20020749 Ver 1_Complete File_20020513

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Mr. J.G. Nance, P.E., Division Engineer
NCDOT, Division 5
2612 N. Duke Street
Durham, NC 27704
June 4, 2002
DWQ No. 020749
Person County
Re: Person County, Replacement of Bridge No. 41 on SR 1 107 over Bushy Fork Creek.
DOT Work Order 6.50.457
Bushy ForkCreek 127-3-3-1; C NSW)
APPROVAL of NEUSE RIVER BUFFER RULES AUTHORIZATION CERTIFICATE with ADDITIONAL
CONDITIONS
Dear Mr. Gilmore.
You have our approval, in accordance with the attached conditions, to impact 2847 square feet of'protected riparian
buffers for the purpose of replacing Bridge Number 41 on SR 1 107 over Bushy Fork Creek. The project shall be
constructed according to your application dated May 10, 2002 and any conditions listed below. This approval shall act
as your Authorization Certificate as required within the Neuse River Area Protection Rules (15A NCAC 2B .0233). In
addition, you should get any other required federal, state or local permits before you go ahead with your project
including (but not limited to) Sediment and Erosion Control.
This approval is only valid for the purpose and design that you described in your application dated May 10, 2002. If
you change your project, you must notify us and you may be required to send us a new application. If the property is
sold, the new owner must be given a copy of this authorization and approval letter and is thereby responsible for
complying with all conditions. For this approval to be valid, you must follow the conditions listed below.
If you do not accept any of the conditions of this authorization, 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, P.O. Box 27447,
Raleigh, N.C. 27611-7447. This authorization 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 the "No Practical Alternatives" determination
required in 15A NCAC 2B .0233(8). If you have any questions. please contact John Hennessy at 919-733-5694.
rel
Klimek, P. .
cc: US Army Corps of Engineers Raleigh Field Office
DWQ Raleigh Regional Office
File Copy
Central Files
('Ancdot\SR 1107\wqc\020749 buffer authorinition.doc
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N. C. Division of Water Quality 1650 Mail Service Center Raleigh, NC 27699-1650 [phone]
Customer Service: 1 800 623-7748
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
N. Q DEPARTMENT OF TRANSPORTATION
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? NOTE AND SEE M[ ASOUT THIS ? P04 YOUR INFORMATION
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? PREPARE REPLY FOR MY SIGNATURE ?SIGNATURE
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COMMENTS:
0120749
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STATE of NORTH CAROLINA
DEPARTMENT OF TRANSPORTA'
MICHAEL F. EASLEY
GOVERNOR
May 10, 2002
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Wetlands/401 Unit
2321 Crabtree Blvd.
Raleigh, NC 27604-2260
020749
MAY 1 3 2002
LYNDO TIPPETT
SECRETARY
Attention: Mr. John Dorney
Subject: Buffer Rule Approval for the replacement of Bridge No. 41 over Bushy
Fork Creek on SR 1107 in Person County. NCDOT Work Order 6.503457
The North Carolina Department of Transportation (NCDOT) proposes to replace
Bridge No. 41 over Bushy Fork Creek on SR 1107 (an existing asphalt roadway) in
Person County (Figures 1-4). The existing structure is a four span (1@ 30'-3", 2@ 20'-
0", 1@ 30'-3") bridge that is in poor condition. The bridge was constructed in 1950 and
has a sufficiency rating of 29.3 out of 100 points. It has been determined that this
structure must be replaced. The proposed replacement structure is a three-span
prestressed cored slab bridge (3@ 45'-0") which will completely span Bushy Fork Creek
(Figure 3). This letter requests buffer rule approval for this project.
Impacts to the Waters of the United States
Construction of the project involving replacement of the existing bridge will not
result in impacts to waters of the United States in the Neuse River basin. Here the project
will span Bushy Fork Creek (NCDENR-DWQ Index No. 27-3-3-1, Best Usage
Classification WS-III).
Bridge Demolition and Removal
Bridge No. 41 will be removed under Case 3, where there are no special
restrictions beyond those outlined in Best Management Practices for Protection of
Surface Waters and Best Management Practices for Bridge Demolition and Removal.
This activity will involve removal of the bridge deck, wing wall abutment pilings, timber
pilings and concrete sills. A silt fence and/or turbidity curtain will be placed around these
structures (where necessary) to reduce sedimentation during construction activity. The
Division 5, 2612 N. Duke Street, Durham, NC 27704
Phone: [phone] Fax: [phone]
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bridge shall be removed by sawing and/or non-shattering methods such that debris will
not fall into waters of the United States.
Bridge Replacement
The proposed structure will open the floodplain and completely span Bushy Fork
Creek. Piles will be drilled into the non-jurisdictional floodplain on each side of the
creek. Class II rip rap will also be placed under a portion of the bridge spans. Please
note that no rip rap will be placed in the stream or along the creek banks.
Waters of the U.S. Mitigation
Avoidance: No wetlands or surface waters will be affected by construction of the
project. No staging of construction equipment or storage of construction supplies will be
allowed in or near wetlands or surface waters. The proposed structure will open the
floodplain and completely span Bushy Fork Creek.
Minimization: Strict enforcement or sedimentation and erosion control by Best
Management Practices for the protection of wetlands and surface waters will be enforced
during project construction.
Compensatory Mitigation: Construction of the project will result in no impacts to
waters of the United States. Therefore, mitigation will not be necessary for this project.
Riparian Buffer Impacts/Stormwater Issues
The construction of the project involves a road crossing of a stream that is subject
to the Neuse River Riparian Buffer Rule. Please note that construction of this project
will not add any additional impervious area in the riparian buffer. No roadside
ditches are currently located or will be constructed within the project limits. Bushy
Fork Creek is depicted on the most recent version of the Hurdle Mills, North Carolina
topographic quadrangle (USGS 1978) (Figure 2), and the United States Department of
Agriculture-Natural Resource Conservation Service Person County Soil Survey (1995)
(Figure 3). The construction impacts 1,248 square feet in zone 1, 1,599 square feet in
zone 2, and 62 linear feet of riparian buffer. The project also involves replacement of a
bridge with a bridge. The NCDOT proposes to install temporary erosion and sediment
control devices at Site 1 in Zone 1 and Zone 2 of the riparian buffer. Specifically, the
NCDOT will place a temporary silt fence in Zone 1 and Zone 2. Based on impacts to the
riparian buffer at this site from this use, these above-mentioned activities are allowable.
The sediment and erosion control plans for Site 1 are depicted in Figure 4. Based on
impacts to the riparian buffer, this project is allowable.
The NCDOT is requesting that the North Carolina Division of Water Quality
(DWQ) complete a "no practicable alternatives" determination. The NCDOT certifies
that the criteria documented in Sub-Item (8)(a) of the buffer rules (which find that there
are no practical alternatives to the project) are met. The NCDOT requests an
Authorization Certificate for this project. Information supporting that there are no
practical alternatives for the issuance of this certification is summarized below:
The existing structure has a sufficiency rating of 29.3 out 100 points. Improvements
must be conducted at the site to allow the roadway to remain open for traffic.
The decision to replace the bridge with another bridge with a larger span will open up
the non jurisdictional floodplain and span Bushy Fork Creek.
The design of the project has reduced the footprint of the project as much as possible.
All efforts to reduce impacts to the riparian buffer have been made during project
design. The amount of rip rap located under the bridge in the riparian buffer is
utilized only for the protection of the bridge abutment and associated pilings. This
amount of rip rap has been reduced during the planning stage of this project.
Protected Species
Plants and animals with federal classifications of Endangered, Threatened,
Proposed endangered ad Proposed Threatened are protected under provisions of Section 7
and Section 9 of the ESA. As of February 27, 2001, there are no federally protected
species listed for Person County.
Summary
NCDOT proposes to replace Bridge No. 41 over Bushy Fork Creek on SR 1107 in
Person County. The proposed replacement structure is a three-span prestressed cored
slab bridge (3@ 45'-0") which will completely span Bushy Fork Creek. The project will
not result in impacts to waters of the United States.
Construction of the project will result in impacts to the riparian buffer. The
construction impacts 1,248 square feet in zone 1, 1,599 square feet in zone 2, and 62
linear feet of riparian buffer. The project also involves replacement of a bridge with a
bridge. A temporary silt fence will be placed in Zone 1 and Zone 2 of the riparian buffer.
Based on these impacts to the riparian buffer, this project is allowable. The NCDOT is
requesting that the North Carolina Division of Water Quality (DWQ) complete a "no
practicable alternatives" determination. The NCDOT certifies that the criteria
documented in Sub-Item (8)(a) of the buffer rules (which find that there are no practical
alternatives to the project) are met. The NCDOT requests an Authorization Certificate
for this project. A pre-construction notification is attached with this request. If you have
any questions or need additional information, please contact me at [phone].
Sincerely,
Christopher A. Murray, P.W.S.
Environmental Officer
cc: Mr. Eric Alsmeyer, USACE, Raleigh
Mr. Dallie Bagwell, NCDOT Bridge Superintendent, Raleigh
Mr. John Kearney, NCDOT, Oxford

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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
littt);/ WWI k SiM USace,ari iii*
l/wCtl?t_ndtii_f'erm-y a?h,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 sa\y._LISUC,army.m_il/wetlands/reotc?tir.fitifl, 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
httt? /_/h?o Crir Ss.ate,nc.,uS!ncNvetlands 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 11
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 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 htt ;//www saw.Lisace aCm? miliwetlands/nyyptinall edRtg.hdt.
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 hap //h?o chnr statc,nc us/ncwctlands/tees,htnil. 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 11
Office Use Only: 020749 Form Version April 2001
USACE Action ID No. DWQ No.
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
1. Processing
1. Check all of the approval(s) requested for this project:
? Section 404 Permit
? Section 10 Permit
? 401 Water Quality Certification
® Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested:
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ?
II. Applicant Information
Owner/Applicant Information
Name: NCDOT/Christopher A. Murray
Mailing Address: 2612 N Duke Street Durham NC 27704
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: cmurrayna.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.)
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
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
Page 3 of 11
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: Bridge No. 41 over Bushy Fork Creek on SR 1107, Person County
2. T.I.P. Project Number (NCDOT Only): NCDOT Division Project (non-TIP), Work Order
No. 6.503457.
3. Property Identification Number (Tax PIN):
4. Location
County: Person Nearest Town: Hurdle Mills
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.): From Hurdle Mills, travel west
on SR 1107 to project study area.
5. Site coordinates, if available (UTM or Lat/Long): 17 673908E 4015882N UTM
(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: Site is
surrounded by a mixture of wooded land and agricultural land.
7. Property size (acres): Project footprint is 475 feet long and is 74 feet wide. Property size is
approximately 0.81 acre
8. Nearest body of water (stream/river/sound/ocean/lake): Bushy Fork Creek
9. River Basin: Neuse River
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at httt)://h2o._e_nr_state. c us/adniln/mans/.)
10. Describe the purpose of the proposed work: Replacement of Bridge No 41 over Bushy
Fork Creek on SR 1107 in Person County.
11. List the type of equipment to be used to construct the project: Excavator, crane,
backhoe and bulldozer.
12. Describe the land use in the vicinity of this project: Mixture of wooded land and
agricultural land.
Page 4 of 11
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 project jurisdictional determination or permit history associated with site.
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: None anticipated.
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
1. Wetland Impacts
Wetland Impact
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***

* 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 Iitip ?t\c.l
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
Page 5 of 11
List the total acreage (estimated) of existing wetlands on the property: 0.00 acre in the
project study area.
Total area of wetland impact proposed: 0.00 acre
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?
(please
specify)

" 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 Ur (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
vga_NN,us4cgm, Several intemet sites also allow direct download and printing of USGS maps (e.g., lojxjwii cpin,
NN _nwt qmA cone, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 0 linear feet.
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.

* 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.):
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:
Page 6 of I I
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.
The existing bridge is structurally deficient and must be replaced. No wetlands or surface
waters will be affected by construction of the project. No staging of construction equipment or
storage of construction supplies will be allowed in or near wetlands or surface waters. Strict
enforcement of sedimentation and erosion control Best Management Practices and Best
Management Practices for Bridge Demolition and Removal will be enforced during project
construction. Continued coordination will occur with maintenance forces and the Environmental
Officer during construction to minimize impacts to waters of the United States.
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
htt,P.PI ?1_enr_State_nc as/nc\,vetIands/strm"ide.htnll.
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
Page 7 of 11
description of the current site conditions'and proposed method of construction. Please attach
a separate sheet if more space is needed.
Not Applicable.
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 ),iii,:/ 1i o.cnr_si itc tic. m.A%rp/indevh1iii. 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 Butlers (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.
Page 8 of 11
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:
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*
(square Impact
feet

Multiplier

Required
1 1,248 3
2 1,599 1.5
Total 2,847
Lone 1 extends out su feet perpendicular trom 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 213 .0242 or.0260.
Not Applicable
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.
Existing: 0.21 acre impervious surface of 0.81 acre total oroiect size.
Proposed: 0.21 acre impervious surface of 0.81 acre total project size.
The construction of this project will not add any impervious surface in the riparian buffer.
No roadside ditches are currently located or will be constructed in the oroiect limits. Best
Management Practices and other erosion control measures will be placed in a manner to preclude
sediment from leaving the site. A temporary silt fence will be placed in Zone 1 and Zone 2 of
the riparian buffer. All temporarily disturbed areas will be revegetated immediately after
construction.
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.
The project will not generate wastewater.
XM. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 214.0500) or any Buffer Rules?
Yes ? No
Page 9 of 11
Is this an aftcr-thc-fact permit application?
Yes ? No
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
Pto.oZ_
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
US Army Corps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Cherokee Iredell Mitchell
US Army Corps of Engineers Avery Clay Jackson Polk
151 Patton Avenue Buncombe Cleveland Lincoln Rowan
Room 208 Burke Gaston Macon Rutherford
Asheville, NC 28801-5006 Cabarrus Graham Madison Stanley
Telephone: [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 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 10 of 1 l
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
1650 Mail Service Center
Raleigh, NC 27699-1650
Telephone: [phone]
Fax: [phone]
Division of Water Quality
Wetlands Restoration Program
1619 Mail Service Center
Raleigh, NC 27699-1619
Telephone: [phone]
Fax: [phone]
State Historic Preservation Office
Department Of Cultural Resources
4617 Mail Service Center
Raleigh, NC 27699-4617
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
Page 11 of 11