20010567 Ver 1_Complete File_20010416

F WAIF
\O?? RQG Michael F. Easley
Governor
William G. Ross, Jr., Secretary
Department of Environment and Natural Resources
Kerr T. Stevens
Division of Water Quality
June 6, 2001
Randolph County
DWQ Project No. 010567
Bridge No. 13, SR 1199
APPROVAL of 401 Water Quality Certification
Mr. E.B. Nelson, P.E., Bridge Maintenance Engineer
NCDOT Division 8
P.O. Box 289
Siler City, NC 27344
Dear Mr. Nelson:
yv
You have our approval, in accordance with the attached conditions and those listed below, to impact 45 linear feet of
McGees Creek for the purpose of replacing Bridge No.. 13 on SR 1199 in Randolph County. The project should be
constructed in accordance with your application dated 24 April 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 Permit 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. For this approval to be valid, you must follow the conditions listed
in the attached 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 the proposed fill is in excess of 150 linear feet of stream length or 1 acre of wetlands, compensatory mitigation will
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 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 CeiUer,
Raleigh, N.C. 27699-6714. This ceitificafion'and i6-6nditions are finaland'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 Ms. Cynthia Van Der Wiele at 919.733.5715 or Ms. Jennifer Frye of the Winston-Salem
Regional Office at 336.771-4600.
Sincerely,
Kerr T. Stevens
Attachment
Pc: Wilmington District Corps of Engineers
Corps of Engineers Raleigh Field Office
NCDWQ Winston-Salem Regional Office
Central Files
File Copy

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401 ISSUEDy
MICHAEL F. EASLEY
GovERNoR
May 2, 2001
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
DIVISION OF HIGHWAYS
PROJECT: Chatham Co. #150 - DWQ #010569
Randolph Co. #13 - DWQ #010567
RE: Stream Impacts
NCDENR
Div. of Water Quality
Mr. John Dorney
4401 Reedy Creek Rd.
Raleigh, NC 27607
DAVID MCCOY
SECRETARY
Length of impact for both projects is expected to be 85 feet as indicated on the enclosed revised section of
the "Pre-Notification to Construct Form".
Sincerely,
GA
E. B. Nelson, P.E.
Div. Bridge Maint. Engineer
Cc: Bridge File
W. F. Rosser, P.E. --Division Engineer
Mike McNeill - City of Raeford
Bridge Maintenance Unit
PO Box 289 - Siler City - NC - 27344
DRAINAGE :
v
EXCAVATION: O
OTHER. 0
TOTAL ACRES TO BE IMPACTED:
0
10b. (1) STREAM CFU'uNNEL TO BE-IMPACTED BY THE PROPOSED PROJECT (IF
RELOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION:
LENGTH BEFORE: FT AFTER: R57
FT
WIDTH BEFORE (based on normal high water contours): FT
AVERAGE DEPTH BEFORE: FT AFTER: -F-1
(2) STRE.-MM CHANNEL II IPACTS WILL RESULT FROM: (CHECK ALL APPLY)
OPEN CHANNEL R?.OCATION: PLkCEvfENT OF PIPE IN CHA NNEL:
CF--\-NN-EL EXCAVATTON: COONSTR=ON OF .-k D:?WFi OODCNG:
O7`HER: P21?GhsT" 96-X g-wLvIl?e.-T eo" poor1hle.,s
11. IF CONSTRUCTION OF A POND IS PROPOSED, i,'Y'HAT IS TrID SIZE OF Tr'y' WATERSP:ED
DRAINING TO THE POND? WH,-%T IS THE EXPECTED
POND SURFACE AREA?
12. DISCITPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF biECF ?NIC ?L
EQUIPMENT TO BE USED? (ATTACH PLANS; 8V2 BY I I DRAWI,i 1GS ONLY)
2*-(ILA-"F- SXIs-r1tJe, gr2Ir->&tW- w It14 25&'>e-f6' PP-Ce- -,7 Z-0ijGrZC 7T.
9OX 6ULVWMa T- 49N GoNG2E.Tl? DoTlw?tr,S . 9QL11P LL5et-> -
IZ ycG.14-Yt?U ?L ? L2J?-!V Ic .
1:. PURPOSE OF PROPOSED WORK: _2EPL.o(-cj-.- t??F???r?nr-r )? e?r> c-ti?,f-
14.. STATE REASONS VN ?:Y IT IS BELIEVED TFaT Tr11S ACTIVITY ti1liST BE CARRIED 0U 1
WETL-?-YDS ( INCL=E A:VY tifEASURES TAKEN TO MrgDy1= W-E i L? -D L-YIPAC i S )
State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
Mr. E.B/ Nelson, NCDOT
Division Bridge Maintenance Engineer
Post Office Box 289
Silver City, NC 27344
Dear Mr. Nelson:
April 19, 2001
DWQ # 010567
Randolph County
On April 16, 2001 the Division of Water Quality (DWQ) was notified by receipt of
your applications regarding your plan to replace bridge No. 13 on SR 1199 for the
purpose of bridge replacement in Randolph County. Please report the length of stream
to be impacted by the box culvert on line 10b of the application form.
Please call me at [phone] if you have any questions or would require
copies of our rules or procedural materials. This project will remain on hold as
incomplete in accordance with 15A NCAC 2H .0505(c). The processing time for this
application will begin when this information is received. If we do not hear from you by
writing within three (3) weeks we will assume you no longer want to pursue the project
and will consider it withdrawn.
Cc: Winston-Salem DWQ Regional Office
Raleigh Corps of Engineers
File Copy
Central Files
k11?W'J
4 •
IT
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
Dorney
7
Wetlands/401 Unit • 4401 Reedy Creek Road • Raleigh, North Carolina 27607
Telephone [phone] FAX # [phone]
An Equal Opportunity Affirmative Action Employer
50% recycled/ 10% post consumer paper
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I
401 ISSUED - °
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY DIVISION OF HIGHWAYS LYNDo TIPPETT
GOVERNOR SECRETARY
March 26, 2001
USACOE OJ G 61
Mr. Eric Alsmeyer O
6512 Falls of the Neuse Road RECEIVED
Suite 105 W'ATFR nI IAL17YSECTION
Raleigh, N.C. 27615 APR
Re: Randolph Co. Bridge No. 13 Replacement
Location: SR 1199, Across McGees Creek Nan-Discharge pem?Wr$g
Dear Mr. Alsmeyer:
We are providing herewith an application package for the replacement of an existing bridge with a 30'x8'
Precast Concrete Box Culvert on footings. A hydrographic survey is not available so a typical cross section
of the proposed structure has been included. Construction shall begin in the Summer of 2001.
To our knowledge, no wetlands are involved and total fill in waters is expected to be less than 0.01 acre.
This bridge is not located in a high quality water area.
Please review this material, and if additional information is needed, or you have comments, please contact
our office.
Thank you for your cooperation and assistance in this matter.
Sliincerely.
E.B. Nelson, P.E.
Div. Bridge Maint. Engineer
Attachments
cc: Bill Rosser, P.E. - Division Engineer
John Hennessey - DWQ - 7 copies w/ attachments
Mrs. Renee Gledhill-Earley - State Historic Preservation Officer
Mike Crocker - US Fish & Wildlife Service

DIV. 8 BRIDGE M.- INTENANCE
PC) BOX 289 - SILER CITY- NC - 27344
PH. 919.742.5649 FAX [phone]

n?LUi nUl7RrU'1 Lr-V. rdX•?ly-(JJ-JJtS?
Jul 2J 1WU to,-b8 P. 44
MINEMMM CRITERIA, DETERNJ VATION CEMOCUST
The following gue dons provide direction In determining whether a proposed project hw only a
minimum potential for environmd I effects.- Anewer the Wowing questions by checking
either yes Ora*.' Refer to ilia attached guidance for assistance.
TIP fro jest 3Yo, '
State Project No. s; sus z
Project Location: 2A?N Pv L. m4 Lo • 5 tz 119°) Ae-rzoSS M G? IES L2EE /G
Prof sot Deaeription: R>2 rr>c iE ^Jo. 15,
Anticipated Permit or Consultation Requirements: l`4wP 4e,4
Special Project Information:

• ...a.v. 1%U%J1v*•1 AA-V. rCX•`J1`a (JJ.OJT' Jul 20 2000 10:58
PAKI' A: MINIbWM CRITERIA
1. Is the proposed project listed as a type which would qualify
as a Non-Major Act:Qn'tuu3?r the Minimum Criteria?
PART B: ? mnnmUM'CRMRIA EXCX#nONS
2. Is the proposed project likely to preolpitate significamt,-foreseeable
alterations In land use, plumed growth, or development patterns?
3- Does the proposed action divide or disrupt an established eotiununity?
4. Does the proposed action bypass an existing oommtaWty?
5. Does the proposed action provide new access to area containing
signifi2,nt amounts of exploitable natural resources?
6. Is the proposed action likely to have a significant detrimental impact
on air 411 t y?
7. Is the proposed action likely to have a significant detrimental impact
on ambient noise levels for adjoining atop
8. is the proposed action likely to have a signif cant impact on travel
patterns or traffic volumes?
9. Is the proposed action likely to significantly affect water quality?
10. Boer the proposed action require the relocation of significant numbers
of people?
11. Is the project likely to be controversial?
12. Will Oe proposed action rewire the use of land owned by the
U. S. Forest Service or the National Park Service?
P. 05
YES NO

? M
? S.
? S

? 0
? 9
PART C: COMPLZA-NCE WITH STATE AND FEDERAL REGULATIONS
EcOloeical Impacts
13. Is a federally protected threatened or endangered species, or its habitat, ? ?
likely to be i.-spatted by the proposed action?
14• Does the action reguira the placement of fill in waters of the United Stites?
2
I V-"J I I NUUNMI `WCV. _ r ax ? toi j-- rod-?52t5 - Jul 20 2000 1058 P.06
15. Does the project require the placement of a significant amount of fill in ?
high Quality or-raWraly rare wetland ecosystems, such as mountain bogs
or pine aavannahs7
16. Does the Pwject require stm= relocation or channel changes? ? r?
17. Is the proposed action located in an Area of Environmental Concern, ?
as dellned in the Coastal Area Management Act?
Cultural Resources `
18. Witt the project have an "effect" on a property or site Us= on the ?
National Register of Historic Places?
19. Will the proposed action require acquisition of additional right of way ?
from publialy owned parkland or recreational areas?
Reviewed by; ;e- Az&k Date: 3 ze,1o
Project Planning Engineer
Project Pluming Uait Hears
If my Questions 2 through 12 are answered "yes". the proposed project does not qualify as a
Non-Major Action. A state environmental assessment (EA) will be required. For assistance,
contact:
William D. Gilmore, P. B.
Manager, Project Development and Environmental Analysis Branch
P. O. Box 25201
Raleigh, NC 27611
[phone]
Fax: [phone]
Questions in Part C are designed to assist the Engineer in•detemlining whether a permit or
consultation with a state or federal resource agency may be required. If any question in Part C is
answered "yes", refer to the Environmental (3Wdanca section of this document and contact the
appropriate individual for assistance.
.r
NATIONWIDE PERK aT REQUESTED (PROVIDE NATIONWIDE PERM LIT #r)
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PER JITS THAT REQUIRE:
1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFC.4TION
3) COORDINATION WITH, THE NC DIVISION OF COASTAL MA`1AGEME TT
SEND THE ORIGINAL ANTI) .(I) COPY OF TM- CO&IPLETED FORM TO TF-IB APPROPRIATE
FIELD OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN
(7) COPIES MUST BE SENT TO THE NC DIVISION OF WATER
OUALITY. ATTN: JOHN DORNEY. 4401 REEDY CREEK ROAD.
RALEIGH. NC 27607. PLEASE PRINT OR TYPE.
;. OWNER'SNANE: NLI?OT' 9jzioG,tf_ /Vl,4IN7-9t4AI14[.FL
2. MAILING ADDRESS: I-10 99)'4 Z99
SUBDIVISION NAME
CITY: 5 IL1£12 G i TY STATE: N L ZIP CODE: 27 3 ??
PROJECT LOCATION ADDRESS. INCLUDING SUBDIVISION NAME (IF D FE =FROM
MAILING ADDRESS ABOVE):
214-N r.)e L. Di4- LD . 13e 1 Dc,w__ nro. 13
3. TELEPHONE NUMBaR: (HOME)
(WORK) '2)M-74z-5t,45
4. IF APPLIC43LE: AGE i S NAIME OR RESPONSIBLE CORPORATE OFFICL4L. ADDRESS.
PHONE NUMBER:
r. 12. 1 L /4 fF_ 1-S oh1
5. LOCATION OF WORK (PROVIDE A &La.P. PRE--_R BLY A COPY OF USGS TOPOGRAIFfSC
MAP OR AERIAL PHOTOGRA2I;'Y WITH SCALE):
COUNTY: IZA r1 a `ice N -NEAREST TOW-N: /?S 1f 1??0 2 0
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.)
"S 2 I/ 9,5 i4-L/Lo ss A4 c L-i,5*E5 G 4ev-v-
6. DAPACTED OR NEAREST STREAM/RIVER: A4. 4 G,Cas GIZ&f ?L
RIVERBASIN: - ' `lit-D?? s?
7a. IS PROJECT LOCATED NEAR WATER CL-.ASS= AS TROUT. TIDAL SALTWATER. (SA),
HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURSE WATERS (ORW), WATER _
SUPPLY (WS-I OR WS-11)? YES ( ) NO ( X ) IF YES. EXPLAIN:
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
1,U',- tAGE:v fEVT AREA OF ETYMOMEIN TAL CONCER:-t (AEC)? YES( ) NO ( X )
7c. IF THE PROJECT IS LOCATED Wn-ELN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF
COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION?
8a. HAVE ANY SECTION 404 PERWrS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT? YES ( ) NO (x) IF YES, PROVIDE ACTION LD. NUMBER OF PREVIOUS
PERhIlTAND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION):
8b. ARE ADDITIONAL PERNNUT REQUESTS EXPECTED FOR THIS PROPERTY IN i rs
FUTURE? YES ( ) NO (X) IF YES, DESCRIBE ANTICIPATED WORK:
9a. ESTIMATED TOTAL. NUMBERS OF ACRES IIv TRACT OF LA-N-D: N41,4
9b. ESTLMATED TOTAL NUMBER OF ACRES OF WE iZ.a v-DS LOCATED ON PR0JEC 1 S! i =:
O
10a. '?ZTMBER OF ACRES OF WETLANDS DAPACTED BY THE PROPOSED PROTECT BY:
FILLING: y
EXCAVATION: O
FLOODING: OTHER : v
DRAINAGE : y TOTAL ACRES TO BE IMPACTED:
0
10b. (1) STREAM CELAI NNEL; TO BE2.4PACTED BY THE PROPOSED PROJECT (IF
RELOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION:
LENGTH BEFORE: FT AFTER: FT
WIDTH BEFORE (based on normal high water contours): FT
AVERAGE DEPTH BE1 ORE: FT AFTER: F-i
(2) STREA,v1 CEUMN- NFL R fP iCTS WILL RESULT FROM: (CHECK ALL i r -kT APPLY)
OPEN CHANNEL RELOCATION: PLACEYIE.VT OF PIPE IN CHANNEL: „
CF1NNEL EXCAVATION: COONSTRUCTION OF A DA.WFLOODD G:
OTHER: P2?Gits7' R bx l?.tk yeE?-T mti ?ooT/M.j?.,
I I. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS TIE SIZE OF TF- WATERSHED
DRAINING TO THE POND? WHAT IS THE EXPECTED
POND SURFACE AREA?
12. DISCTIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF IYIECEL-kNIC AL
EQUIPME.YTTO BE USED? (ATTACH PLANS; 8112 BY I I DRAWINGS ONLY)
2*y(2LA-L4m EL 1CIS7'le?l ?t f21r>&tw- w 1'X1-1 3 & 1 X 9 / Pie ire-t-..T Lo1,jc zcrp,
M dX GLJLVIEILT 49N GoNG2F._TI7 07 JJ?IG-i S /7 QL1! L1S?l? '-
PC-
IL ?[GJ4 ?/4"Td ?L $ GrJ2,14-/V fc
13. PURPOSE OF PROPOSED WORK: rLF-pL.,+c.M 0 '9?r?1?? ?- Rg Ir> c g-
14. S 1:1 1 L REASONS ?v r Y IT IS BET IEVED THAT THIS ACTIVITY 'MUST BE C.A=D = 1 LN'
w7E TLP,NDS ( LNCI--=E All"rY 1 fEASURES TAKEN TO ivfE\Mtil= ZVE T L:Ati-D LMPACTS)
15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR
NATIONAL MARINE FISHERIES SERIVE REGARDING THE PRESENCE OF ANY FEDERALY
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: 191 L a?rre tL-
16. YOU ARE REQU= 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
Ky L.srrrErr- .
17. DOES THE PROJECT DTVOLti'E AN 02ENDTTLRE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? YES(X) NO( ) (IFNO, GO TO 16) _
a. IF YES, DOES THE PROJECT REQUIRE PREPERATION OF AN E_NVIRONME`TAL.
DOCUMENT PURUANT TO THE REQUIREME_NI'S OF THE NORTH CAROLINA
EN VIRONMEEN T AL POLICY ACT? YES ( X j L-40 ( )
b. IF YES. HAS THE DOCU vIEN ' BEEN RE.=mow-ED i HIROUGH T`H=- Lt0R i r_ C AROLD A
DEPARTMENT OF ADMINISTRATION STATE CLEARLVGHOUSE YES ( ) NO (x
1A1/JIMLJM 64179:1Z14 GNrEc.ft-[?ST 's4-^-rr 'T-o pDife
IF ANSWER 17b IS YES. THEN SUBMIT APPROPRIATE DOCUMENTATIONFROM THE STATE
CLEARINGHOUSE Vv= THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CffiRYS BAGGEIT, DIRECTOR STATE CLEARINGHOUSE. NORTH
CAROLINA DEPARTNEEN T OF ADMINISTRATION, 116 WEST JONES STREr i , RALEIGH.
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
1S. THE FOLLOWING =S SHOULD BE INCLUDED WITH THUS APPLICATION IF PROPOSED
ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OF FILL MATERIAL R N-1 O
WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STRE-A.MS. LAKES. Asti tom,
PONDS ON TEE PROPERTY (FOR NATIONWIDE PERMIT NLTZ"IBERS 1", 1S. 21.26.29.
AND 38). ALL STREAM (INTER'vf rrl- 4T AND PERivfA.NE-M ON THE PROPERTY
MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE I INCH EQUALS 50 FEE
OF I INCH EQUALS 100 FEET OF THEIR EQUIV ALE? T .
b. IF AVAILABLE. REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE 2r1PAC iED
BY PRODUCT.
c. LF DELINE.-kilON WAS PERFORMED BY A CONSULTAIN7, INCLUDE AL r DATA
SHEET S R=VAIN7 TO THE PLACEMENT OF Try DEL.LVEATION LLNE.
d. ATTACH A COPY OF The STORMWATER MANAGEMEV-T PLAIN IF REQUIRED.
e. W- AT IS L-\YD USE OF SURROUNDING PROPOERTY?
f. IF APPLICABLE. WIIAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? t-J/A_
SIGNED AND DATED. AGENT AUTHORIZ-kTION LETTER. IF APPLICABLE.
NOTE: WTI-ANDS OR WATERS OF THE US MAY NOT BE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 CORPS OF EiG VEERS PERMIT,
2) ETTHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF WATER QUAL_F7i
CERTIFICATION, AND
31 (IN THE T W-E]NTY COASTAL. COUNTIES ONLY), A LETi"ER FROM THE NORTH
CAROLINA DIVISION OF COASTAL MANAGE_tifEN STATING THE PROPOSED
ACTIVITY IS CONSISTENT WITH THE v OR i H C a ROLEN A COASTAL
_
1,LAXAGEN PR OGR lei.
'L' /- 0e? 3 /ZC?/o 1
OWNER'SIAGEYI"S SIG.NATL"R.=
(.AGENT'S SIGNATURE. VALID ONLY
IF AUTHORIZA.TION LETTER FROM
THE OWNER IS PROVIDED).
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LEAZER) 597 598 55` 599 600 0 INTERIOR-GEOLOGICAL SURVEY, RE
D55 III S W 60
-E 1:24000 ROAD CLASSIFICA
0 ] MILE
Primary highway, Light-c
4nnn nnnn Fnnn cnnn ?nnn cc r-
SR 1199
30'X8' PRECAST
CONCRETE BOX
ON FOOTINGS
III '
CROSS SECTION
r
O
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co
I
I
PLAN
DRAWN BY: RN PROJECT1 SHEET
DATE1 3/29/01 RAN DOLPH BR. 13
30'X8' PRECAST
CONCRETE BOX
ON FOOTINGS

d -
SR 1199

a „STAIE'o
401 ISSUED `s
r; u
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EAsLEY DIVISION OF HIGHWAYS LYNDO TIPPETT
GOVERNOR SECRETARY
March 26, 2001
?
o 1 05 6
USACOE
Mr. Eric Alsmeyer RECEIVED
6512 Falls of the Neuse Road WATER QUALIiYSECTION
Suite 105
Raleigh, N.C. 27615 APR (? b 20C,
Re: Randolph Co. Bridge No. 13 Replacement Non.DiMharg® Perot(
Location: SR 1199, Across McGees Creek
Dear Mr. Alsmeyer:
We are providing herewith an application package for the replacement of an existing bridge with a 30'x8'
Precast Concrete Box Culvert on footings. A hydrographic survey is not available so a typical cross section
of the proposed structure has been included. Construction shall begin in the Summer of 2001.
To our knowledge, no wetlands are involved and total fill in waters is expected to be less than 0.01 acre.
This bridge is not located in a high quality water area.
Please review this material, and if additional information is needed, or you have comments, please contact
our office.
Thank you for your cooperation and assistance in this matter.
Sincerely,
E.B. Nelson, P.E.
Div. Bridge Maint. Engineer
Attachments
cc: Bill Rosser, P.E. - Division Engineer
John Hennessey - DWQ - 7 copies w/ attachments
Mrs. Renee Gledhill-Earley - State Historic Preservation Officer
Mike Crocker - US Fish & Wildlife Service
? 1,0
FO
DIV. 8 BRIDGE MAINTENANCE
PO BOX 289 - SILER CITY - NC - 27344
PH. 919.742.5649 FAN 919.663.0214
iwuul , nuutvmI uv. rdX•y1J-fJJ-JJ255 Jul 1J 2WU 1():58 P.04
NEUMUM'CRITERIA D RR(NATION CHECKLIST
The following questions provide direction in determining whether a proposed project hu only a
minimum potcntial far environntentei effects. Answer the following questions by checking
either yes or no. 'Refer to the attached guidance for assistance.
TIP Project No.
State Project No. s s z
Project Location: 2,4r+fPbLP14 Go• 5IL 119h ,eG2osS M Gi?c?ES L2ee1t.
Project Ducription.. 1321r>6, jE nl o . 175
Anticipated Permit or Consultation Requirements: N W P 464
Special Project Information:
Jul, 20 2000 10:58 P.05
PAKr A; MM41AU1M CRITERIA YES NO
1, Is the proposed project listed as a type which would qualify ?
as a Non Major Attica undcr the Minimum Criteria?
PART R: MINIMUM CRPTERMA EXCEPTIONS
2. Is the proposed project likely to precipitate sigrifi=t, foreseeable
alterations in land use, planned growth, or development pattems?
3- Does the proposed action divide or disrupt an established community?
4. Does the proposed action bypass an existing oommunity? F7
S. Does the proposed action provide new access to areas containing
significant mounts of exploitable nau rai resources?
6. Is the proposed action likely to have a aiWfi=t deftimental impact ?
on air quality?
7. Is the proposed action likely to have a significant dctrinmental impact ?
on ambient noise levels for adjoining areas?
8. Is the proposed action likely to have a significant impact on travel
i ?
patterns or traff
c volumes?
9, Is the proposed action likely to significantly affect water quality? ?
10, 1'3aes the proposed action require the relocation of significant numbers ?
of people?
11. Is the project likely to be controversial? Q
12, Will the proposed action require the use of land owned by the 0
?
U. S. Forest Service or the National Park Service?
PART C: COMPLIANCE WITH STATE AND FEDERAL B GULATIONS
Ecological impacts
13. Is a federally protected threatened or endangered species, or its habitat, ? ED
likely to be impacted by tho proposed action?
14• Does the action requira the placement of ft in waters of the United States? ? ?
2
11.1?w I i Nunn'' Cv. r ax Jly- r?3-J52S5 Jul 20 2000 10:58 P.06

15. Does the project require the placement ofa significant amount of S11 in ?
high quality or relatively rare wetland ecosystems, such as mountain bogs
or pine savannahs?
16. Does the 1rOjeet require Me= rolocation or chum -W changes? ? 3
17. Is the proposed action located is an Area of Environmental Concern, ?
as deSued in the Coastal Area Management Act?
Cultural Reap es
18. Will the project have an "effect" on a property or site listed, on the ?
National Register of Historic Places?
19. Will the proposed action require acquisition of additional right of way ?
fxom publicly owned parkland or recreational areas?
Raviewed by; ?A zej, Date: 3 Z&1o I
Project Planzung Engineer
Project Planning Unit Head
If any questions 2 through 12 are answered "yes". the proposed project does not qualify as a
Non-Major Action. A state environmental assessment (EA) will be required. For assistance,
contact:
Willi= D. Gilmore, P. E.
Manager, Project Development and Envirozunental Analysis Branch
P. O. Box 25201
Raleigh, NC 27611
(919) 7333141
Fax: [phone]
Questions in Part C are designed to assist the Engineer in-determiaing whether a permit or
consultation with a state or federal resource agency may be required. if any question in Part c is
answered "yes", refer to the Environmental Guidance section of this document and contact the
appropriate individual for assistance.
0? 0
DWQ ID: CORPS ACTION M:
NATIONWIDE PERtiIIT REQUESTED (PROVIDE NATIONWIDE PERMIT
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
1) NOTIFICATION TO THE CORPS OF F_NGINEERS
2) APPLICATION FOR SECTION 401 CERTIFC.ATION
3) COORDINATION WITH THE NC DIVISION OF COASTAL MANE AGEMEI T
SEND THE ORIGINAL ANTI) (I) COPY OF T HS COMPLETED FORNI TO THE a-PPROPRLATE
FIELD OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHE-). SEVEN
(7) COPIES AtlUST BE SENT TO THE NC DIVISION OF WATER
QUALITY. ATTN: JOHN DORNEY. 4401-REEDY CREEK ROAD.
RALEIGH. NC 27607. PLEASE PRINT OR TYPE.
;. OWNER'SNA?viE: NLQOT' 132joL-,tf_ /VLAI14T9NANLFL
2. MAILING ADDRESS: PC golc Z89
SUBDIVISION NAME
CITY: -S 1L is rz G rY STATE: N L ZIP CODE: Z -7 3 44
PROJECT LOCATION ADDRESS. INCLUDING SUBDIVISION NAME (IF DIFrtRENT FROM
MAILING ADDRESS ABOVE):
2A,No61_Pi4- LQ. ??il?G-,r£. ?• 13
3. TELEPHONE NUMBER (HOME)
(WORK) 9 I? - 7?F Z - S[o? 9
4. IF APPLICABLE: AGENTS NAME OR RESPONSIBLE CORPORATE OFFiCLkL. ADDRESS,
PHONE NUMBER
r 2 ! C_ /4 w- L•-5 oh1
5. LOCATION OF WORK (PROVIDE A MAP. PRE. ElF_A3LY A COPY OF USGS TOPOGRa.PF-EC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
/?Slfrzt?ot2,o
COUNTY: IZAN?o?i?N -NEARESTTOW.NT:
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.)
S 2 119 -5 /-?-G 20 ss M 6? Lt ecs G j2rc g?1L
6. IMPACTED OR NEAREST STREAMlRIVER: M "fG,CaS Gr2*_f_ L
RIVER BASIN:
7a. IS PROTECT LOCATED NEAR WATER CL.ASS=- D AS TROLZ, TID?L SALTWATER. (SA),
HIGH QUALITY WATERS (HQW), OUI'STANDLNG RESOURSE WATERS (OR'tV), WATER _
SUPPLY (WS-I OR WS-II)? YES ( ) NO ( X ) IF YES. E.2LA.LN:
7b. IS THE PROTECT LOCATED V=HIN A NORTH CAROLINA DIVISION OF COASTAL
NLMNAGEMENT AREA OF ENVIROMENTAL CONCERN (AEC)? YES ( 1 NO ( X j
7c. IF THE PROTECT IS LOCATED WITHIN A COASTAL COUNTY (SEEPAGE-7 FOR LIST OF
COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION?
8a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT? YES ( ) NO ()C) IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS
PER.MIT_.ND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION):
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY LNG
FUTURE? -YES ( ) NO ()<) IF YES, DESCRIBE ANTICIPATED WORK:
9a. EST2vLATED TOT_4L. NUMBERS OF ACRES IN M-kCI' OF L.4v"D: NIA
9b. ESTLMATED TOTAL NUMBER OF ACRES OF WETL.Av-DS LOCATED ON PROJECT S' -H:
O
10a. NUMBER OF ACRES OF WETL.4VDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: v
EXCAVATION: o
FLOODING: " OTHER :
DRAINAGE : Cv
v
TOTAL ACRES TO BE IMPACTED: O
10b. (1) STRE.AIM CF-L?NINEL: TO BE IMPACTED BY THE PROPOSED PROJECT (IF
RELOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION:
LENGTH BEFORE: FT AFTER: FT
WIDTH BEFORE (based on normal high wacer contours):
FT
AVERAGE DEPTH BED ORE: FT AFTER:
(2) STRE.-%"M CH.AMNINIEL L IP iCTS WILL RES= FROIvf: (CHECK ALL APPLY)
OPEN CHANNEL RELOCATION: PI.ACEtifENT OF PIPE IN CHANNEL:
CF-VNIN-EL EXCAVATION: COONSTRUCTION OF A DA-N0 LOODLNG:
OTHER: P/Z&eAsT 9 67C Luwy?i .*y' eo" F:wocrjA g,7
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS TFIE SIZE OF THE WATERSHED
DRAINING TO THE POND? WHAT IS THE EXPECTED,
POND SURFACE ARE-,k?
12. DISCTIPT ION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF \rIECFi4NIC?L
EQUIPME,iT TO BE USED? (ATTACH PLANS; 8112 BY I I DRAWL 1GS ONLY)
2S(2L i-uf- fi Xisrjj*j ., rzIr> w. w l r1? 3 v x l PF-Ce-A-sT 6o^v6rLv-r7',-
M dX GV LV?E4LT C9N GoNG2E.Tl? r p r //ply S ?G?L/ 1? L1S?? "--
IG ZCG14-Y/?U ?L- `d L/L14?V Ic
I-. PURPOSE OF PROPOSED WORK: nt9F?c-?/-"-r^ R?a?r>c-t??
1.? . STATE E REASONS VV r: Y IT IS BET IEVED TIL-?T THIS a CTIVITY M ST BE CAR= OUT EN
WETL?YDS (INCLUDE Al`TY 1,fEASURES TAKEN TO v[LY2\,4= IN-E T L Ati0 Lb1PACi S i
15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR
NATIONAL MARINE FISHERIES SERTVE REGARDING THE PRESENCE OF ANY FEDERALY
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: R y G 4ETT a rz-.
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PER.vIIT AREA
WHICH MAYBE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED
lzy L ar stc .
I7. DOES THE PROJECT i TVOLVE AN L•XPE.NDTI UR.E OF PUBLIC FONDS OT THE USE OF
PUBLIC (STATE) LAND? YES ( X) NO ( ) (IF NO, GO TO 16) _
a. IF YES, DOES THE PROJECT REQUIRE PREPERATION OF AN ENVIRONMENTAL
DOCUME_T PURUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT? YES (X,) NO( )
b. IF YES. HAS 71M DOCUMENT BEEN REF-MEWED THROUGH TH : tOR i r_ C .ROL-T A
DEPART:vlENT OF ADMTi ISTR..kTION STATE CLEARINGHOUSE YES ( ) ti0 (,K)
/? iN i nnunn G 2 rre2 IA G /fr8c.lc usT s?N-r' To pn j ft
IF ANSWER 17b IS YES. THEM SUBMIT APPROPRIATE DOCUMENI'ATIONFROM THE STATE
CLEARINGHOUSE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAG=, DIRECTOR STATE CLEARINGHOUSE. NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STR=T, 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 RN -I O
WETLANDS:
a. WETLAND DE-.INEATION MAP SHOWING ALL WETLANDS, STRE.,VMS, LAKES. A.ti-i
PONDS ON THE PROPERTY (FOR NATIONWIDE PER-= NLiMERS 1=, 18.21.26. _9.
AND 38). ALL STREAM (IN'I'ERvffITENT AND PERM.4NE:V1M ON THE PROPERTY
MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS S0 FEET
OF I INCH EQUALS 100 FEET OF THEIR EQUIV ALEN-T.
b. IF AVAILABLE. REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE MPAC izD
BY PRODUCT.
c. IF DELINEATION WAS PERFOR:vIED BY A CONSULTANT, INCLUDE ALL DATA
S=ETS RELEVANT TO THE PLACE-N ENT OF THE DET L EATION Lf E.
d. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAIN IF REQUIRED.
e. 'N'F-AT IS LA-N D USE OF SURROUNDING PROPOERTY?
f. IF APPLICABLE. WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? -,L?
cr. SIGNED AND DATED. AGENT AUTHORLZ?TION LETTER. IF APPLICABLE.
NOTE: WTLAI DS 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 TW E= COASTAL. COUNTIES ONLY), A LET 1 rR FROM THE NORTIH
CAROL.I\TA DIVISION OF COASTAL. &LAlVAGELV EN STATING THE PROPOSED
ACTIVITY IS CONSISTENT WITH THE NORTH Ca ROLENA COASTAL _
ti L- AGE1d -NT PD OGR.? M.
/> od-
OWTT?ER'SiAGFNT'S SIG.TATL'RE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED).

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_LEAZERI 597 egg 55' 599 (oo 0 INTERIOR-GEOLOGICAL SURVEY, RF
oss /// sw
60
'_E 1:24000 ROAD CLASSI FICA
0 1 MILE
Primary highway, Light-(
3000 4000 5000 5oo0 7000 FEE'
- hard surfar.e
i . .
SR 1199
30'X8' PRECAST
CONCRETE BOX
ON FOOTINGS
CROSS SECTION
o
4E
co
PLAN
DRAWN BY; RN PR?JECTI SHEET
DATE: 3/29/01 RAN D O L P H BR. 13
30'X8' PRECAST
CONCRETE BOX
ON FOOTINGS

SR 1199

401 ISSUED .-ST
O
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EAsLEY DIVISION OF HIGHWAYS LYNDO TIPPETT
GOVERNOR SECRETARY
March 26, 2001
USACOE
Mr. Eric Alsmeyer
6512 Falls of the Neuse Road
Suite 105
Raleigh, N.C. 27615
010667
Re: Randolph Co. Bridge No. 13 Replacement
Location: SR 1199, Across McGees Creek
Dear Mr. Alsmeyer:
RECEIVED
WATER 011AUT`( SEGTi4N
APR U b 2ULl
Non-Dischar9e Permitting
We are providing herewith an application package for the replacement of an existing bridge with a 30'x8'
Precast Concrete Box Culvert on footings. A hydrographic survey is not available so a typical cross section
of the proposed structure has been included. Construction shall begin in the Summer of 2001.
To our knowledge, no wetlands are involved and total fill in waters is expected to be less than 0.01 acre.
This bridge is not located in a high quality water area.
Please review this material, and if additional information is needed, or you have comments, please contact
our office.
Thank you for your cooperation and assistance in this matter.
Sincerely,
E.B. Nelson, P.E.
Div. Bridge Maint. Engineer
Attachments
cc: Bill Rosser, P.E. - Division Engineer
John Hennessey - DWQ - 7 copies w/ attachments
Mrs. Renee Gledhill-Earley - State Historic Preservation Officer
Mike Crocker - US Fish & Wildlife Service
DIV. 8 BRIDGE MAINTENANCE
PO BOX 289 - SILER CITY - NC - 27344
PH. 919.742.5649 FAX [phone]
7.7 ;U
M
rn
d -i
i nuliMM1 i Lcv. r dX • jly-f JJ-0? Jul 2.7 2wU 10:b8 P. 04
1.
#
1ViINIMUM CRITERIA DIrT OUNATION CEMCKLIST
The following questions provide direction In deternsiniug whether a proyated project ha3 only a
minimwm potential for environrrcemai effects. Answer the following questions by checking
either yes or no. Refer to the attached guidance for assist mce.
TIP Project No.
State Project No. S, s7 5 z-
Projeot Location: 2?N po LP1f Go • -5Z 1198 aG•RoSS M = Gi DES L2Erc fC_
Prof sot Description: !32 rr.>G t, . 13
Anticipated Permit or Consultation Requirements: Nwn 4a4
Special Project Inforinstion;
.??.? L+.. rax.yly-(30-oxn Jug 20 2000 10:53 P.05
PAKT A: MINIMUM CRITERIA YES NO
Is the proposed project listed as a type which would qualify ?
as s Non Major Action un dcr the Minimum Criteria?
PAR? B,. MW MUM CMERMA EXCEPTIONS
2. Is the proposed project likely to precipitate sigrificant, foreseeable
l
a
terations in land use, planned growth, or development patterns?
3- Does she proposed action divide or disrupt an established community?
4. Does the proposed action bypass an existing oommtmiry7 F
S. Does the proposed action provide new access to areas containing
significant amounts of exploitable naLLxal resources?
6. Is the proposed action likely to have a significant detrimental impact
on air quality?
7. Is the proposed action likely to have a significant detrimental impact ?
on ambient noise levels for adjoining areas?
8. Is the proposed action likely to have a siuxdficant impact on travel ?
patterns or traffic volumes?
9, Is the proposed action likely to significantly affect water quality? ?
10. Does the proposed action require the relocation of significant numbers [?
of people?
1 i. Is the Project Himly to be controversial?
12. Will the proposed action require the use of land owned by the
U. S. Forest Service or the National Park service?
PART C: COMPLL4NCE WIT$ STATE AND FEDERAL REGULATIONS
Ecological Impacts
13. Is a federally protected threatened or endangered species, or its habitat, ?
likely to be impae%ed by tho proposed action?
14• Does the action requira the placement of fill in waters of the United States? r ?
2
NUU*1 *1 VLV. rax -- yly-fJJ-35215 Jul 20 2000 1058 P.06

15. Does the project require the placement of a sigacant amount of $11 in ? (9
high quality or relatively we wetland ecosystems, such as mountain bogs
or pine savannalss?
16. Does the pwject require Me= relocation or chautiel changes? ? ?'
17. Is the proposed action located in an Arm of Environmental, Concern,
as defined in the Coastal Area Management Act?
Cultural Reno es
18. Will the project Have an "'effect" on a property or site Us= on the Q
National Register of Historic Places?
19. Will the proposed action require acquisition of additional right of way
from publicly owned parkland or recreational areas?
Reviewed b7; --e- Azel Date: 3 Ze,1O I
Project planning Engineer
Project Planning Unit Head
If any que3dorn 2 through 12 are answered "yes". the proposed project does not qualify as a
Non-Major Action. A state environmental assessment (FA) will be required. For assistance,
contact:
William D. Gilmore, P. E.
Manager, Project Development and Enviro=ental Analysis Breach
P. O. Box 25201
Raleigh, NC 27611
(919) 7333141
Fax: [phone]
Questions in Pare C are designed to assist the Engineer in-deterntining whether a permit or
consultation with a State or federal resource agency may be required. If any question in Part C is
answered "yes", refer to the Environmmtal Guidance section of this document and contact the
appropriate individual for assistance.
DWQ ID: CORPS ACTION ID:
NATIONWIDE PERT IIT REQUESTED (PROVIDE NATIONWIDE PERMIT T)
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERLMIITS THAT REQUIRE:
1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFCATION
3) COORDWATION WITH THE NC DIVISION OF COASTAL MAINAGEMEN--T
SEND THE ORIGINAL. AND.(1) COPY OF TIM COIMPLETED FORM TO THE A.PPROPRLATE
FIELD OFFICE OF THE CORPS OF ENGINEERS (SEE AG-=NCY ADDRESSES S=r). SEVEN
(7) COPIES MUST BE SENT TO THE NC DIVISION OF WATER
OUALTTY. ATTN: JOHN DORNEY. 4401 REEDY CREEK ROAD.
RALEIGH. NC 27607. PLEASE PRINT OR TYPE.
1. OWNER'S NAti1E: MC-001' l3 lz (p G? r? /Vl f1 /NT f?JV f} /14 e-e
2. MAILING ADDRESS: ICU gcv1( Z89
SUBDIVISION NAME
CITY: S iLmrz G / TY STATE: N L ZIP CODE: Z7 344
PROJECT LOCATION ADDRESS. INCLUDING SUBDIVISION NAME (IF D rr-R YT FROM
MAILING ADDRESS ABOVE):
aA.NoaLPN- LD. 99lbC ff- t-W. 13
3. TELEPHONE NUMBS (HOME)
(WORK) 91`) - 74 z - -51,4 5
4. IF APPLICABLE: AG-=N-I"S NAME OR RESPONSIBLE CORPORATE OFriCL-%L.. ADDRESS,
PHONE NUMBER:
rr- 1? ! L /? 1rt L_g ohl
5. LOCATION OF WORK (PROVIDE A IVLAP. PRE: tRA-BLY A COPY OF liSGS TOPOGRA.PE-EC
MAP OR AERLAL PHOTOGRAPHY WTI'H SC.%LE):
COUNTY: IZA rti o o ? i? H - NEAREST TO N-N : A-- w*-66 9,o
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.)
5 a 1/ s,5 Az_r.o SS M G 6i aE*ES G jeeg?IL
6. IMPACTED OR NEAREST STRE.ktWRNER: A446-if-s-, Gr2_&f_ L
RIVER BASIN: t&
7a. IS PROJECT LOCATED NEAR WATER CLASS=- D AS TROL I, TIDAL SALTWATER. (SA),
HIGH QUALITY WATERS (HQW), OUITST.AINDLNG RESOURSE WATERS (ORW), WATER _
SUPPLY (WS-I OR WS-II)? YES ( ) NO ( X ) IF YES. EXPL3LN:
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
IvLANAGEItiLENT AREA OF ENVIRON=AL CONCERN (AEC)? YES ( 1 N .-O 1 X j
7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEEPAGE 7 FOR LIST OF
COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION?
8a. HAVE ANY SECTION 404 PERMIT'S BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT? YES ( ) NO (x) IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS
PERMIT-AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATTON):
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY LV i rs
FUTURE? -YES ( ) NO (x) IF YES, DESCRIBE ANTICIPATED WORK:
9a. ESTIMATED TOTAL. NUMBERS OF ACRES IN TRACT OF LANND: N1A
9b. ESTLIAATED TOTAL NUiM3ER OF ACRES OF WETLANDS LOCATED ON PROJECT SI i :
O
10a. `+-UMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: v EXCAVATION: O
FLOODING: " OTHER : v
DRAINAGE : y TOTAL ACRES TO BE IMPACTED:
O
10b. (1) STREA?ML CH.kNIN'EL:"TO BE IMPACTED BY THE PROPOSED PROJECT (IF
RELOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION:
LENGTH BEFORE: FT AFTER: FT
WIDTH BEFORE (based on normal high waccr contours): FT
AVERAGE DEPTH B = -,ORE: FT AFTER: FT
(2) SIRE--UM CH.-?-NINEL. Ili fPACTS WILL RESLZT FROM: (CHECK A.LL 714-1-k-1 APPLY)
OPEN CHANNEL RF OCATION: PLACE-'vT-N ' OF PIPE IN CHANNEL:
CIi-%NN-EL. EXCAVATION: COONSTRUCTION OF A DA:WFI-OODLYG:
OTHER: P2*?GitsT 96-A eo?v F-ocralJG,S
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
DRAINING TO THE POND?
POND SURFACE AREA?
WHAT IS THE EXPECTED
12. DISC=ON OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF I?,IECI rkNIC A L
EQUIPMENT TO BE USED? (ATTACH PLANS; 8112 BY I I DRAWINGS ONLY)
2?PL1i-c?? Exis-'/eJer 9rzIr?Gjts w It14 3y x I PP-Ce-AfsT Cci-G2.crT
M OX GULVIEaLT' 49to GoNG2Ac.Tl? 07 It j&, e, . )5 OuI P Lk5e4r>
f'L X L/4 ? O ?2- 5 e-414-7V g: .
1=. PURPOSE OF PROPOSED WORK: ?L?nL?c r)(9Fte-iw-"-r Rair> c -t
1='. S TALE REASONS Vvv Y IT IS BET IEVED TIL-aT 71-HIS ACTIVITY tifUST BE CARRIED OUT L`+
WETL?.:YDS (L'i ICZI:DE Aii\tY MEASURES TAKEN TO ,Y1D, 4' f[ ZE W-EiZ:?.VD L?IPAC i S i
15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR
NATIONAL MARINE FISHERIES SERIVE REGARDING THE PRESENCE OF ANY FEDERALY
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: F; L r-TTe a--
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
K4 TT t?vL
17. DOES THE PROJECT i 7VOLVE AN =ENDMUTRE OF PUBLIC FUNDS OT THE USE OF
PLMLIC (STATE) LAND? YES (X) NO ( ) (IF NO, GO TO 16) _
a. IF YES, DOES THE PROJECT REQUIRE PREPERATION OF AN EINPgRONMENZTAL.
DOCUMENT PURUANT TO THE REQUIREMENT'S OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT? YES( X) NO ( )
b. IF YES. HAS 711E DOCUMENT BEEN RE: AWED THROUGH THE NOR i a C ARROLE A
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES ( ) NO (x
/,AINjmu^^ 6217'E/L14 G?rgc/?usT S+?cNT -T-0 Pni ff-r
IF ANSWER 17b IS YES. THEN SUBMIT APPROPRIATE DOCUME:NTATIONFRObI THE STATE
CLEARINGHOUSE Vv= 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 rIF- IS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED
ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OF FILL MATERIAL INTO
WETLANDS:
a. WETLAND DEI_IIVEATION MAP SHOWING ALL WETLANDS, STREAMS, LA=S. Av-i
PONDS ON THE PROPERTY (FOR NATIONWIDE PERT NfIT NLR ERS 1=, 19. 21.26. 213
AND 38). ALL STREAM (IN ERIMITTENT AND PERM-NF-NT) 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. REPRESEVI'ATNE PHOTOGRAPH OF WETLANDS TO BE IMPAC ED.
BY PRODUCT.
c. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE AL DATA
SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
d. ATTACH A COPY OF THE STORMWATER MANAGEINIENTT PLAN IF REQUIRED.
e. WHAT IS I-A;ND USE OF SURROUNDING PROPOERTY?
f. IF APPLICABLE. WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? --L?A_
SIGNED AND DATED. AGENT AUTHORIZ-kTION LETTER. IF APPLICABLE.
NOTE: W'I'LAINDS 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 QUAL.1 i Y
CERTIFICATION, AND
1 (IN THE TWENTY' COASTAL COUNTIES ONLY).: LE 11Tr.R FROM THE NORTIH
CAROLINA DIVISION OF COASTAL MANAGEVLEN STATUiG THE PROPOSED
?:CTIVITY IS CONSISTEN'T' WITH THE NORTIH C:? ROLENA COASTAL _
NL?NAG2v=- PD OGR.?lyf.
1'e> od- -3 17- 4,10 1
OWINER'SiAGLYI S SIGNATT=
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZkTION LETTER FROM
THE OWNER IS PROVIDED).
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SR 1199
30'X8' PRECAST
CONCRETE BOX
ON FOOTINGS
CROSS SECTION
0
co
I
PLAN
DRAWN BY; RN PROJECT; SHEET
DATE1 3/29/01 RAN DOLPH BR. 13
30'X8' PRECAST
CONCRETE BOX
ON FOOTINGS

SR 1199