20010578 Ver 1_Complete File_20010417

O`,OF WA
T F9 pG Michael F. Easley -
Governor
UJ r William G. Ross, Jr., Secretary
> Department of Environment and Natural Resources
Kerr T. Stevens
Division of Water Quality
May 22, 2001
Wilkes County
DWQ Project No. 010578
SR 13000 (Summit Road)
APPROVAL of 401 Water Quality Certification with Additional Conditions
Mr. Heath Slaughter, Division Environmental Officer
NCDOT Division 11
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 impact 195
linear feet of unnamed tributaries to Two Mile Branch in order improve SR 13000 (Summit Road) in
Wilkes County. The project should be constructed in accordance with your application dated 11 April
2001 (and additional information received on May 9, 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 fills 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 be valid, you must follow the conditions listed in the attached certification and any additional
conditions listed below.
1. In-stream work and land disturbance within the 25-foot wide buffer zone are prohibited during the
trout spawning season of October 15 through April 15, or as otherwise determined by the North
Carolina Wildlife Resources Commission, to protect the egg and fry stages of trout from
.sedimentation during construction.
2. Storm water should be directed to buffer areas or retention basins and should not be routed directly
into streams.
3. Sedimentation and Erosion Control Guidelines for Sensitive Watersheds (15A NCAC 4B .0024) must
be implemented prior to any ground-disturbing activities to minimize impacts to downstream aquatic
resources. Temporary or permanent herbaceous vegetation should be planted on all bare soil within
10 days of ground-disturbing activities to provide long term erosion control.
4. The culvert required for this project shall be installed in such a manner that the original stream profile
is not altered (i.e. the depth of the channel should not be reduced by a widening of the streambed).
Existing stream dimensions are to be maintained above and below locations of culvert extensions.
5. All work shall be performed during low flow conditions.
North Carolina Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
919-733-1786 (phone), 919-733-6893 (fax), http://h2o.enr.state.nc.us/ncwetlands/
Page 2 of 2
6. All mechanized equipment operated near surface waters should be regularly inspected and maintained
to prevent contamination of stream waters from fuels, lubricants, hydraulic fluids, or other toxic
materials.
7. The presence of equipment in the channels must be minimized. Under no circumstances should rock,
sand or other materials be dredged from the wetted stream channel under authorization of this permit,
except in the immediate vicinity of the culverts.
8. Mowing of existing vegetated buffers is strongly discouraged, so that they may be utilized for storm
water sheet flow.
9. Use of rip-rap for bank stabilization is to be minimized; rather, native vegetation is to be planted
when practical. If necessary, rip-rap should be limited to the stream bank below the high water mark,
and vegetation should be used for stabilization above high water.
10. Rock silt screens at culvert outlets should be removed at project completion.
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.
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.
Sincerely,
,e . Stevens
Attachment
cc: Wilmington District Corps of Engineers
Corps of Engineers Raleigh Field Office
NCDWQ Winston-Salem Regional Office
Central Files
File Copy

• Sri::.. , , ?,. ;; > ? ,.

TO: Eric Alsmeyer, USACOE
Raleigh Field Office
FROM: Ron Linville, Regional Coordinator
Habitat Conservation Program
DATE: May 1, 2001
SUBJECT: North Carolina Department of Transportation (NCDOT), SR13000,
Summitt Road, unnamed tributaries to Two Mile Branch, Wilkes County
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 North
Carolina Environmental Policy Act (G.S. 113A-1 through 113A-10; NCAC 25). The
NCDOT proposes to widen and pave the referenced road. This will require replacement
of 5 existing pipes for a total of 180 feet of additional fill.
We will not object to the project provided the following conditions are
implemented:
Pipes equal in size or larger than 36" should be buried into the streambed
approximately 1 foot. Smaller pipes should be placed on grade or lower. The
passage of aquatic life or fish should not be deterred by the installation, as all
waters should flow through without freefall or damming on either end during
low flow conditions. The dimension, pattern, and profile of the stream above
and below the lower cell should not be modified by widening the stream
channel or reducing the depth of the stream.
2. If concrete will be used, work must be accomplished so that wet concrete does
not contact stream water. This will lessen the chance of altering the stream's
water chemistry and causing a fish kill.
3. 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.
SRI 300C, Summitt Road 2 05/01/01
4. Stringent erosion control measures should be installed where soil is disturbed
and maintained until project completion.
5. 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 when practicable.
6. Instream work and land disturbance within the 25-foot wide buffer zone are
prohibited during the trout spawning seasons of October 15 through April 15 to
protect the egg and fry stages of trout.
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 336/769-9453.
Cc: Cynthia Van Der Wiele, DWQ
MEMORANDUM
TO: John Dorney Regional Contact: Jennifer Frye
Non-Discharge Branch WQ Supervisor: I arry Cable
Date: 5/? R??nni
SUBJECT: WETLAND STAFF REPORT AND RECOMMENDATIONS
Facility Name NCDOT - SR 1300 C
Project Number 01 0578
Recvd From DOT
Received Date 4/17/01 Recvd By Region 4/19/2001
Project Type culvert expansion
County Wilkes
County2
Region Winston-Salem
Certificates Stream
Permit Wetland Wetland Wetland Stream Class Acres Feet
Type Type Impact Score Index Prim. Supp. Basin Req. Req.
14 Stream O YO N F--12-31-1-3 F-c - TR 30,701. F-- 195.00
o Y N I-If?'-
Mitigation Wetland
MitigationType Type Acres Feet
Is Wetland Rating Sheet Attached? 0 Y O N Did you request more Info? * Y 0 N
Have Project Changes/Conditions Been Discussed With Applicant? 0 Y 0 N
Is Mitigation required? 0 Y * N Recommendation: 0 Issue 0 ISSue/Cond 0 Deny
Provided by Region: Latitude (ddmmss) 361319 Longitude (ddmmss) 812219
Comments:
Request for additional information sent by RO on 4/27/01. Information received on 5/9101.
Total impacts 195 LF (180 LF culvert extensions, 15 LE of rip-rap).
The WSRO recommends that this WO Certification be issued,
cc: Regional Office
Central Office Page Number 1
1
DIVISION OF WATER QUALITY
April 27, 2001
CERTIFIED MAIL: 7099 3220 0006 8502 5356
RETURN RECEIPT REQUESTED
Mr. Heath Slaughter
Division Eleven Environmental Officer
NCDOT
PO Box 250
North Wilkesboro, NC 28659
SUBJECT: REQUEST FOR ADDITIONAL INFORMATION
SR 1300 C Summit Road
DWQ Project # 01 0578
Wilkes County
Dear Mr. Slaughter:
I- ( ln?m lk-A
The Division of Water Quality has reviewed your plans for the discharge of fill material
into unnamed tributaries to Two Mile Branch, Class C Tr waters, Yadkin-Pee Dee River Basin,
for the purpose of five (5) road crossings. Insufficient evidence is present in our files to
conclude that your project must be built as planned in waters and/or wetlands in accordance with
15A NCAC 2H.0506. Therefore, unless modifications of the proposal are made as described
below, we will have to move toward denial of your 401 Certification as required by 15A NCAC
2H .0507(e) and will place this project on hold as incomplete until we receive this additional
information. We are requesting (by copy of this letter) that the U. S. Army Corps of Engineers
place your project on administrative hold.
(1) Please provide documentation detailing your position that the project has been
designed such that adverse impacts to surface waters have been minimized and
existing uses have been protected to the best of your ability.
(2) Please provide the exact linear footage that you propose to impact with rip-rap
energy dissipaters for each crossing.
(3) Please provide a map that identifies the location of each of the crossings. A copy
of the most recent USGS 7.5-minute topographic quadrangle is preferred.

01 0578
Page 2
(4) Please keep in mind that if stream impacts to any one tributary equal or exceed
150 linear feet, compensatory mitigation may be required as described in 15A
NCAC 2H .0.506(h).
(5) Please provide supporting documentation that the design and placement of the
culverts will not cause a dis-equilibrium of the streambeds or banks, adjacent to or
upstream and downstream of the structure.
Please respond, in writing, both to this Office and to John Dorney, 2321 Crabtree
Blvd., Raleigh, NC 27604-2260 within three weeks of receipt of this letter outlining your
intent to proceed with this project or withdraw your application. If you wish to proceed,
please address the items listed above.
If you have any questions regarding this matter, please contact Mrs. Jennifer Frye at
[phone], ext. 275.
Sincerely,
Larry D. Coble
WQ Regional Supervisor
cc: Raleigh Field Office, US Army Corps of Engineers
Wilmington Office, US Army Corps of Engineers
Wetlands/401 Unit Central Office
Central Files
WSRO
4e

STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY P. O. Box 25201, Raleigh, NC 27611-5202 LYNDO TIPPETT
GOVERNOR PHONE: [phone] SECRETARY
April 11, 2001
Mr. Eric Alsmeyer
U. S. Army Corps of Engineers
Raleigh Regulatory Field Office z + ?.1
6508 Falls of Neuse Road, Suite 120 3' -
Raleigh, NC 27615
Subject: Nationwide Permit #14 70 --0
SR 1300 C (Summitt Road) n
Wilkes County, North Carolina r
?' r71
Dear Mr. Alsmeyer: v -{
The NC Department of Transportation is scheduled to grade, drain, base, and pave primarily
along the existing roadway of SR 1300 C (Summitt Road) in Wilkes County. This project will
require replacing five (5) wet cross lines as shown below:
1) Replace existing 50'x 18" pipe at station 45+28 with a 120'x 24" CSP.
2) Replace existing 33'x 18" pipe at station 53+68 with a 60'x 24" CSP.
3) Replace existing 33'x 24" pipe at station 68+50 with a 60'x 24" CSP.
4) Replace existing 24'x 18" pipe at station 78+78 with a 40'x 24" CSP.
5) Replace existing 50' ipe a ation 80+25 with a 90'x 36" CSP.
** Total new stream im a ts: 180 linear feet.
All of the above noted wet c afferent unnamed tributaries to Two Mile Branch
(Class: C, Trout). Please note that the wet cross lines at stations 45+28, 53+68 and 78+78
appear to be seeps and are not large enough to support trout. The wet cross lines at stations
68+50 and 80+25 appear to be perennial streams but are very small as well (approximately 1-2
inches deep).
Any widening of the existing roadway will be directed away from any adjacent creek whenever
possible with minimum fill placed in the buffer area. The total project length is approximately 2
miles. Due to the proposed work, we are requesting a 404 Nationwide Permit #14.
P. O. Box 250, N. WiLKESBORO, NC 28659
PHONE [phone] FAX [phone]
A?
1'
Mr. Eric Alsmeycr
SR 13000 (Summitt Road)
Page 2
April 11, 2001
Attached is a Preconstruction Notification Form, plan sheet with proposed erosion control
measures, pipe crossing information, a marked county map, a marked topography map and
photographs.
By copy of this letter, it is requested that Mr. Ron Linville, Mountain Region Coordinator, with
the North Carolina Wildlife Resources Commission comment directly to you concerning the 404
Nationwide Permit application 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
$475.00 check is enclosed for the 401 certification processing fee. It is requested that any
comments related to the 401 certification be forwarded directly to the Corps with a copysent to
me.
We would like to begin construction as soon as possible. If further information is required, please
let me know. Your early review and consideration will be greatly appreciated.
Sincerely,
Heath Slaughter
Division Environmental Officer
Enclosures
cc: Ron Linville, Western Piedmont Region Coordinator, NCWRC
Brian Cole, US Fish and Wildlife Service
Renee Gledhill-Earley, Environmental Review Coordinator, NCDCR
Cynthia Van Der Wiele, Division of Water Quality (7 copies)
R. C. McCann, PE, Division Engineer
Doug Tetzlaff, District Engineer
Heath Slaughter, Division Environmental Officer
Neil Trivette, Area Roadside Environmental Engineer
Bob Bumgarner, County Maintenance Engineer
Vanessa Patrick, PD&EA
- V?_/
110
OF WAT?9
?0 Y; QG
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' ?SACE
)
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:/hvxvw.saw.usace.army.mil/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 littp://Nvww.saw.usace.army.miI/wetlands/re.gtour.litm, 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 caimot 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.ne.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).
n___ 1 ..C t'1

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 (LAMA) 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://wwNv.saxv.usace.arnly.nii]/wetlands/nwpfinalFedRe.Qpdf.
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://li2o.ehnr.state.nc.us/newet1arnds/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, all on-hold letter pending receipt of additional
requested information, or denial.
n......'I ..c 1'I
low
Office Use Only: Form Version April 2001
13.1 0 .?,
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: 14
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: North Carolina Department of Transportation
Mailing Address: P. O. Box 250, North Wilkesboro, NC 28659
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: hslau titer n, 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: Heath Slaughter, Division Environmental Officer
Company Affiliation: North Carolina Department of Transportation
Mailing Address: P. O. Box 250, North Wilkesboro, NC 28659
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: hslau hter a.dot.state.nc.us
T)--- 12 .,c 11)

III. 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 13000. Summitt Road
2. T.I.P. Project Number (NCDOT Only): N/A
3. Property Identification Number (Tax PIN):
4. Location
County: Wilkes Nearest Town: Wilkesboro
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): From Wilkesboro, travel west on
US 421. Turn right onto SR 1307 and travel about 2 miles. Turn right onto SR 1304 and
travel about I mile. Turn left onto SR 1300 and travel throupli Parsonville to the end of
pavement.
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:
Residential/Forest.
7. Property size (acres): Approximately 4.8 acres.
8. Nearest body of water (stream/river/sound/ocean/lake): UTs of Two Mile Branch (Class:
C. Trout).
9. River Basin: Yadkin
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at littp://li2o.enr.state.nc.us/aciniin/maps/.)
D___ A .,c In

10. Describe the purpose of the proposed work: Improvement of SR 13000.
11. List the type of equipment to be used to construct the project: Traekhoe, backhoe, and motor
grader.
12. Describe the land use in the vicinity of this project: Residential/Forest
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: No
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.
n...... c ..c 1'1

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
linear feet
Type of Wetland***
N/A

* 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 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 htti):HxN,NNw.femzi.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 acres
Total area of wetland impact proposed: 0 acres
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 Impact Perennial or
Intermittent?
leasespecify)
Station No. 45+28 Pipe replacement 70 feet UT Two Mile Branch 1 foot Seep
Station No. 53+68 Pipe replacement 27 feet UT Two Mile Branch 1 foot Seep
Station No. 68+50 Pipe replacement 27 feet UT Two Mile Branch 2 feet Perennial
Station No. 78+78 Pipe replacement 16 feet UT Two Mile Branch I foot Seep
Station No. 80+25 Pipe replacement 40 feet UT Two Mile Branch 2 feet Perennial

* 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, ditch ing/strai ghtcni ng, 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.usgs.gov. Several Internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.c(m,
X%A%Av.mopguest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 1801n. ft. of new impacts.
n...-.. c „c 1 11

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.
N/A

* 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.): 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 itnpacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
The existing roadway must be widened to increase public safety. The impacts cannot be
avoided.
n...... q ..F 71

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
ham://l12o.etir.state.nc.us/iicwetlands/strmgide.litml.
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.
N/A
n......o..c1-1
I ?e
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 http: /li2o.enr.stite.nc.tis/i%rp/?ndex.litni. 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): N/A
Amount of buffer mitigation requested (square feet): N/A
Amount of Riparian wetland mitigation requested (acres): N/A
Amount of Non-riparian wetland mitigation requested (acres): N/A
Amount of Coastal wetland mitigation requested (acres): N/A
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 [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 ?
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:
n... n ..c 1')

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* Impact
(square feet Multiplier Required
Mitigation
1 3
2 1.5
Total
* 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.
N/A
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.
Please refer to the attached erosion control plan.
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
XIII. 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
n--- 1 n ..c t'I
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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).

Applicant/Agent's Signatde 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: [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
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Ponder
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
Pitt
Tyrrell
Washington
Wayne
Union
Watauga
Yancey
Wilson
Yadkin
*Croatan National Forest Only
n...-.. 11 -ell)
?e
US Fis
US Fish and Wildlife Service
Raleigh Field Office
Post Office Box 33726
Raleigh, NC 27636-3726
Telephone: [phone]
h 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]
State Historic Preservation Office
Department Of Cultural Resources
4617 Mail Service Center
Raleigh, NC 27699-4617
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
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: [phone] Haywood McDowell Yancey
n--- I'I ,.c I')
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EROSION CONTROL SCHEDULE
(1) All adequate temporary erosion control measures will be installed before
clearing and grubbing operations begin.
(2) As construction progresses, temporary and permanent erosion control
devices shall be installed in a timely matter, according to any special permit
requirements and or requirements set out in G. S. 113A-57.
MANDATORY STANDARDS FOR LAND-DISTURBING ACTIVITY
Pursuant to G.S.113A-57 (3) provisions for a ground cover
sufficient to restrain erosion must be accomplished within 15
working days or 30 calendar days following completion of
construction or development, whichever period is shorter, except
as provided in 15A NCAC 4B.0024 (e).
DESIGN STANDARDS IN SENSITIVE WATERSHEDS
Pursuant to G. S.113A-57 (3) provisions for a ground cover
sufficient to restrain erosion must be provided for any portion of a
land-disturbing activity in a HQW zone within 15 working days or 30
calendar days following completion of construction or
development, whichever period is shorter.
(3) All siltation and erosion control devices shall be properly maintained until no
longer needed.
(4) On projects performed by D.O.T. Maintenance Forces, request will promptly
be made to the Division Roadside Environmental Unit for stage and
permanent seeding.
(5) Any removal of siltation devices will be based on the condition of established
ground cover of that area the device is serving.

CONSTRUCTION SEQUENCE FOR INSTALLING ROADWAY CULVERTS
1 - Clear only enough area and install the downstream measures such as silt check dams,
silt screens, and basins as noted on plans.
2 - Excavate the 2' base tail ditch.
3 - Excavate and install the roadway culvert
4 - install sediment control measures at inlet as noted on plans.
5 - Install additional pipe outlet protection and inlet protection as noted.
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1632.01
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Temporary Silt Ditch-
Temporary Diversion
Temporary Slope Drain
Silt Basin Type-A
Silt Basin Type-B
Temporary Rock Silt Check Type-A
Temporary Rock Slit Check Type-B
T emoor2ry Rock Sediment Dam Type-A
Temporary Rock Sediment Dam Type-i3
Rock Pipe Inlet Sediment Trap Type-A -
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SECTION 1042
RIP RAP MATERIALS
1012-1 PLAIN RIP IZAP.
Stone fo*r plain rip rap shall consist of field stone or rough unhev.,n quarry
stone. The stone shall be sound, tough, dense, resistant to the action of air
and water, and suitable in all other respects for the purpose intended.
Wlheve broken concrete from demolished structures or pavement is avail-
able, it may be used in place of stone provided that such use meets with the
approval of the Engineer..llo%vever, the use of broken concrete which
contains reinforcing steel will not be permitted.
The stone or broken concrete shall be graded to meet the following
requirements:
1. For Class 1 Rip Rap. Stone shall varv in weight from 5 to 200 pounds:
At least 30 percent of the. total weight of the rip rap shall be in
individual pieces weighing a Inininlum of 60 pounds each. Not more
than 10 percent of the local weight of the rip rap may be in individual
pieces weighing less than 15 pounds each.
2. - For Class 2 Rip Rap. Stone shall vary in weight from 25 to 250
pounds. At least 60 percent of the total weight of the rip rap shall be in
individual pieces weighing,a minimum of 100 pounds each. Not more
than 5 percent of the total weight of the rip rap may be in individual
pieces Nveiglling less than 50 pounds each.
6 9' 1
HIGH QUALITY WATERS
1. Uncovered areas are limited at any given time to a maximum total area of
20 acres.
2. Erosion and sedimentation control measures shall be designed to provide
protection from the 25-year storm.
3. Large Type-A basins shall be designed and constructed with a settling
efficiency of at least 70% for the 40 micron soil particle size transported
by runoff from the 2-year storm.
4. Newly constructed channels shall be constructed with side slopes no
steeper than 2:1, unless slopes are to be stabilized by methods other than
vegetation
5. A ground cover sufficient to restrain erosion must be provided for any
disturbed area.
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Replace
Sta. 81+9o
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TYPE C')
EROSION CONTROL PLgN
° 9x3x ?
SR 13oo-C 9x3xZ
COUNTY ?? ll?FS r -
LOCAL NAME Stmr*;-? Ro fad
WORK ORDER NO.
9x3x 2.
U
9 x 3 x Z,.®T?
S+w. 91+oo

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EROSION CONTROL PLAN I G' 11
SR 1300-C
COUNTY ail
k.
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LOCALNAME c?lirnrn;} ?nA?
WORK ORDER NO.
.
i
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• matt: N9
0 PIPE STATION SIZE CLASS REMARKS
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0 I + Cfl5 'x15" ^?P-i-lA:rr AAA
0 C I+ 95 ?F5" X 18" T E Rip P,?t.
0 5 { 10 C00' 16" T F_ Pc IACr
0 E C +4 'x 18" PE B R? IAC.C
0 F 8+. o ' x 19)" TT, Fc- 13 Ri n1p-r-E
0 G 10+50 C 'x I '' Pt IACE
0 I+ p I" I PE RE-a; a
0 Z 15+00 18'' TYPE E A, a
0 T I 3' x 5" CS P- P A.?! RE NC-E
0 IG+95 4- ' x tV, -Ty?q R AcE
0 L lq+?o "
(D 5' x I Ty p p- e) Pr 01Ac.E
0 Zo+ 0 ' x " PE 13 Rr iIAC.F
0 l+2 25' x " P- 1 .• 1
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0 2(+ ' x 18" E C_E
o ' x 19"
TYPE A

Q 9 2D x 1 TYPE R f,r?
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0 fn + ! 2 q. 50 x l C'" -TYPE:
0 LL (? i9+, •5 q-0, x I T (7 f. c.e-
0 t r q 1 +05 4o' > I
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Ditchfiner Requirements
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S.R. /3 60 - C- County W + Ki cq S ' Sheet ?Of-,5-
Name S t,k rY) m , -?- R -? ' - - Date ?a -vn
- - - - - - -
Existing Road
I,
New Road '

Proposed RAV

•.. - 4
Existing Pipe
t-------?

New Pipe

Center Line L'LAsS: /VD 111?1?f 1 ?i?
To Iwo t?;lE .???
c 7W•
sr.A .70
i-'--T

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_- I - --, _ - - _ - - -- - -

1 ------ - -----
Note:
Temporary erosion control
devices not shown, but will
include temporary silt screen,
rock check dams and silt
basins, as needed.
Survey Date e-11- DD
Conducted By6C14,i',g,841 bP
Drawn By EsLE, V- Nn'
S. R.. /3 QQ -? County (._J.IA! .
Name SuAAmtTRy),
Existing Road
New Road ` - - - - - ?.1
Proposed RAV -
Existing Pipe r.
New Pipe
Center Line
I 1
Rr A,,= ) '!- 1/'% "
Tr,;
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Note:
Temporary erosion control
devices not shown, but will
include temporary silt screen,
rock check dams and silt
basins, as needed.
• Sheet -2- Of -5
Date 08- _?4 -00
I?
I ,
-I
'o
... -.ss2i ? Q do ?.?..
?r noc.tc. Sr?rJC?c?rv ` L-p Tcap
Survey Date p,rf -- f I -OO
Conducted By >FH. ,Q.8. , K F
Drawn By
ES? EY 1?zLeY
S.R. 1300 -C- County UJI 11?Fs
Name S U MM T Rb.
Existing Road
New Road
t?
Proposed RAV - ---- - ---------t
e'qfool
Existing Pipe _- _- -? - - -- W - __J . l- -- --
r - - - - - -? New Pipe
r------- I ... 1
Center Line RceK
5ilT
W
e n u e 9 "., 1/1->Ae--
Sheet 3 Of--5'-
Date B -no
. . .

C- T R.
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Note:
Temporary erosion control
devices not shown, but will
include temporary silt screen,
rock check dams and silt
basins, as needed.
Survey Date o-//-00
Conducted By
Drawn By -P9-E:3LEr I(-;LBr
•S.R. 1300'C County L 1C 5
Name S (A M YN i -?_' f1,V
Existing Road
New Road
Proposed R/W --=- --_ - _ - - -
00
Existing Pipe
New Pipe
Center Line

Sheet ? Of 5
Date d-.:2; -oo
?1
C t,'

1

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f
= - - - - --- 1 - - - - ' _
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i
-
---- - -----
-

Note:
Temporary erosion control
devices not shown, but will
include temporary silt screen,
rock check dams and silt
basins, as needed.
Survey Date 1 ~l - 00
Conducted B?
Drawn By
S.R. 1300-C County ?L/ I. K F S
Name Su n1 n-i ?-E-
Existing Road

Sheet
Date <? 3-v0

New Road
Proposed R/«' --
Existing Pipe 7 +so Soma
L ----- J
r -----7
New Pipe
t
Center Line 5^?L E 34.f'T
cAA.,r /?"=913s
Aso
a
Tiva /YJ;1F..?RAn/c?
r?oiT CLAJS•C Tn
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r -t_I_- I_

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t-
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_.. .. __ .._ _....
- _, ... -__

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_ --

- -. -- - -- L i ..___ - -- ' -
Note:
Temporary erosion control
devices not shown, but will
include temporary silt screen,
rock check dams and silt
basins, as needed.
Survey Date 9-/1-00
Conducted By(Efl, ?sFK, Dt
Drawn B yAl F 3 FO 1.1 n/