20021075 Ver 1_Complete File_20020705

F WATF Michael F. Easley, Governor
\O?0 ?QG William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
(3 r Alan W. Klimek, P.E. Director
Division of Water Quality
p Y
August 8, 2002
Wake County
DWQ Project No. 021071
APPROVAL OF 401Water Quality Certification and ADDITIONAL CONDITIONS and Neuse River Buffer
Rules
Mr. J.G. Nance, P.E., Division Engineer
2612 N. Duke Street
Durham, NC 27704
Dear Mr. Nance:
You have our approval, as described in your application dated July 3, 2002, and in accordance with the attached
conditions and those listed below, to place fill material in 36 linear feet of streams for the purpose of widening and
paving SR 1570 in Person County. The project shall be constructed in accordance with your application dated July
3, 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. This approval is also valid for the Neuse River buffer rules (15A NCAC 213 .233). 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 when the accompanying 404 permit expires unless otherwise specified in the General 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). ). This approval shall expire with the corresponding Nationwide
Permit expires or as otherwise provided in the General Certification. For this approval to be valid, you must follow
the conditions listed in the attached certification and any additional conditions listed below.
1. Stormwater shall be directed to sheetflow at nonerosive velocities through the protected stream buffers.
2. 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.
N. C. Division of Water Quality 1650 Mail Service Center Raleigh, NO 27699-1650 [phone]
Customer Service: 1 800 623-7748

F W A TF Michael F. Easley, Governor
\O?? 9pG William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
tom- Alan W. Klimek, P.E. Director
© "C
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing. You must
act within 60 days of the date that you receive this letter. To ask for a hearing, send a written petition, which
conforms to Chapter 150B of the North Carolina General Statutes to the Office of Administrative Hearings, P.O.
Box 27447, Raleigh, N.C. 27611-7447. This certification and its conditions are final and binding unless you ask for
a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water Act. If you
have any questions, please contact John Hennessy at 919-733-5694 or Steve Mitchell at 919-571-4700.
Sincerely, r
Alan W. Klimek, P.E.
Attachment
cc: Wilmington District Corps of Engineers
Corps of Engineers Raleigh Field Office
DWQ Raleigh Regional Office
File Copy
Central Files
c:\ncdot\TIP SR 1570\wqc\021075wgc.doc

STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY
GOVERNOR
July 3, 2002
021®75
LYNDO TIPPETT
SECRETARY
N.C. Dept. of Environment and Natural Resources-Division of Water Quality
2321 Crabtree Blvd.
Raleigh, NC 27604-2260
Attention: Mr. John Dorney
Coordinator
Subject: Secondary road improvements
158 to SR 1567 (Pixley Pritchl
Work Order No. 6.382381.
)
0
j 570 (St Oa oad) from US
Pers*,,.Cou j1NCDOT
Reference: NCDOT permit application (July 3, 2002)
The North Carolina Department of Transportation (NCDOT) plans to upgrade and
pave SR 1570 (Stan Oakley Road) from US 158 to SR 1567 (Pixley Pritchard Road) in
Person County. Construction of the project will necessitate impacts to waters of the
United States. Application was made for a Department of the Army Section 404
Nationwide Permit (NWP) 14 and North Carolina Department of Environment and
Natural Resources-Division of Water Quality (DWQ) Section 401 Water Quality
Certification (WQC) No. 3375 and riparian buffer certification by permit application
dated July 3, 2002.
An automated payment procedure has recently been implemented between the
NCDOT and NCDWQ. This procedure will enable the Division to apply for the 401
WQC without submitting a check for this permit application. This new procedure will
provide payment to the NCDWQ by charging the permit application fee directly to the
appropriate NCDOT work order.
The NCDOT work order for this project is 6.382381. Project impacts are less
than one acre of cumulative wetland/water impacts and less than 150 linear feet
cumulative impacts to streams therefore please note that a fee of $200.00 is required for
this prWgct. If you have any questions or need additional information, please contact me
at [phone].
Sincerely,
C' PAYMENT
Christopher A. Murray, P.W.S. RECEIVED
Environmental Officer
Division 5, 2612 N. Duke Street, Durham, NC 27704
Phone: [phone] Fax: [phone]
N. ('? DEPARTMENT OF TRANSPORTATION
TRANSMITTAL SLIP DATE
0Z.
TO: REP. NO. OR ROOM, BLDG.
OIL
FROM: REF. NO. OR ROOM, BLDG.
V C'r
AC I N
? NOTE AND FILE ? PER OUR CONVERSATION
? NOTE AND RETURN TO ME ? PER YOUR REQUEST
? RETURN WITH MORE DETAILS ? FOR YOUR APPROVAL
? NOTE AND SEE ME ABOUT THIS ? FOR YOUR INFORMATION
? PLEASE ANSWER ? FOR YOUR COMMENTS
? PREPARE REPLY FOR MY SIGNATURE ? SIGNATURE
? TAKE APPROPRIATE ACTION ? INVESTIGATE AND REPORT
COMMENTS:
()21075
021075
VVV
STATE of NORTH CAROLINA
DEPARTMENT OF TRANSPORTATIO
MICHAEL F. EASLEY
GOVERNOR
July 3, 2002
U. S. Army Corps of Engineers
Raleigh Regulatory Field Office
6508 Falls of the Neuse Road, Suite 120
Raleigh, NC 27609
Attention: Mr. Eric Alsmeyer
NCDOT Coordinator
Subject: Secondary road improvements to SR 1570 (Stan Oakley Road) from US
158 to SR 1567 (Pixley Pritchard Road) in Person County. NCDOT
Work Order No. 6.382381.
The North Carolina Department of Transportation (NCDOT) proposes to upgrade
and pave SR 1570 (Stan Oakley Road) from US 158 to SR 1567 (Pixley Pritchard Road)
in Person County (Figures 1 and 2). Total project length is 0.70 miles. Transportation
and highway laws of North Carolina (G.S. 136-44.6, 136-44.7, 136-44.7A, 136-44.8, and
136-44.9) require the NCDOT to develop annual work programs for construction and
maintenance of secondary roads. These general statutes specifically set forth
requirements for annual construction and paving of existing unpaved roads. Paving of
these roads is performed in priority order as established by the NCDOT for each unpaved
road within a given county. This number is based on characteristics of each road,
including number of homes, schools, churches, businesses, industries, recreational
facilities, traffic counts, presence of school bus routes, and value as a thoroughfare.
This roadway is scheduled to be paved in the 2002-2003 Secondary Roads Construction
Program.
Impacts to Waters of the United States
Site 1-Station 39+90-L-
The project crosses an unnamed intermittent tributary to Deep Creek (NCDENR-
DWQ Index No. 27-3-4, Best Usage Classification WS-III NSW) (Figure 3) in the Neuse
River Basin. The existing structure that conveys the creek is a 42 inch concrete pipe that
is 44 feet long. The NCDOT proposes to extend the pipe eight feet on each side.
Permanent impacts at the site associated with the extension of the structure and minimal
Division 5, 2612 N. Duke Street, Durham, NC 27704
Phone: [phone] Fax: [phone]
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amounts of rip rap to protect the structure include <0.01 acre fill in surface water and 36
linear feet existing channel impacted.
Riparian Buffer Impacts
The construction of the project involves a road crossing of a stream that is subject
to the Neuse River Riparian Buffer Rule. The unnamed intermittent tributary to Deep
Creek at Site 1 is depicted on the most recent version of the Moriah, NC (USGS, 1981,
1987) topographic quadrangle (Figure 1) and the Soil Survey of Person County (USDA-
NRCS, 1995) (Figure 2).
The construction of the project at Site 1 results in impacts to the riparian buffer
(Figure 3). Construction impacts at Site 1 total 1,201 square feet in Zone 1, 658 square
feet in Zone 2 and 36 linear feet of riparian buffer. Based on the impacts to the riparian
buffer at this site, this crossing is exempt.
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 rock silt check (Type A) in Zone 1 and a temporary rock sediment dam
(Type B) in Zone 2. The temporary structures will be removed once vegetation has been
established and then seeded with a seed mixture of fescue and bahia grass. Based on
impacts to the riparian buffer at this site from this use, this activity is allowable. The
sediment and erosion control plan for Site 1 is depicted in Figure 3. 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 activity at this project.
Waters of the U.S. Mitigation
Avoidance: All wetlands or surface waters not affected by the project will be
protected from unnecessary encroachment. No staging of construction equipment or
storage of construction supplies will be allowed in wetlands or near surface waters.
Minimization: The side slopes have been steepened to the extent possible at
jurisdictional sites. Best Management Practices for sediment and erosion control will be
strictly enforced during project construction. Continued coordination will occur with
maintenance forces and the Environmental Officer during construction to minimize
impacts to these sites.
Compensatory, Mitigation: Construction of the project will result in only minimal
impacts to waters of the United States. Impacts have been avoided and minimized to the
maximum extent possible during the design process. Due to minimal impacts,
compensatory mitigation for stream impacts will not be provided for 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.
Historical Compliance
Historic compliance work to be scheduled and concurrence with Historic
Preservation Office will be obtained if required.
Summary
NCDOT proposes to upgrade and pave SR 1570 in Person County. Permanent
impacts at Site 1 include <0.01 acre fill in surface water and 36 linear feet existing
channel impacted. Construction impacts at Site 1 total 1,201 square feet in Zone 1, 658
square feet in Zone 2 and 36 linear feet of riparian buffer. 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 rock silt check
(Type A) in Zone 1 and a temporary rock sediment dam (Type B) in Zone 2.
Application is hereby made for a Department of the Army Section 404
Nationwide Permit (NWP) 14 and NCDENR-DWQ Section 401 Water Quality
Certification (WQC) No. 3375 and riparian buffer authorization for construction of this
project. The NCDOT will comply with all applicable NWP, WQC and Riparian Buffer
Rule conditions. A pre-construction notification is attached with this request. If you
have any questions or need additional information, please contact me at [phone].
Sincerely,
0? ____75_
Christopher A. Murray, P.W.S.
Division Environmental Officer
cc: John Dorney, NCDENR-DWQ, Raleigh
M. Shane Parker, P.E., NCDOT District Engineer, Durham
Billy Timberlake, NCDOT County Maintenance Engineer, Person Co.

?O G
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D
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 w. saw usace.arniv.nil I/wetlands/I?er_m app.litn.
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 ?irmynii_I/wetlan_ds/re,,tour litm, or contact one of the field
offices listed at the end of this application. The website also lists the responsible project manager for
each county in North Carolina and provides additional information regarding the identification and
regulation of wetlands and waters of the U. S.
The DWQ issues a corresponding Certification (General or Individual), and 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
htth_//h2o:enr._stat_e.nc_us/ncwe-..//'Iito 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 i of 11
CAINIA 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 htth;//www_saw.usace_army:_mil/wetlaiuls/tlwhtiti lF edReg,Ddt.
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 htth //l 2o.ehiu-_state_II us/tIC, etlatids/Ceeti htrnl. 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: OL^ 1 ®7 5 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: 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 (see section VIII - Mitigation), check here: ?
II. Applicant Information
1. 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: [e-mail]
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:
Company Affiliatioi
Mailing Address:_
Telephone Number:
E-mail Address:
Fax Number:
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 I 1
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 1570 (Stan Oakley Road) from US 158 to SR 1567 (Pixley Pritchard
Road) in Person County.
2. T.I.P. Project Number (NCDOT Only): NCDOT Division Project (non-TIP); Work Order
No.6.3 823 81
3. Property Identification Number (Tax PIN): N/A
4. Location
County: Person Nearest Town: Roxboro
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): From Roxboro, travel south east
on US 158 to project limits.
5. Site coordinates, if available (UTM or Lat/Long): UTM 17 690961E 4024400N
(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 farm land and scattered residential houses.
7. Property size (acres): Project footprint is 0.70 mile (3,696 feet) long and has a right of way
of 60 feet Property size is 5.1 acres
8. Nearest body of water (stream/river/sound/ocean/lake): Unnamed tributary to Deep 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 lit_tp //li2o. ,nr state peas/admin/maps/.)
10. Describe the purpose of the proposed work: Grade drain, base pave and erosion control at
SR 1570 (Stan Oakley Road) At Site 1 the existing 44 foot long pipe will be extended eight
feet on each side.
11. List the type of equipment to be used to construct the project: Excavator. Backhoe,
Bulldozer and Grader.
Page 4 of 11
12. Describe the land use in the vicinity of this project: Mixture of wooded land. farm land and
scattered residential housing;.
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 limned to: mechanized clearing, grading, tut,
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
odine at I i(q) *** Lit 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 project
limits.
Total area of wetland impact proposed: 0.00 acre in project limits.
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact Length of
Average Width of Stream Perennial or
Site Number Type of Impact* Impact Stream Name**
Before Impact Intermittent?
indicate on ma) linear feet) leases pecify)
Site 1 Rip rap along 20 UT Deep Ck. (Dry stream during site visits Intermittent
streambank but channel is 5 feet wide)
Site 1 Pipe Extension 16 UT Deep Ck. (Dry stream during site visits
but channel is 5 feet wide) Intermittent

" List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated np-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
Several internet sites also allow direct download and printing of USGS maps (e.g., w\%\ topo/mie_com,
ucsi.uun,etc. .
Cumulative impacts (linear distance in feet) to all streams on site: 36 feet existing, channel
impacted.
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: till, 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 11
NM. 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 and surface waters not affected by project construction will be protected from
unnecessary encroachment No staging of equipment will be allowed in or adjacent to waters of
the U.S. The side slopes at the jurisdictional site has been steepened to the maximum extent
possible Best Management Practices for erosion and sediment control will be enforced during
construction Only the smallest amount of fill necessary to complete the project will be placed in
waters of the United States. Continued coordination will occur with maintenance forces and the
Environmental Officer during construction to minimize impacts at jurisdictional sites.
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
httD !_h2o.etir.state. nc_us/ncwetlands/strmgide,_litml.
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 h11pJ/h_2o cm s4 Hc,nc nshxrplnde .film. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information:
Amount of stream mitigation requested (linear feet): N/A
Amount of buffer mitigation requested (square feet): N/A
Amount of Riparian wetland mitigation requested (acres): N/A
Amount of Non-riparian wetland mitigation requested (acres): N/A
Amount of Coastal wetland mitigation requested (acres): N/A
IX. Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?
Yes ® No ?
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Page 8 of 11
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 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.
CITE 1
Zone* Impact
(square feet Multiplier Required
Mitigation
1 1,201 3
2 658 1.5
Total 1,859
* Zone 1 extends out 30 feet perpenaicuiar trom near oanK of cnanncl; [Inc L cAwnu3 au
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.
Existing: 2.5 acre impervious surface of 5.1 acre total project size (29 foot wide hard-packed
gravel road Proposed: 1.7 acre impervious surface of 5.1 acre total protect size (20 foot wide
asphalt paved road) The erosion control plan for the project is designed for 900 cubic feet of
storage per acre Erosion and sediment control devices along the project are comprised of
temporary rock pipe inlet sediment trap (Type A) temporary silt basin (Type B) temporary rock
silt check (Type B) temporary rock sediment dam (Type B) temporary rock silt check (Type A).
TemQorga rock silt check (Type A) will be placed in Zone 1 of the riparian buffer and
temporM rock sediment dam (Type B) will be placed in Zone 2 of the riparian buffer. All
temporarily disturbed areas will be revegetated 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.
Page 9 of 11
X111. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No
Is this an after-the-fact permit application?
Yes ? No
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).
U
Pitt
Tyrrell
Washington
Wayne
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
Union
Watauga
Yancey
Wilson
Yadkin
*Croatan National Forest Only
Page 10 of 11
W lmington 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
US Fis
US Fish and Wildlife Service
Raleigh Field Office
Post Office Box 33726
Raleigh, NC 27636-3726
Telephone: [phone]
h and Wildlife Service / National IV
US Fish and Wildlife Service
Asheville Field Office
160 Zillicoa Street
Asheville, NC 28801
Telephone: [phone]
larine Fisheries Service
National Marine Fisheries Service
Habitat Conservation Division
Pivers Island
Beaufort, NC 28516
Telephone: [phone]
North Carolina State Agencies
Division of Water Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Telephone: [phone]
Fax: [phone]
Division of Water Quality
Wetlands Restoration Program
1619 Mail Service Center
Raleigh, NC 27699-1619
Telephone: [phone]
Fax: [phone]
CAMA and NC Coastal Counties
State Historic Preservation Office
Department Of Cultural Resources
4617 Mail Service Center
Raleigh, NC 27699-4617
Telephone: [phone]
Fax: [phone]
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
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