20011152 Ver 1_Complete File_20010731

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross, Jr., Secretary
Gregory J. Thorpe, Ph.D., Acting Director
DWQ Project No.:
61-11S2-
Applicant:
Project Name: _-? K 1 ?12 (-1 t_C,W • S
Date of Issuance of 401 Water Quality Certification:
11k1W,AA1 n
'if 1 ?
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
County:
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable Buffer
Rules, and any subsequent modifications, the applicant is required to return this certificate to the
401/Wetlands Unit, North Carolina Division of Water Quality, 1621 Mail Service Center, Raleigh, NC,
27699-1621. This form may be returned to DWQ by the applicant, the applicant's authorized agent, or the
project engineer. It is not necessary to send certificates from all of these.
Applicant's Certification
1, , hereby state that, to the best of my abilities, due care and.
diligence was used in the observation of the construction such that the construction was observed to be built
within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the
approved plans and specifications, and other supporting materials.
Signature:
Date:
Agent's Certifica
I, L r, . hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to be built
within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the
approved plans and specific ions and other supporting materials.
Signature: Date:
Engineer ;' Zification
Partial Final
I, , as a duly registered Professional Engineer in the State
of North Carolina, having been authorized to observe (periodically, weekly, full time) the construction of
the project,for the Permittee hereby state that, to the best of my abilities, due care and diligence was used in
the observation of the construction such that the construction was observed to be built within substantial
compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and
specifications, and other supporting materials.
Signature
Date
Registration No.
Wetlands/401 Unit 1650 Mail Service Center Raleigh, North Carolina 27699-1621
Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post consumer paper

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross, Jr., Secretary
Gregory J. Thorpe, Ph.D., Acting Director
DWQ Project No..: 6 11- I IS 2-
Applicant: NC C 2b n G. D 1- ?l i"c?.n.5
Project Name: sQ t o?G Leers .s
Date of Issuance of 401 Water Quality Certification:
1 fflY • • WAA
IT A.1 2
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
County:
oU
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable Buffer
Rules, and any subsequent modifications, the applicant is required to return this certificate to the
401/Wetlands Unit, North Carolina Division of Water Quality, 1621 enter, Raleigh, NC,
27699-1621. This form may be returned to DWQ by the applicant, the or the
project engineer. It is not necessary to send certificates from all of these. tt7711??((JJ((JJ??
Applicant's Certification ,QllrryliJO.j
1, _ -hereby state that, Med ies, due %X?e e and. diligence was used in the observation of the construction such that tbuilt
within substantial compliance and intent of the 401 Water Quality Certification and A4bbilit
appro ved plans and specifications; and other supporting materials.
Signature:
Date:
Agent's Certification
I, L rP hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to be built
within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the
approved plans and specific ions and other supporting materials.
Signature: Date:
Engineer ertification
Partial Final
I, , as a duly registered Professional Engineer in the State
of North Carolina, having been authorized to observe (periodically, weekly, full time) the construction of
the project,for the Permittee hereby state that, to the best of my abilities, due care and diligence was used in
the observation of the construction such that the construction was observed to be built within substantial
compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and
specifications, and other supporting materials.
Signature Registration No.
Date
Wetlands/401 Unit 1650 Mail Service Center Raleigh, North Carolina 27699-1621
Telephone [phone] FAX [phone]
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TO: Steve Lund, USACOE
Asheville Field Office
FROM: Maryellen Haggard, Regional Coordinator
Habitat Conservation Program
DATE: August 30, 2001
SUBJECT: North Carolina Department of Transportation (NCDOT), SR 1209, Lewis Road,
Unnamed Tributaries to Pole Bridge Creek, Stanly County
The North Carolina Department of Transportation (NCDOT) is requesting a concurrence letter -
from the North Carolina Wildlife Resources Commission (NCWRC) to obtain a 404 permit from
the U.S. Army Corps of Engineers. Biologists on staff with the NCWRC have reviewed the
proposed improvements and are familiar with habitat values of the project area. These
comments are provided in accordance with the provisions of the Fish and Wildlife Coordination
Act (48 Stat. 401, as amended; 16 U.S.C. 661-667d) and the Clean Water Act of 1977 (33 U.S.C.
466 et seq.).
The proposed project consists of widening and paving SR 1209 from SR 1208 to Cabarrus
County line. Three pipe extension/ replacements will permanently affect 90 feet of unnamed
tributaries to Pole Bridge Creek. Pole Bridge Creek flows into Big Bear Creek. Big Bear Creek
supports the Carolina darter, Etheostoma collis, and the Carolina creekshell, Villosa
vaughaniana, both federal species of concern. This project has the potential to impact these
species by off-site sedimentation during construction. We will not object to the project as
proposed provided that during construction NCDOT adhere to Best Management Practices. and
the following conditions are implemented:
1. Disturbance of the stream channel must be limited to only what is necessary to
install the pipes. Heavy equipment should be operated from the bank rather
than in the stream channel in order to minimize sedimentation and reduce the
likelihood of introducing other pollutants into the stream.
2. The installation and addition of pipes should insure that all waters flow without
freefalling or damming on either end during low flow conditions. Pipes 36" or
smaller should be buried up to 20% of their size. When two pipes are installed (Site
SR 1209, Lewis Road 2 August 30, 2001
Number 3) and both pipes are buried, the base flow channel should be diverted
through a single pipe by installing a short sill on the upstream end of one pipe to
block low flows. All base flow should continue uninterrupted in a single pipe during
normal and low flow conditions to maintain aquatic life passage. Where disrupted,
natural floodplain benching should be restored upstream and downstream of the
second, "dry", pipe.
3. Stringent erosion control measures should be installed where soil is disturbed
and maintained until project completion.
4. Temporary or permanent herbaceous vegetation should be planted on all bare
soil within 10 days of ground disturbing activities to provide long-term erosion
control. We encourage NCDOT to utilize onsite vegetation and materials for
streambank stabilization, to minimize the use of riprap (or hard stabilization methods)
and to maximize the use of native vegetation for stabilization and shade.
5. We discourage the use of energy dissipaters. If a dissipater must be used, it should be
constructed so as not to impede aquatic life passage. Riprap should be buried into the
streambed or not used in the channel. The dimension of the stream below the pipe
should not be widened to accommodate an energy dissipater.
6. If concrete will be used, work must be accomplished so that wet concrete does
not contact stream water.
Thank you for the opportunity to review and comment on this project during the early planning
stages. If you have any questions regarding these comments, please contact me at (336) 527-
1547.
cc: Cynthia Van Der Wiele, NCDWQ
Benton G. Payne, NCDOT
State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross, Jr., Secretary
Gregory J. Thorpe, Ph.D., Acting Director
DWQ Project No.:
Applicant:
Project Name:
Date of Issuance of 401 Water Quality Certification:
1 ? •
A"Oft 2
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
County:
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable Buffer
Rules, and any subsequent modifications, the applicant is required to return this certificate to the
401/Wetlands Unit, North Carolina Division of Water Quality, 1621 Mail Service Center, Raleigh, NC,
27699-1621. This form may be returned to DWQ by the applicant, the applicant's authorized agent, or the
project engineer. It is not necessary to send certificates from all of these.
Applicant's Certification
hereby state that, to the best of my abilities, due care and_
diligence was used in the observation of the construction such that the construction was observed to be built
within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the .
approved plans and specifications, and other supporting materials.
Signature:
Agent's Certification
Date:
I, , hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to be built
within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the
approved plans and specifications, and other supporting materials.
Signature: Date:
Engineer's Certification
Partial Final
as a duly registered Professional Engineer in the State
of North Carolina, having been authorized to observe (periodically, weekly, full time) the construction of
the project,for the Permittee hereby state that, to the best of my abilities, due care and diligence was used in
the observation of the construction such that the construction was observed to be built within substantial
compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and
specifications, and other supporting materials.
Signature Registration No.
Date
Wetlands/401 Unit 1650 Mail Service Center Raleigh, North Carolina 27699-1621
Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post consumer paper
State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross, Jr., Secretary
Gregory J. Thorpe, Ph.D., Acting Director
1 ? •
AdEbN
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
11. This Certification shall be utilized for roads from natural high ground to natural high ground. The
Certification for Nationwide Permit 18 may not be used in conjunction with this Certification to create
high ground for road access;
12. If an environmental document is required, this Certification is not valid until a Finding of No
Significant Impact (FONSI) or Record of Decision (ROD) is issued by the State Clearinghouse. All
water quality-related conditions of the FONSI or ROD shall become conditions of this Certification;
13. That additional site-specific conditions may be added to projects proposed under this Certification in
order to ensure compliance with all applicable water quality and effluent standards;
14. When written concurrence is required, the applicant is required to use the enclosed "Certification of
Completion Form" to notify DWQ when all work included in the 401 Certification has been completed;
15. Concurrence from DWQ that this Certification applies to an individual project shall expire three years
from the date of the cover letter from DWQ or on the same day as the expiration date of the
corresponding Nationwide Permit 14 and Regional General Permit. 198200031 whichever is sooner.
Non-compliance with or violation of the conditions herein set forth by -a specific fill project may result in
revocation of this Certification for the project and may also result in criminal and/or civil penalties.
The Director of the North Carolina Division of Water Quality may require submission of a formal
application for individual certification for any project in this category of activity, if it is determined that the
project is likely to have a significant adverse effect upon water quality or degrade the waters so that existing
uses of the wetland, stream or downstream waters are precluded.
Public hearings may be held for specific applications or group of applications prior to a Certification
decision if deemed in the public's best interest by the Director of the North Carolina Division of Water
Quality.
Effective date: 1 June 2000
DIVISION OF WATER QUALITY
By
Kerr T. Stevens
Director
WQC # 3289
Wetlands/401 Unit 1650 Mail Service Center Raleigh, North Carolina 27699-1621
Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post consumer paper
State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
1?•
Michael F. Easley, Governor
William G. ROSS, Jr., Secretary NORNC ENR
TH CAROLINA DEPARTMENT OF
Gregory J. Thorpe, Ph.D., Acting Director ENVIRONMENT AND NATURAL RESOURCES
fiber and seedling establishment is allowable. Also, rip-rap may be allowed if it is necessary to maintain
the physical integrity of the stream, but the applicant must provide written justification and any
calculations used to determine the extent of rip-rap coverage requested. If suitable stream mitigation is
not practical on-site, then stream impact will need to be mitigated elsewhere;
Impacts to any stream length in the Neuse, Tar-Pamlico and Randleman River Basins requires written
concurrence from DWQ in accordance with 15A NCAC 2B.0233, 15A NCAC 2B .0259 and .0250 and
15A NCAC 2H .0500. New development activities located in the protected 50-foot wide riparian areas
(whether jurisdictional wetlands or not) within the Neuse, Tar-Pamlico and Randleman River Basins
shall be limited to "uses" identified within and constructed in accordance with 15A NCAC 2B .0233,
15A NCAC 2B .0259 and .0250. All new development shall be located, designed, constructed, and
maintained to have minimal disturbance to protect water quality to the maximum extent practicable
through the use of best management practices. Activities listed as "exempt" from these rules do not need
to apply for written concurrence under this Certification;
6. Placement of culverts and other structures in waters, streams, and wetlands must be placed below the
elevation of the streambed to allow low flow passage of water and aquatic life unless it can be shown to
DWQ that providing passage would be impractical. Design and placement of culverts and other
structures including temporary erosion control measures shall not be conducted in a manner that may
result in dis-equilibrium of wetlands or stream beds or banks, adjacent to or upstream and down stream
of the above structures. The applicant is required to provide evidence that the equilibrium shall be
maintained if requested in writing by DWQ. Additionally, when roadways, causeways or other fill
projects are constructed across FEMA-designated floodways or wetlands, openings such as culverts or
bridges must be provided to maintain the natural hydrology of the system as well as prevent constriction
of the floodway that may result in destabilization of streams or wetlands;
7. If this Certification is used to access building sites, all lots owned by the applicant must be buildable
without additional fill beyond that allowed under other General Certifications. Deed restrictions must be
placed on the remaining wetlands and streams on these lots to restrict future wetland and stream fill.
DWQ shall be sent copies of all deed restrictions applied to these lots;
8. That appropriate sediment and erosion control practices which equal or exceed those outlined in the
most recent version of the "North Carolina Sediment and Erosion Control Planning and Design Manual"
- - - - or the "North Carolina Surface Mining Manual" -whichever is more appropriate (available from the
Division of Land Resources (DLR) in the DENR Regional or Central Offices) shall be in full
compliance with all specifications governing the proper design, installation and operation and
maintenance of such Best Management Practices in order to assure compliance with the appropriate
turbidity water quality standard;
9. All sediment and erosion control measures placed in wetlands or waters shall be removed and the natural
grade restored within two months after the Division of Land Resources has released the project;
10. Measures shall be taken to prevent live or fresh concrete from coming into contact with waters of the
state until the concrete has hardened;
Wetlands/401 Unit 1650 Mail Service Center Raleigh, North Carolina 27699-1621
Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post consumer paper
State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
0rX;'F'J
1M•
Michael F. Easley, Governor NCDENR
William G. Ross, Jr., Secretary NORTH CAROLINA DEPARTMENT OF
Gregory J. Thorpe, Ph.D., Acting Director ENVIRONMENT AND NATURAL RESOURCES
ROAD CROSSING CERTIFICATION GENERAL CERTIFICATION FOR PROJECTS
ELIGIBLE FOR CORPS OF ENGINEERS NATIONWIDE PERMIT NUMBER 14 (ROAD
CROSSINGS), REGIONAL GENERAL PERMIT 198200031 AND NEUSE/TAR-
PAMLICO/RANDLEMAN BUFFER RULES
This General Certification is issued in conformity with the requirements of Section 401, Public Laws 92-
500 and 95-217 of the United States and subject to the North Carolina Division of Water Quality (DWQ)
Regulations in 15A NCAC 2H, Section .0500 and 15A NCAC 2B .0200 for the discharge of fill material to
waters and wetland areas as described in 33 CFR 330 Appendix A (B) (14) of the Corps of Engineers
regulations (i.e., Nationwide Permit No. 14 and Regional General Permit 198200031) and for the Neuse,
Tar-Pamlico and Randleman Buffer
Rules (15A NCAC 2B .0233,.0259 and .0250). The category of activities shall include any fill activity for
road crossing and is limited to fill less than one-third of an acre. This Certification replaces Water Quality
Certification Number 2177 issued on November 5, 1987, Water Quality Certification Number 2666 issued
on January 21, 1992, Water Quality Certification Number 2732 issued on May 1, 1992 and Water Quality
Certification Number 3103 issued on February 11, 1997. This WQC is rescinded when the Corps of
Engineers re-authorizes Nationwide
Permit 14 or Regional General Permit 198200031 when deemed appropriate by the Director of the DWQ.
The State of North Carolina certifies that the specified category of activity will not violate applicable
portions of Sections 301, 302, 303, 306 and 307 of the Public Laws 92-500 and 95-217 if conducted in
accordance with the conditions hereinafter set forth.
Conditions of Certification:
1. Proposed fill or substantial modification of wetlands or waters (including streams) under this General
Certification requires application to and prior written concurrence from the Division of Water Quality;
2. In accordance with North Carolina General Statute Section 143-215.3D(e), any application for a 401
Water Quality Certification must include the appropriate fee. If a project also requires a CAMA Permit,
one payment to both agencies shall be submitted and will be the higher of the two fees;
3. In accordance with 15A NCAC 2H.0506 (h) compensatory mitigation may be required for impacts to
- -- -streams and/or wetlands. In addition, buffer mitigation may-be required-for any project with Buffer
Rules in effect at the time of application. A determination of buffer, wetland and stream mitigation
requirements shall be made for any Certification for this Nationwide Permit. The most current design
and monitoring protocols from DWQ shall be followed and written plans submitted for DWQ approval
as required in those protocols;
4. For any project involving a stream re-alignment, a stream relocation plan must be included with the 401
application for written DWQ approval. Relocated stream designs should include the same dimensions,
patterns and profiles as the existing channel, to the maximum extent practical. The new channel should
be constructed in the dry and water shall not be turned into the new channel until the banks are
stabilized. Vegetation used for bank stabilization shall be limited to native woody species, and should
include establishment of a 30 foot wide wooded and an adjacent 20 foot wide vegetated buffer on both
sides of the relocated channel to the maximum extent practical. A transitional phase incorporating coir
Wetlands/401 Unit 1650 Mail Service Center Raleigh, North Carolina 27699-1621
Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled110% post consumer paper
State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross, Jr., Secretary
Gregory J. Thorpe, Ph.D., Acting Director
0
•
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
August 29, 2001
Stanley County
DWQ Project No. 01-1152
SR 1209 Lewis Road
APPROVAL OF 401 Water Quality Certification
Mr. Benton G. Payne, P.E.
Division Engineer
North Carolina Department of Transportation
716 West Main Street
Albemarle, NC 28001
Dear Mr. Payne:
You have our approval in accordance with the attached conditions, to place fill material in the unnamed
tributary to Pole Bridge Creek, at sites S 1, S2, and S3 for the purpose of paving the existing roadway SR
1209, in Stanley County. The project should be constructed in accordance with your application dated 27
July 2001 (received 31 July 2001). After reviewing your application, we have decided that these activities
are covered by General Water Quality Certification Numbers 3289 and 3114. These certification
correspond to the Nationwide Permit Numbers 14 and 33 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 when the accompanying 404 permit expires unless otherwise
specified in the General Certification.
This approval is valid solely for the purpose and design described in your application (unless modified
below). Should your project change, you must notify the DWQ and submit a new application. If the
property is sold, the new owner must be given a copy of this Certification and approval letter, and is thereby
responsible for complying with all the conditions. If total wetland fills for this project (now or in the future)
exceed one acre, or if total impacts to streams (now or in the future) exceed 150 linear feet, compensatory
mitigation may be required as described in 15A NCAC 2H .0506 (h) (6) and (7). ). This approval shall
expire with the corresponding Nationwide Permit expires-or as otherwise provided in the.General
Certification. For this approval to be valid, you must follow the conditions listed in the attached
certification and any additional conditions listed below.
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.
Wetlands/401 Unit 1650 Mail Service Center Raleigh, North Carolina 27699-1621
Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post consumer paper
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water
Act. If you have any questions, please contact Cynthia Van Der Wiele at 919-733-5715, or Pete Colwell in
the Mooresville Regional Office at 704-663-6040.
Attachment
cc: Wilmington District Corps of Engineers
Corps of Engineers Asheville Field Office
Mooresville DWQ Regional Office
File Copy
Central Files
Sincer ly,
go . Phhoo pe,
tin D O1-1 152

R
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STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY DIVISION OF HIGHWAYS W. LYNDo TIPPETT
GovERNoR SECRETARY
July 27, 2001
U. S. Army Corps of Engineers 011
Asheville Regulatory Field Office 'G
Attention: Mr. Steve Lund, MS, PWS
151 Patton Avenue, Room 208
Asheville, NC 28801-5006
Subject: Secondary Road Improvements to SR 1209 (Lewis Road) from SR 1208 (Barrier Store
Road) to Cabarrus County Line, Stanly County.
Dear Sir:
The North Carolina Department of Transportation (NCDOT) proposes to upgrade SR 1209 from
SR 1208 to the Cabarrus County line, in Stanly County. SR 1209 is an unpaved roadway that will
be upgraded to a paved roadway. The total project length is 0.7 miles.
Transportation and highway laws of North Carolina (G.S. 136-44.6, 136-44.7, 136-44.7A, 136-
44.8 and 136-44.9) require the NCDOT to develop annual work programs for construction and
maintenance of secondary roads. These general statutes specifically set forth requirements for
annual construction and paving of existing unpaved roads. Paving of these roads is performed in
priority order as established by the NCDOT for each unpaved road within a given county. This
number is based on characteristics of each road, including number of homes, schools, churches,
businesses, industries, recreational facilities, traffic counts, presence of school bus routes, and
value as a thoroughfare. SR 1959 is scheduled for paving in the 2001-2002 Secondary Roads
Construction Program
Impacts to Waters of the United States
This project cannot be completed without impacts to waters of the United States. The project lies
in the Yadkin River Basin (Hydrologic Unit # 03040105), affecting the drainage of unnamed
tributaries to Pole Bridge Creek. Stream impacts will be incurred from existing pipe replacement
and extensions. There will be approximately 70 square feet (0.0016 acre) of fill placed in surface
water and approximately 30 linear feet of existing stream channel impacted at each crossing.
C--7
r-ri

716 West Main Street, Albemarle, NC 28001 9 [phone] • Fax [phone]

Wetland Impacts
There are no wetland impacts that will result from the construction of this project.
Stream Impacts
There are a total of three impacts to streams. Table 1 includes information related to site number,
stream name, existing pipe length (ft), existing pipe width (in), proposed replacement or extended
pipe length (ft) and width (in). All of the stream sites are intermittent streams except for Site S2
(Little Creek) which is a perennial stream.
Table 1. Imnacts to Streams from improvements to SR 1959 (Western Road)
Site . Existing Existing Proposed Proposed
No. Stream Name Length feet Width inches Length feet Width inches
S1 UT of Pole Bridge 32 24 50 36
Creek
S2 UT of Pole Bridge 36 18 56 24
Creek
S3 UT of Pole Bridge (2) 40 36 (2) 60 36
Creek
Note: "UT' refers to unnamed tributary.
Dewaterin
The NCDOT proposes to temporarily dewater the stream(s), as needed, during the construction
of the project. This will involve the temporary placement of sandbags, sheet metal cofferdams, or
Class B or Class 2 riprap, covered with filter fabric, in the stream channel approximately 10 feet
upstream of the proposed pipe inlet. In order to maintain water flow during construction, water
upstream of this impervious structure will be temporarily pumped out and conveyed downstream
of the construction activity where it will be allowed to filter through vegetation before flowing
back into the stream channel.
This activity will result in temporary impacts to the aforementioned surface waters.
Approximately 70 linear feet of stream channel will need to be dewatered for each site requiring
such. This would result in 140 square feet of dewatered streambed at site numbers S 1 and S2 and
280 square feet at site number S3. Any dewatering activity that occurs will be conducted for less
than five consecutive working days and the sandbags or rip rap covered filter fabric will be
entirely removed from the stream channel after construction. The volume of temporary fill
required for this activity would consist of no more than 6 cubic yards per structure.
The NCDOT believes that each of these sites can be authorized under a Section 404 Nationwide
Permit 14 and 33.
Avoidance/Minimization
All wetlands or surface waters not affected by the project will be protected from unnecessary
encroachment. No staging of construction equipment or storage of construction supplies will be
allowed in or near wetlands or surface waters.
The side slopes have been steepened to the extent possible and the proposed roadway adjusted to
lessen the impacts to jurisdictional sites. Sedimentation and erosion control Best Management
Practices for the protection of wetlands and surface waters will be enforced during project
construction. Continued coordination will occur between maintenance forces and the Division
Environmental Officer during construction in an effort to minimize impacts to jurisdictional sites.
Compensatory Mitigation
At this time, the NCDOT does not anticipate the need for compensatory mitigation based upon
the limited impacts associated with the construction of this project.
Summary
The purpose of this letter is to request authorization to construct the proposed project under
Section 404 Nationwide Permit (NWP) 14. Additionally, the NCDOT requests authorization
under Section 404 Nationwide Permit 33 for temporary impacts that will result from dewatering
activities associated with this project. Application is also made to the North Carolina Division of
Water Quality (NCDWQ) for Section 401 Water Quality Certificate (WQC) No. 3289 that is
required for this project. The 401 WQC No. 3114 (which corresponds to NWP 33) does not
require written concurrence from the NCDWQ as the NCDOT intends to comply with the
conditions for the WQC.
If you have any questions or need any additional information concerning this project, please fee
free to contact Mr. Larry "Thompson, Division Environmental Officer, at [phone].
Sincerely,
A"4' '/-- "
Benton G. Payne, P. E.
Division Engineer
BGP/LBT
cc: Mr. David Franklin, USACE, Wilmington
Mr. John Dorney, NCDWQ, Raleigh
Ms. Marella Buncick, USFWS, Asheville
Ms. Maryellen Haggard, NCWRC, Elkin
Ms. Ranette Davis, County Maintenance Engineer
Mr. Larry Thompson, Division 10 DEO '
Mr. David Harris, Area Roadside Environmental
MINIMUM CRITERIA DETERMINATION CHECKLIST
The following questions provide direction in determining whether a proposed project has
only a minimum potential for environmental effects. Answer the following questions by
checking either yes or no. Refer to the attached guidance for assistance.
TIP Project No.:
State Project No.:
Project Location: Stanly County - SR 1209 (Lewis Road)
Project Description: Grade, Drain, Base, Pave and Seed - .70 mile
Anticipated Permit or Consultation Requirements:
Section 404 Nationwide 14 and 33. Section 401 Water Quality Certification Number
3289 and 3114.
Special Project Information:
Three intermittent stream crossings, all are unnamed tributaries to Pole Bridge Creek.
Threatened and Endangered Species survey has been conducted.
1 of 3
PART A: MINIMUM CRITERIA
1. Is the proposed project listed as a type which would qualify as a
Non-Major Action under the Minimum Criteria?
PART B: MINIMUM CRITERIA EXCEPTIONS
2. Is the proposed project likely to precipitate significant, foreseeable
alterations in land use, planned growth, or development patterns?
3. Does the proposed action divide or disrupt an established
community?
4. Does the proposed action bypass an existing community?
5. Does the proposed action provide new access to areas containing
significant amounts of natural 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 significant impact on travel
patterns or traffic volumes?
9. Does the proposed action require the relocation of significant
numbers of people?
10. Is the project likely to be controversial?
YES NO
a ?
El FX
F] F?
El FS
1-1 N
F-1 N
F1 N
F-1 FX
F] FX
El FX
11. Will the proposed action require the use of land owned by the U.S. ?
Forest Service or the National Park Service?
ifr"`
Item 2 to be co" leted b DnisionEnviro
12. Is the proposed action'likely to significantly affect water quality? ?
PART C: COMPLIANCE WITH STATE AND FEDERAL REGULATIONS
13. Is a federally protected threatened or endangered species, or its ?
habitat, likely to be impacted by the proposed action?
14. Does the action require the placement of fill in waters of the United ® ?
States?
2 of 3
YES NO
15. Does the project require the placement of a significant amount of F-1 [N
fill in high quality or relatively rare wetland ecosystems, such as
mountain bogs or pine savannahs? _
16. Is the proposed action located in an Area of Environmental U
Concern, as defined in the coastal Area Management Act?
Items?l7.? 19 to be"completed b,? th??Engsneer _ . ,,
17 Does the project require stream relocation or channel changes?
Cultural Resources
18. Will the project have an "effect" on a property or site listed on the El National Register of Historic Places?
19. Will the proposed action require acquisition of additional right of El way from publicly owned parkland or recreational areas?
Reviewed by: ?J?fi 44J-z,14-,-X Date: J) 14 4 o
District Engineer
Date:
ivision Environm tal E in r
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:
William D. Gilmore, P. E.
Manger, Project Development and Environmental Analysis Branch
P. O. Box 25201
Raleigh, NC 27611
(919) 733 -3141
Fax: [phone]
Questions in Part "C" are designed to assist the Engineer in determining whether a permit
or consultation with a state or federal resource agency may be required. If any questions
in Part "C" are answered "yes", refer to the Environmental Guidance section of this
document and contact the appropriate individual for assistance.
3 of 3

?OF W ATF9Q
?O G
-11 T?
o -c
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.miI/wetlands/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.mil/wetlands/regtour.ht , 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/ncwetlands 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://www.saw.usace.army.mil/wetlands/nnfinalFedReg.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/ncwetlands/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: 0 1 1 5 ? nn 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
1. Check all of the approval(s) requested for this project:
® Section 404 Permit
? Section 10 Permit
® 401 Water Quality Certification
? Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: NWP 14 & 33
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ?
II. Applicant Information
1. Owner/Applicant Information
Name: N. C. Department of Transportation
Mailing Address: c/o Benton G. Panye, P. E.
Division Engineer
716 West Main Street
Albemarle NC 28001
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: [e-mail]
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: Lam Thompson, R. S.
Company Affiliation: Division Environmental Officer
Mailing Address: N. C. Department of Transportation
716 West Main Street
Albemarle NC 28001
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: [e-mail]
Page 3 of 12
111. 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: SR 1209 (Lewis Road)
2. T.I.P. Project Number (NCDOT Only): N/A
3. Property Identification Number (Tax PIN):
4. Location
County: Stanly County Nearest Town: Albemarle
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): From Albemarle, travel east on
NC 24-27, turn right onto Running Creek Church Road, left onto Mission Church Road, turn
right onto Five Point Road, left onto Barrier Store Road and right onto Lewis Road.
5. Site coordinates, if available (UTM or Lat/Long):
(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:
Rural/Agricultural
7. Property size (acres): N/A
8. Nearest body of water (stream/river/sound/ocean/lake): Pole Bridge Creek
9. River
Page 4 of 12
- (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/.)
10. Describe the purpose of the proposed work: Grading, drainage, base, paving and erosion
control to bring existing gravel road in compliance with standard safety design specifications.
Work will require replacing or extending (see plan sheets) three existing culverts.
11. List the type of equipment to be used to construct the project: Heave construction equipment
(back hoe, track hoe excavator, dump trucks, etc.).
12. Describe the land use in the vicinity of this project: Rural residential/agricultural mix.
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
V. Future Project Plans
Are any additional permit requests anticipated for this project in the future? If so, describe the
anticipated work, and provide justification for the exclusion of this work from the current
application: N/A
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
Page 5 of 12
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.
1. Wetland Impacts
Wetland Impact
Site Number
(indicate on ma
Type of Impact* Area of
Impact
(acres Located within
100-year Floodplain**
( es/no) Distance to
Nearest Stream
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 stnicnire and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodpUn maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at httpJ/www.femasov.
**# List a wetland type that best describes wetland to he 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:
Total area of wetland impact proposed:
2. Stream Impacts, including all intermittent and perennial streams

Stream Impact
Site Number
(indicate on map)

Type of Impact*
Length of
Impact
(linear feet)

Stream Name** Average
Width of
Stream
Before
Impact
Perennial or
Intermittent?
(please specify)
S1 (1) 36" CMP 30' UT to Pole Bridge Creek 2' Intermittent
S2 (1) 24" CMP 30' UT to Pole Bridge Creek 2' Intermittent
S3 (2) 36"CMP 30' UT to Pole Bridge Creek 4' Intermittent

* 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.
Page 6 of 12
** Stream names can be found on USGS topographic maps. If a stream has no name, list as Ur (unnamed tributvy) 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.usss.aov. Several intemet sites also allow direct download and printing of USGS, maps (e.g., w%mr.topozone.com,
www.MMUest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 90 feet
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S.
Open Water Impact
Site Number
indicate on ma)
Type of Impact* Area of
Impact
(acres) Name of Waterbody

(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.)

* List each impact separately and identif}, temporan. impacts. Impacts include. btrt are not limited to: fill. excavation, dredging.
flooding, drainage, bulkheads, etc.
4. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
All wetlands or surface waters not affected by the proiect will be protected from unnecessarv
Encroachment. No staging of construction equipment will be allowed in or near wetlands or
waters of the U. S. Strict enforcement of sedimentation and erosion control Best Manan eg ment
Practices for the protection of wetlands and-surface waters will be enforced durine all phases of
roiect construction.
Page 7 of 12
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/strrn.gide.html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
No mitigation is proposed for this project.
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 httpJ/h2o.enr.state.nc.4s/w?index.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):
VIII. 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 ?
IX. 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.
Page 9 of 12
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:
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* (sqImpact uare feet) Multiplier Required Mitigation
u
1 3
2 1.5
Total
{ Zone 1 extends out 30 teet (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
X. 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.
Temporary dewatering and all appropriate Best Management Practices for sediment and erosion
control will be implemented during pipe replacement/extension activities.
XI. 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
XII. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Page 10 of 12
Yes ? No
Is this an after-the-fact permit application?
Yes ? No
XIII. 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).
L17 d
App ant/Agenfs{Signature Date
(Agent's signature is valid only if an uthorization 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 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
Pitt
Tyrrell
Washington
Wayne
Union
Watauga
Yancey
Wilson
Yadkin
*Croatan National Forest Only
Page 11 of 12
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
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
US Fis
US Fish and Wildlife Service
Raleigh Field Office
Post Office Box 33726
Raleigh, NC 27636-3726
Telephone: [phone]
It and Wildlife Service / National N
US Fish and Wildlife Service
Asheville Field Office
160 Zillicoa Street
Asheville, NC 28801
Telephone: [phone]
[arine Fisheries Service
National Marine Fisheries Service
Habitat Conservation Division
Pivers 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 Bertie Craven Hyde Pender
Raleigh, NC 27699-1638 Brunswick Currituck New Hanover Perquimans
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: (828) SR?-1754 Haywood McDowell Yancey
t ..
Page 12 of 12
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