20010419 Ver 1_Complete File_20010321

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RQG Michael F. Easley
Governor
r William G. Ross, Jr., Secretary
Department of Environment and Natural Resources
Kerr T. Stevens
Division of Water Quality
March 22, 2001
Rowan County
DWQ Project No. 01-0419
Bridge No. 7, SR 1753 (Centenary Church Road)
APPROVAL of 401 Water Quality Certification with Additional Conditions
Ms. Diane Hampton, P.E., Division Environmental Officer
NCDOT Division 9
2125 Cloverdale Avenue
Winston-Salem, NC 27103
Dear Ms. Hampton:
You have our approval, in accordance with the attached conditions and those listed below, to place 30 cubic yards of rip
rap in Back Creek for the purpose of replacing Bridge No. 7 on SR 1753 (Centenary Church Road) in Rowan County.
The project should be constructed in accordance with your application dated 12 March 2001 (received 21 March 2001).
After reviewing your application, we have decided that this project is covered by General Water Quality Certification
Number 3289. This certification corresponds to Nationwide Regional (General) Permit 198200031 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. The following additional conditions will be required:
1. Trout conditions as noted by NC Wildlife Resources Commission.
2. Stormwater should be directed to buffer areas or retention basins and should not be routed directly into streams.
3. High Quality Waters Erosion Control Guidelines must be implemented prior to any ground-disturbing activities to
minimize impacts to downstream aquatic resources. Temporary or permanent herbaceous vegetation should be
planted on all bare soil within S days of ground-disturbing activities to provide long term erosion control.
4. The culvert required for this project shall be installed in such a manner that the original stream profile is not altered
(i.e. the depth of the channel should not be reduced by a widening of the streambed).
5. All work shall be performed during low flow conditions.
6.. All mechanized equipment operated near surface waters should be regularly inspected and maintained to prevent
contamination of stream waters from fuels, lubricants, hydraulic fluids, or other toxic materials.
7. The presence of equipment in the channels must be minimized. Under no circumstances should rock, sand or other
materials be dredged from the wetted stream channel under authorization of this permit, except in the immediate
vicinity of the culverts.
8. Mowing of existing vegetated buffers is strongly discouraged, so that they may be utilized for storm water sheet flow.
9. Use of rip-rap for bank stabilization is to be minimized; rather, native vegetation is to be planted when practical. If
necessary, rip-rap should be limited to the stream bank below the high water mark, and vegetation should be used for
stabilization above high water.
10. Rock silt screens at culvert outlets should be removed at project completion.
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 the proposed fill is in excess of 150 linear feet of stream length or 1 acre of wetlands, compensatory mitigation will
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), httpJ/h2o.enr.state.nc.us/ncwetands/
Page 2 of 2
required as described in 15A NCAC 211.0506 (h) (6) and (7). For this approval to be valid, you must follow the
conditions listed in the attached certification and any additional conditions listed above.
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, 6714 Mail Service Center,
Raleigh, N.C. 27699-6714. This certification and its conditions are final and binding unless you ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water Act. If you have
any questions, please telephone John Dorney at 919-733-9646.
Sincerely,
Stevens
Attachment
Pc: Wilmington District Corps of Engineers
Corps of Engineers Asheville Field Office
NCDWQ Mooresville Regional Office
Central Files
,' „a SfAlFy,
010419
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY LYNDO TIPPET
GOVERNOR SECRETARY
March 12, 2001 44011881iF0
SUBJECT: Rowan County - SR 1753 Bridge 7 Centenary Church Road
Mr. John Dorney PAYMENT
NC Division of Water Quality
4401 Reedy Creek nF?E? Y EU
Raleigh, NC 27607
Dear Mr. Dorney,
in an effort to obtain the necessary permits for the subject bridge replacement, we are providing a
pre-construction notification application with supporting documentation and $200 fee for the replacement
of Bridge Number 7 in Rowan County. There are no wetlands in the project area. We propose to replace
the old timber and steel girder bridge with a cored slab bridge at the same location. We. believe this project
can be accomplished under General Permit 31.
By copy of this letter, we are also seeking approval from the State Historic Preservation Office, the
Corps of Engineers, the Fish and Wildlife Service and the NC Wildlife Resources Commission. Therefore,
we are submitting the enclosed material to them.
If you have any questions, comments or need additional information after reviewing this material,
please contact me at [phone]. Thank you for your cooperation in this matter.
Respectfully,
k?,m.S19i?
Diane K. Hampton, P.E.
Division Environmental Engineer
Enclosures
CF: Mr. Pat Ivey, P.E., Division Engineer
Mr. George Teague, Bridge Maintenance Superintendent
File
Division of Highways • Division Nine • 2125 Cloverdale Avenue, Winston-Salem, NC 27103
Telephone [phone] • Fax [phone] Courier Box 13-12-04
4
010 419 . r ? "401 ISSUED"
DWQ ID: CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #) GP 31
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
1. NOTIFICATION TO THE CORPS OF ENGINEERS
2. APPLICATION FOR SECTION 401 CERTIFICATION
3_ COORDINATION WITH THE NC DIVISION OF COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE FIELD
OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN (7)
COPIES MUST BE SENT TO THE NC DIVISION OF WATER QUALITY,
ATTN: JOHN DORNEY, 4401 REEDY CREEK ROAD, RALEIGH, NC
27607. PLEASE PRINT OR TYPE.
1. OWNER'S NAME: NC Department of Transportation, Division 9
2. MAILING ADDRESS: 2125 Cloverdale Ave.
SUBDIVISION NAME
CITY: Winston-Salem STATE: NC ZIP CODE: 27103
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
3. TELEPHONE NUMBER: (HOME) (WORK) 336-761-2613
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
Diane Hampton, PE, DEO
2125 Cloverdale Ave.
Winston-Salem. NC 27103
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP
OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: Rowan - NEAREST TOWN: Mt. Ulla
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.) SR1753 Centenary
Church Rd. Bridge 7
6. IMPACTED OR NEAREST STREAM/RIVER: Back Creek RIVER BASIN: Yadkin
7. (a) IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER, (SA),
HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER C a
SUPPLY (WS-I OR WS-II)? YES ® NO ? IF YES, EXPLAIN: located within a WS-II protected area, rn
no intakes within 3 miles as seen on ArcView data. ?
Q -i
(b) IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES ? NO
(c) IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF
COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION? N/A
'!
8. (a) HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT? YES ? NO ® IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND
ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION):
(b) ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
YES ? NO ® IF YES, DESCRIBE ANTICIPATED WORK:
9. (a) ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND:.02
(b) ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
none
10. (a) NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: 0 EXCAVATION: 0
FLOODING: 0 OTHER : 0
DRAINAGE : 0 TOTAL ACRES TO BE IMPACTED: none
(b) (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED,
PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION: N/A
LENGTH BEFORE: FT AFTER: FT
WIDTH BEFORE (based on normal high water contours): FT
AVERAGE DEPTH BEFORE: FT AFTER: FT
(b) (2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: PLACEMENT OF PIPE IN CHANNEL:
CHANNEL EXCAVATION: CONSTRUCTION OF A DAM/FLOODING:
OTHER: x minor temporary construction impact for pile replacement, 30 feet alon toe of stream. 30 cubic yards of
riprap to be placed along banks and around piles at toe of creek.
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
DRAINING TO THE POND? N/A WHAT IS THE EXPECTED POND SURFACE AREA? N/A
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMENT TO BE USED? (ATTACH PLANS; 81/2 BY 11 DRAWINGS ONLY)
To replace old steel and timber I-beam bridge with cored slab bridge using standard bridge construction
equipment.
13. PURPOSE OF PROPOSED WORK: To replace old bridge with new on same location.
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND HAPACTS)
N/A
15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR
NATIONAL MARINE FISHERIES SERVICE REGARDING THE PRESENCE OF ANY FEDERALLY
LISTED OR PROPOSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL
HABITAT IN THE PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT.
DATE CONTACTED: 3/13/2001
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA
WHICH MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED 3/13/2001.
't
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OT THE USE OF PUBLIC
(STATE) LAND? YES ® NO ? (IF NO, GO TO 16)
(a) IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT? YES ? NO
(b) IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES ? NO ? N/A
IF ANSWER 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE STATE
CLEARINGHOUSE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMMSTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED
ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OF FILL MATERIAL INTO
WETLANDS:
(a) WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES, AND
PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26, 29, AND 38).
ALL STREAM (INTERMITTENT AND PERMANENT) ON THE PROPERTY MUST BE SHOWN ON
THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET OF 1 INCH EQUALS 100 FEET
OF THEIR EQUIVALENT.
(b) IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE IMPACTED BY
PRODUCT.
(c) IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA SHEETS
RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
(d) ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
(e) WHAT IS LAND USE OF SURROUNDING PROPERTY?
(f) IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE US MAY NOT BE IMPACTED PRIOR TO:
1. ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
2. EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF WATER QUALITY
CERTIFICATION, AND
3. (IN THE TWENTY COASTAL COUNTIES ONLY), A LETTER FROM THE NORTH
CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED
ACTIVITY IS CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT
PROGRAM,
OWNER'S/AGENT'S SIGNA
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED).
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F1? _
Q 4 1 , s"401 ISSUED,,
DWQ ID: CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #) GP 31
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
1. NOTIFICATION TO THE CORPS OF ENGINEERS
2. APPLICATION FOR SECTION 401 CERTIFICATION
3_ COORDINATION WITH THE NC DIVISION OF COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE FIELD
OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN 7
COPIES MUST BE SENT TO THE NC DIVISION OF WATER QUALITY,
ATTN: JOHN DORNEY, 4401 REEDY CREEK ROAD, RALEIGH, NC
27607. PLEASE PRINT OR TYPE.
1. OWNER'S NAME: NC Department of Transportation, Division 9
2. MAILING ADDRESS: 2125 Cloverdale Ave.
SUBDIVISION NAME
CITY: Winston-Salem STATE: NC ZIP CODE: 27103
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
3. TELEPHONE NUMBER: (HOME) (WORK) 336-761-2613
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
Diane Hampton, PE, DEO
2125 Cloverdale Ave.
Winston-Salem, NC 27103
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP
OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: Rowan - NEAREST TOWN: Mt. Ulla
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.) SR1753 Centenary
Church Rd. Bridge 7
6. IMPACTED OR NEAREST STREAM/RIVER: Back Creek RIVER BASIN: Yadkin

7. (a) IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER, (SA),
tTl
HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER ? z
SUPPLY (WS-1 OR WS-II)? YES ® NO ? IF YES, EXPLAIN: located within a WS-II protected area, C7 '-?
no intakes within 3 miles as seen on ArcView data.
(b) IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES ? NO
(c) IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF
COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION? N/A
,fie
x,
a
8. (a) HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT? YES ? NO ® IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND
ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION):
(b) ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
YES ? NO ® IF YES, DESCRIBE ANTICIPATED WORK:
9. (a) ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND:.02
(b) ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
none
10. (a) NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: 0 EXCAVATION: 0
FLOODING: 0 OTHER : 0
DRAINAGE : 0 TOTAL ACRES TO BE IMPACTED: none
(b) (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED,
PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION: N/A
LENGTH BEFORE: FT AFTER: FT
WIDTH BEFORE (based on normal high water contours): FT
AVERAGE DEPTH BEFORE: FT AFTER: FT
(b) (2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: PLACEMENT OF PIPE IN CHANNEL:
CHANNEL EXCAVATION: CONSTRUCTION OF A DAM/FLOODING:
OTHER: x minor temporary construction impact for pile replacement, 30 feet along toe of stream. 30 cubic yards of
riprap to be placed along banks and around piles at toe of creek.
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
DRAINING TO THE POND? N/A WHAT IS THE EXPECTED POND SURFACE AREA? N/A
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMENT TO BE USED? (ATTACH PLANS; 81/2 BY 11 DRAWINGS ONLY)
To replace old steel and timber I-beam bridge with cored slab bridge using standard bridge construction
equipment.
13. PURPOSE OF PROPOSED WORK: To replace old bridge with new on same location.
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS)
N/A
15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR
NATIONAL MARINE FISHERIES SERVICE REGARDING THE PRESENCE OF ANY FEDERALLY
LISTED OR PROPOSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL
HABITAT IN THE PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT.
DATE CONTACTED: 3/13/2001
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA
WHICH MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED 3/13/2001.
?t
1 17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OT THE USE OF PUBLIC
(STATE) LAND? YES ® NO ? (IF NO, GO TO 16)
(a) IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT? YES ? NO
(b) IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES ? NO ? N/A
IF ANSWER 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE STATE
CLEARINGHOUSE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED
ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OF FILL MATERIAL INTO
WETLANDS:
(a) WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES, AND
PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26, 29, AND 38).
ALL STREAM (INTERMITTENT AND PERMANENT) ON THE PROPERTY MUST BE SHOWN ON
THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET OF 1 INCH EQUALS 100 FEET
OF THEIR EQUIVALENT.
(b) IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE IMPACTED BY
PRODUCT.
(c) IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA SHEETS
RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
(d) ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
(e) WHAT IS LAND USE OF SURROUNDING PROPERTY?
(f) IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE US MAY NOT BE IMPACTED PRIOR TO:
I. ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
2. EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF WATER QUALITY
CERTIFICATION, AND
3. (IN THE TWENTY COASTAL COUNTIES ONLY), A LETTER FROM THE NORTH
CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED
ACTIVITY IS CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT
PROGRAM,
OWNER'S/AGENT'S SIGNA
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED).
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ROWAN COUNTY
BRIDGE LOCATION MAP
NORTH CAROLINA
PREPARED BY THE Qo1? _
NORTH CAROLINA DEPARTMENT OF TRANSPORTATION
DIVISION OF HIGHWAYS - BRIDGE MAINTENANCE UNIT
IN COOPERATION WITH THE
U.S.DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION

SCALE
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0 0.5 1 MILE
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10,000 FOOT G o BASED ON NORSN CA OuNA BANE COORDINATE SYSTEM
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