20020496 Ver 1_Complete File_20020401

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Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Gregory J. Thorpe, Ph.D.
Acting Director
Division of Water Quality
April 2, 2002
Surry County
DWQ Project No. 020496
Bridge No. 84 on SR 1605
APPROVAL of 401 Water Quality Certification with Additional Conditions
Mr. Heath Slaughter, Division Environmental Officer
NCDOT Division 11
P.O. Box 250
North Wilkesboro, NC 28659
Dear Mr. Slaughter:
You have our approval, in accordance with the attached conditions and those listed below, to impact
90 linear feet of Little Fisher River in order to replace Bridge No. 84 on SR 1605 in Surry County.
The project must be constructed in accordance with your application dated March 25, 2002 (received
April 1, 2002). After reviewing your application, we have decided that this fill is covered by General
Water Quality Certification No. 3375, corresponding to the U.S. Army Corps of Engineers
Nationwide Permit Number 14. In addition, you must 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). If this project changes, you must notify the DWQ in writing and submit a new
application. If the property is sold, the new owner must be given a copy of this Certification and
approval letter, and is thereby responsible for complying with all the conditions. If total wetland fills
for this project (now or in the future) exceed one acre, or of total impacts to streams (now or in the
future) exceed 150 linear feet, compensatory mitigation may be required as described in 15A NCAC
2H .0506 (h) (6) and (7). For this approval to be valid, you must follow the conditions listed in the
attached certification and any additional conditions listed below.
1. NCDOT shall use Best Management Practices for the Protection of Surface Waters (NCDOT
March 1997) and Sedimentation and Erosion Control Guidelines for Sensitive Watersheds (15A
NCAC 4B .0024) must be implemented prior to any ground-disturbing activities to minimize
impacts to downstream aquatic resources. Temporary or permanent herbaceous vegetation shall
be planted on all bare soil within 10 days of ground-disturbing activities to provide long term
erosion control.
2. In-stream work and land disturbance within the 25-foot wide buffer zone are prohibited during the
trout spawning season of October IS through April IS, or other conditions as determined by the
North Carolina Wildlife Resources Commission, to protect the egg and fry stages of trout from
sedimentation during construction.
3. NCDOT is encouraged to use"existing on-site vegetation and materials for streambank
stabilization and to minimize the use of rip rap.
4. The pipes shall be designed and constructed so that they can be installed one foot below
streambed grade to enable waters to transport sediment and ensure passage of all aquatic life.
North Carolina Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
919-733-1786 (phone), 919-733-6893 (fax), http://h2o.enr.state.nc.us/ncwettands/
The dimension, pattern, and profile of the stream and floodplain above and below the structure
shall not be modified by widening the s! channel or reducing the depth of the stream.
5. All work shall be performed during low `,:low conditions.
6. Disturbance of the stream channel must L :limited to only what is necessary to perform the
culvert installation. Heavy equipment must be operated from the banks rather than in the stream
channel in order to minimize sedimentation and reduce the likelihood of introducing other
pollutants into the stream.
Upon completion of the project, the NCDOT shall complete and return the enclosed
"Certificate of Completion" form to notify NCDWQ 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 NC 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 which conforms to Chapter 150B of the North Carolina General Statutes to the
Office of Administrative Hearings, 6714 Mail Service Center, Raleigh, N.C. 27699-6714. This
certification and its conditions are final and binding unless you ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean
Water Act. If you have any questions, please telephone Ms. Cynthia Van Der Wiele at 919.733.5715
or Ms. Jennifer Frye of the Winston-Salem Regional Office at 336.771.4600.
Sincerely,
Gregory J. Thorpe, Ph.D.
Acting Director
Attachment
cc: Wilmington District Corps of Engineers
Jean Manuele, USACE Raleigh Field Office
NCDWQ Winston-Salem Regional Office
Central Files
File Copy
DWQ Project No.: ZOO Zo J940
County: S•t?.?l
Applicant: Ae- DOT !7. & EE.t,/AIA" 7
Project Name: 4444-e 0,05f 52 /loos
Date of Issuance of 401 Water Quality Certification:
-I/- Z- 02
Certificate of Completion A10At<
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 Certification
I, Z), K • /3Eal? ,hereby state that, to the best of my abilities, due care
and diligence was used in the observation of the construction such that the construction was observed to
be built within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules,
the approved plans and specifications, and other supporting materials.
Signature: Date: D$-
Agent's Certification
I hereby state that, to the best of my abilities, due care
and diligence was used in the observation of the construction such that the construction was observed to
be built within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules,
the approved plans and specifications, and other supporting materials.
Signature:
Date:
Engineer's Certification GAKL .5tiQv'Partial &/ Final ?
I, T2 K v96-"e4e#T , as a duly registered r 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 specifications, and other supporting materials.
Signature Registration No.
7-57.7
'Date f- ??'O5
FILE COPY
TO: Jean Manuele, USACOE
Raleigh Regulatory Field Office
FROM: Ron Linville, Regional Coordinator
Habitat Conservation Program
DATE: April 3, 2002
SUBJECT: North Carolina Department of Transportation (NCDOT), NCSR1605,
Bridge #84, Little Fisher River, Surry County
These comments are provided in accordance with the provisions of the Fish and
Wildlife Coordination Act (48 Stat. 401, as amended; 16 U.S.C. 661-667d) and the North
Carolina Environmental Policy Act (G.S. 113A-1 through 113A-10; NCAC 25). The
NCDOT proposes to replace an existing pipe structure.
NCDOT proposes to replace the existing bridge with a double 50' x 67' CSPA
with a concrete headwall. Miscellaneous riprap impacts are indicated to be 40 linear feet.
Total impacts will be 90 feet. Temporary dewatering and pumping will be necessary
during construction. The second pipe will carry stormwater only. Removal of the
existing bridge should not be allowed to impact waters. Rainbow and brown trout are
anticipated to occur in this general area.
Based on our review of the submittal and our knowledge of trout in the area, we
will not object to the project provided the following conditions are implemented:
1. Instream work and land disturbance within the 25-foot wide buffer zone are
prohibited during the trout spawning seasons of October 15 through April 15
to protect the egg and fry stages of trout.
2. Culverts 48" or larger should be buried approximately 1' into the streambed.
The base flow barrel should be placed in the existing thalweg location. The
second barrel should be reconnected to floodplain bench elevation. We prefer
that the stormwater barrel be placed on the top of existing floodplain bench to
avoid creating any noxious conditions or mosquito habitat inside the pipe.
NCSR1605, Little Fisher River 2 April 3, 2002
3. The dimension, pattern, and profile of the stream above and below the lower
cell should not be modified by widening the stream channel or reducing the
depth of the stream. Previously disturbed floodplains and streams should be
restored to natural geomorphic conditions whenever practicable.
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2. if concrete will be used, work must be accomplished so that wet concrete does
not contact stream water. This will lessen the chance of altering the stream's
water chemistry and causing a fish kill.
3. Heavy equipment should be operated from the bank rather than in the stream
channel in order to minimize sedimentation and reduce the likelihood of
introducing other pollutants into the stream.
4. Stringent erosion control measures should be installed where soil is disturbed
and maintained until project completion.
5. Temporary or permanent herbaceous vegetation should be planted on all bare
soil within 10 days of ground disturbing activities to provide long-term erosion
control. We encourage NCDOT to utilize onsite vegetation and materials for
streambank stabilization when practicable.
Thank you for the opportunity to review and comment on this project during the
early planning stages. If you have any questions regarding these comments, please
contact me at 336/769-9453.
Cc: Cynthia Van Der Wiele, DWQ
Heath Slaughter, DOT
FILE C0 2 04 9 6
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY P. O. Box 25201, Raleigh, NC 27611-5202 LYNDO TIPPETT
GOVERNOR PHONE: [phone] SECRETARY
March 25, 2002
Mrs. Jean Manuele
U. S. Army Corps of Engineers
Raleigh Regulatory Field Office
6508 Falls of Neuse Road, Suite 120
Raleigh, NC 27615
fSSUED '
APR I
.. 2002
WETtAWUn GAUP
?1ATER UAL1Ty SECTICry
Subject: Nationwide Permit #14 & #33
Bridge #84 on SR 1605
Surry County, North Carolina
Project Number. 5.7452023 (DWQ Permit Fee $200)
Dear Mrs. Manuele:
The NC Department of Transportation is scheduled to replace Bridge #84 on SR 1605 in Surry
Cpunty with (2) 50'x 95"x 67" CSPAs with a concrete headwall. Pipe #2 will carry stormwater
only. No detour is proposed.
Miscellaneous rip-rap impacts will total 40 linear feet or less. New stream impacts = 90 In. feet.
The replacement of the deteriorating bridge with the proposed pipes will require temporary
dewatering. An impervious sandbag dike will be constructed approximately 20 feet upstream of
the existing bridge to create a small pool. Clean water will temporarily be pumped around the
construction area. and will be discharged into a buffer area located approximately 90 feet
downstream of the sandbag dice. Any dirty water located inside the construction area will be
pumped into a silt bag. The dewatered area will total approximately 540 square feet or 0.012
acres. Once the new structure is in place, the impervious dike will be removed and
preconstruction streambed elevations will be restored.
Construction of this project will necessitate impacts to waters of the United States in the Yadkin
River Basin. Bridge #84 crosses the Little Fisher River (Class: C, Trout). The Division 11
Environmental Officer reviewed this project for the presence of threatened and endangered
species on March 14, 2002. The subject project has been determined to have no effect on any
federally listed endangered plant or animal species. Historic compliance work will be scheduled
and concurrence with the State Historic Preservation Office will be obtained if required.
P. O. Box 250, N. WILKESBORO, NC 28659
PHONE [phone] FAx [phone]
REru L17VED
Mrs. Jean Manuele
Bridge #84 on SR 1605, Surry
Page 2
March 25, 2002
The modifications proposed in this application should not remove or degrade existing water
quality uses. By utilizing the erosion control measures outlined in the attachments to this
application, downstream water quality standards will be protected.
Attached is a Preconstruction Notification Form, plan sheets with proposed erosion control
measures, a marked county map, a marked topography map and photographs.
By copy of this letter, it is requested that Mr. Ron Linville, Mountain Region Coordinator, with
the North Carolina Wildlife Resources Commission comment directly to you concerning the 404
Nationwide Permit application with a copy sent to me.
By copy of this letter, I am forwarding seven (7) copies of this application package to Cynthia
Van Der Wiele, NCDENR, Division of Water Quality, 401/Wetland Unit, for her review. It is
requested that any comments related to the 401 certification be forwarded directly to me with a t
copy sent to the US Army Corps of Engineers.
We would lice to begin construction as soon as possible. If further information is required, please
let me know. Your early review and consideration will be appreciated.
Sincerely,
*--?e "'?
Heath Slaughter
Division Environmental Officer
Enclosures
cc: Jean Manuele, US Army Corps of Engineers (1 additional copy)
Ron Linville, Western Piedmont Region Coordinator, NCWRC
Cynthia Van Der Wiele, Division of Water Quality (7 copies)
R. C. McCann, PE, Division Engineer
Heath Slaughter, Division Environmental Officer
Neil Trivette, Roadside Environmental Field Operations Engineer
Dennis Bennett, Bridge Maintenance Engineer
Office Use Only: 020496 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
Check all of the approval(s) requested for this project:
Z Section 404 Permit
? Section 10 Permit
® 401 Water Quality Certification
? Riparian or Watershed Buffer Rules
!f
2. Nationwide, Regional or General Permit Number(s) Requested: NW #14 & NW #33
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: ?
H. Applicant Information
1. Owner/Applicant Information
Name: North Carolina Department of Transportation
Mailing Address: P O Box 250, North Wilkesboro NC 28659
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: hslaughter(a dot state nc us
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory authority for the owner/applicant.)
Name: Heath Slab ,hter Division Environmental Officer
Company Affiliation: North Carolina Department of Transportation
Mailing Address: P O Box 250, North Wilkesboro. NC 28659
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: hslaughte-r- dot state.nc.us
Page 3 of 12
M. 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: Bridge #84 on SR 1605
2. T.I.P. Project Number or State Project Number (NCDOT Only): 5.7452023
3. Property Identification Number (Tax PIN): N/A
4. Location
County: Spay Nearest Town: Low Gap
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): From Low Gap, travel east on SR
1602. Turn right onto SR 1605.
5. Site coordinates, if available (UTM or Lat/Long): UTM: 17 517017E 404313 IN
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Describe the existing land use or condition of the site at the time of this application:
Residential/Farm
7. Property size (acres): Approximately 0.03 acres.
8. Nearest body of water (stream/river/sound/ocean/lake): Little Fisher River (Class: C. Trout )
9. River Basin: Yadkin
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/m".)

10. Describe the purpose of the proposed work: Upgrade existing stream crossing
11. List the type of equipment to be used to construct the project: Trackhoe/backhoe and dump
trucks.
12. Describe the land use in the vicinity of this project: Residential/Farm
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.
N/A
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: N/A
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
Pete 5 ?-r , 2
1. Wetland Impacts
Wetland Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Located within
100-year Floodplain**
es/no Distance to
Nearest Stream
linear feet
Type of Wetland***
N/A

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, rill,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at htti)://www.fem&go v.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property: 0 acres `
Total area of wetland impact proposed: 0 acres
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact Length of Average
Width of Perennial or
Site Number Type of Impact* Impact Stream Name**
Stream Before Intermittent?
(indicate on map) (linear feet) Impact (please specify)
Replacing bridge
Bridge #84 with (2) 50'x 50 feet Little Fisher River 6 feet Perennial
95"x 67" CSPAs
Miscellaneous
Bridge #84 rip-rap et or
40 Little Fisher River 6 feet Perennial
placem
for 1 S
stabilization
90 linear
Bridge #84 Temporary feet or 540 Little Fisher River 6 feet Perennial
Dewatering square feet

* 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 losstgain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, eta 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.us¢s.sov. Several Internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com.
www.MMuest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 901n. ft. of new permanent impacts.
Page 6 of 12
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S.
Open Water Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Name of Waterbody
(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.
N/A

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
4. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): N/A
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how 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 must be replaced due to its condition. By utilizing the erosion control
measures as shown in the attached drawings, adverse impacts to streams in the area will be
mLnimi?ed. All appropriate BMPs will be used duringLconstruction.
?r '7 -f
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 E
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
hM://h2o.enr.state.nc.us/newetlands/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
p ?, 8 of»
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 httn://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
IX. Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?
Yes ® No ?
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ? No ® If you answered "yes", provide the following information:
Page 9 of 12
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
s uare feet Multiplier Required
Mitigation
1 3
2 1.5
Total
* Zone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as .f
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.
All appropriate best management practices for sediment and erosion control will be
implemented during construction.
XH. 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.
XIII. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No
Is this an after-the-fact permit application?
Yes ? No
Page 10 of 12
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
OEVO -L-
Applicant/Agent's Signature 0 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
Pitt
Tyrrell
Washington
Wayne
Union
Watauga
Yancey
Wilson
Yadkin
*Croatan National Forest Only
Page 11 of 12
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CULVERT CONSTRUCTION SEQUENCE
LPLACE PROPER EROSION CONTROL DEVICES
(SILT BASINS, TEMP. DIVERSION, SILT FENCE ECT.)
2. REMOVE EXISTING STRUCTURE
lCONSTRUCT IMPERVIOUS DIKE UP STREAM TO
CREATE SMALL POOL (DO NOT DIG A HOLE) SO
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AREA DOWN STREAM. (THIS WILL BE CLEAN WATER)
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AREA WILL BE PUMPED INTO A SILT BAG.
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Top: Bridge #84 on SR 1605, Surry County.
Bottom: Downstream view taken from Bridge #84 on SR 1605, Surry County.