20020076 Ver 1_Complete File_20020117

Michael F. Easley, Govemor
?F W A r?q William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
7 Alan W. Klimek, P.E. Director
T-
T- Division of Water Quality
O 'C
DWQ Project No.: yo2UU>? County: Ch?r?l 1
Applicant: NCDOT
Ile -/- III
Project Name
Date of Issuance of 401 Water Quality ertification: i -v-2
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable Buffer
Rules, and any subsequent modifications, the applicant is required to return this certificate to the
40UWetlands Unit, North Carolina Division of Water Quality, 1650 Mail Service Center, Raleigh, NC,
27699-1650. This form may be returned to DWQ by the applicant, the applicant's authorized agent, or the
project engineer. It is not necessary to send certificates from all of these.
Applicant's Certification
I, Joel B. Setzer. P.E., hereby state that, to the best of my abilities, due care and diligence was used in the
observation of the construction such that the construction was observed to be built within substantial
compliance and intent o e 401 W Quality Certification and Buffer Rules, the approved plans and
specifications, and ywil s?rtSignature: Date:
Agent's Certitl tion
I, , hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to be
built within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the
approved plans and specifications, and other supporting materials.
Signature: Date:
If this project was designed by a Certified Professional
1, , as a duly registered Professional (i.e.,
Engineer, Landscape Architect, Surveyor, etc.) in the State of North Carolina, having been authorized to
observe (periodically, weekly, full time) the construction of the project, for the Permitee hereby state that,
to the best of my abilities, due care and diligence was used in the observation of the construction such that
the construction was observed to be built within substantial compliance and intent of the 401 Water
Quality Certification and Buffer Rules, the approved plans and specifications, and other supporting
materials.
Signature
Registration No.
Date:

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/
F WATF Michael F. Easley, Governor
\0?0 ;9 William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
co r Gregory J. Thorpe, Ph.D.
> y Acting Director
p •? Division of Water Quality
January 29, 2002
Cherokee County
DWQ Project No. 020076
SR 15,6 (Grape Thicket Road)
APPROVAL of 401 Water Quality Certification with Additional Conditions
Mr. Wesley T. Grindstaff
NCDOT Andrews District Office
P.O. Box 1551
Andrews, NC 28901
Dear Mr. Grindstaff:
You have our approval, in accordance with the attached conditions and those listed below, to impact
50 linear feet of an unnamed tributary to Grape Thicket Branch in order to construct a turning pad for
school buses on SR 1586 (Grape Thicket Road) in Cherokc---- County. The project should be
constructed in accordance with your application dated January 11_ ?OD2 (received January 17, 2002).
After reviewing your application, we have decided that this fill ii cmered by General Water Quality
Certification No. 3289 corresponding to the U.S. Army Core of Engineers Nationwide Permit
Number 14. In addition, you should acquire any other federa,! . state or local permits before you
proceed with your project including (but not limited to) Sediinat and Erosion Control, Non-
Discharge and Water Supply Watershed regulations. Thin approval will expire with the
accompanying 404 permit unless otherwise specified in the Water Quality Certification.
This approval is only valid for the purpose and design that you &-B=iibed in your application except as
modified below. If you change your project, you must notify us_ m-writing, and send us a new
application. If the property is sold, the new owner must be given k copy of this Certification and
approval letter and is thereby responsible for complying with all c-mditions. If total wetland fills for
this project (now or in the future) exceed one acre or stream impm----o exceed 150 linear feet,
compensatory mitigation may be required as described in 15A NC-4C 2H .0506 (h) (6) and (7). For
this approval to be valid, you must follow the conditions listed in #ne attached certification and any
additional conditions listed below.
1. Stormwater should be directed to buffer areas or retention buts Bad should not be routed
directly to streams.
2. Temporary or permanent herbaceous vegetation shall be pla?l ca all bars soil within 15 days of
ground-disturbing activities to provide long term erosion coil.
3. The pipe required for this project shall be installed in sudo a manner that the original stream
profile is not altered (i.e. the depth of the channel must net be reduced by a widening of the
streambed). Existing stream dimensions are to be maintainro abvre and below locations of each
culvert. The culvert shall be installed one foot below the snm>m to allow for fish and other
wildlife movement. If the existing pipe is perched, it shall be moved and replaced, and installed
correctly.
4. All work shall be performed during low flow conditions.
North Carolina Division of Water Quality, 401 WaGards Certlillrja0w Unit,
1650 Mail Service Center, Raleigh, NC 27699-16W (MalkV $dkorm)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (legation)
919-733-1786 (phone), 919-733-6893 (fax), http-.1&2o.enr.satlz ;m.u&hxwerla rds:
5. All mechanized equipment operated near surface waters must be regularly inspected and
maintained to prevent contamination of stream waters from fuels, lubricants, hydraulic fluids, or
other toxic materials.
6. The presence of equipment in the channels must be minimized. Under no circumstances must
rock, sand or other materials be dredged from the wetted stream channel under authorization of
this permit, except in the imrnzdiate vicinity of the culverts.
7. Existing vegetated buffers shall not be mowed in order to utilize it for storm water sheet flow.
8. Use of rip-rap for bank stabiliz`rion is to be minimized: rather, native vegetation is to be planted
when practical. If necessary- rh)-mp must be limited to the stream bank below the high water
mark, and vegetation must be --med for stakj=- tion above high water.
9. Rock silt screens at culvert ou l!:s shall be removed at project completion.
Upon completion of the project. sb`NCDOT s?a complet; and return the enclosed
"Certificate of Completion" form it notify tiCDWQ when all work included in the §401
Certification has been completed- ine respecs-3e party- shall complete the attached form
and return it to the 401/Wetlands C7k, of the `NC Division et Water Quality upon
completion of the project-
If %ou do not accept any of the c:zn:!L-orts of toLq z-rtific--4ticn. you may ask for an adjudicatory
hearing. You must act within 60 di,z of the dim that you Peeive this letter. To ask for a hearing,
send a written petition that conic!. :o Chapin LOB of the North Carolina General Statutes to the
Office of Administrative Hearin----,-, '-, 14 N4,--,3 .-ice C.en-.. Raleigh. N.C. 27699-6714. This
certification and its conditions :Ea-1 and b&i=- a unless .:ou ask for a hearing.
This letter completes the review of :2it? Divisc?m z Water- Qaality under Section 401 of the Clean
Water Act. If you have any que-mui.& please ie-?hone M- s- Cynthia Van Der Wiele at 919.733.5715
or NIT. Mike Parker of the Ashe}iIL- ?: 2ion-1 05ce at 52&-151.6208.
?mc ly,
l r?
?.7_ Th , Ph. .
tng '-
Director
Ana.--hment Vr
Pc: Wilmington District Corps ?f neer?
Carps of Engineers AsherL 3?et d Off=
'-'CDWQ Asheville Regicmd ,ce
Central Files
File Copy
a.. STATE
M
020076
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY
GOVERNOR
January 14, 2002
LYNDO TIPPETF
SECRETARY
SR 1586
Cherokee County
Mr. John Hendrix
US Army Corps of Engineers
151 Patton Avenue, Room 208
Asheville, NC 28801-2714
Dear Mr. Hendrix:
? A
The North Carolina Department of Transportation (NCDOT) is proposing to construct a
turnip d to facilitate school buses traveling on SR 1586, Grape Thicket Road. In order to
construct this bus turning area, extension of an existing pipe is necessary. Due to the extension
of this pipe culvert in a live stream (unnamed tributary to Grape Thicket Creek, Class C), we are
requesting authorization under Section 404 of the Clean Water Act.
I am sending a drawing for the pipe culvert replacement, general notes and standards on
some erosion control measures, and a marked map. We propose to install the new culvert
slightly below the existing streambed elevations where bedrock is not encountered to minimize
impacts to wildlife habitats and allow the existing stream gradients to remain as unchanged as is
physically possible. No threatened or endangered species are known to be present in or near the
project area; therefore, no significant impacts are anticipated from project construction.
The best management practices will be used to minimize and control sedimentation and
erosion on this project. The construction foreman will review all erosion control measures daily
to ensure sedimentation and erosion are being effectively controlled. If the planned devices are
not functioning as intended, they will immediately be replaced with better devices. The rocksilt
screens and other erosion control devices will be in place prior to pipe culvert construction and
will remain in place until the project is stabilized.
By copy of this letter, I am asking Owen Anderson, North Carolina Wildlife Resources
Commission (NCWRC) Western Mountain Region Coordinator, to comment directly to you
concerning the 404 Nationwide Permit request.
Andrews District Office (\11?f ` 11
P. O. Box 1551, Andrews, N. C. 28901
Ph-- (Q')R1 111 _A 1115 V- - IQ )Q? 2') I 'II )Q
Mr. John Hendrix
Page 2
January 14, 2002
Also, by copy of this letter, I am requesting authorization to proceed under Section 401 of
the Clean Water Act from the Division of Environmental Management. The $200 application fee
required for 401 requests should be charged to work order # 5.9123.
We would like to begin construction as soon as possible. If further information is
required, please call me at [phone]. Your early review and consideration will be greatly
appreciated.
Sincerely,
-2?V 4 ?..I
Wesley T. Grindstaff
County District Engineer
WTG/rr
Attachments
cc: Mr. Richard Phillips, P.E., Regional Engineer DEHNR
Mr. R. G. Watson, P.E., Division Engineer
Mr. E. L. Ingle, Area Roadside Environmental Engineer
Mr. John Dorney, DWQ, DENR (with attachment)
Mr. Owen Anderson, Western Mountain Region Coordinator, NCWRC
Mr. Mark Davis, Division Environmental Officer
Mr. W. E. Chastain, Transportation Supervisor II
Mr. J. C. Penland, Transportation Supervisor 11

?0?, W A TF9
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>
O ~
Pre-Construction Notification (PCN) Application Form
For Section 404 and/or Section 10 Nationwide, Regional and General Permits, Section 401
General Water Quality Certifications, and Riparian Buffer and Watershed Buffer Rules
This form is to be used for projects qualifying for any of the U.S. Army Corps of Engineers' (USACE)
Nationwide, Regional or General Permits as required by Section 404 of the Clean Water Act and/or
Section 10 of the Rivers and Harbors Act, and for the North Carolina Division of Water Quality's
(DWQ) associated General 401 Water Quality Certifications. This form is also to be used for any
project requiring approval under any Riparian Buffer Rules implemented by the N.C. Division of Water
Quality. This form should not be used if you are requesting an Individual 404 Permit or Individual 401
Water Quality Certification. The USACE Individual Permit application form is available online at
http://www.saw.usace.army.mi]/wetlands/Perm. htm.
The USACE is the lead regulatory agency. To review the requirements for the use of Nationwide,
Regional or General permits, and to determine which permit applies to your project, please go to the
USACE website at http://www.saw.usace.army mil/wetlands/regtour 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/ncwetiands to read about current requirements for the 401 Water Quality
Certification Program and to determine whether or not Riparian Buffer Rules are applicable. The
applicant is also advised to read the full text of the General Certification (GC) matching the specific 404
Permit requested. In some cases, written approval for some General Certifications is not required,
provided that the applicant adheres to all conditions of the GC. Applicants lacking access to the internet
should contact DWQ's Central Office in Raleigh at [phone].
Trout Waters Coordination - Special coordination with the North Carolina Wildlife Resources
Commission (NCWRC) is also required for projects occurring in any of North Carolina's twenty-five
counties that contain trout waters. In such cases, the applicant should contact the appropriate NCWRC
regional coordinator (listed by county on the last page of this application).
Page 1 of 12
CAMA Coordination - If the project occurs in any of North Carolina's twenty coastal counties (listed on
the last page of this application) the applicant should also contact the North Carolina Division of Coastal
Management (DCM) at [phone]. DCM will determine whether or not the project involves a
designated Area of Environmental Concern, in which case DCM will act as the lead permitting agency.
In such cases, DCM will require a Coastal Area Management Act (CAMA) Permit and will coordinate
the 404/401 Permits.
USACE Permits - Submit one copy of this form, along with supportin photos, etc. to the applicable USACE Regulatory Field Office (addre ses a ealisted at the end of his
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.miI/wetlands/nwpfinc edReg pdf.
Processing times vary by permit and begin once the application has been detennmed to be complete.
Please contact the appropriate regulatory field office for specific answers to permit processing periods.
401 Water Quality Certification or Buffer Rules - All information is required unless otherwise stated
as optional. Incomplete applications will be returned. Submit seven collated copies of all USACE
Permit materials to the Division of Water Quality, 401/Wetlands Unit, 1650 Mail Service Center,
Raleigh, NC, 27699-1650. If written approval is required or specifically requested for a 401
Certification, then a non-refundable application fee is required. In brief, if project impacts include less
than one acre of cumulative wetland/water impacts and less than 150 feet cumulative impacts to
streams, then a fee of $200 is required. If either of these thresholds is exceeded, then a fee of $475 is
required. A check made out to the North Carolina Division of Water Quality, with the specific name of
the project or applicant identified, should be stapled to the front of the application package. For more
information, see the DWQ website at http://h2o.eh-nr.state.nc.us/ncwetlands/fees.html. The fee must be
attached with the application unless the applicant is a federal agency in which case the check may be
issued from a separate office. In such cases, the project must be identifiable on the U.S. Treasury check
so that it can be credited to the appropriate project. If written approval is sought solely for Buffer Rules,
the application fee does not apply, and the applicant should clearly state (in a cover letter) that only
Buffer Rule approval is sought in writing. Wetlands or waters of the U.S. may not be impacted prior to
issuance or waiver of a Section 401 Water Quality Certification. Upon receipt of a complete application
for a 401 Certification, the Division of Water Quality has 60 days to prepare a written response to the
applicant. This may include a 401 Certification, an on-hold letter pending receipt of additional
requested information, or denial.
Page 2 of 12
Office Use Only:
USACE Action ID No.
DWQ No.0 2 6 ®7 6
Form Version April 2001
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
1.
II
Processing
1. Check all of the approval(s) requested for this project:
[Section 404 Permit
? Section 10 Permit
Evr 01 Water Quality Certification
? Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: N vd P 4
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: ?
Applicant Information
1. Owner/Applicant Information
Name: NocrH n N T1ot1
Mailing Address: P.O. Box 155?
?rJDIeAVs t 4G 289 n 1
Telephone Number: gz$. 3z1. 4-los- Fax Number: gz8.3z?. 32 zg
E-mail Address:
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. WEA.LEY C1aI?JDSTAFF
Company Affiliation: N c. DoT
Mailing Address:- p, o• Box lssI
?n12e+ys NG Z8°lo I
Telephone Number: AZg• 3Z1. 4-Io57 Fax Number: gZg. 3z1. .322 b
E-mail Address:_ ,, fQ, ; n dstQ {=f ? dot- n c- -is
Page 3 of 12
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.
Name of project: Bus Tve?4 - SR 15gh
2. T.I.P. Project Number (NCDOT Only): N/A
3. Property Identification Number (Tax PIN): N /A
4. Location
County: C1?rrleovm Nearest Town:_ MyaPr1Y
Subdivision name (include phase/lot number): N /R
Directions to site (include road numbers, landmarks, etc.):
F;tcm h'IvWtiY: VS G4 WEST To HAY 1,k sou--H
.. SOu-ro Ta 52 155C0
SR 155'lo To 52 IS-ST
SK 1585" Tb 52 15-9lo
5. Site coordinates, if available (UTM or Lat/Long): o3s o oB-V° 03' zs.5 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:
ir, a4-nni- 79-,en 1.41y1), rV9E5T ASSou,ec65
7. Property size (acres): t o. 05 AcacES
8. Nearest body of water (stream/river/sound/ocean/lake): OienrE Twc.ve-r UANCO (culls c.)
9. River Basin: f41 WAss Ew
(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/maps/.)
Page 4 of 12
10. Describe the purpose of the proposed work: e,,4s-nevcT &,-, T yen/ 7a
AGLOW 54SN001- 8?S ADE u4 76 ,9 EW "Tb ,tN i@*-' 0V D
11. List the type of equipment to be used to construct the project:_ g, rKtIoE D,,
MP TRucK5
12. Describe the land use in the vicinity of this project: )?Es?DtFv7?&
?M LI4ND
-oREST ?c$ou?ecES
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.
?'. 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.
Page 5 of 12
I . Wetland Impacts NIA
Wetland Impact Area of
Site Number Type of Impact* Impact
(indicate on map) (acres)
Locates wttnm Distance to
100-year Floodplain** Nearest Stream Type of Wetland***
(yes/no) (linear feet)
-11 uupaut separately and identity 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 http://www.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: 1401V E
Total area of wetland impact proposed: NoNE
Stream Impacts, including all intermittent and perennial streams
Stream Impact
Site Number
(indicate on map)

T
S
I
Type of Impact* Length of
Impact
(linear feet)
Stream Name** Average Width

of Stream
Before Impact Perennial or

Intermittent?
(please specify)
I
E Ct/L?EA7- 5Q UT-7C 0104PE 77f1
PEREN?// /9 L

* List each impact separately and identify tem ors
p ry Impacts. Impacts Include, but are not ltmited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
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
www.usgs.gov. Several intemet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.mapquest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 570 Lf
Page 6 of 12
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S. NIA
)pen Water Impact Area of
Site Number Type of Impact* Impact Name of Waterbody Type of Waterbody
(indicate on map) (if applicable) (lake, pond, estuary, sound,
(acres) bay, ocean, etc.)
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 NIA
If construction of a pond is proposed, associated wetland and stream impacts should be
included aboye 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): E] uplands [] stream F] wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
iPE MUST ]BE . EX-MM ??? In( 0&halZ 7V FLAC-E FILL- Foe-
W_-2.
MdtS tS -_ME ©NlY FEskSi L..E AREA -To Cb IJSTmyt-
k _PAD .
Page 7 of 12
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.ear.state.nc.us/ncwetlands/strmgide.html.
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.
Page 8 of 12
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP) with the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants
will be notified early in the review process by the 401/Wetlands Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at htt2://h2o.enr.state.nc.us/wrp/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): N/A
Amount of buffer mitigation requested (square feet): N/A
Amount of Riparian wetland mitigation requested (acres): r 41A
Amount of Non-riparian wetland mitigation requested (acres):-11A
Amount of Coastal wetland mitigation requested (acres): N 1A
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 0 No &2/
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 Z' 1v1,4
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 213 .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", p )?
rovide the following information:
Page 9 of 12
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 EReq
I 3
2 1.5
Total
n
* Zone I extends out 30 feet perpendicular from near bank of channel;IZone 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.
X?ST/rl = a ES 'o a6-_D RES
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 0 No 2
Is this an after-the-fact ermit application?
Yes n No
Page 10 of 12
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).
N/A

Applicant/A nt's Signa e 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
US Army Corps of Engineers Alexander Cherokee Iredell
Mitchell
151 Patton Avenue Avery
Buncombe Clay
Cleveland Jackson
Lin
l Polk

Room 208
Asheville
NC 28801-5006
Burke
Gaston co
n
Macon Rowan
Rutherford
,
Telephone: [phone] Cabarrus
Cald
ll Graham Madison Stanley

Fax: [phone] we
Catawba Haywood
Hend McDowell Swain
erson Mecklenburg
Transylvania
Raleigh Regulatory Field Office
US Army Corps Of Engineers Alamance Durham Johnston Rockingham

6508 Falls of the Neuse Road Alleahany

A
h Edgecombe Lee
Stokes

Suite 120
Raleigh
NC 27615 s
e
Caswell Franklin
Forsyth Nash
Northampton Surry
Vance
,
Telephone: [phone] Chatham

Davidson Granville

Guilf
d Orange
Wake

Fax: [phone]
Davie or
Halifax Person
Randolph Warren
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 Pender
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fax: [phone] Cumberland New Hanover Scotland
Pitt
Tyrrell
Washington
Wayne
Union
Watauga
Yancey
Wilson
Yadkin
*Croatan National Forest Only
Page I 1 of 12
US Fish and Wildlife Service / National Marine Fisheries 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: [phone] Telephone: [phone] Telephone: [phone]
North Carolina State Agencies
Division of Water Quality
401 Wetlands Unit Division of Water Quality State Historic Preservation Office

1650 Mail Service Center Wetlands Restoration Program
1619 Mail Service Center Department Of Cultural Resources

Raleigh, NC 27699-1650
Raleigh
NC 27699-1619 4617 Mail Service Center

Telephone: [phone]
F ,
Telephone: [phone] Raleigh, NC 27699-4617
Telephone: [phone]
ax: [phone] Fax: [phone] Fax: [phone]
CAMA and NC Coastal Counties
Division of Coastal Management
1638 Mail Service Center Beaufort Chowan Hertford Pasquotank

Raleigh, NC 27699-1638
Telephone: [phone] Bertie Craven
Brunswick Currituck Hyde Pender
New Hanover Perquimans

Fax: [phone] Camden Dare
Carteret Gat Onslow Tyrrell
es Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator Alleghany Caldwell Watauga
3855 Idlewild Road
Kernersville
NC 27284-9180 Ashe Mitchell Wilkes
,
Telephone: [phone] Avery Stokes

Burke Surry
Mountain Region Coordinator Buncombe Henderson Polk
20830 Great Smoky Mtn. Expressway Cherokee Jackson Rutherford
Waynesville, NC 28786 Clay Macon Swain
Telephone: [phone]
Fax: [phone] Graham Madison Transylvania
Haywood McDowell Yancey
Page 12 of 12

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NATIQNAL GEODETIC VERTICAL DATUM OF )1929 , TENNESSEE ;'NC
MISS. ALA.' GA. S C
THIS NAP COMPLIES WITH NATIONAL MAP ACCURACY STANDARDS QUADRANGLE LOCATION
.S. GEOLOGICAL SURVEY, DENVER, COLORADO 80225, OR RESTON, VIRGINIA 22092 Revisions shown in purple compiled by the Tennes
D U.S. TENNESSEE VALLEY AUTHORITY, CHATTANOOGA, TENN. 37401 Authority from aerial photographs taken 1985 and
DER DESCRIBING TOPOGRAPHIC MAPS AND SYMBOLS IS AVAILABLE ON REOqEST ,
This information not field checked. Map edltPpd 19
• 4 ;
<Default> -1 Markers, Length = 0 feet 3/M I-AW W11.0'IU !bQ4?
Name: MURPHY Location: 035° 00'40.3" N 084° 02'56.4" W
Date: 12/27/101 Caption: SR 1586 - Grape Thicket Road
Scale: 1 inch equals 2000 feet Cherokee County