20010095 Ver 1_Complete File_20010124

State of North Carolina
Department of Environment F'?J*
and Natural Resources A 4 •
Division of Water Quality
Michael F. Easley, Governor NCDENR
William G. Ross, Jr., Secretary Kerr T. Stevens, Director
January 25. 2001
Wilkes County
DWQ Project # 010095
APPROVAL of 401 Water Quality Certification
Mr. Heath Slaughter, Environmental Officer
NCDOT Division I I
P.O. Box 250
North Wilkesboro, NC 28659
Dear Mr. Slaughter:
You have our approval, in accordance with the attached conditions and those listed below, to replace
Bridge No. 295on SR 1114 (Russell Gap Road) over West Prong Moravian Creek in Wilkes County.
The project should be constructed in accordance with your application dated 19 January 2001
(received 24 January 2001). After reviewing your application, we have decided that this fill is
covered by General Water Quality Certification No. 3289 corresponding to the U.S. Army Corps of
Engineers Nationwide Permit Number 14. In addition, you should acquire any other federal, state or
local permits before you proceed with your project including (but not limited to) Sediment and
Erosion Control, Non-Discharge and Water Supply Watershed regulations. This approval will expire
with the accompanying 404 permit unless otherwise specified in the Water Quality Certification.
This approval is valid solely for the purpose and design described in your application (unless
modified below). Should your project change, you must notify the DWQ and submit a new
application. If the property is sold, the new owner must be given a copy of this Certification and
approval letter, and is thereby responsible for complying with all the conditions. If total wetland tills
for this project (now or in the future) exceed one acre, or of total impacts to streams (now or in the
future) exceed 150 linear feet, compensatory mitigation may be required as described in 15A NCAC
2H .0506 (h) (6) and (7). For this approval to remain valid, you must adhere to the conditions listed
in the attached certification.
If you do not accept any of the conditions of this certification, you may ask for an
adjudicatory hearing. You must act within 60 days of the date that you receive this letter.
To ask for a hearing, send a written petition which conforms to Chapter 150B of the North
Carolina General Statutes to the Office of Administrative Hearings, 6714 Mail Service
Center, Raleigh. N.C. 27699-6714. This certification and its conditions are final and
binding unless you ask for a hearing.
1621 Mail Service Center, Raleigh, North Carolina 27699-1621 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50916 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 telephone John Dorney at 919-733-1786.
Attachment
Sincerely,
Stev
'Stev
cc: Wilmington District Corps of Engineers
Corps of Engineers Asheville Field Office
Asheville DWQ Regional Office
Central Files
?I?Pd Z 4 2001
;•? c','Ol)p
?t
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY P. O. Box 25201, Raleigh, NC 27611-5202 DAVID McCOY
GoVERNOR PHONE: [phone] SECRETARY
January 19, 2001
Mr. Eric Alsmeyer o Q 9 l v
U.S. Army Corps of Engineers se'eo,
Raleigh Regulatory Field Office
6508 Falls of Neuse Road, Suite 120
Raleigh, NC 27615
Subject: Nationwide Permit #14
Replacement of Bridge #295 on SR 1114 (Russell Gap Road)
Wilkes County, North Carolina
Dear Mr. Alsmeyer:
The North Carolina Department of Transportation, Bridge Maintenance Unit proposes to replace
the existing substandard bridge #295 on SR 1114 with 2 lines of 95" x 67" CSPA with concrete
headwalls. Due to the proposed work, we are requesting a 404 Nationwide Permit #14.
The current bridge crosses the West Prong Moravian Creek (DEM Class - C). No high quality
waters, trout waters or wetlands will be impacted by this project. A stringent erosion and
sedimentation control plan will be implemented and maintained during the project construction
and every effort will be made to complete this project in a timely manner.
By copy of this letter, I am requesting that Mr. Ron Linville, Western Piedmont Region
Coordinator, comment directly to you concerning the 404 Nationwide Permit request, with a copy
sent to me.
By copy of this letter, I am forwarding seven (7) copies of this application package to Cynthia
Van Der Wiele, NCDENR, Division of Water Quality, 401/Wetland Unit, for her review. A
$200.00 check is enclosed for the 401 certification processing fee. It is requested that comments
pertaining to the 401 Certification be sent directly to the Corps with a copy to the Division 11
Environmental Officer.
PAYMENT
P. O. Box 250, N. WILKESBORO, NC 28659 RECEIVED
PHONE [phone] FAx [phone]
Mr. Eric Alsmeyer
Bridge #295 on SR 1114
Page 2
January 19, 2001
We would like to begin construction when the necessary permits are obtained. If additional
information is required, please let me know. Your early review and consideration will be greatly
appreciated.
Sincerely,
-d
Heath Slaughter
Division I I Environmental Officer
Enclosures
cc: Ron Linville, Western Piedmont Region Coordinator, NCWRC
Cynthia Van Der Wiele, Division of Water Quality (7 copies)
R. C. McCann, PE, Division Engineer
Heath Slaughter, Division Environmental Officer
Neil Trivette, Area Roadside Environmental Engineer
Vanessa Patrick, PD&EA
Rick Minton, TS III Wilkes Bridge
Q-ioo95
DWQ ID: _ CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #) 14
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
1. NOTIFICATION TO THE CORPS OF ENGINEERS
2. APPLICATION FOR SECTION 401 CERTIFICATION
3. COORDINATION WITH THE NC DIVISION OF COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE FIELD
OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). PLEASE PRINT
OR TYPE.
1. OWNER'S NAME: NC Department of Transportation. Division 11
2. MAILING ADDRESS: P. O. Box 250
SUBDIVISION NAME
CITY: North Wilkesboro STATE: NC ZIP CODE: 28659
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
Bridge #295 on SR 1114 (Russell Gap Road) in Wilkes County.
3. TELEPHONE NUMBER: (HOME) _ (WORK) [phone]
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
Heath Slaughter, Division Environmental Officer
P.O. Box, 250, North Wilkesboro, NC 28659
[phone]
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP
OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: Wilkes - NEAREST TOWN: Boomer
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.) From North Wilkesboro,
travel SW on HM. 18 to Boomer. Turn South on SR 1114 and travel approximately 1.8 miles to Bridge
#295.
6. IMPACTED OR NEAREST STREAM/RIVER: West Prong Moravian Creek RIVER BASIN: Yadkin
7. (a) IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER, (SA),
HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-II)? YES NO ® IF YES, EXPLAIN: Class C
(b) IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES ? NO X
(c) IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF
COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION? N/A
8. (a) HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT? YES ? NO X IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND
ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION):
(b) ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
YES NO ® IF YES, DESCRIBE ANTICIPATED WORK:
9. (a) ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND: approx.0.5 Acres
(b) ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
0
10. (a) NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: EXCAVATION:
FLOODING: OTHER :
DRAINAGE_ TOTAL ACRES TO BE IMPACTED: 0
(b) (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED,
PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION:
LENGTH BEFORE: _ FT AFTER: _ FT
WIDTH BEFORE (based on normal high water contours): FT
AVERAGE DEPTH BEFORE: FT AFTER FT
(b) (2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: _ PLACEMENT OF PIPE IN CHANNEL: X
CHANNEL EXCAVATION: _ CONSTRUCTION OF A DAM/FLOODING:
OTHER Replace old bridge with 2 lines of 95" x 67' CSPA (Pipe) with concrete headwalls.
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
DRAINING TO THE POND? - WHAT IS THE EXPECTED POND SURFACE AREA?
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMENT TO BE USED? (ATTACH PLANS; 81/2 BY I 1 DRAWINGS ONLY)
A trackhoe and rubber tired backlhoe will be used for the excavation and backfill of the pipes. Impacts to
the stream bank Neill be minimized and appropriate erosion control measures will be used.
13. PURPOSE OF PROPOSED WORK: Replacement of existing substandard bridge.
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS)
N/A
15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR
NATIONAL MARINE FISHERIES SERVICE REGARDING THE PRESENCE OF ANY FEDERALLY
LISTED OR PROPOSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL
HABITAT IN THE PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT.
DATE CONTACTED: N/A
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA
WHICH MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED By copy of this
application.
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF PUBLIC
(STATE) LAND? YES X NO ? (IF NO, GO TO 18)
(a) IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT? YES NO X
(b) IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES ? NO
IF ANSWER 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE STATE
CLEARINGHOUSE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED
ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OF FILL MATERIAL INTO
WETLANDS: N/A
(a) WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES, AND
PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26, 29, AND 38).
ALL STREAM (INTERMITTENT AND PERMANENT) ON THE PROPERTY MUST BE SHOWN ON
THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET OF 1 INCH EQUALS 100 FEET
OF THEIR EQUIVALENT.
(b) IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE IMPACTED BY
PRODUCT.
(c) IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA SHEETS
RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
(d) ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
(c) WHAT IS LAND USE OF SURROUNDING PROPERTY?
(1) IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE US MAY NOT BE IWACTED PRIOR TO:
1. ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
2. EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF WATER QUALITY
CERTIFICATION, AND
3. (IN THE TWENTY COASTAL COUNTIES ONLY), A LETTER FROM THE NORTH
CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED
ACTIVITY IS CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT
PROGRAM,
OWNER'S/AGENT'S SIGNATURE
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STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY P. O. Box 25201, Raleigh, NC 27611-5202 DAVID McCOY
GovERNOR PHONE: [phone] SECRETARY
January 19, 2001
Mr. Eric Alsmeyer
U. S. Army Corps of Engineers
Raleigh Regulatory Field Office
6508 Falls of Neuse Road, Suite 120
Raleigh, NC 27615
Subject: Nationwide Permit 914
Replacement of Bridge 9295 on SR 1114 (Russell Gap Road)
Wilkes County, North Carolina
Dear Mr. Alsmeyer:
The North Carolina Department of Transportation, Bridge Maintenance Unit proposes to replace
the existing substandard bridge #295 on SR 1114 with 2 lines of 95" x 67" CSPA with concrete
headwalls. Due to the proposed work, we are requesting a 404 Nationwide Permit #14.
The current bridge crosses the West Prong Moravian Creek (DEM Class - C). No high quality
waters, trout waters or wetlands will be impacted by this project. A stringent erosion and
sedimentation control plan will be implemented and maintained during the project construction
and every effort will be made to complete this project in a timely manner.
By copy of this letter, I am requesting that Mr. Ron Linville, Western Piedmont Region
Coordinator, comment directly to you concerning the 404 Nationwide Permit request, with a copy
sent to me.
By copy of this letter, I am forwarding seven (7) copies of this application package to Cynthia
Van Der Wiele, NCDENR, Division of Water Quality, 401/Wetland Unit, for her review. A
$200.00 check is enclosed for the 401 certification processing fee. It is requested that comments
pertaining to the 401 Certification be sent directly to the Corps with a copy to the Division 11
Environmental Officer.
:?o -v
P. O. Box 250, N. WILKESBORO, NC 28659 C
PHONE [phone] FAx [phone] C rri
rn
o ?
Mr. Eric Alsmeycr
Bridge #295 on SR 1114
Page 2
January 19, 2001
We would like to begin construction when the necessary permits are obtained. If additional
information is required, please let me know. Your early review and consideration will be greatly
appreciated.
Sincerely,
Heath Slaughter
Division 11 Environmental Officer
Enclosures
cc: Ron Linville, Western Piedmont Region Coordinator, NCWRC
Cynthia Van Der Wiele, Division of Water Quality (7 copies)
R. C. McCann, PE, Division Engineer
Heath Slaughter, Division Environmental Officer
Neil Trivette, Area Roadside Environmental Engineer
Vanessa Patrick, PD&EA
Rick Minton, TS III Wilkes Bridge
r
DWQ ID: _ CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #) 14
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
1. NOTIFICATION TO THE CORPS OF ENGINEERS
2. APPLICATION FOR SECTION 401 CERTIFICATION
3. COORDINATION WITH THE NC DIVISION OF COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE FIELD
OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). PLEASE PRINT
OR TYPE.
1. OWNER'S NAME: NC Department of Transportation, Division 11
2. MAILING ADDRESS: P. 0. Box 250
SUBDIVISION NAME
CITY: North Wilkesboro STATE: NC ZIP CODE: 28659
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
Bridge #295 on SR 1114 (Russell Gap Road) in Wilkes County.
3. TELEPHONE NUMBER: (HOME) _ (WORK) [phone]
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
Heath Slaughter, Division Environmental Officer
P.O. Box, 250, North Wilkesboro, NC 28659
[phone]
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP
OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: Wilkes - NEAREST TOWN: Boomer
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.) From North Wilkesboro,
travel SW on H%w. 18 to Boomer. Turn South on SR 1114 and travel approximately 1.8 miles to Bridge
#295.
6. IMPACTED OR NEAREST STREAM/RIVER: West Prong Moravian Creek RIVER BASIN: Yadkin
7. (a) IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER, (SA),
HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-II)? YES NO ® IF YES, EXPLAIN: Class C
(b) IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES ? NO X
(c) IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF
COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION? N/A
8. (a) HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT? YES ? NO X IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND
ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION):
(b) ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
YES NO ® IF YES, DESCRIBE ANTICIPATED WORK:
9. (a) ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND: approx.0.5 Acres
(b) ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
0
10. (a) NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: EXCAVATION:
FLOODING: OTHER :
DRAINAGE_ TOTAL ACRES TO BE IMPACTED: 0
(b) (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED,
PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION:
LENGTH BEFORE: _ FT AFTER: _ FT
WIDTH BEFORE (based on normal high water contours): FT
AVERAGE DEPTH BEFORE: FT AFTER FT
(b) (2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: _ PLACEMENT OF PIPE IN CHANNEL: X
CHANNEL EXCAVATION: _ CONSTRUCTION OF A DAM/FLOODING:
OTHER: Replace old bridge with 2 lines of 95" x 67' CSPA (Pipe) with concrete headwalls.
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
DRAINING TO THE POND? WHAT IS THE EXPECTED POND SURFACE AREA?
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMENT TO BE USED? (ATTACH PLANS; 81/2 BY 11 DRAWINGS ONLY)
A tmckhoe and rubber tired backhoe will be used for the excavation and backfill of the pipes. Impacts to
the stream bank will be minimized and appropriate erosion control measures will be used.
13. PURPOSE OF PROPOSED WORK: Replacement of existing substandard bridge.
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS)
N/A
15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR
NATIONAL MARINE FISHERIES SERVICE REGARDING THE PRESENCE OF ANY FEDERALLY
LISTED OR PROPOSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL
HABITAT IN THE PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT.
DATE CONTACTED: N/A
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA
WHICH MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED By copy of this
application.
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF PUBLIC
(STATE) LAND? YES X NO ? (IF NO, GO TO 18)
(a) IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT? YES NO X
(b) IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES ? NO
IF ANSWER 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE STATE
CLEARINGHOUSE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED
ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OF FILL MATERIAL INTO
WETLANDS: N/A
(a) WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES, AND
PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26, 29, AND 38).
ALL STREAM (INTERMITTENT AND PERMANENT) ON THE PROPERTY MUST BE SHOWN ON
THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET OF 1 INCH EQUALS 100 FEET
OF THEIR EQUIVALENT.
(b) IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE IMPACTED BY
PRODUCT.
(c) IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA SHEETS
RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
(d) ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
(c) WHAT IS LAND USE OF SURROUNDING PROPERTY?
(f) IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE US MAY NOT BE IMPACTED PRIOR TO:
1. ISSUANCE OF A SECTION 304 CORPS OF ENGINEERS PERMIT,
2. EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF WATER QUALITY
CERTIFICATION, AND
3. (IN THE TWENTY COASTAL COUNTIES ONLY), A LETTER FROM THE NORTH
CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED
ACTIVITY IS CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT
PROGRAM,
z;2v6eel-
OWNER'S/AGENT'S SIGNATURE
DATE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED).
177. ?.. i / /7 ?5N 9?1? ,9„O 9.
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