20021460 Ver 1_Complete File_20020910

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October 4, 2002
Onslow County
DWQ Project No. 021460
APPROVAL of 401 Water Quality Certification
Mr. H. Allen Pope, P.E., Division Engineer
NCDOT, Division 3
124 Division Dr.
Wilmington, NC 28401
Dear Mr. Pope:
You have our approval, in accordance with the attached conditions and those listed below, to place fill material in
0.01acres of wetlands for the purpose of widening and paving SR 1133 in Onslow County. The project shall be
constructed in accordance with your application dated August 30, 2002. After reviewing your application, we have
decided that this fill is covered by General Water Quality Certification Number 3375. This certification corresponds
to the Nationwide Permit 14 issued by the Corps of Engineers. In addition, you should acquire any other federal,
state or local permits before you proceed with your project including (but not limited to) Sediment and Erosion
Control, Non-Discharge and Water Supply Watershed regulations. This approval will expire 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 remain valid, you must adhere to the
conditions listed in the attached certification.
1.) Upon completion of the project, the NCDOT shall complete and return the enclosed "Certification of
Completion Form" to notify DWQ when all work included in the 401 Certification has been completed. The
responsible party shall complete the attached form and return it to the 401/Wetlands Unit of the Division of
Water Quality upon completion of the project.
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 that conforms
to Chapter 150B of the North Carolina General Statutes to the Office of Administrative Hearings, P.O. Box 27447,
Raleigh, N.C. 27611-7447. This certification and its conditions are final and binding unless you ask for a hearing.
P l ?.
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
N. C. Division of Water Quality 1650 Mail Service Center Raleigh, NC 27699-1650 [phone]
Customer Service: 1 800 623-7748
W ATF Michael F. Easley, Governor
O R William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
C/) 7 Alan W. Klimek, P.E. Director
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water Act. If you
have any questions, please contact John Hennessy at 919-733-5694.
Sincerely,
Attachment
cc: Wilmington District Corps of Engineers
Corps of Engineers Wilmington Field Office
DWQ Wilmington Regional Office
File Copy
Central Files
1
Klime , E.
c:\ncdot\SR 1133\wqc\021460wgc.doc
021460
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STATE OF NORTH CAROLINA r"[{?
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY DIVISION OF HIGHWAYS LYNDO TIPPETT
GOVERNOR SECRETARY
August 30, 2002
David L Timpy, Regulatory Project Manager
U.S. Army Corps of Engineers
Wilmington Regulatory Field Office
Post Office Box 1890
Wilmington, North Carolina 28402.1890
SUBJECT: Grade, drain, base and pave at SR 1133 (Old Wilmington Rd), Onslow County
Dear Mr. Timpy:
Please find enclosed a PCN application from the North Carolina Department of Transportation for a
Nationwide!General Permit from the Army Corp of Engineers for the secondary road improvement project on SR 1133
(Old Wilmington Rd.) in Onslow County, which is 0.39 miles in length. The scope of the project will be to grade,
drain, base and pave the site to current NCDOT secondary mad standards of 20 ft of pavement and 6 ft of earthen
shoulders to improve roadway safety. To bring this project up to NCDOT standards the existing footprint will need to
be widened approximately 9 & into a small wetland area on the west side of the project under a powerline utility
easement. Furthermore, 8 ft of pipe will be added to the west end of the existing 18" RCP (Sta. 2+55.79) at this site. A
field inspection and GIS survey has been conducted by this office for this project and a finding of "no effect" for T & E
species, habitat and historical structures has been determined. Total impacts for this proposed project will consist of
0.01 acres of wetlands associated with an unnamed tributary to Southwest Creek, which are classified as C NSW by the
Division of Water Quality.
By copy of this letter and application, the North Carolina Department of Transportation (NCDOT) also requests
authorization by the North Carolina Division of Water Quality (NCDWQ) for the corresponding Section 401 Water
Quality Certification.
If you have any question or concerns, please feel free to contact me at [phone].
Sincerely,
Mason Herndon, Division Environmental Officer
Division 3
Enclosures
Cc: John Hennessey, NCDWQ, Raleigh j
Office Use Only: 021460 Form Version May 2002
USACE Action ID No. DWQ No.
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
1. Processing
1. Check all of the approval(s) requested for this project:
® Section 404 Permit ? Riparian or Watershed Buffer Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
® 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: NWP 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 (verify availability with NCWRP prior to submittal of PCN), complete
section VIII and check here: ?
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here: ?
H. Applicant Information
1. Owner/Applicant Information
Name: H Allen Pone P E Division 3 Engineer
Mailing Address: North Carolina Department of Tra=ortation
124 Division Dr.
Wilmington. N.C. 28401
Telephone Number: [phone] Fax Number: (910) 251- 5727
E-mail Address:
2. Agent/Consultant 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: Mason Herndon
Company Affiliation: Division 3 Environmental Officer
Mailing Address: North Carolina Doartiment of Transportation
124 Division Dr.
Wilmington, N.C. 28401
Telephone Number: [phone] Fax Number: (910) 51=5727
E-mail Address: mherndon@
,dot.state.nc.us
Page 5 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.
1. Name of project: SR 1133 (Old Wilmington Rd)
2. T.I.P. Project Number or State Project Number (NCDOT Only): 6.262313
3. Property Identification Number (Tax PIN):
4. Location
County: Onslow. Nearest Town: Jacksonville
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.): From Jacksonville, take US 17 S,
go 4.3 miles and turn ri hg t on SR 1107 (Dawson Cabin Rd) go 0.7 miles and turn right onto
SR 1133 (Old Wilmington Rd)
5. Site coordinates, if available (UTM or Lat/Long): 34° 41'36.5" N 77° 29'28.4" 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. Property size (acres): N/A
7. Nearest body of water (stream/river/sound/ocean/lake): Southwest Creek
8. River Basin:_ White Oak
(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/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: Existing u paved secondar_,.y road is bordered by residences
agriculture fields and forested areas
Page 6 of 12

10. Describe the overall project in detail, including the type of equipment to be used:
To grade drain., base and pave the existing secondary road using standard road construction
equipment
11. Explain the purpose ofthe proposed work: To improve the existing secondary road by
bringing it up to NCDOT standards' providing a better and safer road for residents along
the route
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.
No previous permits have been issued
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
No additional permits request are anticipated in the near future
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 7 of 12
1. Provide a written description of the proposed impacts: Impacts will include the
fill of 0l acres of wetlands at Site 1 including the addition of 8 $ of pipe to west end of the
existing; 18" RCP (Sta 2+55.79)
2. Individually list wetland impacts below:
Wetland Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Located within
100-year Floodplain**
es/no) Distance to
Nearest Stream
feet
Type of Wetland***
Site 1 fill .01 no 740 ft forested freshwater

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flood'mg, 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 httT)://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.) Indicate if wetland is isolated (determination of isolation to be made by USACE only).
List the total acreage (estimated) of all existing wetlands on the property: N/A
Total area of wetland impact proposed: 0.01
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact
Site Number
(indicate on ma)
Type of Impact* Length of
Impact
linear feet)
Stream Name** Average Width
of Stream.
Before Imp act Perennial or
Intermittent?
(please specify)
N/A None

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
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.sov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.tolozone.com,
www.mMuest.com. etc.).
Cumulative impacts (linear distance in feet) to all streams on site:
Page 8 of 12
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
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 None

List each impact separately and identify temporary impacts. Impacts include, but are not linuted to: rut, excavation, dredging,
flooding, drainage, bulkheads, etc.
5. Pond Creation N/A
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
All wetlands or surface waters not affected by this project will be protected from unnecessary
gncroachn_gnt Strict enforcement of sedimentation and erosion control BMP's will be enforced.
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.
Page 9 of 12
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application -
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http://h2o.enr.state.nc.us/ncwetlands/strmgide.html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
N/A
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP). Please note it is the applicant's responsibility to contact the NCWRP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCWRP, check the NCWRP website at http://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): N/A
Amount of Non-riparian wetland mitigation requested (acres): N/A
Amount of Coastal wetland mitigation requested (acres): N/A
Page 10 of 12
IX. Environmental Documentation (required by DWQ)
.Does the project involve an expenditure of public (federal/state) funds or the use of public
(federal/state) 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 (required by DWQ)
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 V
Yes ? No Z If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers, ff buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers. Required
Zone* Impact
(square feet Multiplier
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.
Page 11 of 12
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 (required by DWQ)
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.
Strict enforcement of Sedimentation and Erosion control BMP's will be enforced during
construction to protect wetlands and waters of US
XII. Sewage Disposal (required by DWQ)
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 (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No Z
Is this an after-the-fact permit application?
Yes ? No
MV. 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).
S-30-0z-
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12
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Name: JACKSONVILLE SOUTH Location: 034° 41'40.0" N 077° 29' 13.9" W
Date: 7/26/2002 Caption: SR 1133 (OLD WILMINGTON RD)
Scale: 1 inch equals 2000 feet
Cowright (C) 1997, Maptech, Inc.
Markers
Name: SITE
Short Name: SITE
Coordinates: 034° 41'36.5" N, 077° 29'28.4" W
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DATA FORM
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Delineation Manual)
Project/Site: S V- a)
Applicant/Owner: _??c o03
Investigator:
Date: _S-°Z
County: ?n-
State: %IZN C
DO Normal Circumstances exist on the site? Le o Community ID:
Is the site significantly disturbed (Atypical Situation)? N Transect ID:
Is the area a potential Problem Area? Yes Plot ID:
(If needed, explain on reverse.
VEGETAI 1UN
Dominant Plant Species Stratum Indicator Dominant Plant Species Stratum Indicator
r ??a
?
? FnC=
ASL 9.-- -
10.
----s------ ----- -------
xt
i_
2.-ISSLJGi?ar?_ -_---
3. fy\m K CS.D _?C.r`LS - - -- ? 11.------------------ ----- -- --
4.
-- 12.----------------- ------ --------
5.-
?--- --- --- ------ ----- 13._--------------- ------ --
6.-- ---------- ---- - ------ 14.----------------- ------ -------
15._ ------ -------
8. 16.------------------ ------ ---- ---
Percent of Dominant Species that are OBL, FACW or FAC
----------
(excluding FAC-)- -------------------------
Remarks: SGt?r?cl ?trti?
Y LIKU LU U T
Recorded Data (Describe in Remarks):
- Stream, Lake, or Tide Gauge
_ Aerial Photographs
_ Other
No Recorded Data Available
Field Observations:
Depth of Surface Water. NL? (in.)
Depth to Free Water in Pit: NlP (in.)
Depth to Saturated Soil: tN1p' (in.)
Remarks:
Wetland Hydrology Indicators:
Primary Indicators:
_ Inundated
Saturated in Upper 12 Inches
Water Marks
_ Drift Lines
Sediment Deposits
?rainage Patterns in Wetlands
Secondary Indicators (2 or more required):
- Oxidized Root Channels in Upper 12 Inches
Water-Stained Leaves
Local Soil Survey Data
FAC -Neutral Test
_ Other (Explain in Remarks)
B2 Appendix g Blank and Example Data Forms
SOILS
Map Unit Name Drainage Class: _ -_-_-_-_-
(Series and Phase): - _
-- - Field Observations
Confirm Mapped Type? Yes No
Taxonomy (Subgroup): _-_ -_-_ -_ ?_?_----
Profile Description:
Depth Matrix Color
Mottle Colors Mottle Abundance/ Texture, Concretions,
etp
cture
i
l
Horizpn M I Moistl (
n- In (tp5hes) .
p
rontrast y
--?--
Munsell Moist) s
a H?----- -? 3)2^?`-
- - - - - - - - - - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - -
- - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - -- -
Hydric Soil Indicators:
_ Histosol Concretions
Fligh Organic Content in Surface Layer in Sandy Soils
Histic Epipedon
Sulfidic Odor Organic Streaking in Sandy Soils
_
Aquic Moisture Regime Listed on Local Hydric Soils List 4
-
Reducing Conditions Listed on National Hydric Soils List
_
Gleyed or Low-Chroma Colors - Other (Explain in Remarks)
Remarks:
YYCI L.1-UNU ucl crxmrn?.
Hydrophytic Vegetation Present? Y No (Circle) (Circle)
Wetland Hydrology Present? a No
Hydric Soils Present? es No is this Sampling Point Within a Wetland? es No
Remarks:
66 SIX 9 Zl- Pmr-
?l?s (1-1 to P -5- . U a cr
t'J tie 5tat?? ???cer C uc to S en?a\\ Y??ew aI??c e••`] 1o M416C
e.........ed by HOLISACE 3/92
B3
Appendix B Blank and Example Data Forms

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North Carolina Division of Water Quality
401 [Wetlands Unit
STATE of NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY DIVISION OF HIGHWAYS LYNDO TiPPETT
GOVERNOR SECRETARY
August 30, 2002
MEMO TO:
FROM:
SUBJECT:
Work Order Number:
TIP Number:
Category: $200.00 fee
021460
2003 0
Mason Herndon, Division 3 Environmental Officer
North Carolina Department of Transportation
PCN Application fee for Secondary Road Construction on SR
1133 (Old Wilmington Rd), Onslow County
6.262313
PAYMENT
RECEIVED
N/A
124 Division Drive, Wilmington, NC 28401
PHONE: [phone] FAX: [phone]
? V?IATF Michael F. Easley, Governor
`OTC' RpG William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
7 Alan W. Klimek, P.E. Director
DWQ Project No.• 02 14GO
County: Qngt o W
Applicant: NC
Project Name: S 1133 ©l d w ? J Vo; v a Vl V_?.
Date of Issuance of 401 Water Quality Certification: O GA-DGG it 4 1 ?-00-2-
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 401/Wetlands Unit, North
Carolina Division of Water Quality, 1621 Mail Service Center, Raleigh, NC, 27699-1621. This form may be
returned to DWQ by the applicant, the applicant's authorized agent, or the project engineer. It is not necessary to
send certificates from all of these.
Applicant's Ce fication
I, , hereby state that, to the best of my abilities, due care and diligence
was used in tife observation. of the cons uction 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 sup o rials.
Signature: Date: Of
Agent's Certificati n `I, n O.SC"r, , hereby state that, to the best of my abilities, due care and diligence
was used in the observation of the construction such that the construction was observed to be built within substantial
compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and
specifications, and other supporting materials. _
Signature: ??.r.. ?iG %?. •._ Date:-
Engineer's Certification
Partial Final
I, , as a duly registered Professional Engineer in the State of North
Carolina, having been authorized to observe (periodically, weekly, full time) the construction of the project,for the
Permittee hereby state that, to the best of my abilities, due care and diligence was used in the observation of the
construction such that the construction was observed to be built within substantial compliance and intent of the 401
Water Quality Certification and Buffer Rules, the approved plans and specification --r-I -*hi- supporting materials.
Signature Registra
Date L,uz
O?