HomeMy WebLinkAbout20011467 Ver 1_Complete File_200110051
Office Use Only:
USACE Action ID No.
/? Form Version April 2001
DWQ No. OA o
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
I. 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 #3
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here:
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ?
H. Applicant Information
1. Owner/Applicant Information
Name: T R Gibson, P E /NCDOT/Div 6/Division Enaineer
Mailing Address: P.O. Box 1150
Fayetteville, NC 28302
Telephone Number: 910-486-1493 Fax Number: 910-486-1959_
E-mail Address: tgibson(a dot.state.nc us
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory authority for the owner/applicant.)
Name: same as above
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 1 of 10
M. 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: Bridge #197 Robeson County -
2. T.I.P. Project Number (NCDOT Only): B-3367
3. Property Identification Number (Tax PIN):
4. Location
County: Robeson Nearest Town: Lumberton
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): 0.5 mile southwest of
intersection of NC 711 and SR 1339
5. Site coordinates, if available (UTM or Lat/Long): 34.75°N 78.15°W
(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:
Highway application - Existing Bridge
7. Property size (acres): Less than 1.0 Ac.
8. Nearest body of water (stream/river/sound/ocean/lake): Bear Swamp
9. River Basin: Lumber River
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/map .)
Page 2 of 10
10. Describe the purpose of the proposed work: Replace structurally deficient bridge with
A new brid e.
11. List the type of equipment to be used to construct the project: Trackhoe Excavator
& Truck Crane
12. Describe the land use in the vicinity of this project: Rural
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.
NIA
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
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
Page 3 of 10
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 Type of Wetland***
linear feet
N/A
.1_? a . e t ,o i ..1- A- ?d;no fill -
* List each impact separately and identify temporary impacts. lrnpacts mcluae, DUL are nut ullinvu w. ILI aV OJalwu . _... ===b, y rn
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at htm://wtivw.fema.gov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property: 0 ac
Total area of wetland impact proposed: 0 ac
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact
Site Number
indicate on ma
Type of Impact* Length of
Impact
linear feet
Stream Name** Average Width
of Stream
Before Im act Perennial or
intermittent?
leases eci
Crossing #1 Bridge OLF Bear Swamp 35 Ft. Perennial
_ _1__?_ L_.. - ,.+ 1:...:+-.i +..• -1- -rte and accnreiatm rin-ran
=•? ... - -- ?____.__ __r _ _r,
* List each impact separately and identify temporary impacts. impacts ulcluur,, Vu1 a1c 11Vt 111111L\ W. V"S
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
w-A,w.usQs.sov. Several intemet sites also allow direct download and printing of USGS maps (e.g., )x-A-A'•topozone.com,
www.mayc pg .com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: OLF
Page 4 of 10
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, cean, etc.
N/A
__?_ 1:. T
..:a-A X11 rot;n rirl.r?crina
* List each impact separately and identity temporary impacts. unpaua 111?luuc, vu1 WU 11VL 111L11N1 u=?, .n ............ ..-??,..?
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.): N/A
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.
Propose to replace an existing 3 span timber and concrete bridge (52.1 OAL) with a 2 span
reinforced concrete and steel bridge (90.0 OAL). Proposed bridge will increase flow
characteristics while reducing existing impacts to the waterway..
Page 5 of 10
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached 'in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http://h2o.enr.state.nc.us/ncwetlands/strmizide.html.
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 offske), 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.
Mitigation not required
Page 6 of 10
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 httU://h2o enr state.nc.uLAN-rp/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):
IX. Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?
Yes ® No ?
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at (919) 733-5083 to review current thresholds for environmental documentation.
Yes ? No
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No
X. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ? No ® If you answered "yes", provide the following information:
Page 7 of 10
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.
* Impact Multiplier I Required I
Zone c o+N Mitiaation
-2 1 1 1.5 1
Total I I
Zone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or.0260.
XI. Stormwater (DWQ Only)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
Erosion and sedimentation plan shall be incoraorated into the construction seauence.
XII. Sewage Disposal (DWQ Only)
Clearly detail the ultimate treatment methods and disposition (non discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
N/A
XM. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No
Is this an after-the-fact permit application?
Yes ? No
Page 8 of 10
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
None
ApplicantMgent's Signature /Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
US Army Corps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Cherokee Iredell Mitchell
US Army Corps of Engineers Avery Clay Jackson Polk
151 Patton Avenue Buncombe Cleveland Lincoln Rowan
Room 208 Burke Gaston Macon Rutherford
Asheville, NC 28801-5006 Cabarrus Graham Madison Stanley
Telephone: (828) 271-4854 Caldwell Haywood McDowell Swain
Fax: (828) 271-4858 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: (919) 876-8441 Davidson Guilford Person Warren
Fax: (919) 876-5283 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: (252) 975-1616 Chowan Hertford Pasquotank
Fax: (252) 975-1399 Craven Hyde Perquimans
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: (910) 251-4511 Columbus Moore Sampson
Fax: (910) 251-4025 Cumberland New Hanover Scotland
Pitt
Tyrrell
Washington
Wayne
Union
Watauga
Yancey
Wilson
Yadkin
*Croatan National Forest Only
Page 9 of 10
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STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY.
GOVERNOR
NCDENR Division of Water Quality
Robert Ridings
2321 Crabtree Blvd.
Suite 250
Raleigh, NC 27604-2260
LYNDO TIPPETT
SECRETARY
OCTOBER 15, 2001
G T
J i 7 L J?
RE: NCDENR WQC 3290 / USACE NWP#3
DWQ# 011466 - Bridge #151 Replacement - Columbus County (B-3146)
DWQ# 011469 - Bridge #1 Replacement - Columbus County (B-3439)
DWQ# 011468 - Bridge #2 Replacement - Bladen County (B3411)
DWQ# 011467 - Bridge #197 Replacement - Robeson County (B-3367)
Dear Mr.Ridings:
Enclosed, please find two courtesy copies for bridge replacement projects within Division 6. The
projects will be completed in compliance with NCDENR Division of Water Quality General
Certification 3290 and USACE Nationwide Permit #3.
The PCN's for these projects were mailed by Division 6 Bridge Maintenance Department to
NCDENR for review under USACE NWP#31. Richard Spencer of the USACE has determined
that the projects will be permitted as NWP#3. Please disregard all previous notifications
pertaining to the above referenced projects.
If you should have any questions or comments regarding this notification, please feel free to
contact me.
cc: Richard Spencer, USACE
L.L. Upole, P.E.
Sincerely,
/lames . Berko, PWS
ivision 6 Environmental Officer
P. O. Box 1150, Fayetteville, NC 28302-1150 -Telephone (910) 486-1792 -Fax (910) 486-1959
O"O? W AT FRQG
?? r
? Y
Michael F. Easley
Governor
William G. Ross, Jr., Secretary
Department of Environment and Natural Resources
Gregory Thorpe
Division of Water Quality
October 10, 2001
DWQ# 011466 TIP # B-3146
DWQ# 011467 TIP # B-3367
DWQ# 011468 TIP # B-3411
DWQ# 011469 TIP# B-3439
L. L. Upole, Jr. P. E.
Division Bridge Maintenance Engineer
P. O. 1150
Fayetteville, NC 28302
Dear Mr. Upole:
On October 05, 2001, your applications for 401 Water Quality Certifications for projects in
Bladen, Columbus, and Robeson Counties were received by the N.C. Division of Water Quality.
Please note that beginning January 1, 1999, the N.C. General Assembly passed legislation requiring
payment of a fee for all 401 applications. Your applications are being put on hold since no payment
was received with the packages. The fee for applications is $200 for projects impacting less than an
acre of wetland and less than 150 linear feet of streams. For projects impacting one or more acres of
wetland or 150 or more feet of streams, the fee is $475. In order for DWQ to review and process your
request, you must send a check in the appropriate amount made payable to the N.C. Division of
Water Quality. Please refer it to DWQ Project #011466, DWQ Project # 011467, DWQ Project #
011468 and DWQ Project # 011469.
Please call me at 919-733-1786 or visit our web site at http://h2o.enr.state.nc.us/ncwetlands if
you have any questions regarding this fee.
Since y,
Robert Ridings
cc: Central Files
File Copy
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)
010 7.21 170Q 1-k---N 040 7'11 Q00'1 /f-N i.Hn•!/{.7n - ninln nn
r. • r
a ,,,amp.,
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY LYNDO TIPPETT
GOVERNOR SECRETARY
Bridge Maintenance Unit
P. O. Box 1150
Fayetteville, N. C. 28302
September 17, 2001 01 ! 4 6 7
Division of Environmental Management
John Hennessey, WQ Certification Unit
P. O. Box 29535
Raleigh, N. C. 27626-0535
Dear Mr. Hennessey:
Please find two (2) copies of the Pre-Construction Notification (PCN) application form for Water Quality Certification
Permits for your info. on this project.
If you have any questions or comments, please call me at 910-829-6345.
Thank you for your assistance in this matter.
Sincerely
;e X' A /wit
L. L. Upole, Jr, P.E.
Division Bridge Maintenance Engineer
Attachments
P. O. Box 1150 - Fayetteville, N. C. 28302 - PHONE: (910)829-6345 - FAX: (910)829-6348
aJ'w}?r
x
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY LYNDO TIPPETF
GOVERNOR SECRETARY
Bridge Maintenance Unit
P. O. Box 1150
Fayetteville, N. C. 28302
September 17, 2001
USACOE
Mr. Richard Spencer
Wilmington Regulatory Field Office
P O. Box 1890
Wilmington, N. C. 28402-1890
REF: RobesonCounty Bridge Number 197Replacement (TIP B-3367)
LOCATION: SR-1339 Crossing Bear Swamp
Dear Mr. Spencer
We are providing herewith an application package and copies of N.C. Department of Transportation
Hydraulics Unit sketches (plan and profile) as a part of a project involving the replacement of an existing
bridge with a new bridge. The project should be let to contract in 2001.
To our knowledge, no wetlands are involved and total fill in water 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, please contact our office.
Thank you for your cooperation and assistance in this matter.
Sincerely
yu< Alvt
L. L. Upole, Jr, P.E.
Division Bridge Maintenance Engineer .
Attachments
CC: T. R. Gibson, 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
Jim Rerko-Division Environmental Officer
P.O. Box 1150-Fayetteville, NC 28302-Phone: (910-829-6345) Fax: (910.829-6348)
c
_f?il rc?_ C
l? 0 /i C ?fnJ U A +_ y
F t r#,
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' (USAGE)
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
htip://www..saw.usace.army.i-nil/wetlands/Perrn 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.amiy.mil/wetlands/regiglg.htm, or contact one of, the field
offices listed at the end of this application. The website also lists the,responsible project manager for
each county in North Carolina and provides additional information regarding the identification and
regulation of wetlands and waters of the U.S.
The DWQ issues a corresponding Certification (General or Individual), and cannot tell the applicant
which 401 Certification will apply until the 404 Permit type has been determined by the USACE.
Applicants are encouraged to visit DWQ's 401/Wetlands Unit website at
http://h2o.enr.state.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 (919) 733-1786.
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).
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
Page l of 12
Management (DCM) at (919) 733-2293. 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 tnil/wetlands/nwL)finalFedReg.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, 11650 `Mail Service Center,
Raleigh, NC, 27699-1650. If written approval is required or specifically requested for a 441
Certification, then a non-refundable application feeds 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, hen 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 nc iis/newetlands/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 solelyfor 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 Ior waiver of a Section 401 Water Quality Certification. Upon receipt ofa 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.
Office Use Only: Form version April 2001
Q1.1467
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:
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: [Q
11. Applicant Information
1. Owner/Applicant Information
Name: i axf - N6,0o T , u
Mailing Addres A ,tae ( 1150 -
E NG 2.
Telephone Number: 91o- y9G - I q q 3 Fax Number: qp - - i
E-mail Address: r s'7. 7rx .vc Ld :5
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:_ SA m e A s ?,Se
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:-
Page 3 of 12
III. Project Information
Attach a vicuii 'ty 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.
eagESor? ?v - L'aLEn"Le'nT oF" AWrt/17E- ?/9'7
1. Name of project:
2. T.I.P. Project Number (NCDOT Only): 6- 3367
3._ Property Identification Number (Tax PIN):
4. Location
County: og? o,v Nearest Town: um Bf eT.?
Subdivision name (include phase/lot number): N114
Directions to site (include road numbers,' landmarks, etc.): „n S A i ?iau? r??5 T
6 NG 7/1 o.v -5e t 33 9
LA 'r
5. Site coordinates, if available (UTM or Lat/Long) '3 y 5 ) L 7Y 15
(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:
LA 7-/
7. Property size (acres): 1-6-5
8. Nearest body of water (stream/river/sound/ocean/lake). AIZ ? ,gzn a
9. River Basin: Lumf,'Fr-
(Note - this must be one of North Carolina's seventeen designated major, river basins: The
River Basin map is available at littp:Hh2o.enr.state.nc.us/admin/m4M/.)
10. Desscribf a the purpose of the proposed work: Tlgtg- ?71'-#[T,m 7"
Page 4 of 12
1 1. List the type of equipment to be used to construct the project: 7 A(,,4 liRv 764
qP-A L? AA?F
12. Describe the land use in the vicinity of this project:
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 USAGE 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.
,&M
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: k.
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream'
evaluation and, delineation 'forms should be included as appropriate. ,Photographs may be
included at the applicant's discretion. If this proposed' impact is strictly for wetland or stream
mitigation, list and describe the impact in Section. VIII below. If additional space,is needed for
listing or description, please attach a separate sheet.
1. Wetland Impacts
Wetland Impact Area of Located within Distance to
Site Number Type of Impact* Impact 100-year Floodplain** Nearest Stream Type of Wetland** *
(indicate on ma) acres es/no linear feet
Page 3 of iz
* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc, For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains staridentified through the Federal Emergency Management Agency's (FEMA) Flood Insurance, Rate Maps
(FIRM), or l EMA-approve4 local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at httb`//www:fema zov.
*** List a" wetland type that best describes wetland to be. impacted, (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
.
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property:'
Total area of wetland impact proposed: U
2. Stream Impacts, including all intermittent and perennial streams
h
Wid Perennial or
Stream Impact
Site Number
indicate on map)
Type of Impact* Length of
Impact
"linear feet
Stream Name** t
Average
of Stream
Before Impact
Intermittent?
lease s ecif
ed h -f. and associated rip-rap
List each impact separately and identify temporary impacts.. Impacts include, but are not hmrt to. eu v
darns (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc, if stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must; be included.
** Stream names can befound on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named 'stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.usu,eov.' ' Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.coi
www tmpquest.com, etc.):
Cumulative impacts (linear distance in feet) to all streams on site: D
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S.
Open Water Impact
Site NumbemM) r
indicate on
Type of Impact* Area of
Impact
acres
; Name of Waterbody
(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.
Page 6 of 12
* List each impact separately and identify temporary impacts. impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
4. Pond Creation
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.): v16
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.
c C 3 c
w t
VIII. ` Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of'impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USAGE 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
Page 7 of 12
y
necessary to ensure that adverse effects to the aquatic environment are minimal, factors
including size and type of proposed impact and `function ' and relative values 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/ncwetlaiids/strmp, ide.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.
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 irito'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 webste at tittp:l/h2? err state nc:us?wrplindex.htm. if
use of the NCWRP'is proposed, please check the appropriate box on page three and provide
the following information:
Cl
Amount of stream mitigation requested (linear feet):
Page 8 of 12
Amount of buffer mitigation requested (square feet): h
Amount of Riparian wetland mitigation requested (acres): O
Amount of Non-riparian wetland mitigation requested (acres): 6
Amount of Coastal wetland mitigation requested (acres): D
IX. Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?
Yes ® No [?
X.
If yes, does the project require preparation of an environmental document pursuant to <the
requirement 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 (919) 733-5083 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 E] No
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.impaots in Section VII above. All proposed impacts must be listed herein,,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the'
applicant's discretion.
Will the project impact >protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify. )?
Yes ? No IV1 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.
*
done Impact
s uare feet
Multiplier Required
Mitigation
1 3
2 1.5
Total
Gone I extends out 30 feet perpendicular from near bank of channel; Lone 2 extends an
additional 20 feet from the edge of Zone 1.
Page 9 of 12
If buffer mitigation is required, please discuss what type o£ mitigation is proposed` (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or.0260.
XI. Stormwater (DWQ Only)
Describe impervious acreage (both existing and proposed) , versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface° waters and wetlands
downstream from the property.
XII. Sewage Disposal (DWQ Only)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge)` of
wastewater generated from the proposed project, or available capacity of the subject facility.
N?A
XIYI. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No V]
Is this an after-the-fact permit application?
Yes ? No
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits.. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
A:anf-
Page 10 of 12
? 9/zG ?0
? t i
Applicant/Agent's Sign ure Date
(Agent's signature is valid only if a n authorization letter from the applicant is provided.)
US Army Corps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Cherokee Iredell Mitchell Union
US Army Corps of Engineers Avery Clay` Jackson Polk Watauga
151 Patton Avenue Buncombe Cleveland Lincoln Rowan Yancey
Room 208 Burke Gaston Macon Rutherford
Asheville, NC 28801-5006 Cabarrus Graham Madison Stanley
Telephone: (828) 271-4854 Caldwell Haywood McDowell Swain
Fax: (828) 271-4858 Catawba Henderson Mecklenburg Transylvania
Raleigh Regulatory Field Office Alamance Durham Johnston Rockingham Wilson
US Army Corps Of Engineers Alleghany Edgecombe Lee Stokes Yadkin
6508 Falls of the Neuse Road Ashe Franklin - Nash Surry
Suite 120 Caswell Forsyth Northampton Vance
Raleigh; NC 27615 Chatham Granville Orange Wake
Telephone: (919) 876-8441 Davidson Guilford Person Warren
Fax: (919) 876-5283 Davie Halifax Randolph Wilkes
Washington Regulatory Field Office Beaufort Currituck Jones Pitt
US Army Corps Of Engineers Bertie Dare Lenoir Tyrrell
Post Office Box 1000 Camden Gates Martin Washington
Washington, NC 27889-1000 Carteret* Green Pamlico Wayne
Telephone: (252) 975-1616 Chowan Hertford Pasquotank
Fax: (252) 975-1399 Craven Hyde Perquiinans *Croatan National Forest Only
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: (910) 251-4511 Columbus Moore Sampson.
Fat: (910) 2514025 Cumberland New Hanover Scotland
US Fish and Wildlife Service 1 National M arine Fishe ries Service
US Fish and Wildlife Service US Fish and Wildlife Service National Marine Fisheries Service
Raleigh Field Office Asheville Field Office Habitat Conservation Division
Post Office Box 33726 160 Zillicoa Street Pivers Island
Raleigh, NC 27636-3726 Asheville, NC 28801 Beaufort, NC 28516
Telephone: (919) 856-4520 Telephone: (828) 665-1195 Telephone: (252) 728-5090
North Carolina State Agencies
Division of Water Quality Division of Water Quality State Historic Preservation Office
401 Wetlands Unit Wetlands Restoration Program Department Of Cultural Resources
1650 Mail Service Center 1619 Mail Service Center 4617 Mail Service Center
Raleigh, NC 27699-1650 - Raleigh, NC 27699-1619 Raleigh, NC 276994617
Telephone: (919) 733-1786 Telephone: (919) 733-5208 Telephone: (919) 733-4763
Fax: (919) 733-9959 Fax:_(919) 733-5321 Fax: (919) 715-2671
Page l l of 12
CAMA and NC Coastal Counties
Division of Coastal Management Beaufort Chowan Hertford Pasquotank
1638 Mail Service Center Bertie Craven Hyde Pender
NC 27699-1638
Raleigh Brunswick Currituck New Hanover Perquimans
,
Telephone: (919) 733-2293 Camden Dare Onslow Tyrrell
Fax: (919) 733-1495 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: (336) 769-9453 Burke Surry
Mountain Region Coordinator Buncombe Henderson Polk
20830 Great Smoky Mtn. Expressway Cherokee Jackson Rutherford
Waynesville, NC 28786 Clay Macon Swain
Telephone: (828) 452-2546 Graham Madison Transylvania
Fax: (828) 506-1754 Haywood McDowell " Yancey
Page 12 of 12
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