20021260 Ver 1_Complete File_20020813

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
August 16, 2002
Wilkes County
DWQ Project No. 021260
SR 1164 (Sampson Road)
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 permanently
impact 199 linear feet of six unnamed tributaries to Simmons Branch (B trout ORW) in order to improve
SR 1164 (Sampson Road) in Wilkes County. The project must be constructed in accordance with your
application dated August 7, 2002 (received August 13, 2002). After reviewing this application, we have
decided that these impacts will be 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). Should your project change, 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 implement Best Management Practices for the Protection of Surface Waters (NCDOT
March 1997) and adhere to "Design Standards for Sensitive Watersheds" [15A NCAC 413.0124 (a) -
(d) found at
http://ncrules.state.nc.us/ncadministrativ /title l5aenviron /chapter04sedime /default.htm)] 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 S days of ground-disturbing
activities to provide long term erosion control. This shall apply to the entire project corridor.
2. Riparian vegetation must be reestablished within the construction limits of the project by the end of
the growing season following completion of construction.
3. NCDOT is encouraged to use existing on-site vegetation and materials for stream bank stabilization
and to minimize the use of rip rap.
4. The dimension, pattern, and profile of the stream and floodplain above and below each structure shall
not be modified by widening the stream channel or reducing the depth of the stream.
5. All work shall be performed during low flow conditions.
A
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/ncwetiands/
6. 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.
7. All mechanized equipment operated near surface waters must be regularly inspected and maintained
to prevent contamination of stream waters from fuels, lubricants, hydraulic fluids, or other tokic
materials.
8. Upon completion of the project, the NCDOT or its authorized agent shall complete and return the
enclosed "Certificate of Completion" form to notify NCDWQ when all work included in the §401
Certification has been completed. This will satisfy the requirements of Condition 16 of WQC 3375..
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.
Attachment
cc: Wilmington District Corps of Engineers
Jean Manuele, USACE Raleigh Field Office
NCDWQ Winston-Salem Regional Office
Central Files
File Copy
Sincerely,
FILE COPY
TO: Jean Manuele, USACOE
Raleigh Regulatory Field Office
FROM: Ron Linville, Regional Coordinator
Habitat Conservation Program
DATE: August 15, 2002
SUBJECT: North Carolina Department of Transportation (NCDOT), SRI 164,
Sampson Road, Unnamed Tributaries Simmons Branch (Class B, Trout,
ORW), Wilkes County
NCDOT proposes to grade, drain, base and pave the referenced road. Biologists with the
North Carolina Wildlife Resources Commission are familiar with habitat values in the
area. 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 project will require replacement of six (6) cross lines that vary in size from 24" to
48" in diameter. Riprap will add 60 linear feet of impacts. Total new impacts will be
199 linear feet. We have no records indicating trout in these waters; however, these
waters are classified as Outstanding Resource Water suitable for direct human contact.
We will not object to the project provided the following conditions are implemented
during construction:
1. Culverts 48" or larger should be buried approximately l' into the streambed.
Culverts less than 48 inches in diameter should be buried to a depth equal to
or greater than 20% their size to allow for aquatic life passage. These
measurements must be based on natural thalweg depths. All waters must
flow through without freefalling or damming on either end during low flow
conditions to maintain aquatic life and/or fish passage. Any riprap used must
not interfere with aquatic life movement during low flows.
2. The dimension, pattern, and profile of the stream above and below the base
flow barrel should not be modified by widening the stream channel or
SRI 164, Sampson Road 2 August 15, 2002
reducing the depth of the stream. Previously disturbed floodplains and
streams should be restored to natural geomorphic conditions whenever
practicable.
3. 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.
4. Heavy equipment should be operated from the bank rather than in the stream
channel in order to minimize sedimentation and reduce the likelihood of
t c' er, tants into the stream.
5. t ndF r ontrol measures shall adhere to the design standards
r she' rive a s (15A NCAC 4B .0024).
6. 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, DDWQ
Heath Slaughter, DOT
Marella Buncick, USFWS
Becky Fox, EPA
e??o .021260-
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY P. O. Box 25201, Raleigh, NC 27611-5202 LYNDO TIPPETT
GOVERNOR PHONE: [phone] SECRETARY
August 7, 2002
Mrs. Jean Manuele
U. S. Army Corps of Engineers
Raleigh Regulatory Field Office
6508 Falls ofNeuse Road Suite 12?`?' ' AUG ?
fILE COPY
Raleigh, NC 27615 !' ` ?r1
3
Subject: Nationwide Permit #14
41 SR 1164 (Sampson Road) ISSUE[)
Wilkes County, North Carolina
Project Number: 6.762718 (DWQ Permit Fee: $475)
Dear Mrs. Manuele:
The NC Department of Transportation is scheduled to grade, drain, base and pave SR 1164 in
Wilkes County. Total project length is approximately 2.34 miles. The roadway will be widened
from 17 feet to 18 feet. Impervious surface area will increase by 0.28 acres or 2%. This project
will require the replacement of six (6) wet cross lines as shown below:
1) Replace existing 42'x 24" CMP at station 108+36 with a 50'x 24" CMP.
2) Replace existing 24'x 24" CMP at station 109+69 with a 40'x 24" CMP.
3) Replace existing 29'x 24" CMP at station 110+87 with a 50'x 24" CMP.
4) Replace existing 30'x 24" CMP at station 115+06 with a 65'x 24" CMP.
5) Replace existing 41'x 18" CMP at station 118+00 with a 55'x 24" CMP.
6) Replace existing 30'x 36" CMP at station 119+50 with a 75'x 48" CMP.
Miscellaneous rip-rap impacts will total 60 linear fl. or less. New stream impacts =199 linear ft.
** All jurisdictional pipes with the exception of 119+50 are currently dry or have very low flow.
Construction of this project will require impacts to waters of the United States in the Yadkin
River Basin. Each of the above noted jurisdictional cross lines carry different unnamed tributaries
to Simmons Branch (Class: B, Trout, ORW). The Division 11 Environmental Officer reviewed
this project for the presence of threatened and endangered species on July 22, 2002. This project
will have no effect on any federally listed endangered plant or animal species. According to the
NCDOT web site, the NCDOT Historical Architecture Section has reviewed this project and
P. O. Box 250, N. WILKESBORO, NC 28659
PHONE [phone] FAx [phone]
RECEIVED
Mrs. Jean Manuele
SR 1164, Sampson Road, Wilkes
Page 2
August 7, 2002
determined that there are no NR/SL/DOE properties along this roadway that will be impacted by
the proposed project (see attachment).
The project impacts are minor in nature and should not remove or degrade existing water quality
uses. Pipe sizes used will be the minimum necessary to create a safe roadway. By utilizing the
erosion control measures outlined in the attachments to this application, downstream water
quality standards will be protected. All appropriate BMPs will be used during construction.
Attached is a Preconstruction Notification Form, plan sheets with proposed erosion control
measures, a marked county map, and a marked topography map.
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. Please note that a trout water buffer zone
encroachment variance will be requested from stations 103+00 - 111+00 (Rt.), 112+00 - 114+00
LaLd 118+00 -119+50 (Rt.) (UT to Simmons ranc .
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/Wetlands Unit, for her review. It is
requested that any comments related to the 401 certification be forwarded directly to me with a
copy sent to the US Army Corps of Engineers.
We would like 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,
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)
Matt Gantt, PE, Land Quality Section
R. C. McCann, PE, Division Engineer
Doug Tetzlaff, District Engineer
Brian Hamby, County Maintenance Engineer
Heath Slaughter, Division Environmental Officer
Neil Trivette, Roadside Environmental Field Operations Engineer
Office Use Only' 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: NW #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: ?
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: [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: Heath Slaughter 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: hslaughter(a dot state nc.us
Page 3 of 12
III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: SR 1164 Samson Road
2. T.I.P. Project Number (NCDOT Only): N/A
3. Property Identification Number (Tax PIN): N/A
4. Location
County: Wilkes Nearest Town: Darby
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): From Darby, travel southwest on
SR 1162 Turn Right onto SR 1164 This will put you at station 123+45.
5. Site coordinates, if available (UTM or Lat/Long):
Stream crossings on this project do not show up on torso map due to small size.
Approximate location of wet pipe at station 119+50 = UTM: 17 452698E 3995989N
(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
7. Property size (acres): Approximately 14.2 acres
8. Nearest body of water (stream/river/sound/ocean/lake): UTs to Simmons Branch (Class: B,
Trout OR))).
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/maps.)
Page 4 of 12
10. Describe the purpose of the proposed work: Grade drain base and pave SR 1164.
11. List the type of equipment to be used to construct the project: Trackhoe/backhoe, motor
grader 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.
Page 5 of 12
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, 111,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http://wiitiv.fema.sov.
*** 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:
Total area of wetland impact proposed:
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) I (please specify)
mpact
Station No. Pipe replacement 8 feet UT#1 to Simmons 1 foot Perennial
108+36 Branch
Station No. Pipe replacement 16 feet UT#2 to Simmons 2 feet Perennial
109+69 Branch
Station No. Pipe replacement 21 feet UT#3 to Simmons 2 feet Intermittent
110+87 Branch
Station No. Pipe replacement 35 feet UT#4 to Simmons 1 foot Perennial
115+06 Branch
Station No. Pipe replacement 14 feet UT#5 to Simmons 1 foot Intermittent
118+00 Branch
Station No. Pipe replacement 45 feet UT#6 to Simmons 4 feet Perennial
119+50 Branch
Miscellaneous 60 feet or

All of the above rip-rap
placement for
less (10 ft.
UTs to Simmons Branch
1-4 feet Perennial/
Intermittent
stabilization per pipe)
* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
wuw.us,-s.gov. Several Internet sites also allow direct download and printing of USGS maps (e.g., Ar w.topozone.com,
wyow.mapguest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 1991n. ft. of new 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)
(if Name applicable) Waterplicable) body 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 limned to: tilt, 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.
By utilizing the erosion control measures as shown in the attached drawings adverse impacts to
streams in the area will be minimized Since this is an existing roadway, the stream impacts
cannot be avoided However, the replacement pipe lengths will be the minimum needed to
safely construct the paved roadway. All appropriate BMPs will be used during construction.
Page 7 of 12
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http://h2o.en-r.state.nc.us/ncwetlands/strmgide.html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
N/A
Page 8 of 12
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP) with the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants
will be notified early in the review process by the 401/Wetlands Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at http://h2o.enr.state.nc.us/.,k-rp/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
i
r.
Identify the square feet and acreage of impact to each zone of the riparian buffers.. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet Multiplier Required
Mitigation
1 3
2 1.5
Total
* Zone 1 extends out 3U feet perpendicular rrom near oanx or cnannei; LAne L exienus zm
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.
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.
Impervious surface area will increase by approximately 0.28 acres or 2%. All appropriate best
management practices for sediment and erosion control will be implemented during 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.
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).

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
Pitt
Tyrrell
Washington
Wayne
Union
Watauga
Yancey
Wilson
Yadkin
*Croatan National Forest Only
Page 11 of 12

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Target is UTM 17 452581E 3996446N - BUFFALO COVE quad (Quad Infol
EROSION CONTROL SCHEDULE
(1) All adequate temporary erosion control measures will be installed before
clearing and grubbing operations begin.
(2) As construction progresses, temporary and permanent erosion control
devices shall be installed in a timely matter, according to any special permit
requirements and or requirements set out in G. S. 113A-57.
MANDATORY STANDARDS FOR LAND-DISTURBING ACTIVITY
Pursuant to G.S.113A-57 (3) provisions for a ground cover
sufficient to restrain erosion must be accomplished within 15
working days or 30 calendar days following completion of
construction or development, whichever period is shorter, except
as provided in 15A NCAC 413.0024 (e).
DESIGN STANDARDS IN SENSITIVE WATERSHEDS
Pursuant to G. S.113A-57 (3) provisions for a ground cover
sufficient to restrain erosion must be provided for any portion of a
land-disturbing activity in a HQW zone within 15 working days or 30
calendar days following completion of construction or
development, whichever'period is shorter.
(3) All siltation and erosion control devices shall be properly maintained until no
longer needed.
(4) On projects performed by D.O.T. Maintenance Forces; request will promptly
be made to the Division Roadside Environmental Unit for stage and
permanent seeding.
(5) Any removal of siltation devices will be based on the condition of established
ground cover of that area the device is serving.
CONSTRUCTION SEQUENCE FOR INSTALLING ROADWAY CULVERTS
1 - Clear only enough area and install the downstream measures such as silt check dams,
silt screens, and basins as noted on plans.
2 - Excavate the 2' base tail ditch.
3 - Excavate and install the roadway culvert
4 - Install sediment control measures at inlet as noted on plans.
5 - Install additional pipe outlet protection and inlet protection as noted.
SECTION 1042
RIP RAP MATERIALS
1042-1 PLAIN IZII' RAID.
Stone for plain riti rap shall consist of field stone -or rotigtl llIllle:;'I? gllarrV
none. The stone shall be sound, tough, dense, resistant to the action of air
and water, and suitable in all other respects for the purpose intended.
Where broken concrete from demolished structures or pavement is avail-
alile, it may be used in place of stone provided that such use meets with the
approval of the Engineer.:Ilowever, the use of broken concrete -which
contains reinforcing steel will not be permitted.
The stone or broken concrete shall be graded to meet the following
requirements:
1. For Class I Rip Rap. Stoneshall vary in -weight from 5-to 200 pounds:
At least 30 percent of the. total weight of the rip rap shall be in
individual pieces weighing a minimum of 60 pounds each. Mot more
than 10 percent, of the total «?eight of the rip r•a-p may be in individual
pieces %veighing less than 15 bounds each.
2.`For Class 2 Rip Rap. Stolle shall vary in weight from 25 to 250
pounds. At least 60 percent of the total weight of the rip rap shall be in
individual pieces weighing a minimum of 100 pounds each. -Not-more
than 5 percent of the total weight of the rip ran may be in individual
pieces weighing less than 150 pounds each.
.001
HIGH QUALITY 'W'ATERS
1. Uncovered areas are limited at any given time to a maximum total area of
20 acres.
2. Erosion and sedimentation control measures shall be designed to provide
protection from the 25-year storm.
3. Large Type-A basins shall be designed and constructed with a settling
efficiency of at least 70% for the 40 micron soil particle size transported
by runoff from the 2-year storm.
4. Newly constructed channels shall be constructed with side slopes no
steeper than 2:1, unless slopes are to be stabilized by methods other than
vegetation
5. A ground cover sufficient to restrain erosion must be provided for any
disturbed area.
S AND
L
D ETA?
`?- 'PICAT SONS -
Sid- _ Descl-ir)tson " Svinboi-
16 05.Ol ; Temporary Slit f=ence
Temporary Silt Diichl,
1 G3z-0j Temporary Diversion
TD
i 62201 Temporary Slope Drain
16-230-01 Silt Basin T yp-= A
:= S.33o.02
Silt Basin Tyjue-B F71
1333.01 T em, porary Rock Silt Check type-A
1-63'3.02 Temporary .Rock Silt Check i ype-B _
1334.01. TemDorary Rock Sediment D2M T ype-A
334 02 . TemDOrary:.Rock Sediment Darn T ypz-S s -
1 b3? 01 : .l to Pipe ,.Inlet Sediment Trap t ype .A ? Z? . .
1D35.o2. Rock Pipe Inlet- Saiment_Trap Type-B
.
16`3 -01. - Rock- SiIL Screen -

` 1 ?30.0T. --
Stilling Basin
Rock Inlet Sediment Trap:
1632-01
1 63202
532?J3
?5a_ 04
858_ 01
T ype-A
T yp--3
Type-C

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B F-11,
OR C
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EROSION CONTROL PLAN
.SR ST2 11&4
COUNTY (? ; Ice
LOCAL NAME
WORK ORDER NO.
DRAWN BY:
STA. SA Za
Replace-
?.,{/\.'y`fJCC"ili? -?P_?Cla4lC\d 2?0? /.?.pX1i3`r
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DISTRICT ENGINEER:
ROADSIDE ENVIRONMENTAL
ENGINEER:
-:3, E S64 -4-1i- o2
NOTE:
ALL PIPE LOCATION MAY VARY DUE
TO GRADE CHANGES IN ROADWAY.
ROCK CHECKS AND BASINS ARE TO BE
REMOVED BEFORE RIP RAP OR ROVING
PLACEMENT. BASINS AT CROSSLINES
TO REMAIN.
ALL WET CROSSLINE PLACEMENT THAT
REQUIRE MORE THAN ONE WORK DAY TO
INSTALL REQUIRE A SILT SCREEN AT
OUTLET END.
STREAM INFORMATION-
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DITCHLINER REQUIREMENTS
SR 1164 SAMPSON ROAD Wilkes County
STA. STA. RT./LT.
2+50 5+00 LT. ROVING
5+00 8+20 LT. RIP RAP
8+60 10+00 LT. RIP RAP
10+00 11+00 LT. ROVING
12+00 4+75 LT. ROVING
5+00 7+50 LT. RIP RAP
7+50 19+00 LT. ROVING
19+00 20+00 LT. ROVING
20+00 20+50 LT. ROVING
24+65 25+50 LT. ROVING
24+25 25+50 RT ROVING
25+80 32+10 RT RIP RAP
26+25 48+60 LT. RIP RAP
32+50 33+50 RT ROVING
33+50 37+00 RT RIP RAP
50+25 53+00 LT. ROVING
54+00 55+00 LT. ROVING
55+00 68+90 LT. RIP RAP
70+25 83+25 RT RIP RAP
78+00 80+00 LT. RIP RAP
85+50 86+50 RT ROVING
86+50 94+65 RT RIP RAP
93+75 109+69 LT. RIP RAP
110+30 110+87 LT. ROVING
112+00 117+91 LT. RIP RAP
116+00 117+00 RT ROVING
117+00 117+91 RT RIP RAP
120+00 EOP RT ROVING
122+75 EOP LT. ROVING
S.R. 11 (D j County A, I Lr Sheet ?-Of 6
It Name SA+„,,v d Date ),2-217-o;
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Survey Date 1),11-01
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Sheet -Lof--6-
Date 10 -1 1
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Survey Date
Conducted By GE H, D,P, -),B
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Survey Date 11--1 U 01
Conducted By G-E k
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• Name c A m PSCA-

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osed RMI
Pro
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Center Line

Sheet '?' -or
Date I2-97-0

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