' 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://u,%t,%v.fema.cov.
'•' List a wetland type that best describes wetland to be impacted (e.g., freshwater/salhvater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property: 0
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, _ _.T)pe of Impact* Impact Stream Name,* of Stream Intermittent?
indicate on ma (linear feet Before Impact lease specify)
Placement of 10 (Pipe Unnamed tributary to
1 additional fill in extension) Long Branch 2 ft Intermittent
stream
Concrete head-
wall on inlet and Minimal
1 placement of (I Oft on
nprap on pipe inlet &
inlet and outlet outlet)
for stabilization.
Temporary
(15 ft
Pumped stream beyond
1 diversion during inlet and "
pipe installation outlet of
length of
new pipe)

Page 6 of 12
List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-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
wvwxy.usgs.cov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
ww?v.ma uuest.coni, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: Temporary impacts = 30
feet beyond length of new pipe during stream diversion: Pipe extension and riprap placement
will impact and additional 30 feet of stream.
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U. S. NO OPEN WATER IMPACTS
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 impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
4. Pond Creation NO POND CREATION
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? 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.
Page 7 of 12
The existing rusted pipe is being replaced with a slightly larger and longer new pipe (10 feet
longer & 12 inches larger). The pipe length must be increased to provide a safe roadwaX
shoulder width. A concrete headwall and riprap will be used to reduce erosion. Permanent
riprap will extend approximately 10 feet upstream and downstream of the proposed pipe. The
invert of the pipe will be set one foot below the streambed to allow for aquatic passage. The
stream is approximately 2 feet in width and is therefore small enough to be dammed and the
water pumped around the site during installation. The disturbance will be restricted to within 15
feet upstream and downstream of the proposed pipe length. Failure to replace the rusted pipe
could lead to the road being washed out with subsequent danger to life and property.
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
httl2:Hh2o.enr.state.nc.us/newetiands/strmRide.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.
STREAM IMPACTS < 150 FEET, MITIGATION NOT ANTICIPATED
Page 8 of 12
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP) with the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants
will be notified early in the review process by the 401/Wetlands Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at hyp://h2o.enr.state.nc.u,"Awnfindex.htm. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
IX. Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federaVstate/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.
Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ? No ® If you answered "yes", provide the following information:
Page 9 of 12
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* square Impact
( feet) Multiplier Require
Mitigation
1 3
2 1.5
Total
Gone 1 extends out stl feet perpendicular from 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.
N/A
XL 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.
SR 1825 is a partially paved road. Existing impervious surface at bridge is roadway' no
additional impervious surface proposed. Erosion and sedimentation control measures will be in
place during pipe replacement
XH. Sewage Disposal (DWQ Only)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
N/A
XIIL Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No
Is this an after-the-fact permit application?
Yes ? No
Page 10 of 12
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
J gin-
/9_0/
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
US Army Corps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Cherokee Iredell Mitchell
US Army Corps of Engineers Avery Clay Jackson Polk
151 Patton Avenue Buncombe Cleveland Lincoln Rowan
Room 208 Burke Gaston Macon Rutherford
Asheville, NC 28801-5006 Cabarrus Graham Madison Stanley
Telephone: [phone] Caldwell Haywood McDowell Swain
Fax: [phone] Catawba Henderson Mecklenburg Transylvania
Raleigh Regulatory Field Office Alamance Durham Johnston Rockingham
US Army Corps Of Engineers Allcghany Edgecombe Lee Stokes
6508 Falls of the Neuse Road Ashe Franklin Nash Surry
Suite 120 Caswell Forsyth Northampton Vance
Raleigh, NC 27615 Chatham Granville Orange Wake
Telephone: [phone] Davidson Guilford Person Warren
Fax: [phone] Davie Halifax Randolph Wilkes
Washington Regulatory Field Office Beaufort Currituck Jones
US Army Corps Of Engineers Bertie Dare Lenoir
Post Office Box 1000 Camden Gates Martin
Washington, NC 27889-1000 Carteret* Green Pamlico
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pcnder
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fax: [phone] Cumberland New Hanover Scotland
Pitt
Tyrrell
Washington
Wayne
Union
Watauga
Yancey
Wilson
Yadkin
*Croatan National Forest Only
Page 11 of 12
US Fis
US Fish and Wildlife Service
Raleigh Field Office
Post Office Box 33726
Raleigh, NC 27636-3726
Telephone: [phone]
h and Wildlife Service / National N
US Fish and Wildlife Service
Asheville Field Office
160 Zillicoa Street
Asheville, NC 28801
Telephone: [phone]
larine Fisheries Service
National Marine Fisheries Service
Habitat Conservation Division
Pivcrs Island
Beaufort, NC 28516
Telephone: [phone]
North Carolina State Agencies
Division of Water Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Telephone: [phone]
Fax: [phone]
Division of Water Quality
Wetlands Restoration Program
1619 Mail Service Center
Raleigh, NC 27699-1619
Telephone: [phone]
Fax: [phone]
CAMA and NC Coastal Counties
State Historic Preservation Office
Department Of Cultural Resources
4617 Mail Service Center
Raleigh, NC 276994617
Telephone: [phone]
Fax: [phone]
Division of Coastal Management Beaufort Chowan Hertford Pasquotank
1638 Mail Service Center Bcrtie Craven Hyde , Pender
Raleigh, NC 27699-1638 Brunswick Currituck New Hanover Perq»imans
Telephone: [phone] Camden Dare Onslow Tyrrell
Fax: [phone] Carteret Gates Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator Alleghany Caldwell Watauga
3855 Idlewild Road Ashe Mitchell Wilkes
Kernersville, NC 27284-9180 Avery - Stokes
Telephone: [phone] Burke Surry
Mountain Region Coordinator Buncombe Henderson Polk
20830 Great Smoky Mtn. Expressway Cherokee Jackson Rutherford
Waynesville, NC 28786 Clay Macon Swain
Telephone: [phone] Graham Madison Transylvania
Fax: [phone] Haywood McDowell Yancey
Page 12 of 12
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NCDOT
HAZARDOUS SPILL BASIN CHECKLIST
Division: 17- County: I ttf?e,?u- Project ID: 556052.
t467-T77 Yes No
Roadway Criteria:
way
Route Designation-
River Basin: c-,?-,r,J Bridge No: 7>j nu
Route: 5 2 Stream: u vU C-? < guru y -/-p Lo /I 4,z,?x,?, f
Water Quality Criteria:
Stream Crossing Blue Line On USGS r? r
ORw r r
wsI r r
WS 111,11I OR IV, Crossing Within O.Smi of W.S. Critical Area r F-
Site Information:
Yes No
Arterial Urban F P-1
Arterial Rural r r?
Is a Hazardous Spill Basin Required?
Yes No
r rc--,?
Criteria Based Upon NCDOT "Best Management Practices for the
Protection of Surface Waters" (March, 1997).
i
I e s SiNE o
? t r
S
z •?a..:`s• '401 /SSUro.
STATE of NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY P.O. Box 25201, RALEIGH, N.C. 27611-5201 LYNDO TIPPETT
GOVERNOR SECRETARY
P.O. BOX 47, 1710 East Marion Street
Shelby, N. C. 28151-0047
April 19, 2001
Mr. Steve Lund, Project Manager - NCDOT Projects
rn
US Army Corp of Engineers r_n .
Asheville Regulatory Field Office
r-TJ
151 Patton Avenue, Room 143 r i
Asheville, N. C. 28891-5006
Dear Mr. Lund:
The North Carolina Department of Transportation, Division of Highways, proposes the following
project for your issuance of a Section 404 Permit. We believe this project can be accomplished
under NWP #14, Road Crossing.
COUNTY: Iredell
LOCATION: Pipe on SR 1825, 1000 ft. north of SR 1813
STREAM: Unnamed tributary to Long Branch
PROJECT DESCRIPTION: The replacement of an existing 60' long, 60" CMP with a 70'
long, 70" CMP with a concrete headwall and associated rip-rap for stabilization on less than 1/4
acre of NCDOT right of way. The pipe will be placed below existing streambed elevation. A site
location map and a sketch of planned activities are attached.
It is proposed that the watercourse will be managed during construction by the utilizing sand-filled
burlap bags to block the stream approximately 15 feet beyond the upstream and downstream of the
proposed pipe. A pump will be used to divert the water across the road through a flexible pipe.
There are no wetlands; however, the stream is classified "WS-III" waters. Enclosed is a NCDOT
Hazardous Spill Basin checklist documenting the roadway and water quality criteria for this project.
Proper erosion and sedimentation control measures will be implemented during the project
construction.
A review of the Natural Heritage information for the threatened (T/SA -Threatened due to
similarity of appearance) species listed for Iredell County, the bog turtle (Clemntys muhlenbergii),
did not reveal any known sites in the vicinity of the proposed project. I have conducted a survey
for the bog turtle in the project area on April 16, 2001. None were observed. It was determined
that neither the bog turtle nor suitable habitat was located in the proposed project area. No
significant effect on this species is anticipated. A review of the National Register of Historic Places
was also conducted. No sites listed on the National Register will be affected by the proposed
project.
By copy of this letter, we are asking Edward L. Ingle, Area Roadside Environmental Engineer to
comment on the above project. By copy of this letter, we are also requesting concurrence from
the Wildlife Resources Commission, U.S. Fish & Wildlife Service, and the State Historic
Preservation Office.
By copy of this letter, I .am forwarding seven (7) copies of the application package to John Dorney,
NCDENR, Division of Water Quality, 401/Wetland Unit for review. A $200.00 check is enclosed
for application processing.
Your earliest consideration for this request would be greatly appreciated. Should you have any
questions, please call me at 704-480-9020.
Sincerely,

Trish Simon
Division 12 Environmental Officer
Enclosures
cc: Mr. Michael L. Holder, P.E., Division Engineer
Mr. Dan Holderman, P.E. , Division Bridge Engineer
Mr. Ed Ingle, Area Roadside Environmental Engineer
Mr. Ron Linville, WRC
Mr. Brian Cole, USF & WS
Ms. Renee Gledhill-Earley, SHPO
Mr. John Dorney, DENR,DWQ,401/Wetlands Unit
File

W A TF?p
?O G
p ?
Pre-Construction Notification (PCN) Application Form
For Section 404 and/or Section 10 Nationwide, Regional and General Permits, Section 401
General Water Quality Certifications, and Riparian Buffer and Watershed Buffer Rules
This form is to be used for projects qualifying for any of the U.S. Army Corps of Engineers' (USACE)
Nationwide, Regional or General Permits as required by Section 404 of the Clean Water Act and/or
Section 10 of the Rivers and Harbors Act, and for the North Carolina Division of Water Quality's
(DWQ) associated General 401 Water Quality Certifications. This form is also to be used for any
project requiring approval under any Riparian Buffer Rules implemented by the N.C. Division of Water
Quality. This form should not be used if you are requesting an Individual 404 Permit or Individual 401
Water Quality Certification. The USACE Individual Permit application form is available online at
http•//www.saw.usace.army.mil/wetiands/Perm app.htm.
The USACE is the lead regulatory agency. To review the requirements for the use of Nationwide,
Regional or General permits, and to determine which permit applies to your project, please go to the
USACE website at http://www.saw.usace.army.miI/wetlands/regtour.litm, or contact one of the field
offices listed at the end of this application. The website also lists the responsible project manager for
each county in North Carolina and provides additional information regarding the identification and
regulation of wetlands and waters of the U.S.
The DWQ issues a corresponding Certification (General or Individual), and cannot tell the applicant
which 401 Certification will apply until the 404 Permit type has been determined by the USACE.
Applicants are encouraged to visit DWQ's 401/Wetlands Unit website at
http://h2o.enr.state.nc.us/newetiands to read about current requirements for the 401 Water Quality
Certification Program and to determine whether or not Riparian Buffer Rules are applicable. The
applicant is also advised to read the full teat of the General Certification (GC) matching the specific 404
Permit requested. In some cases, written approval for some General Certifications is not required,
provided that the applicant adheres to all conditions of the GC. Applicants lacking access to the internet
should contact DWQ's Central Office in Raleigh at [phone].
Trout Waters Coordination - Special coordination with the North Carolina Wildlife Resources
Commission (NCWRC) is also required for projects occurring in any of North Carolina's twenty-five
counties that contain trout waters. In such cases, the applicant should contact the appropriate NCWRC
regional coordinator (listed by county on the last page of this application).

Page 1 of 12
CAMA Coordination - If the project occurs in any of North Carolina's twenty coastal counties (listed on
the last.page of this application) the applicant should also contact the North Carolina Division of Coastal
Management (DCM) at [phone]. DCM will determine whether or not the project involves a
designated Area of Environmental Concern, in which case DCM will act as the lead permitting agency.
In such cases, DCM will require a Coastal Area Management Act (CAMA) Permit and will coordinate
the 404/401 Permits.
USACE Permits - Submit one copy of this form, along with supporting narratives, maps, data forms,
photos, etc. to the applicable USACE Regulatory Field Office (addresses are listed at the end of this
application). Upon receipt of an application, the USACE will determine if the application is complete as
soon as possible, not to exceed 30 days. This PCN form is designed for the convenience of the applicant
to address information needs for all USACE Nationwide, Regional or General permits, as well as
information required for State authorizations, certifications, and coordination. Fully providing the
information requested on this form will result in a complete application for any of the USACE
Nationwide, Regional or General permits. To review the minimum amount of information that must be
provided for a complete PCN for each USACE Nationwide permit, see Condition 13, 65 Fed.Reg. 12893
(March 9, 2000), available at http://www.saw.usace.army.mil/wetlands/nwpfina]FedRe?pdf.
Processing times vary by permit and begin once the application has been determined to be complete.
Please contact the appropriate regulatory field office for specific answers to permit processing periods.
401 Water Quality Certification or Buffer Rules - All information is required unless otherwise stated
as optional. Incomplete applications will be returned. Submit seven collated copies of all USACE
Permit materials to the Division of Water Quality, 401/Wetlands Unit, 1650 Mail Service Center,
Raleigh, NC, 27699-1650. If written approval is required or specifically requested for a 401
Certification, then a non-refundable application fee is required. In brief, if project impacts include less
than one acre of cumulative wetland/water impacts and less than 150 feet cumulative impacts to
streams, then a fee of $200 is required. If either of these thresholds is exceeded, then a fee of $475 is
required. A check made out to the North Carolina Division of Water Quality, with the specific name of
the project or applicant identified, should be stapled to the front of the application package. For more
information, see the DWQ website at http://h2o.ehnr.state.ne.us/ncwet]ands/fees.html. The fee must be
attached with the application unless the applicant is a federal agency in which case the check may be
issued from a separate office. In such cases, the project must be identifiable on the U.S. Treasury check
so that it can be credited to the appropriate project. If written approval is sought solely for Buffer Rules,
the application fee does not apply, and the applicant should clearly state (in a cover letter) that only
Buffer Rule approval is sought in writing. Wetlands or waters of the U.S. may not be impacted prior to
issuance or waiver of a Section 401 Water Quality Certification. Upon receipt of a complete application
for a 401 Certification, the Division of Water Quality has 60 days to prepare a written response to the
applicant. This may include a 401 Certification, an on-hold letter pending receipt of additional
requested information, or denial.
Page 2 of 12
Office Use Only: Form Version April 2001
0 I
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: Nationwide 14
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ?
H. Applicant Information
1. Owner/Applicant Information
Name: N.C. Department of Transportation
Mailing Address: P.O. Box 47
Shelby, North Carolina 28151
Telephone Number: 704-480-9020 Fax Number: 704-480-5401
E-mail Address:
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory authority for the owner/applicant.)
Name: Trish Simon
Company Affiliation: N.C.Department of Transportation
Mailing Address: P.O. Box 47
Shelby, North Carolina 28151
Telephone Number: 704-480-9044 Fax Number: 704-480-5401
E-mail Address: [e-mail]
Page 3 of 12
III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: Pipe Replacement on SR 1825, 1000 ft. north of SR 1813
2. T.I.P. Project Number (NCDOT Only): N/A
3. Property Identification Number (Tax PIN):
4. Location
County: Iredell Nearest Town: Houstonville
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.):_ Take Highway 901 West from
Harmony. Turn right onto SR 1832 and proceed approximately 3 miles to SR 1813. Turn
left onto SR 1813 and proceed 0.5 miles, turn right onto SR 1825 and proceed 1000 ft to site.
5. Site coordinates, if available (UTM or Lat/Long): 36°02'42N/80°48' 19W
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Describe the existing land use or condition of the site at the time of this application: Pine
crossing on a partially paved secondary road
7. Property size (acres): 1/4 acre (NCDOT right of way)
8. Nearest body of water (stream/river/sound/ocean/lake): Unnamed tributary to Long Branch
9. River Basin: Yadkin
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.ne.us/admin/maps/.)
Page 4 of 12
10. Describe the purpose of the proposed work: Replace and extend a deteriorated and
structurally deficient 60" CNM with a new 72" CMP to provide and adequate and safe
roadway section for the travelling public.
11. List the type of equipment to be used to construct the project: A trackhoe will be used for
excavating and riprap work.
12. Describe the land use in the vicinity of this project: The surrounding area is mostly wooded
with some residential land.
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: SR 1825 is a partially paved road. There are no other stream crossings on the
existing unpaved road alignment; therefore, no future permit requests are anticipated.
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 NO WETLAND IMPACTS
Wetland Impact
Site Number
(indicate on ma
Type of Impact* Area of
Impact
acres Located within
100-year Floodplain**
yes/no Distance to
Nearest Stream
(linear feet
Type of Wetland***

' 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 httn://??ww.fema.gov.
'•• List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property: 0
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 lease specify)
Placement of 10 (Pipe Unnamed tributary to
1 additional fill in extension) Long Branch 2 ft Intermittent
stream
Concrete head-
wall on inlet and Minimal
1 placement of (loft on ,< ,< «
nprap on pipe inlet &
inlet and outlet outlet)
for stabilization.
Temporary
(15 ft
Pumped stream beyond
1 diversion during inlet and "
pipe installation outlet of
length of
new pipe)

Page 6 of 12
" List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-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 topogmphic 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
www.usas.£ov. Several internet sites also allow direct doAiAoad and printing of USGS maps (e.g., w%ti%v.topozone.com,
,vk-,v%v.manuest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: Temporary impacts = 30
feet beyond length of new pipe during stream diversion: Pipe extension and riprap placement
will impact and additional 30 feet of stream.
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S. NO OPEN WATER IMPACTS
Open Water Impact
Site Number
indicate on ma
Type of Impact* Area of
impact
acres Name Waterbody
(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay. ocean, etc.

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
4. Pond Creation NO POND CREATION
If construction of -a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? 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.
Page 7 of 12
The existing rusted pipe is being replaced with a slightly larger and longer new pine (10 feet
longer & 12 inches larger). The pipe length must be increased to provide a safe roadway
shoulder width. A concrete headwall and riprap will be used to reduce erosion. Permanent
riprap will extend approximately 10 feet upstream and downstream of the proposed pipe. The
invert of the pipe will be set one foot below the streambed to allow for aquatic passage. The
stream is approximately 2 feet in width and is therefore small enough to be dammed and the
water pumped around the site during installation. The disturbance will be restricted to within 15
feet upstream and downstream of the proposed pipe length. Failure to replace the rusted pipe
could lead to the road being washed out with subsequent danger to life and property.
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http://h2o.enr.state.nc.us/ncwetlands/strmizide.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.
STREAM IMPACTS < 150 FEET. MITIGATION NOT ANTICIPATED
Page 8 of 12
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP) with the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants
will be notified early in the review process by the 401/Wetlands Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at littT)://h2o.enr.stite.nc.us/i'.Tr)/index.litni. 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.
Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ? No ® If you answered "yes", provide the following information:
Page 9 of 12
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* (s uImpct are feet) Multiplier Mitigation
1 3
2 1.5
Total
' 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.
N/A
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.
SR 1825 is a nartially paved road. Existiniz impervious surface at bridize is roadway no
additional impervious surface proposed. Erosion and sedimentation control measures will be in
place 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.
N/A
XIH. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No N
Is this an after-the-fact permit application?
Yes ? No N
Page 10 of 12
US Fish and Wildlife Service / National Marine Fisheries Service
US Fish and Wildlife Service US Fish and Wildlife Service National Marine Fisheries Service
Raleigh Field Office Asheville Field Office Habitat Conservation Division
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).
_'J/tA?
/9_0/
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
US Army Corps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Cherokee Iredell Mitchell
US Army Corps of Engineers Avery Clay Jackson Polk
151 Patton Avenue Buncombe Cleveland Lincoln Rowan
Room 208 Burke Gaston Macon Rutherford
Asheville, NC 28801-5006 Cabarrus Graham Madison Stanley
Telephone: [phone] Caldwell Haywood McDowell Swain
Fax: [phone] Catawba Henderson Mecklenburg Transylvania
Raleigh Regulatory Field Office Alamance Durham Johnston Rockingham
US Army Corps Of Engineers Alleghany Edgccombe Lee Stokes
6508 Falls of the Neuse Road Ashe Franklin Nash Surry
Suite 120 Caswell Forsyth Northampton Vance
Raleigh, NC 27615 Chatham Granville Orange Wake
Telephone: [phone] Davidson Guilford Person Warren
Fax: [phone] Davie Halifax Randolph Wilkes
Washington Regulatory Field Office Beaufort Currituck Jones
US Army Corps Of Engineers Bertie Dare Lenoir
Post Office Box 1000 Camden Gates Martin
Washington, NC 27889-1000 Carteret* Green Pamlico
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perq»imans
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Hamett Ponder
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fax: [phone] Cumberland New Hanover Scotland
Pitt
Tyrrell
Washington
Wayne
Union
Watauga
Yancey
Wilson
Yadkin
*Croatan National Forest Only
Page 11 of 12
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Downstream of pipe replacement project on SR 1825 on an unnamed tributary to Long
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NCDOT
HAZARDOUS SPILL BASIN CHECKLIST
Division: 17L- County: ?????L?- Project ID: 56Zsz-
River Basin: c7,¢ ),??,J Bridge No: 7>j pG
Route: 5 2 i zs Stream: uAj,u1+7-,c-) T72-1 isurw7zy ;-a Lovh &t/tzt, t
Water Oualitv Criteria:
t457-177 Yes No
Stream Crossing Blue Line On USGS r? r
ORW r r
WSI r r
WS 11,E11 OR IV, Crossing Within 0.5mi of W. S. Critical Area r r?
Roadway Criteria:
Route Designation-
Yes No
Arterial Urban r r-1
Arterial Rural r r?
Additional Site Information: Te is
AT SOY
Yes No
Is a Hazardous Spill Basin Required? r r?
Criteria Based Upon NCDOT "Best Management Practices for the
Protection of Surface Waters" (March, 1997).